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Management of Biceps Tendon Pathology: From the Glenoid to the Radial Tuberosity.
Authors: Frank RM, Cotter EJ, Strauss EJ, Jazrawi LM, Romeo AA Abstract Management of proximal and distal biceps tendon pathology is evolving. The long head of the biceps tendon, if inflamed, may be a pain-producing structure. In appropriately indicated patients, a symptomatic long head of the biceps tendon can be surgically managed via tenotomy, tenodesis, and/or superior labrum anterior to posterior repair. In some patients, primary superior labrum anterior to posterior pathology can be managed via biceps tenodesis. Determining which procedure is most appropriate and which technique and implant are preferred for ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - January 18, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Transforaminal Lumbar Interbody Fusion: Traditional Open Versus Minimally Invasive Techniques.
Authors: Lee MJ, Mok J, Patel P Abstract Recently, minimally invasive spine arthrodesis has gained popularity among spine surgeons. Minimally invasive techniques have advantages and disadvantages compared with traditional open techniques. Comparisons between short-term outcomes of minimally invasive transforaminal interbody fusion and open transforaminal interbody fusion in terms of estimated blood loss, postoperative pain, and hospital length of stay have been well documented and generally favor the minimally invasive technique. However, the advantages of minimally invasive transforaminal interbody fusion must be ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - January 18, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Golf Injuries: Epidemiology, Pathophysiology, and Treatment.
Authors: Zouzias IC, Hendra J, Stodelle J, Limpisvasti O Abstract Increasing numbers of people are playing golf. Golf is a unique sport in that the ability to participate at a high level is not limited by age. In addition, participants tend to play more rather than less as they grow older. Injuries can occur at any point during the golf swing, from takeaway through follow-through. Upper extremity injuries can affect the hands, elbow, and shoulder and are usually a result of the golf swing at impact. Injuries are also common in the lower back as well as the lower extremities. Most injuries are the result of overuse ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - January 13, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Septic Arthritis of the Wrist.
Authors: Jennings JD, Ilyas AM Abstract Septic arthritis of the wrist is an uncommon condition, but one that can result in substantial morbidity. Timely identification and treatment is critical to patient care. No serum laboratory values have been shown to consistently confirm wrist joint infection. Thus, diagnosis is made based mainly on a thorough patient history, physical examination, and joint aspiration. When infection is suspected, aspiration of the wrist should be performed to confirm the diagnosis. Broad-spectrum antibiotics and joint aspiration or surgery are required to manage the infection and prevent se...
Source: The Journal of the American Academy of Orthopaedic Surgeons - January 13, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Polydactyly of the Hand.
Authors: Comer GC, Potter M, Ladd AL Abstract Polydactyly is one of the most common congenital hand deformities managed by orthopaedic surgeons. It is most often found in isolation; however, rarely, it may be associated with genetic syndromes. Polydactyly is classified as postaxial, preaxial, or central depending on the radioulnar location of the duplicated digits. Postaxial polydactyly, which affects the ulnar side of the hand, is most common and is typically managed with excision or suture ligation of the supernumerary digit. Preaxial polydactyly, which affects the thumb or radial side of the hand, often requires...
Source: The Journal of the American Academy of Orthopaedic Surgeons - January 9, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Orthopaedic Manifestations of Sickle Cell Disease.
Authors: Vanderhave KL, Perkins CA, Scannell B, Brighton BK Abstract Sickle cell disease (SCD) is an autosomal recessive disorder that results in hemolytic anemia related to abnormal hemoglobin and erythrocyte levels. SCD is characterized by vascular occlusive episodes, visceral sequestration, and aplastic or hemolytic crises. These crises most commonly occur in bone. The orthopaedic manifestations of SCD comprise much of the morbidity associated with this disorder. Osteonecrosis and osteomyelitis are among the most disabling and serious musculoskeletal complications in patients with SCD. Effective management of th...
