Functional Outcomes Research Articles

Clinical efficacy of arthroscopic single-bundle versus double-bundle reconstruction of the posterior cruciate ligament: a retrospective study.

To compare the functional and clinical outcomes of knee joints in patients over a 10-year period following posterior cruciate ligament (PCL) reconstruction with single-bundle versus double-bundle. Patients who underwent PCL reconstruction were retrospectively analyzed. Based on the surgical approach, they were divided into the single-bundle reconstruction group and the double-bundle reconstruction group. Preoperative and postoperative Lysholm score, International Knee Documentation Committee (IKCD) score, and Tegner activity score were evaluated, and the stability of the joints was assessed using KT-2000 arthrometer. Radiographs were taken at the final follow-up to evaluate the progression of osteoarthritis. A total of 61 patients were included in the analysis: 26 in the double-bundle group and 35 in the single-bundle group. Baseline data were comparable between the two groups (P > 0.05). There were no significant differences between the two groups in preoperative Lysholm, IKDC score, and Tegner activity score. Postoperatively, these scores were significantly higher at two and ten years follow-up (P < 0.05), with no significant difference between the groups (P > 0.05). There was no significant difference in side-to-side differences (SSD) at 30° and 90° of knee flexion preoperatively between the groups (P > 0.05). Postoperatively, SSD decreased significantly at the two year and ten year follow-up (P < 0.05), with no significant difference between the groups (P > 0.05). For osteoarthritis progression, there were four cases of Kellgren-Lawrence grade ≥ II in the single-bundle group and three cases in the double-bundle group, with no significant difference in the progression of osteoarthritis between the groups (P > 0.05). Both single-bundle and double-bundle reconstructions for PCL result in good joint stability and mobility, with similar progression of osteoarthritis in long-term follow-up. Level III.

Morphometrics of polypoidal choroidal vasculopathy lesions and choroidal vascular associated with treatment response using swept-source optical coherence tomography angiography

PurposeTo evaluate quantitative metrics of neovascularization lesions and choroidal vascular using swept-source optical coherence tomography angiography (SS-OCTA) in polypoidal choroidal vasculopathy (PCV) eyes, and investigate the relationship between imaging biomarkers and treatment outcomes of intravitreal anti-vascular endothelial growth factor (VEGF). MethodsWe retrospectively recruited 56 PCV patients. Choroidal features included subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI). Quantitative metrics of neovascularization lesions included total vessel length (TVL), average vessel length (AVL), junction density (JD), total number of endpoints (TNE), and mean lacunarity (ML). We performed multivariate logistic and linear regression models to determine the prognostic factors for functional and morphological outcomes. ResultsBy comparison, functional good-responders had poorer best corrected visual acuity, higher TNE, and lower ML at baseline. Morphological good-responders had higher central retinal thickness, higher TNE, lower TVL and AVL, lower ML, lower SFCT and CVI. High-shrinkage of vessel area subgroup had higher JD and TNE, lower TVL and AVL, lower ML, lower SFCT and CVI. Multivariate analysis showed good morphological response was correlated with lower SFCT (P < 0.01). High-shrinkage subgroup was correlated with lower AVL (P = 0.017) and higher TNE (P < 0.01). ConclusionQuantitative metrics of neovascularization lesions and choroidal characteristics using SS-OCTA had the potential to be imaging biomarkers for predicting the response to anti-VEGF treatment. PCV lesions with higher TNE and lower AVL tended to appear higher shrinkage of vessel area, and lower SFCT was correlated with good morphological response.

Proteomic analysis reveals biomarkers associated with performance-based joint function and patient-reported outcomes in knee osteoarthritis

Proteomic analysis reveals biomarkers associated with performance-based joint function and patient-reported outcomes in knee osteoarthritis

Evaluation of Short-term Functional Mobility Outcomes in Patients with Traumatic Lower Limb Amputations: A Prospective Cohort Study in India

Evaluation of Short-term Functional Mobility Outcomes in Patients with Traumatic Lower Limb Amputations: A Prospective Cohort Study in India

Post-Cataract Surgery Fungal Endophthalmitis: 6-Year Experience in Management and Outcomes at a Tertiary Eye Care Center.

