Purpose: This study sought to assess the long-term
structural integrity of primary anterior cruciate ligament
(ACL) reconstructions using Achilles tendon allografts by
measuring the side-to-side difference in anterior-posterior
tibial translation between the operative knee and the contralateral, asymptomatic knee.
Methods: This study was a retrospective case series
consisting of patients who underwent primary ACL reconstruction with Achilles tendon allograft. Allografts were
chemically processed using the AlloWash or AlloTrue methods and then received either gamma radiation or electron
beam radiation (range: 0.95 to 1.4 Mrad dose). At the time
of follow-up, anterior-posterior tibial translation of both
the operative and contralateral knees was measured using
the Lachmeter� device. Functional outcomes were assessed
using the International Knee Documentation Committee
(IKDC) questionnaire and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire.
Results: The analysis included 20 patients (mean age:
41.38 � 14.27 years) with a mean follow-up time of 7.01 ±
5.24 years. There were no graft failures requiring revision
during the study period. The mean side-to-side difference in
laxity between operative and contralateral knees was 1.10 ±
2.02 mm. Two patients (10%) met the criteria for complete
ACL injury at the time of follow-up, while the remaining 18
patients (90%) met the criteria for no ACL injury. The mean IKDC score was 83.5 ± 13.8, and mean KOOS score was
88.4 � 10.7.
Conclusions: Primary ACL reconstruction using an
Achilles tendon allograft in skeletally mature patients
resulted in maintained knee stability and good functional
outcomes over the long-term postoperative period.
The Use of Computer Navigation and Robotic Technology in Complex Total Hip Arthroplasty
Keir A. Ross, MD, Daniel H. Wiznia, MD, William J. Long, MD, and Ran Schwarzkopf, MD
Computer assisted surgical (CAS) navigation and
robotic-assisted total hip arthroplasty (THA) have the
potential to improve the reproducibility of accurate
component positioning and facilitate complex cases,
including revision and preoperative deformity. Numerous studies, including multiple comparing technology
with conventional THA control groups, suggest that CAS
navigation may improve component accuracy in cases
of deformity such as hip dysplasia and significant leg
length discrepancy. Revision THA data is also encouraging but limited. The functional benefits compared to
conventional techniques remain unclear. The evidence
for robot-assisted THA in complex cases is more limited
but also demonstrates utility. For complex cases, studies
comparing results with conventional THA are not yet
available. The limitations of these systems, including
cost, operative time, learning curves, and possible complications, require further study. The available data for
CAS navigation and robotic-assisted THA indicates that
they may play a role in complex deformity and revision
cases. Further high-quality randomized studies should
be undertaken.
Updates on Residual Limb Management in Lower Extremity Amputation From Nerve to Bone
Blake Schultz, MD, Christian Pean, MD, MS, and Nirmal Tejwani, MD
Traumatic extremity amputation can be devastating for
patients' functional and psychological health. Challenges
of initial management and considerations for limb salvage
versus amputation for mangled lower extremities are well
documented. However, literature geared toward orthopedic
surgeons highlighting management considerations for the
residual limb of an amputation is scarce. This article reviews
recent literature on management of the residual limb in the
perioperative and rehabilitation phases of treatment.
Preoperative Symptom Severity Predicts 5-Year Hip Arthroscopy Outcomes
Berkcan Akpinar, MD, Lawrence J. Lin, BA, David A. Bloom, BS, and Thomas Youm, MD
Purpose: Thisstudy sought to assessthe prognostic effect
of preoperative symptom severity on hip arthroscopy outcomes for femoroacetabular impingement syndrome (FAI).
Methods: Patients undergoing hip arthroscopy between
September 2012 and July 2014 for FAI with a minimum of
5-year clinical outcomes were compiled. Patient reported
outcomes (PROs) including modified Harris Hip Score
(mHHS) and Nonarthritic Hip Score (NAHS) were collected.
High and low preoperative function (PF) subgroups were
created using baseline population median mHHS (43.3) as a
threshold with PROs below the median score indicating low
preoperative function and vice versa for scores above the
median. Kaplan-Meier analysis, Cox proportional modeling,
analysis of variance (ANOVA), and linear regressions were
used for analysis.
