Good Long-term Clinical Outcomes Research Articles

Presumed sympathetic ophthalmia following scleral buckling surgery: A case report and review of the literature.

To report a case of presumed sympathetic ophthalmia (SO) following scleral buckling (SB) surgery and to discuss the possible pathogenesis of this condition by reviewing the current evidence on this subject. Case report and narrative review of the literature; our case was imaged with spectral-domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA), fundus autofluorescence (FAF), fluorescein angiography (FFA) and indocyanine green angiography (ICGA). A 55-year-old man presented with a macula on rhegmatogenous retinal detachment which was treated with 360° SB surgery, subretinal fluid drain (SRFD), cryopexy and pneumoretinopexy. Due to failure of the primary surgery, a second procedure was performed the day after with the explant of the prior buckle and the implant of a wider circumferential element. At three months from surgery, the patient complained of severe bilateral vision loss. Multimodal imaging revealed bilateral, multi-focal exudative retinal detachments and choroidal swelling. A diagnosis of presumed SO was made and the patient was treated with a combination of steroid and immunosuppressive drugs. The clinical picture completely resolved at postoperative month 12. SO may be a rare complication of SB surgery. In our case, early recognition and prompt immunosuppressive treatment achieved good long-term clinical results.

Management of chronic mallet finger: Indications and long-term results of Fowler central slip tenotomy and distal interphalangeal joint arthrodesis

IntroductionMany surgical techniques have been described to correct the sequelae of chronic mallet fingers (MF), but no clear therapeutic strategy has been defined. We have reported the choice of their management according to the severity of the deformities. Two procedures were compared: Fowler's central slip tenotomy (CST) and arthrodesis of the distal interphalangeal joint (DIP). HypothesisThe use of our decision tree, based on the severity of deformity (flexion deformity at the DIP and recurvatum at the proximal interphalangeal joint), allows good long-term clinical results to be obtained. Material and methodsThirty-three patients (34 fingers) were operated on for sequelae of chronic MF either by CST or by DIP arthrodesis. Patients with ≤35° DIP flexion deformity and <25° proximal interphalangeal (PIP) recurvatum, without DIP joint involvement (osteoarthritis, subluxation, stiffness), were treated with CST. For the others, arthrodesis of the DIP joint was performed. ResultsThirteen patients (13 fingers) were evaluated in the CST group with a mean follow-up of 13 years. There were no postoperative complications and no failures. The mean DIP residual extension lag was 4.23° with complete correction of the PIP recurvatum. All patients would redo the intervention in hindsight. The improvement in Quick-DASH was statistically significant (p=0.01). Twenty patients (21 fingers) were included in the DIP arthrodesis group with a mean follow-up of 10 years. Two failures (9.5%) occurred due to failed correction of the PIP recurvatum. No worsening of the deformities was reported, and they were corrected in 90% of cases. The absence of correction of the PIP recurvatum was more frequent in MF bone (p=0.01). All except 1 (95%) patient, who reported a lack of mobility of the DIP joint, would repeat the procedure. Quick-DASH was improved for all patients. DiscussionCST is effective in correcting deformities in chronic MFs for ≤35° DIP flexion deformity and <25° PIP recurvatum without DIP joint involvement. In other cases, it is preferable to perform a DIP arthrodesis by combining, if necessary, a complementary procedure to correct the PIP recurvatum. Level of evidenceIV, retrospective study.

Optimal Neoadjuvant Strategies for Locally Advanced Rectal Cancer by Risk Assessment and Tumor Location

Neoadjuvant therapy is standard of care for locally advanced rectal cancer (LARC). Advancements in multimodality therapy options and sequencing of radiation therapy (RT), surgery, and chemotherapy make decision-making challenging. Traditional treatment of patients with LARC involves neoadjuvant chemoradiation followed by total mesorectal excision and consideration of adjuvant chemotherapy. Advancement in RT has led to trials offering both short-course and long-course RT with good long-term clinical outcomes. Intensification of therapy in high-risk patients has led to studies of total neoadjuvant therapy with chemotherapy and chemoradiation, now standard management for most LARC. De-escalation of therapy in patients with favorable prognosis has led to several considerations, including non-total mesorectal excision management or neoadjuvant chemotherapy only. Several considerations of patient and disease factors can help inform the optimal chemotherapy regimens in different sequencing of neoadjuvant strategies. Finally, novel biomarkers, such as microsatellite instability, has led to utilization of novel therapies, including neoadjuvant immunotherapy, with substantial response. This review attempts to frame the rapidly growing data in LARC in context of disease and patient risk factors, to inform optimal, personalized treatment of patients with LARC.

