Pub Date : 2022-03-15DOI: 10.5435/JAAOS-D-21-01253
Alan H. Daniels, Christopher L. McDonald, B. Basques, Eren O. Kuris
Ossification of the ligamentum flavum (OLF) is an uncommon but potentially serious spinal condition which can cause progressive compression of the spinal canal with associated devastating neurologic compromise. Although debate exists regarding the exact etiology of OLF, overexpression of genes and transcription factors centered around the Notch and Wnt signaling pathways because of increased mechanical stress seems to be related. There are many clinical and radiographic presentations of OLF; however, progressive myelopathy is the most commonly encountered. Radiographic analysis may reveal isolated OLF or OLF combined with ossification of other areas of the spine, such as disk, posterior longitudinal ligament, and dura. When surgery is necessary for OLF, several surgical strategies exist including open laminectomy with excision, endoscopic decompression, Bridge Crane resection, en block resection, and combined anterior and posterior approaches. Resection may be complicated by dural adhesion or dural ossification, and postoperative neurologic deficits are not uncommon.
{"title":"Ossified Ligamentum Flavum: Epidemiology, Treatment, and Outcomes.","authors":"Alan H. Daniels, Christopher L. McDonald, B. Basques, Eren O. Kuris","doi":"10.5435/JAAOS-D-21-01253","DOIUrl":"https://doi.org/10.5435/JAAOS-D-21-01253","url":null,"abstract":"Ossification of the ligamentum flavum (OLF) is an uncommon but potentially serious spinal condition which can cause progressive compression of the spinal canal with associated devastating neurologic compromise. Although debate exists regarding the exact etiology of OLF, overexpression of genes and transcription factors centered around the Notch and Wnt signaling pathways because of increased mechanical stress seems to be related. There are many clinical and radiographic presentations of OLF; however, progressive myelopathy is the most commonly encountered. Radiographic analysis may reveal isolated OLF or OLF combined with ossification of other areas of the spine, such as disk, posterior longitudinal ligament, and dura. When surgery is necessary for OLF, several surgical strategies exist including open laminectomy with excision, endoscopic decompression, Bridge Crane resection, en block resection, and combined anterior and posterior approaches. Resection may be complicated by dural adhesion or dural ossification, and postoperative neurologic deficits are not uncommon.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127509430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-15DOI: 10.5435/JAAOS-D-22-00130
Charles E Abrahamsen
{"title":"Letter to the Editor: JAAOS January 1, 2022 Vol 30 No.1 Pp 7-17.","authors":"Charles E Abrahamsen","doi":"10.5435/JAAOS-D-22-00130","DOIUrl":"https://doi.org/10.5435/JAAOS-D-22-00130","url":null,"abstract":"","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124392243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-15DOI: 10.5435/JAAOS-D-21-00155
Brian K. Lee, V. Patel, J. Itamura
Subscapularis tears occur more commonly than previously reported. Owing to the importance of the subscapularis in shoulder function, strong consideration should be given to repairing a full-thickness subscapularis tear when present. Historically, subscapularis repairs were done through a deltopectoral approach with good results. More recently, arthroscopic techniques have been developed with similar outcomes. When tears of the subscapularis are irreparable, reconstructive options, including tendon transfers, capsular reconstruction, and reverse shoulder arthroplasty, exist and continue to evolve.
