Gait Mechanics After ACL Reconstruction Differ According to Medial Meniscal Treatment
Knee osteoarthritis risk is high after anterior cruciate ligament reconstruction (ACLR) and arthroscopic meniscal surgery, and higher among individuals who undergo both.
Full article: https://bit.ly/2LPna91
An Increased Lateral Femoral Condyle Ratio Is a Risk Factor for Anterior Cruciate Ligament Injury
The purpose of this study was to examine the relationship between distal femoral morphology and anterior cruciate ligament (ACL) injury, ACL reconstruction (ACLR) failure, and contralateral ACL injury. https://jbjs.org/reader.php?source=The_Journal_of_Bone_and_Joint_Surgery/100/10/857/abstract&id=30301&rsuite_id=1666295#info #JBJSInfographics #VisualAbstract
Sports Medicine Update
Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Click here for a collection of all OrthoBuzz Specialty Update summaries.
The May 17, 2017 JBJS Specialty Update on Sports Medicine reflects evidence in the field of sports medicine published from September 2015 to August 2016. Although this review is not exhaustive of all research that might be pertinent to sports medicine, it highlights many key articles that contribute to the existing evidence base in the field.
Topics covered include:
- Prevention of Musculoskeletal Injuries
- Autograft vs Allograft ACL Reconstruction
- Anterior Shoulder Stabilization
- Hip Arthroscopy
New JBJS CME Subspecialty Exams
New subspecialty CME exams are now available from The Journal of Bone & Joint Surgery in the following topic areas:
- Adult Hip Reconstruction
- Adult Knee Reconstruction
- Shoulder and Elbow
- Spine
- Sports Medicine
- Trauma
Each exam consists of 10 questions based on articles published in JBJS within the past 12 months. Exams can be used for study purposes at no cost. Each exam activity may be submitted for a maximum of 5 AMA PRA Category 1 Credits™.
What’s New in Sports Medicine
Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Click here for a collection of all OrthoBuzz Specialty Update summaries.
This month, OrthoBuzz asked Warren Dunn, MD, a co-author of the April 20, 2016 Specialty Update on sports medicine, to select the five most clinically compelling findings from among the more than 30 studies cited in the article.
Shoulder
–What happens to asymptomatic rotator cuff tears over time? According to a long-term prospective study of patients who had an asymptomatic tear in one shoulder and a symptomatic contralateral rotator cuff tear, the asymptomatic tears enlarged in almost one-half of the patients over a median of three years. Those patients who experienced tear enlargement tended to have an onset of new pain and progressive degenerative changes within the supraspinatus and infraspinatus muscles. The authors concluded that many formerly asymptomatic tears will progress to become symptomatic.
–Does tendon repair yield better outcomes than physical therapy (PT) when treating rotator cuff tears? A randomized trial of 103 patients with tears not exceeding 3 cm found that 12 of 51 patients (24%) in the PT group subsequently underwent secondary cuff repair over a 5-year follow-up period. Statistically, patients in the primary repair group had significantly better group-mean improvements on the Constant score, ASES score, and VAS for pain and patient satisfaction than those who underwent secondary repair, but the authors noted that these differences “may be below clinical importance.” Thirty-seven percent of those treated with PT only experienced a >5 mm increase in tear size, which was associated with inferior outcomes.
–Are estimates of Propionibacterium acnes colonization rates in surgical shoulder wounds accurate? A controlled diagnostic study examined P. acnes colonization in 117 open shoulder surgeries that utilized the deltopectoral approach. In 20.5% of the procedures, at least one surgical specimen was positive for P. acnes growth, but 13% of cultures from sterile-sponge control samples also had positive growth. This led the authors to surmise that prior estimates of P. acnes incidence may be higher than actual because of frequent culture contamination. Male sex and preoperative corticosteroid injections were associated with a higher likelihood of bacterial growth.