This study aimed to describe the functional and anatomical outcomes of post-cataract surgery fungal endophthalmitis at King Khaled Eye Specialist Hospital (KKESH). A retrospective analysis of clinical data from a single institution was performed. This study included 29 patients with post-cataract surgery endophthalmitis with suspected or confirmed fungal etiology who presented between January 1, 2017, and December 31, 2022. We evaluated demographics, clinical features, microbiological assessments, and treatment strategies. The effects of various treatments on outcomes were analyzed. The need for additional treatment and functional and anatomical outcomes was also investigated. The mean time from surgery to the onset of ocular symptoms was 52.1 (SD ± 59.9; range, 3-210) days, and the mean time from surgery to the first visit to KKESH was 81.4 (SD ± 103.5; range, 2-510) days. Low culture positivity was noted in four samples, with two revealing Aspergillus sp. and two revealing Cladosporium sp. Of the 29 patients, 6 underwent pars plana vitrectomy (PPV) and received intravitreal antimicrobial/antibiotic injections. Two of the six patients also underwent simultaneous intraocular lens removal. The average number of additional treatments, regardless of visual acuity, was lower in the PPV group than in the conservative group (0.5 [SD ± 1.1; range, 0-3] and 1.48 [SD ± 1.47; range, 0-6], respectively). In the PPV group, 50% (n=3) of the eyes achieved functional success and 83.3% (n=5) of the eyes achieved anatomical success. In contrast, in the conservative group, 43.5% (n=10) of the eyes achieved functional success and 69.6% (n=16) of the eyes achieved anatomical success. For post-cataract surgery fungal endophthalmitis, a high index of suspicion and prompt PPV with empirical administration of intravitreal antifungal agents are required to achieve a favorable prognosis.

Chronic fatigue in the general population: Prevalence, natural course and associations with chronic pain (theHUNT pain study).

Fatigue and pain are both prevalent and frequently co-occur. No standard measure of fatigue exists, but most definitions include a continuum between high levels of energy and fatigue. There is limited knowledge about the course of fatigue in the general population and its association with functioning and other health outcomes. Our main aim was to identify trajectories of energy and fatigue in the general population and to investigate whether chronic pain is related to a negative prognosis of chronic fatigue. Longitudinal latent class analysis was performed to classify 4771 individuals into trajectory groups based on five quarterly repeated measures. A five-cluster solution was identified: 'much energy' (n = 1471, [31%]), 'varying energy' (n = 1445, [30%]), 'some energy' (n = 921, [19%]), 'low energy' [chronic moderate fatigue] (n = 852, [18%]) and 'no energy'[chronic severe fatigue] (n = 82, [2%]). Individuals with chronic moderate fatigue who reported chronic pain had reduced probability of improvement over the following 3 years (OR = 0.67, 95% CI [0.52, 0.88]). Chronic fatigue is highly prevalent in the general population and a small proportion have chronic severe fatigue. When chronic pain co-occurs with chronic fatigue, improvement of chronic fatigue is less likely, indicating that these symptoms may perpetuate each other. Understanding the close relationship between chronic pain and chronic fatigue is important as they both contribute to suffering and loss of functioning, may be related to the same underlying diseases, or in the absence of disease, may share common mechanisms. This study highlights the important role of chronic pain in relation to chronic fatigue, both by showing a strong association between the prevalence of the two conditions, and by showing that chronic pain is associated with a negative prognosis of chronic fatigue.

