Final Follow-up Visit Research Articles

Comparison of Bilateral Lateral Rectus Recession Vs Unilateral Recession/Resection for Basic Type Intermittent Exotropia

Abstract: Background: Intermittent exotropia (IXT), highly prevalent strabismus type in children, characterized by visual axis intermittent divergence. It can cause greater than 50% of all the exotropia cases. Because of different deviation at near and at a distance, IXT can be grouped as Basic, Pseudo-divergence excess, true distance and insufficiency of convergence. The most common is basic exotropia. Objective: To compare post-operative ocular alignment in bilateral lateral rectus recession (BLR) Vs unilateral lateral rectus recession/resection (RR) in basic type intermittent exotropia in young patients. Material and Methods: 96 cases of basic intermittent exotropia who went through surgery were selected. Total duration of study was 18 months from January 2020 to June 2021. The patients were categorized into BLR group and unilateral RR group based on type of surgery received. Based on motor outcomes, patients were categorized as: 1) successful alignment (Orthophoria) Esophoria/tropia< 10 Prism diopters to Exophoria/tropia< 15 Prism diopters.2) Overcorrection (Esophoria/tropia>10 Prism diopters) 3) Under-correction/recurrence (Exophoria/tropia> 15 Prism diopters). Surgical outcome including motor criteria and sensory status compared at post-operative 03, 06, 09 and 12 months between groups. Results: The mean age at the time of surgery was 12.68 ± 8.12yrs. for BLR and 13.88 ± 8.34yrs. for RR group. The rate of successful alignment was 70.83% (n= 34) for BLR group and 58.33% (n=28) for RR group at final follow-up visit (p=0.200). At 03 months, RR had better alignment rate while BLR had superior outcome at 06-, 09- and 12-months’ follow-up visits. The secondary outcome i.e. stereopsis recovery rate was also comparable between the two groups at final follow-up of 12 months (p-value= 0.159). Conclusion: The motor outcomes in BLR group were comparable to RR group at the final follow-up visit. The rates of under-correction were higher in RR group (though not statistically significant) at 12th month visit.

P-476 Barriers and facilitators to nationwide implementation of fertility screening interventions: a qualitative study

Abstract Study question What are the barriers and facilitators to the potential nationwide implementation of Fertility Health Screening (FHS) and/or Fertility Awareness and Education (FAE) in Singapore? Summary answer The study reveals implementation factors that shed light on how advanced societies can adopt evidence-based interventions to deliver fertility education together with behavioural change nudges. What is known already Fertility awareness surveys have consistently shown low public awareness of age-related fertility decline and the limitations of fertility treatments. Furthermore, preventive public health messages to increase fertility awareness are known to produce limited sustained effects. While there is evidence that tailored interventions are more effective than generic ones at increasing fertility awareness, interventional studies targeted at those of reproductive age are scarce. An effectiveness-implementation hybrid type I 3-arm open-label randomized clinical trial (RCT) is underway to evaluate the effects of two theory-based interventions on knowledge, attitudes and practices around childbearing among young married couples in Singapore. Study design, size, duration The present qualitative study was conducted to explore experiences and perspectives on the interventions and their potential implementation among healthcare professionals (HCPs) involved in implementing the interventions and a sub-sample of couples randomized into either treatment group. Recruitment used purposive sampling. Individual semi-structured interviews were conducted from June 2021 to December 2023. The Consolidated Framework for Implementation Research (CFIR) was used to develop the interview guide. Sample size was determined by data saturation. Participants/materials, setting, methods Couples in either treatment group were recruited after completing their final follow-up visit, while HCPs were recruited at their convenience. After taking written informed consent, the interviews were conducted in person or over Zoom and audio recorded. The interviews were transcribed verbatim and inductive thematic analysis was used to evaluate the data. Themes were then mapped to CFIR constructs. The results were reported according to O’Brien et al.’s (2014) Standards for Reporting Qualitative Research. Main results and the role of chance Twenty HCPs (10 doctors, 8 embryologists, 1 nurse and 1 manager) and 29 heterosexual couples (FHS n = 16; FAE n = 13) participated in the interviews. Median age was 30 (women) and 32 (men) years with most participants having post-secondary education. In FHS, couples underwent an Anti-Mullerian Hormone (AMH) test and semen analysis (SA), doctor’s consultation, and standardized counselling by a trained nurse. In FAE, couples watched a video of other couples’ pre-pregnancy experiences, completed an adapted fertility status awareness tool (FertiSTAT), and received an educational brochure. FHS barriers (CFIR constructs n = 6) included the discomfort when producing SA samples, male partners’ reluctance to share personal information with embryologists for SA, stigma associated with undergoing fertility-related tests, lack of time for appointments, limited cost effectiveness, and shortage of human resources due to potential increase in service demand. FHS facilitators (constructs n = 4) included evidence-based testing, increased knowledge of reproductive potential, advice from trained HCPs and comprehensible brochures. Perceived facilitators for FAE (constructs n = 2) included compelling video messages and clearly designed questionnaires. No major barrier was reported for FAE. Overall, insights gained from the interviews can inform strategies to address barriers and leverage facilitators for each intervention. Limitations, reasons for caution Barrers and facilitators may differ between countries. There may also be selection bias in the recruitment strategy, as participants were likely those who wished to have children. Moreover, the lack of diversity in educational qualifications and ethnicity may exclude the influence of class and cultural factors on parenthood intentions. Wider implications of the findings The findings contribute to an understanding of personalised fertility interventions coupled with behavioural change influences by showing how qualitative process indicators could complement research on interventions’ effectiveness. This has implications for other developed countries that are seeking to explore how implementation factors can expedite clinical best practice after research discovery. Trial registration number NCT04647136

