Hybrid Remnant-Sparing Anterior Cruciate Ligament Repair-Reconstruction

In anterior cruciate ligament (ACL) reconstruction, the remnant ACL is often debrided in an effort to improve visualization of patient anatomy and reduce surgical difficulty. However, retention of the tibial remnant of a torn ACL theoretically portends several advantages. These include preservation of knee proprioception and mechanoreceptors, an enhanced biological environment for healing, and accelerated revascularization and ligamentization of the graft. Despite these advantages, it is not a widely adopted practice and the optimal technique is still subject to debate. The purpose of this technical note is to describe our preferred technique for performing hybrid ACL reconstruction with remnant incorporation

Posterolateral Corner Repair with Internal Bracing and Peroneal Nerve Neurolysis

Posterolateral corner (PLC) reconstruction has been shown to be an effective treatment for PLC injuries. Acute anatomical repair of the PLC has the same potential to stabilize the knee; however, outcomes are less defined. Surgical repair minimizes graft harvest morbidity and allows for the maintenance of native tissue proprioception. Furthermore, augmentation with a flat-braided suture (SutureTape; Arthrex) portends additional repair strength and protection. The purpose of this Technical Note and video is to provide our preferred method of PLC repair in a patient with an acute knee dislocation and injury to the biceps femoris, lateral collateral ligament, iliotibial band, popliteofibular ligament, and the meniscocapsular attachment of the lateral meniscus

Acromioclavicular Joint Reconstruction with Recessed Clavicular Implant Technique Guide

Acromioclavicular (AC) joint injuries are common and often require operative intervention. Although there are many described surgical techniques, there remains a lack of consensus on the optimal technique. The purpose of this Technical Note is to provide our preferred method of AC reconstruction with a recessed clavicular implant and semitendinosus allograft, which mitigates hardware pain associated with arthroscopic techniques

Concussion in National Football League Athletes Is Not Associated With Increased Risk of Acute, Noncontact Lower Extremity Musculoskeletal Injury

Background: Impaired neuromuscular function after concussion has recently been linked to increased risk of lower extremity injuries in athletes. Purpose: To determine if National Football League (NFL) athletes have an increased risk of sustaining an acute, noncontact lower extremity injury in the 90-day period after return to play (RTP) and whether on-field performance differs pre- and postconcussion. Study Design: Cohort study, Level of evidence, 3. Methods: NFL concussions in offensive players from the 2012-2013 to the 2016-2017 seasons were studied. Age, position, injury location/type, RTP, and athlete factors were noted. A 90-day RTP postconcussive period was analyzed for lower extremity injuries. Concussion and injury data were obtained from publicly available sources. Nonconcussed, offensive skill position NFL athletes from the same period were used as a control cohort, with the 2014 season as the reference season. Power rating performance metrics were calculated for ±1, ±2, and ±3 seasons pre- and postconcussion. Conditional logistic regression was used to determine associations between concussion and lower extremity injury as well as the relationship of concussions to on-field performance. Results: In total, 116 concussions were recorded in 108 NFL athletes during the study period. There was no statistically significant difference in the incidence of an acute, noncontact lower extremity injury between concussed and control athletes (8.5% vs 12.8%; Conclusion: Concussed, NFL offensive athletes did not demonstrate increased odds of acute, noncontact, lower extremity injury in a 90-day RTP period when compared with nonconcussed controls. Immediate on-field performance of skill position players did not appear to be affected by concussion

Anterior Cruciate Reconstruction with Quadriceps Autograft using QuadLink Anterior Cruciate Ligament FiberTag TightRope Implant

Quadriceps tendon autografts have been shown to be a reliable option for anterior cruciate ligament (ACL) reconstruction. The graft allows for optimal functional outcomes while reducing donor site morbidity. Although quadriceps graft fixation can be achieved using a variety of techniques, there is a lack of consensus on the optimal technique. Additionally, femoral fixation techniques have variance in durability and reproducibility. The purpose of this Technical Note and video is to provide our preferred method of quadriceps tendon autograft preparation and fixation using the Quad Link ACL FiberTag TightRope Implant in a single-bundle ACL reconstruction

