Final Follow-up Research Articles

EPID-26. STEREOTACTIC RADIOSURGERY FOR CRANIAL NERVE METASTASES: A SINGLE INSTITUTION EXPERIENCE

Abstract Cranial nerve metastases (CNM) can be primary via leptomeningeal metastasis or secondary by spread due to head and neck cancers or due to distant tumor metastasis to the skull base. In addition, they may cause cranial nerve-related symptoms that can impact patient quality of life. We performed a single-center retrospective cohort study of all patients with CNM treated with SRS at our institution between April 2003 and February 2021. Demographic and clinical information were retrieved from the electronic medical record. Median follow-up was 12.9 months. Our study cohort consisted of 9 patients with primary CNM and 8 with secondary CNM – for a total of 17 patients, with a total of 33 lesions (23 primary, 10 secondary). Eleven patients (64.7%) had symptoms caused by cranial nerve metastases. Symptoms were resolved in 5 of 11 patients (45.5%) after SRS. Patients with secondary CNM were more likely to have cranial nerve symptoms and more likely to have resolution of symptoms following SRS. The median time between SRS and symptom improvement was 3 months. Local tumor control was achieved in 30 of 33 lesions (90.9%). Local tumor control at 6 months and at 1 year were 100%. Our study suggests that SRS may be a safe and effective treatment for cranial nerve metastasis providing 90.9% local tumor control at final follow-up, and symptomatic stability or improvement in 90.9% of symptomatic cases. Patients with secondary CNM may stand to benefit more from a symptom management standpoint.

Transfibular Total Ankle Arthroplasty: Clinical, Functional, and Radiographic Outcomes and Complications at a Minimum of 5-Year Follow-up.

The Trabecular Metal Total Ankle Implant differs from other newer-generation implants in the transfibular approach, multiplanar external frame for alignment, tantalum trabecular metal interfaces, curved geometry, and shallow resection depths. The primary aim of this study was to report midterm clinical and radiographic results, as well as survivorship and adverse events at a minimum of 5-year follow-up. A total of 83 ankles (81 patients, average age 60.6 years old, 50.6% females) with average 6.3 years' (range, 5.0-10.1) follow-up were included. Postoperative patient-reported outcome measures (PROMs) included SF-12 physical (PCS) and mental component summary (MCS) scores, Ankle Osteoarthritis Scale (AOS), pain visual analog scale (VAS). Radiographic outcomes included postoperative range of motion (ROM) and coronal/sagittal alignment. Adverse events were reported using the Canadian Orthopaedic Foot and Ankle Society Reoperation Coding System (CROCS). Preoperative tibiotalar coronal deformity included 27 valgus (10 degrees, range 2-20 degrees) and 25 varus ankles (-9 degrees, range -2 to -25 degrees), corrected to neutral postoperatively. Postoperative tibiopedal ROM was 17.8 degrees dorsiflexion and 21.8 degrees plantarflexion. Adverse events occurred at average 28.7 months, most commonly gutter debridement (n = 17, 16.7%) and subsequent operative treatment unrelated to metal components (n = 10, 12.0%). There were 2 cases (2.4%) of acute deep infection treated with irrigation and debridement, polyethylene exchange, and retention of metal components without recurrence of infection. There were no cases of fibular nonunion, septic or aseptic loosening, or implant subsidence. Postoperative PROMS included SF-12 PCS: 40.4; SF-12 MCS: 56.0; VAS: 2.3; AOS Pain: 17.0; and AOS Disability: 24.9. Overall implant survival, defined by retention of the metal components, was 100% at final follow-up. At a minimum of 5 years, patients who underwent TM TAA reported minimal ankle pain and regained neutral ankle alignment and mobility, without septic or aseptic implant loosening. Although having certain limitations, this study suggests that TM TAA is a viable option for the treatment of end-stage ankle arthritis.

Effectiveness of Ayush Rasayana A and B on the Quality of Life of Older Adults: Protocol for a Cluster Randomized Controlled Trial.

