Lateral tenodesis tied to fewer ACL revisions in the young, whatever the tibial slope

The edition in brief

In 780 patients aged 25 or under having primary ACL reconstruction at three Dutch centres, 10.8% needed revision. A posterior tibial slope of 12 degrees or more was present in 28% and was independently associated with revision. Adding lateral extra-articular tenodesis was associated with lower odds of revision (OR 0.37), with revision falling from 21.0% to 9.2% in steep-slope knees (number needed to treat 9) and from 13.2% to 5.4% otherwise. A meta-analysis of 20 studies (2,703 patients aged 55 or over) found primary arthroplasty for acetabular fractures, with or without fixation, gave better early hip scores and fewer reoperations than fixation alone, at the cost of longer operations and more blood loss; 90-day mortality did not differ significantly. In a Korean national cohort of more than 300,000 knee replacements, Parkinson disease diagnosed before surgery was associated with a slightly higher five-year risk of cerebrovascular events (aHR 1.11) but not with periprosthetic fracture or infection. A 60-patient trial found liposomal bupivacaine in adductor canal and iPACK blocks lowered pain at 24 hours by about half a point compared with plain bupivacaine plus dexamethasone, a difference of uncertain clinical importance. The pearl covers time-critical Parkinson medicines on the orthopaedic ward.