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Infection is a rare occurrence after revision anterior cruciate ligament reconstruction (rACLR). Because of the low rates of infection, it has been difficult to identify risk factors for infection in this patient population. The purpose of this study was to report the rate of infection following rACLR and assess whether infection is associated with patient- and surgeon-dependent risk factors. We reviewed two large prospective cohorts to identify patients with postoperative infections following rACLR. Age, sex, body mass index (BMI), smoking status, history of diabetes, and graft choice were recorded for each patient. The association of these factors with postoperative infection following rACLR was assessed. There were 1423 rACLR cases in the combined cohort, with 9 (0.6%) reporting postoperative infections. Allografts had a higher risk of infection than autografts (odds ratio, 6.8; 95% CI, 0.9-54.5; p = .045). Diabetes (odds ratio, 28.6; 95% CI, 5.5-149.9; p = .004) was a risk factor for infection. Patient age, sex, BMI, and smoking status were not associated with risk of infection after rACLR., (© 2020 Orthopaedic Research Society. Published by Wiley Periodicals LLC.)

Background: While a large volume of literature has focused on risk factors for anterior shoulder instability, the rates of recurrence are inconsistent and require additional population-based epidemiologic data., Purpose/hypothesis: The purpose was to report the effect of patient age on the number of instability events before physician consultation, rate of surgical stabilization, recurrent instability, and progression to osteoarthritis in patients <40 years old with anterior shoulder instability, utilizing an established US geographic population. We hypothesized that younger patients would be more likely to experience multiple episodes of instability before evaluation, undergo surgery, and experience recurrent instability after surgical intervention., Study Design: Descriptive epidemiologic study., Methods: An established geographic database of more than 500,000 patients was used to identify patients <40 years of age with anterior shoulder instability between 1994 and 2016. Medical records were reviewed to obtain patient characteristics, history, imaging, surgical details, and outcomes. Patients were divided into 5 groups based on age (≤15, 16-20, 21-25, 26-30, and 31-40 years) at initial instability. Comparative analysis was performed to identify differences between groups., Results: The study population consisted of 654 patients with a mean follow-up of 11.1 years (range, 2.0-25.2 years). This resulted in 118 patients (18%) ≤15 years of age at initial instability; 250 (38%), 16 to 20 years; 110 (17%), 21 to 25 years; 80 (12%), 26 to 30 years; and 96 (15%), 31 to 40 years. Of patients ≤15 years old at initial instability 47% had 3+ instability events, compared with 12% of patients aged 31 to 40 years ( P < .001). At 10 years of follow-up, patients ≤15 and 16 to 20 years old demonstrated the highest recurrent instability rates of 38.8% and 47.1% after nonoperative management, respectively. Patients 16 to 20 years old demonstrated the highest rates of both surgical intervention (40.4%) and recurrence after surgery (24.8%). Patients 31 to 40 years of age were significantly more likely to develop clinically symptomatic osteoarthritis (15.6%) than all other age groups., Conclusion: In a US epidemiologic population of patients <40 years old, the rate of recurrent anterior shoulder instability was roughly one-third after initial physician consultation. Younger patients, particularly those ≤15 and 16 to 20 years of age, were more likely to have experienced multiple instability events at the time of initial evaluation, require surgery, and experience recurrent instability compared with older patients. For every year of decrease in age at initial instability, the risk of recurrent instability or surgical intervention after physician consultation increased by 4.1% and 2.8%, respectively.

