Repair Failure Rate Research Articles

Poster 175: ALPSA Lesions Associated with High Rate of Early Repair Failure

Objectives: Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions occur in patients with recurrent shoulder instability and are associated with higher rates of failure after capsulolabral repair surgery compared to typical Bankart lesions. Despite recognition that these lesions can portend poor outcomes, there is relatively limited data to understand the associated injuries and postoperative course in a young, active population. The purpose of this study is to evaluate ALPSA lesions for associated pathology and outcomes. Methods: Methods: We reviewed the records of 312 patients who underwent arthroscopic shoulder stabilization by one of two fellowship trained sports surgeons at a single facility between 1 January 2010 and 31 December 2015. Inclusion criteria were a minimum follow-up of five years after index surgical repair and presence of an ALPSA lesion as identified on arthroscopic exam, leaving 46 patients available for review. Our primary outcome measures were failure and operative revision surgery. We considered failure as any recurrent shoulder instability events including subjective subluxation and dislocation, recurrence of pain consistent with instability, or functionally limiting apprehension. We performed survival analysis and a multivariate logistic regression analysis to identify factors associated with failure. Results: Results: In total, 46 patients with average age 21.2 years met inclusion and underwent surgery a median of 7.1 months after initial recalled injury event. 11/46 had concomitant posterior pathology in addition to anterior labral lesion. Six patients were found to have SLAP lesions. All patients experienced subjective instability, and 44/46 endorsed pain prior to surgery. 38/46 reported having experienced complete dislocation. The median number of dislocations before surgery was 3. Repairs were performed with average 3.7 anchors. Eight patients failed surgery at median 15.1 months post-index procedure, with 75% of failures occurring before two years with the remaining 25% occurring later in follow-up. Three of these failed revision repair. Conclusions: Conclusions: ALPSA lesions frequently occur in the presence of other intra-articular shoulder lesions and portend a high rate of recurrent shoulder instability despite repair. Notably, while failure occurs at a high rate, most repair failure for these lesions tends to occur early.

Autologous Interposition Grafts for Mucosal Flap Septal Perforation Repair.

Background: Nasal septal perforation repair is commonly attempted utilizing bilateral nasal mucosal flaps supported with an interposition graft. Objectives: To compare the failure rates for bilateral flap repairs utilizing four different autologous interposition grafts. Methods: This is a retrospective review of a single surgeon's bilateral flap perforation repairs supported with an autologous interposition graft. Study inclusion over the 18-year review period required at least one examination 1 month after surgery. Repair failure rates were calculated and compared for each graft type, and logistic regression was performed for multivariate analysis. Results: For the 356 study patients, median (range) age was 51 years (14-81) and 63.0% were women. Mean (range) perforation length was 13.9 mm (1-45). Median (range) at last follow-up was 11.2 months (1-192). Graft types used (percentage of patients and failure rate) were temporalis fascia (58.7/4.4), septal cartilage (23.3/7.3), auricular perichondrium (13.8/4.1), and septal bone (4.2/6.7) (p > 0.05). Conclusion: There was no significant difference in bilateral mucosal flap perforation repair failure rate when either a temporalis fascia, septal cartilage, auricular perichondrium, or septal bone interposition graft was used.

Save the Meniscus: The Meniscal Mantra Remains Durable: Commentary on an article by Rick W. Wright, MD, et al.: "Ten-Year Outcomes of Second-Generation, All-Inside Meniscal Repair in the Setting of ACL Reconstruction".

