The edition · Orthopaedics
Wound dehiscence was less common after biportal endoscopic than microscopic lumbar decompression
A pooled analysis of two randomised spine trials, block timing in hip fracture arthroplasty, extensive MCL release during meniscal root repair, and eccentric quadriceps training after knee replacement.
The edition in brief
A post hoc analysis of two randomised trials (211 patients) found wound dehiscence needing resuturing in 8.7% after microscopic and 0% after biportal endoscopic single-level lumbar decompression (OR 0.046, 95% CI 0.003 to 0.798); incision length of 35 mm or more and drainage of 100 mL or more carried the highest risk, and the authors call the work hypothesis-generating. A trial of 79 older adults having hip arthroplasty for fracture found no significant difference in delirium when an anterior iliopsoas space block was given the day before rather than an hour before surgery (8.1% vs 12.8%; risk difference -4.7%, 95% CI -18.4 to 9.0). A 21-patient case series found that extensive percutaneous MCL pie-crusting during medial meniscus posterior root repair left side-to-side valgus gapping of 1.21 mm, below a 3.2 mm laxity threshold. A 44-patient trial found that adding supervised eccentric quadriceps training after total knee arthroplasty improved WOMAC and KSS functional scores over concentric-only rehabilitation, without a significant difference in pain at 8 weeks.
Wound dehiscence after lumbar decompression: none with biportal endoscopy, 8.7% with the microscope
Consider closer wound surveillance after microscopic lumbar decompression with long incisions or high drain output; the technique comparison itself is hypothesis-generating.
Giving an iliopsoas space block the day before hip fracture surgery did not lower delirium
Block timing in hip fracture arthroplasty need not be driven by delirium risk on current evidence; this trial was too small to settle it.
Extensive MCL pie-crusting during meniscal root repair left no clinically meaningful laxity
This small series suggests extensive pie-crusting is compatible with stable knees at six months, but longer follow-up and a control group are needed.
Test extension early after knee replacement
Check active knee extension at each early review after knee replacement and act on a lag early.
Adding supervised eccentric quadriceps training after knee replacement improved function scores
Consider eccentric quadriceps training as an addition to rehabilitation after knee replacement; the evidence is a small single trial.
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