Source: The Journal of the American Academy of Orthopaedic Surgeons - January 9, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Blood-loss Management in Spine Surgery.
Authors: Bible JE, Mirza M, Knaub MA Abstract Substantial blood loss during spine surgery can result in increased patient morbidity and mortality. Proper preoperative planning and communication with the patient, anesthesia team, and operating room staff can lessen perioperative blood loss. Advances in intraoperative antifibrinolytic agents and modified anesthesia techniques have shown promising results in safely reducing blood loss. The surgeon's attention to intraoperative hemostasis and the concurrent use of local hemostatic agents also can lessen intraoperative bleeding. Conversely, the use of intraoperative blo...
Source: The Journal of the American Academy of Orthopaedic Surgeons - January 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Bearing Surfaces for Total Hip Arthroplasty.
Authors: Lachiewicz PF, Kleeman LT, Seyler T Abstract Metal-on-highly cross-linked polyethylene is considered the preferred bearing surface for conventional total hip arthroplasty because of its safety profile and excellent results in the first 10 to 15 years of use. However, with younger patient age, activity expectations increase, and the life expectancy of patients with total hip arthroplasty also has increased, so interest remains in other bearing couples. These other options include the use of various ceramic composites for the femoral head on highly cross-linked polyethylene, the so-called second-generation a...
Source: The Journal of the American Academy of Orthopaedic Surgeons - January 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Flexor Tendon Injuries.
Authors: Klifto CS, Capo JT, Sapienza A, Yang SS, Paksima N Abstract Flexor tendon injuries of the hand are uncommon, and they are among the most challenging orthopaedic injuries to manage. Proper management is essential to ensure optimal outcomes. Consistent, successful management of flexor tendon injuries relies on understanding the anatomy, characteristics and repair of tendons in the different zones, potential complications, rehabilitation protocols, recent advances in treatment, and future directions, including tissue engineering and biologic modification of the repair site. PMID: 29303923 [PubMed - in pro...
Source: The Journal of the American Academy of Orthopaedic Surgeons - January 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Arthritis Gene Therapy Approved in Korea.
Authors: Evans CH, Ghivizzani SC, Robbins PD PMID: 29303924 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - January 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Influence of Trainee Experience on Choice of Orthopaedic Subspecialty Fellowship.
Authors: Matson AP, Kavolus JJ, Byrd WA, Leversedge FJ, Brigman BE Abstract INTRODUCTION: Most orthopaedic surgery residents elect to pursue additional subspecialty training; however, factors influencing the choice of subspecialty and the ways that these factors change during training are not well understood. The aim of this investigation was to determine, on the basis of a trainee's postgraduate year (PGY), whether variability exists in factors valued when choosing a specific subspecialty. METHODS: We emailed an online survey (intended for distribution to current trainees) to a list of orthopaedic surgery resi...
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 30, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Compliance With the AAOS Guidelines for Treatment of Osteoarthritis of the Knee: A Survey of the American Association of Hip and Knee Surgeons.
CONCLUSIONS: Management of moderate to severe knee OA does not align with AAOS guidelines. We encourage researchers to conduct clinical trials to identify the role of intra-articular corticosteroids in treating this condition. PMID: 29283898 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 30, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Radiographic Evaluation of Acetabular Fractures: Review and Update on Methodology.
Authors: Mauffrey C, Stacey S, York PJ, Ziran BH, Archdeacon MT Abstract Despite increased availability of modern imaging techniques, plain radiographs remain the initial step in the classification of acetabular fractures. The ability to interpret the injury configuration allows the surgeon to develop a thorough preoperative plan and to evaluate the quality of reduction and fixation intraoperatively. Proficiency in the mental conversion of a two-dimensional radiograph into a three-dimensional conceptual image is imperative. The widely used radiographic classification scheme developed by Judet and Letournel in the 1...
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 23, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Another Historic Step Forward.
Authors: Levine WN PMID: 29261552 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 22, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Local Modalities for Preventing Surgical Site Infections: An Evidence-based Review.