Comparative Study Between Latarjet Procedure Versus Free Iliac Graft in the Management of Recurrent Shoulder Dislocation

Abstract Background: The most common form of shoulder dislocation is the recurrent anterior traumatic type. Latarjet and Eden Hybinette are the two competing techniques in reconstructing significant bone loss accompanying this type. Aim of the Work: The aim is to evaluate the functional results in the management of recurrent shoulder dislocation with bone loss by comparing Latarjet and Eden Hybinette techniques. Patients and Methods: A prospective, randomized controlled trial was performed on forty adult patients suffering from recurrent shoulder dislocations. Two groups (a total of forty patients; twenty iliac graft cases and twenty Latarjet controls) were performed in a randomized method. We compared the two groups; clinical evaluation was completed before surgery and at least 1 year postoperatively, by using the modified Rowe score which consists of pain level, stability, motion loss, and limitation of function. Satisfactory results included excellent and good results, while unsatisfactory results included fair and poor results. Adverse events were prospectively recorded. CT studies were performed to assess the radiographic result preoperatively, immediately-postoperatively, and at final follow-up visits. Results: Both groups did not differ significantly in either the clinical or the radiological aspects (P > 0.05) except for more limited range of motion (ROM) (external and internal rotation) in the Latarjet group at the final follow-up (P < 0.05). One case in the Latarjet group had recurrent dislocation due to tramadol fits. Two cases in each group had anterior apprehension only. Donor-site sensory disturbances were reported in 10% of the iliac group patients. Computed tomography revealed a larger graft size in the iliac group. Conclusion: Both Latarjet and Eden Hybinette can be used as reconstructive surgeries in restoring critical bone loss accompanying shoulder dislocations; they did not show significant differences except for the more limited external and internal rotation motions in the Latarjet group.

Perfluorocarbon liquid-assisted subretinal fluid drainage via the choroid as a treatment for bullous central serous chorioretinopathy in a nanophthalmic eye.

The report presents a modified surgical technique wherein the perfluorocarbon liquid (PFCL)-assisted drainage of subretinal fluid (SRF) through the choroid was combined with partial-thickness sclerectomy (PTS) and punch sclerostomy as a treatment for bullous central serous chorioretinopathy (bCSCR) in a nanophthalmic eye. The developed surgical approach is herein discussed together with a corresponding surgical video. Briefly, two 5 × 4 mm half-thickness sclerectomies and a punch sclerostomy (diameter: 2 mm) to the choroid were performed in the inferior quadrants. Following vitrectomy, SRF was drained through the exposed choroid in the region where the punch sclerostomy was performed, whereafter PFCL was instilled into the vitreous cavity. The complete resolution of SRF accumulation was evident at one-week post-surgery, with no evidence of recurrence over an 18-month follow-up period. No abnormal fluorescent leakage or choroidal vasodilation were evident via fundus fluorescein angiography and indocyanine green angiography examination at the patient's final follow-up visit. PFCL-assisted SRF drainage through the choroid combined with PTS and punch sclerostomy may represent a viable approach to treating patients with bCSCR and nanophthalmic eyes, providing a rapid and long-lasting means of eliminating SRF accumulation.

Home Blood Pressure Telemonitoring and Nurse Case Management in Black and Hispanic Patients With Stroke

Black and Hispanic patients have high rates of recurrent stroke and uncontrolled hypertension in the US. The effectiveness of home blood pressure telemonitoring (HBPTM) and telephonic nurse case management (NCM) among low-income Black and Hispanic patients with stroke is unknown. To determine whether NCM plus HBPTM results in greater systolic blood pressure (SBP) reduction at 12 months and lower rate of stroke recurrence at 24 months than HBPTM alone among Black and Hispanic stroke survivors with uncontrolled hypertension. Practice-based, multicenter, randomized clinical trial in 8 stroke centers and ambulatory practices in New York City. Black and Hispanic study participants were enrolled between April 18, 2014, and December 19, 2017, with a final follow-up visit on December 31, 2019. Participants were randomly assigned to receive either HBPTM alone (12 home BP measurements/week for 12 months, with results transmitted to a clinician; n = 226) or NCM plus HBPTM (20 counseling calls over 12 months; n = 224). Primary outcomes were change in SBP at 12 months and rate of recurrent stroke at 24 months. Final statistical analyses were completed March 14, 2024. Among 450 participants who were enrolled and randomized (mean [SD] age, 61.7 [11.0] years; 51% were Black [n = 231]; 44% were women [n = 200]; 31% had ≥3 comorbid conditions [n = 137]; 72% had household income <$25 000/y [n = 234/324]), 358 (80%) completed the trial. Those in the NCM plus HBPTM group had a significantly greater SBP reduction than those in the HBPTM alone group at 12 months (-15.1 mm Hg [95% CI, -17.2 to -13.0] vs -5.8 mm Hg [95% CI, -7.9 to -3.7], respectively; P < .001). The between-group difference in SBP reduction at 12 months, adjusted for primary care physician clustering, was -8.1 mm Hg (95% CI, -11.2 to -5.0; P < .001) at 12 months. The rate of recurrent stroke was similar between both groups at 24 months (4.0% in the NCM plus HBPTM group vs 4.0% in the HBPTM alone group, P > .99). Among predominantly low-income Black and Hispanic stroke survivors with uncontrolled hypertension, addition of NCM to HBPTM led to greater SBP reduction than HBPTM alone. Additional studies are needed to understand the long-term clinical outcomes, cost-effectiveness, and generalizability of NCM-enhanced telehealth programs among low-income Black and Hispanic stroke survivors with significant comorbidity. Clinical Trials.gov Identifier: NCT02011685.

