Macalena, Jeffrey A.

Objective To analyze the clinical outcomes, knee function, and activity level of patients after treatment of full-thickness cartilage defects involving the patellofemoral compartment of the knee with cryopreserved osteochondral allograft. Design Nineteen patients with cartilage defects involving the patellofemoral compartment were treated. The average age was 31 years (range 15-45 years), including 12 females and 7 males. Patients were prospectively followed using validated clinical outcome measures including Veterans RAND 12-item Health Survey (VR-12), International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Tegner activity scale. Graft incorporation was evaluated by magnetic resonance imaging (MRI) or second-look arthroscopy. Results The cartilage defects included the patella ( n = 16) and the femoral trochlea ( n = 3). Mean VR-12 scores increased from 31.6 to 46.3 ( P < 0.01), mean IKDC increased from 40.0 to 69.7 ( P < 0.01), mean KOOS increased from 53.9 to 80.2 ( P < 0.01), and mean Tegner scores increased from 3.0 to 4.9 ( P < 0.01), at average follow-up of 41.9 months (range 24-62 months). Of the 3 patients who underwent second-look arthroscopy, all demonstrated a well-incorporated graft. Mean MOCART score for the 6 patients with follow-up MRI was 62.5 (range 25-85). The reoperation rate was 21.1% and 2 patients (12.5%) experienced progressive patellofemoral osteoarthritis requiring conversion to patellofemoral arthroplasty. Conclusion Patients with unipolar cartilage defects involving the patellofemoral compartment of the knee can have positive outcomes at minimum 2-year follow-up after surgical treatment with a cryopreserved osteochondral allograft when concomitant pathology is also addressed, but the reoperation rate is high and bipolar cartilage lesions may increase the failure rate.

Objectives: Participation in National Collegiate Athletic Association (NCAA) football is at an all-time high. This population experiences a substantial injury burden with many of these injuries affecting the upper extremities. The NCAA has adopted a data-driven decision-making process when providing recommendations for protecting player safety. The purpose of this study was to describe the epidemiology of hand and wrist injury in NCAA football in an effort to provide meaningful data for tailoring effective injury prevention strategies. Methods: An epidemiologic study utilizing the NCAA Injury Surveillance Program (NCAA-ISP) database was performed to investigate rates and patterns of hand and wrist injury in NCAA varsity football teams participating in the NCAA-ISP from 2009 to 2014. Descriptive statistics were used to present demographic data. Injury rates were calculated per 1000 athlete-exposures (AEs) using statistical cross-referencing between injury-level and event-level data. Injury mechanism and severity, as measured by time-loss from play, were determined and compared between exposure factors such as player position, player seniority, and practice versus game setting. Results: 725 hand and wrist injuries were captured in 899,225 AEs. The observed practice hand and wrist injury rate was 0.51 injuries per thousand AEs, which was significantly lower than the game injury rate of 3.60 (p < 0.01). Comparing player demographics for injuries sustained during practice as opposed to game time revealed significant differences based on player year, player position, activity performed at the time of injury, and mechanism of injury (p < 0.01, Figure 1). Player-on-player contact was the most common injury mechanism reported with blocking being the most common activity at injury. Of all sustained injuries, 71.4% resulted in no time loss from competition whereas 9.8% of injuries resulted in greater than 7 days of time loss. On average, fracture resulted in the greatest time loss from competition (8.3 ± 24.0 days for injuries sustained in practice setting, 7.7 ±15.8 days for injuries sustained in game setting). When comparing injury by location, hand injury resulted in greater time loss (3.7 ± 15.1, 4.4 ± 13.8) than to nail/subungual (0±0, 0±0), finger (1.6 ± 6.7, 1.1 ± 4.2), and wrist injury (1.2 ± 3.8, 1.8 ± 4.9). Conclusion: This study characterizes the incidence of NCAA football hand and wrist injuries in both practice and game settings and demonstrates the relatively low rate of injuries leading to loss of playing time. Hand and wrist injury was found to be significantly more common in games when compared to practice. Offensive linemen were the most commonly affected players in the cohort, with most injuries occurring during game time compared to practice. This study provides valuable prognostic data regarding expected time loss from play on a per injury pattern basis. Further investigation on specific injury subtypes and expected time loss as a result of these injures would provide trainers, players, and coaches with useful information on an expected post-injury recovery and rehabilitation timeline. [Figure: see text]

