Editorial Commentary: Meniscal Cartilage Suture in the Anterior Cruciate Ligament Reconstructed Knee; To Absorb or Not to Absorb: That Is the Question

When considering repair of the meniscal cartilages of the knee, the indications for repair must be carefully considered. The morphology of the tear, the zone of injury, and likely vascularity have an impact on patient selection. Patient factors, chronicity of tear, medial or lateral tear, and tear complexity all have a bearing on whether to repair or resect and how best to achieve stable repair. The consequences of meniscectomy are well established, and meniscal tissue resection comes at a cost. The success rates of meniscal cartilage repair are greater when performed in conjunction with anterior cruciate ligament reconstruction. Patient outcomes are better for anterior cruciate ligament reconstruction when performed with meniscal repair than when partial meniscectomy is performed. The optimal configuration of sutures, the suture material used, and the type of suture technique are all important considerations. The focus of this commentary is on the use of absorbable versus nonabsorbable suture material.     

Editorial Commentary: Arthroscopic Ankle Arthrodesis Requires Intraoperative Deformity Correction: Size of the Deformity Is Not the Primary Determinant of Outcome

Traditional teaching has told us that arthroscopic ankle arthrodesis is reserved for those patients with severe osteoarthrosis but minimal deformity. However, it is not the size of the deformity that matters; rather, it is the ability to correct the deformity intraoperatively that leads to satisfactory results. Preoperative identification of those patients with significant deformity that can be corrected with an arthroscopic approach would allow for improved selection and likely lead to better patient-reported outcomes and fewer complications.     

Trauma Risk Score Matching for Observational Studies in Orthopedic Trauma

ObjectivesTo determine if matching by trauma risk score is non-inferior to matching by chronic comorbidities and/or a combination of demographic and patient characteristics in observational studies of acute trauma in a hip fracture model.DesignRetrospective cohort studySettingLevel-1 Trauma CenterPatients1,590 hip fracture [AO/OTA 31A and 31B] patients age 55 and over treated between October 2014 and February 2020 at 4 hospitals within a single academic medical center.InterventionRepeatedly matching randomized subsets of patients by (1) Score for Trauma Triage in Geriatric and Middle-Aged (STTGMA), (2) Charlson Comorbidity Index (CCI), or (3) a combination of sex, age, CCI and body mass index (BMI).Main Outcome Measurements“Matching failures” where rate of significant differences in variables of matched cohorts exceeds the 5% expected by chance.ResultsSTTGMA and combination matching resulted in no “matching failures”. Matching by CCI alone resulted in “matching failures” of BMI, ASA class, STTGMA, major complications, sepsis, pneumonia, acute respiratory failure, and 90-day readmission.ConclusionsSTTGMA matching in observational cohort studies is less likely to yield significant differences of demographics and outcomes than CCI matching. STTGMA matching is noninferior to matching a combination of demographic variables optimized for each treatment cohort. STTGMA matching is apt to reflect equipoise of health at admission and outcome likelihood in observational cohort studies of orthopedic trauma, while maintaining consistent weighting of demographic and injury characteristic variables that may expand the generalizability of these studies.Level of EvidenceLevel III     

A new finite element model of intra-articular impacted fragment in posterior malleolar fractures: A technical note

Intra-articular impacted fragment (IAIF) was considered as the articular surface fragment resulting from impact and compressive forces. Malreduction of IAIF in posterior malleolar fractures was associated with the cause of talus subluxation and long-term arthritis. The effect of IAIF on ankle pressure and stress has not been studied, and it's difficult to do this in cadaver bone. So we established IAIF defect finite element model in posterior malleolar fractures and explored the effect of IAIF defect in ankle joint. We also discussed the relation between IAIF defect and post-traumatic arthritis.     

Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis

BACKGROUND CONTEXTPrevious studies have proposed that there is a relationship between low back pain (LBP) and morphology and composition of paraspinal muscles. However, results have been conflicting, especially regarding fatty infiltration of muscles.PURPOSEThe primary goal of this study was to review and analyze results from imaging studies which investigated morphological and composition changes in the multifidus, erector spinae and psoas major muscles in people with LBP.STUDY DESIGN/SETTINGSystematic review with meta-analysis.PATIENT SAMPLEA patient sample was not requiredOUTCOME MEASURESThis review did not have outcome measures.METHODSPubMed, Scopus, Web of Sciences, EMBASE and ProQuest were searched for eligible studies up to 31st July 2020 (all languages). A systematic search of electronic databases was conducted to identify studies investigating the association between the morphology and fat content of lumbar muscles in people with LBP compared with a (no LBP) control group. 13,795 articles were identified. Based on the screening for inclusion/ exclusion, 25 were included. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. From the 25 articles, 20 were included in the meta-analysis.RESULTSResults showed that the total cross-sectional area of the multifidus was smaller in people with LBP (Standardized mean difference, SMD = -0.24, 95% CI = -0.5 to 0.03). Combined SMDs showed a medium effect of LBP on increasing multifidus muscle fat infiltration (SMD = 0.61, 95% CI = 0.30 to 0.91). There were no LBP related differences identified in the morphology or composition of the lumbar erector spine and psoas major muscles.CONCLUSIONSPeople with LBP were found to have somewhat smaller multifidus muscles with a significant amount of intramuscular fat infiltration. Varying sample size, age and BMI of participants, quality of studies and the procedures used to measure fat infiltration are possible reasons for inconsistencies in results of previous studies.