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Journal of ISAKOS
Number of Followers: 0  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 2059-7754 - ISSN (Online) 2059-7762
Published by BMJ Publishing Group Homepage  [66 journals]
  • Dissecting disparity: improvements towards gender parity in leadership and
           on the podium within the Canadian Orthopaedic Association
    • Authors: Hiemstra, L. A; Wittman, T, Mulpuri, K, Vezina, C, Kerslake, S.
      Pages: 227 - 232
      Abstract: ObjectivesThe purpose of this paper was to analyse the 15-year trend of women in leadership roles within the Canadian Orthopaedic Association (COA). This included not only leadership positions at the committee level in the association but also the more visible podium positions in the annual meeting programme: research podium and poster presentations, session moderators, panellists and faculty.MethodsData on the numbers of male and female members were gathered from COA membership records for the most recent 5 years (2014–2018), as well as for 10 years previous (2009) and 15 years previous (2004). Male and female representation on COA committees, as well as the number of presenters at the annual meeting was calculated. Descriptive data were generated to compare the changes in gender representation over time.ResultsIn Canada, in 2018, 11.2% of orthopaedic surgeons were female. Within the COA, 17.6% of the members are female, with active female surgeons comprising 11.6% of the total membership. The largest increase in representation of women within the COA is in the trainee category which is 25.3% female. At the 2018 annual meeting, 25% of the attendees were women, with 22% of all podium appearances by women. Not including research presentations, women participated as faculty in 11% of the appearances at the 2018 annual meeting.ConclusionIn conclusion, gender parity is not yet a reality in Canadian orthopaedics; however, the number of females in leadership roles and on the podium is consistent with the current gender diversity within the COA membership. Further efforts will be required to improve gender diversity as well as to encourage female medical students to consider orthopaedics as a specialty. The availability of female role models that are visible on the podium and in leadership positions may be one strategy to encourage the journey toward gender parity.
      Keywords: Open access
      PubDate: 2019-09-26T08:42:03-07:00
      DOI: 10.1136/jisakos-2019-000290
      Issue No: Vol. 4, No. 5 (2019)
       
  • Medial and lateral meniscus have a different role in kinematics of the
           ACL-deficient knee: a systematic review
    • Authors: Grassi, A; Dal Fabbro, G, Di Paolo, S, Stefanelli, F, Macchiarola, L, Lucidi, G. A, Zaffagnini, S.
      Pages: 233 - 241
      Abstract: ImportanceMeniscal tears are frequently associated with anterior cruciate ligament (ACL) injury and the correct management of this kind of lesion during ACL-reconstruction procedure is critical for the restoration of knee kinematics. Although the importance of meniscus in knee biomechanics is generally accepted, the influence of medial and lateral meniscus in stability of ACL-deficient knee is still unclear.ObjectiveThe aim of this study was to review literature, which analysed effects in cadaveric specimens of meniscal tear and meniscectomy of medial and lateral meniscus on laxity in the ACL-deficient knee.Evidence review
      Authors performed a systematic search for cadaveric studies analysing the effect of medial and lateral meniscus tears or resection on kinematics of ACL-deficient knee. Extracted data included year of publications, number of human cadaver knee specimens, description of apparatus testing and instrumented kinematic evaluation, testing protocol and results.Findings
      Authors identified 18 studies that met inclusion and exclusion criteria of current review. The major finding of the review was that the works included reported a difference role of medial and lateral meniscus in restraining ACL-deficient knee laxity. Medial meniscus tear or resection resulted in a significant increase of anterior tibial displacement. Lateral meniscus lesions or meniscectomy on the other hand significantly increased rotation and translation under a coupled valgus stress and internal-rotation torque/pivot shift test.ConclusionsMedial and lateral meniscus have a different role in stabilising the ACL-deficient knee: while the medial meniscus functions as a critical secondary stabilisers of anterior tibial translation under an anterior/posterior load, lateral meniscus appears to be a more important restraint of rotational and dynamic laxity.Level of evidenceLevel IV, systematic review of level I–IV studies.
      PubDate: 2019-09-26T08:42:03-07:00
      DOI: 10.1136/jisakos-2019-000293
      Issue No: Vol. 4, No. 5 (2019)
       
