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Background: Lateral meniscal deficiency with valgus malalignment increases the rate of lateral compartment osteoarthritis. Lateral meniscal allograft transplantation (LMAT) with a concomitant varus-producing opening-wedge distal femoral osteotomy (DFO) is an option yet to be evaluated biomechanically. Purpose/Hypothesis: The purpose of this study was to clarify the biomechanical effects of the realignment procedure in the setting of LMAT. We hypothesized that (1) given the dependence of the lateral compartment on the lateral meniscus, a DFO and increasing degrees of varus would be insufficient to restore lateral compartment pressures to normal from a lateral meniscus-deficient state, and that (2) LMAT would restore lateral compartment pressures to the intact state while DFO would decrease lateral compartment pressures for any given state of the meniscus. Study Design: Controlled laboratory study. Methods: Ten cadaveric knees underwent opening-wedge varus-producing DFO secured by an external fixator. Anatomic alignment was standardized to 6° of mechanical valgus, and each joint was tested in full extension. Submeniscal placement of thin film pressure sensors allowed for the recording of contact pressure, peak contact pressure, and contact area. The specimens were loaded on a biaxial dynamic testing machine with loading angles between 9° valgus and 6° varus of mechanical alignment. Conditions tested included intact meniscus, meniscal deficiency, and meniscal transplantation. Results: Isolated varus-producing DFO to 6° in the meniscus-deficient state failed to restore joint pressures and contact areas to the intact state, with significant changes in mean contact pressure (175%), mean peak contact pressure (135%), and contact area (–41%) (all P <.05 vs intact), while LMAT restored all outcome measures (all P >.05 compared with intact). After LMAT, every additional 1° of DFO correction contributed to a decrease in the mean contact pressure, peak pressure, and contact area of 5.6% (–0.0479 N/mm2), 5.9% (–0.154 N/mm2), and 1.4% (–6.99 mm2) for the lateral compartment and 7.3% (+0.034 N/mm2), 12.6% (+0.160 N/mm2), and 4.3% (+20.53 mm2) for the medial compartment, respectively. Conclusion: Isolated DFO was inadequate to restore load distribution in meniscus-deficient knees, while concomitant LMAT restored near normal forces and improved the lateral compartment biomechanical profile. Clinical Relevance: Our findings support the concomitant use of LMAT and varus-producing DFO in the setting of lateral meniscal deficiency with valgus malalignment. This study provides tools for the orthopaedic surgeon to individualize the correction for each patient. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to characterize content posted by orthopaedic surgeons on social media (SM) while investigating patient perceptions of this content from various regions of the United States. Analysis was included regarding how this content may influence the respondents' healthcare decisions. Methods: SM posts by orthopaedic surgeons were reviewed and categorized. A patient survey was written to assess respondent SM usage practices as well as respondent perceptions of these categories. The survey was administered in the clinic of 13 separate orthopaedic surgeons via QR code. Survey results were analyzed for differences in SM utilization. Patient responses were assessed to judge perception of social medial content types. Results: There were 674 completed patient surveys. The 18-24 (89.3%) and 25-34 (87.6%) age groups were more likely to report daily use (p=0.002), but SM utilization was high among all age groups. 23% of patients reported using SM to see information about their healthcare at least once per month, 38% of patients reported reviewing the SM account of a physician at least once per month, and 23% of patients reported that they were likely or very likely to view the SM account of their own physician. 