Minimally Invasive Method for Treatment of Syndromic Congenital Vertical Talus Deformity in Children.

Congenital Vertical Talus (CVT) is a rare form of rigid flatfoot commonly seen in patients with underlying neurologic syndromes. This study aims to evaluate the long-term effectiveness of the minimally invasive method for correcting CVT deformity in a large cohort of syndromic patients. A single author recorded preoperative, 2-week postoperative, 1-year postoperative, and most recent radiographic measurements and complications for 25 patients treated with the minimally invasive method from 2006 to 2021. Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires were administered for 12 patients after January 1, 2015, when the institution began collecting PROMIS in all orthopaedic patients. Average follow-up was 55 months (13-111); 18 patients had minimum 24-month follow-up. Forty feet in 25 patients were analyzed. The average preoperative lateral talar axis-first metatarsal base angle (TAMBA) was 68.7 ± 21.3 vs 12.1 ± 8.9 after initial surgical intervention (P < .0001). There was a statistically significant increase in the lateral TAMBA between the initial postoperative and final follow-up visits (13.0 vs 21.6, P = .02). Radiographic recurrence of talonavicular deformity was noted in 12 feet (30.9%); 7 (15.55%) required corrective surgery. Larger preoperative lateral TAMBA was predictive of recurrence. Notably, patients with arthrogryposis experienced higher radiographic recurrence than other syndromic patients (45.0% vs 14.3%, P = .0384). PROMIS scores were within population norms. The study suggests that less than one-third of syndromic CVT patients experienced a radiographic recurrence of talonavicular deformity, with 15% requiring further surgical intervention at an average of 55 months following the initial procedure. A higher incidence of radiographic recurrence occurred in patients with distal arthrogryposis. These findings, along with the satisfactory patient-reported outcomes, suggest that the minimally invasive technique is an effective treatment method for syndromic CVT, underscoring the necessity for clinicians to provide detailed prognoses and consider more intensive follow-up for those at higher risk.

Remote Blood Pressure Monitoring With Social Support for Patients With Hypertension

Hypertension management has traditionally been based on office visits. Integrating remote monitoring into routine clinical practices and leveraging social support might improve blood pressure (BP) control. To evaluate the effectiveness of a bidirectional text monitoring program focused on BP control and medication adherence with and without social support in adults with hypertension. This randomized clinical trial included adults aged 18 to 75 treated at an academic family medicine practice in Philadelphia in 2018 and 2019. Patients had been seen at least twice in the prior 24 months and had at least 2 elevated BP measurements (>150/90 mm Hg or >140/90 mm Hg for patients aged 18-59 years or with diabetes or chronic kidney disease) during visits. All participants had a cell phone with text messaging, offered at least 1 support partner, and were taking maintenance medications to treat hypertension. Patients were randomized 2:2:1 to remote monitoring of BP and medication adherence (RM), remote monitoring of BP and medication adherence with feedback provided to a social support partner (SS), or usual care (UC). Data were analyzed on an intention-to-treat basis between October 14, 2019, and May 30, 2020, and were revisited from May 23 through June 2, 2023. The RM and SS groups received an automatic home BP monitor, 3 weekly texts requesting BP measurements, 1 weekly text inquiring about medication adherence, and a weekly text with feedback. In the SS arm, support partners received a weekly progress report. The UC group received UC through their primary care practice. Clinicians caring for the patients in the intervention groups received nudges via electronic health records to adjust medications when 3 of 10 reported BP measurements were elevated. Patients were followed up for 4 months. The primary outcome was systolic BP at 4 months measured during the final follow-up visit. Secondary outcomes included achievement of normotension and diastolic BP. In all, 246 patients (mean [SD] age, 50.9 [11.4] years; 175 females [71.1%]; 223 Black individuals [90.7%] and 13 White individuals [5.3%]) were included in the intention-to-treat analysis: 100 patients in the RM arm, 97 in the SS arm, and 49 in the UC arm. Compared with the UC arm, there was no significant difference in systolic or diastolic BP at the 4-month follow-up visit in the RM arm (systolic BP adjusted mean difference, -5.25 [95% CI, -10.65 to 0.15] mm Hg; diastolic BP adjusted mean difference, -1.94 [95% CI, -5.14 to 1.27] mm Hg) or the SS arm (systolic BP adjusted mean difference, -0.91 [95% CI, -6.37 to 4.55] mm Hg; diastolic BP adjusted mean difference, -0.63 [95% CI, -3.77 to 2.51] mm Hg). Of the 206 patients with a final BP measurement at 4 months, BP was controlled in 49% (41 of 84) of patients in the RM arm, 31% (27 of 87) of patients in the SS arm, and 40% (14 of 35) of patients in the UC arm; these rates did not differ significantly between the intervention arms and the UC group. In this randomized clinical trial, neither remote BP monitoring nor remote BP monitoring with social support improved BP control compared with UC in adults with hypertension. Additional efforts are needed to examine whether interventions directed at helping patients remember to take their BP medications can lead to improved BP control. ClinicalTrials.gov Identifier: NCT03416283.

