Variability in physical therapy protocols following total shoulder arthroplasty

Background Physical therapy (PT) plays an important role in the recovery of function following anatomic total shoulder arthroplasty (aTSA). While several PT protocols have been published for these patients, there is no standardized protocol for aTSA rehabilitation. This lack of standardization may lead to confusion between patients and physicians, possibly resulting in suboptimal outcomes. This study examines how PT protocols provided by academic orthopedic surgery programs vary regarding therapeutic goals and activities following aTSA. Methods PT protocols for aTSA available online from the Accreditation Council for Graduate Medical Education accredited orthopedic surgery programs were included for review. Each protocol was analyzed to evaluate it for differences in recommendation of length of immobilization, range of motion (ROM) goals, start time for and progression of therapeutic exercises, and timing for return to functional activity. Results Of 175 accredited programs, 25 (14.2%) had protocols publicly available, programs (92%) recommended sling immobilization outside of therapy for an average of 4.4±2.0 weeks. Most protocols gave recommendations on starting active forward flexion (24 protocols, range 1–7 weeks), external rotation (22 protocols, range 1–7 weeks), and internal rotation (18 protocols, range 4–7 weeks). Full passive ROM was recommended at 10.8±5.7 weeks, and active ROM was 13.3±3.9 weeks, on average. ROM goals were inconsistent among protocols, with significant variations in recommended ROM and resistance exercise start times. Only 13 protocols (52%) gave recommendations on resuming recreational activities (mean, 17.4±4.4 weeks). Conclusions Publicly available PT protocols for aTSA rehabilitation are highly variable. Level of evidenceLevel IV

Why Your Patient May Need an ACL Reconstruction Plus Lateral Extra-Articular Tenodesis Procedure

Anterior cruciate ligament (ACL) tears are one of the most common knee injuries experienced by active individuals engaging in cutting sports. Despite improved surgical techniques and rehabilitation, the return to sport rate and re-tear rates remain unsatisfactory. Lateral extra-articular tenodesis (LET) is a procedure that has been growing in interest when performed in conjunction with ACL reconstruction. The benefits of adding an LET procedure to an ACL surgery may include greater rotational stability, decreased re-tear rates, and improved return to play. Level of evidence:

The effect of hydrogen bonding on the diffusion of water in n-alkanes and n-alcohols measured with a novel single microdroplet method

While the Stokes–Einstein (SE) equation predicts that the diffusion coefficient of a solute will be inversely proportional to the viscosity of the solvent, this relation is commonly known to fail for solutes, which are the same size or smaller than the solvent. Multiple researchers have reported that for small solutes, the diffusion coefficient is inversely proportional to the viscosity to a fractional power, and that solutes actually diffuse faster than SE predicts. For other solvent systems, attractive solute-solvent interactions, such as hydrogen bonding, are known to retard the diffusion of a solute. Some researchers have interpreted the slower diffusion due to hydrogen bonding as resulting from the effective diffusion of a larger complex of a solute and solvent molecules. We have developed and used a novel micropipette technique, which can form and hold a single microdroplet of water while it dissolves in a diffusion controlled environment into the solvent. This method has been used to examine the diffusion of water in both n-alkanes and n-alcohols. It was found that the polar solute water, diffusing in a solvent with which it cannot hydrogen bond, closely resembles small nonpolar solutes such as xenon and krypton diffusing in n-alkanes, with diffusion coefficients ranging from 12.5×10−5 cm2∕s for water in n-pentane to 1.15×10−5 cm2∕s for water in hexadecane. Diffusion coefficients were found to be inversely proportional to viscosity to a fractional power, and diffusion coefficients were faster than SE predicts. For water diffusing in a solvent (n-alcohols) with which it can hydrogen bond, diffusion coefficient values ranged from 1.75×10−5 cm2∕s in n-methanol to 0.364×10−5 cm2∕s in n-octanol, and diffusion was slower than an alkane of corresponding viscosity. We find no evidence for solute-solvent complex diffusion. Rather, it is possible that the small solute water may be retarded by relatively longer residence times (compared to non-H-bonding solvents) as it moves through the liquid