Outcomes Of Early And Delayed Intervention Of Maxillofacial Trauma

Background: Maxillofacial trauma is routinely evaluated on the basis of high and low velocity injuries, types of fractures in the literature. On the other hand, we have evaluated them on the basis of timing of surgery after trauma and their outcomes. In India RTA (Road traffic accidents) scenario is quite different from other countries. The highway traffic consists of a variety of vehicles from a cyclist, a two-wheeler, a four-wheeler to a heavy loaded truck. Animals like cows and dogs frequent the highways. Hence, we have classified the patients based on Single jaw and Panfacial fractures with or without the presence of extensive soft tissue injuries. Materials and Methods: In this retrospective record-based descriptive study, 200 patients that were treated at Sri Aurobindo Hospital between January 2023 to July 2024 for maxillofacial trauma were reviewed. Of which 176 patients were surgically operated, averaging 30 years of age and ranging from 12-70 years. For the purpose of our study these 176 patients were categorized into two groups, first of single jaw fractures(108 patients) and second of Panfacial fractures (68 patients). Single Jaw fractures were further divided as mandibular (84 patients); maxilla &amp; zygomaticomaxillary complex fractures (24 patients). These were further evaluated and categorized as those patients who were treated within 72 hours (Early) and after 72 hours (Delayed) following injury. All patients of both the groups were treated with open reduction and internal fixation. Individual complications that of soft tissue dehiscence, plate/bone exposure, bone graft rejection, oroantral/palatal fistula, non-union of fractured segments, infections were analyzed. These complications were again assessed on the basis of their timing; those occurring within 72 hours and those after 72 hours. Results: When each type of complication was compared and evaluated, there was significantly more complication noted among delayed group than in early group. Conclusion: The restoration of the aesthetics and functionality of the face, post-trauma is a critical and an arduous task. As the anatomical complexity of the face must be addressed, timely intervention to achieve optimal functional and aesthetic outcomes is pertinent. Thus, the treatment should be done at the earliest when feasible

Iron Chelators Augment Large Osteochondral Allograft Osseointegration in a Preclinical Canine Model.

Osteochondral allograft transplantation (OCAT) can be a successful joint restoration treatment option for large post-traumatic articular defects but is still associated with significant revision and failure rates. Despite recent advances that have improved OCAT success, insufficient osteochondral allograft (OCA) osseointegration remains a major cause of failure. Deferoxamine (DFO) is an effective angiogenic and osteo-anabolic iron chelator that consistently promotes bone neovascularization and regeneration. This study was designed to investigate local delivery of DFO for augmenting OCA osseointegration using a preclinical canine model for OCAT in the knee and hip as commonly affected joints. On Institutional Animal Care and Use Committee (IACUC) approval, 12 purpose-bred dogs underwent OCAT of the femoral head or femoral condyles with DFO or DFO-free (controls) microspheres in recipient sites. OCA revascularization, cellular repopulation, and integration were evaluated based on functional, diagnostic imaging, microcomputed tomography, histology, and immunohistochemistry outcome measures. Local delivery of DFO into OCAT recipient sites was associated with maintained or improved joint function, superior radiographic appearance, significantly greater trabecular thickness, higher bone volume, and new bone ingrowth compared with DFO-free controls. OCA osseointegration is dependent on cellular repopulation and neovascularization, resulting in new bone ingrowth through creeping substitution, and insufficient osseointegration with resorption and subsidence of the OCA remains a major cause of failure after transplantation. The results of this study suggest that local delivery of DFO using a controlled microsphere release system may reduce resorption and improve revascularization and cellular repopulation to increase new bone ingrowth, potentially expediting OCA osseointegration after transplantation.

Healed Subscapularis and Its Clinical Implications for Internal Rotation in Humeral Lateralized Reverse Shoulder Arthroplasty

The efficacy of subscapularis (SSC) repair in reverse shoulder arthroplasty (RSA) remains controversial. Few studies have evaluated the postoperative integrity and effect on clinical outcomes of repaired SSC; however, conflicting results regarding whether the healing of the repaired SSC influences outcomes have also been reported. Therefore, this study aimed to address the controversy by evaluating clinical outcomes in SSC repair compared to non-repair after humeral lateralized RSA, and to evaluate the significance of the integrity of the repaired SSC. This study included patients who underwent humeral lateralized RSA between 2015 and 2019 and categorized them into two groups: repaired (n=66) and non-repaired (n=36) SSCs. The clinical outcomes, such as the visual analog scale score, constant score, American Shoulder and Elbow Surgeons (ASES) score, active range of motion (aROM), activities of daily living scores consisting of active internal rotation and forward flexion (ADL score), and rotational strength, were compared. Ultrasonography was used to assess the integrity of the repaired SSC following the modified Sugaya classification and to evaluate the acromial fracture. Subgroup analysis was performed on patients with healed SSC versus non-healed SSC, versus non-repaired SSC. Overall, 102 patients were included, with a mean age of 73 ± 5 years. Both groups exhibited substantial postoperative improvements in clinical scores, active ROM, and rotational strength without significant differences. At the 2-year follow-up, 52% of patients showed healed tendons, while 44% exhibited retears in the repaired SSC group. Significant clinical improvements were noted in both groups, regardless of the SSC integrity. However, the healed SSC group exhibited significantly improved outcomes in ADL score, IR aROM, and IR strength compared to the non-healed SSC group (p=0.002, p=0.011, p<0.001). Meanwhile, compared to the non-repaired SSC group, the healed SSC group also showed significant improvements in IR aROM and IR strength (p=0.016, p=0.002), but the difference in ADL score was not statistically significant (p=0.133). Furthermore, while the SSC repair group showed a marginally higher rate of acromial fractures (9% vs. 6%, p=0.709) as evaluated through both radiography and ultrasonography, the overall rates of complications remained statistically comparable across the groups (13% vs. 11%, p=0.854). Healed SSC groups showed significantly better IR aROM, and IR strength than both non-healed and non-repaired SSC groups, highlighting SSC healing's crucial role in enhancing IR functional outcomes even with humeral lateralized RSA; hence, SSC repair should be advocated whenever possible during RSA, though further research is needed to improve its low healing rate.

