May 20, 2020 | Today’s News

Study Compares Patellar Tendon Versus Four-strand Semitendinosus and Gracilis Autografts in ACL Reconstruction

A meta-analysis of randomized, controlled trials published online in Arthroscopy compared mid- to long-term outcomes and complications between anterior cruciate ligament (ACL) reconstruction performed with patellar tendon (PT) autografts versus four-strand semitendinosus and gracilis (STG) autografts. PubMed, Embase, and the Cochrane Library were queried for eligible trials, yielding nine clinical studies with 630 patients: 313 PT and 317 STG autografts. The Lachman and pivot-shift tests; International Knee Documentation Committee and Cincinnati scores; loss of range of motion; kneeling pain; and rates of graft rerupture, revision, and osteoarthritis did not largely differ between the groups. The STG group had less anterior knee pain. Side-to-side difference and Lysholm and Tegner scores were similar between the groups.

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Study Analyzes Child and Parent Scores Using Outcome Tools in Pediatric Foot and Ankle Patients

A study published in the May 1 issue of the Journal of the AAOS ® evaluated child-parent concordance using the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). During the course of nine months, 87 child-parent dyads completed the OxAFQ-C during routine clinic visits. The mean patient age was 12.4 years, 50 patients were female, and all patients had foot and ankle conditions. Most parents (84 percent) were mothers. Pes planus was the most common diagnosis (17 percent). The children had significantly higher scores than their parents in the school and play and emotional domains. In age-specific analyses, scores among children aged younger than 13 years were significantly higher than those of their parents across all domains (physical, school and play, and emotional), but only with moderate evidence for concordance for the school and play and emotional domains. Female patients and their parents, compared to males, had significantly lower emotional domain scores.

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A study published online in The American Journal of Sports Medicine used predictive modeling to determine which patients were the best candidates for arthroscopic rotator cuff repair (ARCR). The following predictors of functional outcomes after ARCR were included in each model: age, sex, workers’ compensation (WC) status, previous cuff repair, tear size, tear shape, multiple-tendon involvement, tendon stump length, Goutallier classification, critical shoulder angle, length of follow-up, and baseline subjective outcomes score. Postoperative American Shoulder and Elbow Surgeons (ASES); 12-Item Short Form Health Survey Physical Component Summary (SF-12 PCS); and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, as well as patient satisfaction, were considered. A total of 449 shoulders had a minimum of two-year postoperative patient-reported outcomes (PROs) at a mean 4.8 years. ASES score significantly improved from pre- (58.0) to postoperatively (98.3). At two years, women were significantly more likely to undergo reoperation than men (5.8 percent versus 1.8 percent). Significant independent predictors of lower postoperative ASES scores were previous ARCR, female sex, and a WC claim. Significant predictors of worse QuickDASH scores were a WC claim, female sex, previous ARCR, and at least seven years of follow-up. Significant predictors for lower SF-12 PCS scores were a WC claim, female sex, and lower baseline SF-12 PCS. Significant independent predictors of patient satisfaction were previous ARCR, a WC claim, female sex, and age.

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A study published in the May issue of The Journal of Arthroplasty compared early- versus late-stage periarticular injection for pain relief after total hip arthroplasty (THA). A total of 140 THA patients were randomized to either the early- (periarticular injection was performed just before arthrotomy, and placebo was injected after implantation) or late-stage (placebo was injected just before arthrotomy, and periarticular injection was performed after implantation) injection group. The main outcome was postoperative pain score at the recovery room The early-stage group had a significantly lower visual analog scale (VAS) score in the recovery room than the late-stage group, with the difference reaching a minimal clinically important difference (MCID). Complication rates did not differ between the groups.

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A study published online in BMC Musculoskeletal Disorders compared risk factors for unfavorable surgical outcomes based on two definitions of “unfavorable” following surgery for lumbar spinal stenosis (LSS). A total of 295 operative LSS patients with a three-year follow-up evaluation were assigned to favorable and unfavorable groups per two different definitions for unfavorable surgical outcomes as evaluated after 12 months: the PRO and MCID methods. The PRO method defined an “unfavorable” outcome as a postoperative Oswestry Disability Index (ODI) score > 22; the MCID method defined it as a postoperative ODI score that changed < 12.8 points from the preoperative value. The following risk factors were associated with higher odds of an unfavorable surgical outcome per the PRO method: female sex, elementary school attainment (versus university attainment), and higher preoperative ODI score. In the MCID method, a higher preoperative ODI score was correlated with a favorable surgical outcome. In the PRO method, the favorable group, compared to the unfavorable group, had significantly lower VAS for back and leg pain and lower ODI scores three years postoperatively; in the MCID method, there were no significant between-group differences in clinical outcomes at three years.

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May AAOS Now Is Now Available Online

AAOS members will soon receive the print edition of the May issue of AAOS Now, but the electronic edition is already available on the AAOS Now website and on iOS and Android devices through the AAOS Access app. This month’s issue highlights include the launch of AAOS’ new advocacy podcast; an introduction to the AAOS Committee on Devices, Biologics, and Technology; personal stories from two orthopaedic surgeons diagnosed with COVID-19; and more.

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Take Part in a CPG Workgroup on the Management of ACL Injuries

AAOS is seeking one volunteer to take part in the workgroup for the development of the clinical practice guideline (CPG) for the Management of ACL Injuries. Apply as soon as possible, as there is only one spot available.

Learn more and submit your application…