Commentary Save the meniscus. Save the meniscus. Save the meniscus. This is a subconscious orthopaedic mantra that we have all heard and repeated numerous times. Ever since Fairbank’s landmark study in 1948, “Knee Joint Changes After Meniscectomy,” and numerous later studies, we have learned to respect the importance of preserving the meniscus and, in turn, preventing degenerative changes1. In 2023, we may continue to debate over the best repair technique and the best repair augmentation and/or biologics, but we can all agree that we should do what we can to preserve and repair the meniscus. This has been demonstrated to be even more certain in the setting of a concomitant anterior cruciate ligament reconstruction (ACLR). Literature has demonstrated that meniscal tears heal better in the environment of an ACLR and, therefore, we should attempt to repair and preserve the meniscus as much as possible in this setting2,3. Historically, inside-out meniscal repair techniques were considered the gold standard, but as all-inside techniques have become more reliable, user-friendly, and able to mimic the traditional technique, they are more popularly used4. There are few 10-year outcome studies, and not many that examine all-inside meniscal suture devices; therefore, I commend Wright et al. on their current study. The authors performed a Level-IV retrospective review of 81 patients with a meniscal repair and concomitant primary ACLR using the second-generation, all-inside FAST-FIX Meniscal Repair System (Smith & Nephew). Some of these patients were included in their previous study evaluating outcomes of all-inside, second-generation repair at a 5-year follow-up4. In this current study, 69 of the 81 patients had a 10-year follow-up and 9 (13%) of the 69 patients had a failed meniscal repair, which was defined as a repeat surgical intervention involving resection or revision repair. The authors demonstrated that 84% to 88% of patients had a successful repair and all patients, regardless of failure, had favorable patient-reported outcome measures, which included the Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee (IKDC) score, and the Marx Activity Rating Scale score, at 10 years. There were 59 medial repairs and 22 lateral repairs, and, of all the repaired tears, there were 13 bucket-handle tears, and the remaining tears were vertical longitudinal tears in the red-red or red-white vascular region. The study did not include radial tears, root tears, or ramp lesions. The mean number of sutures used for repair was only 2. Concerns with regard to the study include the lack of a comparison group, the use of older devices, and the shorter postoperative rehabilitation protocol. There are now third-generation, all-inside repair devices available, and the postoperative rehabilitation after a meniscal repair and ACLR is now ≥8 months. Perhaps this longer rehabilitation time can influence meniscal repair success or failure rates. The authors have demonstrated that the success rate of meniscal repair is 84% to 88% using an all-inside, second-generation technique with a concomitant ACLR. Although this is considered successful, what else can we do to optimize our success rates even more? Should we use better techniques and devices, or orthobiologics? How will this change as we repair different types of tears, including root and ramp tears? Also, how will longer rehabilitation affect meniscal healing and retear rates? If our mantra, save the meniscus, remains true, then I look forward to future data demonstrating what else we can do to improve success rates with all tears (bucket-handle, longitudinal, root, and ramp) with newer techniques and biologics.

Reliability Estimation of Parallel Repairable System under Uncertainty in Lifetime Data

Abstract Reliability is a popular concept that has been used in the manufacturing industry. In this paper, we consider a parallel system containing n non-identical and independent components in which each component is repairable except when all components are failed. As a special case, estimating the reliability of the system with identical components is considered. In real life, the data obtained for repair rate and failure rate could be subject to uncertainty. Here, to address this situation, failure and repair rates are considered as fuzzy numbers to estimate the reliability of the system. Fuzzy system reliability is estimated using fuzzy failure and repair rates, which are obtained by using confidence intervals and point estimators of failure rate and repair rate.

Meniscal Repair Outcome in 3829 Patients With a Minimum Follow-up From 2 Years Up to 5 Years: A Meta-analysis on the Overall Failure Rate and Factors Influencing Failure

Background: The importance of meniscal repair is widely accepted because of the association of loss of meniscal tissue with the development of early-onset knee arthritis. Many factors influencing the results of meniscal repair have been reported, but results remain controversial. Purpose: This meta-analysis determines the pooled meniscal repair failure rate of studies with a minimum follow-up of 2 years up to 5 years, with a mean follow-up of 43 months. Moreover, selected failure-influencing factors are analyzed. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed and Scopus were searched for studies published between January 2000 and November 2021 reporting on meniscal repair outcome with a minimum follow-up of 24 months. The overall pooled failure rate and pooled failure rates for possible predictors were calculated. Random-effect models were used to pool failure rates, and effect estimates in the form of odds ratios with 95% CIs were established. Results: The initial literature search identified 6519 studies. A total of 51 studies met the inclusion criteria. In total, 3931 menisci were included with an overall failure rate of 14.8%. Subgroup analysis revealed a significantly lower failure rate for meniscal repair with concomitant anterior cruciate ligament (ACL) reconstruction compared with knees without any reported injury to the ACL (8.5% vs 14%; P = .043). The pooled failure rate for lateral meniscal repair was significantly lower than that for medial meniscal repair (6.1% vs 10.8%; P = .031). Pooled failure rates of all-inside and inside-out repair were not significantly different (11.9% vs 10.6%; P > .05). Conclusion: This meta-analysis on close to 4000 patients demonstrates an overall meniscal repair failure rate of 14.8% at a minimum follow-up from 2 years up to 5 years. Meniscal repair remains a procedure with a high failure rate, especially within the first 2 postoperative years. This review and meta-analysis also identified clinically relevant factors associated with favorable outcomes such as concomitant ACL reconstruction or repair of the lateral meniscus. All-inside meniscal repair with the latest-generation devices yields failure rates of <10%. The failure mechanism and the time of failure is poorly documented; further studies are needed for a better understanding of the retear mechanism.

