Keeping you up-to-date on recent headlines in orthopedic healthcare:
Rotator cuff treatment offers relief of tendonitis ... A minimally invasive procedure used to treat tendonitis in the rotator cuff can provide immediate symptom relief to patients, according to researchers at the University of Milan School of Medicine (Milan, Italy). The study findings, published in the July issue of Radiology, suggest that ultrasound-guided nonsurgical therapy significantly reduces pain from calcific tendonitis of the rotator cuff and restores lasting mobility after treatment. "With this treatment, we were able to establish a single inexpensive and effective treatment for calcific tendonitis of the rotator cuff. This has never happened before," co-author Luca M. Sconfienza, MD, said in a press release. "Symptoms improved in patients treated with our procedure compared to nontreated patients." For the 20-minute ultrasound-guided percutaneous therapy procedure, the shoulder is anesthetized and, with ultrasound guidance, a radiologist injects a saline solution into the rotator cuff to wash the area and break up the calcium. A second needle is used to aspirate, or withdraw, the calcium residue. Recovery time is about an hour. For the study, Sconfienza – as well as senior author Giovanni Serafini, MD, from the radiology unit at Santa Corona Hospital (Pietra Ligure, Italy), and colleagues – used ultrasound-guided percutaneous therapy to treat 235 shoulders in 133 women and 86 men (mean age 42 years) with calcific tendonitis. An additional 68 patients (31 men and 37 women) did not receive treatment and acted as a control group. The results showed that treated patients exhibited a considerable reduction in pain and significant improvement in mobility of the affected limb after 1 month, 3 months and 1 year compared to nontreated patients. Five and 10 years after the procedure, the condition of nontreated patients had improved to the point that reported outcomes were similar to those of the treated group.
Clinical pathways improve joint replacement outcomes ... Organizational strategies known as clinical pathways can significantly improve the quality of care, shorten hospital stays, and reduce the cost of hip and knee joint replacements, a meta-analysis found. Use of clinical pathways (also called care pathways or critical pathways) resulted in significantly fewer patients with postoperative complications compared with standard care, according to Antonella Barbieri, of the University of Eastern Piedmont (Novara, Italy), and colleagues. A significantly shorter hospital stay also was associated with clinical pathways, with a weighted mean difference of -2.61 days, the investigators reported in the open access journal BMC Medicine. Critical pathways provide a methodology for mutual decision-making and organization of care for a well-defined group of patients during a specified period. They have been in use since the 1980s, but their potential benefits, especially for expensive, increasingly high-volume procedures such as joint replacement were still unclear. So the researchers performed a meta-analysis of the effects of clinical pathways on specific major outcomes of inhospital joint replacement. It included not only postoperative complications and length of stay, but also the direct costs and rates of discharge home. They included 22 studies, with a total sample of 6,316 patients. The main finding of the meta-analysis, according to the researchers, was that clinical pathways can effectively improve the quality of the care provided to patients undergoing joint replacement. The analysis identified a "strongly significant reduction" in length of hospital stay after implementation of the pathways, again as a consequence of standardized organization of care. The improved organization of care resulting from the use of clinical pathways also explained the decreases in direct costs.
Study: Risks of delaying ACL reconstruction in young athletes too high ... A new study presented at the American Orthopaedic Society for Sports Medicine (Rosemont, Illinois) annual meeting in Keystone, Colorado, in July details the benefits and risks of repairing a torn anterior cruciate ligament (ACL) in young athletes under the age of 14. "The risk of inducing a growth disturbance with early reconstruction of a torn ACL must be balanced against the risk of further knee damage by delaying treatment until closer to skeletal maturity. Our study measured the independent risk factors for and relative risk of meniscal and chondral injuries in pediatric ACL patients," said author, Theodore Ganley, MD, Director of the Sports Medicine and Performance Center for The Children's Hospital of Pennsylvania and the University of Pennsylvania School of Medicine (both Philadelphia). Researchers analyzed the records of 69 patients, 14 years of age and younger who had undergone ACL reconstruction between 1991 and 2005. Data collected included demographics, relevant history (mechanism and side of injury, time from injury to surgery, one or more episodes of instability with activity, use of brace and return to sports), earliest MRI findings and physical exam findings. Operative reports and intra-operative images were also used to classify meniscal and articular cartilage pathology. "In our study, the largest of skeletally immature patients to evaluate independent risk factors, a delay in treatment of more than 12 weeks had about a four-fold increase in irreparable medial meniscus tears, an 11-fold increase in lateral compartment chondral injuries and a three-fold increase in patellotrochlear injuries. Issues with instability in the knee were also increased significantly. Our results highlight and help quantify the risk associated with delaying ACL reconstruction in young athletes and the need for continued injury prevention efforts," said Ganley.
Study says ACL reconstruction doesn't harm NFL career length ... Knee injuries are a common problem in collegiate and professional football, often hindering an individual's career length and future. A study presented at the American Orthopaedic Society for Sports Medicine's (Rosemont, Colorado) annual meeting in Keystone, Colorado suggests that anterior cruciate ligament (ACL) reconstruction versus a simple meniscus repair may predict a longer professional career in those that have suffered knee injuries. "ACL reconstruction is a reliable surgical technique that enables professional football players to have similar length careers as their counterparts without ACL injuries. Although meniscectomy has a shorter recovery time than ACL reconstruction, these surgeries appear to lead to a significantly shorter career with fewer games played in the long term," said lead author Robert Brophy, MD, assistant professor in the Department of Orthopaedic Surgery at the Washington University School of Medicine (St. Louis) and assistant team physician for the St. Louis Rams football team. The study utilized a database containing the injury history and career NFL statistics of athletes from 1987- 2000. Athletes who had a history of meniscectomy and/or ACL surgery and no other surgery or major injury were matched to a control group of athletes without previous surgeries. Athletes were also matched by position, year drafted, round drafted and additional history. Fifty-four athletes with a history of meniscectomies, 29 with a history of ACL reconstruction and 11 with a history of both were identified and matched to controls. The results illustrated that those individuals with meniscectomy on average reduced the length of their careers by about 1.5 years and their games played by 23. Isolated ACL surgery did not significantly reduce the length of years or games played. In those athletes with both surgeries, careers were shortened on average by nearly two years and 32 games. "A combination of ACL reconstruction and meniscectomy may be more detrimental to an athlete's durability than either surgery alone. With further research, we will be able to better understand how these injuries and surgeries impact an athlete's career and what can be done to improve long-term outcomes," said Brophy.
– Compiled by Holland Johnson, MDD