With advancing age among older adults, the associated debilities increase, indicating a deteriorating health status as there is a gradual loss of muscle mass, strength, and functionality. Ayush Rasayana A and B are coded Ayurvedic medicines developed from herbal extracts. This study has been planned to prevent debilitating conditions and improve the quality of life (QOL) in older adults. This study aimed to assess the effectiveness of Ayush Rasayana A and B on the QOL, quality of sleep, and functionality of older adults, along with the tolerability of the intervention. This was a multicenter, open-label, cluster randomized controlled trial conducted with 720 participants aged 60 to 75 years. The participants were divided into 2 groups (intervention and control), with both receiving Ayurvedic ancillary treatment for 3 months. The intervention group additionally received 10 g of Ayush Rasayana A orally once daily at bedtime for 6 days, followed by 1.5 g of Ayush Rasayana B orally twice daily before food for the remaining 84 days. The assessment criteria included the Older People's Quality of Life Questionnaire Brief, Katz Index of Independence in Activities of Daily Living, Pittsburgh Sleep Quality Index, Five Times Sit-to-Stand Test, and shoulder and scapular movements. Any change in hematological and biochemical parameters and occurrence of treatment-emergent adverse events were also assessed during the study period. The recruitment of the participants started in December 2023, and the final follow-up was completed in April 2024. Out of the total 720 enrolled participants, 686 (95.3%) completed the study up to the last follow-up. This study may provide evidence-based data to establish preventive treatment protocols for enhancing the QOL and functionality among older adults. The study results may also be helpful for the planning of interdisciplinary health policies for improving the health conditions of different populations. DERR1-10.2196/58186.

Safety and reliability of ultrasound-assisted reduction in the conservative management of completely displaced paediatric distal radius fractures.

To assess the efficacy of ultrasound-assisted reduction in the conservative management of completely displaced pediatric distal radius fractures. The efficacy of ultrasound-assisted reduction versus conventional reduction was compared in a single-centre, retrospective, cross-sectional study involving 51 consecutive paediatric patients with completely displaced distal radius fractures, following manual reduction, from May 2021 to May 2023. The study group received ultrasound-assisted reduction (n = 24), while the control group underwent conventional blind manual reduction (n = 27). Comparative analysis included general clinical data, initial reduction success rates, frequency of exposure to radiation during reduction, post-reduction alignment rates, post-reduction angulation, re-displacement rates, conservative treatment failure rates, pain scores, and wrist joint scores at the last follow-up. All enrolled cases underwent manual reduction and conservative management. In the study group, all 24 patients underwent successful initial reduction procedures, with only one exposure to radiation during the entire process. Notably, no patient experienced re-displacement while in plaster, and the conservative treatment proved effective. The reduction and positioning rates were impressive, with success rates of 86.63 ± 3.65% in the coronal plane and 94.79 ± 3.06% in the sagittal plane. Furthermore, the post-reduction angulation was only 3.58 ± 0.65 degrees in the coronal plane and 8.70 ± 1.45 degrees in the sagittal plane. By contrast, within the control group comprising 27 patients, only 15 achieved successful initial reductions. Unfortunately, 12 patients required multiple exposure to radiation throughout the procedure. Furthermore, nine patients underwent re-displacement while in plaster and seven did not achieve successful conservative treatment. The alignment rates of the control group were similar to those of the study group (84.67 ± 4.35% in the coronal plane and 82.56 ± 5.45% in the sagittal plane). Similarly, the post-reduction angulation remained consistent, measuring 3.93 ± 0.87 degrees in the coronal plane and 12.03 ± 1.32 degrees in the sagittal plane. There were no statistically significant differences in pain scores during the process of fracture reduction and in wrist joint function scores at the final follow-up (P > 0.05). Ultrasound-assisted reduction in the conservative management of completely displaced paediatric distal radius fractures can enhance the initial reduction success rate, decrease the risk of subsequent redisplacement, minimize patient exposure to radiation, and yield favorable clinical outcomes. It is a safe and reliable approach.

Delayed closure of highly myopic macular holes combined with retinoschisis after inverted internal limiting membrane flap.

To assess functional and anatomical outcomes of internal limiting membrane (ILM) inverted flap in highly myopic macular holes (HMMHs) with outer-retinoschisis (O-RS). Retrospective interventional analysis of 19 eyes with HMMH and O-RS undergoing vitrectomy and ILM inverted flap. At baseline and every follow-up visit (1, 3, 6, 12months and the most recent) we performed best-corrected visual acuity (BCVA, Snellen) and optical coherence tomography (OCT), collecting several parameters: minimum linear diameter (MLD), basal diameter (BD), peri-HMMH nasal and temporal retinal thickness (RTNAS and RTTEM), peri-HMMH nasal and temporal O-RS height (O-RSNAS and O-RSTEM). The ratios O-RSNAS/ RTNAS and O-RSTEM/RTTEM were defined as %O-RSNAS and %O-RSTEM. Postoperatively, we distinguished classic HMMH closure (n = 14) from a newly described "delayed" closure pattern (n = 5). Primary anatomical closure was obtained in 89% of eyes. Mean BCVA improved from 0.23 ± 0.17 to 0.44 ± 0.20 and 0.46 ± 0.25 at 6-months and final follow-up (p = 0.009 and p = 0.001, respectively). At every follow-up, "classic" vs. "delayed closure" did not influence BCVA (all p > 0.05). Baseline O-RSNAS (p = 0.026), O-RSTEM (p = 0.04), %O-RSNAS (p = 0.04) and %O-RSTEM (0.004), were significantly associated with the "flap closure" pattern, differently from MLD and BD. In the "delayed closure" subgroup we reported a 100% closure rate, but 65.8 ± 64.4days after first surgery. Meantime, OCT showed an inverted ILM flap covering an area of persistent tissue loss. O-RSNAS and O-RSTEM progressively reduced until HMMH closure. Inverted flap is useful to close HMMH with O-RS. In case of "delayed closure" pattern, watchful-waiting allows for HMMH self-sealing, without impact on BCVA. What is known Inverted internal limiting membrane (ILM) flap showed favorable anatomic success in cases of highly myopic macular holes (HMMH). What is new HMMHs with outer retinoschisis (class 2c of the staging system) may close following a classic or "delayed closure" pattern. In cases of delayed closure, it took a variable range of 30-179days to seal the HMMH but no further surgery was advisable. Post-operative BCVA improvement was not impacted at any follow-ups when comparing "delayed" and "classic" closure subgroups.