Repair of a Radial Tear of the Meniscus Augmented With a Biocomposite Scaffold

Meniscal tears are a common musculoskeletal pathology in the United States, affecting 61 in every 100,000 people. Surgical repair is indicated for certain tear patterns to reduce the risk of joint degeneration, normalize contact forces in the knee, and help restore normal knee kinematics. However, radial meniscus tear repairs fail to completely heal 38% of the time due to tear characteristics, biology, surgical technique, and inadequate rehabilitation. Recent efforts have incorporated biological augmentation to enhance the healing potential of the meniscus. The BioBrace is a biocomposite scaffold designed to mechanically reinforce tissue and biologically enhance healing. The purpose of this article is to describe an all-inside, meniscal radial tear repair augmented with BioBrace

Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft: Surgical Technique Using Augmentation With a Biocomposite Scaffold

Anterior cruciate ligament (ACL) reconstruction augmentation continues to be widely studied. Both biologic and synthetic augments have been employed to enhance ACL healing and provide early protection. The BioBrace is a biocomposite scaffold that both mechanically reinforces the graft while biologically enhancing graft healing. The purpose of this article is to describe augmentation of an ACL reconstruction with BioBrace

Changes in Plasma Levels of ADAMTS13 and von Willebrand Factor in Patients Undergoing Elective Joint Arthroplasty

Background: The risk of venous thromboembolic events (VTE) increases in patients undergoing total shoulder arthroplasty (TSA). However, there is no guidelines for prophylaxis. A decreased ratio of ADAMTS13 to VWF has been reported in patients with VTE. This study evaluates how TSA affects this ratio to better characterize timing of VTE risk and develop better guidelines for prophylactic treatment. Methods: Patients receiving TSA between 2016 and 2019 were recruited for this study following informed consent. Blood samples were collected at the clinic visit prior to surgery, postoperatively within one hour, at 24 h, 48 h, 2 and 6 weeks. Plasma levels of ADAMTS13 activity and VWF antigen were determined with a FRETS-VWF73 and an enzyme-linked immunoassay, respectively. Results: Of 22 patients included in the study, the mean age (± SD) was 68 ± 11 years. The most common diagnosis and surgery were osteoarthritis (68%) and reverse TSA (77%), respectively. Plasma ADAMTS13 activity was reduced immediately following surgery and remained lower than the baseline until postoperative day 2 (POD-2) (93.7 ± 28.5 IU/dL, p = 0.009). VWF antigen was the highest on POD-2 (253.2 ± 101.0%, p = 0.0034). The ADAMTS13/VWF ratio followed the same pattern, lowest on POD-2 (0.41 ± 0.20, p = 0.0016). All levels returned to baseline by two weeks. Conclusions: TSA resulted in low ADAMTS13 activity and high VWF acutely post-surgery day 2, suggesting that risk for VTE may be the highest during this period. ADAMTS13/VWF ratio is a useful marker to identify patients who may need proper anticoagulation after TSA

CHARACTERIZATION OF FREE-LIVING STEP-BASED PHYSICAL ACTIVITY METRICS AMONG PATIENTS WITH FEMOROACETABULAR IMPINGEMENT SYNDROME

BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is a hip-joint disorder characterized by abnormal bony morphology (femoral-sided, “cam”; or acetabular-sided, “pincer”). FAIS is a precursor to hip arthritis and is often associated with low physical activity (PA) due to pain. Previous studies have relied on self-report questionnaires to assess PA. Device-based measurement (e.g., accelerometry), specifically step-based metrics (e.g., steps/day and cadence indices), may offer a more comprehensive assessment of PA patterns in this population. METHODS: We recruited 25 participants with FAIS (age=31.0±9.2 years, 60% women, BMI=26.1±4.7 kg/m2) and 14 healthy controls (age=28.1±9.1 years, 64% women, BMI=26.3±3.4 kg/m2). Participants were categorized as Cam only, Combined (cam and pincer), or Healthy (controls). Participants wore a waist-mounted accelerometer (ActiGraph GT3X+, ActiGraph LLC, Pensacola, FL) for 7 days during waking hours. Step-based metrics were computed, including steps/day, peak 1- and 30-min cadence (PK1 and PK30; steps/min), and time spent in various cadence bands (1-19, 20-39, 40-59,⋯100-119 steps/min). One-way ANOVAs with post hoc testing were conducted to examine group differences. Effect sizes (eta squared; η2) were calculated and interpreted as small=0.01, medium=0.06, and large=0.14. RESULTS: We found significant group effects for PK1 and PK30 (p=0.02 and 0.05, η²=0.29 and 0.25, respectively). Post hoc tests showed lower PK1 and PK30 for Cam vs. Healthy (p=0.003 and 0.005, respectively) and Combined vs. Healthy (p=0.02 and 0.05, respectively). Similarly, there were main effects for time spent in slow, medium, and brisk cadence bands (60-79, 80-99, and 100-119 steps/min (p=0.004, 0.02, and 0.02; η²=0.27, 0.26, and 0.19, respectively). Post hoc tests indicated differences in time spent in these cadence bands for Cam vs. Healthy (p=0.007, 0.03, and 0.02, respectively), while Combined differed significantly from Healthy only for the slow and medium cadence bands (p=0.01 and 0.03, respectively). There was no main effect for steps/day between groups (p=0.06, η²=0.1). CONCLUSION: Although there was no main effect of group for steps/day, several cadence-based metrics were lower among the FAIS groups, particularly for Cam vs Healthy. Future studies are encouraged to examine step-based metrics in individuals with FAIS, as they appear to capture real-world differences in walking behaviors

The incidence of shoulder arthroplasty infection presents a substantial economic burden in the United States: a predictive model

Background: Periprosthetic joint infections (PJIs) are a major cause of morbidity after shoulder arthroplasty. Prior national database studies have estimated the trends of shoulder PJI up to 2012.21 Since 2012, the landscape of shoulder arthroplasty has changed drastically with the expanding popularity of reverse total shoulder arthroplasty. The dramatic growth in primary shoulder arthroplasties is likely paralleled with an increase of PJI case volume. The purpose of this study is to quantify the rise in shoulder PJIs and the economic stress they currently place on the American healthcare system as well as the toll they will incur over the coming decade. Methods: The Nationwide Inpatient Sample database was queried for primary and revision anatomic total shoulder arthroplasty, reverse total shoulder arthroplasty, and hemiarthroplasty from 2011-2018. Multivariate regression was used to predict cases and charges through the year 2030 adjusted to 2021 purchasing power parity. Results: From 2011 to 2018, PJI was found to be 1.1% shoulder arthroplasties, from 0.8% (2011) to 1.4% (2018). Anatomic total shoulder arthroplasty experienced the greatest proportion of infections at 2.0%, followed by hemiarthroplasty at 1.0% and reverse total shoulder arthroplasty at 0.3%. Total hospital charges grew 324%, from $44.8 million (2011) to$190.3 million (2018). Our regression model projects 176% growth in cases and 141% growth in annual charges by 2030. Conclusion: This study demonstrates the large economic burden that shoulder PJIs pose on the American healthcare system, which is predicted to reach nearly $500 million in charges annually by 2030. Understanding trends in procedure volume and hospital charges will be critical in evaluating strategies to reduce shoulder PJIs

Cardiovascular disease in retired NFL players: a systematic review

Despite robust research endeavors exploring post-play health implications in former NFL players, the impact of former-player status on long-term cardiovascular health has not yet been elucidated. The purpose of this systematic review is to describe the available research on the cardiovascular health in former NFL players. Relevant studies were included from the PubMed, Scopus, and Embase databases. Studies were evaluated in accordance with PRISMA guidelines. Two independent reviewers conducted the title/abstract screenings and risk of bias determinations. The results of the studies were extracted for inclusion in the review. Sixteen studies met inclusion criteria. Though evidence was discordant among studies, former NFL players appeared to possess more favorable metabolic profiles and decreased mortality compared to community controls. Of note, 90% of former players were found to be overweight or obese. Though cardiovascular disease is the leading cause of death among former NFL players, they possess comparable metabolic and cardiovascular profiles to community controls. Further research is necessary to ascertain the impact of NFL play on cardiovascular health and develop tailored preventative care strategies for former players.</p