Results: One hundred five of 131 eligible patients(80.2%
inclusion; age: 42.6 ± 1.4 years; body mass index: 25.3 ±
0.4 kg/m2
) met the study criteria. The 5-year survival-torevision rate (85% versus 61%, p = 0.013) and survivalto-arthroplasty rate (95% vs. 82%, p = 0.022) were greater
in the high versus low PF group. ANOVA demonstrated the
high versus low PF group had higher baseline (mHHS:
52.7 ± 1.4 vs. 36.1 ± 1.1, p < 0.001; NAHS: 57.4 ± 1.6 vs.
39.3 ± 1.2, p < 0.001) and 1-year (mHHS: 91.9 ± 1.8 vs.
79.5 ± 2.7, p < 0.001; NAHS: 91.7 ± 1.6 vs. 80.8 ± 2.5, p
< 0.001) outcomes. High versus low PF achieved higher
Minimal Clinically Important Difference (77% vs. 57%, p
= 0.026) at 5-years. High versus low PF achieved higher
Patient Acceptable Symptomatic State rates at 1 year (79%
vs. 47%, p < 0.001) and 5 years (66% vs. 45%, p = 0.032).
Linear regression demonstrated body mass index (mHHS:
p = 0.002; NAHS: p = 0.005), pincer resection (mHHS: p
= 0.046), and preoperative symptom severity (mHHS: p =
0.001; NAHS: p = 0.002) to be predictors of 5-year change
in PROs.
Conclusion: Preoperative symptom severity is a reliable
prognostic indicator of clinical survival rates and PROs
after hip arthroscopy for FAI. Subjects with high PF are
likely to have increased longevity of the index procedure
while maintaining excellent PASS and MCID rates mid-term
as opposed to those with low PF.
Temporal, Seasonal, and Monthly Effects on Total Knee Arthroplasty Surgical Site Infection Rates
Jason B. Kreinces, BS, Mackenzie A. Roof, BS, Lorraine Hutzler, MPA, Anna Stachel, PhD,
MPH, Scott Friedlander, MPH, Michael Phillips, MD, and Joseph A. Bosco, III, MD
Background: Deep surgical site infections (dSSI) following total knee arthroplasty (TKA) are associated with
morbidity and poor outcomes. Although numerous patient
and non-patient factors have been correlated with dSSI
development, the temporal and seasonal variability of dSSI
is unclear. The purpose of this study was to investigate the
monthly and seasonal variability of dSSI rates following
TKA.
Methods: The dSSI database at a single large, urban,
academic medical center was reviewed for TKAs performed
between January 2009 and August 2018. The monthly and
seasonal variability of dSSI was evaluated using a Poisson
regression. Additionally, the change in dSSI rate was calculated over the entire study period.
Results: We reviewed 15,230 consecutive TKAs. The average dSSI rate following TKA was 1.11% (SD: 0.91). The
rate of dSSI decreased over the study period (r = 0.94, 95%
CI: 0.85-1.05) but did not reach statistical significance. With
summer as the reference season, there were no significant
differences in the dSSI rate in fall, winter, or spring. With
July as the reference season, there were no differences in
the dSSI rate in any other months of the year.
Conclusion: Although non-significant, this analysis found
a decreasing rate of dSSI after TKA over a nearly 10-year
period. Interestingly, there was no difference in the dSSI rate
following TKA in July as compared to other months or in
summer as compared to other seasons. This conflicts with
previous reports that have found an increased incidence of
dSSI and other complications in July when the graduate
medical education calendar begins.
Clinical Outcomes Following Resection of Distal Lower Extremity Soft Tissue Sarcomas
Charles A. Gusho, BS, Linus Lee, BE, Johnathon R. McCormick, MD, Gordon H. Derman, MD,
Deana S. Shenaq, MD, Amir H. Dorafshar, MD, George Kokosis, MD, Matthew W. Colman, MD,
Steven Gitelis, MD, and Alan T. Blank, MD, MS
Objective: Resection of soft tissue sarcoma (STS) in the
distal lower extremity can result in large soft tissue defects
that create difficult wounds to manage and significant risks
for complications. Often, the anticipated or resultant tissue
defect or loss of functional anatomy is an indication for
amputation over limb salvage. Soft tissue reconstruction
managed by plastic and reconstructive surgery (PRS) may
help offer limb salvage as a therapeutic option with acceptable oncologic outcomes and wound complication rates.