Influence of Preoperative Disability on Outcomes Following Primary Surgical Treatment of Cervical Disc Herniation.

Retrospective review. To evaluate how preoperative disability influences patient-reported outcomes (PROs) following primary surgical intervention for cervical herniated disc. The effect of baseline disability has been evaluated for various spinal surgeries, but not specifically for primary cervical herniated disc. A prospectively maintained single surgeon database was retrospectively reviewed to identify patients who underwent primary cervical spine surgery for herniated nucleus pulposus. Demographics, perioperative data, and baseline/postoperative PROs were collected including Neck Disability Index (NDI), Visual Analog Scale-Arm/Neck (VAS-A/N), 12-Item Short Form Mental/Physical Component Scores (SF-12 MCS/PCS), Patient-Reported Outcome Measure Information System-Physical Function (PROMIS-PF), and 9-Item Patient-Health Questionnaire (PHQ-9). Baseline NDI <50/≥50 defined 2 cohorts. ΔPROs were determined at 6-week postoperatively/final follow-up (average 11.8±7.7 postoperative months). Overall rates of minimal clinically important difference (MCID) achievement were determined for each PRO. Perioperative characteristics/demographics/baseline PROs were compared with χ2 tests (categorical variables)/the Student t test (continuous variables). Intercohort postoperative PROs/ΔPROs/MCID attainment rates were compared with multivariate linear regression (continuous variables)/multivariate logistic regression (categorical variables) accounting for differences in insurance type. Of 190 patients, there were 69 in the NDI ≥50 group. Patients with NDI ≥50 were more likely to have workers' compensation, or Medicare/Medicaid insurance (P<0.001) and report worse baseline PROs (P≤0.001, all). After controlling for insurance type, NDI ≥50 patients continued to report worse PROs at 6 weeks/final follow-up (P≤0.037, all), except PROMIS-PF at 6 weeks postoperatively. NDI ≥50 patients reported greater NDI improvements at 6 weeks (P=0.007) and final follow-up (P<0.001). NDI ≥50 patients experienced higher overall MCID achievement rates for PHQ-9/NDI (P≤0.015, both). NDI ≥50 patients reported worse baseline mental/physical health and neck/arm pain and continued to report inferior postoperative outcomes including disability. Despite inferior absolute outcomes, NDI ≥50 patients reported greater improvements/achievement of clinically significant differences in disability through final follow-up. Further, these patients were more likely to experience clinically significant improvements in depressive burden.

Radiographic Outcome Following Treatment of Residual Hip Dysplasia with Pemberton Versus Salter Osteotomy: Comparison of Results in Patients Followed to Skeletal Maturity.

Salter osteotomy (SO) and Pemberton acetabuloplasty (PA) are procedures to treat skeletally immature patients with developmental dysplasia of the hip (DDH). The purpose of this study was to compare the radiographic results and rate of residual dysplasia (RD) after treatment with SO and with PA. This was a retrospective analysis of pediatric patients treated with either SO or PA for DDH between 1980 and 2013 who were skeletally mature at the time of follow-up. The preoperative and postoperative acetabular index (AI) and postoperative lateral center-edge angle (LCEA) and anterior center-edge angle (ACEA) were collected. RD was defined as an LCEA or ACEA of <20° or an acetabular inclination (AIn) of >15° at skeletal maturity. Continuous variables were compared between treatment groups with 2-sample t tests, and categorical variables were compared using chi-square tests. Multivariable analysis was used to identify risk factors for RD with p < 0.05. The study included 113 hips in 102 patients with a mean follow-up of 10.5 years. The SO group had 73 hips treated at a mean patient age of 5.4 years, and the PA group had 40 hips treated at a mean age of 5.3 years. The preoperative AI did not differ between the treatment groups (32.2° versus 31.3°, p = 0.658), nor did the immediate postoperative AI (20.0° versus 20.2°, p = 0.459). At the time of final follow-up, the SO group had a significantly smaller AIn (8.6° versus 13.2°, p = 0.001), a trend toward a greater LCEA (26.2° versus 21.6°, p = 0.056), and a similar ACEA (24.1° versus 26.1°, p = 0.808). By the abovementioned definition, 36 hips (31.9%) had evidence of RD, with a lower rate in the SO group (26.0% versus 42.5%, p = 0.07). Patients who had a positive family history of hip dysplasia were more likely to have RD (odds ratio = 4.311, 95% confidence interval = 1.125 to 16.528). Patients with RD could be effectively treated with either SO or PA, with overall good radiographic outcomes. However, SO achieved a better AI and may thus yield better long-term health of the affected hip. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Outcomes of Trochleoplasty versus Tibial Tubercle Osteotomy for Treatment of Patellar Instability Associated with Trochlear Dysplasia: A Systematic Review and Meta-analysis.