Treatment of Failed Anterior Instability Repair With DTA

This chapter explores the use of distal tibia allograft (DTA) for addressing glenoid bone deficiencies in revision surgery for anterior glenohumeral instability. Traditional approaches have often overlooked glenoid bone loss, which can negatively impact functional outcomes of a shoulder instability repair. The DTA offers a promising solution, effectively reconstructing the glenoid vault while minimizing damage to surrounding tissues when performed arthroscopically. This approach not only simplifies the surgical technique but also enhances stability when combined with soft tissue procedures. By allowing for personalized graft sizing, the DTA presents an adaptable option for various patients facing revision surgeries for anterior instability, making it a leading consideration in modern orthopaedic practice for the management of shoulder instability repair.

AAOS 2024 Best Paper in the Shoulder and Elbow Classification: Watchful Waiting Provides Higher Value with Similar Functional Outcomes to Physical Therapy for Frozen Shoulder: A Prospective Randomized Controlled Trial

Physical therapy remains a ubiquitous treatment modality for the management of frozen shoulder (adhesive capsulitis) despite limited high-level evidence supporting its use. Leveraging patient-reported outcome measures (PROMs) and healthcare costs, this study compared patient outcomes and value achieved through watchful waiting (WW) versus physical therapy (PT) for conservative management of frozen shoulder. Patients in this prospective, parallel randomized controlled trial who were diagnosed with frozen shoulder were randomized 1:1 to WW or PT. All patients were offered therapeutic, intra-articular corticosteroid injections (CSIs). The primary outcome was the American Shoulder and Elbow Surgeons (ASES) Score. Secondary outcomes included patient value (i.e., 12-month ASES score divided by healthcare costs), the Disabilities of the Arm, Shoulder, and Hand questionnaire, and Visual Analog Scale pain. Due to the confidentiality of internal hospital data, all economic outcomes were divided by an undisclosed constant to set the normalized study mean for direct costs to 1,000; similarly, patient value was normalized to set the study mean to 100. Outcomes were assessed at baseline, 6 weeks, 3 months, 6 months, and 12 months using mixed-effects models, with sensitivity analyses adjusting for nonlinear improvement trajectories and CSIs. Between November 2014 and November 2022, 175 patients were screened, 61 of whom (34.9%) were randomized to WW (31 patients) or PT (30 patients). Forty-seven patients (96%) received at least one CSI, with no significant difference in CSI administration between cohorts (p=0.29). Relative to baseline scores, patients from both cohorts improved significantly at each time point for all PROMs (p<0.05 for all), with no significant differences in PROMs between groups at any time point (p>0.05 for all). However, compared to those assigned WW, patients randomized to PT incurred 10.0x higher costs (normalized mean difference: 1,636; 95% CI: 967, 2,304; p<0.001) and achieved only 16.9% of the patient value (normalized mean difference: -147.0; 95% CI: -207.5, -86.5; p<0.001). These results held across all sensitivity analyses. Relative to WW, patients randomized to PT reported similar PROMs but incurred significantly higher direct costs (10.0x) and imposed a greater economic burden on the healthcare system (3.4-6.0x). Accordingly, WW resulted in significantly higher (5.9x) patient value than PT. Although additional high-level, multicenter studies are needed to corroborate these findings, the present study may support physicians and patients in pursuing the most appropriate treatment plan for each patient based on their individualized needs and preferences.