26% of patients reported that SM content is likely or very likely to influence which physician they see. Patients held the most consistently positive view of posts educating patients regarding common injuries, discussing sports team coverage, providing patient testimonials, and posts illustrating examples of imaging used to diagnose and treat patients. Patients held consistently neutral views of posts educating colleagues, discussing research and presentations at national meetings, displaying aspects of surgeons' personal lives, and supporting marginalized groups. Several post categories elicited negative or highly polarized responses including those discussing research publications, showing surgical techniques or pictures/videos taken during surgery, or political statements. Conclusions: SM is an increasingly useful tool to help physicians interact with patients or build a practice. Physicians who wish to interact with patients should consider posting content viewed most positively including posts educating patients, discussing sports team coverage, and patient testimonials. Content that is viewed less favorably should be posted sparingly or with a sensitive tag. The most effective way to reach large patient populations appears to be through Instagram, Facebook, Tik Tok, Snapchat, and LinkedIn, in that order. Further ongoing study is required to understand the differences between physician SM content focused on interacting with patients compared to content focused on interacting with other physicians. [ABSTRACT FROM AUTHOR]

Background: Patients with posterior shoulder instability may have bone and cartilage lesions (BCLs) in addition to capsulolabral injuries, although the risk factors for these intra-articular lesions are unclear. Hypothesis: We hypothesized that patients with posterior instability who had a greater number of instability events would have a higher rate of BCLs compared with patients who had fewer instability episodes. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Data from the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group instability patient cohort were analyzed. Patients aged 12 to 99 years undergoing primary surgical treatment for shoulder instability were included. The glenohumeral joint was evaluated by the treating surgeon at the time of surgery, and patients were classified as having a BCL if they had any grade 3 or 4 glenoid or humeral cartilage lesion, reverse Hill-Sachs lesion, bony Bankart lesion, or glenoid bone loss. The effects of the number of instability events on the presence of BCLs was investigated by use of Fisher exact tests. Logistic regression modeling was performed to investigate the independent contributions of demographic variables and injury-specific variables to the likelihood of having a BCL. Significance was defined as P <.05. Results: We identified 271 patients (223 male) for analysis. Bone and cartilage lesions were identified in 54 patients (19.9%) at the time of surgical treatment. A glenoid cartilage injury was most common and was identified in 28 patients (10.3%). A significant difference was noted between the number of instability events and the presence of BCLs (P =.025), with the highest rate observed in patients with 2 to 5 instability events (32.3%). Multivariate logistic regression modeling indicated that increasing age (P =.019) and 2 to 5 reported instability events (P =.001) were significant independent predictors of the presence of BCLs. For bone lesions alone, the number of instability events was the only significant independent predictor; increased risk of bone lesion was present for patients with 1 instability event (OR, 6.1; P =.012), patients with 2 to 5 instability events (OR, 4.2; P =.033), and patients with more than 5 instability events (OR, 6.0; P =.011). Conclusion: Bone and cartilage lesions are seen significantly more frequently with increasing patient age and in patients with 2 to 5 instability events. Early surgical stabilization for posterior instability may be considered to potentially limit the extent of associated intra-articular injury. The group of patients with more than 5 instability events may represent a different pathological condition, as this group showed a decrease in the likelihood of cartilage injury, although not bony injury. [ABSTRACT FROM AUTHOR]

Introduction: Often referred to as aseptic or osteonecrosis, avascular necrosis (AVN) typically affects people between 30 and 50 years of age. Given the substantial morbidity associated with AVN as well as overlapping age groups of both the military and average age at diagnosis for AVN, the military represents an ideal cohort for a large database study to elicit the incidence and epidemiology of AVN. The purpose of this study was to identify demographic risk factors in the United States military.Materials and Methods: First-time occurrences for ICD-9-CM codes for all types of AVN (head of humerus, head and neck of femur, medial femoral condyle, talus, and other bone) between 2004 and 2014 were queried in the Defense Medical Epidemiology Database. Multivariate data analysis was performed to obtain adjusted rate (adjusted for age, sex, race, rank, and branch of service).Results: Between 2005 and 2014, 2,671 cases of AVN occurred among an at-risk population of 13,820,906 servicemembers for an unadjusted IR of 0.19 per 1,000 person-years. The most common location was located at the proximal femur, responsible for 41.7% of all cases. With an adjusted rate ratio of 18.7, the over 40 age-group accounted for 53.3% of cases. Servicemembers of black race, Senior rank, and the Army branch of service were more at risk for AVN.Conclusions: The overall incidence of AVN was 0.19 per 1,000 person-years. Whilte increasing age had the greatest influence on the development of symptomatic AVN, other statistically significant risk factors were found to be increasing age, black race, senior enlisted rank, and Army branch of service. [ABSTRACT FROM AUTHOR]