Methods: This was a review of 52 patients who underwent
resection of STS at the level of the knee or distal between
2010 and 2020. Plastic and reconstructive surgery soft tissue
management was utilized in 40.4% (n = 21) of cases, most
of whom would have otherwise been considered candidates
for amputation.
Results: The overall rate of limb salvage was 76.9%. The
overall rate of wound complications was 19.2%. The overall
rate of negative margins of resection was 92.3%. The 1-, 5-,
and 10-year overall survival probabilities were 92%, 85%,
and 85%, respectively. Of the 40 limb salvage procedures,
two required subsequent amputation, one for multiply recurrent disease and one for necrosis. The wound complication
rate was 14.3% in the PRS management group and 22.6%
in cases of wound closure managed by the primary surgeon.
There were zero instances of total wound or flap loss in PRS-
managed closures. When comparing patients with wound
complications to those without, there was no difference in
age (59.5 ± 21 vs. 51 ± 18 years, p = 0.42), body mass index
(31.1 ± 4.8 vs. 26.1 ± 7.1 kg/m2
, p = 0.19), or tumor size (6.8
± 5.0 vs. 6.4 ± 4.7 cm, p = 0.82). At final follow-up, 67% (n
= 35) of patients were alive and disease-free.
Conclusions: Wound complications are not uncommon
after resection of distal lower extremity STS. Our experience has been successful in achieving limb salvage in these
challenging cases. Without PRS soft tissue management,
however, many patients may alternatively be candidates for
amputation.
Impact of a Novel Navigational Technology on Short-Term Patient Outcomes Following Total Knee Arthroplasty A Propensity Matched Cohort Study
Benjamin Fiedler, BA, Vivek Singh, MD, MPH, Alex Tang, BS, Scott Marwin, MD, Morteza
Meftah, MD, and Ran Schwarzkopf, MD, MSc
Purpose: The use of intraoperative technology is increasing among orthopedic surgeons in the United States. However, there is continued debate as to whether intraoperative
technologies provide clinical benefits in patients undergoing
total knee arthroplasty (TKA). This study sought to determine
whether the use of a novel intraoperative navigation technology produces equivalent or superior short-term outcomes
compared to conventional technique.
Methods: Fifty-nine consecutive patients underwent
primary TKA with a novel imageless intraoperative navigational technology between October 2019 and January 2020
at a single, urban, orthopedic specialty hospital. A 1:1 cohort
propensity matching was performed with patients with similar demographics who underwent primary TKA without the
use of technology. Demographics, clinical data, as well as
preoperative and 3-month Knee Injury and Osteoarthritis
Outcome Score, Joint Replacement (KOOS, JR) scores
were collected. Demographic differences, clinical data, and
mean KOOS, JR scores were assessed using chi-squared
analysis for categorical variables and independent sample
t-test for continuous variables.
Results: Upon 1:1 cohort matching, patients in both the
navigational cohorts and non-navigational cohorts were
statistically similar demographically. Length of stay (2.11
vs. 1.71 days; p = 0.108), surgical time (108.89 vs. 101.19
minutes, p = 0.066), discharge disposition (p = 0.675), 90-
day readmissions (4 vs. 4, p = 0.999), and 90-day reoperations (2 vs. 2, p = 0.999) did not statistically differ between
the two matched cohorts. Additionally, KOOS, JR scores
evaluated between the two cohorts preoperatively (46.06
vs. 45.17, p = 0.836) and at 3-month follow-up (57.63 vs.
55.06, p = 0.580) were similar.
Conclusion: This study demonstrates that the use of this
novel intraoperative navigational technology yields similar
short-term TKA results when compared to conventionally
performed TKA. Further studies are required to validate
new technologies and determine their effect on long-term
clinical and patient-reported outcomes.
