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JAAOS Rebranding Completed and Other Achievements.
Levine, William N. MD, FAAOS; Fischgrund, Jeffrey S. MD, FAAOS
doi : 10.5435/JAAOS-D-20-01189
Volume 29(1), 1 January 2021, p 1-2
No Abstract
Diagnosis and Treatment of Chronic Lateral Ankle Instability: Review of Our Biomechanical Evidence.
Chang, Song Ho MD, PhD; Morris, Brandon L. MD; Saengsin, Jirawat MD; Tourne, Yves MD, PhD; Guillo, Stephane MD; Guss, Daniel MD, MBA; DiGiovanni, Christopher W. MD
doi : 10.5435/JAAOS-D-20-00145
Volume 29(1), 1 January 2021, p 3-16
Definitive diagnosis and optimal surgical treatment of chronic lateral ankle instability remains controversial. This review distills available biomechanical evidence as it pertains to the clinical assessment, imaging work up, and surgical treatment of lateral ankle instability. Current data suggest that accurate assessment of ligament integrity during physical examination requires the ankle to ideally be held in 16[degrees] of plantar flexion when performing the anterior drawer test and 18[degrees] of dorsiflexion when performing the talar tilt test, respectively. Stress radiographs are limited by their low sensitivity, and MRI is limited by its static nature. Surgically, both arthroscopic and open repair techniques appear biomechanically equivalent in their ability to restore ankle stability, although sufficient evidence is still lacking for any particular procedure to be considered a superior construct. When performing reconstruction, grafts should be tensioned at 10 N and use of nonabsorbable augmentations lacking viscoelastic creep must factor in the potential for overtensioning. Anatomic lateral ligament surgery provides sufficient biomechanical strength to safely enable immediate postoperative weight bearing if lateral ankle stress is neutralized with a boot. Further research and comparative clinical trials will be necessary to define which of these ever-increasing procedural options actually optimizes patient outcome for chronic lateral ankle instability.
Tourniquetless Total Knee Arthroplasty: History, Controversies, and Technique
Stronach, Benjamin M. MS, MD; Jones, Richard E. MD; Meneghini, R. Michael MD
doi : 10.5435/JAAOS-D-20-00321
Volume 29(1), 1 January 2021, p 17-23
We present a literature review with technique for tourniquetless TKA for surgeons interested in transitioning away from the tourniquet. Tourniquet use provides a bloodless field and improved visualization with decreased intraoperative blood loss, but the arguments for tourniquet use of improved cement fixation and decreased overall blood loss have not been supported by the literature. Regarding recovery, tourniquetless TKA has demonstrated less postoperative pain and improved knee function. There is also the potential for patient harm with tourniquet use. The process of tourniquetless TKA begins preoperatively with anemia screening and treatment. Tranexamic acid decreases the overall blood loss and blood transfusion risk. We recommend preemptive analgesia. The surgery is performed with the knee flexed for a near bloodless field. For cementation, the knee irrigation removes lipids from the exposed bone along with meticulous cement technique. Tourniquetless TKA is able to be safely performed on a routine basis and brings potential benefits to the patient with no evident increased risk in comparison to tourniquet use.
Low Surgeon and Hospital Volume Increase Risk of Early Conversion to Total Knee Arthroplasty After Tibial Plateau Fixation.
Brodke, Dane J. MD, MPH; Morshed, Saam MD, PhD, MPH
doi : 10.5435/JAAOS-D-19-00403
Volume 29(1), 1 January 2021, p 25-34
Background: Some orthopaedic procedures exhibit volume-outcome relationships that suggest benefits associated with a triage and treatment by higher volume surgeons and hospitals. The purpose of this study was to determine whether this association is present for open reduction internal fixation (ORIF) of tibial plateau fractures regarding the outcome of conversion to total knee arthroplasty (TKA).
Preoperative Carbohydrate Drinks Do Not Decrease Postoperative Nausea and Vomiting in Type 2 Diabetic Patients Undergoing Total Knee Arthroplasty-A Randomized Controlled Trial
Shin, Seokyung MD, PhD; Choi, Yong Seon MD, PhD; Shin, Hyejung MS; Yang, Ick Hwan MD, PhD; Park, Kwan Kyu MD, PhD; Kwon, Hyuck Min MD, PhD; Kang, Byunghag MD; Kim, So Yeon MD, PhD
doi : 10.5435/JAAOS-D-20-00089
Volume 29(1), 1 January 2021, p 35-43
Introduction: We evaluated whether preoperative carbohydrate drink would be able to decrease postoperative nausea and vomiting (PONV) and improve the quality of recovery (QoR) in diabetic patients undergoing total knee arthroplasty (TKA).