  • Evolving indications and reported complications suggest total knee
           arthroplasty after acute and complex periarticular fractures remains a
           high-risk operation: a systematic review
    • Authors: Lau, S; Guest, C, Annabell, L.
      Pages: 242 - 247
      Abstract: ImportanceComplex periarticular fractures of the knee can be difficult to reconstruct with osteosynthesis, can result in poor function and can lead to increased morbidity and mortality—particularly in the elderly. Primary acute total knee arthroplasty (TKA) is a surgical option which is rarely performed, but thought to have high rates of complication postoperatively.ObjectiveTo investigate the literature regarding optimal patient selection for TKA after acute fracture with particular emphasis on postoperative outcomes and complications.Evidence reviewA literature search of the MEDLINE, EMBASE and Cochrane Databases using established methodology for conducting systematic reviews investigating acute TKA after trauma. Two reviewers screened citations using the methodological index for non-randomi zed studies score to determine inclusion, methodological quality assessment and data extraction.FindingsEighteen papers met the inclusion criteria; totalling 284 acute arthroplasty procedures. The majority of cases were performed in elderly females and the most common fracture pattern was the Arbeitsgemeinschaft für Osteosynthesefragen type C. Inclusion criteria for acute arthroplasty—whether fracture or patient specific—was poorly defined. Modular, stemmed and highly constrained (condylar or hinged) prostheses were used. Complications were often seen including 44 deaths within 5 years of surgery and three instances of above knee amputation.Conclusion and relevanceAcute knee arthroplasty can be considered as primary management for an acute periarticular fracture in some cases, although patient selection is vital. These patients should also be viewed similar to fractured neck of femur patients and cared for appropriately.Level of evidence4.
      PubDate: 2019-09-26T08:42:03-07:00
      DOI: 10.1136/jisakos-2019-000297
      Issue No: Vol. 4, No. 5 (2019)
       
  • Presently PROMs are not tailored for athletes and high-performance sports
           practitioners: a systematic review
    • Authors: Rocha Piedade, S; Hutchinson, M. R, Maffulli, N.
      Pages: 248 - 253
      Abstract: ImportanceThe concept of patient-reported outcome measures (PROMs) has come to the forefront in the evaluation of the results of treatment for musculoskeletal ailments, reflecting the concerns of improving patient-centred care. However, athletes and physically active individuals have physical and psychological expectations and goals that differ from those of the general population.ObjectiveThis systematic review aimed to investigate, with no restriction to the type of musculoskeletal sports injury, whether there is a standardisation of how to perform PROMs for athletes and physically active individuals.Evidence reviewA systematic review of the literature was performed searching the following electronic databases—The Cumulative Index to Nursing and Allied Health Literature; Cochrane Library; Embase; Medline-Ovid; Portal Regional da BVS/BIREME; ProQuest Health and Medical Collection; PubMed; SPORTDiscus, Web of Science with no limitations for year of publication up to December 2018. The search terms used were: patient outcomes measures, patient outcomes assessment, sports medicine. The articles were considered eligible according to the following criteria: studies related to populations of regular professional or recreational sports practitioners of any age, surgically managed sports injury, articles reporting PROMS evaluation in at least 50 athletes, postoperative evaluation and articles published in English, French, Portuguese, Spanish and Italian. We excluded systematic reviews, meta-analyses, editorials, articles reporting the results of non-surgical treatment, articles where no PROMS evaluation was performed, abstracts and case reports.FindingsPROMs in athletes and high-performance sports practitioners were not uniform even when the same surgical procedure, such as anterior cruciate ligament reconstruction, was performed. Moreover, this study found 24 different PROMs reported in the 16 selected articles, confirming that, in Sports Medicine, there is a void in PROMs tailored to evaluate the postoperative outcomes regarding the physical and psychological demands of athletes and sports practitioners.Conclusion and relevanceThis systematic review evidences that the 16 selected articles did not present a standardisation in how to evaluate the postoperative outcomes in athletes and high-performance sports practitioners. Moreover, the preinjury status of physical demand reported should be of prime importance in developing PROMs tailored to this group athletes and regular sports practitioner.PROSPERO registration numberCRD42019120701.Level of evidenceLevel IV, systematic review of levels I–IV studies.
      PubDate: 2019-09-26T08:42:03-07:00
      DOI: 10.1136/jisakos-2019-000286
      Issue No: Vol. 4, No. 5 (2019)
       
  • Fair evidence consistently supports open surgical treatment for chronic
           ankle instability: a systematic review
    • Authors: Purcell, C. A; Calder, J, Matsui, K, Andersson, P, Karlsson, J, ESSKA AFAS Ankle Instability Group, Glazebrook, M. A.
      Pages: 254 - 269
      Abstract: ImportancePatients with chronic ankle instability (CAI) who have failed non-operative treatments are most commonly treated with open ankle repair or reconstruction of the anterior talofibular ligament and/or calcaneofibular ligament. Over 50 operative techniques have been described for the treatment of CAI. However, there is no current systematic evaluation of currently used open operative techniques for the treatment of CAI.Aim/ObjectiveThe primary objective of this study is to provide evidence-based treatment recommendations for CAI in adults based on a comprehensive systematic review of the literature.Evidence reviewThe literature review of PubMed, EMBASE, Cochrane and Web of Science databases was completed on 22 February 2017. Search terms included two concepts: lateral ligament of the ankle (patients) and open reconstructive or repair procedures (intervention). All published clinical studies with English translation were included. Biomechanical, cadaveric, review articles, minimally invasive procedures and arthroscopic procedures were excluded. Open operative procedures from included articles were classified as anatomical or non-anatomical and repair or reconstructive. Articles were then assigned a level of evidence (I-V) to denote quality of the research methods. Articles were reviewed collectively to provide a grade of recommendation (A-C or I) in support for or against the operative intervention in treatment of CAI.FindingsSeventy one of 1635 identified articles were included for review. There is fair evidence (Grade B) in support of anatomical repair, anatomical reconstruction and non-anatomical reconstruction procedures. There was insufficient evidence available to grade internal brace and non-anatomical repair procedures.Conclusions and relevanceAlthough only fair-quality evidence exists in support of open operative treatment of CAI, this systematic review helps reassure clinicians of their current practices. The literature reaffirms support for open anatomical repair and anatomical reconstruction technique for CAI.Level of evidenceLevel II, systematic review.
      PubDate: 2019-09-26T08:42:03-07:00
      DOI: 10.1136/jisakos-2018-000265
      Issue No: Vol. 4, No. 5 (2019)
       
