Jung Ho Noh

Outcome of the functional treatment of first-time ankle inversion injury

BackgroundAvulsion fractures of the lateral malleoli in ankle inversion injuries are often undetected on routine radiographs. Undetected avulsion fractures have been managed as ankle sprain, which may affect the outcome of the treatment of the ankle sprain. The purposes of this study are to compare the outcomes of functional treatment between the first-time severe ligament injury and avulsion fracture of the lateral ankle, and to investigate how the anterior talofibular ligament (ATFL) view or the calcaneofibular ligament (CFL) view affects the diagnosis of the avulsion fracture and outcome of functional treatment of the ankle inversion injury.MethodsA total of 276 consecutive patients with a first-time severe ankle inversion injury were classified into a ligament injury group (group I) or an avulsion fracture group (group II) on the basis of physical examination and radiographs. The patients with a negative finding on routine radiographs and a positive finding on the ATFL or CFL view derived from group II (group IIA). Age, sex, and activity level were analyzed. Patients were treated by stirrup splint.ResultsA total of 202 (73.2%) patients were in group I and 74 (26.8%) were in group II. In all, 50 patients in group II showed negative standard radiographs and a positive ATFL or CFL view. Altogether, 240 patients were followed up for at least 1 year and assessed clinically and radiographically. Differences in age, sex, and activity level before injury between groups were not statistically significant. Clinical and radiographic results of group II were inferior to those of group I. The outcome of group IIA was comparable to that of group I.ConclusionsThe outcome of functional treatment of avulsion fracture was inferior to that of ligament injury. The ATFL and CFL views provide a more precise diagnosis but do not affect the outcome of the functional treatment.

Anterior cruciate ligament reconstruction using 4-strand hamstring autograft: conventional single-bundle technique versus oval-footprint technique.

PURPOSE The purpose of this study was to compare short-term results of conventional anterior cruciate ligament (ACL) reconstruction with oval-footprint (modified) single-tunnel ACL reconstruction with 4-strand hamstring autograft. METHODS A prospective comparative study was performed in 74 consecutive subjects who underwent ACL reconstruction with the conventional technique (group I, 40 cases) or the modified technique (group II, 34 cases), in which the entrances of the femoral and tibial tunnels were more elongated, by use of 4-strand hamstring tendon. The Lachman test, pivot-shift test, range of motion, International Knee Documentation Committee classification, Lysholm score, and side-to-side differences were evaluated preoperatively and at the last follow-up. The Tegner activity scale was evaluated before injury and at the last follow-up. RESULTS There were 38 patients in group I and 32 in group II who were followed up for at least 2 years (mean follow-up, 32.4 months). At the last follow-up, Lachman test results were negative in 34 in group I and 30 in group II (P = .624) and the pivot-shift test was negative in 32 in group I and 30 in group II (P = .397). Mean range of motion of the injured knee was 142.2° in group I and 141.9° in group II (P = .771). The International Knee Documentation Committee classification was A or B in 37 in group I and 31 in group II (P = .872). The median Lysholm score was 94 in group I and 96 in group II (P = .048). The mean side-to-side difference averaged 2.08 mm in group I and 2.07 mm in group II (P = .943). The median score on the Tegner activity scale was 6 in group I and 6 in group II (P = .968). CONCLUSIONS The Lysholm score in the modified-technique group at the last follow-up was better than that in the conventional-technique group in terms of statistical significance, but this may not be clinically significant. LEVEL OF EVIDENCE Level II, prospective comparative study.

Intraarticular epidermal cyst of knee

An epidermal cyst is a common benign lesion that generally exists in subcutaneous tissue. Prevalent sites of the lesion are the trunk, neck, face, hand, and foot [1]. It generally develops from a trauma leading to the implantation of an epithelial element. It can also congenitally develop, probably through the inclusion of epidermal elements during neural tube closure in embryogenesis. It rarely develops after an orthopedic procedure, and there have been only a few reports of such a lesion around the knee [2–4]; the majority of them developed in subcutaneous tissue. The authors know of only one report on an epidermal cyst in a joint cavity [3]. In this work, we report an epidermal cyst that developed in a knee joint cavity after an arthroscopic procedure.

Patients With Limited Health Literacy Have Similar Preferences but Different Perceptions in Surgical Decision-making for Carpal Tunnel Release

Background Health literacy is the ability to obtain, process, and understand health information needed to make appropriate health decisions. The proper comprehension by patients regarding a given disease, its treatment, and the physician’s instructions plays an important role in shared decision-making. Studies have disagreed over the degree to which differences in health literacy affect patients’ preferences for shared decision-making; we therefore sought to evaluate this in the context of shared decision-making about carpal tunnel release. Questions/purposes (1) Do patients with limited health literacy have different preferences of shared decision-making for carpal tunnel release than those with greater levels of health literacy? (2) How do patients with limited health literacy retrospectively perceive their role in shared decision-making after carpal tunnel release? Methods Over a 32-month period, one surgeon surgically treated 149 patients for carpal tunnel syndrome. Patients were eligible if they had cognitive and language function to provide informed consent and complete a self-reported questionnaire and were not eligible if they had nerve entrapment other than carpal tunnel release or had workers compensation issues; based on those, 140 (94%) were approached for study. Of those, seven (5%) were lost to followup before 6 months, leaving 133 for analysis here. Their mean age was 55 years (range, 31–76 years), and 83% (111 of 133) were women. Thirty-three percent (44 of 133) of patients had less than a high school education. Health literacy was measured according to the Newest Vital Sign during the initial visit, and a score of ⩽ 3 was considered limited health literacy. Forty-four percent of patients had limited health literacy. The Control Preferences Scale was used for patients to indicate their preferred role in surgical decision-making preoperatively and to assess their perceived level of involvement postoperatively. Bivariate and multivariable analyses were performed to determine whether patients’ clinical, demographic, and health literacy factors accounted for the preoperative preferences and postoperative assessments of their role in shared decision-making. A total of 133 patients would provide 94% power for a medium effect size for linear regression with five main predictors. Results We found no differences between patients with lower levels of health literacy and those with greater health literacy in terms of preferences of shared decision-making for carpal tunnel release (3.0 ± 1.6 versus 2.7 ± 1.4; mean difference, 0.3; 95% confidence interval, -0.2 to 0.8; p = 0.25). A history of surgical procedures (coefficient = -0.32, p < 0.01) and a lower Disabilities of the Arm, Shoulder and Hand score (coefficient = 0.17, p = 0.02) were independently associated with a preference for an active role in shared decision-making. However, patients with limited health literacy (coefficient = -0.31, p = 0.01) and an absence of a caregiver (coefficient = -0.28, p = 0.03) perceived a more passive role in actual decision-making. Conclusions Physicians should be aware of the discrepancy between preferences and perceptions of shared decision-making among patients with limited health literacy, and physicians should consider providing a decision aid tailored to basic levels of health literacy to help patients achieve their preferred role in decision-making. Level of Evidence Level II, prognostic study.