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Duethman NC, Wilbur RR, Song BM, Stuart MJ, Levy BA, Camp CL, Krych AJ. Lateral Meniscal Tears in Young Patients: A Comparison of Meniscectomy and Surgical Repair. Orthop J Sports Med 2021; 9:23259671211046057. [PMID: 34660830 PMCID: PMC8511929 DOI: 10.1177/23259671211046057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/29/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Meniscal tears are common in active patients, but treatment trends and
surgical outcomes in young patients with lateral meniscal tears are
lacking. Purpose: To evaluate treatment trends, outcomes, and failure rates in young patients
with lateral meniscal tears. Study Design: Cohort study; Level of evidence, 3. Methods: Patients aged ≤25 years treated surgically for isolated lateral meniscal
tears from 2001 to 2017 were identified. Treatment trends were compared over
time. International Knee Documentation Committee (IKDC) scores and failure
rates were compared by treatment modality (meniscectomy vs meniscal repair).
Failure was defined as reoperation, symptomatic osteoarthritis, or a
severely abnormal IKDC score. Univariate regression analyses were performed
to predict failure and IKDC scores based on treatment, type and location of
tear, or extent of meniscectomy. Results: Included were 217 patients (226 knees) with a mean age of 17.4 years (range,
7-25 years); of these patients, 144 knees (64%) were treated with
meniscectomy and 82 knees (36%) with meniscal repair. Treatment with repair
increased over time compared with meniscectomy (P <
.001). At a minimum 2-year follow-up (mean, 6.1 ± 3.9 years), 107 patients
(110 knees) had IKDC scores, and analysis indicated that although scores in
both groups improved from pre- to postoperatively (repair: from 69.5 ± 13.3
to 97.4 ± 4.3; meniscectomy: from 75.7 ± 9.0 to 97.3 ± 3.9;
P < .001 for both), improvement in IKDC score was
greater after repair (27.9 ± 13.9) versus meniscectomy (21.6 ± 9.4)
(P = .005). Included in the failure analysis were 184
patients (192 knees) at a mean follow-up of 8.4 ± 4.4 years. The rates of
reoperation, symptomatic osteoarthritis, and failure were not significantly
different between the meniscectomy and repair groups. Conclusion: An increase was seen in the rate of isolated lateral meniscal tear repair in
young patients. IKDC score improvement was greater after repair than
meniscectomy, although postoperative IKDC scores were similar. Symptomatic
arthritis, reoperation, and failure rates were similar between groups;
however, there was a trend for increased arthritis symptoms in patients
treated with meniscectomy, especially total meniscectomy. Treatment
modality, type and location of tear, and amount of meniscus removed were not
predictive of final IKDC scores or failure.
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Affiliation(s)
- Nicholas C Duethman
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan R Wilbur
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryant M Song
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
Background: There is limited literature regarding the treatment of concomitant scapholunate ligament (SL) injuries in acute distal radius fractures (DRFs). We hypothesized that surgical treatment of SL injuries in adult patients with DRFs leads to improved functional outcomes. Methods: A retrospective review was made of 42 adult patients who underwent surgical treatment of a DRF with a SL injury between 2005 and 2013. In all, 39 of the 42 patients sustained an intra-articular DRF (AO B or C). SL injury was diagnosed by SL diastasis > 3 mm on posteroanterior (PA) radiographs, magnetic resonance imaging, or with wrist arthroscopy. Patients were divided into 3 groups: 23 had a SL repair and were treated within 21 days of injury (acute), 8 underwent SL repair greater than 21 days from injury (subacute/chronic), and 11 did not undergo repair (non-operative). Median overall time to clinical follow-up was 5.1 years. Mayo Wrist Scores (MWS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores were used to evaluate functional outcome. Results: Clinical outcomes measured by the MWS at final follow-up (6 months-12 years) showed no significant differences between the 3 groups. Of patients treated acutely, 17.3% had good to excellent MWS. MWS at 1-year follow-up was 68.4, 70, and 64 in the acute, subacute/chronic, and non-operative groups, respectively. DASH scores were 16.7, 14.3, and 11.8 in the acute, subacute/chronic, and nonoperative groups, respectively, at a mean of 7.8 years. Conclusions: At mid-term follow-up, all 3 treatment groups had similar DASH scores to the general population. There were no statistical functional differences between any of the groups based upon MWS or DASH scores.