  • Restorative procedures for articular cartilage in the ankle:
           state-of-the-art review
    • Authors: Shimozono, Y; Vannini, F, Ferkel, R. D, Nakamura, N, Kennedy, J. G.
      Pages: 270 - 284
      Abstract: Articular cartilage is a highly specialised connective tissue that serves to lubricate joint surfaces and distribute loads across the joint. Injury to articular cartilage is a significant cause of pain and dysfunction that may eventually lead to osteoarthritis or degenerative arthrosis. Management of these injuries is complicated by the complex architecture and poor vascularity of this tissue. The field of articular cartilage restoration has evolved rapidly over the past several decades and current techniques offer promising results. However, despite the fast pace of progress in the treatment and repair of articular cartilage injury, a clear gold standard in management has yet to emerge. Current techniques for managing cartilage injuries discussed in this review include bone marrow stimulation, osteochondral transplantation, chondrocyte implantation, cell-based transplantation, biological augmentation and scaffold-based therapies. Heterogeneity in study design, including surgical procedures, lesion and patient characteristics, cell collection, biologics preparation protocols and outcome measures limits interpretation of results presented in the literature. Therefore, standardisation across research protocols and collaboration among centres will be necessary. This ‘state-of-the-art review’ presents the indications and techniques for managing ankle articular cartilage lesions, as well as future directions and geographical differences in management.
      PubDate: 2019-09-26T08:42:03-07:00
      DOI: 10.1136/jisakos-2017-000163
      Issue No: Vol. 4, No. 5 (2019)
       
  • From painkiller to killer: the 'oxy case
    • Authors: Van Dijk C. N.
      Pages: 173 - 174
      PubDate: 2019-08-28T02:14:32-07:00
      DOI: 10.1136/jisakos-2019-000342
      Issue No: Vol. 4, No. 4 (2019)
       
  • Proximal hamstring tendon avulsion treatment choice depends on a
           combination of clinical and imaging-related factors: a worldwide survey on
           current clinical practice and decision-making
    • Authors: van der Made, A. D; Hölmich, P, Kerkhoffs, G. M. M. J, Gouttebarge, V, DHooghe, P, Tol, J. L.
      Pages: 175 - 180
      Abstract: ObjectivesTo evaluate current practice in the treatment of proximal hamstring tendon avulsions and identify decision-making preferences.MethodsAn invitation to an anonymous e-survey containing 32 questions was sent to 3475 members of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) and the European College of Sports and Exercise Physicians (ECOSEP).ResultsWe received 403 (12%) unique responses with a completion rate of 79%. Participants were orthopaedic/trauma surgeons (90%), sports medicine physicians (7%) or physical therapists (2%). For 83% of the participants, the preferred treatment (ie, surgical or non-operative) depends on the individual case. Participants base their decision-making process on patient- and injury-related factors (decision modifiers). The five most frequently selected decision modifiers that support the choice for surgical treatment were diminished function (84%), neurological symptoms (74%), involved tendons (82%), tendon retraction on MRI (84%) and patient preference for surgery (78%). The majority prefer early surgical repair (2 cm) two-tendon avulsion (ie, common tendon and semimembranosus tendon), is unable to engage in sports or activities of daily life, reports sciatic symptoms and prefers surgical treatment. Surgery is thought to prolong recovery and decrease reinjury risk compared with non-operative treatment and is preferably performed early.Level of evidenceLevel V.
      PubDate: 2019-08-28T02:14:32-07:00
      DOI: 10.1136/jisakos-2019-000292
      Issue No: Vol. 4, No. 4 (2019)
       
