Second Look—Clinical News and Views

ACLR revision factors
A study in The American Journal of Sports Medicine (AJSM) attempts to identify factors linked to increased risk of revision after allograft anterior cruciate ligament reconstruction (ACLR). The retrospective cohort study of 5,968 primary ACLR cases performed with allograft found that use of the BioCleanse processing method and irradiation greater than 1.8 Mrad were associated with a higher risk of revision when compared with all other processing methods, after adjustment for patient age, sex, and body mass index (BMI). In addition, bone–patellar tendon–bone allografts were at increased risk of revision compared with soft tissue allografts, and younger patient age and male sex were linked to increased risk of revision.

Treating FAI
Findings from a study in AJSM suggest that treating femoroacetabular impingement (FAI) with either hip arthroscopy or open surgical hip dislocation may offer excellent and equivalent hip survival rates at medium-term follow-up. The systematic review and meta-analysis of 16 studies covering 2,084 hips found that both treatments demonstrated good outcomes in their respective scoring systems. However, compared to open treatment, hip arthroscopy was associated with a higher general health-related quality of life score on the 12-Item Short-Form Survey physical component score.

Reducing 90-day mortality
According to findings in The Lancet, patients who are readmitted to the index hospital after a major surgical procedure have better survival rates compared to those admitted to a different institution. The review of Medicare claims data found that readmissions due to a surgical complication were more likely to be to the index hospital than to another hospital. Readmission to the index hospital was associated with a 26 percent lower risk of 90-day mortality than was readmission to another hospital, with inverse probability weighting used to control for selection bias. The effect was significant for all procedures in inverse probability-weighted models.

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