Higher Reoperation Rate Research Articles

Endoscopic retrograde cholangiopancreatography, endoscopic papillary balloon dilation, and laparoscopic hepatectomy for intra- and extrahepatic bile duct stones.

Intrahepatic and extrahepatic bile duct stones (BDSs) have a high rate of residual stones, a high risk of recurrence, and a high rate of reoperation. It is very important to take timely and effective surgical intervention for patients. To analyze the efficacy, postoperative rehabilitation, and quality of life (QoL) of patients with intra- and extrahepatic BDSs treated with endoscopic retrograde cholangiopancreatography (ERCP) + endoscopic papillary balloon dilation (EPBD) + laparoscopic hepatectomy (LH). This study selected 114 cases of intra- and extrahepatic BDSs from April 2021 to April 2024, consisting of 55 cases in the control group receiving laparoscopic common bile duct exploration and LH and 59 cases in the observation group treated with ERCP + EPBD + LH. Efficacy, surgical indicators [operation time (OT) and intraoperative blood loss (IBL)], postoperative rehabilitation (time for body temperature to return to normal, time for pain relief, and time for drainage to reduce jaundice), hospital stay, medical expenses, and QoL [Gastrointestinal Quality of Life Index (GIQLI)] were comparatively analyzed. Further, Logistic regression analysis was conducted to analyze factors influencing the QoL of patients with intra- and extrahepatic BDSs. The data demonstrated a higher overall effective rate in the observation group compared to the control group (P = 0.011), together with notably reduced OT, less IBL, shorter body temperature recovery time, pain relief time, time for drainage to reduce jaundice, and hospital stay (all P < 0.05). The postoperative GIQLI of the observation group was more significantly increased compared to the control group (P < 0.05). The two groups demonstrated no marked difference in medical expenses (P > 0.05). The above indicates that ERCP + EPBD + LH is effective in treating patients with intra- and extrahepatic BDSs, which is conducive to postoperative rehabilitation and QoL improvement, with promising prospects for clinical promotion.

25 years of Ross operation in adults: the inclusion technique keeps up the expectations.

In adults the Ross procedure provides an excellent alternative to prosthetic valves, but it is underutilised because of concerns about technical complexity, durability, and perceived high late reoperation rates. The inclusion technique stabilizes the aortic root, prevents dilatation, and respects the dynamic root physiology. Long-term outcomes of the Ross procedure with the inclusion cylinder technique (1992-2022) are reported. Long-term (12.2, 95% CI 11.5-12.8 years) single institution results, with more than 25 years follow up in 44 patients. Total of 516 patients aged 39 (SD±13) years underwent Ross procedure with inclusion cylinder and annular reduction. All had yearly clinical review and biannual transthoracic echo. The aetiology of valve disease comprised aortic stenosis (AS) n=233 (44.8%), aortic regurgitation (AR) n=179 (34.4%), mixed AS/AR n=108 (20.8%). The Primary endpoints were 25-year survival and freedom from reoperation, with degree of autograft regurgitation in all morphologies (AS, AR, mixed AR/AS) the secondary endpoint. Total reoperation rate was 8.3% after 25 years (n=43, AoV=28, PV=15), with early reoperation <1y in 0.6% and early postoperative death (n=1, 0.2%) following myocardial infarction. Overall, 25-year survival was 85.3%, and 25-year freedom from autograft reoperation 89.5% (AS=95.0%, AR=78.0%, Mixed AS/AR=94.3%), (p=0.01). Freedom from redo pulmonary valve replacement was 92.7%. The Ross procedure with inclusion cylinder technique provides excellent haemodynamics. Autograft inclusion in native aorta minimizes prosthetic material and respects physiological root changes, reducing shear stress on neo-aortic cusps and increasing durability. Long-term reoperation rate is low in experienced centers.

Return to Work, Sport, and Sport- Related Activity After Distal Triceps Tendon Repair: A Systematic Review.

