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Objectives: High tibial osteotomy (HTO) has become a well-established treatment for unicompartmental osteoarthritis of the knee. Over the last 30 years, various techniques have been introduced to advance this procedure. The purpose of this study is to review the outcomes of patients who received medial opening wedge HTO over the last ten years (2002-2012) using a modern, low profile, medially based fixation device. In addition, we sought to determine if obese patients had a less favorable outcome than their non-obese counterparts. Methods: Ninety-three patients were identified from a surgical database as having undergone a HTO for medial compartment osteoarthritis of the knee with varus mal-alignment . All procedures were performed by one of two fellowship trained orthopedic surgeons from 2002-2012 utilizing a low profile fixation device and identical surgical technique. Minimum follow-up was one year for inclusion in the study. Outcomes were measured using Lysholm and WOMAC scores. Radiographs were evaluated to determine delayed union or non-union at the osteotomy site and surveillance was undertaken to evaluate post operative complications. Results: 93 patients were identified from the database, 63 (70%) were available for follow-up and are included in this analysis. Average follow-up time was 48 months (range 17 to 137). There were 44 males and 19 females. The average age was 45 years old. The average final Lysholm and WOMAC scores were 66.4 (range: 13-100) and 18.6 (range: 0-86) respectively. There was no significant difference in reported Lysholm or WOMAC scores between obese (BMI >30) and non-obese patients (p=.31;p=.69). Complications were as follows: 3 patients required a surgical lysis of adhesions, 2 patients developed an infection, and 1 patient experienced a delayed union. At final follow-up, 18 patients received additional treatment on the affected knee: 11 required removal of symptomatic hardware, 5 received viscosupplementation, 2 underwent a total knee replacement. Conclusion: Low profile, medial based devices used in the setting of HTO is an accepted treatment for unicompartmental osteoarthritis of the knee. At final follow-up, a majority of patients reported positive outcomes and few complications. 18 patients required additional treatment for osteoarthritis. In our analysis, obese patients faired equally as well as their non-obese counterparts, with no significant difference in outcomes scores or complication rate. Survivorship of high tibial osteotomy was excellent in this series, with only 2 patients having undergone total knee replacement at last follow-up.

Objectives: Health expenditures in the United States are outpacing national income, and affordability has become a major policy issue. Over 500,000 rotator cuff repairs (RCR) are performed annually in the United States making RCR a potential source of cost savings. Arthroscopic trans-osseous equivalent (TOE) repair using a double row of anchors has shown superior biomechanical strength compared to other techniques, but at a higher cost. The arthroscopic transosseous (TO) repair is a novel technique allowing arthroscopic rotator cuff repair to be performed without suture anchors. Arthroscopic TO repair may be a means to provide similarly excellent patient outcomes while lowering the cost of care. The primary purpose is to compare the price differential and time of surgery for an arthroscopic rotator cuff repair using anchorless TO repair verses an anchor trans-osseous equivalent (TOE) repair. A secondary purpose of the study was to evaluate outcomes at 6 months postoperatively. Methods: A prospective, case-controlled study evaluating arthroscopic rotator cuff repair using two techniques was performed. The study group consisting of 21 patients undergoing TO repair was compared to a control group consisting of 22 patients undergoing TOE repair. The groups were controlled for size of tear, biceps treatment, acromioplasty, distal clavicle excision, and labral pathology. The primary outcome measures were surgical time as well as total cost of implants and equipment for each surgery, determined by an independent third party, Atlanticare Hospital. Secondary outcomes were changes in the SST, VAS, and SANE scores. Results: Mean total surgical implant/equipment cost per procedure for TOE repair was $2348.03 (SD 490.30) and for TO repair was $1204.97 (SD 330.69; p

Objectives: Meniscus root tears are associated with loss of hoop stress, increased peak pressure, and reduction in contact area of the affected compartment of the knee. Reversal of this outcome is predicated on the successful restoration of the meniscus through biologic healing to the tibial attachment. The purpose of this investigation was to evaluate the biologic healing of meniscus root tears through high resolution MRI and correlate this appearance to clinical outcome Methods: Nine patients were identified as having undergone a medial meniscus root repair using an identical pull-out surgical technique by a single surgeon. Outcomes were determined using Lysholm and WOMAC scores and quality of meniscus healing was assessed using a 3 Tesla MRI. MRI studies were reviewed by two fellowship trained musculoskeletal radiologists according to pre-defined criteria. Results: There were 4 females and 5 males in the study group. The average follow-up time was 30 months (range 21-41). MRI demonstrated a new tear medial to the prior repair in 4/9 patients. 4 patients demonstrated recurrence of tear or lack of biologic healing of the root attachment. In patients with recurrent tears of the root, meniscal extrusion averaged 1.5mm. In patients with evidence of healing, extrusion averaged 1.0mm. The average WOMAC and Lysholm scores were 11.2 and 81.6 respectively. There was no correlation between healing and clinical outcome scores in this series. Conclusion: 4 of 9 patients demonstrated recurrent tearing of the meniscus root. There was an increase in peripheral meniscus tears away from the repair in 4/9 patients, indicating excessive stress induced by the repair. Successful repair and healing was associated with decreased meniscus extrusion; however, this did not correlate with functional outcome scores, indicating that biologic healing is not a pre-requisite for good clinical outcome. A similar finding has been shown in studies evaluating rotator cuff repair.

