Background:Femoroacetabular impingement (FAI) has become a more commonly recognized cause of limited hip range of motion and hip pain among young adults and athletes Hip arthroscopy is recommended

Systematic Review and Meta-analysis of Outcomes After Hip Arthroscopy in Femoroacetabular Impingement:

The Use of Vancomycin Powder In Modern Spine Surgery: Systematic Review and Meta-Analysis of the Clinical Evidence

Intrasite vancomycin powder for the prevention of surgical site infection in spine surgery: a systematic literature review.

The use of local antibiotics for the prevention of infection in the setting of open fractures and as part of the treatment of osteomyelitis is well established Antibiotics are most commonly incorporated into polymethylmethacrylate (PMMA) cement, which can then be formed into beads, moulded to fit a bone defect or used to coat a guide wire or IM nail Newer delivery vehicles and techniques are being evaluated to improve upon these methods Many factors influence how local antibiotics are applied Treatment strategies are challenging to standardise due to the variability of clinical presentations The presence of hardware, upper versus lower extremity, healed versus non-healed fracture and quality of soft tissues overlying the affected bone, as well as patients' comorbidities all need to be considered Despite the accepted use of local antibiotic therapy in orthopaedic trauma, high-quality evidence regarding the use of local antibiotics is lacking Indications, techniques, dosages, types of antibiotics, elution properties and pharmacokinetics are poorly defined in the clinical setting The purpose of our manuscript is to review current strategies and provide practical tips for local application of antibiotics in orthopaedic trauma We focus on delivery vehicles, types of antibiotics, dosage recommendations when mixed with PMMA and indications

Local antibiotic therapy strategies in orthopaedic trauma: Practical tips and tricks and review of the literature

Background:Persistent clinical instability after anterior cruciate ligament (ACL) reconstruction may be associated with injury to the anterolateral structures and has led to renewed interest in ant...

Anterolateral Knee Extra-articular Stabilizers: A Robotic Study Comparing Anterolateral Ligament Reconstruction and Modified Lemaire Lateral Extra-articular Tenodesis

Background:Studies have demonstrated hip arthroscopy to be an effective treatment for femoroacetabular impingement (FAI) with associated labral tears. The purposes of this study were to report 10-year outcomes and hip survival following hip arthroscopy for FAI and to compare labral debridement with

Survivorship and Outcomes 10 Years Following Hip Arthroscopy for Femoroacetabular Impingement: Labral Debridement Compared with Labral Repair.

Study design Retrospective cohort analysis. Objective To establish if drain levels exceed the minimum inhibitory concentrations for common pathogens (methicillin-resistant Staphylococcus aureus, methicillin-sensitive Staphylococcus aureus, and Propionibacterium acnes-2 μg/mL; Staphylococcus epidermidis, Enterococcus faecalis-4 μg/mL). Evaluate the safety of topical vancomycin in pediatric patients undergoing spinal deformity surgery and determine if postoperative serum levels approach toxicity (25 μg/mL). Summary of background data The application of topical vancomycin powder has decreased postoperative wound infections in retrospective analyses in the adult population with minimal local and systemic risks. The safety and efficacy of vancomycin powder has not been completely evaluated in the pediatric population after deformity surgery. Methods Topical vancomycin powder (1 g) was applied during wound closure after instrumented posterior spinal fusion. All patients received intravenous perioperative antibiotics and a subfascial drain was used. Serum and drain vancomycin levels were collected immediately postoperatively and during the first 2 postoperative days (PODs). Complications were recorded. Results The study population consisted of 25 patients with a mean age of 13.5 years (9.5-17.1 yr) and mean ± standard deviation body weight of 44.5 ± 18 kg. Underlying diagnoses included: adolescent idiopathic scoliosis (12), neuromuscular scoliosis (10), and kyphosis (3). Mean serum vancomycin levels trended downward from 2.5 μg/mL (POD 0) to 1.9 μg/mL (POD 1) to 1.1 μg/mL (POD 2). Mean drain levels also trended downward from 403 μg/mL (POD 0) to 251 μg/mL (POD 1) to 115 μg/mL (POD 2). No vancomycin toxicity or deep wound infections were observed. One patient with neuromuscular scoliosis developed a superficial wound dehiscence that was managed with dressing changes. Conclusion Topical application of vancomycin powder in pediatric spinal deformity surgery produced local levels well above the minimum inhibitory concentration for common pathogens and serum levels below the toxicity threshold (25 μg/mL). There were no deep wound or antibiotic related complications. Level of evidence 3.