This study compared the outcomes of tibial tubercle osteotomy (TTO) and trochleoplasty for the treatment of patellar instability associated with trochlear dysplasia. This was a systematic review of the literature including published articles that describe either trochleoplasty or TTO in addition to medial patellofemoral ligament reconstruction for the surgical treatment of patellar instability associated with trochleoplasty. Main outcomes assessed were Kujala and International Knee Documentation Committee (IKDC) scores, in addition to recurrent instability and complications. Outcome measures reported were provided in a table format and a subjective analysis was performed. Ten studies were included with a total of 362 knees including 132 in the trochleoplasty group and 230 in the TTO group. Mean follow-up ranged from 27.6 to 61.3 months. At the final follow-up, both Kujala and IKDC scores improved significantly in all studies that reported both preoperative and postoperative scores in both groups. There was a total of three instability events in the trochleoplasty group as opposed to 21 in the TTO group. Both procedures, trochleoplasty and TTO, may provide satisfactory functional improvement in patients with patellar instability associated with trochlear dysplasia. However, trochleoplasty may be a better option to minimize the risk of recurrent instability. Level of evidence: level IV, systematic review of level III and level IV studies.

Short-term efficacy of unilateral biportal endoscopy technology in the treatment of cervical spondylotic radiculopathy.

To compare the clinical efficacy of unilateral biportal endoscopy technology (UBE) with anterior cervical discectomy and fusion(ACDF)for the treatment of single-segment cervical spondylotic radiculopathy (CSR). Retrospective analysis of 60 patients with CSR, of which 30 were treated with ACDF (group A) and 30 were treated with UBE (group B). Cision length, operation time, intraoperative blood loss, hospitalization duration, postoperative complications preoperative and postoperative VAS, NDI scores, height and stability of the liability gap were compared between the two groups. Compared with the A group, the incision length, duration and intraoperative blood loss were significantly less in the B group (P < 0.05), and the difference was statistically significant. As the postoperative time increased, the VAS score and NDI score decreased significantly in both groups (P < 0.05or < 0.01). However, the differences in VAS and NDI scores between the two groups at the corresponding time points were not statistically significant, and only the VAS score at 1day postoperatively showed a more pronounced decrease in the B group, which was statistically significant compared with that in the A group. The difference in intervertebral space height and stability of the postoperative liability gap between the two groups at the final follow-up was not statistically significant when compared with the preoperative period. The incidence of postoperative complications in the two groups was smaller in the B group than in the A group, and the difference was not statistically significant. UBE can effectively treat patients with single-segment CRS and promote rapid recovery.

Clinical Efficacy and Complications of Spinal Surgery Unilateral Biportal Endoscopy for Cervical Spondylosis: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis evaluated the clinical efficacy and complications of unilateral biportal endoscopy (UBE) for treating cervical spondylosis (CS), providing evidence-based guidance for optimal treatment decisions. Relevant studies on UBE for CS were identified through comprehensive searches of PubMed, Embase, Web of Science, and the Cochrane Library up to April 22, 2024. Studies included patients diagnosed with CS who underwent UBE surgery and reported outcomes such as VAS scores, NDI scores, and postoperative complications. Data extraction and quality assessment were performed independently by two reviewers. Statistical analyses were conducted using Stata 15, employing random-effects models due to significant heterogeneity (I2 > 50%). Nine publications, comprising 353 patients and 400 operation levels, met the inclusion criteria. The mean follow-up duration was 17.01 months, and the operative time for a single level was 71.29 minutes. The average VAS score for neck pain decreased from 6.08 preoperatively to 1.52 postoperatively, the average VAS score for arm pain decreased from 7.13 to 1.35, and the average NDI decreased from 34.61 to 6.83 at the final follow-up. The mean satisfaction rate (good or excellent using the Macnab criteria) was 91%. The overall complication rate was 5%, with the most frequent complication being a dural tear (1%), followed by nerve root injury or transient hypoesthesia (0.3%). UBE demonstrates strong efficacy and safety in treating CS, with significant improvements in pain and disability scores, shorter operative times, and lower complication rates.