Impact of Patellar Tendinopathy on Player Performance in the National Basketball Association

Background: The extent to which patellar tendinopathy affects National Basketball Association (NBA) athletes has not been thoroughly elucidated. Purpose: To assess the impact patellar tendinopathy has on workload, player performance, and career longevity in NBA athletes. Study Design: Cohort study; Level of evidence, 3. Methods: NBA players diagnosed with patellar tendinopathy between the 2000-2001 and 2018-2019 seasons were identified through publicly available data. Characteristics, return to play (RTP), player statistics, and workload data were compiled. The season of diagnosis was set as the index year, and the statistical analysis compared post- versus preindex data acutely and in the long term, both within the injured cohort and with a matched healthy NBA control cohort. Results: A total of 46 NBA athletes were included in the tendinopathy group; all 46 players returned to the NBA after their diagnosis. Compared with controls, the tendinopathy cohort had longer careers (10.50 ± 4.32 vs 7.18 ± 5.28 seasons; P \u3c .001) and played more seasons after return from injury (4.26 ± 2.46 vs 2.58 ± 3.07 seasons; P = .001). Risk factors for patellar tendinopathy included increased workload before injury (games started, 45.83 ± 28.67 vs 25.01 ± 29.77; P \u3c .001) and time played during the season (1951.21 ± 702.09 vs 1153.54 ± 851.05 minutes; P \u3c .001) and during games (28.71 ± 6.81 vs 19.88 ± 9.36 minutes per game; P \u3c .001). Players with increased productivity as measured by player efficiency rating (PER) were more likely to develop patellar tendinopathy compared with healthy controls (15.65 ± 4.30 vs 12.76 ± 5.27; P = .003). When comparing metrics from 1 year preinjury, there was a decrease in games started at 1 year postinjury (-12.42 ± 32.38 starts; P = .028) and total time played (-461.53 ± 751.42 minutes; P = .001); however, PER at 1 and 3 years after injury was unaffected compared with corresponding preinjury statistics. Conclusion: NBA players with a higher PER and significantly more playing time were more likely to be diagnosed with patellar tendinopathy. Player performance was not affected by the diagnosis of patellar tendinopathy, and athletes were able to RTP without any impact on career longevity

Infection and Rerupture After Surgical Repair of Achilles Tendons.

Background: Surgical repair of an Achilles tendon rupture has been shown to decrease rerupture rates. However, surgery also increases the risk of complications, including infection. Purpose: To determine the risk factors for infection and rerupture after primary repair of Achilles tendon ruptures. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was performed on 423 patients who underwent operative treatment of Achilles tendon ruptures between the years 2008 and 2014. The primary outcome of interest was the total rate of infection, and the secondary outcome of interest was the incidence of rerupture within 2 years of operation. Results: A total of 423 patients were analyzed, with a mean age of 46 years (range, 16-83 years) and a mean body mass index of 31.4 kg/m2 (range, 17-55 kg/m2). The overall infection rate was 2.8%, and the rerupture rate was 1%. The median time between surgery and superficial surgical site infection was 30 days, and the median time between surgery and rerupture was 38 days. Longer tourniquet times (100.3 ± 34.7 minutes vs 69.9 ± 21.4 minutes; P = .04) and greater estimated blood loss (15.0 ± 9.1 mL vs 5.1 ± 12.0 mL; P = .01) were associated with an increased rate of deep surgical site infections. Patients who had longer operation and tourniquet times trended toward higher rerupture rates (P = .06 and .08, respectively). When compared with nonsmokers, current and previous smokers had an increased incidence of superficial or deep surgical site infections (6.25% vs 1.42%; P = .02). Age, sex, race, body mass index, alcohol use, diabetes, past steroid injections, and mechanism of injury did not contribute to complication rates. Conclusion: Achilles tendon repairs were associated with a low risk of infection and rerupture. Patients with longer tourniquet times, higher estimated blood loss, and a history of smoking were at increased risk for surgical site infections. Patients with longer operative times had increased rates of rerupture

Lower Extremity Injury After Return to Sports From Concussion: A Systematic Review

