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Background: Demand for total knee arthroplasty (TKA) is increasing as it remains the gold-standard treatment for end-stage osteoarthritis (OA) of the knee. Magnetic resonance imaging (MRI) scans of the knee are not indicated for diagnosing knee OA and represent a possible delay to orthopaedic surgeon referral and unnecessary expenditure. The purpose of this study was to determine the proportion of patients who underwent an MRI in the two years prior to their primary TKA for OA and determine patient and physician associations with increased MRI usage. Methods: This is a population-based cohort study using administrative data from Ontario, Canada. All patients over 40 years old who underwent their first primary TKA between April 1, 2008, and March 31, 2019, were included. Statistical analyses were performed using SAS and included the Cochran–Armitage test for trend of MRI prior to surgery. A predictive multivariable regression model was used to determine features correlated to receiving an MRI. Results: There were 194,989 eligible first-time TKA recipients, of which 38,244 (19.6%) received an MRI in the two years prior to their surgery. The majority of these (69.6%) were ordered by primary care physicians. Patients who received an MRI were younger, had fewer comorbidities and were more affluent than patients who did not (p < 0.001). MRI use prior to TKA increased from 2008 to 2018 (p < 0.001). Conclusion: Despite MRIs rarely being indicated for the work-up of end-stage OA, nearly one in five patients have an MRI in the two years prior to their TKA. This may be increasing healthcare expenditure and surgical wait-times. [ABSTRACT FROM AUTHOR]

Background: The time between an anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) may influence baseline knee-related and general health-related patient-reported outcome measures (PROMs). Despite the common use of PROMs as main outcomes in clinical studies, this variable has never been evaluated. Purpose: To compare baseline health-related quality of life measures and the prevalence/pattern of meniscal and articular cartilage lesions between patients who underwent acute and chronic ACLR so as to provide clinicians with benchmark PROMs in 2 different patient populations with ACL injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 1192 patients from the MOON (Multicenter Orthopaedic Outcomes Network) cohort who underwent primary ACLR were eligible. “Acute” ACLR was defined as <3 months (n = 853; 71.6%) and “chronic” ACLR as >6 months (n = 339; 28.4%) from injury. Patient demographics, surgical characteristics (articular cartilage injury, medial meniscal [MM] and lateral meniscal [LM] tears), and baseline PROM scores (Marx activity rating scale, International Knee Documentation Committee [IKDC] subjective form, Knee injury and Osteoarthritis Outcome Score [KOOS], and Short Form–36 Health Survey [SF-36]) were collected to determine whether the time from injury to ACLR influences (1) baseline PROMs and (2) the pattern and prevalence of concurrent articular cartilage and meniscal injuries. Analysis of covariance models were used to adjust for confounders on baseline outcome scores (age, sex, body mass index [BMI], smoking status, competition level, education). Results: The median patient age was 23 years (interquartile range [IQR], 17-35 years), 530 (44.5%) were female, and the median BMI was 25.0 kg/m2 (IQR, 22.3-27.9 kg/m2); however, the chronic group was older, had a higher BMI, and consisted of fewer collegiate athletes. A significantly greater number of partial LM tears were seen in the acute group versus the chronic group (14.2% vs 6.5%, respectively; P < .001), but there were more meniscal tears overall (73.5% vs 63.2%, respectively; P = .001), complete MM tears (49.0% vs 22.5%, respectively; P < .001), and articular cartilage injuries (54.0% vs 32.8%, respectively; P < .001) in the chronic group versus the acute group. After controlling for confounders, patients in the chronic ACLR group reported a significantly lower baseline Marx score (7.75 vs 12.10, respectively; P < .001) but higher baseline IKDC, SF-36 physical functioning, and all KOOS subscale scores except the KOOS–quality of life subscale score compared to those in the acute ACLR group; however, only the KOOS–sports and recreation subscale exceeded the minimum clinically importance difference of 8 points (62.30 vs 48.26, respectively; P < .001). Conclusion: After controlling for age, sex, competition level, smoking, and BMI, patients in the chronic ACLR group participated in less pivoting and cutting sports but reported better pain/function. Whether decreased activity is deliberate after an ACL injury or patients who undergo chronic ACLR are simply less active and may be treated successfully without surgery warrants further investigation. Nonrandomized studies that utilize PROMs should consider time from injury in study design and data interpretation. [ABSTRACT FROM AUTHOR]