Performance Analysis of Continuous Casting System of Steel Industry

The continuous casting system is the most important to solidify the liquid steel in the steel industry. Steel is the backbone of civilization and modernization. So, there is a need to optimize the performance of continuous casting system of steel industry. Continuous casting system has six subsystems: “Pouring turret ladle”, “Tundish”, “Mold”, “Water spray chamber”, “Support roller” and “Torch cutter”. Series configuration is used to arrange these subsystems. The subsystem “Pouring turret ladle” is having three similar units. These units are operating in parallel. The subsystems “Tundish”, “Mold”, “Water spray chamber” and “Support roller” have a single unit. The subsystem “Torch cutter” contains two identical units: one is operative and other keep in cold standby. For all subsystems, the distribution of repair rates and failure rates of continuous casting system are taken as arbitrary distributions. Analysis of continuous casting system has been done by using supplementary variable technique. The numerical results of reliability measure of continuous casting system in terms of availability and profit have been computed by assuming exponential, Rayleigh and Weibull distributions.

Knotless Tendon Repair with a Resorbable Barbed Suture: An In-vivo Comparison in the Turkey Foot.

Background: Un-knotted barbed suture constructs are postulated to decrease repair bulk and improve tension loading along the entire repair site resulting in beneficial biomechanical repair properties. Applying this repair technique to tendons has shown good results in ex-vivo experiments previously but thus far no in-vivo study could confirm these. Therefore, this current study was conducted to assess the value of un-knotted barbed suture repairs in the primary repair of flexor tendons in an in-vivo setting. Methods: Two groups of 10 turkeys (Meleagris gallapovos) were used. All turkeys underwent surgical zone II flexor tendon laceration repairs. In group one, tendons were repaired using a traditional four-strand cross-locked cruciate (Adelaide) repair, while in group two, a four-strand knotless barbed suture 3D repair was used. Postoperatively repaired digits were casted in functional position, and animals were left free to mobilise and full weight bear, resembling a high-tension post-op rehabilitation protocol. Surgeries and rehabilitations went uneventful and no major complications were noted. The turkeys were monitored for 6 weeks before the repairs were re-examined and assessed against several outcomes, such as failure rate, repair bulk, range of motion, adhesion formation and biomechanical stability. Results: In this high-tension in-vivo tendon repair experiment, traditionally repaired tendons performed significantly better when comparing absolute failure rates and repair stability after 6 weeks. Nevertheless, the knotless barbed suture repairs that remained intact demonstrated benefits in all other outcome measures, including repair bulk, range of motion, adhesion formation and operating time. Conclusions: Previously demonstrated ex-vivo benefits of flexor tendon repairs with resorbable barbed sutures may not be applicable in an in-vivo setting due to significant difference in repair stability and failure rates. Level of Evidence: Level IV (Therapeutic).

Interpositional scaffold anchor rotator cuff footprint tear repair: excellent survival, healing, and early outcomes.