Authors: Katarincic JA, Fantry A, DePasse JM, Feller R Abstract Surgical site infections remain a dreaded complication of orthopaedic surgery, affecting both patient economics and quality of life. It is important to note that infections are multifactorial, involving both surgical and patient factors. To decrease the occurrence of infections, surgeons frequently use local modalities, such as methicillin-resistant Staphylococcus aureus screening; preoperative bathing; intraoperative povidone-iodine lavage; and application of vancomycin powder, silver-impregnated dressings, and incisional negative-pressure wound thera...
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 22, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

The Utility of Biologics, Osteotomy, and Cartilage Restoration in the Knee.
Authors: Frank RM, Cotter EJ, Strauss EJ, Gomoll AH, Cole BJ Abstract The management of complex cartilage and meniscal pathology in young, athletic patients is extremely challenging. Joint preservation surgery is most difficult in patients with concomitant knee pathologies, including cartilage defects, meniscal deficiency, malalignment, and/or ligamentous insufficiency. Clinical decision making for these patients is further complicated by articular cartilage lesions, which often are incidental findings; therefore, treatment decisions must be based on the confirmed contribution of articular cartilage lesions to symp...
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 22, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Prolonged Preoperative Weakness Affects Recovery of Motor Function After Anterior Cervical Diskectomy and Fusion.
CONCLUSION: Patients being considered for anterior cervical diskectomy and fusion who have substantial preoperative motor deficits may benefit from earlier surgical intervention. PMID: 29239868 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 16, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Challenges in the Management of Anterior Cruciate Ligament Ruptures in Skeletally Immature Patients.
Authors: DeFrancesco CJ, Storey EP, Shea KG, Kocher MS, Ganley TJ Abstract Although initially considered rare, anterior cruciate ligament (ACL) ruptures in pediatric patients recently have increased substantially as a result of greater awareness of the injury and increased participation in youth sports. Although pediatric patients with an ACL injury and a clinically stable joint may handle the injury well and return to sports activity without requiring surgical reconstruction, young, active patients with an ACL rupture and an unstable joint may be good candidates for ACL reconstruction to prevent ongoing instabilit...
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 16, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Factors Motivating Medical Students in Selecting a Career Specialty: Relevance for a Robust Orthopaedic Pipeline.
Authors: Segal D PMID: 29239870 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 16, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Integrative Medicine as an Adjunct to Orthopaedic Surgery.
Authors: Ficke JR, Moroski NM, Ross SD, Gupta R Abstract Patients often seek nontraditional forms of treatment, including alternative/complementary medical options, such as chiropractic care and acupuncture, to meet their personal needs. In the United States, interest has grown in methods to reduce pain and improve function through Ayurvedic medicine, which uses plant-based supplements, such as turmeric. Traditional allopathic medicine attempts to provide patients with evidence-based therapeutic regimens for their musculoskeletal conditions. Integrative medicine often is used to prevent and manage the sequelae asso...
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 16, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

No Clear Benefit of Chlorhexidine Use at Home Before Surgical Preparation.
CONCLUSION: At-home use of chlorhexidine gluconate wipes did not decrease the topical bacterial burden. Therefore, using chlorhexidine gluconate wipes at home before surgery may offer no added benefit.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. PMID: 29227322 [PubMed - as supplied by publisher] (Source: The Journal of the American Acad...
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 13, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Comprehensive Review of Skiing and Snowboarding Injuries.
Authors: Owens BD, Nacca C, Harris AP, Feller RJ Abstract Skiing and snowboarding have increased in popularity since the 1960s. Both sports are responsible for a substantial number of musculoskeletal injuries treated annually by orthopaedic surgeons. Specific injury patterns and mechanisms associated with skiing and snowboarding have been identified. No anatomic location is exempt from injury, including the head, spine, pelvis, and upper and lower extremities. In these sports, characteristic injury mechanisms often are related to the position of the limbs during injury, the athlete's expertise level, and equipment ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 7, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

The Weight-Bearing Shoulder.
