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Anterior Cruciate Ligament Revision Reconstruction
Miller, Mark D. MD; Kew, Michelle E. MD; Quinn, Courtney A. MD
doi : 10.5435/JAAOS-D-21-00088
September 1, 2021 - Volume 29 - Issue 17 - p 723-731
Revision anterior cruciate ligament (ACL) reconstruction is used in patients with recurrent instability after primary ACL reconstruction. Identifying the etiology of graft failure is critical to the success of revision reconstruction. The most common etiologies include technical errors, trauma, failure to recognize concomitant injuries, young age, incomplete rehabilitation, and hardware failure. Patients should undergo a complete history and physical examination with a specific focus on previous injury mechanism and surgical procedures. A revision ACL reconstruction is a technically demanding procedure, and the surgeon should be prepared to address bone tunnel osteolysis, concurrent meniscal, ligamentous, or cartilage lesions, and limb malalignment. Surgical techniques described in this article include both single-stage and two-stage reconstruction procedures. Rates of return to sport after a revision reconstruction are lower than after primary reconstruction. Future research should be focused on improving both single-stage and two-stage revision techniques, as well as concomitant procedures to address limb malalignment and associated injuries.
Shoulder Injury Related to Vaccine Administration
Wiesel, Brent B. MD; Keeling, Laura E. MD
doi : 10.5435/JAAOS-D-21-00021
September 1, 2021 - Volume 29 - Issue 17 - p 732-739
Shoulder injury related to vaccine administration (SIRVA) is a rare yet increasingly recognized complication of immunization. Although a medicolegal term rather than a true diagnosis, SIRVA was introduced in 2010 by the Vaccine Injury Compensation Program after an increase in claims filed for vaccine-related shoulder injury. Patients typically present with severe pain and limited range of motion within 48 hours of vaccination and may experience notable functional limitations. Although the underlying pathophysiology is incompletely understood, the existing literature suggests that SIRVA results from the inflammatory response produced when the vaccine is injected into tissues containing a preexisting antibody. Current treatment modalities include physical therapy, corticosteroid injections, and antiinflammatory medications. In some cases, surgery may be required to treat underlying pathology, such as rotator cuff or biceps tendinopathy. Although the available literature indicates modest improvement in patients with SIRVA undergoing treatment, current data are limited to case series. Larger, high-quality studies are needed to determine the natural history and optimal treatment of this increasingly prevalent condition.
Popliteal Artery Entrapment Syndrome: A Diagnostic and Treatment Enigma for Orthopaedic Surgeons
Miller, Timothy L. MD; Backs, Rose PA-C; Vaccaro, Patrick S. MD
doi : 10.5435/JAAOS-D-21-00151
September 1, 2021 - Volume 29 - Issue 17 - p e834-e845
Popliteal artery entrapment syndrome (PAES) is an uncommon condition that causes recurrent posterior leg pain and foot paresthesia in running athletes. This condition occurs most commonly due to an accessory or abnormal implant of the medial head of the gastrocnemius muscle. It may mimic or coincide with other chronic conditions of the lower extremity including chronic exertional compartment syndrome but is most consistent with vascular claudication. Clinical features that distinguish PAES from other causes of leg pain include a sensation of coolness of the posterior leg during exercise and associated paresthesia of the plantar aspect of the foot. Physical examination often reveals decreased intensity of the posterior tibial or dorsalis pedis pulses with passive dorsiflexion or active plantarflexion of the ankle. Diagnostic tests that confirm the presence of PAES include lower extremity angiography during active resisted plantarflexion or maximal passive dorsiflexion, and magnetic resonance angiography done after exercise provocation. Nonsurgical treatment with physical therapy and stretching of the gastrocnemius complex should be done as the first line of treatment. When conservative treatments are ineffective, referral to a vascular specialist for surgical intervention with a muscular band excision or transection, vascular bypass, or arterial reconstruction is necessary.
Management of Humeral and Glenoid Bone Defects in Reverse Shoulder Arthroplasty
Friedman, Lisa G. M. MD, MA; Garrigues, Grant E. MD
doi : 10.5435/JAAOS-D-20-00964
September 1, 2021 - Volume 29 - Issue 17 - p e846-e859
Bone loss of either the glenoid or the humerus is a challenging problem in reverse total shoulder arthroplasty. When left unaddressed, it can lead to early failure of the implant and poor outcomes. Humeral bone loss can be addressed with the use of an endoprosthesis or allograft prosthetic implant. Glenoid bone loss can be treated with a variety of grafting options, such as augmented implants, patient-specific navigation, and implantation systems.