The Aortic Root in Acute Type A Dissection: Repair or Replace?

BackgroundThe effect of an “aggressive” approach on the aortic root in acute type A aortic dissection (ATAAD) remains insufficiently explored. MethodsRetrospective analysis was conducted between 1992 and 2020 of a single-center, prospective cohort of consecutive patients aged ≥18 years diagnosed with ATAAD. Patients were divided into 2 groups: aortic root replacement (ARR; prosthetic or valve-sparing root replacement, n = 141) and conservative root approach (CRA; root sparing of partially dissected root, n = 90; and supracoronary ascending replacement in nondissected root, n = 68). Inverse probability weighting was used to compare patients with different preoperative characteristics. Mean follow-up was 5.1 (0-21) years in ARR and 7.1 (0-25) years in CRA. ResultsThe frequency of ARR increased over the years, with 19% and 78% of patients undergoing ARR in the earliest and most recent periods, respectively. Early mortality decreased over the years, despite a more aggressive approach, and remained lower in ARR. CRA was associated with a higher hazard of late mortality (hazard ratio, 1.38; 95% CI, 1.12-1.68; P = .001) and reintervention (hazard ratio, 2.08; 95% CI, 1.44-3.56; P = .001). After CRA, new-onset aortic valve insufficiency was a common cause of reintervention. ConclusionsOver the years, there was a gradual increase in the root replacement approach in ATAAD. Root replacement was associated with better long-term survival and fewer reinterventions compared with the conservative approach, whereas the in-hospital mortality decreased during these years. Hence, aggressive root replacement is safe and may be applied in ATAAD with good long-term clinical results, without increased hospital mortality.

Long-Term Clinical and Radiologic Outcome Following Surgical Treatment of Lumbar Spondylodiscitis: A Retrospective Bicenter Study.

Spinal instrumentation for spondylodiskitis (SD) remains highly controversial. To date, surgical data are limited to relatively small case series with short-term follow-up data. In this study, we wanted to elucidate the biomechanical, surgical, and neurologic long-term outcomes in these patients. A retrospective analysis from two German primary care hospitals over a 9-year period (2005-2014) was performed. The inclusion criteria were (1) pyogenic lumbar SD, (2) minimum follow-up of 1 year, and (3) surgical instrumentation. The clinical and radiologic outcome was assessed before surgery, at discharge, and at a minimum of 12 months of follow-up. Follow-up included physical examination, laboratory results, CT and MRI scans, as well as assessment of quality of life (QoL) using short-form health survey (SF-36) inventory, Oswestry Disability Questionnaire, and visual analog scale (VAS) spine score. Complete data were available in 70 patients (49 males and 21 females, with an age range of 67±12.3 years) with a median follow-up of 6.6 ± 4.2 years. Follow-up data were available in 70 patients after 1 year, in 58 patients after 2 years, and in 44 patients after 6 years. Thirty-five patients underwent posterior stabilization and decompression alone and 35 patients were operated on in a two-stage 360-degree interbody fusion with decompression. Pre- and postoperative angles of the affected motion segment were 17.6 ± 10.2 and 16.1 ± 10.7 degrees in patients with posterior instrumentation only and 21.0 ± 10.2 and 18.3 ± 10.5 degrees in patients with combined anterior/posterior fusion. Vertebral body subsidence was seen in 12 and 6 cases following posterior instrumentation and 360-degree instrumentation, respectively. Nonfusion was encountered in 22 and 11 cases following posterior instrumentation and 360-degree instrumentation, respectively. The length of hospital stay was 35.0 ± 24.5 days. Surgery-associated complication rate was 18% (12/70). New neurologic symptoms occurred in 7% (5/70). Revision surgery was performed in 3% (2/70) due to screw misplacement/hardware failure and in 3% (2/70) due to intraspinal hematoma. Although patients reported a highly impaired pain deception and vitality, physical mobility was unaffected and pain disability during daily activities was moderate. Surgical treatment of SD with a staged surgical approach (if needed) is safe and provides very good long-term clinical and radiologic outcome.

A 24-year single-centre experience with Collum Femoris Preserving stem: clinical and radiological results in young and elderly population.