  • Exorotated radiographic views have additional diagnostic value in
           detecting an osseous impediment in patients with posterior ankle
           impingement
    • Authors: Dobbe, J. G. G; Streekstra, G. J, Blankevoort, L, Wiegerinck, J. I, Maas, M, Zwiers, R, van Dijk, C. N, On behalf of the Ankle Platform Study Group
      Pages: 181 - 187
      Abstract: ObjectivesA standard lateral radiograph is the first step in the diagnostic workup in patients with posterior ankle pain. Because of overprojection by other structures at suboptimal radiographic projection angle, often an os trigonum is not discovered or erroneously be mistaken for a hypertrophic posterior talar process. The aim of this study was to identify the projection angles at which a radiograph is optimal for detecting bony impediments in patients suffering from posterior ankle impingement.MethodsUsing ankle CT scans of patients with posterior ankle impingement, digitally reconstructed radiographs (DRRs) simulating 13 different radiographic projection angles were generated. The ankle CT scans served as a reference for the detection of an os trigonum and hypertrophic posterior talar process. Members of the Ankleplatform Study Group were invited to assess the DRRs, for presence or absence of an os trigonum or hypertrophic posterior talar process. Diagnostic accuracy and interobserver reliability were estimated for each projection angle. In addition, the diagnostic accuracy of the standard lateral view in combination with the rotated views was calculated.ResultsHigh sensitivity for detecting an os trigonum was found for +15° (90.3%), +20° (81.7%) and +25° (89.7%) degrees of exorotation. Specificity in this range of projection angles was between 89.6% and 97.8%. Regarding the presence of a hypertrophic posterior talar process, increased sensitivity was found for +15° (65.7%), +20° (61.0%), +25° (60.7%), +30° (56.3%) and +35° (54.5%). Specificity ranged from 78.0% to 94.7%. The combination of the standard lateral view in combination with exorotated views showed higher sensitivity. For detecting an os trigonum, a negative predictive value of 94.6% (+15°), 94.1% (+20°) and 96.1% (+25°) was found.ConclusionThis study underlines the additional diagnostic value of exorotated views instead of, or in addition to the standard lateral view in detecting an osseous impediment. We recommend to use the 25° exorotated view in combination with the routine standard lateral ankle view in the workup of patients with posterior ankle pain.Level of evidenceLevel III
      PubDate: 2019-08-28T02:14:32-07:00
      DOI: 10.1136/jisakos-2019-000272
      Issue No: Vol. 4, No. 4 (2019)
       
  • Platelet-rich plasma in orthopaedic sports medicine: state of the art
    • Authors: Milano, G; Sanchez, M, Jo, C. H, Saccomanno, M. F, Thampatty, B. P, Wang, J. H.-C.
      Pages: 188 - 195
      Abstract: Platelet-rich plasma (PRP) is one of the many new developments within the expanding field of regenerative medicine. It aims to improve the process of tissue repair through local delivery of autologous bioactive agents to influence critical physiological mechanisms such as inflammation, angiogenesis or extracellular matrix synthesis. Within orthopaedics and sports medicine, the use of PRP has been rapidly increasing in popularity as patients seek non-surgical approaches to acute and chronic musculoskeletal injury and disease. The popularity of this new treatment option has prompted a rapid increase in research endeavours. Although preclinical studies were encouraging, clinical studies often reported controversial results. The differences in the composition and application techniques of PRP have made comparisons regarding its efficacy difficult and somehow inconclusive. Although PRP appears to be a safe treatment option with potentially beneficial effects to injured musculoskeletal tissues, continuous efforts are needed to identify factors that influence the biological response to PRP treatment. It is likely that in the near future the PRP preparation will be tailored not only to the specific pathology of interest but also to stage of disease. However, the growing emphasis on an evidence-based approach in the sports medicine setting demands additional research efforts before incorporating this technology in routine clinical care. The current review explores the latest findings on PRP efficacy in several musculoskeletal conditions, focusing on results of the highest level of evidence available.
      Keywords: Editor's choice
      PubDate: 2019-08-28T02:14:32-07:00
      DOI: 10.1136/jisakos-2019-000274
      Issue No: Vol. 4, No. 4 (2019)
       
  • Selected Abstracts from the 12th Biennial ISAKOS Congress
    • Pages: 196 - 226
      PubDate: 2019-08-28T02:14:32-07:00
      DOI: 10.1136/jisakos-2019-12THCONGRESSABS2
      Issue No: Vol. 4, No. 4 (2019)
       
  • The case for case reporting
    • Authors: Van Dijk C. N.
      Pages: 121 - 122
      PubDate: 2019-08-19T06:11:08-07:00
      DOI: 10.1136/jisakos-2019-000317
      Issue No: Vol. 4, No. 3 (2019)
       
  • Overnight call is associated with poor resting heart rate and heart rate
           variability in orthopaedic surgeons
    • Authors: Sochacki, K. R; Dong, D, Peterson, L, McCulloch, P. C, Lisman, K, Harris, J. D.
      Pages: 123 - 126
      Abstract: ObjectivesThe purpose of this study was to determine orthopaedic surgery residents’ and attending surgeons’ resting heart rate (RHR) and heart rate variability (HRV) and if there is a correlation between subject-specific variables (age, attending surgeon, resident, postgraduate year (PGY) level, gender, number of calls, total hours worked, and total hours of sleep) and surgeon RHR and HRV.MethodsOrthopaedic surgery residents and attending surgeons at a single institution were prospectively enrolled and provided a validated wearable device to determine hours of sleep, RHR and HRV. Demographic information, hours worked and overnight calls were recorded. Bivariate correlations were determined using the Spearman rank correlation. Multiple linear regression models were constructed to determine the effect of relevant variables. All p values were reported, and a significance level of α=0.05 was used (p
      PubDate: 2019-08-19T06:11:08-07:00
      DOI: 10.1136/jisakos-2019-000273
      Issue No: Vol. 4, No. 3 (2019)
       