Background: The incidence of posterior shoulder instability (PSI) in the general population is not well defined. This study aimed to define the population-based incidence of PSI and describe trends in incidence and surgery rates., Methods: The study population included 143 patients (16 females, 127 males) diagnosed with new-onset PSI between January 1, 1994, and December 31, 2015. Medical records were reviewed to extract patient data. Age- and sex-specific incidence rates were calculated and adjusted to the 2010 United States population. Poisson regression was performed to examine trends by timeline, sex, and age., Results: Age- and sex- adjusted annual incidence of PSI was 4.64 per 100,000 person-years, and posterior dislocation was 1.30 per 100,000 person-years. Peak PSI incidence for males and females was at 14 to 19 years (31.82 and 5.23 per 100,000 person-years). PSI incidence was higher in males than females (8.86 vs. 1.07 per 100,000 person-years, P < .001). The 5-year cumulative risk of surgery for patients with PSI was 53.1% between 1996 and 2002, 59.9% between 2003 and 2008, and 87.5% between 2009 and 2015. Patients with PSI between 2009 and 2015 had a significantly increased rate of surgery (hazard ratio, 2.2; 95% confidence interval, 1.4-3.6; P = .001) compared with those between 1996 and 2002., Conclusion: The age- and sex- adjusted incidence of PSI in the general population was 4.64 per 100,000 person-years. There is a significantly greater incidence of PSI in males than females, with both sexes peaking at 14 to 19 years and incidence rates remaining elevated throughout the third and fourth decades of life. The incidence of PSI remained stable over time; however, the rate of surgical intervention increased significantly, from 53.1% of patients between 1996 and 2002 to 87.5% of patients between 2009 and 2015., (Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Few studies have explored the frequency and impact of lower extremity injuries, such as those to the knee, among professional baseball players. The purpose of this study was to detail the epidemiology of knee injuries in Major League Baseball (MLB) and Minor League Baseball (MiLB) players during the 2011-2014 seasons. It was hypothesized that knee injuries are a common occurrence in these athletes, and represent a significant source of time away from play. The MLB Health and Injury Tracking System database was searched to identify all patients diagnosed with knee injuries during the 2011-2014 seasons. All injuries that occurred during the preseason, regular season, and postseason that resulted in time away from play were included. Injury data analyzed included total number of knee injuries, specific diagnoses, injury mechanisms, locations, player positions, and time lost. Descriptive statistics were conducted and injury rates per athlete-exposures were calculated. During the 2011-2014 seasons, a total of 2171 knee injuries occurred in MLB and MiLB players, representing 6.5% of all injuries in professional baseball. The knee injury rate across both the MLB and MiLB was 1.2 per 1000 athlete-exposures. The mean number of days missed per injury across both leagues was 16.2 with a total of 30,449 days of missed play amongst all athletes over the 4 seasons. Injuries to the knee were the fifth most common cause of missed time in all of baseball, and the fourth most common reason for missed games in the MLB alone. Approximately 12% of all injuries required surgical intervention. The most common mechanism of injury was noncontact (44%), and base runners were injured more frequently than any other position (24%). The infield (30%) and home plate (23%) were the most common locations in which injuries occurred. These data can be utilized for targeted injury prevention initiatives.

Background: Reconstruction of the multiligament-injured knee often involves extended surgical and tourniquet use times and often is performed in patients who have sustained concomitant fractures as well as vascular injuries, all of which would appear to predispose the patient to the potentially serious complications of deep vein thrombosis and perhaps pulmonary embolism, yet little is known about the frequency of venous thromboembolic (VTE) events after multiligamentous knee reconstruction., Questions/purposes: The purposes of this study were to (1) determine the frequency of symptomatic VTE after multiligamentous knee reconstruction at a single institution; and (2) to determine associated risk factors for VTE in these patients., Methods: The records of 134 (63% of the 213 consented individuals in our longitudinal database) patients who underwent primary (129 [96%]) or revision (five [4%]) multiligamentous knee reconstruction at a single institution between 1992 and 2013 were retrospectively reviewed. With two patients undergoing procedures bilaterally, this resulted in a total of 136 multiligamentous knee reconstructions. VTE for which clinical symptoms were evident and confirmed by imaging within 3 months after the reconstructive procedure was noted. Pre- and perioperative data were collected with respect to demographics, associated injuries, medical history, smoking status, and surgical data. Standard rehabilitation and thromboprophylaxis protocols were used in all patients., Results: Three cases of symptomatic VTE (three deep vein thromboses) occurred after the 136 reconstructions (2%; 95% confidence interval, 0.53%-7.3%). Two of the three patients were obese and the remaining patient smoked and abused alcohol. However, as a result of a low frequency of VTE, no risk factors could be identified in this series., Conclusions: Symptomatic VTE occurred in 2% of multiligamentous knee reconstructions at our institution while receiving thromboprophylaxis. This is similar to rates documented after anterior cruciate ligament reconstruction without thromboprophylaxis. Further multicenter research is required to identify the true frequency of and risk factors for developing VTE in patients undergoing multiligamentous knee reconstruction after knee dislocation., Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Women are prone to certain orthopedic conditions and may present to their primary care physician for treatment. An appreciation of the physiological and anatomical differences between women and men and the musculoskeletal conditions that commonly affect active women can aid the physician in diagnosis and treatment. We discuss common musculoskeletal conditions of active women including those affecting the low back, knee, shoulder, and foot. We also discuss common stress fractures seen in women. Various treatment and prevention strategies are reviewed and include physical therapy, bracing, medications, and surgery.

A survey of members of the American Association of Hip and Knee Surgeons was done to document surgeons' attitudes and practices regarding discussion of return to sexual activity, timing of return, and safety of various sexual positions for patients after total hip arthroplasty. Surveys were returned by 254 of 821 surgeons (31%). Two hundred thirty-three (80%) surgeons reported they rarely or never discuss sexual activity with their patients who have had hip arthroplasty. Of surgeons who stated they did discuss this topic, 96% spent 5 minutes or less. Most respondents (67%) recommended delaying return to sexual activity until 1-3 months postoperatively. Fifty-one respondents (20%) reported knowledge of patients experiencing dislocation of the total hip replacement during sexual activity. Five specific sexual positions for men and three positions for women were considered acceptable by more than 90% of respondents. Most agreed that sexual activity could be resumed safely 1-3 months postoperatively if acceptable positions were used.