Background: Procedure-specific opioid-prescribing guidelines have the potential to decrease the number of unused pills in the home without compromising patient satisfaction. However, there is a paucity of data on the minimum necessary quantity to prescribe for outpatient orthopaedic surgeries. Purpose: To prospectively record daily opioid use and pain levels after arthroscopic meniscal procedures and anterior cruciate ligament reconstruction (ACLR) at a single institution. Study Design: Case series; Level of evidence, 4. Methods: A total of 95 adult patients who underwent primary arthroscopic knee surgery (meniscectomy, repair, or ACLR) were enrolled. Patients with a history of opioid dependence were ineligible. Daily opioid consumption and Numeric Rating Scale pain scores were collected through an automated text-messaging platform starting on postoperative day 1 (POD1). At 6 weeks or at patient-reported cessation of opioid use, final survey questions were asked. Patients who failed to complete data collection were excluded. Opioid use was converted into “pills” (oxycodone 5-mg equivalents) to facilitate comparisons and clinical applications. Factors associated with high and low opioid use were compared. Results: Of the 95 patients enrolled, 71 (74.7%) were included in the final analysis. Of these, 40 (56.3%) underwent meniscal surgery and 31 (43.7%) underwent ACLR. After outpatient arthroscopic meniscectomy or repair, the total median postdischarge opioid use was 0.3 pills (oxycodone 5-mg equivalents), with 75% of patients consuming 3.3 or fewer pills (range, 0-19 pills). For ACLR, the median postdischarge consumption was 7 pills (75th percentile, 23.3 pills; range, 0-41 pills). Almost one-third of patients (32.3%) took no opioids after surgery (3 ACLR, 20 meniscus). All meniscus patients and 71% of ACLR patients ceased opioid consumption by postoperative day 7. Conclusion: Opioids may not be necessary in all patients, particularly after meniscal surgery and in comparison with ACLR. For patients requesting opioids for pain relief, reasonable prescription quantities are 5 oxycodone 5-mg pills after arthroscopic meniscal procedures and 20 5-mg pills after ACLR. Slowing the current opioid epidemic and preventing future crises is dependent on refining prescribing habits. Clinicians should strongly consider patient education regarding expected pain as well as pain management strategies.

<p class="abstract"><strong>Background:</strong> Determining the incidence of deep venous thrombosis (DVT), a prospective study, in patients treated with Ilizarov external fixators for lower extremity fractures, fracture non unions or deformity correction.</p><p class="abstract"><strong>Methods:</strong> A Prospective, observational and cross sectional study. 49 Patients with complex lower extremity injuries, deformities and non-union of fractures were treated with Ilizarov external fixator application, were assessed clinically and radiological (Venous Doppler) at regular intervals- 6 days post-surgery then at 6 weeks, 12 weeks and between 4 to 6 months post-operative. None were given chemoprophylaxis for the prevention of DVT and everyone were assessed pre operatively with a questionnaire and wells criteria was taken for assessment of high risk for developing venous thrombosis. There were 41 men and 8 women, 85.75% of the study group is of age 30 to 60 years.<strong></strong></p><p class="abstract"><strong>Results:</strong> Only 1 of 49 patients developed radiological evident DVT within 6 days of surgery. Patients who underwent application of Ilizarov external fixator electively for deformity correction, osteomyelitis and non-union showed no clinical or radiological evident signs of DVT.</p><p><strong>Conclusions:</strong> The incidence of DVT and PTE is minimal when patients without chemoprophylaxis underwent lower limb Ilizarov external fixator application for acute trauma and electively for deformity correction, treatment of non-union and osteomyelitis. However further comparative and randomized studies need to be done to confirm our results.</p>

Arthroscopic anterior cruciate ligament (ACL) reconstruction is a common procedure performed for symptomatic ACL tears, especially in athletes. The desired surgical end product with any surgical fixation device remains a taut ACL graft, which is crucial during postoperative rehabilitation to reduce the risk of knee instability and rerupture of the ACL graft. The purpose of this Technical Note and accompanying video is to describe a simple and cost-effective technique to easily retension the ACL graft after tibial fixation in ACL reconstruction using a suture disk device. The technique uses a simple suture disk device to provide strong tibial fixation, along with the unique ability to retension the ACL graft by dialing it in a clockwise direction.

In knee arthroscopy, a posteromedial portal is used for various indications including arthroscopic posterior cruciate ligament reconstruction, posterior cruciate ligament avulsion fracture fixation, posterior medial meniscal repair, medial ramp lesion repair, and synovectomy. Making the posteromedial portal is challenging for young and even experienced surgeons. Creating the posteromedial portal in knee arthroscopy is challenging and technically demanding for surgeons because of the thick muscular cover, proximity of the neurovascular bundle, tenacious tough capsule, and excessive fat deposition in the posteromedial knee and thigh region. Access for viewing the posteromedial compartment during different procedures is made simple, safe, and replicable with this technique of creating the posteromedial portal. This article describes a simple way to create the posteromedial portal using a radiofrequency device by a modified outside-in surgical technique.