Shoulder function limitation duration after a full-thickness rotator cuff tendon (RCT) tear may influence post-repair healing and outcomes. A suture anchor was developed to improve footprint repair fixation and healing through biological fluid delivery and scaffold augmentation. The primary multicenter study objective was to evaluate RCT repair failure rate based on 6-month MRI examination, and device survival at 1-year follow-up. The secondary objective was to compare the clinical outcomes of subjects with shorter- and longer-term shoulder function limitation duration. Seventy-one subjects (46 men) with moderate-to-large RCT tears (1.5-4cm), at a median 61years of age (range = 40-76), participated in this study. Pre-repair RCT tear location/size and 6-month healing status were confirmed by an independent radiologist. Subjects with shorter- (Group 1: 17.8 ± 21days, n = 37) and longer-term (Group 2: 185.4 ± 89days, n = 34) shoulder function limitation durations were also compared over 1year for active mobility, strength, American Shoulder and Elbow Surgeon's Shoulder Score (ASES score), Veterans RAND 12 Item Health Survey (VR-12), and visual analog scale (VAS) pain and instability scores. Three of the 52 subjects [5.8%] who underwent 6-month MRI experienced a re-tear at the original RCT footprint repair site. By the 1-year follow-up, overall anchor survival was 97%. Although Group 2 displayed lower ASES and VR-12 scores pre-repair (ASES = 40.1 ± 17 vs. 47.9 ± 17; VR-12 physical health (PH) = 37.2 ± 9 vs. 41.4 ± 8) (p ≤ 0.048), at 3-month post-RCT repair (ASES = 61.3 ± 19 vs. 71.3 ± 20; VR-12 PH = 40.8 ± 8 vs. 46.8 ± 9) (p ≤ 0.038), and at 6-month post-RCT repair (ASES = 77.4 ± 18 vs. 87.8 ± 13; VR-12 PH = 48.9 ± 11 vs. 54.0 ± 9) (p ≤ 0.045), by 1-year post-RCT repair, groups did not differ (n.s.). Between-groups VR-12 mental health score differences were not evident at any time period (n.s.). Shoulder pain and instability VAS scores also did not differ (n.s.), displaying comparable improvement between groups from pre-RCT repair to 1-year post-RCT repair. Groups had comparable active shoulder mobility and strength recovery at each follow-up (n.s.). At 6-month post-RCT repair, only 3/52 of patients [5.8%] had a footprint re-tear, and at 1-year follow-up, overall anchor survival was 97%. Use of this scaffold anchor was associated with excellent early clinical outcomes regardless of shoulder function impairment duration. II.

Prospective Randomized Trial of Biologic Augmentation With Bone Marrow Aspirate Concentrate in Patients Undergoing Arthroscopic Rotator Cuff Repair

Background: Although initial studies have demonstrated that concentrated bone marrow aspirate (cBMA) injections promote rotator cuff repair (RCR) healing, there are no randomized prospective studies investigating clinical efficacy. Hypothesis/Purpose: To compare outcomes after arthroscopic RCR (aRCR) with and without cBMA augmentation. It was hypothesized that cBMA augmentation would result in statistically significant improvements in clinical outcomes and rotator cuff structural integrity. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients indicated for aRCR of isolated 1- to 3-cm supraspinatus tendon tears were randomized to receive adjunctive cBMA injection or sham incision. Bone marrow was aspirated from the iliac crest, concentrated using a commercially available system, and injected at the aRCR site after repair. Patients were assessed preoperatively and serially until 2 years postoperatively via the following functional indices: American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Simple Shoulder Test, 12-Item Short Form Health Survey, and Veterans RAND 12-Item Health Survey. Magnetic resonance imaging (MRI) was performed at 1 year to assess rotator cuff structural integrity according to Sugaya classification. Treatment failure was defined as decreased 1- or 2-year ASES or SANE scores as compared with preoperative baseline, the need for revision RCR, or conversion to total shoulder arthroplasty. Results: An overall 91 patients were enrolled (control, n = 45; cBMA, n = 46): 82 (90%) completed 2-year clinical follow-up and 75 (82%) completed 1-year MRI. Functional indices significantly improved in both groups by 6 months and were sustained at 1 and 2 years (all P < .05). The control group showed significantly greater evidence of rotator cuff retear according to Sugaya classification on 1-year MRI (57% vs 18%; P < .001). Treatment failed for 7 patients in each group (control, 16%; cBMA, 15%). Conclusion: cBMA-augmented aRCR of isolated supraspinatus tendon tears may result in a structurally superior repair but largely fails to significantly improve treatment failure rates and patient-reported clinical outcomes when compared with aRCR alone. Additional study is warranted to investigate the long-term benefits of improved repair quality on clinical outcomes and repair failure rates. Registration: NCT02484950 (ClinicalTrials.gov identifier).

Predictors and outcomes of surgical repair of obstetric fistula at Mekelle Hamlin Fistula Center, Northern Ethiopia.

Obstetric fistula is a medical condition that involves an opening between vagina and bladder or vagina and rectum. From 2010 to 2013, on average, around 2000 women each year had surgery for obstetric fistula in Ethiopia. The success and failure rate of obstetric fistula repair varies from center to center and is determined by many factors. Thus, this study aimed to assess the predictors and outcomes of surgical repair of obstetric fistula at Mekelle Hamlin Fistula Center (MHFC). A retrospective reviewed medical records of 328 patients with obstetric fistula were carried out at MHFC. Multivariable logistics regression analysis was conducted, a significant association was declared when the p-value was less than 0.05, and the strength of the association was determined by computing the odds ratio at 95% CI. The analysis was done using SPSS version 24. Obstetrics fistula patients who had formal education were 13% more likely to be successfully repaired than obstetrics fistula patients who had no formal education. Additionally, obstetrics fistula patients who had a live birth were 32.325 (exp (β) = 32.325) times more likely to have had a successful repair than those who had a stillbirth. Fistula closure was achieved in 89.3% of cases. The success rate for VVF (vesico-vaginal fistula) and RVF (recto-vaginal fistula) surgical repair was 86.9% and 100% respectively, which is higher than the WHO target. Body mass index between 18.5-24.9kg/m2, formal education, antibiotic use, live birth, large fistula size, and home and cesarean delivery were predictors of successful closure of obstetric fistula.