Outcomes Following Medial Patellofemoral Ligament Reconstruction with Allograft A Systematic Review
Christopher A. Colasanti, MD, Eoghan T. Hurley, MB, MCh, PhD, Delon McAllister, MD,
Bogdan A. Matache, MDCM, FRCSC, Dip Sports Med, Laith M. Jazrawi, MD, Eric J. Strauss,
MD, and Kirk A. Campbell, MD
Purpose: The purpose of this study was to systematically
review the evidence in the literature in order to evaluate the
outcomes following medial patellofemoral ligament (MPFL)
reconstruction with allograft compared to autograft reconstruction.
Methods: A systematic literature search was performed
based on PRISMA guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Inclusion
criteria for the study was clinical studies reporting on
MPFL reconstruction with allograft. Recurrence rate, complications, rate of return-to-play, and functional outcomes
including the Kujala, Tegner, and visual analog scale (VAS)
scores were evaluated. Statistical analysis was performed
using GraphPad Prism 8.3.
Results: Our review identified 12 studies with a total of
336 patient knees meeting the inclusion criteria. The majority of patients were female (61.6%), with a mean age of 22.3
years and a mean follow-up of 43.4 months. The overall
rate of recurrence of lateral patellar instability was 2.7%
in the allograft cohort as compared to 7.8% in the autograft
cohort (p = 0.01). The mean Kujala score was 91.8%, and
the mean VAS score was 1.3 at final follow-up. Additionally,
81.5% of patients were able to return to play in the studies
reporting this outcome measure. The overall complication
rate was 1.4%.
Conclusion: The overall rate of recurrence was lower
following MPFL reconstruction with allograft as compared
to autograft in the treatment of lateral patellar instability.
Additionally, there were excellent patient reported outcomes
and a low complication rate following the use of allograft
for MPFL reconstructionPurpose: The purpose of this study was to systematically
review the evidence in the literature in order to evaluate the
outcomes following medial patellofemoral ligament (MPFL)
reconstruction with allograft compared to autograft reconstruction.
Methods: A systematic literature search was performed
based on PRISMA guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Inclusion
criteria for the study was clinical studies reporting on
MPFL reconstruction with allograft. Recurrence rate, complications, rate of return-to-play, and functional outcomes
including the Kujala, Tegner, and visual analog scale (VAS)
scores were evaluated. Statistical analysis was performed
using GraphPad Prism 8.3.
Results: Our review identified 12 studies with a total of
336 patient knees meeting the inclusion criteria. The majority of patients were female (61.6%), with a mean age of 22.3
years and a mean follow-up of 43.4 months. The overall
rate of recurrence of lateral patellar instability was 2.7%
in the allograft cohort as compared to 7.8% in the autograft
cohort (p = 0.01). The mean Kujala score was 91.8%, and
the mean VAS score was 1.3 at final follow-up. Additionally,
81.5% of patients were able to return to play in the studies
reporting this outcome measure. The overall complication
rate was 1.4%.
Conclusion: The overall rate of recurrence was lower
following MPFL reconstruction with allograft as compared
to autograft in the treatment of lateral patellar instability.
Additionally, there were excellent patient reported outcomes
and a low complication rate following the use of allograft
for MPFL reconstruction
Severe Contour Deformity of the Hip Following Corticosteroid Injection
Lawrence J. Lin, MD, Tiffany X. Chen, BS, Laith M. Jazrawi, MD, and
Ernest S. Chiu, MD, FACS
A 50-year-old woman developed severe soft tissue atrophy
of the hip following a triamincolone acetonide injection to
the greater trochanteric bursa. Saline injection therapy was
initially attempted without improvement and the defect was
ultimately treated effectively with serial fat grafting. Adverse
soft tissue reactions are rare but potentially devastating complications of corticosteroid injections, and the use of soluble
steroid preparations and proper injection techniques can
minimize the risk to surrounding tissue. Serial fat grafting
represents a promising treatment option for severe cases of
steroid-induced soft tissue atrophy.
