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This study supports the use of a simple, field-based observational drop vertical jump screening test to identify athletes at risk for ACL injury. Our study shows good inter- and intra-rater reliability and high sensitivity and suggests that screening can be performed without significant training by physicians as well as allied health professionals, including: coaches, athletic trainers and physical therapists. Identification of these high-risk athletes may play a role in enrollment in appropriate preventative neuromuscular training programs, which have been shown to decrease the incidence of ACL injuries in this population.

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Joint pain accompanied by erythema, swelling, and decreased range of motion is concerning for septic arthritis and typically warrants joint aspiration. The synovial fluid white blood cell count plays a central role in the decision-making process regarding these patients. Traditional teaching holds that a cell count greater than 50,000 white blood cells/µL is likely caused by infection and therefore warrants either operative intervention or serial aspiration. This report describes 2 patients with extremely high synovial fluid white blood cell counts in the absence of infection. Case 1 involved a 59-year-old man who presented to the emergency department with sudden onset of atraumatic left elbow pain and was found to have a white blood cell count of 168,500 white blood cells/µL on joint aspiration and innumerable monosodium urate crystals. The patient ultimately improved with treatment with oral prednisone, avoiding operative intervention. Case 2 involved a 69-year-old man who presented to the emergency department with acute onset of atraumatic left knee pain. On arthrocentesis, the patient had a cell count of 500,000 white blood cells/µL and was therefore taken to the operating room for arthroscopic irrigation and debridement. Final analysis of the synovial fluid showed monosodium urate crystals and negative culture findings. These cases illustrate the highest synovial fluid white blood cell count reported in patients with gout and highlight the potential difficulty in differentiating between acute gout and septic arthritis in the setting of markedly elevated white blood cell count.

BackgroundClosed-suction drainage has been studied extensively in hip and knee arthroplasty literature. However, little is known about outcomes in patients treated with drainage after shoulder arthroplasty, particularly relative to transfusion requirements.MethodsAll primary total and reverse total shoulder arthroplasties (TSAs and RSAs) performed at a single institution during a 5-year period were retrospectively reviewed. Data collected included patient demographic information, estimated blood loss (EBL), drain output, length of drain use, changes in hemoglobin (Hgb) level postoperatively, transfusions, and complications. A multivariable regression analysis was performed to identify independent risk factors for transfusion.ResultsThere were no differences in surgery duration, EBL, or complications between TSA and RSA patients (P > .05). Patients undergoing RSA were older (74.0 vs. 68.4 years; P < .001) and had lower preoperative and postoperative Hgb levels (P < .001) compared with TSA patients. Reverse arthroplasty was also associated with longer hospital stays (2.8 vs. 2.2 days; P < .001), longer drain durations (1.6 vs. 1.2 days; P < .001), increased total wound drainage (209 vs. 168 m; P = .006), and higher transfusion rates (11.7% vs. 3.1%; P = .002). Independent risk factors for transfusion included low preoperative Hgb levels in both TSA (P = .024) and RSA (P = .002) and higher EBL in TSA (P = .031).ConclusionLow preoperative Hgb level is an independent risk factor for requiring blood transfusion after TSA and RSA. Increased wound drainage was not a risk factor for transfusion, and the 40-mL increase in wound drainage found in RSA is of questionable clinical significance.

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2016-11-03T14:11:40