  • High accuracy of the osteotomy angle can be achieved without the use of
           calibrated guides when performing anteromedialisation tibial tubercle
           osteotomy
    • Authors: Ackermann, J; Mestriner, A. B, Shu Small, K. M, Sheehy, E, Gomoll, A. H.
      Pages: 127 - 130
      Abstract: ObjectivesTibial tubercle osteotomy (TTO) is a frequently performed procedure for the treatment of patellar instability and allows for chondral defect unloading when performed in conjunction with cartilage repair. Accurate intraoperative execution of the osteotomy is of utmost importance to achieve the desired outcome. The purpose of this study is to validate the intraoperative accuracy of the osteotomy angle of TTO.MethodsBetween January 2007 and May 2017, a total of 212 patients underwent TTO; however, only patients with postoperative axial (magnetic resonance) imaging were eligible for inclusion. Thus, 124 patients (126 knees) (58.5%) were evaluated in this study. The osteotomy angle was assessed by two independent reviewers (fellowship trained radiologist and orthopaedic surgeon) using MRI and compared with preoperative planning.ResultsPatients were on average 32.89 years (range 15–56, SD 9.7) of age at the time of surgery with an equal gender contribution (50% women vs 50% men). Postoperative MRI was conducted at 12.53 months (range 2–91 months, SD 12.2) follow-up. Postoperative MRI-measured osteotomy angles averaged 104.1% of planned angles and showed a high intraclass correlation coefficient of 0.87. The accuracy of the osteotomy cut did not vary with the planned steepness of the cut (p=0.984).ConclusionThis study demonstrates that the high accuracy of the osteotomy angle can be achieved without the use of calibrated guides. Good exposure and visualisation of the TT intraoperatively are paramount for the precision of anteromedialisation TT osteotomy using the Fulkerson’s technique.Level of evidenceLevel IV, retrospective case seriesIRB protocol number2017P001677
      PubDate: 2019-08-19T06:11:08-07:00
      DOI: 10.1136/jisakos-2018-000270
      Issue No: Vol. 4, No. 3 (2019)
       
  • Cryotherapy duration is critical in short-term recovery of athletes: a
           systematic review
    • Authors: Jinnah, A. H; Luo, T. D, Mendias, C, Freehill, M.
      Pages: 131 - 136
      Abstract: ImportanceCryotherapy is one of the simplest and oldest therapeutic methods used to alleviate acute soft tissue trauma and muscle soreness. However, inconsistent outcomes have been reported due to inconsistent protocols.ObjectiveTo determine if various cryotherapy methods lead to enhanced recovery in athletes and identify optimal methods and protocol for short-term recovery in athletes.Evidence reviewPubMed/MEDLINE and SPORTDiscus databases were searched from 1 April 1950 to 31 December 2018. The search algorithm used was: (Icing OR Ice Therapy OR Cryotherapy) AND (Athlete OR Sports) NOT (Case Reports). Inclusion criteria was human clinical studies with level 1–4 evidence, a cohort of at least 20 athletes, who were followed to determine the effect cryotherapy had on performance, pain and/or recovery were included. s, reviews, case reports and conference proceedings were excluded. Seven studies investigating the effect cryotherapy recovery were included. Manual extraction and compilation of demographic, methodology, functional and biochemical outcomes from the studies were completed. Non-randomised trials were assessed using the Methodological Index for Non-Randomised Studies and the randomised were assessed using Oxford quality scoring system.FindingsDecreased pain or muscle soreness was seen with cold water immersion(CWI) when compared with passive recovery. Other outcome variables assessed (biomarkers, functional tests) did not reveal consistent findings. Longer icing times (>10 min) were associated with detrimental effects in muscle power and activity.Conclusions and relevanceDuration is the critical variable in conventional cryotherapy, with prolonged icing leading to immediate detriment in muscle power and activity. Thus, we recommend using ice cryotherapy following exercise for no longer than 10 min for pure hypoalgesia. CWI had a greater benefit on recovery than passive recovery. Furthermore, CWI has a more beneficial effect on recovery in the first 24 hours following exercise versus immediately postrecovery. We recommend using a protocol to include immersion times of 11–15 min in 11°C–15°C (52°F–59°F) water.Level of evidenceLevel III.
      Keywords: Editor's choice
      PubDate: 2019-08-19T06:11:08-07:00
      DOI: 10.1136/jisakos-2018-000259
      Issue No: Vol. 4, No. 3 (2019)
       
  • Selected Abstracts from the 12th Biennial ISAKOS Congress
    • Pages: 137 - 172
      PubDate: 2019-08-19T06:11:08-07:00
      DOI: 10.1136/jisakos-2019-12THCONGRESSABS
      Issue No: Vol. 4, No. 3 (2019)
       