A novel custom bent 27G needle-guided suture snare technique for scleral fixation of posterior chamber intraocular lenses

PURPOSE: To describe a custom bent 27G needle-guided suture snare technique for scleral fixation of posterior chamber intraocular lenses (PCIOL). METHODS: An 8-0 polypropylene suture was threaded into the lumen of a custom bent 27G needle, and the needle tip was advanced into the eye from the IOL fixation point. The suture was threaded through the posterior limbal incision inside the IOL haptic loop and pulled out. The needle tip was advanced into the eye again, going around the IOL haptic loop through the same limbal incision. The suture was threaded in again, and the needle was withdrawn from the eye, completing fixation of the IOL haptic loop. The suture knot was buried in the stroma of the sclera. RESULTS: The technique was performed in 10 eyes of 10 patients, with a preoperative logarithm of the minimum resolution angle corrected visual acuity of 0.73 ± 0.55 (Snellen 20/107), improvement of 0.24 ± 0.27 (Snellen 20/35) at the final follow-up visit, and a mean postoperative PCIOL tilt of 2.78 ± 1.32°. There were no cases of pupillary capture or suture-related complications during follow-up. CONCLUSION: The curved needle-guided suture snare technique provides a simple minimally-invasive method of scleral suture fixation of PCIOL.

Clinical characteristics, etiologies, co-injuries, and visual outcomes of eyelid lacerations

Background: Eyelid trauma may be accompanied by open globe injury, canalicular injury, hyphema, angle recession, or retinal detachment. Therefore, a detailed assessment should be performed during the associated ophthalmological examinations. We assessed the demographic and clinical characteristics, etiologies, co-injuries, and visual outcomes in patients with eyelid lacerations. Methods: This retrospective, cross-sectional study included individuals 18 years of age and older who underwent repair of an eyelid injury at our tertiary referral center between January 2021 and March 2023. Patients with known structural eyelid disorders or previous ocular surgery were excluded. Demographic and clinical data, including injury site and type, mechanism of injury, and presence of additional ocular injuries, were noted. Best-corrected visual acuity (BCVA) was recorded as the logarithm of the minimum angle of resolution (logMAR) notation at the initial and final follow-up visits. Results: Of 195 included patients with a mean (standard deviation [SD]) age of 42.5 (5.6) years, 164 (84.1%) were men. The most common etiology was accidental (n = 70, 35.9%) and almost half of these injuries occurred at the workplace (n = 32 out of 70, 45.8%). Nine patients (4.6%) had no co-injury, 47 (24.1%) had imaging evidence of orbital bone fractures, 25 (12.8%) had nasolacrimal system involvement, and 11 (5.6%) had an open globe injury. The right upper eyelid (n = 62, 31.8%) was the most commonly affected site. Tissue loss was observed in 77 (39.5%) patients; however, no grafting was required. Five patients (2.6%) underwent lateral canthotomy to improve tissue apposition. On initial examination, 24 patients (12.3%) had traumatic myogenic ptosis, 13 (6.7%) had traumatic aponeurotic ptosis, and ptosis persisted in 7 of these 37 patients (18.9%) 6 months after laceration repair. We observed significant improvement in BCVA at the final follow-up visit (P &lt; 0.001); at the preoperative and final visits, mean (SD) BCVA measurements were 0.21 (0.15) and 0.12 (0.07) logMAR, respectively. Conclusions: Eyelid injuries are more common in men, and the most common etiology is accidental. These injuries occur most commonly in the workplace. Isolated eyelid lacerations are rare. Early ocular assessment and prompt management ensure better visual outcomes. We recommend preventive safety precautions for workplaces to reduce the incidence of avoidable injuries. Identifying risk factors in further population-based studies could prevent loss of labor in a productive population. Further multicenter, nationwide, longitudinal studies could estimate the actual burden and prognosis of ocular trauma, particularly that of eyelid lacerations.

Treatment and Outcome of Supracondylar Humeral Fractures in Children Over 10 Years of Age at the Time of Injury: A Review of 60 Cases.