Background: As the demand increases for demonstration of competence in surgical skill, the need for validated assessment tools also increases. Hypothesis/Purpose: The purpose of this study was to validate a dry knee model for the assessment of performance of anterior cruciate ligament reconstruction (ACLR). The hypothesis was that the combination of a checklist and a previously validated global rating scale would be a valid and reliable means of assessing ACLR when performed by residents in a dry model. Study Design: Controlled laboratory study. Methods: All residents, sports medicine staff, and fellows were invited to perform a hamstring ACLR using anteromedial drilling and Endobutton fixation on a dry model of an anterior cruciate ligament. Previous exposure to knee arthroscopy and ACLR was recorded. A detailed surgical manuscript and technique video were sent to all participants before the study. Residents were evaluated by staff surgeons with task-specific checklists created by use of a modified Delphi procedure and the Arthroscopic Surgical Skill Evaluation Tool (ASSET). Each procedure (hand movements and arthroscopic video) was recorded and scored by a fellow blinded to the year of training of each participant. Results: A total of 29 residents, 5 fellows, and 6 staff surgeons (40 participants total) performed an ACLR on the dry model. The internal reliability (Cronbach alpha) of the test when using the total ASSET score was very high (>0.9). One-way analysis of variance for the total ASSET score and the total checklist score demonstrated a difference between participants based on year of training (P < .001). Post hoc analysis demonstrated a significant difference in global ratings and checklist scores between junior residents (postgraduate year [PGY] 1-3) and senior residents (PGY 4 and 5) and senior residents and fellows (P < .05). A significant difference was seen between fellows and staff on the global rating (P < .05) but not on the checklist scores (P > .05). A good correlation was seen between the total ASSET score and prior exposure to knee arthroscopy (0.73) and ACLR (0.65). The interrater reliability (intraclass correlation coefficient) between the examiner ratings and the blinded assessor ratings for the total ASSET score was very high (>0.8). Conclusion: The results of this study provide evidence that the performance of an ACLR in a dry model is a reliable method of assessing a resident’s knowledge of the steps and instrumentation required, and the method shows evidence of validity. Clinical Relevance: These models may be used to ensure a minimal level of competence before residents and fellows perform ACLR in the operating room. [ABSTRACT FROM AUTHOR]

Objective Therapeutic intraarticular injections are used in the management of hip osteoarthritis (OA). Some studies suggest that their use increases the risk of infection and subsequent revision surgery after primary total hip arthroplasty (THA), while others do not. We undertook this study to clarify the relationship between prior intraarticular injection and the risk of complication in a subsequent primary THA. Methods In a cohort of patients with hip OA who underwent a primary elective THA between 2002 and 2009, we identified those who received ≥1 intraarticular injection performed by a radiologist in the 5 years preceding their THA. Multivariable Cox proportional hazards models were used to determine the relationship between receipt of a presurgical injection (no injection, 1-5 years prior to THA, or <1 year prior to THA) and the occurrence of postsurgical joint infection and revision THA in the following 2 years, while controlling for confounders. Results Of 37,881 eligible THA recipients, 2,468 (6.5%) received an intraarticular injection performed by a radiologist within 5 years of their THA (1,691 at <1 year, 777 at 1-5 years). Controlling for age, sex, comorbidity, frailty, income, and provider volume, those who had an injection in the year preceding surgery were at increased risk of infection (adjusted hazard ratio [HR] 1.37, P = 0.03) and revision THA (adjusted HR 1.53, P = 0.03) within 2 years of the primary THA, relative to patients who did not. The association between prior injection and revision arthroplasty was attenuated and became nonsignificant (adjusted HR 1.41, P = 0.13) after occurrence of postoperative infection was controlled for in the regression model. No effect was found for injection 1-5 years prior to surgery. Conclusion Intraarticular injection in the year preceding THA independently predicted increased risk of infection leading to early revision surgery. Further studies are warranted to elucidate explanations for these findings. [ABSTRACT FROM AUTHOR]

The article presents research which discussed the rate and risk factors for patients who underwent revision anterior cruciate ligament reconstruction in Ontario. Topics covered include the number of participants who have been readmitted after the surgery as well as survival rate among those who had re-revision of the approach. Also mentioned is the rarity of patients who had total knee arthroplasty.

The article discusses a study which calculated the incidence density rate (IDR) of primary anterior shoulder dislocation requiring closed reduction in the general population and demographic subgroups in Ontario. Results showed that young male patients have the highest incidence of primary anterior shoulder dislocation requiring CR and the greatest risk of repeat shoulder CR. The study also found that patient, provider, and injury factors all influence repeat shoulder CR risk.