Introduction: Historically, Achilles tendon repairs and other surgeries about the hindfoot have demonstrated a significantly higher rate of wound healing complications and surgical site morbidity. The purpose of this study was to evaluate the comprehensive complication profile and risk factors for adverse short-term, clinical outcomes after primary repair of Achilles tendon ruptures.Methods: Between the years 2005 and 2014, all cases of primary Achilles tendon repair (Current Procedural Terminology code 27650) entered into the National Surgical Quality Improvement Project (NSQIP) database were extracted for analysis. Primary outcomes of interest were rates of total complication, reoperation, and rerupture within 30 days of index surgery. Independent risk factors associated with these selected endpoints were assessed with chi-square and logistic regression analysis and odds ratios with 95% confidence intervals were used to express relative risk.Results: Of 1626 patients with an average age of 44 years (SD 13.3), the average ASA classification was 1.69 and hypertension (20.7%), morbid obesity (8.3%), and diabetes (4.9%) were among the most common medical comorbidities. A total of 28 (1.7%) patients sustained perioperative complications, including 1.3% with local complications (0.7% superficial wound infection, 0.4% wound disruption) and no cases of peripheral nerve injury or early repair failure. Systemic complications occurred in 0.4%, most commonly with deep venous thrombosis or nonfatal thromboembolism. Preoperative albumin was independently associated with an increased risk of local wound complications (odds ratio [OR] 28.67; 95% CI 1.42-579.40; P = .029). Chronic obstructive pulmonary disease (OR 22.33, 95% CI 2.49-199.81; P = .006) and bleeding disorder (OR 14.83, 95% CI 1.70-129.50; P = .015) were more likely to result in a systemic complication, and preoperative creatinine correlated with an increased risk of any complication (OR 6.11, 95% CI 1.15-32.34; P = .033). In total there were 5 (0.3%) readmissions with 2 (0.1%) unplanned reoperations attributed to local wound complications.Conclusion: Among a broad-based demographic of the United States, the rate of local wound complications was exceedingly low in the short-term perioperative period, although this risk may be significantly magnified with subtle decreases in albumin levels. Preoperative risk stratifications should carefully scrutinize for subtle abnormalities in nutritional parameters and renal function prior to undergoing Achilles surgery.Levels Of Evidence: Therapeutic, Level II: Prospective, comparative trial. [ABSTRACT FROM AUTHOR]

The article discusses a study on the incidence of meniscus repair and meniscectomy with and without concomitant anterior cruciate ligament (ACL) reconstruction in the U.S. over the past seven years as of 2013. It says that meniscus deficiency may lead to degenerative arthritis in the knee. Results of the study revealed the database represented 9 percent of the U.S. population younger than 65 years. The authors report an increase in isolated meniscus repairs during the period covered.

Cell therapies hold significant promise for the treatment of injured or diseased musculoskeletal tissues. However, despite advances in research, there is growing concern about the increasing number of clinical centres around the world that are making unwarranted claims or are performing risky biological procedures. Such providers have been known to recommend, prescribe, or deliver so called 'stem cell' preparations without sufficient data to support their true content and efficacy. In this annotation, we outline the current environment of stem cell-based treatments and the strategies of marketing directly to consumers. We also outline the difficulties in the regulation of these clinics and make recommendations for best practice and the identification and reporting of illegitimate providers. Cite this article: Bone Joint J 2020;102-B(2):148-154.