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Affiliation(s)
| | | | | | | | - Sanjeev Kakar
- Mayo Clinic, Rochester MN, USA,Sanjeev Kakar, Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Duethman NC, Bernard CD, Leland D, Wilbur RR, Krych AJ, Dahm DL, Barlow JD, Camp CL. Multiple Instability Events at Initial Presentation Are the Major Predictor of Failure of Nonoperative Treatment for Anterior Shoulder Instability. Arthroscopy 2021; 37:2432-2439. [PMID: 33812027 PMCID: PMC8985112 DOI: 10.1016/j.arthro.2021.03.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To define the success rate of initial nonoperative treatment for traumatic anterior shoulder instability in a defined U.S. geographic population, describe factors that predict conversion to surgery after initial nonoperative management, and describe the long-term outcomes of nonoperative treatment after the index traumatic anterior instability event. METHODS The Rochester Epidemiology Project database was used to identify patients aged 14 to 39 years treated for anterior shoulder instability between 1994 and 2016. Patient demographic characteristics, comorbidities, injury characteristics, and imaging were evaluated. Patients treated nonoperatively for the first 6 months after the index instability event were analyzed to determine long-term outcomes (recurrence rate, pain at last follow-up, radiographic outcomes), the success rate of continued nonoperative treatment (no conversion to surgery), and factors associated with conversion to surgery (patient and injury characteristics). Survivorship free of surgery was reported with a Kaplan-Meier survival curve, and Cox proportional hazards models were used to evaluate association of variables with conversion to surgery. RESULTS A total of 379 patients met the study criteria, with an average follow-up period of 10.2 years (range, 0.53-25.00 years). The average age was 23.9 years, the mean body mass index was 26.2, and 100% of instability events were due to trauma. Of the shoulders, 79 (20.1%) ultimately failed initial nonoperative treatment and progressed to surgery. At final follow-up, the rate of recurrent instability was 52.3% in the group treated definitively without surgery, and the recurrence rate decreased from 92.4% to 10.1% in patients who underwent conversion to surgical treatment. Factors associated with conversion to surgery included 2 or more subluxations prior to the first evaluation (hazard ratio [HR], 1.82; P = .002), 2 or more dislocations prior to the first evaluation (HR, 1.76; P = .006), and recurrent instability at follow-up (HR, 4.21; P < .001). CONCLUSIONS Most patients younger than 40 years with shoulder instability who were initially treated nonoperatively for 6 months were definitively treated without surgery. Ultimately, 35% of these patients experienced recurrent dislocations after 6 months of conservative treatment and 20% underwent surgical treatment. In most patients who underwent conversion to surgical treatment, surgery was performed within 12.5 years of their first instability event. Patients who experienced multiple instability events before or after consultation were more likely to undergo conversion to surgery after initial nonoperative management. LEVEL OF EVIDENCE Level III, retrospective database review.
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Affiliation(s)
| | | | - Devin Leland
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Ryan R. Wilbur
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Diane L. Dahm
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jonathan D. Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christopher L. Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Address correspondence to: Christopher L. Camp, M.D., Mayo Clinic, 200 First St SW, Rochester MN 55905, Ph: 507-284-8314, Fax: 507-266-1803, , Twitter: @ChrisCampMD
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Hammarstedt JE, Duethman NC, Dennison DG. Pigmented Villonodular Synovitis as an Atypical Cause of Deep Motor Branch Neuropathy. J Orthop Case Rep 2021; 11:80-84. [PMID: 34327172 PMCID: PMC8310647 DOI: 10.13107/jocr.2021.v11.i04.2162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives Compression of the ulnar nerve in Guyon's canal results in ulnar tunnel syndrome (UTS). The patient may present with sensory and motor deficits (zone 1), motor deficit (zone 2), or sensory deficit (zone 3). The most common causes of UTS include ganglion cysts, idiopathic ulnar nerve compression, occupational pressure neuritis (repetitive compression), prolonged compression, hook of hamate fractures, and arterial thrombus or aneurysm. Case Report We report an atypical cause of UTS involving pigmented villonodular synovitis (PVNS) with a review of the literature. Surgical decompression of the ulnar nerve at Guyon's canal has resulted in resolving motor weakness and improved interosseous strength at latest follow-up. Conclusion The most common causes of UTS are ganglion, occupational neuritis, prolonged compression, and ulnar artery thrombi/aneurysms. However, other more rare causes such as PVNS should be considered in the appropriate patient.