ARTICLES
Long-Term Outcomes of Primary Anterior Cruciate Ligament Reconstruction Using Achilles Tendon Allograft
Purpose: This study sought to assess the long-term
structural integrity of primary anterior cruciate ligament
(ACL) reconstructions using Achilles tendon allografts by
measuring the side-to-side difference in anterior-posterior
tibial translation between the operative knee and the contralateral, asymptomatic knee.
Methods: This study was a retrospective case series
consisting of patients who underwent primary ACL reconstruction with Achilles tendon allograft. Allografts were
chemically processed using the AlloWash or AlloTrue methods and then received either gamma radiation or electron
beam radiation (range: 0.95 to 1.4 Mrad dose). At the time
of follow-up, anterior-posterior tibial translation of both
the operative and contralateral knees was measured using
the Lachmeter� device. Functional outcomes were assessed
using the International Knee Documentation Committee
(IKDC) questionnaire and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire.
Results: The analysis included 20 patients (mean age:
41.38 � 14.27 years) with a mean follow-up time of 7.01 ±
5.24 years. There were no graft failures requiring revision
during the study period. The mean side-to-side difference in
laxity between operative and contralateral knees was 1.10 ±
2.02 mm. Two patients (10%) met the criteria for complete
ACL injury at the time of follow-up, while the remaining 18
patients (90%) met the criteria for no ACL injury. The mean IKDC score was 83.5 ± 13.8, and mean KOOS score was
88.4 � 10.7.
Conclusions: Primary ACL reconstruction using an
Achilles tendon allograft in skeletally mature patients
resulted in maintained knee stability and good functional
outcomes over the long-term postoperative period.
The Use of Computer Navigation and Robotic Technology in Complex Total Hip Arthroplasty
Keir A. Ross, MD, Daniel H. Wiznia, MD, William J. Long, MD, and Ran Schwarzkopf, MD
Computer assisted surgical (CAS) navigation and
robotic-assisted total hip arthroplasty (THA) have the
potential to improve the reproducibility of accurate
component positioning and facilitate complex cases,
including revision and preoperative deformity. Numerous studies, including multiple comparing technology
with conventional THA control groups, suggest that CAS
navigation may improve component accuracy in cases
of deformity such as hip dysplasia and significant leg
length discrepancy. Revision THA data is also encouraging but limited. The functional benefits compared to
conventional techniques remain unclear. The evidence
for robot-assisted THA in complex cases is more limited
but also demonstrates utility. For complex cases, studies
comparing results with conventional THA are not yet
available. The limitations of these systems, including
cost, operative time, learning curves, and possible complications, require further study. The available data for
CAS navigation and robotic-assisted THA indicates that
they may play a role in complex deformity and revision
cases. Further high-quality randomized studies should
be undertaken.
Updates on Residual Limb Management in Lower Extremity Amputation From Nerve to Bone
Blake Schultz, MD, Christian Pean, MD, MS, and Nirmal Tejwani, MD
Traumatic extremity amputation can be devastating for
patients' functional and psychological health. Challenges
of initial management and considerations for limb salvage
versus amputation for mangled lower extremities are well
documented. However, literature geared toward orthopedic
surgeons highlighting management considerations for the
residual limb of an amputation is scarce. This article reviews
recent literature on management of the residual limb in the
perioperative and rehabilitation phases of treatment.
Preoperative Symptom Severity Predicts 5-Year Hip Arthroscopy Outcomes
Berkcan Akpinar, MD, Lawrence J. Lin, BA, David A. Bloom, BS, and Thomas Youm, MD
Purpose: Thisstudy sought to assessthe prognostic effect
of preoperative symptom severity on hip arthroscopy outcomes for femoroacetabular impingement syndrome (FAI).
Methods: Patients undergoing hip arthroscopy between
September 2012 and July 2014 for FAI with a minimum of
5-year clinical outcomes were compiled. Patient reported
outcomes (PROs) including modified Harris Hip Score
(mHHS) and Nonarthritic Hip Score (NAHS) were collected.