Knee/ACL
–Most people who undergo ACL reconstruction experience significant improvement in physical quality of life and quality-adjusted life years, but who is more or less likely to benefit? A 2- and 6-year longitudinal analysis of a multicenter cohort found that those who underwent revision, smoked cigarettes, had lateral tibial plateau chondromalacia, or had less education were more likely to score lower on the Physical Component Summary of the Short Form-36. Those who tended to have higher postoperative functional scores were those with higher baseline function, younger age, lower BMI, and either no lateral meniscal treatment or >50% lateral meniscectomy.
Hamstring Injuries
–Hamstring injuries are common among soccer players. A Level I randomized controlled trial among 579 high-level amateur soccer players found that 13 weeks of participation in Nordic hamstring exercises significantly reduced injury incidence and risk for injury compared with a control group over a 1-year period. No differences in injury severity were found.1
Reference
- van der Horst N, Smits DW, Petersen J, Goedhart EA, Backx FJG. The preventive effect of the Nordic hamstring exercise on hamstring injuries in amateur soccer players: a randomized controlled trial. Am J Sports Med. 2015 Jun;43(6):1316-23. Epub 2015 Mar 20.
Not So Run-of-the-Mill Running Injuries
Lower-extremity stress fractures account for an estimated 16% of all injuries among runners. The April 2016 “Case Connections” article sprints forward from an April 13, 2016, Case Connector report about a stubborn running-related stress fracture of the inferior pubic ramus that did not respond to the usually successful conservative approach.
It’s often challenging for orthopaedists to make a diagnosis in a patient group in whom multiple musculoskeletal injuries or ailments may exist. Patients with suspected stress fractures may have radiographs with subtle, easily overlooked findings. A bone scan and/or other advanced imaging are often required to make a definitive fracture diagnosis.
Continued running due to a missed diagnosis or a patient’s ardent noncompliance can culminate in complications that may eventually require surgical intervention. The best outcomes are perhaps achieved in a setting that fosters strong collaboration between the surgeon, patient, physiatrist, and/or physical therapist with expertise in the mechanisms and physiology of running.
In a postscript to this Case Connections article, JBJS Case Connector co-editor Tom Bauer, MD describes his fateful experience with a calcaneal stress fracture while running the 2013 Boston Marathon.
It Takes a Team: Head and Neck Injuries in the Helmeted Athlete
Increasingly, the care of patients with musculoskeletal problems is being provided by teams of providers with varied professional backgrounds and diverse types of experience.
On March 1, 2016, JBJS Reviews presented its inaugural “team approach” article, entitled “Treatment of Head and Neck Injuries in the Helmeted Athlete,” by Diduch et al.
The article summarizes updated recommendations for on-field and in-hospital injury evaluation, spine-boarding, and equipment removal. Throughout, the authors stress that initial and follow-up steps in the process are a team effort that may involve the athletic trainer, team physician, EMS provider, and emergency, orthopaedic, and primary-care physicians.
Insisting that team collaboration should begin prior to any athletic competition or event, the authors strongly recommend preseason training and pregame time-outs for all members of the sidelines medical team to clarify roles, responsibilities, and communication strategies.
Diduch et al. also discuss in detail the team approach to concussion evaluation and management, including team-based decisions about the need for and destination of emergency transport.
A Conversation with Dr. Jo Hannafin, President of AOSSM
Here are a few excerpts from the JBJS conversation with Dr. Jo Hannafin, President of AOSSM (American Orthopaedic Society for Sports Medicine).
JBJS: You were recently elected the first woman president of AOSSM – what significance do you see in that fact?
Dr. Jo Hannafin: My election to the AOSSM presidency reflects the breadth of membership in the AOSSM and the slowly changing face of orthopaedic surgery. Our goal as educators and surgeons is to bring the best and brightest medical students into our field and this includes men, women and individuals with diverse racial and ethnic backgrounds.
JBJS: What are your key goals for your presidency?
Dr. Jo Hannafin: My goals as president are to increase engagement of the membership in the AOSSM via volunteerism (committee involvement), attendance at specialty day and the annual meeting, and by providing continued opportunities for community education by our members via the STOP Sports Injury program started by Dr. James Andrews.