The primary aim was to evaluate the long-term follow-up of Collum Femoris Preserving (CFP) stem, specifically focusing on stem survivorship, complications, as well as on clinical and radiological results. The secondary study objective is an age-based sub-analysis (<65 years vs. ⩾65 years) of long-term results. We performed a retrospective analysis of patients who underwent CFP implantation between 1997 and 2009. A total of 311 patients (342 hips) were included with a mean follow-up of 15.8 ± 2.2 (range 11-24) years. 2 age groups were analysed: Group-Y (age <65) and Group-E (age ⩾65). Group-Y included 182 hips (mean follow-up 16.3 ± 4.2 years), whereas Group-E included 160 hips (mean follow-up 15.5 ± 3.7 years). Clinical (HHS, OHS and VAS) and radiological data were obtained at final follow-up. Any complications, reoperations, prosthetic components revisions and stem revisions were analysed. According to HSS score, 95% of patients reported excellent/good results (95.6% Group-Y vs. 94.4% Group-E) with an overall stem survival rate of 93.3% (94% Group-Y vs. 92.5% Group-E; p = 0.37). Overall, 87% of stem revisions were performed with primary stems. The rate of prosthetic components revision was 9.9 % (9.9% in Group-Y vs. 10% in Group-E; p = 1). The reoperation rate was 10.8% (11.5% in Group-Y vs. 10.0% in Group-E; p = 0.73). The CFP stem provides good clinical and radiological long-term results with low rate of complications in both young and elderly patients. No significant difference in stem revision and reoperation rates was observed between the 2 groups. Both in elderly and young patients, CFP stem allows revisions to be performed with primary stems.

Retrospective comparison of outcomes following tibial plateau levelling osteotomy and lateral fabello-tibial suture stabilisation of cranial cruciate ligament disease in small dogs with high tibial plateau angles

ABSTRACT Aims To compare short and long-term outcomes after tibial plateau levelling osteotomy (TPLO) and lateral fabello-tibial suture (LFTS) techniques for the management of cranial cruciate ligament disease in small dogs with high tibial plateau angles (TPA). Methods In this retrospective study, the medical records of two veterinary specialist practices in the United Kingdom were searched for dogs (<20 kg) that underwent TPLO or LFTS between 2000 and 2010, and had a preoperative radiographic TPA >30° with either short-term (6 weeks) and/or long-term (>3 months) follow-up data. Data collected at a 6-week post-surgical re-examination was derived from orthopaedic examination and radiographic assessment and included the incidence of major and minor complications and scoring of the short-term outcome. Long-term outcome was scored based on results of a subjective owner questionnaire and veterinary orthopaedic examination. Results A total of 61 (84 stifles) dogs were included in the study: 24 (30 stilfes) and 37 (54 stifles) dogs underwent LFTS and TPLO, respectively. Long-term clinical outcome was different (p = 0.017) between groups; 15/15 stifles in the TPLO group had a good or excellent long-term clinical outcome, compared to 4/8 (50%) in the LFTS group. There was no evidence of a difference in short-term post-operative outcome or owner subjective long-term outcome between treatment groups. Stifles in the LFTS group were more likely (p = 0.027) to have palpable stifle pain at long-term follow-up. Owners reported that 5/16 (31.3%) dogs in the LFTS group required oral non-steroidal anti-inflammatory drug (NSAID) treatment at least monthly (4/5 required daily treatment), whereas no dogs in the TPLO group required treatment with NSAID more frequently than three times per year (p = 0.011). No correlation was found between short-term outcome and owner subjective long-term outcome but there was a positive correlation between short-term outcome and long-term clinical outcome. There was no evidence of a difference in overall major complication rates between treatment groups. The occurrence of complications was associated with heavier body weight at the time of surgery. No other variables were shown to be risk factors for complications. Conclusion and clinical relevance Small breed dogs with high TPA that underwent TPLO had better long-term clinical outcomes and were less likely to require NSAID administration than those that underwent LFTS. The risk of complication increased with the weight of the dog at surgery. There was a positive correlation between short-term outcome and long-term clinical outcome.