Objectives: The American Academy of Orthopaedic Surgeons (AAOS) and other orthopaedic societies require members who present original research to disclose conflicts so that audiences can make informed decisions when interpreting data. To what degree members use this information when interpreting studies has never been investigated. The purpose of our study was to evaluate how a reported conflict of interest by the primary research team can influence the perceived value of data presented in original research. Methods: We devised a hypothetical prospective study (https://www.surveymonkey.com/s/MPCCLCX) and asked orthopaedic surgeons and non operative sports medicine specialists to rate the perceived clinical value of the data that was obtained based upon variations of study design, statistical significance of outcomes between treatment groups, and characteristics of the research setting (academic v. private institution). The research team in question was disclosed to have the following conflict of interest: the project was funded by a pharmaceutical company and that all authors received compensation for consulting services. Results: 750 sports medicine physicians were sent a survey request to participate in this IRB approved study. 522 responses were obtained for an overall response rate of 70%. 99% of respondents were orthopaedic surgeons. The majority of respondents were from the Northeastern U.S. (32%) and male (96%). Most have been in practice for over 20 years (40%) and were from private practice single specialty groups (58%). 80% of respondents strongly agreed with the statement that conflict disclosure is important when interpreting study results. 62% of respondents reported always reading the disclosure slide during academy or other meeting presentations. 41% of respondents reported always using this information when deciding how to interpret scientific data. Using a case series design with significant positive results at an academic center, 24% reported that the study was likely trustworthy. When the setting of the study was changed to a community hospital, this number decreased to 5%. When no significant difference was found between the groups, 42% believed the study to be trustworthy. When the study design was Level I evidence (RCT trial) and at an academic center, 57% believed the study to be trustworthy. With the same criteria but at a community hospital, this number decreased to 39%. When the results of this design showed no difference among groups, the majority of respondents believed the study to be trustworthy (62%). Conclusion: Although the majority of orthopaedic surgeons in our analysis believed that disclosure of conflict of interest is important, less than half used this information when interpreting studies. Changing the study design from a case series to a randomized controlled trial improved the perceived reliability of the data, but was not as important as the reporting of “negative” results.

Objectives: Coverage of high school athletic football by orthopaedic sports medicine specialists is considered standard of care in many localities. Taking time away from an orthopaedic practice to provide on field athletic care has potential advantages and disadvantages. Determining the economic viability of this endeavor has never been investigated. The purpose of the present investigation was to perform a cost/benefit risk analysis of local high school sports coverage by an orthopaedic sports medicine practice. Methods: From January 2010 to June 2012, a prospective injury report database was used to collect sports injuries from five high school athletic programs covered by a single orthopaedic sports medicine practice. Patients referred for orthopaedic care were then tracked to determine ultimate cost of care (potential revenue). Evaluation and management codes and current procedure terminology codes were obtained to determine the value of physician visits and surgical care rendered using standardized Medicare reimbursement rates. Total values were also analyzed in respect to visits and surgical treatments for the covering practice during this time period. Direct costs were estimated based on physician time required for team coverage and hourly reimbursement rates for orthopaedic surgeons, based on previously reported hourly reimbursement rates. Results: 19,165 athletic trainer evaluations resulted in 473 (2.5%) physician referrals. 185 (39%) of these referrals were to an orthopaedic surgeon. Of the physician referrals, 26 (5.4%) required orthopaedic surgical treatment. The covering team practice handled 89/185 (48%) of the orthopaedic referrals, and handled 17/26 (65%) of the patients that required surgical treatment. The total cost of orthopaedic care for the athletes requiring treatment was $44,239.94 (total potential revenue). The total revenue collected by the covering team practice was $26,226.14 (actual revenue). The cost of a covering team physician for the required hours of coverage was $12,627.81 (overhead). Overall profit of orthopaedic visits and treatment during this period for the covering practice was $13,598.33 (actual revenue - overhead). Total possible profit during the treatment period was $31,612.13 (total potential revenue - overhead). Based on actual revenue collections, the hourly wage of the sports medicine surgeon was calculated to be $116.24. Conclusion: A potentially profitable and personally beneficial engagement with local athletes can lead to a symbiotic relationship between physicians and their local communities. The covering team practice handled 48% of the orthopaedic referrals, 65% of the surgical cases, and captured 43% of the potential profit. The hourly rate of reimbursement calculated based on this revenue for the covering team physician is only slightly higher to that found in a prior study.