To assess the treatment and outcomes of supracondylar humeral fractures (SHFs) in children older than 10 years of age at the time of injury. The study analyzed clinical data from 60 patients who sustained SHF, all over the age of 10 years, were analyzed. The patients included 49 males and 11 females with a mean age of 10.9 ± 0.9 years (range, 10 to 14.5). All patients underwent surgical treatment under general anesthesia. Closed reduction (CR) and percutaneous fixation were the primary treatment, with open reduction and internal fixation being employed only in cases CR was unsuccessful. The study assessed the healing of fractures by measuring the radiographic angles, including the carrying angle (RCA), Baumann's angle (BA), and metaphyseal-diaphyseal angle (MDA) on anteroposterior radiographs of the elbow joint. In addition, the study evaluated whether the anterior humeral line (AHL) appropriately passed through the middle third of the capitellum. The final follow-up visit used the Mayo Elbow Performance Index score (MEPI) and Flynn's criteria to analyze the recovery of elbow function. There were 15 (25%) SHF type II, 17 (28.3%) type III and 28 (46.7%) type IV. Of the 60 patients, 56 (93.3%) underwent successful CR, whereas 4 (6.7%) required open reduction and internal fixation because of an unsuccessful CR. The final follow-up showed the average BA as 72° ± 5.3°, the average MDA as 88.3° ± 2.8°, and the average RCA as 9.6° ± 3.9°. The AHL bisected accurately the capitellum in 59 cases (98.3%). The average range of elbow flexion-extension was 146.6° ± 8.6°, whereas the average MEPI score was 99.9 ± 0.6; 98.3% (n=59) were rated as excellent and 1.7% (n=1) were rated as good. According to Flynn's criteria, 86.7% had an excellent outcome (n=52), 10% had a good outcome (n=6), and 3.3% had a poor outcome (n=2). Only 1 patient (1.7%) experienced redisplacement. Eight cases of nerve injury were reported, with 7 involving the radial nerve and 1 involving the ulnar nerve; all resolved spontaneously. CR and percutaneous fixation have been shown to be effective in treating SHF in 93.3% of children aged 10 years old and older at the time of injury, with favorable radiographic and functional outcomes and a low risk of secondary displacement. Open reduction should only be considered when CR is ineffective.

Anatomic total shoulder arthroplasty for B2 glenoids treated with asymmetric reaming has equivalent survivorship and patient outcomes compared with type A glenoids at a mean 9-year follow-up

BackgroundWalch B2 glenoids can present a challenge to shoulder arthroplasty surgeons. Short-term studies have demonstrated that corrective reaming to 10° of retroversion in anatomic total shoulder arthroplasty (aTSA) can result in good outcomes, however there is little data reporting the long-term outcomes in this cohort. B2 glenoids treated with high-side reaming present a theoretical risk of early glenoid component failure as one may ream into the subchondral bone. This study aimed to demonstrate that 1) B2 glenoids treated with corrective reaming have durable results and 2) offer similar results to Walch A1/2 in long-term follow-up. MethodsPatients who underwent aTSA by a single surgeon (E.L.F.) were identified from a shoulder arthroplasty registry. Inclusion criteria included Walch A1, A2 or B2 glenoid, a diagnosis of primary shoulder osteoarthritis, and a minimum radiographic and clinical follow-up of 5 years. 43 patients with B2 glenoids were compared to a cohort of 42 patients with A1 or A2 glenoids. Preoperative computed tomography (CT) and radiographs were utilized to assess deformity, glenoid version, and posterior subluxation of the humeral head. Postoperatively, patients were assessed with radiographs and patient-reported outcome measures including American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST) score, and Visual Analog Scale (VAS). Results85 shoulders (82 patients, 42 B2 and 43 A1/A2 glenoids) with an average follow-up of 9.4 years were included. In the B2 cohort, the average retroversion was 21.1° and posterior subluxation was 69.4% compared with 10.6°(p<0.001) and 57.5% (p<0.001) in the A1 or A2 cohort. The cohort demographics were similar except for male sex (B2 69.8% vs A1 or A2 37.2%, p=0.008). There was no difference between the cohorts in their improvement in ASES (p=0.807), SST (p=0.586), or VAS (p=0.930) scores. There was no difference in lateral humeral offset (p=0.889) or acromial humeral interval (p=0.468) between initial postoperative and final follow-up visits. Survivorship for B2 glenoids was 97.6%, 94.1% and 73.3% at 5, 10 and 15 years, respectively compared to 97.6%, 91.9% and 83.5% in type A glenoids. The revision rate was similar between the two groups (p=0.432). Lazarus score (p=0.682) and rates of humeral radiolucency (p=0.366) and humeral osteolysis (p=0.194) were similar between the two cohorts at final follow-up. ConclusionAsymmetric reaming of patients with B2 glenoids is a reliable method of glenoid preparation with excellent mid- to long-term clinical results, patient reported outcomes, and low revision rates similar to their A1 and A2 counterparts.

Surgical treatment of patellar tendon rupture after total knee arthroplasty with a double-row repair method using the hamstring tendons: A novel technique with functional results.

Patellar tendon rupture (PTR) is extremely rare but serious complication after primary or revision total knee arthroplasty. Due to the serious failure rates of end-to-end repair techniques, various augmentation techniques have been described. In this study, the results of patients with PTR after reconstruction using our own technique with semitendinosus (ST) and gracilis tendons taken from the affected side were evaluated retrospectively. A total of 14 patients, whose diagnosis was made based on physical examination and clinical findings, and supported radiologically (ultrasonography), were included in the study. In these patients, reconstruction was performed using double-row repair technique with the ST and gracilis tendons. Active-passive knee joint range of motion, active knee extension loss, and the Caton-Deschamps index at preoperative and final follow-up visits were compared. Tegner-Lysholm knee score and Kujala score were used to evaluate functional results. In 14 patients (8 women and 6 men) with a mean age of 68.1 years, the median time between injury and surgery was 6.6 weeks. In all patients, the rupture was in the distal part of the patellar tendon. While the median preoperative Caton-Deschamps index was 1.8, the postoperative median value was found to be 1.25 after an average follow-up of 3.8 years (P = .014). The median preoperative knee extension loss decreased from 25° to 5° postoperatively. Tegner-Lysholm knee score and Kujala score of the patients at their last follow-up were significantly increased (P < .01). For PTR developing after total knee arthroplasty, the double-row reconstruction technique with ST and gracilis tendons is effective.

