The American journal of sports medicine
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Realignment osteotomies of valgus knee deformities are usually performed at the distal femur, as valgus alignment is considered to be a femoral-based deformity. This dogma, however, has not been proven in a large patient population. Valgus malalignment may also be caused by a tibial deformity or a combined tibial and femoral deformity. ⋯ In contrast to the widespread belief that valgus malalignment is usually caused by a femoral deformity, this study found that valgus malalignment was attributable to tibial deformity in the majority of patients. In addition, a combined femoral- and tibial-based deformity was more common than an isolated femoral-based deformity. As a clinical consequence, varus osteotomies to treat lateral compartment osteoarthritis must be performed at the tibial site or as a double-level osteotomy in a relevant number of patients to avoid an oblique joint line.
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There is increasing interest in defining meaningful improvement in patient-reported outcomes. Knowledge of the thresholds and determinants for successful femoroacetabular impingement (FAI) outcomes is evolving. ⋯ The HOS had excellent predictive ability for identifying patient thresholds of achieving the MCID; patients with preoperative scores below identified thresholds were most likely to achieve the MCID. Additionally, anterior acetabular undercoverage, chondral injuries, and relative femoral retroversion were clinically significant negative modifiers of outcomes. These findings have implications for managing preoperative expectations of FAI surgery.
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The time between an anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) may influence baseline knee-related and general health-related patient-reported outcome measures (PROMs). Despite the common use of PROMs as main outcomes in clinical studies, this variable has never been evaluated. ⋯ After controlling for age, sex, competition level, smoking, and BMI, patients in the chronic ACLR group participated in less pivoting and cutting sports but reported better pain/function. Whether decreased activity is deliberate after an ACL injury or patients who undergo chronic ACLR are simply less active and may be treated successfully without surgery warrants further investigation. Nonrandomized studies that utilize PROMs should consider time from injury in study design and data interpretation.
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Observational Study
Unused Opioid Pills After Outpatient Shoulder Surgeries Given Current Perioperative Prescribing Habits.
In the past 16 years, the number of prescription opioids sold in the United States, as well as deaths from prescription opioids, has nearly quadrupled. However, the overall amount of pain reported by patients has not changed significantly. Specific information about opioid prescriptions in the perioperative period is lacking. Of the studies that have been published, investigators have shown that the majority of patients have unused postoperative opioid pills. Moreover, patients appear to lack information about disposal of unused opioid pills. ⋯ Most outpatient shoulder surgery patients who underwent certain operations were prescribed more opioid analgesics than they consumed. Patient education regarding the disposal of opioids was lacking.
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Osteochondral allograft transplantation (OAT) is being performed with increasing frequency, and the need for reoperations is not uncommon. ⋯ In this series, there was a 37% reoperation rate and an 87% allograft survival rate at a mean of 5 years after OAT. The number of previous ipsilateral knee surgical procedures was predictive of reoperations and failure. Of the patients who underwent arthroscopic debridement with an intact graft at the time of arthroscopic surgery, 82% experienced significantly improved outcomes, while 18% ultimately progressed to failure. This information can be used to counsel patients on the implications of a reoperation after OAT.