Presbyterian Rust Medical Center

Study Objective: We sought to assess the factors that are associated with ovarian preservation in the setting of surgically confirmed ovarian torsion, specifically focusing on the time to surgery after the emergency department (ED) presentation. Methods: We conducted a retrospective cohort study at a single tertiary care academic hospital from 2008 to 2021. Patients aged 12–40 with ovarian torsion were identified using diagnosis codes. We compared the outcome of ovarian preservation versus removal based on time to surgery after ED presentation, age, parity, Doppler flow, presence of ovarian mass, detorsion attempt, intraoperative suspicion of necrosis, and time of day. Results: We identified 60 surgical cases of ovarian torsion, with 25 undergoing oophorectomy (58.3% preserved). The median time from ED presentation to surgery was 8.6 hours, and only six surgeries occurred in <4 hours, which was not associated with ovarian preservation. Preservation was associated with Doppler flow (60% vs. 27%, p = 0.019) and was less likely when necrosis was suspected (20% vs. 84%, p < 0.001) and age ≥25 years (34% vs. 68%, p = 0.010). Detorsion attempts resulted in the preservation of 25% of ovaries with suspected necrosis. Parity and presentation time of day were not associated with preservation. Discussion: Time to surgery was not associated with ovarian preservation, possibly because few cases occurred in <4 hours. Setting goal times might improve outcomes. Ovaries are more likely to be preserved when detorsion is attempted despite necrotic appearance and when Doppler flow is present on sonographic exam. The surgical decision for oophorectomy may be based on factors unrelated to functional loss of the ovary.

Infectious aortitis is an uncommon but life-threatening cause of aortitis. Given the lack of specific symptoms, establishing the diagnosis is often a challenge. When it is associated with an endovascular infection, such as infective endocarditis, blood cultures may be diagnostic although often limited by low positive predictive value. Imaging studies may reveal characteristic findings, with computerized tomography angiography being the most sensitive. Management includes prompt initiation of antimicrobial therapy followed by surgical intervention, keeping in mind that operative mortality is high due to weakened arterial wall integrity. Here we describe a 25-year-old woman without relevant medical history, who presented to the hospital with subacute onset of fever, back pain and malaise, and was found to have infectious aortitis secondary to Streptococcus pneumoniae endocarditis. Despite appropriate antimicrobial coverage and surgical repair attempts, she succumbed to aortic perforation after a complicated and prolonged hospitalization.

Background:Previous studies have reported varying return-to-sport protocols after knee cartilage restoration procedures.Purpose:To (1) evaluate the time for return to sport in athletes with an isolated chondral injury who underwent an accelerated return-to-sport protocol after osteochondral autograft plug transfer (OAT) and (2) evaluate clinical outcomes to assess for any consequences from the accelerated return to sport.Study Design:Case series; Level of evidence, 4.Methods:An institutional cohort of 152 OAT procedures was reviewed, of which 20 competitive athletes met inclusion and exclusion criteria. All patients underwent a physician-directed accelerated rehabilitation program after their procedure. Return to sport was determined for all athletes. Clinical outcomes were assessed using International Knee Documentation Committee (IKDC) and Tegner scores as well as assessment of level of participation on return to sport.Results:Return-to-sport data were available for all 20 athletes; 13 of 20 athletes (65%) were available for clinical evaluation at a mean 4.4-year follow-up. The mean time for return to sport for all 20 athletes was 82.9 ± 25 days (range, 38-134 days). All athletes were able to return to sport at their previous level and reported that they were satisfied or very satisfied with their surgical outcome and ability to return to sport. The mean postoperative IKDC score was 84.5 ± 9.5. The mean Tegner score prior to injury was 8.9 ± 1.7; it was 7.7 ± 1.9 at final follow-up.Conclusion:Competitive athletes with traumatic chondral defects treated with OAT managed using this protocol had reduced time to preinjury activity levels compared with what is currently reported, with excellent clinical outcomes and no serious long-term sequelae.

Sports hernia represents a complex clinical entity that is generally poorly understood and commonly missed by sports medicine clinicians. Patients are typically athletes involved in sports requiring explosive movements with rapid changes in direction, resulting in trunk hyperextension and thigh hyperabduction and resultant shear injury to the hemi-pelvis with pathologic weakening of the posterior inguinal canal. They present with chronic activity-related groin or lower quadrant abdominal pain that is relieved by rest but returns with sport. The discrete diagnosis of sports hernia has been historically difficult to make due to the fact that a number of other musculoskeletal, gastrointestinal, genitourinary, and systemic diagnoses can have a similar presentation. The pathoanatomy of sports hernia, therefore, does not fit perfectly into one medical subspecialty, making it difficult for a single provider to adequately evaluate a patient with activity-related groin pain. Clinicians require not only a high index of suspicion, but also a broad clinical skill set to be able to rule out the numerous other clinical mimickers, and rule in the diagnosis of sports hernia. The goal of this chapter is to assist the clinician in the distillation of what can be a tremendous amount of vague clinical data, into a focused constellation of history and physical exam findings, resulting in the confident diagnosis of this condition.