In a new initiative to deliver timely and clinically relevant content, The American Journal of Orthopedics is putting together news briefs from recently published ground-breaking research. This American Orthopaedic Society for Sports Medicine (AOSSM) 2012 conference news update is provided in addition to the daily eNewsletters that were distributed during the meeting. If you would like to receive these eNewsletters, please register here.
Age may be a predictor of failure rate in anterior cruciate ligament (ACL) reconstruction with hamstring autographs, data suggest. Gene R. Barrett, MD, et al identified 98 patients from their computerized regional database who underwent the surgery between 2000 and 2007. Patients with a minimum of 2 years follow-up, regardless of age or activity level, were included in the study. Fifteen patients (15.3%) had ACL reconstruction failures (ie, positive Lachman and pivot shift; ≥ 5 mm difference on KT1000 arthrometer). Of these, 12 patients were 25 years and younger (n = 48), and 3 were older than 25 (n = 50); this was statistically significant. Tegner activity level and graft size were not significantly associated with ACL reconstruction failure rates.
Increased glenoid retroversion is a significant risk factor for posterior shoulder instability (PSI) among young athletes. “This is the largest known prospective study to follow healthy subjects for the development of [PSI],” according to Brett D. Owens, MD, et al. The investigators followed 714 patients from June 2006 to May 2010 to find the modifiable and non–modifiable risk factors for PSI. Sixty-two shoulders sustained documented glenohumeral instability events during the surveillance period. Increased glenoid retroversion was the most significant risk factor for PSI. Other significant risk factors included increases in external rotation strength in adduction and external rotation strength at 45° of abduction.
KD3M was the most common knee dislocation (KD) injury pattern seen at the University of New Mexico during a span of 8 years, preliminary data from a patient series suggested. In a retrospective chart review, Dustin Richter, MD, et al evaluated 97 patients (average age, 39 years) and found that 6% had KD1, 1% KD2, 75% KD3, 4% KD4, and 14% KD5. In addition, 56% of the neurologic injuries were associated with a KD3L pattern and 75% of the vascular injuries with a KD3M pattern. “It is critical to evaluate the long-term clinical outcomes of KD’s to assess the efficacy of various treatment modalities and aid in patient diagnosis,” they concluded.
Autologous chondrocyte implantation (ACI) is a durable method to repair knee cartilage defects for up to 16 years, Arvind von Keudell, MD, et al found. Of 204 patients with knee cartilage lesions treated with ACI between 1995 and 2001 included in this study and available for postoperative evaluation, 40 patients had at least 1 failed ACI (ie, revision cartilage repair, partial or total knee replacement, or unknown). The researchers also found significant differences in survival between simple, complex, and salvage cases. “Our results advocate good to excellent results in clinical assays after a minimum follow-up of 10 years and can substantially delay the need for prosthesis in the young,” they noted.
Symptomatic femoroacetabular impingement (FAI) tends to occur in young patients, white patients with a normal BMI, and at a higher rate in women, reported John C. Clohisy, MD, et al. “This multicenter, prospective, longitudinal cohort, is one of the largest FAI cohorts to date,” they noted. In an effort to report the clinical epidemiology and trends in contemporary surgical treatment in patients with symptomatic FAI, 790 consecutive patients undergoing surgical intervention for symptomatic FAI were enrolled between 2008 and 2011. Overall, 60% of the patients were women, the average age of the patient population was 26.2 years, average BMI 25, 91% were white, and arthroscopy was used in 51% of the cases.
Medial Cartilage Injury
When it comes to reducing knee pain, improving knee function and quality of life, arthroscopic meniscectomy with supervised exercise has no advantage over supervised exercised alone in patients with degenerative horizontal tear of the medial meniscus, Jeehyoun Yim, MD, et al reported. They reviewed and followed 102 patients with an average age of 56.8 years between January 2003 and July 2008 (79% women; average follow-up, 37.3 months), and found that, based on functional outcomes, patients who underwent a meniscectomy (n = 50) did not have a greater improvement than patients who had conservative treatment (n = 52).
Prolotherapy (PT) and platelet-rich plasma (PRP) yield better clinical outcomes than extracorpeal shockwave therapy (ESWT) and physiotherapy in patients with lateral epicondylitis, according to the results of a prospective, randomized clinical study. Fifty patients were allocated to 1 of 4 treatment groups (N = 200); mean age of the study population was 51.7 years and mean follow-up was 22 months. They observed that while all 4 treatment options showed a significant increase in the DASH score, PRP and PT were significantly superior to ESWT and physiotherapy. “It seems that treatment based on ‘regeneration’ shows better results, but ultrasound did not show a significant difference among the 4 groups,” Sang-Hoon Lhee, MD, PhD, et al noted.
—Frederique H. T. Evans
Editor of The American Journal of Orthopedics