Long-term functional outcomes of multiligament knee reconstructions with lateral injuries

IntroductionMultiligament knee injuries are a rare but serious injury, affecting functional prognosis. The objective of this study was to assess the long-term clinical and laximetric outcomes of acute or chronic multiligament knee reconstructions, with lateral impairment, using autografts. HypothesisAutograft reconstructions give good long-term clinical and laximetric results. Material and methodA retrospective monocentric consecutive study was conducted in patients who had multiligament knee reconstructions. The criteria for inclusions were cruciate ligament lesions associated with lateral injuries, reconstructed using autografts, regardless of the time to surgery. A minimum follow-up of 5-years was required. Twenty-nine patients were analysed. The average age at surgery was 30.2±13 years. The patients were clinically reviewed at the last follow-up. Differential residual laxity was objectively assessed with comparative dynamic X-rays. Functional IKDC, Lysholm and KOOS scores were analyzed. ResultsThe average follow-up was 7.5±1.7 years. The lesions were divided into 12 KD-I, 16 KD-IIIL and 1 KD-IV, including 16 acute lesions (time to surgery <30-day) and 13 chronic lesions. At the last follow-up, the objective IKDC identified: 3 stage A, 15 stage B and 11 stage C. The average scores were: subjective IKDC 70.1±16, Lysholm 76.8±14 and KOOS: pain 71.6±20, symptoms 83.6±22, activity 90.6±20, sport 58.8±23, quality of life 60.0±30. Dynamic X-rays showed an average differential laxity of 2.8±2.6mm anteriorly, 5.0±2.2mm posteriorly, and 2.0±2.5mm in varus. Four cases required surgery: 3 arthrolysis procedures for stiffness and 1 joint lavage for sepsis. DiscussionWith an average follow-up of 7.5 years, multiligament knee reconstructions using autografts with lateral involvement provide good long-term control of frontal and sagittal laxities. A comparison with allograft reconstructions is necessary to be able to potentially overcome the morbidity associated to donor sites. Level of evidenceIV; monocentric retrospective descriptive study.

Long-Term Outcomes of Autograft Osteochondral Transplantation for Osteochondral Lesions of the Talus: Eight to Twelve Years Follow-Up

Category:AnkleIntroduction/Purpose:Autologous osteochondral transplantation (AOT) is a replacement strategy used to treat osteochondral lesions of the talus (OLT), typically reserved for the treatment of lesions of larger sizes, highly cystic lesions, or in patients who have failed previous treatment. The purpose of this study was to evaluate the long-term (>8 years) clinical and radiographic outcomes of AOT for the treatment of OLT in the form of a retrospective case series.Methods:Patients who underwent AOT between 2006 and 2008 were evaluated. Functional outcomes were assessed pre- and post-operatively using the Foot and Ankle Outcome Score (FAOS), and Short-Form-12 (SF-12) general health questionnaire. The most recent post-operative MRI was evaluated with the modified Magnetic resonance Observation of Cartilage Repair Tissue (MOCART) score.Results:Twenty-eight patients who underwent AOT were included and evaluated at a mean follow-up of 122.9 months. The mean FAOS pain subscale improved from 52.7 to 82.9 and the mean SF-12 improved from 30.3 to 58.3 at final follow-up (both, p < 0.01). The mean FAOS pain subscale then decreased to 77.6 at final follow-up, but this decrease was not statistically significant (p=0.293). At the final follow-up, the mean FAOS subscale scores of symptoms, pain, daily activities, sports activities, and quality of life were 66.6, 77.6, 86.0, 60.4, and 53.6, respectively. The mean VAS score was 2.2 at a final follow-up. The mean MOCART score was 83.8 with a mean MRI follow-up of 82.8 months. Ten patients (35.7%) had additional surgery, with the most common procedure being arthroscopic anterior ankle debridement. One patient failed AOT and developed osteoarthritis of the ankle requiring a total ankle replacement.Conclusion:AOT appears to be an effective treatment for OLT with good long-term clinical and radiographic outcomes. Secondary procedures were typically minor and the overall clinical failure rate was low.

The outcome of 70/30 taco insertion through a 2.8 mm clear corneal incision in Descemet's stripping automated endothelial keratoplasty - A retrospective analysis.

Purpose:To assess the long-term outcome of graft insertion by taco technique through a 2.8-mm clear corneal incision in patients undergoing Descemet’s stripping automated endothelial keratoplasty (DSAEK).Methods:This is a retrospective interventional case series of 77 eyes of 75 patients who underwent DSAEK in a tertiary eye hospital. The DSAEK donor grafts were folded to an uneven 70/30 taco and held at a single point using Utrata forceps. All insertions were through a 2.8-mm clear corneal incision except the two aphakic patients requiring combined SFIOL implantation. All patients underwent a comprehensive eye examination preoperatively and were followed up to 6 years postoperatively. Visual outcomes, graft clarity, and complications of all and endothelial cell loss in 22 patients with available postop specular microscopy were analyzed.Results:Overall, 59 (76.6%) had clear grafts until the final follow-up. Visual acuity improved in 48 (62.3%) from an average of 1.3 to 0.8 logMAR (P = 0.0001). Vision was maintained in seven and worsened in four eyes. Grafts failed in 18 (23.3%) eyes: seven (9%) were primary failures, two post rejection, four done for failed PK did not clear, four due to worsening of preexisting glaucoma, and one noncompliant failed eventually. Average endothelial cell density reduction was 26.3% (mean preop donor 2419 to postop 1779 cells/mm2; P = 0.000).Conclusion:Our study shows good long-term clinical outcome of DSAEK using Taco technique through a 2.8-mm clear corneal incision in a tertiary hospital.

