The Segond Fracture as a Vital Diagnostic Tool for Anterior Cruciate Ligament Injury in Acute Settings: A Case Report

A Segond fracture is a specific type of avulsion fracture involving the lateral aspect of the proximal tibia adjacent to the tibial plateau. Segond fractures are indicative of ligamentous injury in the knee. In this case report, a 29-year-old male delivery driver presented to the ED with acute onset right knee pain after losing control of his motorbike at low speed. Examination revealed significant effusion and medial and lateral joint line tenderness. An anterior-posterior radiograph of the knee showed a Segond fracture. Subsequent MRI confirmed a full-thickness anterior cruciate ligament (ACL) rupture and medial collateral ligament (MCL) tear. Despite surgical reconstruction options, the patient chose conservative management. At eight-week follow-up, he demonstrated satisfactory progress. This case highlights the diagnostic significance of Segond fractures in identifying ligamentous damage in the knee without the availability of MRI. It also highlights the feasibility of non-operative management in some instances.

Readability of Online Information on the Latarjet Procedure

Introduction A common complication of first-time or recurrent shoulder dislocations is bone loss at the humeral head and glenoid. Recurrent shoulder instability is often a result of bony defects in the glenoid following shoulder dislocations. In the setting of glenoid bone loss, surgical interventions are generally required to restore stability. The Latarjet procedure is a challenging operation and, due to its complexity, may be associated with operative complications. It can be difficult to explain the procedure to patients in a manner that is easily comprehensible, which may lead to confusion or being overwhelmed with information. Hence, it is important that the information available to patients is easily accessible and perceivable to allow for adequate health literacy. Health literacy is defined as the ability to make health decisions in the context of everyday life. Methods The search engines Google and Bing were accessed on a single day in the month of July 2023, searching the terms "Latarjet surgery" and "Latarjet procedure." For each term on both search engines, the first three pages were evaluated, resulting in a total of 114 websites for review. Out of these, 25 websites met the inclusion criteria and underwent further in-depth analysis through the online readability software, WEB FX. This software generated a Flesch Reading Ease Score (FRES) and a Reading Grade Level (RGL) for each website. Results In our study, the mean FRES was 50.3 (SD ±12.5), categorizing the data as 'fairly difficult to read.' The mean RGL score was 8.12 (SD ±2.35), which exceeds the recommended target. Conclusion In conclusion, the results of this study have demonstrated that the material available on the Internet about the Latarjet procedure is above the recommended readability levels for the majority of the population. Our findings align with similar studies assessing the readability of online patient information. Based on these findings, physicians should provide patients with vetted information to facilitate a better understanding of the procedure, thereby enabling patients to make more informed decisions regarding their health.

Medial-Sided Ligamentous Injuries of the Athlete's Knee: Evaluation and Management

The superficial medial collateral ligament (sMCL) is the most commonly injured ligamentous structure in the knee. The other medial knee stabilizers include the deep medial collateral ligament, the posterior oblique ligament, and the medial meniscus. Medial collateral ligament injuries frequently occur in young athletes. As a result of the good healing capacity of the sMCL, the majority of acute medial-sided knee injuries can be treated nonoperatively with good outcomes. However, missed concomitant injuries can lead to residual laxity and instability of the knee when treated conservatively. When surgical management is warranted, numerous techniques exist, including repair, augmentation, and reconstruction. Recent anatomic and biomechanical studies defining the attachment sites and functional roles of the individual medial knee structures have led to advancements in diagnosis, treatment, and rehabilitation. These studies have allowed for the development of an anatomic reconstruction technique that restores the native stability and load-sharing relationships among the medial knee structures. The purpose of this narrative review is to summarize the recent updates in the anatomy, biomechanics, evaluation, and treatment of ligamentous injuries on the medial side of the athlete's knee.

Evaluating the Early Impact of the COVID-19 Pandemic on Sports Surgery Fellowship Education

Purpose The COVID-19 pandemic forced many hospitals to cancel elective surgeries to minimize the risk of viral transmission and ensure the availability of vital health resources. The unintended consequences of this action on the education and training of orthopaedic sports surgeons are unknown. The purpose of this study is to measure the impact of COVID-19 on orthopaedic sports surgery fellows, their education and training, and their readiness for practice. Methods A comprehensive survey was created and distributed to all U.S. fellows and fellowship directors registered with the American Orthopaedic Society for Sports Medicine. Responses were collected between April 22, 2020, and May 5, 2020. Results Fifty-one sports fellows and twenty-nine sports fellowship directors completed the survey. Over 80.4% of fellows reported a greater than 50% decrease in the case volume since the cessation of elective cases. Average hours worked per week decreased by 58.2% during the pandemic. Fellows reported completing an average of 324.6 ± 97.4 cases prior to the COVID-19 crisis and 86.0% expected to complete at least 11% to 25% fewer cases by graduation compared to previous fellows. 87.5% of fellows were not concerned about their ability to complete their fellowship training but more than one-third of fellows voiced concerns to their fellowship directors regarding their readiness for independent practice. Fellowship directors were generally not concerned that COVID-19 would prevent their fellows from completing the fellowship. At least 54.2% are somewhat concerned about the impact of COVID-19 on their future job opportunities. Conclusions The COVID-19 pandemic has universally affected work hours and case volume of sports fellows. Nevertheless, most sports fellows feel prepared to enter practice and are generally supported by the confidence of their fellowship directors. The results of this survey emphasize the importance of the fellowship year in sports training and highlight the future of online education and simulation as useful adjuncts.

Fifty Most Cited Articles for Femoroacetabular Impingement and Hip Arthroscopy

Growing awareness of femoroacetabular impingement (FAI) and recent innovations in management have resulted in hip arthroscopy becoming one of the fastest-growing orthopedic subspecialties. The purpose of this study was to identify the 50 most cited articles related to the topic of FAI and hip arthroscopy and to analyze their characteristics. The overall number of citations within these articles ranged from 99 to 820. Citation density ranged from 4.41 to 74.55. Seven countries produced these articles with the majority attributed to the United States (n = 26) and Switzerland (n = 18). Clinical studies made up more than half of the top articles (n = 27). The Journal of Bone and Joint Surgery level of evidence most commonly encountered was level IV (n = 24), while the remaining articles were level III (n = 3). No randomized controlled trials or non-randomized controlled trials were encountered in this search. The level of evidence was not significantly correlated with the overall number of citations, publication year, or citation density. The current top 50 list provides orthopedic surgeons interested in hip arthroscopy with an up-to-date core list of the most cited articles in the scientific literature and represents a foundation to use to develop their knowledge regarding hip arthroscopy and FAI.