Safety of topical vancomycin for pediatric spinal deformity: nontoxic serum levels with supratherapeutic drain levels.

Background:Lateral compartment osteoarthritis of the knee can be a challenging pathology in the younger, active population due to limited treatment options and high patient expectations. Distal femoral osteotomy (DFO) has been reported to be a potential treatment option.Purpose:To perform a systematic review on the survival, outcomes, and complications of DFO for treatment of genu valgum with concomitant lateral compartment osteoarthritis of the knee.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the literature was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Registry of Controlled Trials, PubMed, and MEDLINE from 1980 to present. Inclusion criteria were as follows: outcomes of opening- and closing-wedge DFOs performed for treatment of genu valgum with concomitant lateral compartment osteoarthritis of the knee, English language, minimum 2-year follow-up, and human studies. Data abstracted from the selected studies included type of o...

https://journals.sagepub.com/doi/pdf/10.1177/2325967116649901

Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis.

Restoration of anteroposterior laxity after an anterior cruciate ligament reconstruction has been predictable with traditional open and endoscopic techniques. However, anterolateral rotational stability has been difficult to achieve in a subset of patients, even with appropriate anatomic techniques. Therefore, differing techniques have attempted to address this rotational laxity by augmenting or reconstructing lateral-sided structures about the knee. In recent years, there has been a renewed interest in the anterolateral ligament as a potential contributor to residual anterolateral rotatory instability in anterior cruciate ligament–deficient patients. Numerous anatomic and biomechanical studies have been performed to further define the functional importance of the anterolateral ligament, highlighting the need for surgical techniques to address these injuries in the unstable knee. This article details our technique for an anatomic anterolateral ligament reconstruction using a semitendinosus tendon allograft.

https://www.arthroscopytechniques.org/article/S2212-6287(16)00034-7/pdf

Anterolateral Ligament Reconstruction Technique: An Anatomic-Based Approach.

Background:Previous studies have shown that professional hockey players return to sport at a high rate after hip arthroscopy, although it is unknown how long players continue to compete at a professional level after surgery.Purpose:To determine the prevalence of athletes who continued playing in the National Hockey League (NHL) for a minimum of 5 years after hip arthroscopy for treatment of symptomatic femoroacetabular impingement (FAI) and to determine predictors associated with length of career.Study Design:Case series; Level of evidence, 4.Methods:A total of 60 professional hockey players (69 hips) underwent hip arthroscopy for FAI by a single surgeon between 2005 and 2010. Data were retrieved from NHL.com and Hockey-reference.com regarding information on each player’s professional career. Position played, age, surgical procedure, and intraoperative findings were also used in data analysis.Results:There were 12 centers, 15 defensemen, 16 goalies, and 17 wings studied. Of the 60 athletes, 40 (67%) conti...

https://journals.sagepub.com/doi/pdf/10.1177/2325967116S00175

Travis J. Menge

Papers

Survivorship and Outcomes 10 Years Following Hip Arthroscopy for Femoroacetabular Impingement: Labral Debridement Compared with Labral Repair.

Safety of topical vancomycin for pediatric spinal deformity: nontoxic serum levels with supratherapeutic drain levels.

Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis.

Anterolateral Ligament Reconstruction Technique: An Anatomic-Based Approach.

Predictors of Length of Career After Hip Arthroscopy for Femoroacetabular Impingement in Professional Hockey Players