Background: Medial epicondylitis (ME) is characterized as an overuse injury resulting in pathological alterations of the common flexor tendon at the elbow. Platelet-rich plasma (PRP) has recently become of interest in the treatment of musculoskeletal conditions as an alternative to operative management. Purpose: To compare the outcomes of recalcitrant type 1 ME after treatment with either PRP or surgery. Study Design: Cohort study; Level of evidence, 3. Methods: To compare the 2 methods of treatment, we performed a retrospective review of 33 patients diagnosed with type 1 ME from 2006 to 2016 with a minimum clinical follow-up of 1 year who had failed an initial nonoperative treatment program of injections, medication, topical creams, and/or physical therapy. Overall, 15 patients were treated with a series of 2 leukocyte-rich PRP injections, and 18 patients were treated with surgery. Outcome measures included time to pain-free status, time to full range of motion (ROM), the Mayo Elbow Performance Score (MEPS), and the Oxford Elbow Score (OES). Each patient had at least 1-year follow-up. They were then contacted by telephone to determine final scores at a minimum 2-year follow-up. Unsuccessful outcomes were determined by the Nirschl grading system and failure to reach pain-free status, achieve baseline ROM, or return to previous activity. Results: The mean final follow-up was 3.9 years. A statistically significant improvement was noted in both time to full ROM (42.3 days for PRP vs 96.1 days for surgery; P < .01) and time to pain-free status (56.2 days for PRP vs 108.0 days for surgery; P < .01). Successful outcomes were observed in 80% of patients treated with PRP and 94% of those treated operatively ( P = .37). No significant difference was found in return-to-activity rates, overall successful outcomes, MEPS scores, or OES scores. Conclusion: In this case series, the use of PRP showed clinically similar outcomes to those of surgery in recalcitrant type 1 ME. PRP can be considered as an alternative to surgery in the treatment of recurrent ME, with an earlier time to full ROM and time to pain-free status compared with surgery.

Background:Various techniques have been described for surgical treatment of recalcitrant medial epicondylitis (ME). No single technique has yet to be proven the most effective.Purpose:To evaluate the clinical outcomes of a double-row repair for ME.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review was performed on 31 consecutive patients (33 elbows) treated surgically for ME with a minimum clinical follow-up of 2 years. All patients were initially managed nonoperatively with anti-inflammatories, steroid injections, topical creams, and physical therapy. Outcome measures at final follow-up included visual analog scale (VAS) scores (scale, 0-10), time to completely pain-free state, time to full range of motion (FROM), Mayo Elbow Performance Scores (MEPS), and Oxford Elbow Scores (OES). Patients were contacted by telephone to determine current functional outcomes, pain, activity, functional limitations, and MEPS/OES. Successful and unsuccessful outcomes were determined by the Nirschl grading system.Results:The mean clinical and telephone follow-up periods were 2.3 and 3.6 years, respectively, and 31 of 33 (94%) elbows were found to have a successful outcome. The mean VAS improvement was 4.9 points, from 5.8 preoperatively to 0.9 postoperatively (P < .001). The mean MEPS and OES at final follow-up were 95.1 and 45.3, respectively. The mean time to pain-free state and time to FROM were 87.4 and 96 days, respectively. Unlike prior studies, no difference in outcome was found between those with and without ulnar neuritis preoperatively (P = .67).Conclusion:A double-row repair is effective in decreasing pain and improving the overall function for recalcitrant ME. Uniquely, the presence of preoperative ulnar neuritis was associated with higher patient-reported preoperative pain scores but not with poor outcomes using this protocol.

Knee articular cartilage defects can result in significant pain and loss of function in active patients. Osteochondral allograft (OCA) transplantation offers a single-stage solution to address large chondral and osteochondral defects by resurfacing focal cartilage defects with mature hyaline cartilage. To date, OCA transplantation of the knee has demonstrated excellent clinical outcomes and long-term survivorship. However, significant variability still exists among clinicians with regard to parameters for graft acceptance, surgical technique, and rehabilitation. Technologies to optimize graft viability during storage, improve osseous integration of the allograft, and shorten recovery timelines after surgery continue to evolve. The purpose of this review is to examine the latest evidence on treatment indications, graft storage and surgical technique, patient outcomes and survivorship, and rehabilitation after surgery.

