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Purpose To determine the rate of recurrent dislocation and patellar instability following medial patellofemoral ligament (MPFL) reconstruction with allograft or autograft tissue and compare patient‐reported outcomes for patients undergoing allograft and autograft MPFL reconstruction. Methods One hundred and fifteen MPFL reconstructions (78 allograft, 37 autograft) without concurrent bony procedures performed between 2008 and 2014 by four sports medicine fellowship‐trained orthopedic surgeons at our center were identified. Patient demographics and surgical data were identified by chart review. Chart review and patient interviews were undertaken to identify recurrent patellar dislocations and as recurrent subjective patellofemoral instability. Recurrent dislocation and subjective instability risk were compared between the allograft and autograft groups. Results Eighty‐seven patients (76%) with complete baseline data and minimum 1‐year follow‐up were contacted at a mean of 4.1 years following isolated MPFL reconstruction, including 57 patient with allograft reconstructions and 30 with autograft reconstructions. No significant differences in patient sex, age at reconstruction, body mass index, or time to follow‐up were noted between groups. Recurrent dislocation occurred in 2 patients in the allograft group (3.5%) and 1 patient in the autograft group (3.3%), (n.s.). Recurrent subjective instability occurred in 17 patients in the allograft group (28.9%) and 11 patients in the autograft group (36.7%), (n.s.). No significant differences in patient‐reported outcomes were noted between groups. Conclusion The use of either allograft or autograft tissue for MPFL reconstruction results in low (< 3%) risk of recurrent patellar dislocation. Risk of recurrent subjective instability is higher but is similar for both graft types. Surgeons can utilize either graft choice at their discretion without anticipating a significant impact of graft choice on patient outcomes. Level of evidence III.

Low back pain is one of the most common reasons for physician visits in the United States and is a chief complaint frequently seen by orthopedic surgeons. Patients with chronic low back pain can experience recurring debilitating pain and disability, decreasing their quality of life. A commercially available software platform, Explorys (Explorys, Inc, Cleveland, Ohio), was used to mine a pooled electronic health care database consisting of the medical records of more than 26 million patients. According to the available medical history data, 1.2 million patients had a diagnosis of low back pain (4.54%). The information was used to determine the incidence of low back pain in patients with a history of nicotine dependence, obesity (body mass index, >30 kg/m(2)), depressive disorders, and alcohol abuse. Relative risk was then calculated for the defined modifiable risk factors. Patients with nicotine dependence, obesity, depressive disorders, and alcohol abuse had a relative risk of 4.489, 6.007, 5.511, and 3.326 for low back pain, respectively, compared with patients without the defined risk factor. A statistically significant difference was found in the incidence of low back pain between all 4 groups with the risk factors evaluated and the general population (P<.05). By determining treatable patient risk factors for low back pain, physicians can monitor at-risk patients and focus on prevention and control of debilitating disease. These approaches can decrease the number of patients with isolated low back pain who are seen by orthopedic surgeons. [Orthopedics. 2016; 39(3):e413-e416.].

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Hallux valgus is a very common orthopedic problem. In patients with pain not responsive to footwear and activity modification, chevron distal metatarsal osteotomy bunionectomy is a commonly performed and highly successful procedure for the treatment of mild and moderate hallux valgus. 3,4,6 We have previously reported our results in a prospective study of 57 patients who underwent chevron bunionectomy in which the metatarsal osteotomy was stabilized with an intramedullary plate system, 3 which secures the metatarsal shaft to the first metatarsal head after lateral displacement of the metatarsal head. The intramedullary device is secured to the head and shaft with 2.4-mm screws. Although our results with this technique were good, we wanted to evaluate the potential added benefit of performing an Akin osteotomy of the proximal phalanx in addition to the metatarsal osteotomy. This is the double osteotomy bunionectomy. When we first started performing this procedure, we observed that we were able to achieve a better cosmetic result with less aggressive tightening of the medial capsule and better range of motion of the first metatarsophalangeal (MTP) joint. Although most series of bunionectomies have good patient satisfaction, we wanted to see if the double osteotomy bunionectomy technique would result in a higher degree of patient satisfaction and better cosmesis. The purpose of this study was to prospectively evaluate the results of double osteotomy bunionectomy in a consecutive group of 138 patients operated on by a single surgeon over a 2-year period of time. Methods We performed double osteotomy bunionectomies on 138 consecutive patients (145 feet) between June 13, 2013, and March 18, 2015. All operative procedures were performed 800635F AIXXX10.

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