Review Article Joint preservation procedures: osteotomies about the knee Michael S. Rocca, Karina Dias, Jonathan D. Hughes

The purpose of this study was to define the rate of preoperative opioid use among patients undergoing hip arthroscopy, ascertain which clinical factors are associated with opioid use, and assess the effect of preoperative opioid usage on preoperative patient-reported outcome (PRO) measures. A single institution orthopaedic registry was retrospectively analyzed for patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAI) with or without labral tear between 2015 and 2022. Patients completed Patient-Reported Outcomes Measurement Information System (PROMIS) in six domains, Numeric Pain Scores (NPS), and Musculoskeletal Outcomes Data Evaluation and Management System expectations domain preoperatively. Patients' charts were reviewed to determine demographic factors and identify any active opioid prescription within 6 weeks before surgery. Bivariate analysis was used to determine associations between preoperative opioid use and baseline PROs. Statistically significant bivariate associations were further tested by multivariate analysis to determine independent predictors. A total of 123 patients were included (age 39.7 ± 12.0 years; 87 females; body mass index 27.4 ± 5.7 kg/m²). There were 21 patients (17%) using opioids preoperatively. Prior orthopaedic or other surgery and lower education level was associated with preoperative opioid use. Patients with preoperative opioid use scored statistically significantly worse compared to those without preoperative opioid use on baseline PROMIS Physical Function (38.6 vs 40.5, p = 0.01), Pain Interference (65.9 vs 60.2, p = 0.001), Fatigue (60.7 vs 51.6, p = 0.005), Social Satisfaction (38.2 vs 43.2, p = 0.007), and Depression (54.2 vs 48.8, p = 0.01). Preoperative opioid use was also associated with statistically significantly worse pre-operative NPS for both the operative hip (6.3 vs 4.6, p = 0.003) and whole body (3.0 vs 1.4, p = 0.008). Preoperative opioid use was an independent predictor of worse baseline PROMIS Pain Interference, Fatigue, Social Satisfaction, and NPS for the operative hip. Patients using opioids preoperatively had worse baseline PROs for physical function, pain, social satisfaction, and depression than those not using opioids preoperatively. When controlling for confounding variables, preoperative opioid use was independently predictive of worse baseline pain, fatigue, and social satisfaction. Level III, prognostic study.

Background: Postoperative infection following anterior cruciate ligament reconstruction (ACLR) is a rare yet severe complication that can compromise patient outcomes, leading to prolonged recovery, graft failure, and knee dysfunction. Although infection rates are reported to be less than 2%, it remains essential to implement strategies to reduce infection risk and improve surgical outcomes. Methods: This review explores current evidence on the prevention of infections in ACLR, emphasizing the importance of timely antibiotic prophylaxis and vancomycin presoaking of grafts, which has been associated with a substantial reduction in infection rates. Results: Empirical antibiotic therapy should be started immediately after joint aspiration when infection is suspected. Treatment must prioritize culture-specific antibiotic regimens to optimize patient outcomes. Surgical intervention with arthroscopic debridement and irrigation needs to occur as soon as the diagnosis of infection is made. Often, this is performed with a focus on retaining the graft in order to preserve knee stability, if possible. Careful intraoperative management, along with the aid of infectious disease specialists, is paramount to help optimize outcomes following infection after ACLR. Conclusions: This review emphasizes the need for treatment protocols and highlights areas for future research to establish clear guidelines on infection after ACLR, especially with decisions of graft retention versus removal.