High and low preoperative function (PF) subgroups were
created using baseline population median mHHS (43.3) as a
threshold with PROs below the median score indicating low
preoperative function and vice versa for scores above the
median. Kaplan-Meier analysis, Cox proportional modeling,
analysis of variance (ANOVA), and linear regressions were
used for analysis.
Results: One hundred five of 131 eligible patients(80.2%
inclusion; age: 42.6 ± 1.4 years; body mass index: 25.3 ±
0.4 kg/m2
) met the study criteria. The 5-year survival-torevision rate (85% versus 61%, p = 0.013) and survivalto-arthroplasty rate (95% vs. 82%, p = 0.022) were greater
in the high versus low PF group. ANOVA demonstrated the
high versus low PF group had higher baseline (mHHS:
52.7 ± 1.4 vs. 36.1 ± 1.1, p < 0.001; NAHS: 57.4 ± 1.6 vs.
39.3 ± 1.2, p < 0.001) and 1-year (mHHS: 91.9 ± 1.8 vs.
79.5 ± 2.7, p < 0.001; NAHS: 91.7 ± 1.6 vs. 80.8 ± 2.5, p
< 0.001) outcomes. High versus low PF achieved higher
Minimal Clinically Important Difference (77% vs. 57%, p
= 0.026) at 5-years. High versus low PF achieved higher
Patient Acceptable Symptomatic State rates at 1 year (79%
vs. 47%, p < 0.001) and 5 years (66% vs. 45%, p = 0.032).
Linear regression demonstrated body mass index (mHHS:
p = 0.002; NAHS: p = 0.005), pincer resection (mHHS: p
= 0.046), and preoperative symptom severity (mHHS: p =
0.001; NAHS: p = 0.002) to be predictors of 5-year change
in PROs.
Conclusion: Preoperative symptom severity is a reliable
prognostic indicator of clinical survival rates and PROs
after hip arthroscopy for FAI. Subjects with high PF are
likely to have increased longevity of the index procedure
while maintaining excellent PASS and MCID rates mid-term
as opposed to those with low PF.
Temporal, Seasonal, and Monthly Effects on Total Knee Arthroplasty Surgical Site Infection Rates
Jason B. Kreinces, BS, Mackenzie A. Roof, BS, Lorraine Hutzler, MPA, Anna Stachel, PhD,
MPH, Scott Friedlander, MPH, Michael Phillips, MD, and Joseph A. Bosco, III, MD
Background: Deep surgical site infections (dSSI) following total knee arthroplasty (TKA) are associated with
morbidity and poor outcomes. Although numerous patient
and non-patient factors have been correlated with dSSI
development, the temporal and seasonal variability of dSSI
is unclear. The purpose of this study was to investigate the
monthly and seasonal variability of dSSI rates following
TKA.
Methods: The dSSI database at a single large, urban,
academic medical center was reviewed for TKAs performed
between January 2009 and August 2018. The monthly and
seasonal variability of dSSI was evaluated using a Poisson
regression. Additionally, the change in dSSI rate was calculated over the entire study period.
Results: We reviewed 15,230 consecutive TKAs. The average dSSI rate following TKA was 1.11% (SD: 0.91). The
rate of dSSI decreased over the study period (r = 0.94, 95%
CI: 0.85-1.05) but did not reach statistical significance. With
summer as the reference season, there were no significant
differences in the dSSI rate in fall, winter, or spring. With
July as the reference season, there were no differences in
the dSSI rate in any other months of the year.
Conclusion: Although non-significant, this analysis found
a decreasing rate of dSSI after TKA over a nearly 10-year
period. Interestingly, there was no difference in the dSSI rate
following TKA in July as compared to other months or in
summer as compared to other seasons. This conflicts with
previous reports that have found an increased incidence of
dSSI and other complications in July when the graduate
medical education calendar begins.