Complicating Acute Myocardial Infarction. Current Status and Unresolved Targets for Subsequent Research.

Mechanical reperfusion with primary angioplasty, as the treatment of choice in acute myocardial infarction (MI), is associated not only with a high percentage of full epicardial and tissue reperfusion but also with a very good immediate and long-term clinical outcome. However, the Achilles heel of MI treatment is its ensemble of complications, such as cardiogenic shock due to severe systolic and/or diastolic dysfunction or MI mechanical complications, including perforation of the left ventricular free wall, papillary muscle rupture with acute mitral regurgitation and ventricular septal rupture. They are associated with an increased or, sometimes, with an extremely high mortality rate, determining the overall mortality in an MI patient population. In this review we summarize the mechanisms of MI complications, current therapeutic management and alternative directions for overcoming their devastating consequences. Moreover, we have sought to indicate gaps in the evidence on current treatments as the potential targets for further clinical research. From the perspective of mortality trends that are not improving, the forthcoming therapeutic management of complicated MI will require an individualized and novel approach based on their thorough pathobiology.

Patient-Reported Long-Term Outcomes After Free Vascularized Fibula Graft in Spinal Reconstruction: a 24-year Cohort

The use of free vascularized fibula grafts (FVFG) in complex spinal deformity surgery intends to allow for life-long stability of the spine with good long-term clinical outcome. However, these long-term outcomes of this technique are still lacking. The objective of this study is to report the long-term postoperative outcomes and establish the long-term viability of this method for spinal reconstruction. A retrospective cohort study was conducted in all patients who underwent spinal reconstructive surgery utilizing a FVFG at a tertiary medical centre. Questionnaires taken from the participants were the Numeric Pain Rating Scale (NPRS), Oswestry Low Back Pain Disability (also known as Oswestry Disability Index (ODI)), Scoliosis Research Society 22r (SRS-22), the EQ-5D-5L and a self-assembled questionnaire regarding donor site comorbidities and patient satisfaction. Over a period of 24 years (1995-2019), we used FVFG for spinal reconstruction in 31 patients. A total of 25 patients were included in this study, 8 patients were deceased at the time of this study, and sixteen patients responded to the questionnaires. Patient satisfaction was rated 6.8 out of 10, the average SRS-22r score was 3.6, EQ-5D-5L score was 0.725, and the ODI score showed a minimal disability (0-20%) postoperatively. Overall complication-free survival was 8.9 years. Nine patients underwent a re-operation in the spinal area; five for the removal of the spinal instrumentation. Patients reported satisfied and good long-term outcomes following FVFG surgical procedure for complex spinal deformities. Therefore, considering the alternatives, this procedure provides a good long-term solution for complex spinal deformity surgery.

Bone impaction grafting and anti-protrusio cages in high-grade acetabular defects: a 22-year single centre experience.

Report clinical and radiological long-term follow-up (FU) outcome of bone impaction grafting (BIG) and anti-protrusio cage (APC) technique in hip revision surgery. We analysed data on complications, as well as the clinical and radiological outcome of patients treated using this technique at our institution. We evaluated the acetabular bone stock renovation, acetabular component stability and its radiological migration. The clinical parameters considered were the Visual Analogue Scale (VAS) and the modified Harris Hip Score (mHHS). Forty hips, with a mean 14.3-year FU, were included. This technique showed good clinical long-term results in an elderly and low-demanding population (mean age at surgery 71.4 ± 12.1years). The radiological results were not as good as clinical results: 67.5% of cases had a radiographic evidence of resorption of less than 1/3 of the bone graft; 27.5% had a resorption ranging from 1/3 and ½ of the graft, and 5% had more than ½ of the graft. Paprosky type III B reported worse results in terms of graft resorption and a greater migration of the APC (p < 0.001). The survival rate was 95% and a 2.5% rate of septic failure was recorded. Impaction grafting with femoral head and APC is an effective technique for treating high-grade acetabular defects. APC reconstructs the hip centre of rotation, avoiding loading forces on the underlying bone graft that can be correctly integrated. At long-term FU, satisfactory clinical results, not strictly correlated to radiological signs of integration, were observed; Paprosky type III B reported worse results in terms of graft resorption and a greater migration of the APC.

