The OJSM Hot Corner

Meniscal root tears are a problem. They can occur without trauma, they can only be diagnosed on MRI but occur commonly in a patient population where MRI is not routinely utilized, they don't respond reliably to partial menisectomy, and they result in rapid degeneration of the knee joint. What we don't know is how rapid is that arthritic progression. Dr. Caitlin Chambers from the University of Minnesota and her team address this question with their study, "Association of Medial Meniscus Root Tears and Nonroot Tears with Worsening of Radiographic Knee Osteoarthritis." She joins us to discuss her results and gives advice on managing patients with this problematic meniscal tear pattern.

Platelet-Rich Plasma (PRP) remains a topic of controversy in Sports Medicine. One of the limitations surrounding this therapy is the paucity of high-quality data to support or refute its efficacy. We welcome Dr. Dean Wang, MD from UC Irvine to discuss his study looking at the fragility of the highest quality data we have on PRP. A fragile study is one in which the study's conclusion would change with the reversal of only a few outcomes. Our medical community holds randomized-controlled trials in high regard, however if these studies are fragile, how much can we rely on them to be true?

The correct surgical approach for a skeletally immature athlete with an ACL tear remains controversial. Transphyseal ACL reconstruction with a soft tissue autograft is a popular choice that most resembles the technique performed in adults. However, crossing an open growth plate comes with risk of growth arrest, though the frequency and magnitude of that risk is not well known. We thank Drs. Alexander Seeto, MD and Ivan Astori, MBBS for their discussing their findings with us.

We welcome Drs. Adam Daniel, MD and Patrick Smith, MD from Columbia Orthopaedic Group to discuss their study "Reduced Incidence of Revision Anterior Cruciate Ligament Reconstruction with Internal Brace Augmentation." Though a proprietary orthopaedic implant, the term "Internal Brace" has become a household name in Sports Medicine and Orthopaedic Surgery in general. It's application in the realm of ACL reconstruction has been theorized, however due to poor performance of prior augmentation efforts with ACLR, Internal Bracing for ACLR has been met with some degree of skepticism. Dr. Smith has decades of experience searching for ways to improve upon ACLR, a surgery that is still far from perfect. He reports on his experience with ACLR with autograft plus Internal Bracing. His results speak for themselves.

2023 OJSM William A. Grana Award for Best Research Paper spotlight - Dr. Olufemi Ayeni from McMaster University Medical Centre in Ontario joins us to discuss his award-winning study "Effect of Osteochondroplasty on Time to Reoperation After Arthroscopic Management of Femoroacetabular Impingement: Analysis of a Randomized Controlled Trial." As hip arthroscopy continues to grow as a beneficial treatment option in Sports Medicine, high level evidence is needed to support its efficacy. Dr. Ayeni and his group provide high quality data supporting the long term benefits of osteochondroplasty versus soft tissue work alone.

We welcome Dr. Gregory Maletis, MD sports medicine surgeon at Kaiser Permanante Baldwin Park and head of the Kaiser Permanente ACL Registry. The KP ACL Registry has generated 55 high-quality, peer-reviewed publications, with huge sample sizes. Dr. Maletis discusses the registry's inception, history, inner workings, strengths, and weaknesses. We close by looking at this current study, selected as an AOSSM Specialty Day Abstract 2023 and featured in OJSM, as an example of what the registry can do.

We welcome Dr. Daniel Whelan, Head of University of Toronto Sports Medicine, to discuss his team's recent publication "Assessment of 30 Years of Randomized Controlled Trials in The American Journal of Sports Medicine: 1990-2020." This critical look at how our very best clinical studies have changed over a 30-year period is a fascinating reflection of our own evolution as orthopaedic sports medicine specialists. The past informs the present and can teach us lessons on how to be better in the future.

We welcome Dr. Patrick McCulloch, co-program director of The Houston Methodist Sports Medicine Fellowship, and his current fellow, Dr. Matthew Kraeutler to discuss their study "Effects of Running on the Development of Knee Osteoarthritis: An Updated Systematic Review at Short-Term Follow-up" published in OJSM in March. The connection between running and osteoarthritic progression in the knee has been a topic of controversy for years. Common sense would say running must be bad for your knees, however could the health benefits of running actually play a protective role? We thank Drs. McCulloch and Kraeutler and their team for tackling this hot topic and sharing their discoveries with us.

We welcome back Foot & Ankle Specialist and Residency Director of Loyola University Medical Center, Dr. Adam Schiff, MD to discuss surgical versus nonsurgical management of Achilles tendon ruptures. We review the study "Operative versus nonoperative treatment of acute Achilles tendon rupture: a propensity score-matched analysis of a large national dataset" published in OJSM in February coming to us from Duke University. In the study, Dr. Brian Lau and his team found an increased risk of complications with surgical versus nonsurgical care, no difference in reoperation rates, and increased costs with surgical care initially but an equalization of costs at 5 years post-injury. The authors also report that over the study period from 2007-2015, there was little change in the rate of surgical repair, despite the widely published success of modern nonsurgical care. Dr. Schiff lends his expertise on this topic, lays out the pros and cons of each approach, the historical perspective, what situations might be best suited for each treatment pathway, and the psychology he sees in his patients as they decide whether to have surgical repair of their Achilles tendon rupture.

We welcome Foot & Ankle Specialist and Residency Director of Loyola University Medical Center, Dr. Adam Schiff, MD to discuss suture button versus screw fixation for ankle syndesmotic injuries. We review the study "Comparison of Suture Button and Syndesmotic Screw for Ankle Syndesmotic Injuries: A Meta-Analysis of Randomized Controlled Trials" published in OJSM in January coming to us from Southwest Hospital of Army Medical University in Chongqing, China. In the study, Dr. Kang-Lai Tang and his team found no difference in terms of malreduction, however the suture button group had significantly lower rates of local irritation and unplanned reoperation. Dr. Schiff lends his expertise on this topic, lays out the pros and cons of each approach, the historical perspective, and what situations might be best suited for each treatment construct.