A Comparison of All-inside and Inside-out Meniscal Repair in Elite Athletes

Background: The popularization of all-inside (AI) meniscal repair devices has led to a shift away from the historical gold standard of inside-out (IO) meniscal repair without comparative studies to support the change. Purpose: To compare the failure rate and time to failure of AI and IO meniscal repair performed in elite athletes. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was performed of all professional and national- and international-level amateur athletes who underwent meniscal repair, with a minimum of 2-year follow-up between January 2013 and September 2019. Meniscal repair was classified as AI or IO depending on the surgical technique performed. Treatment failure was defined as patients having to undergo subsequent surgery to address a persistent meniscal tear after repair. Cox proportional hazards modeling was used to determine if meniscal repair failure rates differed by the location and technique of meniscal repair. Models were controlled for known risk factors such as age, sex, sport, and concurrent cruciate ligament reconstruction. Results: A total of 192 (135 lateral and 57 medial) meniscal repairs were performed in elite athletes during the study period. Overall, 41 (21%) meniscal repairs met the criteria for failure. Medial meniscal tears repaired with the AI technique failed at a significantly higher rate (18/31 [58%]) than medial meniscal tears repaired with the IO technique (6/26 [23%]) or lateral meniscal tears repaired with the AI (9/76 [12%]) or IO (8/59 [14%]) technique (P < .001). Cox proportional hazards modeling revealed that a medial meniscal tear repaired with the AI technique had an almost 8 times greater hazard of failure than a lateral meniscal tear repaired with the AI technique (P < .001). At 1 year postoperatively, 8% of lateral meniscal repairs had failed (regardless of technique), while medial meniscal tears failed at a rate of 16% with the IO technique and 42% with the AI technique. By 2 years, 53% of medial meniscal tears repaired with the AI technique had failed, and by 5 years, 63% had failed. Conclusion: AI repair of medial meniscal tears led to a higher rate of failure than IO repair of medial or lateral meniscal tears in elite athletes. Medial meniscal repair failed at a higher rate than lateral meniscal repair.

Long-term recurrence rate in anterior shoulder instability after Bankart repair based on the on- and off-track concept.

Since its first proposal, the concept of on- and off-track lesions in anterior shoulder instability has gained clinical relevance as a tool to predict the failure rate of arthroscopic Bankart repair. Current literature only reports either short-term follow-up or long-term results of small sample sizes. The aim of this study was to provide a long-term evaluation of recurrent instability following arthroscopic Bankart repair in a large cohort using the on-track vs. off-track concept as a predictor for failure. We retrospectively analyzed 271 patients who underwent primary arthroscopic Bankart repair for anterior shoulder instability between 1998 and 2007. All patients with a minimum follow-up of 78 months and a preoperative computed tomographic (CT) or magnetic resonance imaging (MRI) scan were included into the study. Preoperative CT and/or MRI scans were used to determine the glenoid track and width of Hill-Sachs lesion. Recurrence of instability was defined as presence of instability symptoms (dislocation, subluxation, and/or apprehension) or revision surgery (stabilization procedure) and was assessed as the primary outcome parameter. The glenoid track of 163 shoulders was assessed (female n=51, malen =112) with a mean follow-up of 124 months (99.4-145.6, standard deviation=2.5) and a mean age of 24 years (20-34.). An off-track Hill-Sachs lesion was found in 77 cases (47%), and in 86 cases (53 %) it was on-track. The rate of recurrent instability in the off-track group was 74% (n=57) compared with 27% (n=23) in the on-track group (P < .001). The overall rate of revision surgery due to instability was 29% (n=48) after a mean time of 50.9 months (±42.8) following Bankart repair. The rate of revision surgery in the off-track group was 48% (n=37) after a mean of 53.5 months (±42.0) vs. 13% (n=11) after 42.3 months (±46.3) in the on-track group (P < .001). This study shows that the on- and off-track concept helps to distinguish patients for whom an isolated arthroscopic Bankart repair yields long-term benefits. Because of the high rate of recurrent instability in the off-track group, an off-track lesion should be treated surgically in such a way that the off-track lesion is converted into an on-track lesion.