Excellent Clinical Outcomes and Rapid Return to Activity Following In-Office Needle Tendoscopy for Chronic Achilles Tendinopathy

To assess outcomes following Achilles in-office needle tendoscopy (IONT) for the treatment of chronic Achilles tendinopathy (cAT) at a minimum 12-month follow-up. A retrospective case series was conducted to evaluate patients who underwent Achilles IONT for cAT between January 2019 and December 2022. Inclusion criteria were patients ≥18 years of age and clinical history, physical history, and magnetic resonance imaging findings consistent with cAT who did not respond to a minimum of 3 months of conservative management for which each patient underwent Achilles IONT and had a minimum 12-month follow-up. Clinical outcomes were evaluated using the Victorian Institute of Sport Assessment-Achilles and visual analog scale scores. Patient satisfaction was measured at the final follow-up visit with a 5-point Likert scale. Twelve patients (13 Achilles) with a mean age of 50.9 ± 14.6 years were included in the study. The mean follow-up time was 26.3 ± 6.3 months. The mean Victorian Institute of Sport Assessment-Achilles scores improved from a preoperative score of 35.6 ± 5.9 to a postoperative score of 83.6 ± 14.1 (P < .001). The mean visual analog scale score improved from a preoperative score of 6.6 ± 1.0 to a postoperative score of 1.3 ± 1.7 (P < .001). There were 10 patients (83.3%) who participated in sports activities before the IONT procedure. Within this group, 9 patients (90.0%) returned to play at a mean time of 5.9 ± 2.6 weeks. The mean time to return to work was 4.2 ± 1.2 days. Patients reported an overall positive IONT experience with a mean rating scale of 4.5 ± 0.9. This retrospective review demonstrated that Achilles IONT for the treatment of cAT results in significant improvements in subjective clinical outcomes and a low complication rate together with high patient satisfaction scores at short-term follow-up. Level IV, therapeutic case series.

Long-term outcomes of reconstructive treatment for painful dislocations in patients with cerebral palsy.

This report presents the long-term results of the hip joint reconstruction in patients with spastic hip disease through open reduction, proximal femur varus derotation osteotomy, and Dega transiliac osteotomy. We analyzed retrospectively patients diagnosed with a spastic form of bilateral cerebral palsy with painful hip subluxation or dislocation. All patients underwent the same surgical procedure. The minimum follow-up time was 15 years. The study group comprised 15 patients (22 hips), classified with the Gross Motor Function Classification System as levels IV and V. The hip joint range of motion and anteroposterior X-ray examination at the final follow-up visit were compared with pre-operative data. The pain level was evaluated using the Visual Analogue Scale (VAS), and the femoral head shape was assessed using the Rutz classification. The patients' caregivers answered questions regarding pain during sitting, personal hygiene activities, and at rest. The caregivers' satisfaction with the treatment was also assessed with the Caregiver Priorities and Child Health Index of Life with Disabilities questionnaire. We observed a significant reduction of the hip joint pain and improvement in both radiological hip stability parameters and range of motion at the final follow-up visit. Based on the Rutz classification, one hip remained type B, while the other joints became type A. Reduced pain was reported in all three positions, with the most pronounced improvement during sitting and personal hygiene activities. Interestingly, patients with unilateral hip reconstruction were more prone to pain after reconstruction than those operated bilaterally. Primary reconstruction of the painful hip joint neurogenic dislocation results in a stable joint reduction, pain decrease, and improved quality of life in patients with cerebral palsy. IV case series.

External Validation of a Model to Predict Postoperative Globe Axial Length in Children After Bilateral Cataract Surgery

PURPOSETo perform the external validation of a model to predict postoperative axial length (AL) in children undergoing bilateral cataract surgery with primary intraocular lens (IOL) implantation older than 2 years. DESIGNValidation study using a retrospective case series METHODSUsing a different population than the one that created the model, but with the same characteristics regarding age, bilateral cataract, primary IOL implantation, and follow-up assessment, AL was estimated. The AL values ​​estimated by the model were compared with the AL measured in the follow-ups. RESULTSFifty-five eyes of 30 children were selected for this study; in five children with bilateral cataracts, only one eye was included. The median age at the time of surgery was 5.01 years. Follow-up AL measurements were obtained for 179 visits. The median age at the final follow-up visit was 10.15 years. The median AL measured and estimated by the model in all visits were 22.37 mm and 22.16 mm respectively (Person's coefficient: 0.9534; Lin's correlation: 0.9258). In the Bland-Altman analysis, the 95% limit of agreement between the two methods (measured and estimated AL) was 0.71 to -1.19. In three eyes (1.68%) with AL shorter than 21.2 mm, the difference was >0.71, and in nine eyes with AL longer than 22.5 (5.03%), it was less than -1.19. The Median AL measured and estimated at the final visit were 22.69mm and 22.43mm, respectively. CONCLUSIONOur previously developed prediction model for globe AL growth demonstrated good external validity by accurately predicting measured AL changes with growth in the validation cohort.