Clinical Outcomes Following Resection of Distal Lower Extremity Soft Tissue Sarcomas
Charles A. Gusho, BS, Linus Lee, BE, Johnathon R. McCormick, MD, Gordon H. Derman, MD,
Deana S. Shenaq, MD, Amir H. Dorafshar, MD, George Kokosis, MD, Matthew W. Colman, MD,
Steven Gitelis, MD, and Alan T. Blank, MD, MS
Objective: Resection of soft tissue sarcoma (STS) in the
distal lower extremity can result in large soft tissue defects
that create difficult wounds to manage and significant risks
for complications. Often, the anticipated or resultant tissue
defect or loss of functional anatomy is an indication for
amputation over limb salvage. Soft tissue reconstruction
managed by plastic and reconstructive surgery (PRS) may
help offer limb salvage as a therapeutic option with acceptable oncologic outcomes and wound complication rates.
Methods: This was a review of 52 patients who underwent
resection of STS at the level of the knee or distal between
2010 and 2020. Plastic and reconstructive surgery soft tissue
management was utilized in 40.4% (n = 21) of cases, most
of whom would have otherwise been considered candidates
for amputation.
Results: The overall rate of limb salvage was 76.9%. The
overall rate of wound complications was 19.2%. The overall
rate of negative margins of resection was 92.3%. The 1-, 5-,
and 10-year overall survival probabilities were 92%, 85%,
and 85%, respectively. Of the 40 limb salvage procedures,
two required subsequent amputation, one for multiply recurrent disease and one for necrosis. The wound complication
rate was 14.3% in the PRS management group and 22.6%
in cases of wound closure managed by the primary surgeon.
There were zero instances of total wound or flap loss in PRS-
managed closures. When comparing patients with wound
complications to those without, there was no difference in
age (59.5 ± 21 vs. 51 ± 18 years, p = 0.42), body mass index
(31.1 ± 4.8 vs. 26.1 ± 7.1 kg/m2
, p = 0.19), or tumor size (6.8
± 5.0 vs. 6.4 ± 4.7 cm, p = 0.82). At final follow-up, 67% (n
= 35) of patients were alive and disease-free.
Conclusions: Wound complications are not uncommon
after resection of distal lower extremity STS. Our experience has been successful in achieving limb salvage in these
challenging cases. Without PRS soft tissue management,
however, many patients may alternatively be candidates for
amputation.
Impact of a Novel Navigational Technology on Short-Term Patient Outcomes Following Total Knee Arthroplasty A Propensity Matched Cohort Study
Benjamin Fiedler, BA, Vivek Singh, MD, MPH, Alex Tang, BS, Scott Marwin, MD, Morteza
Meftah, MD, and Ran Schwarzkopf, MD, MSc
Purpose: The use of intraoperative technology is increasing among orthopedic surgeons in the United States. However, there is continued debate as to whether intraoperative
technologies provide clinical benefits in patients undergoing
total knee arthroplasty (TKA). This study sought to determine
whether the use of a novel intraoperative navigation technology produces equivalent or superior short-term outcomes
compared to conventional technique.
Methods: Fifty-nine consecutive patients underwent
primary TKA with a novel imageless intraoperative navigational technology between October 2019 and January 2020
at a single, urban, orthopedic specialty hospital. A 1:1 cohort
propensity matching was performed with patients with similar demographics who underwent primary TKA without the
use of technology. Demographics, clinical data, as well as
preoperative and 3-month Knee Injury and Osteoarthritis
Outcome Score, Joint Replacement (KOOS, JR) scores
were collected. Demographic differences, clinical data, and
mean KOOS, JR scores were assessed using chi-squared
analysis for categorical variables and independent sample
t-test for continuous variables.
Results: Upon 1:1 cohort matching, patients in both the
navigational cohorts and non-navigational cohorts were
statistically similar demographically. Length of stay (2.11
vs. 1.71 days; p = 0.108), surgical time (108.89 vs. 101.19
minutes, p = 0.066), discharge disposition (p = 0.675), 90-
day readmissions (4 vs. 4, p = 0.999), and 90-day reoperations (2 vs. 2, p = 0.999) did not statistically differ between
the two matched cohorts. Additionally, KOOS, JR scores
evaluated between the two cohorts preoperatively (46.06
vs. 45.17, p = 0.836) and at 3-month follow-up (57.63 vs.
55.06, p = 0.580) were similar.
Conclusion: This study demonstrates that the use of this
novel intraoperative navigational technology yields similar
short-term TKA results when compared to conventionally
performed TKA. Further studies are required to validate
new technologies and determine their effect on long-term
clinical and patient-reported outcomes.