Re-tear following rotator cuff repair: Do functional outcomes predict success?

The purpose of this study is to compare functional outcomes between patients who were found to have a retear on ultrasound versus those with an intact repair following arthroscopic rotator cuff repair. Retrospective cohort study comparing functional outcomes of 84 patients who underwent arthroscopic rotator cuff repair and were found to have a retear versus those who did not experience a retear. Functional outcomes included American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test, strength and active range of motion (AROM) assessed preoperatively and postoperatively at 3 and 6 months. Patients without a retear by 6 months demonstrated greater improvements in internal rotation at 3 months (2.3° of mean change, p = 0.0356), as well as greater improvements in external rotation range of motion (8.8° of mean change, p = 0.0210) between 3 and 6 months as compared to those patients who did experience a retear. Both groups showed decreased pain scores and increased ASES scores at all points postoperatively. Our study found statistically significant improvements in internal rotation at 3 months, and external rotation between 3 and 6 months in the non-retear group. No differences in functional outcomes existed between at final follow-up.

Tobacco Quitline Retreatment Interventions Among Adults With Socioeconomic Disadvantage

A single round of standard tobacco quitline treatment may not be sufficient to sustain abstinence, particularly among people experiencing socioeconomic disadvantage. Adaptive retreatment may help more individuals with socioeconomic disadvantage achieve abstinence and reduce disparities in smoking cessation outcomes. To evaluate 4 evidence-based strategies for adults with limited education, no insurance, or Medicaid eligibility who continued smoking after quitline treatment. A factorial randomized clinical trial with 4 factors adapting quitline strategies was conducted for participants enrolled from June 7, 2018, to January 25, 2023, with 6-month follow-up. Adults using the Wisconsin Tobacco Quit Line who were smoking cigarettes 3 to 6 months after prior quitline treatment who were uninsured, Medicaid insured, or had no more than a high school education were included. Quitline retreatment strategies were (1) increased counseling intensity (4 calls vs 1 call), (2) increased nicotine replacement therapy intensity (4 weeks of combination nicotine patch plus nicotine lozenge vs 2 weeks of nicotine patch), (3) text-message support (National Cancer Institute SmokefreeTXT program vs none), and (4) financial incentives for engagement in counseling and SmokefreeTXT ($30/call and/or 6-week SmokefreeTXT retention vs no incentives). Primary outcome was 7-day point-prevalence biochemically confirmed abstinence 26 weeks after the target quit day. Intention-to-treat analysis was performed. Of 6019 people assessed for eligibility, 1316 (21.9%) participants were randomized (mean [SD] age, 53.1 [11.9] years; 760 [57.8%] women), and 919 (69.8%) provided final follow-up. Intention-to-treat analyses showed 162 participants (12.3%) had biochemically confirmed abstinence at 26 weeks (368 [28.0% self-reported abstinence]). There were no significant main effects for the primary outcome: 1 call (11.6% [77 of 662]) vs 4 calls (13.0% [85 of 654]) (odds ratio [OR], 1.04; 95% CI, 0.88-1.24), 2-week patch (11.2% [73 of 654]) vs 4-week combination nicotine replacement therapy (13.4% [89 of 662]) (OR, 1.12; 95% CI, 0.94-1.34), no SmokefreeTXT (13.4% [88 of 657]) vs SmokefreeTXT (11.2% [74 of 659]) (OR, 0.88; 95% CI, 0.74-1.05), and no financial incentives (12.8% [85 of 662]) vs financial incentives (11.8% [77 of 654]) (OR, 0.94; 95% CI, 0.78-1.11). In this randomized clinical trial evaluating enhancements to tobacco quitlines for adults with socioeconomic disadvantage who were smoking after quitline treatment, none of the adaptive treatment strategies robustly improved long-term abstinence. Strategies are needed to enhance quitline retreatment effectiveness for adults with socioeconomic disadvantage. ClinicalTrials.gov Identifier: NCT03538938.

Is partial excision of the radial head safe and effective in all-arthroscopic treatment of terrible triad fractures?