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Affiliation(s)
- Jon E Hammarstedt
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA
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Duethman NC, Statz JM, Trousdale RT, Taunton MJ. Reasons for Failure of Primary Total Hip Arthroplasty Performed Through a Direct Anterior Approach. Orthopedics 2020; 43:239-244. [PMID: 32501515 DOI: 10.3928/01477447-20200521-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/14/2019] [Indexed: 02/03/2023]
Abstract
The direct anterior approach (DAA) for total hip arthroplasty (THA) is a technique popular among some arthroplasty surgeons. There is currently a paucity of data regarding reasons for failure of THA using the DAA. The authors conducted a retrospective review of prospectively collected data on 56 patients who underwent revision THA at their institution after failing primary THA that was performed through a DAA either at their institution (n=8) or elsewhere (n=48) from January 1, 2010, to June 1, 2017. Patients were grouped by modes of failure and compared using patient characteristics, surgical factors, and radiographic outcomes. Total hip arthroplasties performed through the DAA failed due to infection in 21 (38%) patients, aseptic/mechanical loosening in 14 (25%) patients, intraoperative fracture in 6 (11%) patients, postoperative fracture in 6 (11%) patients, tendinitis or pain of unknown etiology in 3 (5%) patients, metallosis in 3 (5%) patients, instability/dislocation in 2 (4%) patients, and leg length discrepancy in 1 (2%) patient. Patients who underwent revision due to unrecognized intraoperative fracture had a lower body mass index (BMI) and weight than patients who had failure due to postoperative fracture, aseptic loosening, or infection. The 4 most common modes of failure included infection, aseptic loosening, unrecognized intraoperative fracture, and postoperative fracture. Together, these made up 84% of failed DAA THAs. Patients with a lower BMI are more likely to have failure due to intraoperative fractures. Patients with a higher BMI are more likely to have failure due to postoperative fracture, aseptic loosening, or infection. [Orthopedics. 2020;43(4);239-244.].
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Duethman NC, Aibinder WR, Nguyen NTV, Sanchez-Sotelo J. The influence of glenoid component position on scapular notching: a detailed radiographic analysis at midterm follow-up. JSES Int 2020; 4:144-150. [PMID: 32195477 PMCID: PMC7075770 DOI: 10.1016/j.jses.2019.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Glenoid baseplate and glenosphere positioning may affect scapular notching rates. The purpose of this study was to assess various radiographic parameters and correlate them with scapular notching after primary reverse total shoulder arthroplasty (RTSA) at a minimum follow-up time of 5 years. Methods The study sample included 147 primary RTSA with good-quality postoperative radiographs at least 5 years after implantation (mean follow-up 6.1 years, range 5-12 years). The center of rotation (COR) of the glenosphere in reference to the bone-baseplate interface was medialized in 71 and lateralized in 76 shoulders, with a varus polyethylene opening angle in 134 shoulders. Preoperative and immediate postoperative radiographs were measured to determine (1) glenoid baseplate inclination: α, β, and the reverse shoulder arthroplasty (RSA) angles; (2) glenoid component inferiorization—peg glenoid rim distance (PGRD); and (3) sphere bone overhang distance (SBOD). Scapular notching was graded according to the Sirveaux classification. Results Scapular notching was noted in 98 shoulders (67%) and classified as grade 1 in 46, grade 2 in 25, grade 3 in 20, and grade 4 in 7. There were statistically significant associations between notching and both medialized glenospheres (91% vs. 45%, P = .001) and varus polyethylene angle (P = .0001). The mean postoperative RSA angle, PGRD, and SBOD were 6.6 degrees, 23.8 mm, and +2.6 mm, respectively. Preoperative α and postoperative β, RSA, PGRD, and SBOD were all associated with notching (P < .05). The rate of reoperation was 2.7% at a minimum of 5 years, with reasons for reoperation related to component failure in only one shoulder. Conclusion Scapular notching correlates with glenoid and baseplate inclination, baseplate inferiorization, inferior glenosphere overhang, glenosphere COR, humeral polyethylene angle, and longer clinical follow-up. SBOD is a clinically useful measurement with decreased values associated with notching. It is the superior measurement in implants with eccentric glenospheres. Moderate or severe notching was seen in only approximately 15% of the shoulders. Revision surgery was extremely low in this cohort, and it was not related to notching or instability.
