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A large proportion of patients use the internet to research orthopedic information and most patients, especially younger males, find the information useful.

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Objectives:Patellar instability caused by severe trochlear dysplasia is best treated by sulcus-deepening trochleoplasty. There have been no studies examining outcomes after this procedure in the United States. The purpose of this study was to evaluate the early outcome data of patients undergoing sulcus-deepening trochleoplasty for high-grade trochlear dysplasia at our institution.Methods:A total of 43 patients (49 knees) with severe trochlear dysplasia were prospectively enrolled and underwent sulcus-deepening trochleoplasty. 23 out of 49 (46.9%) knees had prior surgery related to patellar instability, and six knees had more than one such surgery. Concomitant procedures during the trochleoplasty included medial patellofemoral ligament reconstruction (100%), lateral release (49.0%), tibial tubercle osteotomy (36.7%), and some type of cartilage procedure (49.0%). Physical examination, radiographic analysis, and clinical follow up were obtained for all patients. Patients also completed pre and postoperative Kujala and IKDC scores, in addition to reporting on return to sport and any instances of recurrent instability.Results:79.6% of patients were female with an average age of 20.1 +/- 6.3 years. Follow up ranged from 6 weeks to 49 moths (mean 10.6 +/- 10.5 months). There were no episodes of recurrent instability. All patients reported clinically significant improvements compared with baseline preoperative outcome scores. Patellar tracking was normal in all cases with no patellar apprehension at final follow up. The mean preoperative IKDC score was 49.6, which improved to 78.3 (p < 0.001), and the mean preoperative Kujala score was 54.5 which improved to 82.8 (p < 0.001). Patients reported high satisfaction rates (mean 9.3 +/- 1.8 out of 10), and 81.5% patients were able to return to sport. 9 knees (18.4%) developed arthrofibrosis and required manipulation under anesthesia, 7 of which underwent simultaneous arthroscopic lysis of adhesions. At the latest follow-up, average knee range of motion was 126.6 +/- 13.7 degrees. Radiographic analysis of the sulcus angle demonstrated a significant decrease from 144.2 degrees preoperatively to 133.0 postoperatively (p < 0.001).Conclusion:When indicated in the setting of severe trochlear dysplasia, sulcus-deepening trochleoplasty can provide a reliable and successful surgical solution to recurrent patellar instability. Early follow up demonstrates improved radiographic parameters coupled with excellent clinical outcomes and no recurrent instability.

Background Ganglion cysts are the most frequent soft tissue tumor encountered in the upper extremity and are commonly treated by aspiration or by surgical excision. Ultrasound is a promising addition to traditional aspiration, as it allows for visualization of the needle within the ganglion before aspiration. Questions Are ganglion cysts of the wrist less likely to reoccur if they are aspirated under ultrasound guidance versus “blind” aspiration without the use of ultrasound guidance? Does patient functionality change based on whether or not the cyst recurred? Patients and Methods In total, 52 patients were successfully contacted and recurrence rates were compared between those whose cyst was treated with ultrasound-guided (13 patients) with those whose cyst was treated with blind aspiration (39 patients). Mean follow-up time was 2.9 years. Results Recurrence rates were 69% (9 patients) and 74% (29 patients) for the ultrasound-guided and blind aspiration groups, respectively (p-value: 0.73), showing no significant difference in recurrences of wrist ganglion between the two groups. A metric of functionality (Quick–DASH [Disabilities of the Arm, Shoulder, and Hand]) revealed worse outcomes in patients who experienced return of ganglion cyst after aspiration versus those who did not. Conclusion Additional studies with improved sample sizes are needed to demonstrate the superiority of ultrasound-guided aspiration versus blind aspiration. Due to a high recurrence rate following aspiration (both ultrasound-guided and blinded), a lower threshold for surgical intervention is likely reasonable. Level of Evidence This is a Level IIIb study.

Background: Surgery for degenerative foot and ankle conditions often results in a lengthy recovery. Current outcome measures do not accurately assess postoperative mobility, especially in older patients. The Life-Space Assessment (LSA), a questionnaire quantifying patients’ mobility after a medical event, was used in this study to assess perioperative mobility in total hip arthroplasty (THA) and foot and ankle surgery patients. We hypothesized that patients undergoing elective foot and ankle surgery would have greater postoperative mobility limitation than THA patients. Methods: Preoperative, 3-month, and 6-month postoperative LSA data were collected from THA and foot and ankle cohorts. Twelve-month postoperative data were obtained for the foot and ankle group as well. Patient demographics were recorded, and data were analyzed using a Mann-Whitney U test. Results: Twenty-eight degenerative foot and ankle operative patients and 38 THA patients met inclusion criteria. Only patients aged ≥60 years were included in this study. The mean preoperative LSA score was lower in the foot and ankle group (68.8) compared with THA (74.0), although the difference was not statistically significant ( P = .602). THA patients showed a significant increase in LSA score from preoperative (74) to 6 months postoperation (95.9) ( P = .003); however, foot and ankle patients showed no significant difference between preoperative (68.8) and 6-month (61.2) scores ( P = .468). Twelve months postoperatively, foot and ankle patients showed improvement in LSA score (88.3) compared with preoperation ( P = .065). Conclusion: Compared with THA, recovery of mobility after foot and ankle surgery was slower. THA patients exhibited improved mobility as early as 3 months after surgery, whereas foot and ankle patients did not show full improvement until 12 months. This work will assist the foot and ankle specialist in educating patients about challenges in mobility during their recovery from surgery. Level of Evidence: Level II, prospective cohort study.

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Case: A 13-year-old girl presented after a right proximal femur replacement after proximal femoral resection for treatment of an Ewing sarcoma. She presented after multiple episodes of recurrent instability with her hip endoprosthesis chronically dislocated. Her hip was revised to a custom, constrained metal-on-metal acetabular component with a small iliac flange. The femoral component was revised to an allograft-prosthetic composite. She has been free of malignancy recurrence, implant failure, or dislocation at 19-year follow-up duration. Conclusion: Dislocation of the prosthetic hip can be a challenging postoperative complication, particularly when associated with a tumor megaprosthesis in a pediatric age group. This is further compounded in the presence of deficient pelvic bone stock. Restoration of bone stock is optimal, but when impossible, custom components may be necessary to establish hip stability.