Robby S. Sikka

Autograft Versus Allograft: An Economic Cost Comparison of Anterior Cruciate Ligament Reconstruction

PURPOSE The purpose of this study was to compare the costs associated with anterior cruciate ligament (ACL) reconstruction with either bone-patellar tendon-bone (BPTB) autograft or BPTB allograft. METHODS Surgical costs are reported, including supply costs, based on invoice costs per item used per procedure, and personnel costs calculated as cost per minute. All operations were performed at an ambulatory surgery center between March 2005 and March 2006. A total of 160 patients underwent primary ACL reconstruction with either BPTB autograft (n = 106) or BPTB allograft (n = 54). Procedure cost data were retrieved from a financial management database and divided into various categories for comparison of the 2 groups. Payment data were provided by the surgery centers billing office. RESULTS The total mean cost per case was

Correlating MRI Findings With Disability in Syndesmotic Sprains of NFL Players

4,147 ±

Exercise in pregnancy.

943 in the allograft group compared with

Reprocessing Single-Use Devices: An Orthopaedic Perspective

3,154 ±

An Avulsion of the Subscapularis in a Skeletally Immature Patient

704 in the autograft group; this was statistically significant (P < .001). The mean operating room time was 12 minutes greater in autograft cases (P = .006). Supply costs comprised a mean of 58.7% of total expenses in the autograft group and 72.2% in the allograft group. CONCLUSIONS Allograft reconstruction of the ACL was significantly more expensive than autograft reconstruction. LEVEL OF EVIDENCE Level II, economic analysis.

Anterior Cruciate Ligament Allograft Surgery Underreporting of Graft Source, Graft Processing, and Donor Age

Background: Syndesmotic sprains may be a significant source of missed playing time, especially in football players. Advanced imaging is frequently used to confirm the clinical diagnosis. Our purpose was to evaluate the prognostic ability of MRI in predicting time of disability. Methods: Training room records from 1993 to 2007 for three National Football League teams were reviewed. Forty-three players were diagnosed with syndesmotic ankle injuries and underwent radiographs and magnetic resonance imaging. A blinded musculoskeletal radiologist interpreted all images. Players with fractures were excluded. Results: Thirty-six professional football players were included in the final analysis. Twenty-three players had a positive squeeze test which was correlated with increased missed practices (p = 0.012) and increased missed games (p ≤ 0.01). The average number of games missed was 3.3 (range, 0 to 20) and the average number of practices missed was 16.7 (range, 0 to 114). Four players had isolated injury to the anterior tibio-fibular ligament (AITFL) (MRI Grade I). Five players had injury to the AITFL and interosseous ligament (MRI Grade II). Twenty-four players sustained injury to the AITFL, interosseous ligament, and posterior inferior tibio-fibular ligament (MRI Grade III). Three players had Grade III injuries with additional injury to the deltoid ligament (MRI Grade IV). Increasing grade of injury was positively correlated with increased number of missed games (p = 0.033) and missed practices (p = 0.002). Conclusion: MRI can be useful to help delineate the injury pattern and associated injuries, and may be useful in predicting time of disability using a grading system. Positive squeeze test can also be useful to determine prognosis. Level of Evidence: IV, Retrospective Case Series

Football injuries: current concepts

A greater number of women are choosing to exercise in pregnancy as the recommendations by the American College of Obstetrics and Gynecology (ACOG) and other organizations have changed in recent years. Exercise during pregnancy can be beneficial to the health of the fetus and mother. Physicians should be aware of the contraindications to exercise, the warning signs to terminate exercise, and the latest recommendations by the ACOG. In the absence of contraindications, the authors believe that physicians should help to develop a reasonable exercise protocol for women based upon their previous activity levels. It is incumbent upon physicians to be aware of the unique physiologic factors present during pregnancy that may predispose women to injuries. Treatment of injuries sustained during pregnancy must balance the risks to both the mother and fetus.

Anterior Cruciate Ligament Injuries in Professional Hockey Players

In response to increasing environmental and economic pressure, the reuse of single-use devices has become more prevalent in the United States. Managed care and Medicare have reduced reimbursements in the past decade, and annual surgical waste from common operations of the back, knee, and hip has inc

Injuries in professional football: current concepts.

In 1835, Smith first reported an isolated tear of the subscapularis tendon in a cadaver. 10 Partial ruptures of the subscapularis associated with anterior dislocation are well documented. However, isolated avulsion of the subscapularis from the lesser tuberosity of the humerus is an uncommon injury typically described in older patients following traumatic anterior dislocation of the glenohumeral joint. In patients without a history of anterior dislocation, the diagnosis may be missed clinically. 2,7 In our case, a 14year-old male with no history of anterior dislocation had a complete avulsion of the subscapularis tendon with a bony fragment that included an avulsion of the lateral capsule. The diagnosis of the injury was delayed as a result of an incomplete examination specifically assessing the function of the subscapularis. We describe the case and surgical management.

Desmoid tumor of the subscapularis presenting as isolated loss of external rotation of the shoulder. A report of two cases.

Background: There has been much controversy regarding the effects of sterilization techniques and graft history on the structural integrity of allograft ligaments used in reconstruction of the anterior cruciate ligament. The purpose of this review was to comprehensively examine anterior cruciate ligament allograft studies published in the last decade to evaluate the extent to which tissue source, tissue processing techniques, and donor age are reported. Methods: The authors reviewed 202 articles published from 1999 through November 2009, of which 68 retrospective, prospective, biomechanical, and histology studies evaluating 4689 allografts were included. Results: The majority of studies do not accurately report key elements of graft history including tissue bank, processing or sterilization technique, or donor age. Underreporting was particularly prominent in clinical studies as compared with basic science studies. Limited reporting of allograft processing, allograft source, and donor age raises serious questions regarding the generalizability of published studies of allograft tissue for anterior cruciate ligament reconstruction. Conclusion/Clinical Relevance: Orthopaedic surgeons who use allograft tissue must understand the tissue treatments being used (ie, preservation methods, chemical and sterilization processes) to best inform their patients regarding the risks, benefits, and long-term outcomes when such tissues are used. A complete understanding of the implanted tissue, as well as surgeon and recipient demographics, is necessary to ensure appropriate and predictable long-term outcomes.