Our study aimed to evaluate the clinical and radiologic results of all-arthroscopic treatment of terrible triad injuries followed-up for a minimum of 5 years and investigate how arthroscopic partial excision for radial head fractures affects the results at the final follow-up. We retrospectively reviewed consecutive patients with terrible triad injuries who underwent all-arthroscopic treatment between January 2011 and June 2018. In group I, we performed conservative or arthroscopic fixation of stable radial head fractures, while in group II, arthroscopic partial excision of unstable radial head fractures involving <30%-50% of the articular surface area was performed. Clinical outcomes were measured by visual analog scale score and assessment of instability, range of motion (ROM), and Mayo Elbow Performance Score. Radiological outcomes were evaluated using x-rays, and the integrity of the repaired lateral collateral ligament complex was confirmed through magnetic resonance imaging. Thirty-two patients with an average age of 49.5±16.2 years met the inclusion criteria and were followed-up for a mean of 82.7±22.2 months. Twenty patients were assigned to group I and 12 patients to group II. Clinical outcomes showed no significant differences between the two groups at the final follow-up (P>0.05). On radiological evaluation, more heterotopic ossifications were found in the radial head excision group (group II, 66.7% versus group I, 35%, P=0.02); however, there was no significant difference in ROM between the two groups (P>0.05). In all-arthroscopic treatment of terrible triad injuries, arthroscopic partial excision of the radial head did not seem to have a significant impact on elbow joint stability. Level of evidence: III.

Comparison of Short-Term Clinical Effects of Minimally Invasive Anterior Talofibular Ligament Reconstruction versus Suture Anchor Repair for Chronic Lateral Ankle Instability

Objective: To compare the short-term clinical effects of minimally invasive anterior talofibular ligament (ATFL) reconstruction versus suture anchor repair in patients with chronic lateral ankle instability. Methods: A retrospective analysis was conducted on 68 patients at the 960th Hospital of the Chinese People’s Liberation Army Joint Logistics Support Force between January 2022 and June 2023, patients were divided into two groups based on surgical procedure: Group A (ATFL reconstruction, 35 cases) and Group B (suture anchor repair, 33 cases). Follow-up ranged from 1 to 12 months, assessing the American Orthopaedic Foot and Ankle Society (AOFAS) score, VAS pain score, Tegner activity score, and patient satisfaction, while noting any recurrence of ankle instability or complications such as numbness or infection. Results: In Group A, the AOFAS score improved from 74.46 ± 2.96 preoperatively to 90.91 ± 2.79 at final follow-up, Tegner score from 2.40 ± 0.50 to 5.69 ± 0.76, and VAS from 3.14 ± 0.85 to 1.60 ± 0.50; patient satisfaction was 8.31 ± 0.72. In Group B, AOFAS improved from 74.48 ± 2.29 to 90.55 ± 3.12, Tegner from 2.48 ± 0.51 to 5.76 ± 0.79, and VAS from 3.45 ± 0.83 to 1.73 ± 0.50, with patient satisfaction at 8.27 ± 0.63. No significant statistical difference was found between groups in any score (P &gt; 0.05), with both groups showing significant postoperative improvement (P &lt; 0.05) and no serious complications within 1-year follow-up. Conclusion: Both ATFL reconstruction and suture anchor repair yield favorable short-term outcomes in treating lateral ankle instability. Further research is needed to assess if anatomical reconstruction offers superior biomechanical benefits in scar healing over the suture anchor repair in long-term follow-up.

Risk factors for screw loosening in patients with lumbar degenerative spondylolisthesis treated with Dynesys dynamic stabilization.

Posterior decompression with Dynesys dynamic stabilization (DDS) is an effective treatment option for degenerative spondylolisthesis. However, postoperative pedicle screw loosening (PSL) often results in poor outcomes. Determining possible risk factors may aid in making informed decisions. This study aimed to evaluate the incidence and risk factors for PSL in patients who underwent elective DDS. We conducted a retrospective analysis of 94 patients with L4-L5 grade I degenerative spondylolisthesis who underwent DSS at a single academic institution between May 2008 and February 2015. Screw loosening was defined as a halo or double halo sign on plain radiography. The screw loosening rate was 4.8% among screws and 11.7% among patients. Multivariate analysis revealed that age >65 years, smoking, segmental ROM >13°, and L1 vertebral body (VB) Hounsfield unit (HU) <110 were risk factors for PSL after DDS. Five reoperations were performed; however, no screw breakage was observed. The Oswestry Disability Index and visual analog scale scores did not differ significantly at the final follow-up between the screw loosening and no screw loosening groups. Our study suggests that patients with age >65 years, smoking, segmental ROM >13°, and L1 VB HU <110 had a higher risk of PSL after DDS.

One-Step Cartilage Repair of Full-Thickness Knee Chondral Lesions Using a Hyaluronic Acid-Based Scaffold Embedded With Bone Marrow Aspirate Concentrate: Long-term Outcomes After Mean Follow-up Duration of 14 Years.