Background: Anterior cruciate ligament reconstruction (ACLR) is routinely performed for symptomatic instability. Although it isa common procedure, there remain differences in surgical technique. Hospital administrative records in a public health care systemwere used to investigate the effect of patient, provider, and surgical factors on the risk of revision ACLR.Purpose: To define the rate and risk factors for ACL reoperation in Ontario, Canada, including both ipsilateral revision and contralateralprimary procedures.Study Design: Cohort study; Level of evidence, 3.Methods: All primary elective ACLR procedures performed in Ontario (July 2003 to March 2008) in patients aged 15 to 60 yearswere identified via physician billing and hospital databases. Revision and contralateral ACLR were sought until January 2012.Patient factors (age, sex, comorbidity, income quintile, length of index hospital admission), provider factors (surgeon volume, academichospital status), and surgical factors (allograft vs autograft; fixation type [screw, button, staple]; concomitant operative procedures)were used as covariates in a Cox proportional hazards survivorship model to generate hazard ratios (HRs) withconfidence intervals (CIs) (α = .05). Kaplan-Meier survivorship curves with ACL revision as the end point were generated.Results: A total of 12,967 ACLR procedures with a mean follow-up of 5.2 years were eligible for study using preset criteria. The revisionrate was 2.6% (mean ± SD, 2.91 ± 1.71 years to revision). The rate of primary contralateral ACLR was 4.6% (mean, 2.95 ± 1.81years). In the Cox model, younger age (15-19 years) (HR, 2.1; 95% CI, 1.5-2.9; P<.001), ACLR performed at an academic hospital(HR, 1.6; 95% CI, 1.2-2.1; P<.001), and the use of allograft (HR, 1.7; 95% CI, 1.1-2.6; P = .02) significantly increased the risk of revisionACLR. Only younger age (HR, 2.1; 95% CI, 1.6-2.7; P<.001) was associated with an increased risk of contralateral ACLR.Conclusion: Contralateral ACLR was more frequent than revision ACLR in this population, while both surgical procedures weremost common in patients younger than 20 years. Academic hospital status, but not surgeon volume, as well as the use of allograftalso increased the risk for revision ACLR. [ABSTRACT FROM AUTHOR]

Background: Factors contributing to recurrent dislocation, revision stabilization, and complications requiring reoperation after aninitial shoulder stabilization procedure for instability have not been evaluated on a population level.Purpose: (1) To define the rate of ipsilateral revision stabilization, contralateral primary stabilization, postoperative dislocation,and complications after primary shoulder stabilization in a population cohort. (2) To understand which risk factors among patient,surgical, and provider factors influence these outcomes.Study Design: Cohort study; Level of evidence, 3.Methods: All residents of Ontario, Canada, aged 16 to 60 years undergoing primary shoulder stabilization between July 2003 andDecember 2008 were identified from billing and hospital databases. Separate Cox proportional hazards survivorship models werebuilt for the outcomes revision stabilization and postoperative physician-documented shoulder relocation (minimum 2-yearfollow-up). Model covariates included patient demographics (age, sex, preoperative dislocations), provider characteristics (surgeonvolume, hospital academic status), and type of surgery (open, arthroscopic). The frequency and risk factors for contralateralstabilization were identified.Results: A total of 5904 patients (80.6% male; median age, 29 years) were identified. Arthroscopic stabilization was used in ~60% ofcases in 2003, increasing to ~80% in 2008. The rates of postoperative dislocation were 6.9%, revision stabilization 4%, and contralateralprimary stabilization 3.9%. Patients aged younger than 20 years had a 7.7% revision rate (hazard ratio [HR], 2.7; 95% confidenceinterval [CI], 1.7-4.2; P < .0001) and a 12.6% rate of postoperative physician-documented dislocation (HR, 2.4; 95% CI,1.8-3.4; P < .0001), compared with 2.8% and 5.5%, respectively, in patients 29 years old (median cohort age). Patients with 3 ormore preoperative dislocations in Ontario had an increased risk of revision (HR, 2.1; 95% CI, 1.5-3.0; P<.0001) and postoperativedislocation (HR, 10.6; 95% CI, 8.1-14.0; P < .0001). Revision was more common after arthroscopic (4.3%) compared with open(3.5%) stabilization (HR, 1.4; 95% CI, 1.02-1.98; P = .04). No provider factor was predictive, including surgeon volume. Reoperationrate for complications not related to recurrent instability was 0.23% (infection, 0.07%; manipulation under anesthesia, 0.15%).Conclusion: The risks of revision stabilization and postoperative (either shoulder) dislocation were most influenced by young age(<20 years) and having had 3 or more preoperative dislocations. Complications requiring surgery are rare. [ABSTRACT FROM AUTHOR]

The article reports a study which was conducted to determine whether meniscal repair (MR) in a presumed stable knee has the same rate of re-operation as MR performed with anterior cruciate ligament reconstruction (ACLR). The results revealed that concomitant ACLR and MR is statistically and clinically significantly protective against re-operations after MR.