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Background Arthroscopically assisted anterior cruciate ligament reconstruction using a bioabsorbable tibial fixation screw is occasionally complicated by pretibial cyst formation. The few case reports describing pretibial cyst formation noted several graft types and fixation techniques, making it difficult to establish one etiology. Some literature suggests cysts form from communication between the joint and pretibial area leading to extravasation of joint fluid, maturing into a cyst. We propose the development of cysts after PLLA screw use may be related to a foreign body reaction. Questions/purposes We propose this foreign body reaction (1) relates to the biochemical breakdown of bioabsorbable materials; and (2) differs from cystic formations resulting from joint communication. Methods We retrospectively reviewed seven patients who developed pretibial cysts at least 2 years after original primary ACL reconstruction surgery. MRI was used to visualize the extent of cystic formation. Cysts were treated by débridement with specimens sent for histologic analysis. Cyst appearance had a 3-year incidence of 5%.

Background: The minimal clinically important difference (MCID) is a term synonymous with orthopaedic clinical research over the past decade. The term represents the smallest change in a patient-reported outcome measure that is of genuine clinical value to patients. It has been derived in a myriad of ways in existing orthopaedic literature. Purpose: To describe the various modalities for deriving the MCID. Study Design: Narrative review; Level of evidence, 4. Methods: The definitions of common MCID determinations were first identified. These were then evaluated by their clinical and statistical merits and limitations. Results: There are 3 primary ways for determining the MCID: anchor-based analysis, distribution-based analysis, and sensitivity- and specificity-based analysis. Each has unique strengths and weaknesses with respect to its ability to evaluate the patient’s clinical status change from baseline to posttreatment. Anchor-based analyses are inherently tied to clinical status yet lack standardization. Distribution-based analyses are the opposite, with strong foundations in statistics, yet they fail to adequately address the clinical status change. Sensitivity and specificity analyses offer a compromise of the other methodologies but still rely on a somewhat arbitrarily defined global transition question. Conclusion: This current concepts review demonstrates the need for (1) better standardization in the establishment of MCIDs for orthopaedic patient-reported outcome measures and (2) better study design—namely, until a universally accepted MCID derivation exists, studies attempting to derive the MCID should utilize the anchor-based within-cohort design based on Food and Drug Administration recommendations. Ideally, large studies reporting the MCID as an outcome will also derive the value for their populations. It is important to consider that there may be reasonable replacements for current derivations of the MCID. As such, future research should consider an alternative threshold score with a more universal method of derivation.

This novel intramedullary AC ligament reconstruction may be considered when seeking to improve horizontal stability in an anatomical CC ligament reconstruction.

Background: A major byproduct of the recent coronavirus disease 2019 (COVID-19) pandemic has been the accelerated adoption of telemedicine within orthopedic practices. Introduction: The purpose of the study is to evaluate satisfaction associated with telemedicine and to determine how telemedicine is used by orthopedic surgeons in response to social distancing efforts necessitated by the COVID-19 pandemic. Methods: We developed a survey to evaluate surgeon's perception of telemedicine during the COVID-19 pandemic. The survey consisted of four major sections focusing on (1) surgeon characteristics and current use of telemedicine, (2) telemedicine for new patients, (3) telemedicine for routine followup patients, and (4) telemedicine for postoperative patients. Results: We collected 268 survey responses. Overall, 84.8% of surgeons were using telemedicine, but only 20.5% of surgeons were using it before the COVID-19 pandemic. The overall satisfaction with telemedicine was 70.3%-20.9%. Of those who use telemedicine, 75% currently use it for new patients, 86.6% currently use it for routine follow-up patients, and 80.8% currently use it for postoperative patients (p = 0.01). Surgeons had higher satisfaction with building rapport and performing physical examination maneuvers for either routine follow-up or postoperative patients than for new patients (p < 0.0001 for both). However, satisfaction with obtaining imaging did not differ among the cohorts (p = 0.36). Surgeons felt they are more likely to continue to use telemedicine after the COVID-19 pandemic for either routine follow-up or postoperative patients than for new patients (p < 0.0001). Discussion: Owing to challenges posed by the COVID-19 pandemic, telemedicine use has increased substantially among orthopedic surgeons in recent months. Conclusions: Our study established that physician implementation of telemedicine has increased significantly as a result of the COVID-19 pandemic, with the majority of surgeons satisfied with its use in their practice, and plan on incorporating telemedicine in their practices beyond the pandemic.

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BackgroundLack of insurance has been shown to lead to delays in seeking care as well as fewer preventive medicine visits and poorer overall health status.PurposeTo investigate the effects of insurance status on the timing and treatment of patients with bucket-handle meniscus tears.Study DesignCohort study; Level of evidence, 3.MethodsCharts from 2004 to 2013 were retrospectively reviewed for patients diagnosed with bucket-handle meniscus tears. Patients were divided into 2 groups: insured or underinsured. The insured group included patients with commercial insurance or Medicare. The underinsured group included patients with Medicaid or Charity Care. Time intervals were categorized as <6 weeks or ≥6 weeks.ResultsA total of 52 patients were included in this study: 15 (29%) insured and 37 (71%) underinsured. Underinsured patients experienced delays in initial presentation to an orthopaedic surgeon (P = .004), time from magnetic resonance imaging to surgery (P = .01), and time from injury to surgery (P = .007). Repair rates were 40% and 38% (P > .999) for the insured and underinsured, respectively. Repair rates for <6 weeks from injury to surgery were 75% for insured (P = .007) and 100% for underinsured patients (P = .001). Repair rates for ≥6 weeks from injury to surgery were 0% for insured and 30% for underinsured patients. Overall, patients with an injury-to-surgery time of <6 weeks had a significantly higher repair rate (87%) than those managed >6 weeks (19%) (P < .001).ConclusionUnderinsured patients experience significant delays in time to presentation and overall time to surgery. However, the overall repair rate between the insured and underinsured is similar. Regardless of insurance status, patients undergoing arthroscopy within 6 weeks of injury have a significantly higher repair rate than those after 6 weeks.Clinical RelevancePatients undergoing arthroscopy within 6 weeks of injury have a significantly higher repair rate than those after 6 weeks.

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