Catatonia in anti-NMDA receptor encephalitis: a case series and approach to improve outcomes with electroconvulsive therapy

BackgroundAnti-N-methyl-D-aspartate (NMDA) receptor encephalitis has been recognised to present with the syndrome of catatonia. In severe cases dysautonomia is representative of malignant catatonia. The treatment with benzodiazepines (BZDs) and electroconvulsive therapy (ECT) may decrease morbidity and mortality in patients presenting with anti-NMDA receptor encephalitis and catatonia.MethodsThis is a retrospective case series of eight patients with anti-NMDA receptor encephalitis treated with ECT. We use clinical prediction scores (Clinical Assessment Scale for Autoimmune Encephalitis [CASE] and anti-NMDAR Encephalitis One-Year Functional Status scores) to compare expected outcomes and observed outcomes.ResultsCASE scores in our group ranged between 5 and 19, with a mean score of 13.8 (median 15.5). NEOS scores ranged from 2 to 4, with a mean and median of 3. Of the eight patients, six had a favourable modified Rankin Score (0–2) at a follow-up of 8 to 12 months. Patients received an average of 29.9 ECT treatments in total.ConclusionsBased on clinical prediction scores, this cohort had better than expected functional outcomes. We discuss the use of BZDs and ECT in these cases and propose a treatment algorithm for patients who present with catatonic syndrome in anti-NMDA receptor encephalitis.

Improved clinical and radiographic outcomes with expandable cages in transforaminal lumbar interbody fusion: a propensity-matched cohort analysis.

The restoration of sufficient overall lumbar lordosis (LL) and segmental LL (SL) is associated with achieving optimal sagittal balance, decreasing back pain, and enhancing functional outcomes for patients. Expandable cages were developed in hopes of improving radiographic parameters and clinical outcomes, although current clinical evidence is inconclusive. Here, the authors aimed to evaluate the clinical and radiographic outcomes in patients undergoing one- or two-level open transforaminal lumbar interbody fusion (TLIF) with expandable versus static cage placement, using propensity-matched cohorts. An institutional retrospective cohort of patients who underwent one- or two-level open TLIF with either expandable cage or static cage placement was identified. Using relevant preoperative covariates, including age, primary versus revision operation, number of cages implanted, and surgical level implanted, the authors built propensity-matched cohorts. They identified clinical outcomes in both cohorts, including operative characteristics and complication rates, along with pain, weakness, and sensory deficits over follow-up. Furthermore, they extracted and examined preoperative, postoperative, and last follow-up radiographic parameters. A total of 148 patients were included, and they were followed for a mean of 1.7 years (range 0.5-4.3 years). Propensity matching was used to create cohorts of patients who were similar with respect to age, surgical indication, revision status, number of cages implanted, surgical level implanted, and length of follow-up. Patients in both groups had similar preoperative radiographic parameters. Patients with expandable cages saw larger increases in SL, both postoperatively (5.3° ± 7.5° vs 1.6° ± 5.6°, p = 0.006) and at last follow-up (5.7° ± 7.4° vs 1.0° ± 6.1°, p = 0.003). They also saw significant improvements in pelvic incidence minus LL mismatch at last follow-up (-4.4° ± 13.2° vs 5.8° ± 13.8°, p = 0.009). No differences in intraoperative or perioperative complications were found, but patients with expandable cages were less likely to require readmission, develop adjacent-segment disease, or require revision surgery. They were also more likely to be symptom free at 1 month after surgery and at last follow-up. Expandable cages lead to better restoration of radiographic features, including SL and improvements in clinical outcomes, compared with static cages in propensity-matched cohorts in patients undergoing one- or two-level open TLIFs.

