Arthroscopy News

LAS VEGAS — At the American Academy of Orthopaedic Surgeons Annual Meeting, James Gladstone, MD, chief of the orthopedic sports medicine service in the department of orthopedic surgery at the Mount Sinai Health System and associate professor of orthopedic surgery at the Icahn School of Medicine at Mount Sinai, spoke about the prescribing and use practices for opioids after arthroscopic meniscectomy.

There is no question in my mind that the ideal ACL graft for an active older patient who is uncomfortable with an allograft is a quadrupled semitendinosus autograft. By quadrupling the tendon, sufficient size and strength of the graft can be achieved. The fact that the quadrupled graft may be shorter can easily be accommodated by using an all-inside technique with bony sockets. With the harvesting of only a single hamstring, the risk of harvest morbidity is low and there is little early postoperative pain. This allows early weight-bearing and shorter time on crutches, which should decrease the risk of deep vein thrombosis or falls. The harvesting is relatively straightforward and can be performed quickly without a tourniquet. Any resulting minor hamstring weakness is unlikely to be noticed in these patients. With respect to concerns about graft retear, because the risk of ACL graft retear declines with age, as much as 50% for each decade of life, retear rates should be low. There is a reason hamstring grafts are the most commonly used grafts for ACL reconstruction worldwide and the benefits of this graft choice are amplified in the older population. In addition, any potential downsides of hamstring graft use are minimized in this age group.

The ACL is reportedly one of the most commonly injured knee ligaments among professional- and recreational-level athletes, with a high risk for primary and secondary ACL injuries found with participation in pivoting and cutting sports, such as football, basketball, skiing and soccer.

A 21-year-old man presented with a 3-year history of intermittent 8/10 lateral right knee pain. He failed two prior surgical procedures done at outside hospitals. The patient initially sustained a jumping injury while playing basketball and recalled feeling a pop at the time. At presentation, his knee pain was associated with a catching sensation and swelling. He tried viscosupplementation injections and physical therapy without resolution of symptoms. Two years ago, he underwent arthroscopic partial lateral meniscectomy and chondroplasty at an outside hospital without improvement in symptoms. One year ago, he underwent arthroscopy and microfracture at a different outside hospital. His symptoms persisted and continued to be aggravated by playing basketball and other impact activities.

LAS VEGAS — Approximately half of patients who underwent arthroscopic shoulder stabilization demonstrated symptoms of major depressive disorder during a 1-year study, according to a presenter, here. Findings also showed symptomatic depression positively correlated with a decrease in shoulder outcome functionality.

Despite significant improvements in patients with combined excessive femoral anteversion and borderline dysplasia when treated with arthroscopic labral preservation and capsular closure, these results were significantly inferior when compared with a matched control group, according to a recently published study.

Between 2009 and 2016, nearly 70% of patients experienced symptoms for 1 to 5 years while they waited for hip replacement surgery, with longer durations significantly predictive of poorer post-surgery outcomes, according to data published in Arthritis Care & Research.

The incidence rate of upper limb joint replacements among patients with rheumatoid arthritis decreased from 2002 onward, coinciding with the introduction of biological disease-modifying antirheumatic drugs, although other factors may have contributed, according to findings published in Arthritis Care & Research.

Superior outcomes were seen in patients who underwent arthroscopic hip surgery for symptomatic femoroacetabular impingement compared with patients who were placed in physiotherapy and activity modification, according to a recently published study.

Use of low-value procedures was associated with more hospital-acquired complications, according to findings published in JAMA Internal Medicine.