Distal triceps tendon injuries are relatively rare injuries, often occurring in highly active patients with physically demanding jobs or lifestyles. Information on return to work, sport, and activity is essential for patient education and counseling after a distal triceps tendon rupture. To determine the rates of return to work, sport, and sport-related activity after distal triceps tendon repair. Systematic review; Level of evidence, 4. PubMed, CINAHL, MEDLINE, Web of Science, and SPORTDiscus were queried from the earliest record through January 12, 2024. Articles were included if they examined return to various activities (exercise, sport, work, or military duty) after distal triceps tendon repair. Data on return to sport/work/activity were collected as well as information on patient satisfaction, pre-existing medical history or medication use (ie, anabolic steroids or corticosteroids), and complications. Article quality was assessed via the Methodological Index for Non-Randomized Studies (MINORS) scale. Of 164 articles initially retrieved, 10 retrospective studies were included. Patients (n = 318; 74.2% male, 25.8% female) who underwent distal triceps tendon repair had a mean age of 44.7 ± 5.5 years with a mean follow-up time of 52.6 ± 21.4 months. After distal triceps tendon repair, 93.3% of patients (112/120) returned to sport, 95.3% (81/85) returned to military duty, and 92.6% (100/108) returned to work. Of the studies that evaluated satisfaction, the majority of patients reported high satisfaction after surgery. The overall complication rate (ranging from persistent pain and wound complications to nerve injuries and reruptures) after distal triceps tendon repair was 18.0%, the rerupture rate (complete and partial) was 7.2%, and the reoperation rate was 3.9%, with all partial reruptures undergoing nonoperative care. A distal triceps tendon rupture is a rare but potentially challenging injury, traditionally occurring in an active population, and often requires surgical repair. Importantly, >90% of an active-duty military population, athletes, and the general workforce was able to return to sport or their respective activity after surgery. Furthermore, there was high patient satisfaction and low rates of complications and reoperations after distal triceps tendon repair.

Comparison of mitral valve repair versus replacement for mitral valve regurgitation.

Mitral regurgitation (MR) is a prevalent valvular abnormality categorized as primary or secondary based on aetiology. Surgical intervention, particularly mitral valve repair, is often preferred over replacement due to its association with better outcomes. However, the benefits of repair versus replacement, especially in secondary MR, remain debated. This study aims to evaluate the long-term survival and reoperation rates in patients undergoing mitral valve repair compared to mitral valve replacement for MR in a cardiothoracic surgery unit in North-West England and in subgroups with degenerative and secondary aetiology. We analysed 1 724 consecutive patients undergoing first-time mitral valve surgery (repair: n=1 243; replacement: n=481) between 2000-2021. Primary outcome was all-cause mortality. Genetic matching and overlap weighting were used to balance baseline characteristics. Median follow-up was 7.1 years. In the matched cohort, mitral valve replacement was associated with higher rates of blood transfusion (29%vs 22%), longer ICU stays, and more strokes (3.7%vs 0.4%). While 90-day mortality did not differ significantly between groups, long-term follow-up showed a survival advantage for repair (HR: 1.32, 95% CI: 1.08-1.63). Although repair had higher reoperation rates (4.3%vs 2.1%), the composite of death or reoperation did not differ significantly. In degenerative MR subgroup, repair showed superior long-term survival, whereas in secondary MR, no significant survival difference was observed between strategies. Among patients suitable for either surgical strategy, mitral valve repair showed better long-term survival compared to replacement, particularly in degenerative MR. However, this advantage was not observed in secondary MR.

Racial Disparities in Perioperative Outcomes for Patients With Head and Neck Cancer.

To characterize the perioperative complications after ablative and reconstructive surgery in patients with head and neck cancer (HNC) based on race. We conducted a retrospective study of the 2015-2020 National Surgical Quality Improvement Program Database. We compared the perioperative outcomes between White, Asian, Black, Native Hawaiian or Pacific Islander, and American Indian or Alaskan Native patients with bivariate analysis. Multivariate logistic regression assessed the independent association of race with perioperative complications. Black patients experienced longer surgeries (aβ, 43; 95% CI, 33, 53), longer hospital stays (aβ, 1.6 [95% CI, 1.1-2.1]), and were less likely to be discharged home (aOR, 0.64; [95% CI, 0.54, 0.76]). Black patients also had higher major complications risk (aOR, 1.38; [95% CI, 1.13-1.67]) with the most common being reintubation/ventilation (Black, 4.4% vs. White 2.7%; p = 0.003) and sepsis/septic shock (Black, 3.4% vs. White 1.8%; p = < 0.001). Black patients had higher reoperation rates (aOR, 1.33; [95% CI, 1.12-1.56]) with incision and drainage of abscess and hematoma, exploration of postoperative hemorrhage, thrombosis or infection, or surgical debridement being the top reasons for reoperation. Concordantly, they were at higher risk of postoperative transfusion (Black, 18%; White, 7.2%; p = < 0.001) and wound dehiscence (Black, 4.1%; White, 2.1%; p = < 0.001). There is evidence of racial disparities in HNC surgery perioperatively. Black patients face an increased risk of major complications, reoperation, extended hospital stay, and non-home discharge. Developing a comprehensive surgical database with more social determinants of health variables and using a socioecological framework of health can help us identify contributors to these disparities and design high-leverage solutions.