Maternal care is associated with neural and behavioral effects of oxytocin administration during empathic accuracy in schizophrenia and controls

Empathic accuracy, the ability to accurately understand other people’s emotions, is a complex social cognitive skill that is often impaired in schizophrenia and this impairment is associated with poor functional outcomes. Intranasally administered oxytocin, a neuropeptide implicated in social behavior, is thought to improve empathic accuracy for individuals with schizophrenia. However, early experiences related to caregiving may shape the oxytocinergic system and influence individual responses to oxytocin administration. Using a cross-over, double-blind, placebo-controlled design coupled with fMRI, the current study investigated whether administration of oxytocin improves empathic accuracy in schizophrenia compared to a matched placebo, and the moderating role of early maternal care. Results revealed that, compared to controls, individuals with schizophrenia had lower empathic accuracy and recruited a sparser pattern of neural activation to achieve empathic accuracy. Oxytocin administration was not associated with improved empathic accuracy for either group. However, in both groups, individuals reporting higher maternal care demonstrated the greatest improvements in empathic accuracy with oxytocin administration, accompanied by decreased activity in the right dorsolateral prefrontal cortex, a region implicated in selective attention to socioemotional stimuli. Findings highlight the importance of examining individual differences in responses to oxytocin administration and suggest that early social experiences influence later responses to oxytocin administration.

Efficacy of Diagnostic In-Office Shoulder Ultrasound in the Surgical Treatment of Full-Thickness Rotator Cuff Tears.

Early surgical management of full-thickness traumatic rotator cuff tears (RCTs) may optimize functional outcomes, prioritizing timely diagnoses. Ultrasound and magnetic resonance imaging (MRI) are highly sensitive and specific modalities for RCT diagnosis, yet MRI remains the gold standard diagnostic tool despite increased costs and potential delays in care. Ultrasound can provide same-day diagnosis, thus possibly expediting care. The use of diagnostic shoulder ultrasound alone in the orthopaedic surgeon's office could increase the efficiency of diagnosis and care of traumatic full-thickness RCTs compared with MRI. Cohort study; Level of evidence, 3. A retrospective chart review of patients with full-thickness traumatic RCT diagnosed via ultrasound or MRI who subsequently underwent rotator cuff repair with 1 of 2 ultrasound-trained surgeons between January 1, 2014, and December 31, 2019, was performed. Inclusion criteria included patients ≥18 years old, documentation of a first-time traumatic event, and the patient's desire to have immediate surgical management. Revision surgeries, long-term shoulder instability, and nontraumatic injuries were excluded. Basic demographic data were collected, and the number of preoperative office visits and the timing from initial evaluation to diagnosis and surgery were calculated for the ultrasound and the MRI cohorts. A power analysis of 0.8 with an alpha of .05 required 38 patients per group. Overall, 133 patients were diagnosed via MRI compared with 76 via ultrasound. Besides body mass index, there were no significant differences in demographic variables or insurance status. Compared with the MRI cohort, patients in the ultrasound cohort received their diagnosis almost 2 weeks faster (P < .0001), were scheduled for surgery almost 3 weeks faster (P < .0001), and underwent surgery 2 weeks faster after initial evaluation (P < .0001) while requiring nearly half as many clinical visits (P < .0001). Regression analysis confirmed that ultrasound significantly reduced time to imaging, scheduling, and surgery after initial evaluation while requiring fewer clinical visits (P < .05). The study findings indicated that ultrasound was a time-saving alternative diagnostic modality for traumatic RCT compared with MRI without compromising standard of care. These results were achieved independent of patient insurance status, disability index, or other demographic variables.

Long-Term Functional Outcomes of BIFOLD Osteosynthesis in Distal Femoral Fractures with Metaphyseal Comminution: A Retrospective Analysis

Long-Term Functional Outcomes of BIFOLD Osteosynthesis in Distal Femoral Fractures with Metaphyseal Comminution: A Retrospective Analysis

Utilization of Surgical Fixation for Distal Radius Fractures in the United States: A Population-Based Cohort Study

