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featured article:
american journal of sports medicine
SEPTEMBER 2020

empty pill bottle

Can We Eliminate Opioid Medications for Postoperative Pain Control? A prospective, surgeon-blinded, randomized controlled trial in knee arthroscopic surgery.

Matthew Hartwell, et al. Am J Sports Med. 2020; 48(11): 2711-2717.

This study performed at the Feinberg School of Medicine at Northwestern University in Chicago examines the amount of opioid tablets utilized by patients undergoing partial meniscectomy.  115 patients were randomized into two groups.  All patients were instructed on multimodal pain management using aspirin, acetaminophen, and naproxen.  Group 1 was electronically prescribed oxycodone.  Group 2 was given a physical prescription for oxycodone which was optional to fill.

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RESULTS: There was no significant difference in the number of opioid tablets utilized by the different groups.  The majority (89%) of patients provided with the option of filling a prescription for opioid medications ended up filling the prescription.   Of the 1,820 tablets prescribed, only 380 (21%) were utilized.  35 patients (37%) did not take any opioid tablets after surgery.

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My Big Takeaway: Yes, we can eliminate opioid pain medications following arthroscopic partial meniscectomy.  Pain can be adequately controlled with a multimodal pain management strategy (aspirin, acetaminophen, naproxen).  79% of opioid tablets prescribed for pain control following arthroscopic partial meniscectomy are unused.

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My Other Takeaway: When given a prescription by a physician, most patients will fill the prescription whether or not the medication is needed.  One method to minimize use of opioid medications after surgery is for surgeons to discuss a multimodal pain management strategy with patients prior to surgery and not prescribe opioids.

featured article:
american journal of sports medicine
AUGUST 2020

graft tissue used for ACL reconstruction surgery

Allograft Donor Characteristics Significantly Influence Graft Rupture After Anterior Cruciate Ligament Reconstruction in a Young Active Population.

Sarah Shumborski et al. Am J Sports Med. 2020; 48(10): 2401-2407.

This cohort study performed in Syndey, Australia examined the ACL graft rupture rates in 179 patients, aged 13-25 years, who underwent ACL reconstruction using fresh-frozen, non-irradiated allograft.

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RESULTS: 42 patients (23.5%) sustained an ACL graft rupture within 24 months.  Single-strand grafts had higher rates of rupture (Achilles 27.5%, Bone-patellar tendon-bone 35.1%) than multi-strand grafts (Tibialis anterior 8.1%, Tibialis posterior 16.0%).

 

Graft rupture was also higher when the allograft was obtained from a female donor 50 years or older (52.6%).  There was no difference in graft rupture rates between donor sex when the donor was under 50 years old (male 18.9%, female 20.0%).

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Big Takeaway: Use of allograft for ACL reconstruction has a high rate of rupture.  Patients must be informed of this risk when choosing a graft prior to ACL reconstruction.

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Other takeaway: If allograft is chosen, then the allograft must be obtained from a donor under 50 years of age.

featured article:
american journal of sports medicine
june 2020

picture from arthroscopic camera during rotator cuff repair surgery

Does the Dog-Ear or Bird-Beak Deformity Remodel AFter Rotator Cuff Repair?

Yong Bok Park et al. Am J Sports Med. 2020; 48(7): 1575-1582.

This retrospective cohort study performed at Samsung Medical Center in Seoul, Republic of Korea evaluates the remodeling potential and outcomes of dog-ear and bird-beak deformities that can occur following transosseous-equivalent arthroscopic rotator cuff repair surgeries.  MRI evaluation was performed at 1 week and 6 months postoperatively.  Clinical assessment was performed with minimum 2 year followup.

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RESULTS: Dog-ear and bird-beak deformities up to 13.7mm remodel between 1 week and 6 months postoperatively.  There were no differences in retear rates and clinical outcome between rotator cuff repairs with a deformity and without a deformity.

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Big Takeaway: Surgeons do not need to take extreme measures in an attempt to correct small dog-ear and bird-beak deformities.

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Other takeaway: The retear rate, evaluated by MRI 6 months postoperatively, was 8.7% (4 out of 46 shoulders) in the no deformity group and 7.5% (4 out of 53 shoulders) in the deformity group.

featured article:
american journal of sports medicine
july 2020

illustration of surgical preparation of quadriceps tendon graft for ACL reconstruction surgery

Anterior Cruciate Ligament Reconstructions with Quadriceps Tendon Autograft Result in Lower Graft Rupture Rates but Similar Patient-Reported Outcomes as Compared with Hamstring Tendon Autograft.

Armin Runer et al. Am J Sports Med. 2020; 48(9): 2195-2204.

This prospective cohort study performed in Innsbruck, Austria evaluates the outcomes of ACL reconstruction in 875 patients with 2 year follow up.  Outcomes measured were rate of rupture of the ACL graft, visual naalog pain scale scores, Lysholm scores, and Tegner activity scores.

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RESULTS: Odds of graft rupture were 2.7 times greater in patients treated with ACL reconstruction with hamstring autograft as compared to quadriceps tendon autograft.  Other factors that increase risk of graft rupture were younger age and higher activity level.  There were not differences in the other patient-reported outcomes.

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Big Takeaway: Use of quadriceps tendon autograft for ACL reconstruction is favored over hamstring tendon autograft.

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Other takeaway: Further research is needed comparing quadriceps tendon autograft to bone-patellar tendon-bone autograft for ACL reconstruction.

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