April 29, 2020 | Today’s News

Governing Bodies Vote to Approve Bylaws Amendments

The needs of AAOS members in different stages of their careers are changing. To maintain its relevance, AAOS must also change to meet members’ new needs. This year’s proposed bylaws amendments align with and support AAOS’ new Governance Principles, specifically Nos. 5 and 6. Bylaws amendments Nos. 1 and 2 are an effort to improve the current Academy and Association bylaws that are antiquated, cumbersome, confusing, and redundant. No. 3 relates to the composition of the AAOS Nominating Committee. At the recent virtual AAOS 2020 Annual Meeting, AAOS President Joseph A. Bosco III, MD, FAAOS, summarized: “We recommend that the AAOS Fellowship carefully review the three bylaws amendments. We encourage each Fellow to cast their ballot and participate in this important process for their Academy. It is vital that each of your voices are heard.”

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Study: How Significant are Incidental Findings on Preoperative Computer-assisted TJA Images?

A study published in the April issue of The Journal of Arthroplasty assessed the frequency, cost, and clinical significance of incidental findings on preoperative planning images for computer-assisted total joint arthroplasty (CA TJA). The study included 573 primary CA TJA patients who underwent planning imaging. Incidental findings were defined as those unrelated to the planned surgery. Just under half of patients (n = 262, 45.7 percent) had at least one incidental finding; about a quarter (n = 144, 25.1 percent) had two, and 65 (11.3 percent) had three. About two-thirds of finding types were musculoskeletal (67.7 percent); other types included digestive (19.5 percent), cardiovascular (4.9 percent), and reproductive (4.7 percent). Total hip arthroplasty patients, compared to total knee arthroplasty, were more likely to present musculoskeletal (67.9 percent versus 42.2 percent) and nonmusculoskeletal incidental findings (15.4 percent versus 8.3 percent). Six cases (1.0 percent) required further testing, and one case (0.2 percent) required delay in surgery. Per the 2016 volume of TJA procedures, the annual cost of additional testing when assuming a 10 percent utilization rate was $2.7 million; when assuming a 15 percent and 25 percent utilization rate, the annual costs were $4.1 million and $6.9 million, respectively.

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A study published in the April issue of Arthroscopy examined the use of MRI to observe the anterolateral ligament (ALL) and identify ALL injuries among intact anterior cruciate ligament (ACL) and torn ACL. Eligible MRIs were stratified into two groups: ACL-injured (study; n = 82) or ACL-intact (control; n = 116). Two radiologists investigated the MRIs and collected data, including demographics, ALL visualization, presence of ALL injury, and concomitant knee abnormalities. Regardless of ACL integrity, at least part of the ALL was visible in more than 95 percent of MRIs. The ACL injury group had a mean ALL injury incidence of 53.05 percent. Among MRIs with concomitant ALL and ACL injuries, a mean 13.95 percent presented Segond fractures.

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A study published in the April issue of Foot & Ankle International assessed return to play, performance, and career outcomes following Achilles tendon repair in National Collegiate Athletic Association (NCAA) Football Bowl Subdivision (FBS) defensive football players. Achilles repairs performed in FBS defensive football players between 2010 and 2016 were evaluated to determine return to play among eligible underclassmen athletes, as well as preinjury and postoperative performance. A total of 57 Achilles ruptures occurred during the study period, including 40 in underclassmen; the return to sport rate among this group was 92.5 percent. Among players who met performance criteria, the only differences observed between players and controls was in defensive backs in terms of solo tackling and total tackling, while still increasing compared to preoperatively.

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A study published online in the Journal of Shoulder and Elbow Surgery assessed the impact of previous nonarthroplasty surgery on clinical outcomes and revision rates in primary anatomic shoulder arthroplasty. A total of 640 patients were retrospectively reviewed: 345 total shoulder arthroplasty (TSA) and 295 ream-and-run arthroplasty patients; 183 patients underwent previous nonarthroplasty surgery. Data collection included baseline and demographic information, two-year postoperative outcome scores, and revision surgical procedures with associated culture results. In the TSA group, previous nonarthroplasty surgery was correlated with a significantly lower two-year Simple Shoulder Test (SST) score, percentage maximum possible improvement (MPI), and Single Assessment Numeric Evaluation (SANE) score. Ream-and-run arthroplasty patients with previous nonarthroplasty surgery also had lower SST and SANE scores and percentage MPI, as well as had a higher reoperation rate. Prior fracture surgery, compared to other types of surgery, was correlated with a greater reoperation risk.

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A study published online in the European Spine Journal evaluated the relationship between increased sagittal vertical axis (SVA) and sarcopenia. Seventy-one female patients aged 60 to 85 years were retrospectively reviewed. Radiological parameters were measured using entire-spine radiography. Skeletal muscle mass index (SMI), gait velocity (GV), and hand grip strength (HGS) were all assessed. Patients were stratified into two groups: group 1, SVA > 50 mm; and group 2, SVA ≤ 50 mm. Group 1 had lower GV, HGS, and SMI than group 2, as well as a higher prevalence of sarcopenia (56.7 percent versus 17.1 percent). Group 1 had lower functional cross-sectional area and higher fat signal fraction (FSF) of the paraspinal muscle. Multivariate analysis yielded a correlation between FSF and HGS and increased SVA.

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The ‘Root’ of All Evil: Mounting Evidence Supports Fixing Meniscal Root Tears

Meniscal tears make up 12 percent to 14 percent of orthopaedic presentations involving the knee, with a prevalence of 60 to 70 per 100,000. Some estimate that “root” tears are present in approximately a fifth of those cases. Recognizing root tears and their potential sequelae, as well as newer repair techniques, may become increasingly important in the future. This article describes the epidemiology, anatomy, and diagnosis of root meniscal root tears, as well as why and how to fix them—and when not to.

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