Authors: Patel RM, Gelber JD, Schickendantz MS Abstract The shoulder achieves a wide spectrum of motion, and in a subset of patients, including those who use manual wheelchairs and upper extremity walking aids, the shoulder also serves as the primary weight-bearing joint. Because the weight-bearing shoulder is subject to considerable joint reaction forces and overuse, a broad spectrum of pathology can affect the joint. The combination of muscle imbalance and repetitive trauma presents most commonly as subacromial impingement syndrome but can progress to other pathology. Patients with high-level spinal cord injury, ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 29, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

The Relative Effects of Manual Versus Automatic Exposure Control on Radiation Dose to Vital Organs in Total Hip Arthroplasty.
CONCLUSION: Radiation exposure to radiosensitive organs increased up to threefold after total hip implantation with automatic exposure control and up to approximately 1.5 times with the manual protocol. Doses were greater with manual exposures than with automatic exposure control (except at the control probe on the stomach, where exposure was negligible, as expected). However, after implant placement, doses increased more with automatic exposure control than with manual exposure. This difference can be attributed to increased scatter and the difficulty of dose modification because of the density of the implant. Current rad...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 29, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Venous Thromboembolism Prophylaxis in Total Hip Arthroplasty and Total Knee Arthroplasty Patients: From Guidelines to Practice.
Authors: Lieberman JR, Heckmann N Abstract Venous thromboembolism (VTE) prophylaxis is recommended for all patients undergoing total hip arthroplasty or total knee arthroplasty. The selection of an appropriate prophylaxis regimen represents a balance between efficacy and safety. To help orthopaedic surgeons select an appropriate VTE prophylaxis regimen for their patients, the American Academy of Orthopaedic Surgeons and the American College of Chest Physicians have developed guidelines. These guidelines do not recommend an optimal regimen, however. Rather, an individualized prophylaxis regimen that balances efficac...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 29, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Diagnostic Injections About the Shoulder.
Authors: McFarland E, Bernard J, Dein E, Johnson A Abstract Injections about the shoulder serve diagnostic as well as therapeutic purposes. Diagnosis of shoulder conditions, such as rotator cuff tears, acromioclavicular joint pathology, subacromial impingement or anterolateral pain syndrome, glenohumeral joint pathology, suprascapular nerve entrapment, and biceps tendon pathologies, is often complicated by concomitant conditions with overlapping symptoms and by inconclusive physical examination and imaging results. Injections of anesthetic agents can often help clinicians locate the source of pain. However, techniq...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 29, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Screening for Infection Before Revision Hip Arthroplasty: A Meta-analysis of Likelihood Ratios of Erythrocyte Sedimentation Rate and Serum C-reactive Protein Levels.
DISCUSSION: With a low pretest probability of PJI, a negative test result for either the ESR or CRP level is enough to rule out infection before revision hip arthroplasty. LEVEL OF EVIDENCE: III. PMID: 29176504 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 29, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Sex-specific Outcomes and Predictors of Concussion Recovery.
CONCLUSION: This study confirms sex-based differences in SRCs. Longitudinal studies of collegiate cohorts should attempt to limit follow-up bias and offer opportunities to clarify determinants of SRC. PMID: 29176505 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 29, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Complication Rates After Total Hip and Knee Arthroplasty in Patients With Hepatitis C Compared With Matched Control Patients.
CONCLUSIONS: Further research is needed to establish quantifiable associations between hepatitis C and postoperative complications among patients with the disease who undergo total joint arthroplasty. PMID: 29176506 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 29, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Variables Affecting Return to Work After Spinal Surgery in a Non-workers' Compensation Population: A Retrospective Cohort Study.
