Tummala, Sailesh

Objectives: Prior literature has shown female soccer athletes are at a higher risk for anterior cruciate ligament (ACL) rupture. This risk persists even after primary ACL reconstruction (ACLR), given increased graft failure rates seen in this population. Thus, augmentation strategies such as lateral extra-articular tenodesis (LET) have gained increasing attention, but there is limited data in high-risk female soccer. The primary outcome of this study was to compare the graft failure rates and patient outcomes of ACLR with LET augmentation compared to isolated ACLR in female soccer players. Methods: A cohort of female soccer athletes who underwent ACLR was retrospectively analyzed. Participants were divided into two groups: those who received ACLR alone (control) and those who received ACLR with LET. Exclusion criteria included patients who were not involved in competitive soccer at the time of surgery or had less than 2-years follow-up. Patient demographics and physical exam findings, including the pivot shift results, were collected. Patient outcomes included graft failure, International Knee Documentation Committee (IKDC) and Lysholm scores, return to sport rates, and complications. Independent t-tests and chi-squared tests were conducted to compare outcomes between the two groups. Results: A total of 133 female soccer players who underwent ACLR and met inclusion criteria were identified, with 43 patients receiving LET and 90 patients undergoing sole ACLR. The LET cohort had a higher mean Beighton score (3.0 vs. 1.5; P<0.001) and greater proportion of generalized ligamentous laxity (48.8% vs. 18.9%; P<0.001). There were no significant differences between the two cohorts in age, level of competition, type of graft used, or meniscal intervention (P>0.05). Average follow-up was 39.0 and 36.1 months in the LET group and the control group, respectively. Final postoperative IKDC scores were greater in patients who received LET compared to those who did not (91.3 vs. 88.3; P=0.012). Further, there was a lower rate of graft failure, indicated by a confirmed ACL re-tear or a positive post-operative pivot shift, in patients who underwent LET compared to the control group (14% vs. 31.1%; P=0.036). The presence of positive post-operative pivot shift was also lower in the LET group compared to the control (9.3% vs. 27.8%; P=0.023). There were no significant differences in the rates of complications between the two groups (P>0.05), except for 9.3% of the LET patients developing a hematoma at the LET site. Conclusions: LET augmentation in ACLR is associated with a reduced graft failure rate and decreased post-operative rotational instability in female soccer athletes regardless of graft type used. This augmentation strategy may enhance the stability of the knee joint and help improve clinical outcomes, suggesting its potential as a standard adjunctive procedure for female soccer players undergoing primary ACLR.

Background: The increased focus on patient satisfaction has led to growth in the use of physician rating websites. Purpose: To analyze the factors associated with online 5-star patient reviews for orthopaedic sports medicine surgeons. Study Design: Cross-sectional study. Methods: A total of 70 orthopaedic sports medicine surgeons were randomly selected from the AOSSM website. A search was performed for these surgeons on Yelp.com. All reviews other than 5 stars (of a possible 5 stars) were excluded from the study. Each review was categorized as referring to a surgical or nonsurgical aspect of care, and each comment within the review was categorized as being clinically or nonclinically related. Comments were further subcategorized by specific features such as bedside manner, clinical outcomes, and patient education. Categorical variables were analyzed using the chi-square test. Results: Overall, 400 five-star reviews were included in the study, comprising 1225 total positive comments. Of the 400 five-star reviews, 200 (50%) were from surgically treated patients, and 200 (50%) were from nonsurgically treated patients. Of the 1225 positive comments, 505 (41%) were clinically related, and 720 (59%) were nonclinical. The most common positive clinical comments were for clear treatment plans (191 reviews [48%]), good outcomes (173 reviews [43%]), and providing alternative treatment plans (55 reviews [14%]). The most common positive nonclinical comments were for good physician bedside manner (287 reviews [72%]), friendly/professional staff (194 reviews [49%]), and ease of scheduling (68 reviews [17%]). Conclusion: The majority of 5-star patient reviews left positive comments regarding nonclinical aspects of care such as physician bedside manner and friendly staff. The most common positive comments regarding clinical aspects concerned good outcomes and clear treatment plans. The overall most common positive comment, in both surgically and nonsurgically treated patients, referred to good bedside manner.

