Current Orthopaedic Practice

Analysis of National Football League preseason injuries resulting in roster cuts: a retrospective review Background: The National Football League (NFL) schedule consists of 16 regular season games and four additional preseason games each season. The structure of the NFL preseason allows franchises to evaluate 90 players in four games to determine which 53 should make the final roster. The purpose of this study was to investigate preseason injuries in NFL players and to identify risk factors for being cut from NFL teams after preseason injury. Methods: This study was a retrospective review of all injuries suffered by NFL athletes during the 2014 through 2019 NFL preseasons. The data were compiled using publicly available injury reports published on multiple websites. Results: We identified 110 injuries during the period of study involving players that were later cut from an NFL team during the preseason. The incidence of a preseason injury before being cut from the team was 1.59 per 1000 athletic exposures. The majority of NFL players who were cut after being injured were undrafted free agents (69 players, 63%). Rookies (38 players, 35%) most commonly were cut after being injured. Most athletes cut from NFL teams after preseason injury did not play another year in the NFL (82 players, 75%). The lower extremity was the most frequently injured body area, accounting for 45% (49 players) of all injuries. Conclusions: No prior NFL experience and being undrafted in the NFL draft were two common characteristics identified among athletes that sustained preseason injury and were later cut from the roster. Level of Evidence: Level III.

Clinical tests used to diagnose anterior cruciate ligament tears are less sensitive in obese patients: a retrospective cohort study Background: Anterior cruciate ligament (ACL) rupture is a common athletic injury. Multiple clinical studies have evaluated the sensitivity and specificity of physical examination tests that are used to diagnose ACL injury. We sought to determine if the sensitivity of these clinical tests is affected by a patient's body habitus. We hypothesized that sensitivity of the Lachman, anterior drawer, and pivot shift tests is lower in obese patients than in patients with a normal body mass index (BMI). Methods: We compared the sensitivity of three clinical tests, the Lachman, anterior drawer, and pivot shift, in a group of obese patients with a group of nonobese patients. A total of 181 adult patients who had undergone ACL reconstruction by a single surgeon were included in the study. Results: Sensitivity of the Lachman test was 87.3% in obese patients versus 94.1% in the nonobese control group. Sensitivity of the anterior drawer test was 76.3% in obese patients compared to 88.2% in the nonobese control group. Sensitivity of the pivot shift test could not be accurately assessed because pain and swelling prevented the physician from performing this test in most patients on their initial presentation. Conclusions: The sensitivity of common clinical tests used to diagnose ACL tear, the Lachman, anterior drawer, and pivot shift, is decreased in obese patients compared with the nonobese control group. This study suggests that a clinician may need to have a lower threshold to perform advanced imaging in an obese patient with a suspected ligamentous injury of the knee even if the physical examination is not fully indicative of ligamentous injury. Level of Evidence: Level III.

Jones fractures outcome measurement: a case series Background: Jones fracture of the base fifth metatarsal is one of the most common foot injuries. Delayed union, nonunion and, refracture are all known complications that can occur, and operative intervention then must be considered. Methodology: Seventy-five patients who had recent Jones fractures were treated surgically by intramedullary cannulated screws. Age of the patients ranged from 18 to 40 yr with an average age of 26.4 yr. There were 51 male patients and 24 female patients. Results: All fractures were united within 6 to 12 wk, with an average of 7.2 wk. According to American Orthopaedic Foot and Ankle Society (AOFAS) score, final scores ranged from 95 to 98 points with an average of 97.5 points. An irritant screw that needed to be removed after fracture union was encountered in two patients. Conclusions: The use of primary intramedullary screws is a safe and effective option for patients who have Jones fractures, especially those who need early ambulation and excellent osseous union rates. Level of Evidence: Level IV.

Examining the use of the pressure modulated knee rehabilitation machine (PMKR) with traditional physical therapy versus traditional physical therapy alone following total knee arthroplasty: a randomized control study Background: Total knee arthroplasty (TKA) is considered a successful operation, however, 8% to 25% of patients are not satisfied with their TKA after surgery, with contracture being a common reason. The purpose of this study was to compare range of motion (ROM), patient-reported outcomes, and patient satisfaction between patients who utilized the X10™ Pressure Modulated Knee Rehabilitation (PMKR) machine (X10 Therapy, Franklin, MI) in addition to physical therapy and patients who only had physical therapy after TKA. Methods: Patients were randomized to either the PMKR plus traditional physical therapy group or the traditional physical therapy only group. Patient-reported outcome scores and ROM were recorded at baseline, 2 wk, 4 wk, and 4 mo postoperatively. Patient satisfaction was also assessed. Results: A total of 107 patients underwent TKA surgery (50 PMKR group, 57 traditional therapy alone group). At 4 wk, the PMKR group exceeded the minimally clinical important difference of 5 degrees after TKA; however, this was not sustained at 4 mo. There were no statistically significant differences in the patient-reported outcome scores, but patients in the PMKR group had statistically significantly higher satisfaction. Conclusions: In summary, our results demonstrate that patients who utilize a PMKR machine in addition to traditional physical therapy may have an initial increase in postoperative knee ROM; however, this clinical relevance was not sustained at the 4-month time point. Even though this difference in ROM was not maintained over the entire study, patients who used the PMKR machine had greater satisfaction with their TKA than those who underwent traditional physical therapy alone. Level of Evidence: Level II.