Phasor data concentrator placement in phasor measurement unit networks considering communication channel uncertainty and failure

AbstractOne challenge in Wide Area Measurement System is to design a reliable network which assures data availability. The availability of data in Phasor Measurement Unit (PMU) networks depends on two factors: 1‐Reliable data measurements which depend on performance of PMUs and transmission branches, 2‐Reliable data transmission which depends on the reliability of communication networks used to transfer data from PMUs to Phasor Data Concentrators (PDCs) and control centre. The reliability of data transmission can be improved by choosing proper locations for PDCs. In this paper, a novel approach for PDC placement is proposed based on two pre‐defined indices; observability reliability and Loss Of Data Expectation (LODE). In the proposed method, the probability of regional communication networks' failure and the uncertainty of failure data for all components are also included in the calculation of these two indices to achieve more realistic results. To handle uncertainty, fuzzy membership functions are obtained for repair time and failure rate of all components, and a fuzzy Monte Carlo method is presented to evaluate both indices for each possible PDCs' location. The minimum LODE is used to find the best locations for PDCs. The proposed method is investigated for three sample systems which prove the system efficacy.

Quantitative MRI indicators and features for partial subscapularis tendon tears on conventional shoulder MRI

BackgroundDiagnosing partial subscapularis (SSC) tendon tears still faces challenges. A failure rate of massive posterosuperior rotator cuff tear repair will be highly increased when extending more than one-third of SSC tendon. This study aims to investigate the quantitative indicators and features of partial SSC tears on conventional shoulder MRI and improve the preoperative diagnostic accuracy.Materials and methodsFour hundred and thirty-seven patients underwent MRI and arthroscopy were retrospectively reviewed; 89 patients with partial SSC tears in case group and 50 patients with normal SSC in control group were included. Six MRI features with the explicit definition of some quantitative indicators were evaluated.ResultsFissure sign showed the highest diagnostic efficiency for the partial SSC tears, with a specificity of 92%, sensitivity of 75.3%, and accuracy of 81.3%. Thinning of SSC, fluid collection under the coraco-glenoid arch (CGA), and combined SSP complete tear also showed high specificity of 86%, 80%, and 80%, respectively, while the sensitivity and accuracy were moderate, with a sensitivity of 38.2%, 50.6%, and 48.3%, respectively, an accuracy of 55.4%, 61.2%, and 59.7%, respectively. The specificity, sensitivity, and accuracy of lesser tuberosity cysts were all moderate with values of 68%, 56.2%, and 60%, respectively. However, fat accumulation under the CGA showed no significant difference between the partial SSC tears group and the control group.ConclusionSeveral specific MRI features with quantitative indicators defined in this study can be used to improve the accuracy of preoperative MRI diagnosis of partial SSC tears.

Compressed Biceps Autograft Augmentation of Arthroscopic Rotator Cuff Repair

Rotator cuff repair failure rates continue to be a challenging problem. Various methods of biological and structural augmentation of the rotator cuff have been explored to improve tendon healing after repair. We describe a technique in which biceps tendon autograft is harvested after tenodesis. The biceps tendon is then compressed into a patch that is placed over the repaired rotator cuff tendon. Repurposing the portion of the tendon that is otherwise discarded offers several advantages over other augmentations that have been used, including the biological potential of live autograft tenocytes in the patch, lower cost, and no donor-site morbidity.

Roux-en-Y Gastrojejunostomy: is it an effective treatment for complex Hiatal hernias in the morbidly obese?

Primary repair failure rates for hiatal hernias (HH) can reach up to 40%, this is especially high in the morbidly obese patient. There is no clear data on how to manage this patient subset. This paper evaluates the efficacy of Roux-N-Y Gastrojejunostomy (RNY GJ) for treatment of symptomatic HH. A retrospective analysis of all patients who received a Roux-en-Y Gastrojejunostomy (RNY GJ) for HH at our institution between January 2016 and January 2021 was performed. Patient demographics, symptoms, and post-operative outcomes were recorded and univariate analysis was performed between preoperative and postoperative symptoms. Thirty-seven patients with a mean age of 56.9years (SD 11.8) underwent RNY GJ. Patients were mostly female (81.1%) with a mean BMI of 36.8 (SD 8.4). An 78.4% reduction in symptoms of either heartburn, dysphagia, or regurgitation was noted at follow up (p < 0.001). RNY GJ represents a safe procedure for morbidly obese patients with hiatal hernias with no mortalities amongst our patient cohort along with a significant reduction in pre-operative symptoms and no symptomatic recurrences. RNY GJ should be considered as the operation of choice for repair for this patient population.