{"title":"Subscapularis Tears: Evolution in Treatment Options.","authors":"Brian K. Lee, V. Patel, J. Itamura","doi":"10.5435/JAAOS-D-21-00155","DOIUrl":"https://doi.org/10.5435/JAAOS-D-21-00155","url":null,"abstract":"Subscapularis tears occur more commonly than previously reported. Owing to the importance of the subscapularis in shoulder function, strong consideration should be given to repairing a full-thickness subscapularis tear when present. Historically, subscapularis repairs were done through a deltopectoral approach with good results. More recently, arthroscopic techniques have been developed with similar outcomes. When tears of the subscapularis are irreparable, reconstructive options, including tendon transfers, capsular reconstruction, and reverse shoulder arthroplasty, exist and continue to evolve.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"305 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134415021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-11DOI: 10.5435/JAAOS-D-22-00168
Gabriella E. Ode
{"title":"Response to Letter to the Editor: Perception of Racial and Intersectional Discrimination in the Workplace Is High Among Black Orthopaedic Surgeons: Results of a Survey of 274 Black Orthopaedic Surgeons in Practice.","authors":"Gabriella E. Ode","doi":"10.5435/JAAOS-D-22-00168","DOIUrl":"https://doi.org/10.5435/JAAOS-D-22-00168","url":null,"abstract":"","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114115308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-08DOI: 10.5435/JAAOS-D-21-00414
M. O’Connor, K. Rankin, Erick M Santos
Mental illness affects 20.6% of American adults. The lifetime prevalence of depression and anxiety is 17% and 29%, respectively. In particular, women suffer more from mental illness than men. Racial and ethnic minorities experience disproportionate discrimination, which has been linked to depression, anxiety, and psychological distress. African Americans are more likely to be chronically depressed, have higher levels of impairment and more severe symptoms, and often have challenges accessing treatment. Poor mental health is associated with low socioeconomic status, prolonged hospital stays, psychosis, postoperative anemia, infection, and pulmonary embolism. For total hip and knee arthroplasty, mental health conditions have been linked to higher hospital charges, higher rates of nonroutine discharges, and an increased Charlson Comorbidity Index. Mechanisms to address mental health are varied and range from psychosocial to pharmacologic modalities. Optimization in these vulnerable patients includes appropriate preoperative screening, assessment of support systems, identifying resources, and providing a safe discharge plan.
{"title":"Movement Is Life-Optimizing Patient Access to Total Joint Arthroplasty: Mental Health Disparities.","authors":"M. O’Connor, K. Rankin, Erick M Santos","doi":"10.5435/JAAOS-D-21-00414","DOIUrl":"https://doi.org/10.5435/JAAOS-D-21-00414","url":null,"abstract":"Mental illness affects 20.6% of American adults. The lifetime prevalence of depression and anxiety is 17% and 29%, respectively. In particular, women suffer more from mental illness than men. Racial and ethnic minorities experience disproportionate discrimination, which has been linked to depression, anxiety, and psychological distress. African Americans are more likely to be chronically depressed, have higher levels of impairment and more severe symptoms, and often have challenges accessing treatment. Poor mental health is associated with low socioeconomic status, prolonged hospital stays, psychosis, postoperative anemia, infection, and pulmonary embolism. For total hip and knee arthroplasty, mental health conditions have been linked to higher hospital charges, higher rates of nonroutine discharges, and an increased Charlson Comorbidity Index. Mechanisms to address mental health are varied and range from psychosocial to pharmacologic modalities. Optimization in these vulnerable patients includes appropriate preoperative screening, assessment of support systems, identifying resources, and providing a safe discharge plan.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122713655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-07DOI: 10.5435/JAAOS-D-21-00302
C. Piper, Andrew S. Neviaser
Anatomic total shoulder arthroplasty provides pain relief and improved quality of life for patients suffering from glenohumeral arthritis. The 10-year survival rate for these implants has been most recently reported at 96%. As the number of shoulder arthroplasties per year increases, it is important to evaluate factors associated with failure. Patient-specific variables such as age, sex, medical comorbidities, a history of previous shoulder surgery, and rotator cuff integrity can influence implant survival. Both surgeon and hospital volume have been shown to affect perioperative outcomes. Implant design and glenoid pathoanatomy are important structural considerations because both have a causal relationship with survivorship. Modifiable factors, such as smoking, body mass index, and alcohol or opioid consumption, should be addressed preoperatively when possible. Modifiable factors that pertain to surgery are equally as important; it is the responsibility of the surgeon to be aware of the reported outcomes for varying implants and technique-related pearls and pitfalls. For those perioperative factors that are nonmodifiable, it is prudent to counsel patients accordingly because these individuals may be more likely to require an eventual revision procedure.