Background: Participation in National Collegiate Athletic Association (NCAA) football is at an all-time high. This population of athletes experiences a substantial injury burden, with many injuries affecting the upper extremities. Purpose/Hypothesis: The purpose of this study was to describe the epidemiology of hand and wrist injuries in college football players from the academic years 2009–2010 to 2013–2014. We hypothesized that variables such as event type (practice vs game), mechanism of injury, and player position would have an effect on the injury incidence. Study Design: Descriptive epidemiological study. Methods: An epidemiological study utilizing the NCAA Injury Surveillance Program was performed to investigate rates and patterns of hand and wrist injuries in participating varsity football teams from 2009–2010 to 2013–2014. Results: A total of 725 hand and wrist injuries were captured in 899,225 athlete-exposures. The observed practice injury rate was 0.51 injuries per 1000 athlete-exposures, compared with a game injury rate of 3.60 ( P < .01). Player-on-player contact was the most common injury mechanism reported, with blocking being the most common activity at the time of injury. Offensive linemen were most likely to experience an injury. Of all injuries sustained, 71.4% resulted in no time loss from competition, whereas 9.8% of injuries resulted in longer than 7 days of time loss. A fracture resulted in the greatest time loss from competition (mean ± SD, 8.3 ± 24.0 days; median, 0 days [range, 0-148 days] for injuries sustained in a practice setting) (mean ± SD, 7.7 ± 15.8 days; median, 0 days [range, 0-87 days] for injuries sustained in a game setting). Conclusion: Hand and wrist injuries were found to be significantly more common in games when compared with practices. This study provides valuable prognostic data regarding expected time loss on a per-injury pattern basis. Further investigation on specific injury subtypes and expected time loss as a result of these injures would provide trainers, players, and coaches with useful information on an expected postinjury recovery and rehabilitation timeline.

Background: A sterile surgical marking pen is commonly used during anterior cruciate ligament reconstruction (ACLR) to outline the proposed skin incision and then to mark the graft during preparation. Once in contact with the skin, the pen is a potential source of bacterial transmission and subsequent infections after ACLR. Purpose/Hypothesis: The purpose of this study was to assess whether the skin marking pen is a fomite for contamination during arthroscopic ACLR. We hypothesized that there would be a difference in the rate of culture-positive pens between control pens and the study pens used to delineate the proposed skin incision. Study Design: Controlled laboratory study. Methods: Twenty surgical marking pens were collected prospectively from patients undergoing ACLR over a 12-month period. All patients underwent standard preoperative sterile preparation and draping procedures. Proposed incisions were marked with a new sterile pen, and the pen tip was immediately sent for a 5-day inoculation in broth and agar. Negative controls (unopened new pen) and positive controls (used to mark the skin incisions preoperatively) were also cultured. Additionally, blank culture dishes were observed during the growth process. All pens were removed from the surgical field before incision, and new marking pens were used when needed during the procedure. Results: Three of the 20 study pens (15%) demonstrated positive growth. All 3 pens grew species of Staphylococcus. None of the negative controls demonstrated growth, 6 of the 12 positive controls showed growth, and none of the blank dishes exhibited growth. Conclusion: This study found a 15% rate of surgical marking pen contamination by Staphylococcus during ACLR. It is recommended that the skin marking pen not be used for any further steps of the surgical case and be discarded once used. Clinical Relevance: Infections after ACLR are rare but may result in significant morbidity, and all measures to reduce them should be pursued. Surgeons performing ACLR should dispose of the surgical marking pen after skin marking and before intraoperative use such as graft markup.

