Orthopaedic Specialty Clinic

This systematic review evaluates long-term outcomes after anterior cruciate ligament reconstruction (ACLR) with lateral extra-articular tenodesis (LET), including patient-reported outcome measures (PROMs), failure rates, objective knee scores and radiographic osteoarthritis (OA). A search of MEDLINE, Embase and Emcare was conducted until April 2025. Studies were eligible if they reported ≥10-year outcomes following combined ACLR and LET in adults. Exclusion criteria included cadaveric, biomechanical, paediatric and non-English studies. Methodological quality was assessed using Risk of Bias 2.0 Tool (RoB 2) for randomized trials and methodological index for non-randomized studies (MINORS) for non-randomized studies. Narrative synthesis and descriptive statistics were performed. Eleven studies (n = 603) were included, with a mean follow-up of 15.8 years (standard deviation [SD] 5.9). Graft failure rates ranged from 0% to 19.5%, with lower rates in studies using stricter revision-based definitions. LET was associated with lower failure and instability rates compared to isolated ACLR in three studies. Radiographic OA findings were mixed: some reported increased lateral OA (notably with bone-patellar tendon-bone [BTB] grafts), while others suggested protective effects, especially in patients with hamstring grafts and prior meniscectomy. Lysholm scores consistently exceeded 85, while Tegner activity levels declined modestly. International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores were favourable, and most patients achieved IKDC objective Grade A or B. This review demonstrated that ACLR augmented with LET provided durable long-term outcomes, including high rates of subjective satisfaction and objective stability, without being consistently associated with increased radiographic OA or unacceptable failure rates. However, heterogeneity in study design, surgical technique and outcome reporting limits definitive conclusions. Level IV.

Oliphant, Bryant W. MD, MBA, MSc, FACS; Miller, Anna N. MD, FACS; Wolinsky, Philip MD, FACS Author Information

Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux metatarsophalangeal (MTP) proximal capsular origin on the metatarsal neck is essential for surgeons in planning and executing extracapsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. The ten specimens had a mean age of 77 years, with 5 female and 5 male. The mean distances from the central hallux metatarsal head to the MTP capsular origin were 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopaedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus. Cadaveric Study.

Lithium is one of the mainstays of treatment for bipolar disorder. Chronic lithium therapy can rarely lead to hypercalcemia secondary to lithium-induced hyperparathyroidism. We present a 66-year-old female patient with bipolar disorder on lithium therapy presenting with hypercalcemia. We discussed the pathophysiology and management of hyperparathyroidism and hypercalcemia in patients on chronic lithium therapy.

Metatarsal fistulation is an uncommon cutaneous condition reported almost exclusively in German shepherd dogs and their cross-breeds. To the best of the authors' knowledge this is the first reported case of focal metatarsal fistulae syndrome affecting a greyhound. Remission was obtained within 6 weeks of commencing treatment using compounded 0.1% tacrolimus ointment twice daily and the dog remained stable for another 6 months with twice weekly application before treatment was discontinued. The dog remained in remission at the time of writing, which is 1 year after treatment withdrawal.

The Agility (DePuy, Warsaw, Indiana) total ankle replacement has been in use since 1984. One of the most common complications continues to be delayed union or nonunions of the distal tibiofibular syndesmosis. In the reported studies on the Agility ankle the delayed union and nonunion rate can be as high as 38%. Since 1999, 114 Agility total ankle replacements were done at two centers in the United States without the use of autologous concentrated growth factors. Since July of 2001, 66 Agility ankles were implanted with Symphony (DePuy, Warsaw, Indiana) augmented bone grafting. The standard operative technique was followed in all the patients. Prospective data was collected on all patients. The standard ankle radiographs were taken preoperatively and postoperative at 8 weeks, 12 weeks, 16 weeks, 6 months, and yearly. CT scans were obtained at 6 months if fusion at the syndesmosis was questionable. The Graphpad Instat software (Graphpad Software Inc., San Diego, CA) was used for statistical analysis. The two-tailed unpaired t-test was used, and the value <0.05 was considered significant. There was no statistical difference in the demographic data for the two groups. In 114 ankle replacements without autologous concentrated growth factors 70 fused at 8 weeks (61%), 14 fused at 12 weeks (12%), 13 fused at 6 months (12%). There were 17 nonunions (15%); delayed unions (3 to 6 months) and nonunions, therefore, equaled 27%. The syndesmosis fused in 50 of the 66 ankle replacements (76%) that had autologous concentrated growth fractures at 8 weeks (76%); 12 fused at 3 months (18%), 2 fused at 6 months (3%), 2 had nonunions (3%). Delayed unions (3 to 6 months) and nonunions equaled 6%. There was a statistically significant improvement in the 8- and 12-week fusion rates, and a statistically significant reduction in delayed unions and nonunions. Autologous concentrated growth factors appear to make a significant positive difference in the syndesmosis union rate in total ankle replacements.

SUMMARYThe efficacy and safety of oral moxifloxacin (400 mg once daily, 7 days) versus cephalexin (500 mg three times daily, 7 days) were compared in a prospective, multicentre, randomised, double‐blind trial in 401 adults with uncomplicated skin infections. Clinical outcome was evaluated in 351 patients. Moxifloxacin proved to be as effective as cephalexin both clinically (90% versus 91%, respectively) and bacteriologically in eradicating the most frequently isolated pathogen Staphylococcus aureus (92% and 93%, respectively). Moxifloxacin was more effective than cephalexin in eliminating Streptococcus spp. (90% and 82%, respectively). Drug‐related adverse events were comparable in both treatment groups with the most frequently reported being nausea in the moxifloxacin‐treated patients and headache in the cephalexin‐treated patients. Medication was discontinued due to unwanted reactions in 3% of the moxifloxacin‐ and 4% of the cephalexin‐treated patients. Moxifloxacin, 400 mg once daily for 7 days, is as safe and effective as cephalexin 500 mg three times daily for 7 days in the treatment of uncomplicated skin infections.