Background: Reliable methods for measuring range of motion is important for hand therapists. Currently, there is no gold standard for the measurement of thumb metacarpophalangeal joint (MCPJ) hyperextension. We hypothesised that visual and goniometric measurements of thumb MCPJ hyperextension vary greater than 10° from radiographic measurements, and between observers. Methods: Twenty-six fresh-frozen hands were measured by a senior orthopaedic resident and fellowship trained hand surgeon. Passive thumb MCPJ hyperextension was measured by visual estimation, goniometry and axis measurement on a lateral thumb radiograph. Raters were blinded to each other’s and their own prior measurements. Descriptive statistics were recorded for measurement type and inter-observer agreement using a two-way intra-class correlation coefficient (ICC). Intra-observer agreement was calculated using concordance correlation coefficient (CCC). Bland–Altman plots identified trends, systemic differences or potential outliers. Results: Mean measurements for both raters were similar for visual estimation and radiographic measurements. Mean goniometric measurements were twice as high for Rater B, and closer to radiographic measurements. For both raters, mean radiographic measurements were 10° greater than the other two methods. For inter-rater agreement, measurements were within 10° most frequently with radiographic measurement, then visual estimates, and least by goniometer measurements. Rater B had better agreement comparing visual and goniometric to radiographic measurements. Conclusions: Radiographic measurement has the best inter-observer agreement and precision for evaluating passive thumb MCPJ hyperextension, especially considering adjunct corrective procedures when performing a soft-tissue basal joint arthroplasty. Rater experience improves precision, but there is still poor agreement between visual estimates and goniometer measurements compared to radiographic measurements, as the former two underestimate hyperextension by 10°. Development of a standard method of clinical measurement is needed to improve reliability.

Purpose To systematically review the literature to examine current understanding of the meniscofemoral ligaments (MFLs), their function, their importance in clinical management, and known anatomical variants. Methods A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines using PubMed, EMBASE, and Cochrane databases. Studies were included if they reported on the biomechanical, radiographic, or arthroscopic evaluation of human MFLs, or if they reported on an anatomical variant. These were then categorized as cadaveric, radiographic, or clinical. Biomechanical, radiographic, patient‐reported, and functional outcomes data were recorded. Results Forty‐seven studies were included in the qualitative analysis, and 26 of them were included in the quantitative analysis. Of these, there were 15 cadaveric, 3 arthroscopic, and 9 radiographic studies that reported on the prevalence of MFLs. Overall, when looking at all modalities, the presence of either the anterior or posterior MFL (aMFL, pMFL) has been noted to be 70.8%, with it being the aMFL 17.4% and the pMFL 40.6%. The presence of both ligaments occurs in approximately 17.6% of individuals. Eleven reported on mean MFL length and thickness. When evaluating mean length in both men and women, the aMFL has been reported between 21.6 and 28.3 mm and the pMFL length in this population is between 23.4 and 31.2 mm. Five reported on cross‐sectional area. Nine additional papers report anatomical variants. Conclusions This review shows that there continues to be a variable incidence of MFLs reported in the literature, but our understanding of their function continues to broaden. A growing number of anatomic and biomechanical studies have demonstrated the importance of the MFLs in supporting knee stability. Specifically, the MFLs serve an important role in protecting the lateral meniscus and augmenting the function of the posterior cruciate ligament. Clinical Relevance Our findings will aid the clinician in both identifying and treating pathologies of the meniscofemoral ligaments.

AbstractWhile much detail is known about each anatomic structure of the knee and its contributory effect on biomechanics, our understanding is still evolving. In particular, the function of the meniscofemoral ligaments and their anatomical variants have yet to be fully described. In this report, a never‐before‐described anatomical meniscofemoral ligament variant intra‐substance to the PCL is presented. Arthroscopists should be aware of the novel variant as a growing number of studies have demonstrated the biomechanical importance of the meniscofemoral ligaments in protecting the lateral meniscus and supporting the function of the PCL.Level of Evidence: IV.