Purpose: To evaluate the current status of advanced cartilage restoration procedures among newly trained orthopaedic surgeons in the United States., Methods: The American Board of Orthopaedic Surgery database was queried to identify all advanced cartilage restoration procedure cases submitted by American Board of Orthopaedic Surgery part II board certification examination candidates from 2003 to 2015. All documented autologous chondrocyte implantation, autologous osteochondral transfer, osteochondral allograft transplantation, and marrow stimulation techniques (MSTs) procedures were analyzed. Analysis was performed to describe trends in annual incidence, types of complications, concomitant procedures, and geographical differences in incidence of advanced cartilage procedures., Results: From 2003 to 2015, a total of 2,827 surgeons submitted 7,522 cartilage restoration procedures, with 7,060 cases documented as MST (80.01%). The number of cartilage cases decreased significantly from 2003 to in 2015 (P <.001), with MST having the largest decline (P < .001). The incidence of open osteochondral allograft transplantation (odds ratio = 1.35; P = .023) and open autologous osteochondral transfer (odds ratio = 0.84; P = .004) increased over the study period. Overall, the majority of patients (57.0%) were male; however, female patients were on average significantly older than male patients (P < .001). Cartilage procedures were performed concomitantly with a realignment osteotomy procedure in 1.7% of cases. The incidence of surgical complications increased throughout the study period from 2.9% in 2003 to 9.5% in 2015 (P < .001)., Conclusions: Cartilage restoration procedures, specifically MSTs, are being decreasingly performed among recently trained orthopaedic surgeons. In contrast, complication rates have been increasing since 2003, demonstrating a possible paradigm shift toward more complex cartilage procedures, specifically osteochondral grafting procedures., Clinical Relevance: This study demonstrates a significant decline in the use of MSTs by recently trained orthopaedic surgeons. In addition, an increase in several more complex cartilage restoration procedures was found. Taken in sum, these changes may reflect a shift in residency and fellowship training away from marrow stimulation procedures that elicit a fibrocartilage reparative tissue and toward more complex procedures that provide a more hyaline-like articular cartilage surface., (Copyright © 2019 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the incidence and demographic characteristics of shoulder stabilization in the United States, with particular focus on age, sex, and inpatient versus outpatient treatment., Methods: The National Hospital Discharge Survey and the National Survey of Ambulatory Surgery databases were searched using a combination of International Classification of Diseases, Ninth Revision diagnosis and procedure codes, encompassing open and arthroscopic shoulder stabilization procedures. Incidence was determined using National Survey of Ambulatory Surgery, National Hospital Discharge Survey, and US census data, and the results were stratified by age, sex, facility, and concomitant diagnoses. Data were analyzed between 1994 and 2006, the most recent year for which data are available within these sources., Results: The incidence of shoulder stabilization in the United States was 5.84 per 100,000 person-years (n = 15,514; 95% confidence interval, 11,975-19,053) in 1994 to 1996 and 6.89 per 100,000 person-years (n = 20,588; 95% confidence interval, 16,254-24,922) in 2006 (P = .0697). The number of inpatient procedures decreased significantly whereas the number of outpatient procedures increased significantly over the same period (P < .0001 for both). The incidence of stabilization increased in patients aged 45 to 64 years (P < .0001) and patients aged 65 years or older (P = .0008) but was unchanged in patients aged 44 years or younger (P = .4745). The average age of patients undergoing stabilization increased over the study period, from 30 years to 47 years for inpatients (P = .01) and from 27 years to 34 years for ambulatory patients (P = .05). The incidence of stabilization increased significantly in male patients (P = .0075) but remained stable in female patients (P = .8057) over the same period. Diagnoses related to rotator cuff pathology and shoulder derangement were the most common concurrent diagnosis codes., Conclusions: The overall incidence of shoulder stabilization in the United States is 6.89 per 100,000 person-years. The incidence increased by 18% between 1994 and 2006. During the study period, shoulder stabilization shifted to become a largely outpatient procedure, and the average age increased significantly., Level of Evidence: Level IV, therapeutic case series., (Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Although studies have revealed high readability levels of orthopedic patient education materials, no study has evaluated sports medicine-related patient education materials. We conducted a study to assess the readability of sports medicine-related patient education materials from the American Academy of Orthopaedic Surgeons (AAOS) and the American Orthopaedic Society for Sports Medicine (AOSSM). All sports medicine patient education articles available online in 2012 from the AAOS and the AOSSM, including the Stop Sports Injuries Campaign (STOP), were identified, and their readability was assessed with the Flesch-Kinkaid (FK) readability test. Mean overall FK grade level of the 170 articles reviewed (104 from AAOS, 36 from AOSSM, 30 from STOP) was 10.2. Mean FK levels for the 3 sources were 9.5 (AAOS), 11.0 (AOSSM), and 11.5 (STOP) (P = .16). Fifteen (8.8%) of the 170 articles had a readability level at or below eighth grade (average reading level of US adults); only 2 (1.2%) of the 170 articles were at or below the recommended sixth-grade level. The majority of sports medicine-related patient education materials from AAOS and AOSSM had reading levels higher than recommended, indicating that the majority of the patient population may find it difficult to comprehend these articles.