Management of infected nonunions of the femur and tibia with compression-distraction osteogenesis coupled with modern methods at a tertiary military establishment: a prospective case series Background: Infected nonunions pose a daunting challenge to any orthopaedic surgeon. The essence of treatment is a radical debridement for eradication of infection coupled with various approaches to address the bone gap. Bone transport and acute docking along with a corticotomy and distraction osteogenesis have stood the test of time. Our purpose was to evaluate the treatment outcome of the modified Ilizarov technique in infected nonunions of the femur and tibia. Methods: Twenty-six patients with infected femoral and tibial nonunions underwent aggressive debridement and either bifocal compression-distraction osteogenesis or bone transport using an Ilizarov frame. Adjuvant methods such as local antibiotic delivery systems, bone marrow aspirate concentrate (BMAC) injections, pulsatile recombinant parathyroid hormone (PTH) injections, and negative pressure wound therapy (NPWT) were deployed, as deemed necessary, in specific situations. Results: The mean follow-up period was 24.2 mo. The mean time to union was 267.7 days. Union was achieved in 25 cases with complete eradication of infection. Bone results as per the Association for Study of Application of Methods of Ilizarov (ASAMI) scoring system were excellent in 19 patients, good in four, fair in two, and poor in one. The average duration for external fixation was 8.9 mo. Complications occurred in 30.8% of patients. Conclusions: The Ilizarov method, by itself or in combination with modern methods, gives satisfactory bone and functional results. Complication rates depend upon the surgeon's adherence to the cardinal principles of Ilizarov. Level of Evidence: Level IV.

Incidence of radiographic findings of femoroacetabular impingement in a healthy Egyptian population: a cross-sectional study Background: Femoroacetabular impingement (FAI) is a unique pathological problem affecting young adults. It can be defined as the impingement between the proximal femur and the acetabular rim. Although clinical presentation usually is hip pain, it can be asymptomatic. Radiographic FAI findings are quite common in a population of healthy young adults and must be correlated to the clinical presentation. The aim of our study was to evaluate the incidence of radiographic findings of FAI among a cohort of healthy Egyptian participants. Methods: From March 2017 to April 2019, a cross-sectional study was conducted among a cohort of 160 Egyptians (100 men and 60 women) from 20 to 40 yr old. Anteroposterior and frog-leg lateral views were obtained for 320 hips. By using computer software (ICONICO Screen Protractor, ICONICO, Inc., New York, NY), we measured central edge crossover sign alpha angle and the acetabular index. Results: Pincer type FAI was found in 86 hips on the right side (53.27%) and in 104 hips on the left side (65%). Cam type of FAI was found in 54 hips on the right side (34.2%) and in 54 hips on the left side (34.2%). Mixed type was found in 26 hips on the right side (16.25%) and in 32 hips on the left side (20%). Conclusions: Radiographic FAI findings are quite common in Egyptian healthy young adults who have no hip symptoms. Clinical diagnosis is necessary for FAI and must be correlated with the radiographic data. Level of Evidence: Level II.

Outcomes after primary reverse total shoulder arthroplasty in patients with comorbid anxiety and depressive disorders: a retrospective cohort study Background: Current literature generally indicates that anxiety and depressive disorders have negative effects on the outcomes of orthopaedic procedures. We studied a patient population with primary reverse total shoulder arthroplasty (RTSA) to evaluate the effect of these disorders on 2-year outcomes. Methods: Patients were classified as having depression or anxiety by documentation of such in the chart or the use of a prescription mood-stabilizing drug. Pain and function were evaluated with visual analog scale (VAS) and American Shoulder and Elbow Surgeons (ASES) scores, respectively. Data for complications, reoperations, and readmissions were also compiled, and radiographs were assessed for loosening or component failure at the most recent follow-up. Results: Database search identified 112 patients (114 shoulders) with primary RTSA and a minimum of 2-year clinical and radiographic follow-up. Thirty-one patients were categorized as having depression and/or anxiety, and 81 (83 shoulders) did not have these disorders. Significantly more women than men were in the anxiety and depression group (P=0.007). There were no significant differences in other patient demographics or VAS, ASES score, range of motion, or strength at 2-year follow-up (all P>0.05). Three complications occurred in the anxiety/depression group, and 16 occurred in the group without these disorders (P=0.34). Conclusions: Contrary to most current literature, these results suggest that patients with anxiety and/or depression can expect similar outcomes as those of patients without these disorders after primary RTSA. Level of Evidence: Level III.