CONCLUSIONS: Patients not receiving WC who underwent spinal surgery had a high chance of returning to employment within 1 year if they had been working at least 3 months before the date of surgery. PMID: 29176507 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 29, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Mysteries Behind the Cellular Content of Tendon Tissues.
Authors: Schneider M, Docheva D PMID: 29076923 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - October 28, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Stemless Prosthesis for Total Shoulder Arthroplasty.
Authors: Lazarus MD, Cox RM, Murthi AM, Levy O, Abboud JA Abstract The fourth generation of humeral components currently are being used in anatomic shoulder arthroplasty. Anatomic shoulder arthroplasty implants have evolved to better re-create anatomy, improve fixation, preserve bone, and facilitate revision surgery. Most of the design changes for shoulder arthroplasty implants have centered on the humeral stem, with a transition to shorter, metaphyseal humeral stems. Many of these humeral component design changes may be beneficial; however, long-term studies are necessary to determine if the results of anatomic sh...
Source: The Journal of the American Academy of Orthopaedic Surgeons - October 25, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Metabolic Bone Diseases and Total Hip Arthroplasty: Preventing Complications.
Authors: Moya-Angeler J, Lane JM, Rodriguez JA Abstract Metabolic bone diseases are a diverse group of conditions characterized by abnormalities in calcium metabolism and/or bone cell physiology. These unbalanced processes can eventually lead to bony deformities and altered joint biomechanics, resulting in degenerative joint disease. Not infrequently, patients with metabolic bone diseases have restricting hip joint pain that ultimately necessitates hip arthroplasty. To minimize complications, the surgeon must consider the particular characteristics of these patients. The surgical and medical management of patients ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - October 24, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Discoid Lateral Meniscus in Children: Diagnosis, Management, and Outcomes.
Authors: Kocher MS, Logan CA, Kramer DE Abstract Discoid meniscus is a congenital variant of the knee joint that typically involves abnormal morphology and potential instability of the lateral meniscus. Some discoid menisci have abnormal peripheral attachments and are unstable. Discoid menisci are prone to tearing secondary to increased thickness, poor tissue quality, and instability. Patients may or may not be symptomatic. Torn or unstable discoid menisci cause mechanical symptoms, pain, and swelling. Symptomatic patients in whom nonsurgical management fails most frequently are treated with arthroscopic surgery. H...
Source: The Journal of the American Academy of Orthopaedic Surgeons - October 24, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Pedicled Rotational Medial and Lateral Gastrocnemius Flaps: Surgical Technique.
Authors: Walton Z, Armstrong M, Traven S, Leddy L Abstract Gastrocnemius flaps have been used for decades to reconstruct defects of the proximal tibia and knee. They have proven to be useful in the soft-tissue reconstruction of defects caused by trauma, tumors, and infections about the knee, and the reconstruction of extensor mechanism discontinuity with and without total joint arthroplasty. The flaps have low failure rates and a distinct proximally based blood supply that allows them to be elevated and rotated up to 15 cm above the level of the knee joint. The vascular anatomy is reproducible because rotational fl...
Source: The Journal of the American Academy of Orthopaedic Surgeons - October 24, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

The Posteromedial Corner of the Knee: Anatomy, Pathology, and Management Strategies.
Authors: Dold AP, Swensen S, Strauss E, Alaia M Abstract The posteromedial corner of the knee encompasses five medial structures posterior to the medial collateral ligament. With modern MRI systems, these structures are readily identified and can be appreciated in the context of multiligamentous knee injuries. It is recognized that anteromedial rotatory instability results from an injury that involves both the medial collateral ligament and the posterior oblique ligament. Like posterolateral corner injuries, untreated or concurrent posteromedial corner injuries resulting in rotatory instability place additional str...
Source: The Journal of the American Academy of Orthopaedic Surgeons - October 24, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

The Diagnostic Utility of Synovial Fluid Markers in Periprosthetic Joint Infection: A Systematic Review and Meta-analysis.