The patellofemoral joint is an articulation between the patella and the femoral trochlea, which serves to increase the lever arm of the extensor mechanism. The stability of the patella within the trochlear groove is supported statically by the bony confines of the groove itself, as well as the medial patellofemoral ligament, and dynamically by the vastus musculature. Pathologic changes seen on magnetic resonance imaging (MRI) are frequently well correlated with findings found by arthroscopy at the time of surgery. Degenerative changes to the articular cartilage, osteochondral lesions and loose bodies, tears in the retinaculum, and the medial patellofemoral ligament can be seen in MRI and are well correlated with arthroscopy. In addition, other findings that may predispose an individual to injury or degenerative changes over time, such as patella alta and trochlear dysplasia, can also be assessed by MRI and observed arthroscopically.

Purpose To compare microfracture (MFX) and osteochondral autograft transfer (OAT) surgical techniques to determine (1) postoperative activity level, (2) subjective patient outcomes, (3) failure rates, and (4) assess if any lesion characteristics favored one technique over the other. Methods A comprehensive review of literature was performed of all studies comparing MFX and OAT. Studies included were all prospective studies that reported on activity‐based outcome measures such as Tegner activity scores and subjective outcomes such as the International Knee Documentation Committee score. Failure rates, as determined by the publishing authors, were recorded for each study. Meta‐analyses were conducted using a random‐effects model. Paired standardized mean differences (Hedges's g to account for small sample bias) were used for continuous outcome measures, and risk ratios (Mantel‐Haenszel method for small sample bias) for dichotomous outcome measures. Results Six prospective studies satisfied the eligibility criteria and included 249 patients (186 male, 120 female) with an average age of 26.4 years and follow‐up of 67.2 months. Tegner scores were superior in patients treated with OAT compared with MFX (ΔOAT‐MFX for pre‐post scores = 0.94 Tegner points, standardized mean difference [SMD] = 0.469, P = .005). Failure rates of MFX were higher than OAT (OAT = 11%, MFX = 32%, risk ratio = 2.42, P < .036). OAT was superior to MFX at 3 years in relation to subjective outcome scores (SMD = 0.404, P = .008). When assessing OAT lesions larger than 3 cm 2 , OAT was superior to MFX with respect to activity level (SMD = 0.506, P = .001). Conclusions OAT may achieve higher activity levels and lower risk of failure when compared with MFX for cartilage lesions greater than 3 cm 2 in the knee, although there was no significant difference for lesions less than 3 cm 2 at midterm. However, because of variability in patient‐specific factors such as age, preinjury activity level, lesion location and size, the superiority of OAT over MFX cannot be generalized to all patient populations and therefore requires individualized patient care. Level of Evidence Level II, meta‐analysis of Level I and II studies.

Purpose To (1) evaluate long‐term outcomes of osteochondral allograft (OCA) with regard to clinical outcome scores, reoperation and failure rates, and (2) examine if certain factors predispose patients to worse outcomes. Methods A comprehensive review was performed with specific inclusion criteria for studies with long‐term outcomes after OCA. Studies reported on patient clinical scores such as Hospital for Special Surgery score, Knee Society Score (knee and function score), and Lysholm score. Reoperation and failure rates were recorded for each study. Modified Coleman Methodology Scores assessed study methodological quality. Results Five studies with a total of 291 patients (55% male, 45% female) and average age of 34.8 years (range, 15 to 69 years) were included. Of all lesions, 67% were on the femoral condyles, 29% on the tibial plateau, and 4% were patellofemoral. All scores (Knee Society Function Score, Knee Society Knee Score, and Lysholm score) have significant mean improvement from preoperative to final follow‐up. The mean postoperative Hospital for Special Surgery score was 84.1. The mean failure rate was 25% at 12.3 years with a reoperation rate of 36%. A total of 72% of the failures were conversion to total (68%) or unicompartmental (4%) knee arthroplasty and 28% involved graft removal, graft fixation, and graft revision. Patellofemoral lesions (83%) had a significantly higher reoperation rate than lesions involving the tibial plateau or the femoral condyles (34%, P = .01). Conclusions Overall, OCA demonstrated significant improvements in clinical outcome scores and good durability with successful outcomes in 75% of the patients at 12.3 years after surgery. Patellofemoral lesions are associated with decreased clinical improvement and more frequent reoperations. The orthopaedic literature is limited by heterogeneity in surgical technique, lesion and patient characteristics, and reporting of nonstandardized outcome measures. Level of Evidence Level IV, systematic review of Level II and IV studies.