{"title":"Survivorship of Anatomic Total Shoulder Arthroplasty.","authors":"C. Piper, Andrew S. Neviaser","doi":"10.5435/JAAOS-D-21-00302","DOIUrl":"https://doi.org/10.5435/JAAOS-D-21-00302","url":null,"abstract":"Anatomic total shoulder arthroplasty provides pain relief and improved quality of life for patients suffering from glenohumeral arthritis. The 10-year survival rate for these implants has been most recently reported at 96%. As the number of shoulder arthroplasties per year increases, it is important to evaluate factors associated with failure. Patient-specific variables such as age, sex, medical comorbidities, a history of previous shoulder surgery, and rotator cuff integrity can influence implant survival. Both surgeon and hospital volume have been shown to affect perioperative outcomes. Implant design and glenoid pathoanatomy are important structural considerations because both have a causal relationship with survivorship. Modifiable factors, such as smoking, body mass index, and alcohol or opioid consumption, should be addressed preoperatively when possible. Modifiable factors that pertain to surgery are equally as important; it is the responsibility of the surgeon to be aware of the reported outcomes for varying implants and technique-related pearls and pitfalls. For those perioperative factors that are nonmodifiable, it is prudent to counsel patients accordingly because these individuals may be more likely to require an eventual revision procedure.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126937733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-02DOI: 10.5435/JAAOS-D-21-01112
J. Buckley, L. Dearolf, L. Lattanza
{"title":"The Perry Initiative: Building the Pipeline for Women in Orthopaedics.","authors":"J. Buckley, L. Dearolf, L. Lattanza","doi":"10.5435/JAAOS-D-21-01112","DOIUrl":"https://doi.org/10.5435/JAAOS-D-21-01112","url":null,"abstract":"","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128277033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-02DOI: 10.5435/JAAOS-D-22-00153
P. Rose
{"title":"JAAOS Editorial Board Update.","authors":"P. Rose","doi":"10.5435/JAAOS-D-22-00153","DOIUrl":"https://doi.org/10.5435/JAAOS-D-22-00153","url":null,"abstract":"","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133521975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-15DOI: 10.5435/jaaos-d-21-00165
A. Nourbakhsh, Zachary C. Hanson
Odontoid fractures represent the most common fractures involving C2 and the most common cervical spine fractures in patients older than 65 years. Despite their increasing frequency, optimal management of these injuries remain a subject to debate. Although types I and III injuries have relatively good healing potential with nonsurgical treatment, type II fractures carry a higher risk for nonunion. In particular, elderly patients are at risk for nonunion or fibrous malunion after nonsurgical treatment; however, increased medical comorbidities and poor bone quality also increase the risks of surgery in this cohort. The high morbidity and mortality associated with these injuries has made it an area of particular interest among spine surgeons. The purpose of this review was to summarize the pathophysiology, evaluation, and diagnosis of these injuries and to review controversies in management and considerations for treatment based on the most recent available literature.
{"title":"Odontoid Fractures: A Standard Review of Current Concepts and Treatment Recommendations.","authors":"A. Nourbakhsh, Zachary C. Hanson","doi":"10.5435/jaaos-d-21-00165","DOIUrl":"https://doi.org/10.5435/jaaos-d-21-00165","url":null,"abstract":"Odontoid fractures represent the most common fractures involving C2 and the most common cervical spine fractures in patients older than 65 years. Despite their increasing frequency, optimal management of these injuries remain a subject to debate. Although types I and III injuries have relatively good healing potential with nonsurgical treatment, type II fractures carry a higher risk for nonunion. In particular, elderly patients are at risk for nonunion or fibrous malunion after nonsurgical treatment; however, increased medical comorbidities and poor bone quality also increase the risks of surgery in this cohort. The high morbidity and mortality associated with these injuries has made it an area of particular interest among spine surgeons. The purpose of this review was to summarize the pathophysiology, evaluation, and diagnosis of these injuries and to review controversies in management and considerations for treatment based on the most recent available literature.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"587 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131512460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.5435/JAAOS-D-21-00730
D. Wiznia, M. O’Connor, H. Clarke
In coordination with Movement is Life, a multistakeholder coalition dedicated to promoting musculoskeletal health equity, the JAAOS Editorial Board has overseen the preparation of 12 articles that focus on methodology to optimize patients and improve access to total hip and knee arthroplasty for underserved populations.
JAAOS编辑委员会与致力于促进肌肉骨骼健康公平的多利益相关方联盟“运动即生命”(Movement is Life)协调，监督编写了12篇文章，重点关注优化患者和改善服务不足人群获得全髋关节和膝关节置换术的方法。
{"title":"The Relationship Between Preoperative Optimization and Healthcare Disparities.","authors":"D. Wiznia, M. O’Connor, H. Clarke","doi":"10.5435/JAAOS-D-21-00730","DOIUrl":"https://doi.org/10.5435/JAAOS-D-21-00730","url":null,"abstract":"In coordination with Movement is Life, a multistakeholder coalition dedicated to promoting musculoskeletal health equity, the JAAOS Editorial Board has overseen the preparation of 12 articles that focus on methodology to optimize patients and improve access to total hip and knee arthroplasty for underserved populations.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126491632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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