Endovascular Management of Distal Anterior Cerebral Artery Aneurysms: A Multicenter Retrospective Review

Distal anterior cerebral artery aneurysms (DACAA) are a rare and difficult entity to manage. Endovascular treatment has evolved for safe and durable treatment of these lesions. The objective of this study is to report the safety, efficacy, and outcomes of endovascular treatment of DACAA. A retrospective review of DACAA endovascularly treated at 5 different institutions was performed. Data included demographics, rupture status, radiographic features, endovascular technique, complication rates, and long-term angiographic and clinical outcomes. A primary endpoint was a good clinical outcome (modified Rankin scale 0-2). Secondary endpoints included complications and radiographic occlusion at follow-up. A total of 84 patients were reviewed. The mean age was 56, and 64 (71.4%) were female. Fifty-two (61.9%) aneurysms were ruptured. A good functional outcome was achieved in 59 patients (85.5%). Sixty (71.4%) aneurysms were treated with primary coiling, and the remaining 24 were treated with flow diversion. Adequate occlusion was achieved in 41 (95.3%) aneurysms treated with coiling, and 17 (89.5%) with flow diversion. There were total 11 (13%) complications. In the flow diversion category, there were 2, both related to femoral access. In the coiling category, there were 9: 5 thromboembolic, 3 ruptures, and 1 related to femoral access. Endovascular treatment, and in particular, flow diversion for DACAA, is safe, feasible, and associated with good long-term angiographic and clinical outcomes.

Biomechanical evaluation of syndesmotic fixation techniques via finite element analysis: Screw vs. suture button

Background and ObjectiveTibiofibular syndesmotic injuries may cause degenerative changes, reduction in ankle function and compromising ankle stability. Different fixation techniques try to restore its functionality. Screw-fixation is the gold-standard. Recently, suture-button fixation has aroused the attention because it allows for physiologic micromotion while maintaining an accurate reduction. The aim of this study is to compare the biomechanical behaviour of both fixation techniques using the finite element method. MethodsA three-dimensional finite element model of the tibiofibular joint was reconstructed simulating the intact ankle and the injured syndesmosis. Then, different methods of syndesmosis fixation were analysed: screws (number of cortices, number of screws and distance between screws) and suture buttons (single, double parallel and double divergent with a sensitivity analysis on the pretension forces) configuration. Ligaments and cartilages were included and simulated as spring elements. Physiological loads during stance phase were simulated. ResultsSyndesmosis widening and von Mises stresses were computed. Syndesmosis widening in the injured configuration compromised joint stability (2.06 mm), whereas using a single quadricortical screw (0.18 mm) stiffened the joint. Syndesmosis widening using suture-buttons were closer to syndesmosis widening of the intact ankle configuration (0.97 mm). Von Mises stresses were higher for the titanium screws than for the suture buttons. ConclusionsA detailed biomechanical comparison among different syndesmotic fixation was performed. Suture buttons have advantages with regard to syndesmosis widening in comparison to screw fixation. This fact supports the good long-term clinical results obtained with suture buttons fixation. The proposed methodology could be an efficient tool for preoperative planning.

Long-term outcomes after partial patellectomy in comminuted fractures - a clinical study.

The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of partial patellectomy (PP) in patients with patella comminuted distal pole fractures. Seventeen patients who were diagnosed with patella comminuted distal pole fractures and underwent PP procedures were retrospectively included between January 1995 and January 2005. We collected patient demographics and data on the mechanism of injury, time to surgery, fracture type, follow-up time, and post-operative complications (infection, patellofemoral arthritis, and stiffness). At the final follow-up, functional outcome was evaluated by the range of motion (ROM) and the Bostman Scoring System. Quadriceps strength was evaluated by using an isokinetic dynamometer to measure peak torque, and patellar height was evaluated by the Insall-Salvati (IS) ratio in lateral knee radiographs. The average follow-up period was 14.6years (range, 11-19years). We analyzed 17 patients (AO/OTA 34-A1), with an average age of 59.8years (range, 43-76years). According to the Bostman grading scales, final functional outcomes were excellent in 11 (64.7%) and good in six (35.3%) patients. All patients had full knee extension, and the average ROM was 125.1° (range, 121.4-129.3°). The average peak torque of the injured knee was 103.2 ± 9.7 Nm, and that of the uninjured opposite side was 108.3 ± 7.6 Nm, with no significant difference (p > 0.05). Furthermore, no postoperative complications, such as infection, posttraumatic osteoarthritis, or stiffness, were observed. Compared to the uninjured knee, the IS ratio of the injured knee was 0.76 ± 0.13, indicating that the patellar height was decreased, which meant patella baja. The PP procedure for patella comminuted distal pole fractures is a safe, simple, and reliable technique that can provide good long-term clinical outcomes even with decreased patellar height and could be a satisfactory alternative treatment option when anatomical reduction is difficult.

