The American journal of sports medicine
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Anterior-inferior shoulder instability is a common injury in young patients, particularly those practicing overhead-throwing sports. Long-term results after open procedures are well studied and evaluated. However, the long-term results after arthroscopic repair and risk factors of recurrence require further assessment. ⋯ Clinical outcome at a mean follow-up of 13 years after arthroscopic repair of anterior-inferior shoulder instability is comparable with the reported results of open Bankart repair in the literature and allows management of concomitant lesions arthroscopically. Modifiable risk factors of postoperative redislocation and arthropathy must be considered. Stabilization after the first-time dislocation achieves better clinical and radiological outcomes than after multiple dislocations.
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Realignment osteotomies of valgus knee deformities are usually performed at the distal femur, as valgus alignment is considered to be a femoral-based deformity. This dogma, however, has not been proven in a large patient population. Valgus malalignment may also be caused by a tibial deformity or a combined tibial and femoral deformity. ⋯ In contrast to the widespread belief that valgus malalignment is usually caused by a femoral deformity, this study found that valgus malalignment was attributable to tibial deformity in the majority of patients. In addition, a combined femoral- and tibial-based deformity was more common than an isolated femoral-based deformity. As a clinical consequence, varus osteotomies to treat lateral compartment osteoarthritis must be performed at the tibial site or as a double-level osteotomy in a relevant number of patients to avoid an oblique joint line.
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Randomized Controlled Trial
Two-Year Outcomes of a Randomized Trial Investigating a 6-Week Return to Full Weightbearing After Matrix-Induced Autologous Chondrocyte Implantation.
Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated encouraging outcomes in treating patients with knee cartilage defects. Postoperatively, the time required to attain full weightbearing (WB) remains conservative. ⋯ Patients in the AR group who reduced the length of time spent ambulating on crutches produced comparable outcomes up to 24 months, without compromising graft integrity.
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Osteochondral allograft transplantation (OAT) is being performed with increasing frequency, and the need for reoperations is not uncommon. ⋯ In this series, there was a 37% reoperation rate and an 87% allograft survival rate at a mean of 5 years after OAT. The number of previous ipsilateral knee surgical procedures was predictive of reoperations and failure. Of the patients who underwent arthroscopic debridement with an intact graft at the time of arthroscopic surgery, 82% experienced significantly improved outcomes, while 18% ultimately progressed to failure. This information can be used to counsel patients on the implications of a reoperation after OAT.
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Research on the acute effects of a concussion among lacrosse players is limited, and postconcussion patterns between male and female athletes have yet to be clearly established. Differences in the style of play and protective gear worn among male and female lacrosse players potentially confound a direct comparison of sex-based differences in this population. ⋯ Athletes performed more poorly on computerized cognitive screening tools and reported greater symptoms after an acute concussion relative to their baseline performance. Female sex may be a modifier of an acute concussion outcome, given that female athletes in this study performed significantly worse than male athletes across all neurocognitive measures and reported greater symptoms relative to their baseline testing compared with male athletes, regardless of the sport played. Female athletes were also more likely than male athletes to demonstrate scores on neurocognitive testing that exceeded reliable change cutoffs and were predictive of a protracted recovery. The practical significance of these findings should be further verified by prospective longitudinal research given the medium- to large-sized effect demonstrated for the overall relationship between sex and concussions.