May 27, 2020 | Today’s News

Study Assesses Arthroscopic Pie-crusting Release of Posteromedial Complex of Knee

A study published online in BMC Musculoskeletal Disorders analyzed the use of pie-crusting release of the posteromedial complex (PMC) for arthroscopic meniscal surgery in tight knees. Patients who accepted arthroscopic pie-crusting PMC release were stratified into two groups: meniscoplasty (n = 40) and meniscal suturing (n = 20). Measurements were taken of the medial space before and after release. Radiographic measurements were taken of the joint space width (JSW) in 20 degrees half-flexion to assess the medial stability. Healing of the medial collateral ligament and meniscus were evaluated with MRI, and functional outcomes were measured per the visual analog scale (VAS), Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores. No cases of iatrogenic cartilage injury were observed. The arthroscopic width of the medial space increased from pre-PMC release (2.5 mm) to post-PMC release (5.7 mm). No residual valgus laxity of the knee was observed after 21.93 months of follow-up. The radiographic JSW changed from 5.97 mm preoperatively to 9.20 mm one week postoperatively and 6.1 mm three months postoperatively. In the sutured meniscus group, 15 patients demonstrated healing on MRI, and five had two-grade abnormal signals. VAS, Lysholm, IKDC, and Tegner scores all significantly differed from pre- to postoperatively.

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Study: How Much Do Patients Want to Participate in Disease Management Decision-making?

A study published in the May 15 issue of the Journal of the AAOS ® assessed the extent to which patients prefer to take part in decision-making when managing a musculoskeletal condition. Patients rated their preferred level of involvement in 25 common theoretical clinical decisions as passive (0), semipassive (1 to 4), equally shared involvement between patient and surgeon (5), semiactive (6 to 9), or active (10). Final analysis included 115 patients at an orthopaedic surgery clinic. For most decisions (92 percent), patients preferred to take a semipassive role. Patients preferred to be the most involved in scheduling surgical treatments (4.75) and least involved in determining incision sizes (1.13). Patient involvement preferences did not differ whether patients had previously undergone orthopaedic surgery. Younger age and higher education level were associated with a desire for more decision-making responsibility; patients on Medicare were more likely to prefer a passive role.

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The presence of malnutrition combined with frailty may significantly increase the risk for complications in total hip arthroplasty (THA), according to a study published online in The Journal of Arthroplasty. Primary THA data from the American College of Surgeons-National Surgery Quality Improvement Program database were retrospectively reviewed, including preoperative serum albumin levels and five-item modified frailty index scores. Malnutrition was defined as serum albumin level < 3.5 g/dL; frailty was defined as a score of two or greater. Patients were stratified into four groups: healthy (82 percent), frail-only (14 percent), hypoalbuminemia-only (3 percent), and hypoalbuminemia and frail (combination group; 1 percent). The combination group, compared to all other groups, had higher odds of complication, as well as increased resource utilization. The 30-day mortality rate in the combination group was 1.9 percent.

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According to a study published online in the Journal of Shoulder and Elbow Surgery, reverse total shoulder arthroplasty (RTSA) performed with the Univers Revers™ prosthesis yielded a low complication rate and improved clinical outcomes. Rotator cuff tear arthropathy patients who underwent RTSA with the Univers Revers™ prosthesis were assessed for incidence percentages of complications and pathologic radiographic changes, as well as changes in range of motion, shoulder function (Constant-Murley score, Shoulder Pain and Disability Index, Subjective Shoulder Value), and quality of life (European Quality of Life Five Dimensions Five Level [EQ-5D-5L] and EuroQol VAS [EQ-VAS]). Final analysis included 187 patients (mean age, 75.3 years; 59.4 percent were female). A quarter of patients had a postoperative complication; five were severe, and two were implant-related. Scapular notching was observed in 10.6 percent of cases. Two years postoperatively, abduction improved by 54 degrees, flexion by 57 degrees, and abduction strength by 5 kg, but external rotation did not improve. The Constant-Murley score improved by 39, Shoulder Pain and Disability Index by 50, and Subjective Shoulder Value by 43. The EQ-5D-5L index value and EQ-VAS score improved by 0.31 and 16, respectively.

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A study published in the May issue of The American Journal of Sports Medicine evaluated the Achilles tendon total rupture score (ATRS) at different time points after rupture and sought to develop a manual explaining how to use the ATRS. For part one of the mixed-methods study, researchers prospectively collected data at four, 12, and 24 months after rupture and compared the original 10-item ATRS versus an adjusted seven-item ATRS. Part two of the study was a discussion among the researchers to develop an ATRS manual. Final analysis included 2,790 complete ATRSs. At all time points, the seven-item ATRS significantly overestimated the 10-item score’s value, although the difference was only clinically relevant at four months. The study authors recommended that, rather than eliminating the last three questions of the ATRS, the how-to manual be used.

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eSports Gamers Emerge as the Newest Orthopaedic Patient

As a pediatric hand surgeon, Julie Balch Samora, MD, PhD, MPH, FAAOS, has seen more and more gamers presenting to her clinic for overuse-type injuries. She realized she knew very little about eSports, and even her teenage son couldn’t provide much insight. Dr. Samora had the pleasure of meeting a 15-year-old patient who has been competing professionally in the eSports industry for nearly two years. In such time, he has earned more than $200,000 in prize money competing in the game Fortnite—as well as a diagnosis of wrist tendonitis/overuse. In part one of a two-part series, Dr Samora speaks with the patient and his mother about the world of eSports and what other gamers and orthopaedists who treat them should know about the growing musculoskeletal injuries in this population.

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AAOS Launches Virtual Education Experience Media Program

The AAOS 2020 Annual Meeting media program shifted to showcase the new medical, clinical, and scientific research that is now part of the AAOS Virtual Education Experience. Highlights included cannabis use for musculoskeletal pain, quality of life after a spouse’s joint replacement on marital functioning, declining trend in opioid prescribing for minor orthopaedic injuries in children, concussion rates among high school athletes, the perception of cigarette smoking versus smoking alternatives on bone fracture healing, and more.

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