The edition · Orthopaedics
Non-hamstring ACL grafts were linked to higher scores, and an MCL injury did not clearly change that
A French registry associated non-hamstring grafts with better patient-reported outcome across medial injury patterns; a hip-preservation series set thresholds for a worthwhile result after periacetabular osteotomy; and exercise was linked to better forearm bone in women, on very low-certainty evidence.
The edition in brief
A French multicentre registry of 489 primary ACL reconstructions found non-hamstring grafts were associated with IKDC scores about 8 points higher than hamstring grafts, and that concomitant MCL injury did not significantly modify that association, although isolated ACL injuries scored about 10 points higher than combined injuries treated non-operatively. A single-surgeon series of 133 Bernese periacetabular osteotomies defined minimal-important, acceptable-state and substantial-benefit thresholds for HOOS and iHOT-12; 77% reached an acceptable symptom state, but symptoms for more than two years and femoral antetorsion above 25° were associated with lower odds of a satisfactory result. A case series of 19 elite athletes with failed ACL reconstruction and posterior tibial slope of 10° or more found all returned to their pre-injury level after revision with slope-reducing osteotomy, with no graft failures. A meta-analysis of 26 trials in 1880 women found exercise was associated with better upper-limb bone density (SMD 1.05), but heterogeneity was very high and certainty very low, and fracture outcomes were not measured. Today's pearl covers the early signs of compartment syndrome.
Weight-bearing exercise was linked to better forearm bone in women, on very low-certainty evidence
Recommend progressive weight-bearing and resistance exercise after a wrist fracture, but alongside, not instead of, fracture-risk assessment and treatment.
Long-standing symptoms and high femoral antetorsion predicted a less satisfying periacetabular osteotomy
Refer symptomatic hip dysplasia early and assess femoral version before osteotomy; delay and high antetorsion both predicted a worse result.
Slope-reducing osteotomy with revision ACL reconstruction returned 19 elite athletes to their level
Measure tibial slope before revising a failed ACL, and consider slope-reducing osteotomy when it is 10° or more.
In compartment syndrome, the pulse is the last thing to go
Escalating pain and pain on passive stretch after a fracture mean compartment syndrome until proven otherwise; a pulse does not exclude it.
Non-hamstring ACL grafts were linked to better patient-reported outcomes, with or without an MCL injury
In ACL reconstruction with or without an MCL injury, non-hamstring grafts were associated with higher patient-reported scores; MCL status should not drive you to a hamstring graft.
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