  • Shoulder crane: a new paradigm
    • Authors: Van Dijk C. N.
      Pages: 59 - 60
      PubDate: 2019-05-08T04:01:50-07:00
      DOI: 10.1136/jisakos-2019-000294
      Issue No: Vol. 4, No. 2 (2019)
       
  • Shoulder crane: a concept of suspension, stability, control and motion
    • Authors: Bain, G. I; Phadnis, J, Itoi, E, Di Giacomo, G, Sugaya, H, Sonnabend, D. H, McLean, J.
      Pages: 63 - 70
      Abstract: Framework and suspensory cascadeThis novel model uses the structure and workings of the industrial crane as a simile to explain the function of the human shoulder. As a crane consists of a base, axial tower, boom and suspensory cascade that move and position loads in space, the base consists of the pelvic platform, with outriggers (legs) that provide stability in human body. The axial tower consists of an articulated spinal column and thoracic platform, which are stabilised by the core muscles. The clavicular boom articulates with the anterior thoracic platform and is elevated by the trapezius from the posterior tower. The ‘suspensory cascade’ extends from the skull and cervical spine to the trapezius and on to the clavicle, coracoclavicular ligaments, coracoid process, coracohumeral ligament and humeral head.MotionThe rotator cuff muscles take origin from the scapula and coalesce with each other to form a multilayered rotator cuff tendon and cable, which cups to closely contain the humeral head. The four muscles insert into the common tendon and together share the load to stabilise and mobilise the arm in space. The coracoid is a pulley that allows the scapula to swivel on the coracoclavicular ligaments to enable adjustment of the angle of force transmission delivered by the rotator cuff to the humeral head.Stability and controlThe inferior glenoid and labrum are a fixed organ of compression, which coalesces with the hammock formed by the static inferior glenohumeral ligaments. The rotator cuff and deltoid compress the humeral head onto this static structure.The biceps tendon passes adjacent to the condensations of the coracohumeral ligament to insert into the mobile superior labrum and glenoid. Contraction of the biceps pulls the mobile superior labrum onto the humeral head and tightens the glenohumeral ligaments that wrap around the humeral head at the extremes of motion. The coracohumeral ligament is a sensory organ that interfaces with these structures and is well positioned to work as a servomechanism to redirect the rotator cuff in providing stability, control and motion.Level of evidenceLevel V.
      Keywords: Editor's choice
      PubDate: 2019-05-08T04:01:50-07:00
      DOI: 10.1136/jisakos-2017-000187
      Issue No: Vol. 4, No. 2 (2019)
       
  • Patients treated with surgical irrigation and debridement for infection
           after ACL reconstruction have a high rate of subsequent knee surgery
    • Authors: Brophy, R. H; Huston, L. J, Wright, R. W, Liu, X, Amendola, A, Andrish, J. T, Flanigan, D. C, Jones, M. H, Kaeding, C. C, Marx, R. G, Matava, M. J, McCarty, E. C, Parker, R. D, Wolcott, M. L, Wolf, B. R, Spindler, K. P, MOON Knee Group
      Pages: 73 - 78
      Abstract: ObjectivesThe purpose of this cross-sectional study was to describe the rates of additional surgery and patient-reported outcomes in patients who underwent surgical irrigation and debridement (I&D) for infection following anterior cruciate ligament reconstruction (ACLR) and test the hypothesis that additional surgery is associated with worse patient-reported outcomes.MethodsPatients diagnosed with a postoperative infection following ACLR (defined as one requiring surgical treatment with either a deep or superficial I&D) were identified from a prospective cohort. Both primary and revision ACLRs were included, as well as any graft type (autografts and allografts). Patient-reported outcomes (International Knee Documentation Committee [IKDC], Knee Injury and Osteoarthritis Outcome Score [KOOS] and Marx activity level) and subsequent surgeries were collected at 2-year and 6 year follow-up from the initial ACLR surgery. Baseline demographics and 2-year and 6-year outcomes (from initial ACLR) were compared between patients who did or did not undergo additional surgery subsequent to I&D using Wilcoxon rank-sum tests for continuous variables and Fisher’s exact tests for categorical variables.ResultsTwenty-one of 3210 ACLR patients (0.7%) had a postoperative infection requiring surgical I&D. This group consisted of 12 men and 9 women, mean (SD) age of 25.8 (11.3) years, 18 primary and 3 revision ACLRs and 16 autografts and 5 allografts. The mean time from ACLR to the surgical I&D was 39 days. In these patients, IKDC scores improved from 44±17 prior to initial ACLR to 83±16 at 6-year follow-up (p
      PubDate: 2019-05-08T04:01:50-07:00
      DOI: 10.1136/jisakos-2018-000264
      Issue No: Vol. 4, No. 2 (2019)
       
