Minnesota Orthopedic Sports Medicine Institute

Mazkur maqolada bo‘lajak estrada va ommaviy tomoshalar rejissyorlarida adabiy asar tahlili ko‘nikmalarini shakllantirish masalalari ilmiy-pedagogik jihatdan tahlil etilgan. Adabiy asar tahlilining rejissyorlik faoliyatidagi o‘rni, uning sahnaviy talqin va badiiy konsepsiyani shakllantirishdagi ahamiyati yoritib berilgan. Shuningdek, oliy ta’lim jarayonida adabiy tahlil ko‘nikmalarini rivojlantirishda qo‘llaniladigan samarali metod va pedagogik yondashuvlar asoslab berilgan. Maqola natijalari estrada va ommaviy tomoshalar rejissyorlarini tayyorlash jarayonini takomillashtirishga xizmat qiladi.

The purpose of the study was to compare the safety and effectiveness of ultrasound-guided carpal tunnel release (UGCTR) and open carpal tunnel release (OCTR) in real-world clinical settings. Patients with carpal tunnel syndrome were prospectively enrolled in the multicenter MISSION registry and treated with unilateral UGCTR or OCTR by experienced surgeons. Outcomes included the Boston Carpal Tunnel Questionnaire Symptom Severity and Boston Carpal Tunnel Questionnaire Functional Status Scale, pain (0-10 scale), opioid use, health-related quality of life (EuroQoL 5-Dimension 5-Level), satisfaction (overall and wound), and adverse events through 3 months. Baseline group characteristics were balanced using propensity score matching. A total of 178 patients per group were analyzed. The predominant anesthesia methods differed between groups (84.8% wide awake local anesthesia no tourniquet with UGCTR; 68.5% monitored anesthesia with OCTR). Ultrasound-guided carpal tunnel release was associated with shorter incisions (5.2 vs 16.5 mm) and less sutured wound closure (14.6% vs 100%), but longer procedure times (15 vs 6 minutes). At 3 months, UGCTR showed minor statistical advantages in Boston Carpal Tunnel Questionnaire Symptom Severity (group difference: -0.14 points), Boston Carpal Tunnel Questionnaire Functional Status Scale (group difference: -0.16 points), and pain severity (group difference: -0.6 points), with no statistical differences in EuroQoL 5-Dimension 5-Level (group difference: 0.03 points) or overall satisfaction (group difference: 4.9%). Opioid use was less common (10.2% vs 49.1%), wound satisfaction was higher (94.2% vs 84.0%), and wound symptoms were less severe after UGCTR (60.7% vs 22.8% with no sensitivity or pain). Nonserious adverse event rates were comparable (1.1% vs 0.0%). Ultrasound-guided CTR and OCTR provided safe and effective symptom relief in routine clinical practice. Ultrasound-guided CTR was associated with less anesthesia, shorter incisions, reduced opioid use, and fewer wound symptoms, whereas procedure time was shorter with OCTR. Technique selection should be guided by shared decision making, considering patient expectations and surgeon's judgment. Therapeutic II.

Team physicians may be called upon to treat adolescent athletes, defined in this document as those in the range of 12-18 yr of age. Many are involved in school-based, intramural, or specialized sports participation and/or training, potentially resulting in injury and/or illness. Specialized treatments may be necessary due to growth and development of the adolescent. Additionally, psychological factors in this age group may play an important role in sports participation, emotional well-being, and injury rehabilitation. While many children younger than 12 yr of age are active in sports participation, their medical and musculoskeletal concerns are not included in the scope of this consensus statement. The healthcare team must stay educated and knowledgeable regarding potential challenges to individuals participating safely in sport. All healthcare professionals should provide quality care, free from discrimination and specific to the needs of every unique individual. Ensuring access to care, fostering welcoming sporting environments, and recognizing the distinct challenges faced by underrepresented populations will reduce healthcare disparities and improve safe participation across all sports.

Background:Injuries of the medial ulnar collateral ligament (MUCL) among baseball pitchers are increasing. Surgical treatment is evolving to optimize outcomes.Purpose/Hypothesis:This study’s purpose was to highlight trends in MUCL repair and reconstruction in professional pitchers, describe outcomes such as return to any level of play (RTP), and identify factors impacting these outcomes. It was hypothesized that primary and revision MUCL surgery is increasing, with revision surgery requiring greater RTP time.Study Design:Case series; Level of evidence, 4.Methods:The Major League Baseball (MLB) Health and Injury Tracking System database was used to procure data during the study period (2010-2023). All professional pitchers who underwent MUCL surgery during this period were included. RTP was defined as a pitcher returning to at least 1 professional game after index surgery. Return to the same level of play (RTSL) was defined as return to at least 1 game in the same league of play as before surgery. Because of the coronavirus pandemic, the year 2020 was considered an outlier and omitted from time-trend analysis.Results:A total of 2281 pitchers who underwent MUCL surgery during the study period were included for analysis. The number of MUCL surgeries for pitchers increased yearly (R2 = 0.821; P < .001), as did the number of reconstructions with internal brace augmentation (R2 = 0.896; P < .001). The RTP rate for MLB pitchers was significantly higher than the RTSL rate (93% vs 71%; P < .001). This difference was not observed in Minor League Baseball (MiLB) pitchers (RTP 76% vs RTSL 74%; P = .142). RTP rates after revision surgery were lower than those after primary surgery (71% vs 80%; P = .020). The mean time to RTP was shorter (470 ± 135 days) than the mean time to RTSL (499 ± 153 days; P < .001).Conclusion:The incidence of MUCL surgery and revision surgery is increasing among professional pitchers. Overall, 79% of pitchers returned to any level of play at a mean of 470 days, while 74% returned to the same level of play at a mean of 499 days, but this varied based on level of play. This study will guide athlete expectations and surgeon decision-making.