Treatment of Acute Acromioclavicular Joint Dislocations Type III and Type V by Rockwood Classification Using a Dynamic Stabilization System under Arthroscopic Control with and without Suture of the Ligaments of the Acromioclavicular Joint

Summary. Acute acromioclavicular (AC) joint dislocation is still a challenging task for orthopedic surgeons. Objective: to compare the clinical and radiological results of treatment of patients with acute dislocation of the acromial end of the clavicle who were treated with a dynamic stabilization system with and without suture of acromioclavicular ligaments under arthroscopic control.&#x0D; Materials and Methods. A retrospective analysis of the treatment of 44 patients with acute AC joint dislocations type III and type V by Rockwood classification was performed. The patients were divided into 2 groups: group I – 18 patients (40.9%) who underwent stabilization of the dislocation and fixation of the acromial end of the clavicle using a dynamic stabilization system and suture of the ligaments of the acromioclavicular joint under arthroscopic control; group II – 26 patients (59.1%) who underwent stabilization of the dislocation and fixation of the acromial end of the clavicle using a dynamic stabilization system without suture of the ligaments of the acromioclavicular joint under arthroscopic control. There were 40 male (90.9%) and 4 female (9.1%) patients aged 18–58 years (mean age 32.9±10.1 years). The mean time from injury to surgical treatment was 8.3±3.2 days (from 3 to 17 days). Clinical observation was carried out at an average time of 20.1±3.9 months after surgery (from 12 to 28 months). Clinical outcomes were assessed using the Oxford Shoulder scale, the Constant-Murley scale, and the Acromioclavicular Joint Instability Scoring System.&#x0D; Results. The mean Oxford Shoulder score at the final follow-up on the injured side was 45.8±1.3 points and 46.2±1.3 points (p=0.422) in groups I and II, respectively. The mean Constant-Murley score at the final follow-up on the injured side was 94.6±2.4 points and 91.7±4.2 points (p=0.0134) in groups I and II, respectively. The mean score on the Acromioclavicular Joint Instability Scoring System at the final follow-up on the injured side was 83.8±7.1 points and 78.1±11.8 points (p=0.075) in groups I and II, respectively. No significant complications were observed in both groups.&#x0D; Conclusions. The combination of the arthroscopically assisted technique of reconstruction of the acromioclavicular ligaments using high-strength sutures and fixation of the coracoclavicular ligaments using a dynamic stabilization system provides good long-term clinical results.

Long-term survivorship of total knee arthroplasty with a single-radius, high-flexion posterior stabilized prosthesis

BackgroundThe purpose of this study was to determine functional outcomes, implant survival rate, and complications of a single-radius, high-flexion posterior stabilized (PS) total knee prosthesis at a minimum follow up of 10 years for a consecutive series. MethodsThis retrospective observational study included 395 consecutive patients who underwent 585 single-radius, PS total knee arthroplasties (TKAs) between January 2009 and December 2009. Their functional outcomes, implant survival rates, radiological findings, and complications were evaluated. ResultsAt a mean follow up of 11.2 years (range, 10.6–11.8 years), 395 (80.8%) patients were available for review. At final follow up, preoperative Knee Society knee scores were improved from 37.3 to 80.1 (P < 0.05) and function scores were improved from 35.7 to 80.5 points (P < 0.05). Sixteen knees (2.7%) in 15 patients required revision surgery due to 11 septic loosening (1.9%) and five aseptic loosening events (0.8%). Cumulative survival for the prosthesis was 97.3% for any cause at 10 years. A total of 34 radiolucent lines (5.8%) were detected an average of 2.4 years following surgery and radiological assessment did not reveal any evidence of component migration at final follow up. ConclusionsSingle-radius, high-flexion PS TKA showed good long-term survival rates and clinical outcomes. Further study is required to determine whether limited radiolucency findings at the tibial component–tibial plateau could progress to or result in the loosening of components.

