Stuart, Michael J

AbstractThe purpose of this study was to determine patient-reported outcomes, hardware removal rates, as well as conversion to arthroplasty at mid-term follow-up following high tibial osteotomy (HTO) with a modern polyetheretherketone (PEEK) system. All PEEK system-based HTOs performed at a single institution between January 2010 and January 2016 with a minimum of 2 years follow-up were reviewed. Rates of postoperative complications, hardware removal and conversion to arthroplasty were calculated. Patient-reported outcomes including visual analog pain scale (VAS), Tegner activity scale, Lysholm, Knee Injury and Osteoarthritis Outcome Score (KOOS), and 36-Item Short Form Survey (SF-36) were obtained. Forty-seven HTOs in 43 patients (mean age: 37.6 ± 10.8 years; 30 M, 13 F) were followed for a mean of 6.0 ± 1.5 years. A total of four postoperative complications occurred in three patients, resulting in an overall complication rate of 6.4%. Hardware removal occurred in three patients at a mean of 0.73 ± 0.53 years after surgery, with overall survival free of hardware removal of 96% (95% confidence interval [CI]: 85–99) at 1 year, 94% (95% CI: 82–98) at 2 years, and 94% (95% CI: 82–98) at 8 years. Conversion to arthroplasty occurred in three patients at a mean of 3.2 ± 1.0 years after surgery, with mean survival of 100% (95% CI: 94–100) at 1 year, 100% (95% CI: 94–100) at 2 years, and 93% (95% CI: 81–98) at 8 years. VAS at rest improved, from 3.1 ± 2.5 preoperatively to 1.1 ± 1.6 postoperatively (p < 0.001). Patients remained active, with a mean Tegner activity scale of 4.4 ± 1.4 at final follow-up and satisfactory Lysholm, KOOS, and SF-36 scores. At mid-term follow-up, medial opening-wedge HTO using a modern PEEK-based system was found to be safe, efficacious, and durable, with satisfactory outcome scores and a low rate of conversion to arthroplasty. PEEK-based implants were found to have low hardware removal rates of 6% at 5 years, which compares favorably to historic metal fixation. This is a Level III study.

AbstractCartilage defects in the knee are common resulting in significant pain and morbidity over time. These defects can arise in isolation or concurrently with other associated injuries to the knee. The treatment of small (< 2–3 cm2) cartilage deficiencies has changed as our basic science knowledge of tissue healing has improved. Advancements have led to the development of new and more effective treatment modalities. It is important to address any associated knee injuries and limb malalignment. Surgical options are considered when nonoperative treatment fails. The specific procedure depends on individual patient characteristics, lesion size, and location. Debridement/chondroplasty, microfracture, marrow stimulation plus techniques, fixation of unstable osteochondral fragments, osteochondral autograft transfer, and osteochondral allograft transplantation, all have roles in the treatment of small cartilage defects.

Fair Play (FP) is a behavioral modification program originally created in Quebec, Canada, by Edmund Vaz when injuries, violence, aggressive infractions, and expense drastically decreased ice hockey registration numbers. He found that emphasizing sportsmanship had the potential to reduce dangerous plays. FP awards teams one additional point in the district standings after each game if the following criteria are met: (a) the team remained below the predetermined penalty minute threshold, (b) a coach was not assessed a game misconduct, and (c) none of the spectators were ejected from the arena. In collaboration with the Mayo Clinic, Minnesota Hockey adopted FP successfully in 2004. However, it was only applied to district games, accounting for just 36% of the games in a team's season. FP is currently a loosely recommended model in tournaments and plays no role in nondistrict games. In a study of two youth hockey tournaments, the tournament governed by intensified FP found significantly fewer head hits than the tournament without FP. Junior gold-level tournaments also experienced fewer injuries and concussions when using FP. Despite its established effectiveness, FP is underutilized by Minnesota Hockey. The Mayo Clinic Ice Hockey Research Team (MCIHRT) has therefore determined that FP requires a complete relaunch. The Minnesota Hockey board members, district leaders, and MCIHRT have agreed that increasing visibility and establishing universal application by Minnesota Hockey leadership are the most urgent needs. The MCIHRT action plan addressing shortcomings includes: (a) making a FP announcement before and after games; (b) publishing shortened, universal booklets solely regarding FP; (c) coordinating a distribution of new booklets to coaches, officials, and players/parents; and (d) creating webpages on all district and association sites including the rules of FP and access to the FP standings. Finally, creative ways to increase FP's power to favorably modify behavior will be solicited.

Hockey is known for speed, skill, hard hits, and fighting. The violence and aggression present in professional hockey contrasts greatly with the skill and finesse of international play. Aggressive behavior across all levels of hockey has devastating long-term consequences resulting from the high prevalence of head trauma. Retired National Hockey League (NHL) players attribute their cognitive difficulties to the repetitive concussive events sustained during their careers. Some retired professional players, such as Daniel Carcillo and Nick Boynton, claim they would trade their name on the Stanley Cup to have known about the long-term consequences of repetitive head trauma. Many retired professional players, such as Ken Dryden, believe the aggressive intent to injure in hockey is completely unnecessary. Junior A hockey is consistently accompanied by a high risk of head trauma. For example, a single Tier III Junior A team experienced thirteen concussions to ten players in one season. Of six players who perceived it “definitely true” that their role on the team was to be an aggressive, forceful, and physical player, four were objectively diagnosed with a concussion during the season. Hypothesized was that intrinsic psychological factors, such as perceived aggression and willingness to fight, and extrinsic factors, such as role modeling by NHL players and feeling pressured by others to fight, contribute to sustaining concussions in hockey. For example, players perceiving themselves as aggressive and physical are at greater risk of concussion than those who see themselves as finesse, skilled players.