BACKGROUND: Recent studies have suggested increased rates of lower extremity (LE) musculoskeletal injury after a diagnosed concussion, although significant heterogeneity exists. PURPOSE: To examine the current body of research and determine whether there is an increased risk for LE musculoskeletal injury after a concussion and to identify populations at an increased risk. STUDY DESIGN: Systematic review; Level of evidence, 3. METHODS: A systematic review of current literature using MEDLINE and PubMed databases was performed. Keywords included concussion, athlete, lower extremity injury, and return to sport. Inclusion criteria required original research articles written in the English language examining the rate of LE injuries after a diagnosed concussion. RESULTS: A total of 13 studies involving 4349 athletes (88.1% male and 11.9% female; mean age, 19.8 years) met inclusion criteria. Athletes were classified as high school (46.1%), collegiate (17.0%), or professional (36.9%). Of the 13 studies, 4 demonstrated an increased risk of LE injury within 90 days of a diagnosed concussion (odds ratio [OR], 3.44; 95% CI, 2.99-4.42), and 6 revealed an elevated risk of injury within 1 year of concussion (OR, 1.85; 95% CI, 1.73-2.84). Increased risk was seen in professional (OR, 2.49; 95% CI, 2.40-2.72) and collegiate (OR, 2.00; 95% CI, 1.96-2.16) athletes compared with high school athletes (OR, 0.97; 95% CI, 0.89-1.05). A stepwise increase in risk of sustaining an LE injury was observed with multiple concussions, with increasing risk observed from ≥2 (OR, 2.29; 95% CI, 1.85-2.83) to ≥3 (OR, 2.86; 95% CI, 2.36-3.48) career concussions. CONCLUSION: An increased incidence of LE injuries was observed at 90 days and 1 year after the diagnosis of a concussion. Higher levels of competition, such as at the collegiate and professional levels, resulted in an increased risk of sustaining a subsequent LE injury after a diagnosed concussion. These results suggest an at-risk population who may benefit from injury prevention methods after a concussion. Future studies should focus on identifying which injuries are most common, during what time period athletes are most vulnerable, and methods to prevent injury after return to sports

Multimodal Nonopioid Pain Protocol Provides Equivalent Pain Versus Opioid Control Following Meniscus Surgery: A Prospective Randomized Controlled Trial

PURPOSE: To assess the effectiveness of a nonopioid pain regimen in controlling postoperative pain as compared with a traditional opioid pain control following primary meniscectomy or meniscal repair. METHODS: Ninety-nine patients undergoing primary meniscectomy or meniscal repair were assessed for participation. A prospective randomized control trial was performed in accordance with the Consolidated Standards of Reporting Trials 2010 statement. The 2 arms of the study included a multimodal nonopioid analgesic protocol and a standard opioid regimen with a primary outcome of postoperative pain level (visual analog scale) for the first 10 days postoperatively. Secondary outcomes included patient-reported outcomes, complications, and patient satisfaction. Randomization was achieved using a random-number generator. Patients were not blinded. Data collection was done by a blinded observer. RESULTS: Eleven patients did not meet the inclusion criteria, and 27 declined participation. A total of 61 patients were analyzed with 30 randomized to the opioid regimen and 31 randomized to the nonopioid regimen. Patients receiving the nonopioid regimen demonstrated noninferior visual analog scale scores compared with patients who received opioid pain medication (P \u3e .05). No significant differences were found in preoperative (opioid: 58.9 ± 7.0; nonopioid: 58.2 ± 5.5, P = .724) or postoperative (opioid: 59.8 ± 6.5; nonopioid: 54.9 ± 7.1, P = .064) Patient-Reported Outcomes Measurement and Information System Pain Interference Short Form scores. No difference was found in recorded side effects between both groups at any given time point: constipation, nausea, diarrhea, upset stomach, and drowsiness (P \u3e .05). CONCLUSIONS: This study found that a multimodal nonopioid pain protocol provided equivalent pain control and patient outcomes following primary meniscus surgery while having an equivalent side effect profile. All patients reported satisfaction with their pain management without requiring emergency opioid analgesia. LEVEL OF EVIDENCE: Level I, prospective randomized controlled trial