Long-term outcome after the arterial switch operation: 43 years of experience.

OBJECTIVESThe objective of this study was to assess our 43-year experience with arterial switch operation (ASO) for transposition of the great arteries (TGA) by analysing cardiac outcome measures (hospital and late mortality, reoperations and catheter interventions, significant coronary artery obstruction) and to identify risk factors for reoperation and catheter interventions. METHODSA total of 490 patients who underwent ASO for TGA from 1977 to 2020 were included in this retrospective, single-centre study. Data on reoperation and catheter intervention of hospital survivors were estimated by the Kaplan–Meier method and compared using a long-rank test. Risk factors for reoperation and/or catheter intervention were assessed by multivariate Cox regression analysis.RESULTSHospital mortality occurred in 43 patients (8.8%), late death in 12 patients (2.9%) and 43 patients were lost to follow-up. Median follow-up time of 413 hospital survivors was 15.6 (interquartile range 7.0–22.4) years. Reoperations were performed in 83 patients (117 reoperations). Neoaortic valve regurgitation with root dilatation was the second most common indication for reoperation (15/83 patients, 18.1%) after right ventricular outflow tract obstruction (50/83 patients, 60.2%). Risk factors for any reoperation on multivariable analysis were: TGA morphological subtype [TGA with ventricular septal defect: hazard ratio (HR) = 1.99, 95% confidence interval (CI) 1.18–3.36; P = 0.010 and Taussig-Bing: HR = 2.17, 95% CI 1.02–4.64; P = 0.045], aortic arch repair associated with ASO (HR = 3.03, 95% CI 1.62–5.69; P = 0.001) and a non-usual coronary artery anatomy (HR = 2.41, 95% CI 1.45–4.00; P = 0.001). One hundred and one catheter interventions were performed in 54 patients, usually for relief of supravalvular pulmonary stenosis (44/54 patients, 81.5%) or arch obstruction (10/54 patients, 18.5%). Main risk factor for catheter intervention on multivariable analysis was aortic arch repair associated with ASO (HR = 2.95, 95% CI 1.37–6.36; P = 0.006). Significant coronary artery stenosis was relatively uncommon (9/413 patients, 2.2%) but may be underrepresented.CONCLUSIONSPatients after ASO typically have good long-term clinical outcomes but reoperations and interventions remain necessary in some patients. Neoaortic valve regurgitation with root dilatation is the second most common indication for reoperation after right ventricular outflow tract obstruction and an increasing need for neoaortic valve and root redo surgery in future is to be expected.

Results of Four-Level Anterior Cervical Discectomy and Fusion Using Stand-Alone Interbody Titanium Cages.

Study DesignThis is a retrospective study with a minimum follow-up of 2 years.PurposeThe aim of this study is to assess the long-term outcomes after performing the four-level anterior cervical discectomy and fusion (ACDF) in the treatment of degenerative cervical spine disease using stand-alone titanium cages.Overview of LiteratureOver the last decades, a rapid increase in the use of stand-alone cages for ACDF has been observed. However, research on their application in the treatment of four-level diseases is insufficient.MethodsIn this study, 130 patients presenting with symptomatic cervical spondylosis who underwent four-level ACDF using stand-alone cages in our institution between 2008 and 2016 were assessed. Fifty-two patients were women and 78 men with a mean age of 60.5 years. Their clinical and radiological outcomes were assessed. The results of the Neck Disability Index (NDI) and Visual Analog Scale as well as bony fusion were evaluated, and the revisions were analyzed. All of the patients underwent the four-level microscopic ACDF using the same titanium rectangular cage.ResultsThe mean follow-up was 47±11.4 months. A fusion of all four levels was achieved in 80.72% of the patients. In 25 patients (19.23%), an incomplete bony bridging was observed in at least one fusion level at the final follow-up. However, only two patients (1.5%) were symptomatic and underwent revision. The mean NDI improved significantly from 39.4±9.3 at presentation to 8.3±6.6 at the final follow-up. Cervical lordosis improved significantly from a mean of 5.5° preoperatively to a mean of 15° postoperatively. Cage sinking and loss of segment height during healing had a mean of 3 mm.ConclusionsOverall, the application of four-level ACDF using titanium cages in a stand-alone technique has been proven to be a safe and effective treatment method for degenerative disease. In a large cohort, a high rate of good long-term clinical and radiological results was achieved.