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Affiliation(s)
| | | | | | - Joaquin Sanchez-Sotelo
- Corresponding author: Joaquin Sanchez-Sotelo, MD, PhD, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Statz JM, Duethman NC, Trousdale RT, Taunton MJ. Outcome of Direct Anterior Total Hip Arthroplasty Complicated by Superficial Wound Dehiscence Requiring Irrigation and Debridement. J Arthroplasty 2019; 34:1492-1497. [PMID: 30975479 DOI: 10.1016/j.arth.2019.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Superficial wound dehiscence after total hip arthroplasty (THA) performed through the direct anterior approach (DAA) can be treated with superficial irrigation and debridement (I&D). The incidence and treatment of this complication has been described, but there are little data on the outcomes after a superficial I&D have not been described. The purpose of this paper was to examine the clinical outcomes of DAA THAs requiring postoperative superficial I&D. METHODS A retrospective review of 1573 THAs performed using the DAA were identified utilizing a prospectively collected, single-institution joint registry. Of these 1573 cases, 18 THAs in 18 patients (1.1%) underwent a superficial I&D for superficial wound dehiscence. Outcomes studied included prosthetic joint infection (PJI) after superficial I&D, revisions, re-reoperations, complications, and clinical outcome scores. RESULTS Survivorship from superficial I&D at 1, 2, and 5 years postoperatively was 98.6% at all time points. In the 18 patients who underwent superficial I&D, this was performed an average of 37 (range 12-83) days after their THA. Female gender (hazard ratio 5.5, 95% confidence interval 1.20-32.34, P = .0271) was associated with a higher risk of undergoing superficial I&D as was body mass index >30 kg/m2 (P = .0028), >35 kg/m2 (P < .0001), and >40 kg/m2 (P = .0037). At average follow-up of 2.2 (range 0.2-5.5) years, 0 patients developed PJI. Complications included femoral revision for a painful fibrously ingrown femoral component (1), pulmonary embolus (1), and death from respiratory failure (1). Postoperative Harris Hip Scores averaged score was 86.8 (range 57-99). CONCLUSIONS Superficial wound dehiscence requiring superficial I&D after DAA THA occurs in about 1%-2% of patients with low risk of subsequent PJI.
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Affiliation(s)
- Joseph M Statz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Abstract
The main indication for performing a distal femoral osteotomy is valgus malalignment of the knee joint. The ideal candidates are young and active individuals with isolated lateral compartment arthritis. The goal of the procedure is to create a neutral mechanical axis of the limb to relieve pain and preserve the knee joint. The amount of correction is calculated from a preoperative, high-quality, weight-bearing radiograph from the hip to ankle. This technically challenging operation is a viable option for patients with valgus malalignment because early survivorship is strong and patient-reported outcome scores are significantly improved.
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Affiliation(s)
- Nicholas C Duethman
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA; Department of Sports Medicine, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA
| | - Christopher D Bernard
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA; Department of Sports Medicine, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA; Department of Sports Medicine, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA; Department of Sports Medicine, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA; Department of Sports Medicine, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA.
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