CONCLUSION: The most frequently studied synovial fluid markers for the diagnosis of periprosthetic joint infection are C-reactive protein, leukocyte esterase, interleukin-6, interleukin-1β, α-defensin, and interleukin-17, all of which have high diagnostic utility. LEVEL OF EVIDENCE: Level II. PMID: 29059113 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - October 24, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Findings Associated With Knee Pathology on MRI in Patients Without Osteoarthritis.
CONCLUSIONS: In patients without osteoarthritis, positive findings on knee MRI could be associated with a number of presenting signs and symptoms, and this information could aid physicians in deciding which patients should undergo knee MRIs. Additional prospective research is needed to validate the relationships discovered in our study. LEVEL OF EVIDENCE: Level III retrospective study. PMID: 29059114 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - October 24, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Using Lean Process Improvement to Enhance Safety and Value in Orthopaedic Surgery: The Case of Spine Surgery.
Authors: Sethi R, Yanamadala V, Burton DC, Bess RS Abstract Lean methodology was developed in the manufacturing industry to increase output and decrease costs. These labor organization methods have become the mainstay of major manufacturing companies worldwide. Lean methods involve continuous process improvement through the systematic elimination of waste, prevention of mistakes, and empowerment of workers to make changes. Because of the profit and productivity gains made in the manufacturing arena using lean methods, several healthcare organizations have adopted lean methodologies for patient care. Lean methods ha...
Source: The Journal of the American Academy of Orthopaedic Surgeons - October 24, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Management of Failed Rotator Cuff Repair in Young Patients.
Authors: Elhassan BT, Cox RM, Shukla DR, Lee J, Murthi AM, Tashjian RZ, Abboud JA Abstract Management of failed rotator cuff repair may be difficult, especially in young patients. Various nonmodifiable and modifiable patient factors, including age, tendon quality, rotator cuff tear characteristics, acute or chronic rotator cuff tear, bone quality, tobacco use, and medications, affect rotator cuff repair healing. Surgical variables, such as the technique, timing, tension on the repair, the biomechanical construct, and fixation, as well as the postoperative rehabilitation strategy also affect rotator cuff repair heal...
Source: The Journal of the American Academy of Orthopaedic Surgeons - October 24, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Reconstruction Following Tumor Resections in Skeletally Immature Patients.
Authors: San-Julián M, Vázquez-García B, Aquerreta JD, Idoate MA PMID: 29059117 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - October 24, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

The Effect of Obesity on Surgical Treatment of Achilles Tendon Ruptures.
Authors: Ahmad J, Jones K Abstract INTRODUCTION: We conducted a retrospective comparison of surgical treatment outcomes for acute Achilles tendon ruptures in nonobese and obese patients. METHODS: Between October 2006 and April 2014, we studied 76 patients with acute midsubstance Achilles tendon rupture: 44 nonobese and 32 obese (body mass index>30 kg/m). Preoperative and postoperative function and pain were graded with the Foot and Ankle Ability Measure (FAAM) Sports subscale and the visual analog scale for pain, respectively. RESULTS: All 76 patients presented for follow-up. On a scale of 100, the mean ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 30, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Measuring Surgical Skills in Simulation-based Training.
Authors: Atesok K, Satava RM, Marsh JL, Hurwitz SR Abstract Simulation-based surgical skills training addresses several concerns associated with the traditional apprenticeship model, including patient safety, efficient acquisition of complex skills, and cost. The surgical specialties already recognize the advantages of surgical training using simulation, and simulation-based methods are appearing in surgical education and assessment for board certification. The necessity of simulation-based methods in surgical education along with valid, objective, standardized techniques for measuring learned skills using simulato...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 28, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Distal Humerus Fractures in the Elderly Population.