Background: Total ankle arthroplasty (TAA) is successful at reducing pain and improving patient satisfaction. A paucity of literature exists regarding racial disparities in TAA. The aim of this study was to update the literature, analyze utilization rates, and detect differences in postoperative outcomes between the racial/ethnic groups. Methods: A retrospective study was performed utilizing the National Surgical Quality Improvement Program (NSQIP) database between the years 2012 and 2018. The postoperative complications were identified as outcomes. Patients were categorized based on race/ethnicity for comparison. A p-value less than 0.05 was considered significant. Results: 1164 patients met criteria, 1051 (90.3%) were White, 113 (9.7%) were Non-White, a nearly 10-fold difference in utilization rate. The mean age of White patients undergoing TAA was older than Non-White patients, 63.7 and 55.3 years respectively (p-value &lt; 0.01). Incidence of postoperative complications showed no significant differences based on racial group. Conclusions: Our results found a nearly 10-fold difference in White patients undergoing TAA compared to other racial/ethnic groups. This highlights the continued racial disparities present in TAA. Further efforts are needed to improve the proportion of minority populations who undergo TAA to bridge the current racial disparities present in the field of TAA.

Passive smartphone-based apps are becoming more common for measuring patient progress after total hip arthroplasty (THA). Optimum activity levels during early THA recovery have not been well documented. Correlations between step-count and patient reported outcome measures (PROMs) during early recovery were explored. This study also investigated how demographics impact step-count during early post-operative recovery. Smartphone captured step-count data from 666 THA patients was retrospectively reviewed. Mean age was 64 ± 11 years. 55% were female. Mean BMI was 29 ± 8kg/m2. Mean daily step-count was calculated for each patient over four time-windows: 60 days prior to surgery (preop), 42-49 days postop (6 weeks), 91-98 days postop (3 months), and 183-197 days postop (6 months). Spearman correlation coefficients and linear regression were used to assess the association between PROMs (HOOS-12, HOOS-Jr, and UCLA) and step-count. Patients were separated into three step-count levels: low (< 2500 steps/day), medium (2500-5500 steps/day), and high (> 5500 steps/day). Age > 65 years, BMI > 35 kg/m2, and sex were used for demographic comparisons. Post hoc analyses were performed using Welch's unequal variances t-tests, or Wilcoxon rank-sum tests, both with Bonferroni corrections, where appropriate when comparing between groups. Chi-squared analyses were also used when comparing categorical variables. UCLA correlated with step-count at all time-windows (p< 0.001). HOOS12-Function correlated with step-count preoperatively, at 6 weeks, and at 3 months (p< 0.001). High step-count individuals had improved UCLA scores compared to low step-count individuals preoperatively (Δ1.5, p< 0.001), at 6 weeks (Δ0.9, p< 0.001), at 3 months (Δ1.4, p< 0.001), and at 6 months (Δ1.4, p< 0.001). High step-count individuals had improved HOOS12-Function scores compared to low step-count individuals preoperatively (Δ9.6, p< 0.001), at 6 weeks (Δ5.3, p< 0.001), and at 3 months (Δ6.1, p< 0.001). Males had greater step-count at all time points (p< 0.001). Younger patients and low BMI patients had greater step-count across all time points (p< 0.001). High step-count improved PROMs scores compared to low step-count. Early post-operative step-count was significantly impacted by age, sex, and BMI. Generic recovery profiles may not be appropriate across diverse populations.

Background: Hip arthroscopy is commonly used for the treatment of hip pathologies. As population obesity rates continue to increase, elucidating the impact of body mass index (BMI) on hip arthroscopy outcomes is essential. This investigation was conducted to quantify the effects of BMI on hip arthroscopy outcomes.Methods: We conducted a retrospective medical records review of 459 patients undergoing hip arthroscopy at a single center from 2008 to 2016. The Harris Hip Score (HHS) and 2 component scores of the 12-Item Short Form Survey—the physical component score (PCS-12) and the mental component score (MCS-12)—were used to measure outcomes. Patients were stratified into 4 cohorts based on their BMI: underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5 to 24.9 kg/m2), overweight (BMI 25.0 to 29.9 kg/m2), and obese (BMI ≥30.0 kg/m2).Results: At 1 and 2 years postoperatively, all cohorts experienced statistically significant improvements in the HHS and PCS-12. At 3 years postoperatively, statistically significant improvements were seen in the HHS for all cohorts; in the PCS-12 for the normal weight, overweight, and obese cohorts; and in the MCS-12 for the normal weight cohort. Intercohort differences were not statistically significant at 1, 2, or 3 years postoperatively.Conclusion: In our population, BMI did not have statistically significant effects on patient outcome scores following hip arthroscopy. All patient cohorts showed postoperative improvements, and differences between BMI cohorts were not statistically significant at any postoperative time point.