In contrast to younger adult populations, clinical practice guidelines state that there is no difference in long-term functional outcomes in surgically versus nonoperatively treated distal radius fractures in patients ≥65 years old. In this study, we asked the following questions: (1) has treatment for distal radius fractures in younger and older adult populations changed over time? (2) What patient and surgeon factors are associated with treatment trends? Using a national administrative claims database, we identified patients aged ≥18 years with isolated, closed distal radius fractures, subdivided by age (18-64 years, ≥65 years old). We characterized the proportion of patients who underwent open reduction and internal fixation (ORIF) over time. We stratified our analysis by surgeon subspecialty, region, and mean area income. Changes in ORIF utilization over time were evaluated using linear regression models. The proportion of distal radius ORIF, including in patients aged ≥65 years, increased from 10.4% in 2012 to 15.1% in 2020. Of the ORIF procedures performed, hand surgeons accounted for an increasing proportion over time, with a corresponding decrease in those performed by general orthopedic surgeons. The proportion of ORIF increased over time in all US regions, with the largest rate of increase in the Midwest for patients aged ≥65 years and Northeast for patients aged 18-64 years. Patients living in areas with mean family income ≥$65,000 were more likely to undergo ORIF. The proportion of distal radius ORIF including in older adult populations is increasing in all US regions, and an increasing proportion is performed by hand surgeons. Further analysis of the drivers of these trends is warranted, given the rising incidence of surgical treatment in older patients, which could reflect evolving patient activity demands and suggest a need to further evaluate conventional treatment algorithms based on age.

P288 Functional outcomes of orthotopic ileal neobladder more than a decade of follow up

P288 Functional outcomes of orthotopic ileal neobladder more than a decade of follow up

Randomized Controlled Study Comparing Hamstring Graft and Peroneus Longus Tendon Graft in Arthroscopic ACL Reconstruction.

Graft choice for anterior cruciate ligament reconstruction (ACLR) has been evolving. The peroneus longus tendon (PLT) has been seen as a suitable choice for ACLR, providing comparable results to those of hamstring tendon (HT) autograft, but its clinical relevance in terms of return to sports, to our knowledge, has not been studied. One hundred and twenty patients who sustained an isolated ACL injury were enrolled and underwent ACLR using tripled or quadrupled PLT autograft (if graft thickness exceeded 10 mm then tripled) or quadrupled HT autograft. Patients were followed for 24 months. Functional scores (International Knee Documentation Committee [IKDC] and Tegner-Lysholm scores) were assessed preoperatively and at 3, 6, 12, and 24-month post-operatively. Graft diameter and graft harvesting time were measured intraoperatively. Donor-site morbidity was evaluated using subjective evaluation. Time to return to sports in both groups was compared. The mean diameter of the PLT autograft was significantly larger than that of the HT autograft, and the mean graft harvesting time was less (P < 0.001). Patients in the PLT group returned to sports a mean of 36 days earlier than those in the HT group (P < 0.001) and had a lower rate of donor-site morbidity, and better patient-reported outcomes at the knee (P < 0.001). There was a significant difference between the groups in IKDC and Tegner-Lysholm scores at the 24-month follow-up. Despite some donor site complications, such as numbness and infection, both PLT and HT grafts offer acceptable knee stability. However, PLT grafts seem to provide superior subjective functional outcomes based on patient-reported scores. More research is needed to further establish these findings and optimize graft choices for individual patients.

Musculoskeletal Ultrasound Assessment of the Clinical Efficacy of the Combination of Acupressure and "Three Methods of Neck Movement (TCM)" Therapy in the Treatment of Cervical Spondylosis: A Study Protocol for a Randomized Controlled Trial.

Neck-type cervical spondylopathy (NTCS), a common degenerative disorder affecting the spine, poses challenges for patients and society. Research has demonstrated the effectiveness of traditional tuina techniques in treating NTCS, although some limitations still exist. Our study aimed to evaluate the effectiveness of combining regular massage techniques with three methods of neck movement (TCM) therapy for managing NTCS, utilizing musculoskeletal ultrasound measurements. In this study, 70 eligible patients with non-traumatic cervical spondylosis will be randomly assigned in a 1:1 ratio to either the experimental group, which will receive Tuina combined with a three-method neck movement treatment, or the control group, which will receive standard Tui Na manipulation. All participants will receive treatment for four weeks. Assessments will be conducted using musculoskeletal ultrasound, the McGill Pain Scale, and the Neck Disability Index (NDI) at three-time points: before treatment, at the end of treatment, and after 12 and 16weeks of treatment. This paper investigates the utility of musculoskeletal ultrasound as a tool for evaluating the therapeutic efficacy of an integrated Traditional Chinese Medicine (TCM) strategy in alleviating pain and enhancing functional outcomes for patients with NTCS.The objective is to present a clinically viable and long-term treatment option. Chinese Clinical Trial Registry, ChiCTR2300072648. Registered on June 20, 2023.