Authors: Varecka TF, Myeroff C Abstract Distal humerus fractures present complex challenges in the elderly patient. These fractures often occur in patients who are living independently but have poor bone quality and low physiologic reserve, thus complicating management decisions and treatment. The goal is a painless, functional, stable elbow that allows completion of the activities of daily living. Nonsurgical management is reserved for those who cannot tolerate surgery. Open reduction and internal fixation is the preferred choice in fractures amenable to rigid fixation and early motion. Although total elbow arthro...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 28, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Understanding the Basics of Computational Models in Orthopaedics: A Nonnumeric Review for Surgeons.
Authors: Mehta S, Tyler A, Hast M Abstract Computational models represent more than just finite element analysis, a term that many clinicians may know and globally apply. Over the past 30 years, many published studies have addressed clinically relevant orthopaedic questions with speed and precision by using a wide variety of computational approaches. Given such a wide spectrum of techniques, clinicians often do not have a full understanding of the methods used to create models and therefore do not appreciate the strengths, weaknesses, and potential pitfalls of published results. The short, nonnumeric summaries of t...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 28, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Allergic or Hypersensitivity Reactions to Orthopaedic Implants.
Authors: Roberts TT, Haines CM, Uhl RL Abstract Allergic or hypersensitivity reactions to orthopaedic implants can pose diagnostic and therapeutic challenges. Although 10% to 15% of the population exhibits cutaneous sensitivity to metals, deep-tissue reactions to metal implants are comparatively rare. Nevertheless, the link between cutaneous sensitivity and clinically relevant deep-tissue reactions is unclear. Most reactions to orthopaedic devices are type IV, or delayed-type hypersensitivity reactions. The most commonly implicated allergens are nickel, cobalt, and chromium; however, reactions to nonmetal compounds...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 28, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis.
This study investigates the efficacy of intra-articular corticosteroid injections in patients with symptomatic knee OA and factors that affect treatment response. METHODS: This prospective, multicentered cohort study had 100 participants with radiographic evidence of knee OA enrolled. Participants received one corticosteroid injection into the affected knee and were evaluated before the injection (baseline) and at 3 weeks, 6 weeks, 3 months, and 6 months after the injection. RESULTS: Participants' Visual Numeric Scale and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores improved at all time ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 28, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Survivorship of Hemiarthroplasty With Concentric Glenoid Reaming for Glenohumeral Arthritis in Young, Active Patients With a Biconcave Glenoid.
DISCUSSION: Modest results were achieved with a hemiarthroplasty and concentric glenoid reaming in young patients with end-stage glenohumeral arthritis and a biconcave glenoid. Younger age and stiffness were associated with worse outcomes. Given the high revision rate and the percentage of patients who had unsatisfactory results, this procedure should be performed only after careful patient selection. Patients who are willing and able to undergo aggressive physical therapy focused on achieving early range of motion are more likely to have a satisfactory outcome after humeral hemiarthroplasty with concentric glenoid reaming...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 28, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Cubital Tunnel Syndrome: Current Concepts.
Authors: Staples JR, Calfee R Abstract Cubital tunnel syndrome is the second most common upper extremity compressive neuropathy. In recent years, rates of surgical treatment have increased, and the popularity of in situ decompression has grown. Nonsurgical treatment, aiming to decrease both compression and traction on the ulnar nerve about the elbow, is successful in most patients with mild nerve dysfunction. Recent randomized controlled trials assessing rates of symptom resolution and ultimate success have failed to identify a preferred surgical procedure. Revision cubital tunnel surgery, most often consisting of ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 28, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Spine Surgery Outcomes in Workers' Compensation Patients.
Authors: Daniels AH, Kuris EO, Kleinhenz DT, Palumbo MA Abstract Occupational spine injuries place a substantial burden on employees, employers, and the workers' compensation system. Both temporary and permanent spinal conditions contribute substantially to disability and lost wages. Numerous investigations have revealed that workers' compensation status is a negative risk factor for outcomes after spine injuries and spine surgery. However, positive patient outcomes and return to work are possible in spine-related workers' compensation cases with proper patient selection, appropriate surgical indications, and reali...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 28, 2017 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research