Osteoporosis Is Undertreated After Low-energy Vertebral Compression Fractures
Haffner, Max R. MD; Delman, Connor M. MD; Wick, Joseph B. MD; Han, Gloria BS; Roberto, Rolando F. MD; Javidan, Yashar MD; Klineberg, Eric O. MD; Le, Hai V. MD
doi : 10.5435/JAAOS-D-20-01132
September 1, 2021 - Volume 29 - Issue 17 - p 741-747
Despite guidelines recommending postfracture bone health workup, multiple studies have shown that evaluation and treatment of osteoporosis has not been consistently implemented after fragility fractures. The primary aim of this study was to evaluate rates of osteoporosis evaluation and treatment in adult patients after low-energy thoracolumbar vertebral compression fractures (VCFs).
Two-Year Postoperative Validation of Patient-Reported Outcomes Measurement Information System Physical Function After Lumbar Decompression
Cha, Elliot D. K. MS; Lynch, Conor P. MS; Parrish, James M. MPH; Jenkins, Nathaniel W. MS; Geoghegan, Cara E. BS; Jadczak, Caroline N. BS; Mohan, Shruthi BS; Singh, Kern MD
doi : 10.5435/JAAOS-D-20-01194
September 1, 2021 - Volume 29 - Issue 17 - p 748-757
Physical function evaluated by Patient-Reported Outcomes Measurement Information System (PROMIS PF) instrument has been validated through the short-term postsurgical period in spine surgery patients. Evidence for long-term efficacy of PROMIS PF is lacking in lumbar decompression (LD) patients. The objective of this study was to evaluate correlations between PROMIS PF and legacy patient-reported outcome measures for patients undergoing LD.
A Novel Scoring System to Predict Length of Stay After Anterior Cervical Discectomy and Fusion
Russo, Glenn S. MD, MS; Canseco, Jose A. MD, PhD; Chang, Michael BA; Levy, Hannah A. BS; Nicholson, Kristen PhD; Karamian, Brian A. MD; Mangan, John MD; Fang, Taolin MD, PhD; Vaccaro, Alexander R. MD, PhD, MBA; Kepler, Christopher K. MD, MBA
doi : 10.5435/JAAOS-D-20-00894
September 1, 2021 - Volume 29 - Issue 17 - p 758-766
The movement toward reducing healthcare expenditures has led to an increased volume of outpatient anterior cervical diskectomy and fusions (ACDFs). Appropriateness for outpatient surgery can be gauged based on the duration of recovery each patient will likely need.
Lumbar Spine Fusion Before Revision Total Hip Arthroplasty Is Associated With Increased Dislocation Rates
Klemt, Christian PhD; Padmanabha, Anand MD; Tirumala, Venkatsaiakhil MS; Walker, Paul MS; Smith, Evan J. MD; Kwon, Young-Min PhD, MD
doi : 10.5435/JAAOS-D-20-00824
September 1, 2021 - Volume 29 - Issue 17 - p e860-e868
The aim of this study was to determine whether timing of lumbar spinal fusion (LSF) before revision total hip arthroplasty (THA) would impact dislocation and rerevision rates.
Impact of Advanced Age on Postoperative Outcomes Following Transforaminal Lumbar Interbody Fusion
Mohan, Shruthi BS; Cha, Elliot D. K. MS; Lynch, Conor P. MS; Geoghegan, Cara E. BS; Jadczak, Caroline N. BS; Singh, Kern MD
doi : 10.5435/JAAOS-D-20-01382
September 1, 2021 - Volume 29 - Issue 17 - p e869-e879
Age 65 years or older is considered a risk factor for worse outcomes after transforaminal lumbar interbody fusion (TLIF). However, few studies have differentiated this cohort from younger patients. This study compares postoperative outcomes among patients 65 years or older of age with a younger cohort after minimally invasive (MIS) TLIF.
Patient Goal-directed Care in an Orthopaedic Spine Specialty Clinic
Turcotte, Justin PhD, MBA; Kelly, McKayla BS; Lynch, Kerry BS; Pipkin, Karen MS, ACNP-C, FNP-C; Patton, Chad MD, MS
doi : 10.5435/JAAOS-D-20-01105
September 1, 2021 - Volume 29 - Issue 17 - p e880-e887
Using health-related goals to direct care could improve quality and reduce cost of medical care; however, the effect of these goals for patients with spinal pathologies is not well understood. The purpose of this study was to describe patient-reported goals by provider type and to evaluate the effect of patient-provider goal awareness on patient satisfaction and treatment pathway.