Outcomes Following Medial Patellofemoral Ligament Reconstruction with Allograft A Systematic Review
Christopher A. Colasanti, MD, Eoghan T. Hurley, MB, MCh, PhD, Delon McAllister, MD,
Bogdan A. Matache, MDCM, FRCSC, Dip Sports Med, Laith M. Jazrawi, MD, Eric J. Strauss,
MD, and Kirk A. Campbell, MD
Purpose: The purpose of this study was to systematically
review the evidence in the literature in order to evaluate the
outcomes following medial patellofemoral ligament (MPFL)
reconstruction with allograft compared to autograft reconstruction.
Methods: A systematic literature search was performed
based on PRISMA guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Inclusion
criteria for the study was clinical studies reporting on
MPFL reconstruction with allograft. Recurrence rate, complications, rate of return-to-play, and functional outcomes
including the Kujala, Tegner, and visual analog scale (VAS)
scores were evaluated. Statistical analysis was performed
using GraphPad Prism 8.3.
Results: Our review identified 12 studies with a total of
336 patient knees meeting the inclusion criteria. The majority of patients were female (61.6%), with a mean age of 22.3
years and a mean follow-up of 43.4 months. The overall
rate of recurrence of lateral patellar instability was 2.7%
in the allograft cohort as compared to 7.8% in the autograft
cohort (p = 0.01). The mean Kujala score was 91.8%, and
the mean VAS score was 1.3 at final follow-up. Additionally,
81.5% of patients were able to return to play in the studies
reporting this outcome measure. The overall complication
rate was 1.4%.
Conclusion: The overall rate of recurrence was lower
following MPFL reconstruction with allograft as compared
to autograft in the treatment of lateral patellar instability.
Additionally, there were excellent patient reported outcomes
and a low complication rate following the use of allograft
for MPFL reconstructionPurpose: The purpose of this study was to systematically
review the evidence in the literature in order to evaluate the
outcomes following medial patellofemoral ligament (MPFL)
reconstruction with allograft compared to autograft reconstruction.
Methods: A systematic literature search was performed
based on PRISMA guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Inclusion
criteria for the study was clinical studies reporting on
MPFL reconstruction with allograft. Recurrence rate, complications, rate of return-to-play, and functional outcomes
including the Kujala, Tegner, and visual analog scale (VAS)
scores were evaluated. Statistical analysis was performed
using GraphPad Prism 8.3.
Results: Our review identified 12 studies with a total of
336 patient knees meeting the inclusion criteria. The majority of patients were female (61.6%), with a mean age of 22.3
years and a mean follow-up of 43.4 months. The overall
rate of recurrence of lateral patellar instability was 2.7%
in the allograft cohort as compared to 7.8% in the autograft
cohort (p = 0.01). The mean Kujala score was 91.8%, and
the mean VAS score was 1.3 at final follow-up. Additionally,
81.5% of patients were able to return to play in the studies
reporting this outcome measure. The overall complication
rate was 1.4%.
Conclusion: The overall rate of recurrence was lower
following MPFL reconstruction with allograft as compared
to autograft in the treatment of lateral patellar instability.
Additionally, there were excellent patient reported outcomes
and a low complication rate following the use of allograft
for MPFL reconstruction
Severe Contour Deformity of the Hip Following Corticosteroid Injection
Lawrence J. Lin, MD, Tiffany X. Chen, BS, Laith M. Jazrawi, MD, and
Ernest S. Chiu, MD, FACS
A 50-year-old woman developed severe soft tissue atrophy
of the hip following a triamincolone acetonide injection to
the greater trochanteric bursa. Saline injection therapy was
initially attempted without improvement and the defect was
ultimately treated effectively with serial fat grafting. Adverse
soft tissue reactions are rare but potentially devastating complications of corticosteroid injections, and the use of soluble
steroid preparations and proper injection techniques can
minimize the risk to surrounding tissue. Serial fat grafting
represents a promising treatment option for severe cases of
steroid-induced soft tissue atrophy.