October 21, 2019
 
Today’s Top Story

Study Evaluates Effect of Overcorrected Medial Proximal Tibial Angle Following Open-wedge High Tibial Osteotomy

According to a study published in the October issue of Arthroscopy, a certain degree of overcorrected medial proximal tibial angle (MPTA) after open-wedge high tibial osteotomy (OWHTO) may not have significant effects on clinical outcomes due to compensatory changes in the hip and ankle joints. The study included consecutive OWHTO patients treated between July 2006 and August 2015 who did not have bilateral OWHTO and had at least two years of follow-up. Patients were stratified into two groups based on postoperative MPTA: normal MPTA (< 95 degrees, n = 52) and overcorrected MPTA (≥ 95 degrees, n = 42). Clinical (Japanese Orthopedic Association score, Oxford Knee Score, and Knee Injury and Osteoarthritis Outcome Score) and radiologic (hip-knee-ankle angle [HKA], joint line convergence angle, MPTA, knee joint line obliquity [KJLO], ankle joint line obliquity [AJLO], and hip abduction angle [HAA]) outcomes were assessed preoperatively and at final follow-up. Postoperative mean HKA increased by 11.0 degrees, and MPTA increased by 10.4 degrees, while mean AJLO and HAA decreased to –1.3 degrees and –1.1 degrees, respectively. Mean KJLO did not significantly change, increasing by 3.7 degrees. In the overcorrected cohort, the mean postoperative MPTA was 96.9 degrees and KJLO was 3.1 degrees. There were no significant between-group differences in clinical outcomes.

Read the study…

 
 
 
 
In Other News

Study: Adverse Outcomes of Achilles Tendon Elongation Following Rupture Repair

Postoperative Achilles tendon (AT) elongation after acute AT rupture repair could adversely impact plantarflexion strength, according to a retrospective chart review published online in Foot & Ankle International. Forty patients with acute AT rupture underwent open operative repair. AT resting angle (ATRA) was measured at final follow-up to determine AT elongation. An isokinetic dynamometer was used to determine plantarflexion strength. The operated ankles had a greater mean ATRA than the contralateral ankles (57 degrees versus 52 degrees). All angle-specific torques were lower in the operated ankles except the plantarflexion torque at 20 degrees of plantarflexion. The operated ankle had a lower peak flexion torque at 30 degrees. There was a negative association between operated and contralateral ATRA and operated and contralateral plantarflexion torque ratios at zero degrees, 10 degrees, and 20 degrees.

Read the abstract…

 
 
 
 
Study Compares Treatments for Unstable Metacarpal Shaft Fracture

A study published online in Injury compared mini-open antegrade intramedullary nailing (AIN) and low-profile locking plate open reduction and internal fixation (ORIF) to treat angulated metacarpal shaft fractures. Patients were stratified into two groups: mini-open AIN (n = 40) and locking plate (n = 35). Analysis included radiological findings, clinical conditions (pain, per visual analog scale [VAS] and Disabilities of the Arm, Shoulder, and Hand [DASH] scores), active range of motion (ROM), and grip strength. Both groups achieved successful union with no significant complications. The final angulation measurements and VAS scores did not largely differ between the groups, but the mini-open AIN group had a better final DASH score than the locking plate ORIF group. Fourteen patients had their plates removed 9.6 months postoperatively for different reasons; at the time of removal, these patients had a significantly lower mean ROM compared to the final ROM in the other two groups. The mini-AIN group had significantly better recovered final grip strength compared to the locking plate ORIF group. Four locking plate patients presented extension lag with a mean amount of 15 degrees, but it was resolved by tenolysis during plate removal.

Read the abstract…

 
 
 
Study: Handheld Dynamometer Readings Unable to Predict Rotator Cuff Tear Size

According to a study published online in the Journal of Shoulder and Elbow Surgery, handheld dynamometer readings cannot accurately predict rotator cuff tear size, but they may be able to predict the presence of a tear. Researchers retrospectively reviewed handheld dynamometer readings collected preoperatively for 2,100 consecutive patients who were categorized by whether they did (n = 1,747) or did not (n = 353) have rotator cuff tears. The with-tears group was further stratified by partial- or full-thickness tears and into four groups based on tear size area. Compared to those with full-thickness tears, patients with partial-thickness tears had greater internal rotation, external rotation, and supraspinatus strength. Patients with tears of either thickness had lower supraspinatus strength than those without tears. Larger tear size was associated with reduced external rotation and supraspinatus strength. A model that took into account internal rotation and supraspinatus strength predicted tear presence with 82 percent sensitivity and 29 percent specificity. The overall correct prediction rate was 73 percent: 82 percent in the tear group and 29 percent in the no-tear group. The formula that predicted rotator cuff tear size with modest correlation with the raw data was: tear size = 482.8 + (3.9 × internal rotation strength) + (1.6 × adduction strength) – (7.2 × external rotation strength) – (2.0 × supraspinatus strength).

Read the abstract…

 
 
 
Bipartisan Effort to Target Surprise Medical Bills Garners 100 Cosponsors

The Protecting People From Surprise Medical Bills Act, a bipartisan effort to address surprise medical billing, reached 100 cosponsors, giving it the most support of any surprise medical billing legislation awaiting approval in the House of Representatives. The bill takes patients out of the middle, ensures that they have access to healthcare services when and where they need them, and provides a level playing field between physicians and insurers—including a fair process for resolving billing and payment disputes. The Out of the Middle Coalition, of which AAOS is a member, applauded Representatives Raul Ruiz, MD (D-Calif.), and Phil Roe, MD (R-Tenn.), for their work on this legislation and strongly encourages key committees to consider this particular legislation as the most equitable and common-sense solution to tackle surprise medical bills.

Read the Out of the Middle Coalition press release…

Help stop the threat of government price-setting…

 
 
 
AAOS Now

Autograft or Allograft?

Treatment strategies for symptomatic cartilage defects are typically grouped into reparative or restorative. Restorative techniques can be further classified into surface-type strategies, such as allogenic or autogenic compounds and cellular matrices applied on top of the subchondral plate, or composite options containing both hyaline cartilage and bone to address deep lesions. Specifically, this includes osteochondral autograft and allograft transplantation. Determining the most appropriate strategy depends on lesion characteristics, pathogenesis, and patient factors.

Read more…

 
 
 
Your AAOS

Apply for Volunteer Opportunities

Consider applying for the following positions:

  • Research Development Committee member-at-large position—applications are accepted until Oct. 22
  • Liaison Activities member position (alternate delegate: house of delegates)—applications are accepted until Oct. 25
  • Diversity Advisory Board chair position—applications are accepted until Oct. 28
  • Communications Committee chair position—applications are accepted until Oct. 29
  • International Committee chair position—applications are accepted until Nov. 1
  • Practice Management/Rehabilitation Program Committee chair position—applications are accepted until Nov. 1
  • Basic Science Content Committee chair designee position—applications are accepted until Dec. 10

Learn more and submit applications…(member login required)

 

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