One-step cell-based techniques of cartilage repair that lead to restoration of durable chondral tissue and long-term maintenance of joint function are cost-effective and ideal for routine use. To examine the long-term clinical outcomes, after a mean follow-up duration of 14 years, of cartilage repair in the knee using a hyaluronic acid-based scaffold in association with bone marrow aspirate concentrate (HA-BMAC) and to evaluate the effect of age, lesion characteristics, and associated treatments on the outcome of this cartilage repair method. Case series; Level of evidence, 4. Patients were followed prospectively for a mean duration of 14.0 years after undergoing treatment of knee full-thickness articular cartilage injury using HA-BMAC. Clinical evaluation consisted of the patient-reported scoring tools of the visual analog scale and the Knee injury and Osteoarthritis Outcome Score, which were completed preoperatively and at the time of final follow-up. A total of 26 patients with a mean age of 48.3 years (17 male, 9 female) and median chondral lesion size of 6.6 cm2 (range, 1-27 cm2) were followed prospectively. There were 3 treatment failures, and 1 patient who underwent medial compartment unicompartmental arthroplasty 12 years after HA-BMAC treatment of patellar chondral injury. Of the 22 remaining patients, after a mean final follow-up duration of 14.0 years (range, 12-16 years), the median visual analog scale score of 0.6 was significantly decreased from the preoperative median score of 5.0 (P < .001). The median Knee injury and Osteoarthritis Outcome Score Pain (92), Symptoms (86), Activities of Daily Living (96), Sports (85), and Quality of Life (88) subscale values were all increased compared with the preoperative scores (P≤ .001). There was no correlation of clinical outcome score and body mass index. One-step cartilage repair of full-thickness chondral defects in the knee using an HA-BMAC led to successful long-term clinical outcomes and maintenance of joint junction after a mean follow-up duration of 14 years. Long-term clinical success in active, nonobese patients has been uniformly demonstrated across a wide range of patient ages and lesion types, including cases of multicompartment involvement, treatment of associated conditions, and large or bipolar chondral lesions.

Comparison of anterior spinal fusion and posterior cervical foraminotomy for cervical spondylotic radiculopathy in terms of postoperative recovery of upper-limb motor deficits

This study compared postoperative motor recovery between anterior spinal fusion (ASF) and posterior cervical foraminotomy (PCF) in patients with cervical spondylotic radiculopathy (CSR) who had motor deficits. From a database maintained by surgeons across 27 institutions, 227 patients undergoing primary ASF or PCF for CSR without myelopathy were evaluated. Among these, 106 patients with upper-limb motor deficits (manual muscle testing [MMT] grade 0–3) were observed for at least 12 months post-surgery. Data on preoperative and postoperative MMT grades were collected at 3, 6, and 12 months after surgery and at the final follow-up. The recovery of motor function was compared between the ASF and PCF groups using Kaplan–Meier curves and Cox regression analysis. While the overall excellent recovery rates (MMT grade ≥ 2) at the final follow-up were similar between the ASF and PCF group (74 % vs. 86 %, p = 0.15), the PCF group showed significantly faster motor recovery at 3, 6, and 12 months postoperatively, with recovery rates of 43 %, 63 %, and 82 %, respectively, compared to 18 %, 46 %, and 54 % in the ASF group (HR = 1.62, p = 0.031). These findings suggest that PCF may offer a quicker recovery of motor function and could be a more suitable surgical procedure than ASF for patients with CSR and motor deficits.

Feasibility and acceptability of the Problem Management for Moms programme for improving maternal mental health in Zambia: an open-label trial

Psychological distress is common among mothers in low-income and middle-income countries, limiting their capacity to care for themselves and their children. This study aimed to test the feasibility and acceptability of an adapted psychosocial intervention for distressed mothers in low-resource settings. In this open-label trial, we enrolled women living in Lusaka, Zambia, with high mental distress (>7 score on the 20-item Self-Reporting Questionnaire [SRQ-20]) and children younger than 2 years, who had previously enrolled in the ZamCharts early childhood nutrition trial. We randomly assigned participants (1:1) to the intervention or control group using a random number draw. The intervention was a newly developed Problem Management for Moms (PM4M) programme: a ten-session treatment adapted from Problem Management Plus, which was offered by phone or in person. After randomisation, participants in the intervention group underwent pre-intervention screening, a post-intervention assessment, and a final follow-up assessment 9 months after treatment initiation (ie, final follow-up visit). The control group was assessed at the baseline of ZamCharts and at the final follow-up assessment, and these participants did not receive any intervention. The primary study outcomes were feasibility, acceptability, and participant mental distress measured using the SRQ-20. All primary and secondary outcomes were estimated in the intention-to-treat population, which included all participants who were randomised to the intervention group and attended the final follow-up assessment. Data on ethnicity were not collected. The trial is registered at ClinicalTrials.gov, NCT05627206, and has been completed. Women with lived experience of mental health symptoms were involved in this study. Between April 26, and July 14, 2021, 790 women were interviewed in the ZamCharts trial, of whom 265 had high mental distress and were randomly assigned to treatment groups in this trial (134 to the intervention group and 131 to the control group). Of the 134 women in the intervention group, 61 (46%) received the PM4M intervention and 73 (55%) were excluded; 103 in the intervention group and 106 in the control group were successfully interviewed at the final follow-up assessment. The mean age of participants was 27·6 years (SD 7·6) at ZamCharts baseline. PM4M sessions were conducted between Dec 16, 2022, and May 6, 2023. The 61 participants deemed eligible after pre-intervention screening who started the intervention completed a mean of 7·9 (SD 2·9) of ten sessions. 55 (77%) of these 61 participants were somewhat or very satisfied with the intervention. In adjusted intention-to-treat models, the intervention reduced mean SRQ-20 scores by 2·11 points (95% CI -3·50 to -0·63) at the final follow-up, and the adjusted odds ratio of having an SRQ-20 of more than 7 was 0·50 (95% CI 0·27 to 0·93). No serious adverse events were reported. The results presented here suggest that the PM4M mental health intervention is feasible and has high rates of acceptability. Further research is needed to assess the long-term efficacy of this intervention on women and their children, and its suitability for integration into routine care. The Eckenstein-Geigy Professorship.