  • Worker compensation status increases the risk for presence of pain in the
           contralateral knee at final follow-up after arthroscopic knee surgery
    • Authors: van Eck, C. F; Burleson, D, Kharrazi, D. F.
      Pages: 82 - 85
      Abstract: ObjectivesIn patients undergoing arthroscopic knee surgery, it is not uncommon to complain of pain in both the ipsilateral and the contralateral knee. The primary aim of the present study was to evaluate the prevalence of contralateral knee pain in patients undergoing arthroscopic knee surgery. The secondary aim was to identify risk factors for contralateral knee pain in this population.MethodsAll patient who underwent arthroscopic knee surgery between 2015 and 2017 were included. The prevalence of pain in the contralateral knee prior to and at the final follow-up after ipsilateral knee surgery was assessed. The following potential risk factors for contralateral knee pain were evaluated: age, gender, worker comp status, duration of symptoms, pre-operative diagnosis, activity level, history of a fall, use of a walking aid and findings during surgery.ResultsA total of 142 patients met the inclusion criteria. The average age was 45±11 years, 104 patients (73%) were men. Prior to the surgery on the ipsilateral knee, only 1 patient (
      PubDate: 2019-05-08T04:01:50-07:00
      DOI: 10.1136/jisakos-2019-000281
      Issue No: Vol. 4, No. 2 (2019)
       
  • Early resumption of driving within 3 weeks following patient-specific
           instrumented total knee arthroplasty: an evaluation of 160 cases
    • Authors: Nizam, I; Batra, A, Gogos, S.
      Pages: 88 - 92
      Abstract: ObjectivesMost patients want to resume normal activities as soon as possible after total knee arthroplasty (TKA), with driving an integral aspect to re-establish social and recreational independence. This study aimed to determine when patients resumed driving after TKA.MethodsAll patients undergoing patient-specific instrumented (PSI) medial pivot TKA between January 2017 and April 2018 were included. Patients who did not drive were excluded. A detailed questionnaire was sent to patients 2 weeks after surgery to record their driving status. 50 patients were randomly selected to assess flexion at the hip, knee and ankle joints while seated in the driver’s seat of their own vehicle.Results160 patients (female=94 and male=66) with a mean age of 68 years (45–90 years) underwent a PSI TKA (left side [L]=75, right side [R]=85). 73% patients returned to driving within the first 3 weeks after surgery, of which 15 (10%) resumed driving within the first postoperative week, 52 (35%) in the second week and 41 (28%) in the third week. The median time to resume driving following surgery was 3 weeks for both operative sides, with IQR of 2.0 (L) and 1.0 (R).ConclusionA majority of patients resume driving within 3 weeks after undergoing a PSI TKA, regardless of operative side or transmission of vehicle.Level of evidenceIV
      Keywords: Open access
      PubDate: 2019-05-08T04:01:50-07:00
      DOI: 10.1136/jisakos-2018-000268
      Issue No: Vol. 4, No. 2 (2019)
       
  • Congenital internal rotation deformity of the distal femur presenting as
           patellofemoral instability and pain
    • Authors: Zhang, X; Attenello, J, Safran, M. R, Lowenberg, D. W.
      Pages: 93 - 97
      Abstract: ObjectivesFemoral antetorsion, defined as the angle of rotation of the femoral head and neck axis in relation to the transcondylar axis of the distal femur, is a cause for patellofemoral instability and anterior knee pain. Most clinical reports do not distinguish between antetorsion of the femur distal to the isthmus and anteversion of the proximal femur, which is another cause of femoral internal rotational deformity.MethodsThis retrospective observational case series evaluated four cases in three female patients who underwent evaluation of surgical intervention for chronic anterior knee pain since childhood. Physical examination and radiographic images supported the diagnosis of internal rotation deformity at the distal femora in all four cases. Distal femoral derotational osteotomy of 45°, 60° and 30° were performed, respectively. Kujala scoring system for patellofemoral pathology was used to assess the change in knee symptoms before and after the osteotomies.ResultsThis study demonstrated successful treatment of the resultant knee symptoms from femoral antetorsion with distal femur derotational osteotomy in all three patients.ConclusionsPatellofemoral syndrome is multifactorial, and the true anatomic reason for each patient’s individual pathology must be determined before surgery proceeds.Level of evidenceLevel V.
      PubDate: 2019-05-08T04:01:50-07:00
      DOI: 10.1136/jisakos-2018-000260
      Issue No: Vol. 4, No. 2 (2019)
       