JBJS: How do you think JBJS can best address the needs of the members of AOSSM and other sub-specialty organizations?
Dr. Jo Hannafin: JBJS can address the needs of orthopaedic surgeons by partnering in webinar programs and by continuing to publish high quality manuscripts in subspecialty areas.
JBJS: What trends in orthopaedics/sports medicine are you most intrigued by?
Dr. Jo Hannafin: The identification of biomarkers with early association with trauma or sports injury has the potential to modify the development of post-traumatic arthrosis. This idea is particularly compelling in sports injuries such as the acute ACL. The frequency of this injury continues to increase, and we are seeing younger athletes sustaining this injury. The continued attention to the development and validation of injury prevention programs provides opportunity for risk modification.
The use of biologic therapy in sports medicine, such as stem cell transplantation and PRP, may have the potential to treat sports injuries, but the clinical use of these treatments needs to be carefully studied and validated.
JBJS: What at are your expectations of changes to come as a result of the Affordable Care Act (ACA)?
Dr. Jo Hannafin: The ACA is an extraordinarily complex document and quite honestly, with a few exceptions, I don’t think we know what it will bring. The ACA will provide health insurance to a large number of previously uninsured or uninsurable people (those with pre-existing conditions). The volume of patients seeking care will increase, and that has the potential to stress the existing system. Reimbursement for orthopaedic care will likely be modified and requires the careful attention of our members, hospital systems, specialty organizations, and the AAOS.
JBJS: Looking ahead to the next 20 years or so, what do you think might be three significant advances or changes in orthopaedics?
Dr. Jo Hannafin: I anticipate that scientists will be able to identify biomarkers associated with acute injury and physicians/surgeons will have the capacity to modify the response to catabolic agents, thus preventing the development of post-traumatic arthrosis. The field of biomechanical engineering will provide surgeons with improved scaffolds which when combined with biologic therapies will permit restoration of bone, cartilage, and ligaments. The field of total joint arthroplasty will benefit from continued interaction with scientists to optimize interface mechanics and prolong the lifetime of arthroplasty implants.
JBJS: You recently participated in a webinar co-sponsored by JBJS and JOSPT. Do you see benefits from greater teamwork among different types of health-care providers? If so, what are the most important benefits? What barriers remain to greater collaboration?
Dr. Jo Hannafin: Teamwork and interaction between providers of musculoskeletal care will continue to grow and will be necessary as the volume of patients treated increases. We need to define the scientific benefits of conservative and surgical treatments for musculoskeletal conditions, and this will require interactions between scientists, physicians, surgeons, and physical therapists. The questions posed during the adhesive capsulitis webinar reflected input from both surgeons and physical therapists and helped each group to understand the issues associated with treatment. The ultimate benefit of this interaction is improved patient care, which is important to all of us. The biggest barrier is time!
JBJS: You have recently overcome some serious health issues. It’s great to hear that you are doing well. Has this experience changed the way you approach your patients?
Dr. Jo Hannafin: The last two years of my life have been marked by highs and lows. My election to the presidency of the AOSSM, and the associated opportunities, has been personally and professionally fulfilling. In April 2012 I was diagnosed with early multiple myeloma, which was treated at Dana Farber Cancer Institute with chemotherapy followed by an autologous stem cell transplant. The experience was the most difficult challenge that I have faced but I received incredible support from family, friends, patients and AOSSM colleagues from across the country. I am happy to report that my health is excellent and I have been back to a normal schedule for almost one year. The experience reinforced the need for careful and thoughtful communication with our patients.
JBJS: What is your favorite thing about your profession?
Dr. Jo Hannafin: As a sports medicine specialist, I love taking care of athletes and active people of all ages. While many sports related injuries do not require surgery, it is especially gratifying as a surgeon to restore function via repair and reconstruction of injured structures, permitting return to sports or fitness activities.
JBJS: Thank you, Dr. Hannafin for sharing this time with us. We look forward to speaking with you again in the near future.
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