Predictors of transfusion in adults undergoing elective posterior thoracolumbar spinal fusion: a retrospective case series Background: Posterior thoracolumbar spinal fusion surgery can be associated with significant blood loss. The purpose of this study was to investigate suspected risk factors of blood transfusion in posterior thoracolumbar fusion patients and determine if blood transfusion had a negative impact on the outcomes for those patients after surgery. Methods: All adults undergoing posterior thoracolumbar spine fusion in our institution from May 2015 to May 2018 were included. Data collected included demographic data as well as body mass index (BMI), preoperative hemoglobin, American Society of Anesthesiologists (ASA) classification, change in hemoglobin, estimated blood loss, incidence of blood transfusion, number of units transfused, number of levels fused, length of stay, and readmission within 30 days. The data were analyzed to correlate these variables with the frequency of blood transfusion and to assess the association of adverse outcomes after blood transfusion. Results: This study included 125 patients. Six patients (4.8%) required readmission within the first 30 days after discharge. Length of stay averaged 8.4 days (range 3 to 74). Eighteen patients (14.4%) required blood transfusion perioperatively. When multiple variables were analyzed for any correlations, the number of levels fused, age, and BMI had statistically significant correlations with the need for blood transfusion (P<0.005). None of the other factors showed any statistically significant correlation. Patients who required blood transfusion were more likely to stay in the hospital more than 7 days (P<0.005). Conclusions: Patients undergoing posterior thoracolumbar fusion are more likely to require blood transfusion if they are older, have a higher BMI, or have a multilevel fusion. Receiving a blood transfusion is associated with increased complication rates. Level of Evidence: Level IV.

Accuracy of imageless navigation for functional cup positioning and restoration of leg length in total hip arthroplasty: a matched comparative analysis Background: Computer-assisted navigation has the potential to improve the accuracy of cup positioning during total hip arthroplasty (THA) and prevent leg-length discrepancy (LLD). The purpose of this study was to compare acetabular cup position and postoperative LLD after primary THA using posterolateral approach. Methods: Between August 2016 to December 2017, 57 THAs using imageless navigation were matched with 57 THA without navigation, based on age, gender, and BMI. Postoperative weight-bearing radiographs were assessed for anteversion, inclination, and LLD. Functional LLD was measured in comparison to the contralateral side. The proportion of cups within Lewinnek's safe zone and LLD greater than 5 mm were assessed. Results: The mean age was 54.9±9.6 yr and 57.6±12.5 yr in control and navigated groups, respectively. Mean cup orientation in the navigated group was 20.6±3.3 degrees (17 to 25) of anteversion and 41.9±4.8 degrees (30 to 51) of inclination, versus 25±11.1 degrees (10 to 31) and 45.7±8.7 degrees (29 to 55) in the control group; these were statistically significant (P=0.005 and P<0.001, respectively). In the navigated group, significantly more acetabular cups were placed within Lewinnek's safe zone (anteversion: 77% vs. 47%, P=0.005; inclination: 91% vs. 67%, P<0.001). There was no significant difference in mean LLD in the navigation and control groups (3.2±1.5 mm vs. 4.6±3.4 mm, P=0.36), although fewer LLDs of greater than 5 mm were reported in the navigated group (7.1%) than in the control group (31.6%, P=0.007). Conclusions: The use of imageless computer-assisted navigation improved the accuracy of acetabular cup components and LLD. Level of Evidence: Level III.

Pain and patellofemoral functionality in total knee arthroplasty: a comparative cohort study of two prosthesis designs Background: Total knee arthroplasty designs have changed from the original design, with the goal of becoming as close to normal knee biomechanics and anatomy as possible. Since 2009, Optetrak® Logic incorporated modifications to the previous product Optetrak® PS (Exactech, Gainsville, FL), with a change of the anterior surface of the tibial post of the polyethylene insert and the surface that articulates with the femoral component box. Also, the sagittal geometry of the femoral trochlea was changed, which decreased rates of anterior knee pain and "patellar clunk." The purpose of this study was to determine if there are differences in terms of pain and patellofemoral functionality between Optetrak PS and Optetrak Logic. Methods: A prospective follow-up was performed comparing the results of the Kujala pain and patellofemoral functionality scale. Clinical and functional follow-up was performed in 132 knees (66 from the Optetrak Logic group and 66 from the Optetrak PS group) that underwent total knee arthroplasty from January 2015 to August 2019. Results: Global results of the functional tests were: Oxford postoperative 50; Knee Society Score postoperative 85; Kujala postoperative 76. In comparing the two groups the Kujala score for Optetrak PS was 71 and the Kujala score for Optetrak Logic was 81. Conclusions: Patellofemoral knee pain and functionality before and after total knee arthroplasty must be analyzed with functional scales. The new prosthetic designs are gentler to the patellofemoral joint, and this has been verified by objective analysis with functional scales such as the Kujala scale. Level of Evidence: Level III.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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