Abstract MP17: Sustained Improvements in Liver Fat Reduction and Cardiometabolic Health at Nine Months After a 12 Week Digital Health Program in Individuals With Non-Alcoholic Fatty Liver Disease - A Feasibility Study

Introduction: Behavioral changes can improve health outcomes, but maintaining improvements can be challenging. A 12-week digital health program for Non-Alcoholic Fatty Liver Disease (NAFLD) was previously shown to be feasible in terms of patient engagement, program retention, and improvements in clinical markers of liver and cardiometabolic health. Here, we report on retention and clinical measurements after a 6-month maintenance program. Hypothesis: We hypothesized that improvements in cardiometabolic health can be sustained six months beyond an active program’s duration. Methods: A prospective, open label, single arm, 12-week long study was first conducted, where a digital health program was delivered through the Sidekick app with emphasis on disease education, lowering dietary carbohydrates, increasing activity levels, reducing stress and lifestyle coaching. Individuals with either BMI&gt;30, metabolic syndrome or type 2 diabetes were screened for NAFLD with a FibroScan assessment. Data collection included demographics, anthropometric and clinical measurements, MRI-PDFF for liver fat content, dual-energy X-ray absorptiometry for body composition and blood tests. Measurements were done at baseline, 12 weeks and nine months. Once the 12-week program concluded, a six-month maintenance program was initiated with no new educational materials and the health coaching ceased. During the maintenance program the participants retained access to the app with recurring educational content. Summary statistics were calculated for all participants who started the health program. Missing values at follow-up were imputed using baseline observation carried forward. Results: In total, 38 individuals were included in the study and 34 (89%) completed the 12-week program, of which 28 (83%) attended the third and final follow-up visit at nine months. The median population age was 59.5 [IQR 46.3,68.8] years and 23 (60.5%) were females. At month nine the mean weight loss compared to baseline was 4.0 kg (SD=5.0) (p&lt;0.001) with 5.2% (SD=10.0) reduction in fat mass (p&lt;0.001). The average relative liver fat reduction was 18.4% (SD=30.5) (p&lt;0.001). Systolic blood pressure decreased by 8.3 mmHg on average (SD=13.4) (p&lt;0.001), diastolic blood pressure by 2.5 mmHg (SD=6.0) (p=0.015) and waist circumference by 4.7 cm (SD=7.1) (p&lt;0.001). According to a sensitivity analysis the observed changes were not explained by changes in medication. Previous changes in triglyceride levels were not maintained. In the final week, 50% (19/38) of the users were retained in the app. Conclusion: This study suggests that improvements after a 12-week digital health program can be sustained at nine months despite coaching cessation. We observed sustained improvements for weight loss, liver fat, blood pressure and body composition. This approach could provide a new tool to obtain and maintain improvements in NAFLD.

Long-Term Outcome of Metal-on-Metal Total Hip Arthroplasty with Modular Neck Stem.

Background: This study aimed to report the long-term outcomes of total hip arthroplasty (THA) using a Conserve Plus (Wright Medical, Japan) metal-on-metal (MoM) acetabular prosthesis with a modular neck stem. Methods: This study enrolled 50 patients (10 men and 40 women; mean age, 65.8 (39-87) years) who underwent primary THA using a Conserve Plus MoM acetabular prosthesis with a modular neck stem. The preoperative diagnosis in most patients was osteoarthritis. Clinical function of hip joint outcomes was investigated using the Japanese Orthopedic Association (JOA) hip score preoperatively and at the final follow-up. The perfect JOA hip score was 100, while the worst score was 0. Radiological analyses were evaluated during the final follow-up visit. Magnetic resonance imaging (MRI) images were evaluated to screen for pseudotumors in 43 hips postoperatively. Results: Six patients did not visit before their 10-year follow-up for unknown reasons. Therefore, 44 patients were evaluated at a mean of 11-years of follow-up (10-12 years). The mean (±SD) preoperative JOA hip score of 44.2 (±15.5) improved significantly to 85.1 (±12.9) postoperatively at the final follow-up (n = 36 hips, excluding eight revision cases). One patient underwent femoral fixation for a periprosthetic fracture due to trauma that occurred 4 years postoperatively. Spot welds were identified in 93.2% (41/44 hips) of cases. Severe (third- and fourth-degree) stress shielding was identified in 40.9% (18/44 hips) of cases. Twenty-two patients (51.2%) had pseudotumors attributable to MoM articulation based on MRI results, 2 to 10 years after arthroplasty. Three hips showed cup osteolysis (7%) and three showed trochanteric region osteolysis (7%). There were seven cup and/or three stem revisions for aseptic loosening and/or osteolysis at 4 months (with trauma) and 3.3 to 11 years (with pseudotumor) postoperatively. The Kaplan-Meier survivorship for the THA construct in this group was constant at 93.0% and 75.9% at 10 and 12 years after arthroplasty, respectively. The rates of survivorship of revision and loss of follow-up at 10 and 12 years were 83.9% and 66.8%, respectively. Conclusions: In summary, we reported on the long-term treatment results of MoM THA, precautions based on our cohort's findings, and the measures taken to address these issues, such as revision replacement and its outcomes. Clinical scores revealed good outcomes during the mean 11-year follow-up period. However, the prevalence of pseudotumors (PTs) was 51.2%. Some cases required revisions even after the 10 years following surgery. This is because in MoM THA, PT occurrence increases over time, and as a result, there were cases in which revised THA was required even after 10 years.