Use of a Nanofiber Resorbable Scaffold During Rotator Cuff Repair: Surgical Technique and Results After Repair of Small- to Medium-Sized Tears.

Background:The rate of retear after primary rotator cuff failure remains unacceptably high (up to 36% for small- to medium-sized tears). Augmentation of cuff repair with scaffold devices has been reported to improve healing after cuff repair.Purpose/Hypothesis:To describe the surgical technique of using an interpositional nanofiber scaffold during rotator cuff repair and report on a retrospective series of patients regarding functional outcomes and postoperative healing on magnetic resonance imaging (MRI). We hypothesized that augmentation of cuff repair with an interpositional scaffold would result in a high rate of tendon healing and excellent functional outcomes.Study Design:Case series; Level of evidence, 4.Methods:A total of 33 patients underwent arthroscopic rotator cuff repair augmented with a nanofiber, bioresorbable polymer patch secured as an inlay between the tendon and underlying bone. Patients were evaluated preoperatively and postoperatively with the Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) shoulder score, and active range of motion (ROM) measurements. Postoperative MRI was used to evaluate repair status.Results:At a minimum follow-up of 6 months, the patients showed significant improvement on SST and ASES scores (P < .0001 for both). ROM in forward flexion, abduction, internal rotation, and external rotation significantly improved at 6 months postoperatively (P < .05 for all). MRI at an average of 11 months postoperatively showed healing in 91% of patients; one patient had a recurrent tear with transtendon failure, and another patient had retear at the insertional site. The patch was not visible on postoperative imaging, suggesting complete resorption in all patients. No adverse events were associated with the patch.Conclusion:Our results demonstrate the preliminary safety and efficacy of a novel, bioresorbable synthetic scaffold for rotator cuff repair. The use of the scaffold resulted in a 91% tendon healing rate and significant improvements in functional and patient-reported outcome measures. The results are promising for improving the current unacceptably high rate of rotator cuff repair failure.

Accelerated Vs Conservative Rehabilitation Following Meniscus Repair In Pediatric Pateints With Or Without Acl Reconstruction

Background:There are variations in postoperative restrictions following pediatric meniscus repairs, whether they are performed in isolation or at the time of an anterior cruciate ligament reconstruction (ACLR).Hypothesis:We hypothesized that there would be no difference in failure rates when comparing accelerated versus conservative post-operative management following both isolated meniscus repairs and meniscus repairs performed at the time of an ACLR.Methods:A retrospective chart review was performed to investigate pediatric patients who underwent an isolated medial or lateral meniscus repair with or without a combined primary ACLR from January 2010 to January 2019 within a large children’s health system among eight different surgeons who all utilized different rehabilitation protocols. Patient outcomes of a need to return to the operating room secondary to failure of meniscus repair were analyzed with regard to accelerated versus conservative rehabilitation. Accelerated management included early unrestricted weightbearing within 3 weeks, unrestricted range of motion in a brace within 6 weeks, less than 6 weeks of brace use, initiation of outpatient physical therapy within 6 weeks, and returning to play sports earlier than 16 weeks for the isolated meniscus group or earlier than 30 weeks for the combined group.Results:138 patients aged 14.1 + 2.9 years had an isolated meniscus repair with 24.6 + 16.8 weeks of follow-up and a 17% failure rate, and 190 patients aged 15.5 + 1.6 years had a meniscus repair at the time of an ACLR with follow-up of 42.9 + 27.4 weeks and a 13% failure rate. A binomial logistic regression showed no differences in failure rates for accelerated versus conservative weightbearing restrictions, brace immobilization, physical therapy timing, or return to play timing (Table 1).Conclusion:These findings demonstrate that pediatric meniscus repair failure rates remain similar despite wide variations in postoperative management, whether performed in isolation or at the time of an ACLR. Further investigation should be directed towards determining optimal post-operative management protocols that attempt to strike a balance between protecting the surgical repair and avoiding measures that may be overly burdensome to the patient or add unnecessary treatment costs.Table 1.Results of binomial logistic regressions used to predict failure rates