AAOS Clinical Practice Guideline: Management of Acute Compartment Syndrome
Coe, Marcus P. MD, MS; Osborn, Colonel Patrick M. MD; Schmidt, Andrew H. MD
doi : 10.5435/JAAOS-D-19-00326
Volume 29(1), 1 January 2021, p e1-e4
No Abstract
Evolution in Surgical Management of Ankle Instability in Athletes
Lau, Brian C. MD; Barg, Alexej MD; Haytmanek, C. Thomas MD; McCullough, Kirk MD; Amendola, Annunziato MD
doi : 10.5435/JAAOS-D-20-00176
Volume 29(1), 1 January 2021, p e5-e13
Recent concepts are changing the management of ankle instability. These include concurrent medial and lateral instabilities, use of ankle arthroscopy, use of suture anchors, all-arthroscopic stabilization, synthetic augmentation, and early postoperative rehabilitation. Medial sided injuries occur in up to 72% of the lateral ankle sprains, and concomitant repair may provide greater stability. Suture anchors are equally as strong as transosseous tunnels, and the technique is simple, reproducible, and may decrease complications, but anchors do increase costs. Synthetic augmentation demonstrates greater strength than Brostrom alone in cadaver-based biomechanical testing. Although clinical studies of synthetic augmentation have demonstrated equivocal stability and pain compared with Brostrom alone, synthetic augmentation may expedite rehabilitation. All-arthroscopic ankle stabilization is gaining popularity with increasing publications. Early findings demonstrate comparable biomechanical and clinical data compared with open techniques. Early postoperative weight-bearing within 2 weeks seems to be safe and may shorten time to return to play. Surgeons may consider using these novel techniques in the management of lateral ankle instability.
Relative Energy Deficiency in Sport: an Orthopaedic Perspective
Vopat, Lisa MD; Mackay, Matthew J. MD; Vopat, Bryan G. MD; Mulcahey, Mary K. MD
doi : 10.5435/JAAOS-D-20-00460
Volume 29(1), 1 January 2021, p e14-e21
Relative energy deficiency in sport (RED-S) is a constellation of clinical findings related to low energy availability. Manifestations are variable but may include endocrine and reproductive dysfunction, impaired bone and muscle health, psychological complaints, and performance issues, among many others. Unlike the previously common terminology, the female athlete triad, RED-S encompasses a broader range of signs and symptoms and includes descriptions for the male athlete. Since first being described in 2014 by the International Olympic Committee, an abundance of research has sought to define, prevent, and treat the underlying condition of RED-S. Although medicine, and society in general, has tried to expose the hazardous training and lifestyle behaviors that can underpin RED-S, further research and education is required on the part of the clinician and athlete to reshape the culture and prevent the deleterious consequences of low energy availability.
The Pronounced Impact of Hip Fractures on Psychosocial Well-being
Swayambunathan, Jay BS; Dasgupta, Abhijit PhD; Bhattacharyya, Timothy MD
doi : 10.5435/JAAOS-D-19-00530
Volume 29(1), 1 January 2021, p e22-e30
Background: There are little data on the psychosocial well-being of hip fracture patients. Previous studies lacked a control group to isolate the impact of hip fractures from general aging. We sought to overcome these limitations and quantify the impact of hip fractures on psychosocial well-being.
Taking Family Call: Understanding How Orthopaedic Surgeons Manage Home, Family, and Life Responsibilities
Higgins, Margaret J. BS; Kale, Nisha N. BA; Brown, Symone M. MPH; Mulcahey, Mary K. MD
doi : 10.5435/JAAOS-D-20-00182
Volume 29(1), 1 January 2021, p e31-e40
Introduction: Although women account for more than half of matriculating US medical students, they remain underrepresented in orthopaedic surgery, especially in leadership positions. This may, in part, be due to the disproportionate time spent on household responsibilities by women as compared to men. Understanding whether household responsibilities differ between female and male orthopaedic surgeons is critical to better understand how the demands of family life impacts their careers.
Revision Hip Arthroplasty Using a Porous-coated or Taper ZMR Implant: Minimum 10-year Follow-up of Implant Survivorship
McInnes, James MD; Allen, James MB, BCh; Garceau, Simon P. MD; Warschawski, Yaniv MD; Rajgopal, Raghav MD; Safir, Oleg A. MD, MEd; Gross, Allan E. MD; Kuzyk, Paul R. MD, MSc
doi : 10.5435/JAAOS-D-19-00512
Volume 29(1), 1 January 2021, p e41-e50
Introduction: The Zimmer Modular Revision hip (ZMR) system is available in two stem options, a porous-coated cylindrical (PCM) and a taper (TM) stem. Several concerns have been reported regarding modular implants. Specifically, because of early junctional fractures, the ZMR system was redesigned with a wider modular interface. As such, we designed a study assessing long-term ZMR survivorship and functional and radiographic outcomes.