Secondary intervention after failed initial intervention for primary congenital glaucoma

To report on the outcome of subsequent interventions after failed initial intervention for primary congenital glaucoma (PCG). Retrospective chart review of children presenting with PCG and failed the initial glaucoma surgery in Alexandria Main University Hospital from 2005 to 2017. The data included demographics, preoperative, operative and postoperative clinical characteristics. Success was defined as IOP<16mmHg and <20% from the presenting IOP and C/D ratio like or better than presentation. The charts of 531 (260 right, 49%) eyes of 360 (224 males, 62%) children presenting with PCG and failed the initial glaucoma surgery (58 [31 right, 53%] eyes [10.9%] of 50 [28 males, 56%] children) revealed that at initial presentation, the mean±standard deviation (range, median) of the age of the children subjected to one successful glaucoma procedure and the study children was 8.6±11.7 (0.6-109, 5.2) and 4.9±6.1 (0.5-34.4, 3.0) months, respectively. Each of the study eyes was subjected to 2.6±0.8 (2-5.2) glaucoma procedures. The mean±standard deviation (range, median) duration between the initial and second glaucoma surgery and the duration of follow-up was 6.9±7.8 (0.7-39,3.9) and 61.5±32.1 (12.0-139.1, 60.1) months, respectively. At the final follow-up visit success was reported in 41 (70.1%) eyes by IOP<16mmHg criterion, 39 (67.2%) eyes by IOP>20% reduction criterion and in 28 (out of 35 eyes, 80.0%) by the optic nerve condition (C/D ratio) criterion. Success by all 3 criteria was reported in 25 (out of 35 eyes, 71%) eyes. A repeat glaucoma surgical procedure maybe needed in up to 11% of operated PCG eyes, with the subsequent glaucoma surgical procedures being successful by about 70%.

Pulsed Radiofrequency Neuromodulation for Post-Stroke Shoulder Pain in Patients with Hemorrhagic Stroke.

Post-stroke shoulder pain (PSSP) is a common complication that limits the range of motion (ROM) of the shoulder, the patient's rehabilitation and in turn, affects the patients' quality of life (QoL). Several treatment modalities such as sling, positioning, strapping, functional electrical stimulation, and nerve block have been suggested in literatures, however none of the treatments had long-term effects for PSSP. In this study, the authors evaluated clinical efficacy of pulsed radiofrequency (PRF) neuromodulation on the suprascapular nerve for PSSP, and suggested it as a potential treatment with long-term effect. This retrospective case series was conducted at a single center, a private practice institution. From 2013 to 2021, 13 patients with PSSP underwent PRF neuromodulation of the suprascapular nerve. The primary outcome measure was the Visual analog scale (VAS) score. The secondary outcome measurements included the shoulder ROM, Disability assessment scale (DAS), modified Ashworth scale, modified Rankin scale (mRS), and EuroQol-5 dimension-3L questionnaire (EQ-5D-3L) scores. These parameters were evaluated before PRF modulation, immediately after PRF modulation, and every 3 months until the final follow-up visit. Six men and seven women were enrolled, and all patients were followed-up for a minimum of 12 months. The mean VAS score was 7.07 points before PRF neuromodulation and 2.38 points immediately post-procedure. Shoulder ROM for abduction and flexion, DAS for pain, mRS, and EQ-5D-3L demonstrated marked improvement. No complications were reported. PRF neuromodulation of the suprascapular nerve is an effective modality in patients with PSSP, and has long-term effect of pain relief, improvement of QoL.

Outcomes After Total Ankle Arthroplasty in Patients Aged ≤50 Years at Midterm Follow-up.

Ankle arthritis differs from arthritis of the hip and knee in that 80% is posttraumatic and thus often occurs in a younger patient population. The literature supporting total ankle arthroplasty (TAA) in younger patients has increased over recent years and has bolstered the argument that in the short term, TAA in younger patients has successful outcomes that are comparable to older, lower-demand patients.The purpose of our study was to evaluate patient-reported outcomes (PROs) and implant survivorship at midterm after primary TAA in patients ≤ 50 years of age at the time of surgery. A retrospective chart review was conducted of patients ≤ 50 years of age who underwent primary TAA at a single institution from 2000 to 2017. Patient demographics, outcome measures, and complications were recorded. All patients had a minimum clinical follow-up of 5 years. PRO measures were evaluated at preoperative, 1-year postoperative, and final follow-up visits. Paired t tests were performed to compare individual patient changes in PROs from preoperative. Implant survivorship was evaluated based on need for revision of either the tibial or talar component. The need for additional surgery related to the TAA was also evaluated. A total of 58 patients were included. The average age at the time of the index surgery was 43.3 years (range 22-50 years). All patients had a minimum follow-up of 5 years with a mean follow-up of 8.8 years. A total of 11 patients required additional surgery related to their TAA. Six patients (10.3%) required bone grafting of peri-implant cysts, 3 patients (5.2 %) required gutter debridement, and 1 patient underwent complete revision of metal components. Mean visual analog scale, 36-item Short Form Health Survey, Short Musculoskeletal Function Assessment, and American Orthopaedic Foot & Ankle Society hindfoot scores significantly improved from preoperative to 1-year postoperative and final postoperative follow-up. The patients aged ≤50 years treated with a TAA whom we have been able to observe for a minimum of 5 years showed generally maintained improvement in functional scores and thus far have had a relatively low rate of secondary surgeries.Level of Evidence:Level III, retrospective cohort study.