Orthopedic ReviewsOrthopedic surgeons are obtaining Master of Business Administration (MBA) degrees at an increasing rate. This study aimed to identify the motivations, trends, and perceived value of the MBA degree for these dual degree surgeons. A total of 157 orthopedic surgeons with both MD and MBA degrees were surveyed with a 19-item questionnaire to identify surgeons' motivations for obtaining an MBA degree and the perceived value of the degree. A total of 66 responses (42%) were received. Most respondents (89.4%) viewed the MBA degree as either extremely valuable or valuable. Prior to obtaining an MBA, 71.9% of dual degree surgeons dedicated time to administrative duties outside of the clinic. This number increased to 98.4% after receiving an MBA (p < 0.001). With the growing number of surgeons pursuing MBA degrees, there is a decrease in the time spent in the clinical role suggesting that either the non-clinical burden is increasing, or surgeons choose to re-allocate their time. Despite the high direct costs of an MBA, a majority of orthopedic surgeons perceived the MBA degree as a valuable investment they would pursue again.

Background: Postoperative knee arthrofibrosis is a common and potentially detrimental complication affecting knee function and gait. Several cohort studies have reported good outcomes after arthroscopic lysis of adhesions (LOA) with manipulation under anesthesia (MUA). Purpose: To review the literature assessing the efficacy and complications of arthroscopic LOA and MUA for postoperative arthrofibrosis of the knee and evaluate whether any relevant subgroups are associated with different clinical presentation and outcomes. Study Design: Systematic review; Level of evidence, 4. Methods: This review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Eligible studies published from January 1, 1990, to April 1, 2021, were identified through a search of the US National Library of Medicine (PubMed/MEDLINE), EMBASE, and Cochrane databases. All studies included in this analysis included pre- and postoperative range of motion measurements for their treated patients. Studies reporting outcomes for patients with isolated cyclops lesions after anterior cruciate ligament reconstruction were excluded. Results: Eight studies comprising 240 patients were included. The mean time from index surgery to arthroscopic LOA and MUA was 8.4 months, and the mean postoperative follow-up was at 31.2 months. All studies demonstrated a significant improvement (41.6°) in arc of motion after arthroscopic LOA. Clinically significant improvements in outcome measures, including the International Knee Documentation Committee, Western Ontario and McMaster Universities Osteoarthritis Index, and Knee injury and Osteoarthritis Outcome Score, were reported after arthroscopic LOA across all applicable studies. Of 240 patients, a single complication (synovial fistula) occurred after LOA and MUA, which resolved without intervention. Conclusion: The results of this review indicated that arthroscopic LOA and MUA is a safe and efficacious treatment for postoperative arthrofibrosis of the knee.

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Transient arterial injury is a common complication encountered in the management of pediatric supracondylar humerus fractures, often presenting as a pulseless hand that appears well perfused, also known as the “pink, pulseless hand.” Arterial injuries in pediatric humeral shaft fractures, on the other hand, are exceedingly rare, especially in closed fractures. The authors report a rare case of a humeral shaft fracture presenting as a pink, pulseless hand. Although this complication was initially managed according to supracondylar protocol, the patient's neurologic status deteriorated. This prompted vascular assessment with computed tomography angiography, revealing a complete occlusion of the brachial artery. At this more proximal level, there is significant risk for compromise of the collateral circulation. The patient was eventually treated successfully with open reduction of the fracture followed by brachial artery repair. Although watchful waiting may be appropriate in the management of this entity for supracondylar fractures, more aggressive management was indicated for this patient because of the occlusion occurring prior to the bifurcation of the brachial artery. The lack of collateral circulation makes improvement in this injury pattern unlikely. This report emphasizes that suspected vascular injury following humeral shaft fractures should be evaluated with computed tomography angiography. If an occlusion is identified, it should be treated aggressively with immediate open fracture reduction and evaluation by a vascular team for possible repair vs grafting. [ Orthopedics . 2019; 42(2):e279–e281.]

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