Promising functional outcomes following anterior cruciate ligament repair with suture augmentation

PURPOSE

There has been a renewed interest in the repair of the torn anterior cruciate ligament (ACL). Purpose of this study was to evaluate the functional outcome of arthroscopic ACL repair with additional suture augmentation (SA), hypothesizing that isolated ACL ruptures would yield superior patient-reported outcome measures (PROMs) compared to those with concomitant meniscal and/or ligamentous injuries.

METHODS

This is a retrospective analysis of 93 consecutive patients (67 female, median age 42 years) who underwent arthroscopic ACL repair with SA between January 2017 and March 2019 for an acute traumatic ACL tear confirmed by magnetic resonance imaging (MRI). Patients with pre- or intraoperative mid-substance or distal ACL tears and/or poor tissue quality of the ACL remnant were not considered for ACL repair but were scheduled for an ACL reconstruction with a tendon autograft. In patients who underwent ACL repair with SA, the SA construct was proximally stabilized with a flip-button and distally with a suture anchor. Surgery was preferably performed on the day of injury and all surgeries were performed by the same surgeon. Postoperative rehabilitation included partial weight-bearing (20 kg) for 6 weeks and immobilization in a brace limited at 90-degrees of knee flexion for 4 weeks. Patient-reported outcome measures (PROMs) were determined using International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Lysholm Score (LS), Tegner Activity Score (TS) and Forgotten Joint Score (FJS). Knee-laxity was assessed using the KT-1000 arthrometer (Med Metrics Corp. Inc., San Diego, USA).

RESULTS

Nine patients underwent revision surgery for a traumatic re-tear (four patients) and chronic instability (five patients) and were excluded from further functional analysis. Functional results of 77 patients (54 female) with a median age of 44 years (IQR 33-51) on the day of surgery were available for follow-up after a median time of 35 months (IQR 33-44). Concomitant injuries were observed in 66 Patients (86%), meniscal injuries in 43 patients (55%) and ligamentous injuries in 50 patients (65%). Median interval from injury to surgery was 1 day (IQR 0-1) with 81% (62/77) of patients being treated within 24 h of injury. The median IKDC was 92 (IQR 86-99), the median LS was 95 (IQR 86-100), the median pre-traumatic TS was 7 (IQR 6-7), the median post-traumatic TS was 6 (IQR 5-7) with a non-significant median difference (TS_Diff) of 0 (IQR 0-1). The median FJS was 95 (IQR 78-98). KT-1000 measurements were available in 34 of 77 patients with a median postoperative laxity compared to the uninjured side of 1 mm (IQR 0-2). Interval from injury to surgery, patients' age, body mass index (BMI), knee laxity and concomitant ligamentous or meniscal injuries had no statistically significant impact on postoperative PROMs (n.s.).

CONCLUSION

Following arthroscopic ACL repair with SA good-to-excellent functional results were observed. However, a failure rate of 10% cannot be neglected and warrants further attention. Concomitant injuries to the meniscus and/or collateral ligaments do not seem to be associated with inferior PROMs.

LEVEL OF EVIDENCE

Level IV.

Assessing the spreading potential of an undetected case of COVID-19 in orthopaedic surgery

BACKGROUND

With the novel coronavirus-induced disease (COVID-19), there is the fear of nosocomial infections and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmissions to healthcare workers (HCW). We report the case of a 64-year-old male patient who underwent explantation of a shoulder prosthesis due to a periprosthetic infection. He was tested SARS-CoV-2 positive 7 days after admission to the orthopaedic department following strict infection control measures, routinely including screening all patients for multi-drug-resistant organism (MDRO) colonization upon admission. Aim of our study is to report on the spreading potential of SARS-CoV-2 in a healthcare setting if standard contact precautions and infection control measures have been established.

METHODS

All HCW with exposure to the patient from day of admission until confirmed diagnosis of COVID-19 were identified and underwent oropharyngeal swab testing for SARS-CoV-2 by real-time RT-PCR.

RESULTS

Sixty-six HCW were identified: nine orthopaedic surgeons, four anaesthesiologists, 25 orthopaedic nurses, five nurse anesthetists, eight scrub nurses, five nursing students, two medical assistants and seven service employees. Fourteen HCW (21%) showed clinical symptoms compatible with a SARS-CoV-2 infection: cough (n = 4), sore throat (n = 3), nasal congestion (n = 3), dyspnea (n = 2), fever (n = 1), headache and myalgia (n = 1). SARS-CoV-2 was not detected in any of the 66 HCW.

CONCLUSION

Hygienic measures and contact precautions, aimed at preventing the spread of MRDO, may have helped to prevent a SARS-CoV-2 transmission to HCW-despite high-risk exposure during intubation, surgical treatment and general care.

LEVEL OF EVIDENCE

IV, case series.