Evaluation of Rotator Cuff Repair With and Without Concomitant Biceps Intervention: A Retrospective Review of Patient Outcomes

Background: Biceps tendon pathology is common in patients with rotator cuff tears. Leaving biceps pathology untreated in rotator cuff repairs (RCRs) may lead to suboptimal outcomes. Purpose/Hypothesis: The purpose was to compare clinical outcomes between patients who underwent isolated RCR versus patients who underwent RCR with concomitant biceps treatment. It was hypothesized that there would be no difference in clinical outcomes between groups. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 244 patients who underwent RCR in 2016 were included. Patient characteristics, presence of concomitant biceps pathology, pre- and postoperative American Shoulder and Elbow Surgeons (ASES) scores, rotator cuff failure, revision surgery, and complications were recorded. Results: There were no significant differences between patients who underwent isolated RCR (n = 143) and those who underwent RCR with biceps treatment (n = 101) at 2 years postoperatively in ASES scores (RCR, 81.5; RCR+biceps treatment, 79.5; P = .532), cuff failure rate (5.6% vs 4.0%; P = .760), revision RCR rate (3.5% vs 2.0%; P = .703), or complication rate (11.9% vs 5.0%; P = .102). Furthermore, when comparing concomitant biceps tenotomy (n = 30) versus concomitant biceps tenodesis (n = 71), there were no differences in ASES scores (P = .149), cuff failure rate (P > .999), revision RCR rate (P > .999), or complication rate (P > .999) postoperatively. Finally, when comparing arthroscopic biceps tenodesis (n = 50) versus subpectoral biceps tenodesis (n = 21), there were no differences in ASES scores (P > .592), cuff failure rate (P > .999), revision RCR rate (P = .507), or complication rate (P > .999) 2 years postoperatively. Conclusion: Addressing biceps pathology when performing RCR resulted in similar rates of cuff failure, revision RCR, and complications, as well as a similar improvement in patient-reported outcomes when compared with isolated RCR at 2 years postoperatively. Furthermore, when comparing tenotomy versus tenodesis and arthroscopic versus subpectoral tenodesis, comparable outcomes with regard to rate of rotator cuff repair failure, revision RCR, complications, and patient-reported outcomes were found.

Résultats cliniques après réparation méniscale itérative à distance d’une reconstruction du LCA : 32 patients avec un suivi moyen de 89 mois

Meniscus preservation is protective against long-term osteoarthritis. High failure rates for isolated meniscus repair are reported. Low is known about meniscus repair after anterior cruciate ligament reconstruction (ACLR). This study aimed to report clinical outcomes and failure rate for isolated meniscal repairs in patients with a prior history of ACLR. A retrospective analysis of prospectively collected data from (blinded) database was performed. Patients who underwent isolated meniscal repair in a stable knee with a prior history of ACLR with a minimum follow-up of 2 years were included. Preoperative evaluation of knee stability was performed with instrumented differential laxity. Tegner activity scale, ACL-RSI scale, Lysholm knee score, WOMET score, subjective IKDC and KOOS score were reported at the final follow-up. Clinical Failure was defined as recurrence of lesion in the previously sutured meniscus by clinical or radiological evaluation, or as reoperation for secondary meniscectomy. Failure risk factor analysis was performed. Thirty-two isolated meniscal repairs in 32 patients with a mean follow-up of 89.39 ± 29.50 months (range 29–150) were included. Preoperative knee stability was confirmed with mean side-to-side laxity of 1.53 ± 1.01 millimeter (range 0–4). The lateral meniscus (LM) was involved in 20 tears (62.5%) and the medial meniscus (MM) in 12 (37.5%). The overall failure rate was 46.87% (n = 15). No significant difference was found (P = 0.784) between MM (n = 6, 50%) and LM (n = 9, 45%) failure rate, as for patient-reported outcomes at final follow-up (P > 0.05). Good to excellent clinical outcomes were reported in the overall cohort. Failed meniscal repairs reported lower ACL-RSI (P = 0.047), subjective IKDC (P = 0.019), Lysholm (P = 0.023) and KOOS Sport (P = 0.038) scores compared to succeed ones. No failure risk factor was identified with multivariate analysis. This study demonstrated high failure rate of meniscus repair after ACLR in stable knees. Repair of new meniscal tears should nevertheless be considered as good clinical outcomes were achieved in case of success, especially for the LM regarding the risk of rapid chondrolysis.