  • Determining the force required in arthroscopic evaluation to assess the
           stability of syndesmotic ankle injury: a cadaveric study
    • Authors: DHooghe, P; Chambers, M. C, Hogan, M. V, Musahl, V, Alkhelaifi, K, Montassar, T, Fu, F. H, Kaux, J.-F.
      Pages: 100 - 104
      Abstract: IntroductionThe diagnosis of isolated distal tibiofibular syndesmotic ankle instability proves to be a challenge. Although diagnostic imaging has added value, it is limited in the detection of distal syndesmotic ankle instability. The gold standard remains intraoperative testing through arthroscopic probing while externally stressing the ankle in a sagittal direction. However, no validated arthroscopic guidelines have been established to distinguish a stable from an unstable syndesmotic ankle joint. This cadaveric study presents anatomical and biomechanical data that can help surgeons correctly identify isolated distal syndesmotic ankle instability.ObjectiveThe purpose of this study is to quantify the necessary forces applied during ankle arthroscopy to evaluate syndesmotic instability in freshly frozen cadaveric ankles.MethodsA total of 16 fresh frozen cadaveric (age 58–74 years) ankles were included in the study. A dynamometer was used to measure the force necessary for the shaver tip to be inserted into the distal tibiofibular joint with the ankle in a neutral position. Measurements were performed first with the syndesmosis intact, and again following progressive transection of the syndesmotic ligaments, along with distal fixation.ResultsSignificant differences were noted in the mean force required between the anterior inferior tibiofibular ligament (AITFL)+interosseous ligament (IOL) and no ligament cut methods (p
      Keywords: Open access
      PubDate: 2019-05-08T04:01:50-07:00
      DOI: 10.1136/jisakos-2017-000183
      Issue No: Vol. 4, No. 2 (2019)
       
  • Suture and anchors may be retained during treatment of deep infection
           after rotator cuff repair: a systematic review
    • Authors: Rosen, M. R; Lakehomer, H, Kasik, C. S, Stephenson, K.
      Pages: 108 - 112
      Abstract: ImportanceRotator cuff repairs (RCRs) are one of the most common orthopaedic surgeries performed, and infection is a rare but serious complication. It is important to know the ideal management of infection after RCR.ObjectiveTo systematically review the literature regarding deep infection following RCR to characterise the success and failure rates of irrigation and debridement (I & D), with particular attention focused on potential predictors of failure, retention of suture anchor hardware and the necessity for serial I & Ds.Evidence reviewFour databases (Embase, PubMed, Google Scholar and EBSCOHost) were screened for clinical studies involving the treatment of infection after RCR. A full-text review of eligible studies was conducted. Inclusion and exclusion criteria were applied to the searched studies. Data from the selected studies were combined for comparative analysis to elucidate factors associated with the success of I & D.FindingsWe identified 11 eligible studies involving 172 patients. These studies described the number of I & D procedures necessary for successful treatment of infection after RCR. The mean number of I & Ds while retaining suture anchors and suture material was 2.3, compared with 2.2 I & Ds when removing all hardware. Propionibacterium acnes was the most common organism cultured, seen in 75 of 172 (43.6%) patients. Staphylococcus aureus and S. epidermidis accounted for 40 (23.3%) and 42 (24.4%) cases, respectively.Conclusions and relevanceIn managing infection following RCR, the current literature supports retaining suture anchors and suture material when the prior repair is found intact at the initial I & D. Further studies are necessary to strengthen the evidence for retaining hardware and ensuring there is not a statistically significant difference between the number of I & Ds needed to eradicate infection with the routine retention versus removal of suture anchors in this setting.Level of evidenceLevel IV, systematic review of Level III and IV studies.
      PubDate: 2019-05-08T04:01:50-07:00
      DOI: 10.1136/jisakos-2018-000241
      Issue No: Vol. 4, No. 2 (2019)
       
  • Critical shoulder angle is an effective radiographic parameter that is
           associated with rotator cuff tears and osteoarthritis: a systematic review
           
    • Authors: Kuper, G; Shanmugaraj, A, Horner, N. S, Ekhtiari, S, Simunovic, N, Cadet, E. R, Ayeni, O. R.
      Pages: 113 - 120
      Abstract: ImportanceThe critical shoulder angle (CSA) is a relatively new radiographic parameter correlated with pathologies such as rotator cuff tears and osteoarthritis.ObjectiveThe purpose of this systematic review was to: (1) determine the degree of correlation between the CSA and shoulder pathologies, (2) determine the reliability of measuring CSA between (inter-rater reliability) and within (intrarater reliability) clinicians, (3) assess the accuracy of different imaging modalities used for measuring the CSA and (4) determine the association of CSA with patient outcomes after surgery.Evidence reviewThe electronic databases MEDLINE, EMBASE and PubMed were searched in March 2018 for relevant studies. The results are presented in a narrative summary.FindingsA total of 26 studies and 4563 patients satisfied the inclusion criteria. The majority of CSAs were measured using radiographs (98.2%) in neutral rotation (72.9%). Significant associations (p0.05) of outcomes after the surgical management of shoulder pathologies.Conclusions and relevanceThe CSA is an effective radiographic parameter that is associated with rotator cuff tears and osteoarthritis. Lower CSAs (35°) are associated with primary rotator cuff tears and re-tear after arthroscopic repair. Currently, there is a limited predictive value of the CSA in patient-reported outcomes after rotator cuff repair. The CSA is measured with high intrarater and inter-rater reliability for both radiographs and CT scans. Measuring the CSA using radiographs with the arm in the neutral rotation is currently recommended. Future studies are required to further investigate how best use the CSA to guide patient management and its predictive value.Level of evidenceIV.
      PubDate: 2019-05-08T04:01:50-07:00
      DOI: 10.1136/jisakos-2018-000255
      Issue No: Vol. 4, No. 2 (2019)
       
 
 
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