A blue encrustation found on skeletal remains of Americans missing in action in Vietnam

A blue encrustation was found on the repatriated remains of three U.S. Servicemen listed as missing in action (MIA) from Vietnam after 28 years. The identification and origin of the blue material was determined. Scanning electron microscopy with energy dispersive analysis and powder X-ray diffraction identified the material as the mineral vivianite, Fe3 (PO4)2.8H2O. Vivianite has been found often associated with fossilized bone and teeth, but this example is unusual in that it is only the second published forensic example of vivianite growing from human bone after such a short period of time. The presence of vivianite provides information leading to a more complete and accurate understanding of the taphonomic process associated with American MIA remains.

Stature estimation in prehistoric Native Americans of Ohio

In the present report we investigate stature estimation techniques in a sample of 64 (35 male, 29 female) prehistoric Native Americans from Ohio. Because living stature is unknown for these 64 individuals, we use Fully's (1956) anatomical method to provide the best estimates of living stature. In this method all osseous components of skeletal height are measured and soft tissue correction is added. Comparisons of regression equations commonly used for stature estimation in prehistoric Eastern Woodland Native American populations, but developed for East Asian and East Asian-derived populations (using lower extremity components), show that these commonly used equations consistently yield stature estimates 2 to 8 cm in excess of the best estimates from Fully's method. Based on the skeletal height measures of the 64 individuals in the present sample, we develop regression equations for the estimation of stature. These equations yield stature estimates virtually identical to estimates from Fully's method and may prove useful for stature reconstruction in other prehistoric Eastern Woodland Native American populations.

Evaluating residence patterns among prehistoric populations: clues from dental enamel composition

We determined enamel composition (Ca, P, Mg, Cu, Mn, Se, Zn, Al, Sr, Pb) for the mandibular canines of 94 individuals from 4 prehistoric Arikara cemetery populations, collecting the compositional data using scanning electron microscopy energy dispersive x-ray analysis. We examined each of the four samples independently and then pooled them for a group comparison using correspondence analysis. The results indicate significant intrapopulational dispersal, particularly when viewed by age and sex subgroups. When all sites are included for correspondence analysis, a distinctive pattern of adult male dispersal compared to the more tightly clustered adult female and subadult subsample is apparent. We hypothesize that the observed pattern of dispersal indicates local geographic and possible dietary differences among the groups. Furthermore, we hypothesize that the observed differences between males, and females and subadults for each site are the result of a residence pattern of out-migration for males.

Dental caries, enamel composition, and subsistence among prehistoric Amerindians of Ohio

Six populations of prehistoric Amerindians from Ohio are sampled to establish the relationship of enamel composition and dental caries experience. The populations used included groups practicing hunting-gathering-fishing and maize horticulture, and they represent at least two major cultural traditions, the Late Archaic/Glacial Kame (1000-500 BC) and the Fort Ancient and Sandusky Bay Traditions (AD) 1200-1600). Characterization of enamel composition is achieved using scanning electron microscopy energy-dispersive X-ray analysis. Thirteen elements present are quantified, and they are analyzed with respect to each population's subsistence base using correspondence analysis. Evaluations of cariogenic and cariostatic effects of elements are made on the basis of caries frequency comparisons among the populations. Results indicate that zinc, copper, iron, nickel, and calcium-phosphorus ratio distinguish populations exhibiting high, moderate, and low caries frequency as well as discriminate hunter-gathers from maize horticulturalists.

Third trochanter incidence and metric trait covariation in the human femur

The relationship between third trochanter incidence and femoral metric trait covariation has been investigated in a group of 60 left human femora. The experimental sample was constructed so that one group consisted of 15 male and 15 female femora which displayed a third trochanter and a second group consisted of an equal number of sexed long bones which lacked this trait. A battery of ten femoral measurements was sorted according to main effects and interactions and respective covariance matrices were tested for equivalence. Covariance matrices of sorted variables determined not to be significantly different were initially subjected to both ANOVA and MANOVA and subsequently to a principal component analysis. Covariance matrices determined to be significantly different were subjected to a principal component analysis separately. Results of this study indicate that third trochanter incidence is associated with short femora displaying robust proximal diaphyses. The gluteus maximus muscle may act as a primary factor governing third trochanter expression. Further, this infracranial discrete trait appears well suited for human taxonomy studies.

Double-rooted maxillary primary canines

This paper includes morphological descriptions of bifurcated maxillary primary canines. Three major primary canine root types are recognized: A single root without trace of a groove, a root with a faint to distinct labial groove, a root with a broad and deep labial groove in the apical portion of the root.

Cranial variation in the terminal Late Archaic of Ohio

Cranial and mandibular discrete traits and cranial metric traits were collected from 99-125 individuals in eight terminal Late Archaic sites. The analysis of ten metric traits in six samples showed that the samples shared the same generalized variance and that sexual dimorphism in the means of the metric traits was greater than inter-site differences. Since these samples share the same size and shape expression of a complex set of polygenic traits, we hypothesize a historical relationship among these samples. Discrete trait analysis showed a pattern of differentiation among the eight samples. This pattern of differentiation is related directly to the geographical separation between samples, and, as with metric traits, cultural differences do not contribute to the pattern of biological differences. The overall pattern of osteological variation in these samples can be summarized parsimoniously by paraphrasing the first law of geography: All of the terminal Late Archaic populations of Ohio were related to each other, but closer ones were more related than distant ones.