Posterior Cruciate Ligament Reconstruction Improves Sexual Health Post-Operatively

PurposeThe purpose of this study was to investigate changes in sexual function and quality of life following arthroscopic posterior cruciate ligament (PCL) reconstruction. MethodsPatients aged between 18 and 45 years who underwent PCL reconstruction were considered for inclusion. At the time of hospital admission, each patient was asked to complete the New Sexual Satisfaction Scale-Short Form (NSSS-S), before injury (preinjury) and at the time of hospital admission (preoperative). In addition, patients were followed for a minimum of 24 months (final follow-up). Quality of life was measured using the Anterior Cruciate Ligament Quality of Life Questionnaire (ACL-QOL) at hospital admission (preoperative) and at the 24-month follow-up visit (final follow-up). ResultsA total of 35 patients were included in the study; 24 (68.6%) were male, and 11 were female (31.4%). The mean age at the time of surgery was 29.23 ±7.52 years, and the mean follow-up duration was 52.97 ±22.69 months. In all patients, the hamstring tendon was used. Sexual activity at the last follow-up visit was significantly different from that preoperatively (p=0.024), while no difference was observed between the preinjury and last follow-up values (p=0.243). Sexual activity was more frequent before injury than preoperatively (p=0.009). Quality of life at the last follow-up visit was significantly better than that preoperatively (p<0.001). ConclusionsReconstructive surgery after PCL injury improves the sexual health of patients regardless of age or sex.

High-Energy Transsyndesmotic Ankle Fracture Dislocation-Does Deltoid Ligament Repair Influence the Progression of Posttraumatic Arthritis in Logsplitter Injuries?

To determine the effect of deltoid ligament repair on the development of posttraumatic arthritis in logsplitter ankle injuries. Retrospective cohort. Academic, Level I trauma center. Patients ≥18 years of age with logsplitter injuries (OTA/AO 44B, 44C) treated with open reduction internal fixation (ORIF) with or without deltoid ligament repair from January 2008 to October 2021. The rate of posttraumatic arthritis (PTOA) development at the final follow-up (minimum 6 months) after ORIF was evaluated using the Kellgren-Lawrence scale. The achievement of acceptable reduction indicated by articular reduction <2 mm, and a medial clear space ≤4 mm was assessed at 6 weeks postoperatively with weight-bearing radiographs. The effect of deltoid ligament repair on the development of PTOA was investigated. Fifty-nine patients aged 49.1 ± 17.2 years met inclusion criteria with a mean follow-up of 16.6 months (range = 6 to 96). Twenty-six of 59 patients (44%) had developed PTOA at the final follow-up. Acceptable reduction was achieved in 83.1% (49/59) of fractures. The acceptable reduction rate in fractures undergoing deltoid ligament repair was 100% versus 78% in those without deltoid ligament repair (13/13 vs. 36/46, P = 0.017). The rate of PTOA development was significantly lower in patients who underwent deltoid ligament repair (15%) than those who did not (52%), P = 0.026. Patients who underwent deltoid ligament repair had a significantly reduced rate of PTOA development leading to arthrodesis compared with those who did not (0% vs. 17%, P = 0.013). Logsplitter injuries resulted in a high rate of development of posttraumatic arthritis. An acceptable reduction is required to minimize the risk of development of PTOA and progression to arthrodesis. Deltoid ligament repair during ORIF may facilitate acceptable reduction and decrease the rate of PTOA and progression to arthrodesis in these injuries. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.