Long-term outcomes in thoracic aortic surgery: 11 year single centre experience

ObjectivesThoracic aortic aneurysms and dissections provide a complex surgical cohort termed thoracic aortic surgery. Regular follow-up at specialist clinics with cross-sectional imaging is recommended. Identifying risk factors that lead to re-operations as well as the requirement for and appropriate length of follow-up remain points of debate.MethodsPatients undergoing thoracic aortic surgery performed at a single centre from January 2012 to December 2022 were retrospectively reviewed. The clinical information, operative details, histological reports, post-operative outcomes and follow up were collected from electronic patient records. Statistical analysis was performed using Microsoft Excel and R Studio.Results409 patients met the inclusion criteria for the study with a median follow-up of 3.8 years (IQR 1.6–7.6). The prevalence of all cause re-operations was 10.8% (n = 44). The median time to re-operation was 1.8 years. 68% of the reoperations occurred within the first 5 years. Multi and univariate logistic regression identified young age, arteritis and/or aortitis as the main risk factors associated with increased risk of re-operation. Connective tissue disease and systemic inflammatory diseases approached but didn’t meet statistical significance. Bicuspid aortic valve pathology was associated with reduced risk of re-operation.ConclusionsPatients undergoing thoracic aortic surgery have a high rate of re-operation. The first 5 years represent a high-risk period and follow-up with cross-sectional imaging during that time by specialist aortic services is essential. Patient with aortitis remain at high risk and should be treated by appropriate by specialist aortic services with subspecialty interest and expertise on treating patients with aortitis.Graphical

Lateral Opening Distal Femoral Osteotomy with Concomitant MPFL Reconstruction is Efficacious in Addressing Patellar Instability.

To describe the clinical and radiographic outcomes of patients undergoing a lateral opening distal femur osteotomy (DFO) to address valgus alignment and restore patellar stability. A retrospective review of patients who underwent lateral opening DFO for recurrent patellar instability in the setting of valgus leg alignment at a single academic institution between January 2016 to December 2021 was performed. Patients without a minimum 24-month postoperative follow-up were excluded. Rates of recurrent patellar instability, patient-reported outcomes, and complications were assessed. Pre- and post-operative radiographic anatomic lateral distal femoral angle (aLDFA) was evaluated to assess alignment correction. 20 lateral opening DFO cases were included from 15 patients [mean age 19.6 years, mean follow-up 42.4 months (range 24-63 months)]. 19 of 20 (95.0%) knees experienced no recurrent patellar dislocation. 13 of 20 (65.0%) knees underwent re-operation [hardware removal (n = 10); revision stabilization procedure (n = 1); lysis of adhesions and manipulation under anesthesia (LOA/MUA) (n = 1); nonunion revision with bone grafting (n = 1). mLDFA significantly changed from 86.3 degrees preoperatively to 91.4 degrees postoperatively (p < 0.001). Mean aLDFA changed significantly from 77.4 preoperatively to 84.4 degrees postoperatively (p < 0.001). The final Kujala score had a median value of 92 (IQR 85.5 - 98), Lysholm score was 90 (IQR 76 - 95), and Tegner score was 5 (IQR 4 - 7). Lateral opening DFO is an efficacious procedure to address recurrent patellar instability in patients with valgus leg alignment. The present retrospective case series demonstrates good functional outcomes and low rates of recurrent instability and major complications after a lateral opening DFO, despite a large proportion of patients having undergone previous surgery. There were relatively high rates of reoperation and hardware irritation. Retrospective case series; Level of evidence, 4.

Systematic Review of Evidence for Conservative Management of Pelvic Organ Prolapse in Younger Women.

Treatment of pelvic organ prolapse (POP) is poorly understood in younger women as the majority of prolapse research is conducted in the older population. There is an urgent need to evaluate conservative POP treatments for management in younger women due to high surgical complications and reoperation rates. Systematic review of the literature following PRISMA guidelines and registered in PROSPERO. Included studies were of conservative treatments in women younger than 51 years old. From 416 retrieved studies, nine were included in the analysis. Two of three studies found pelvic floor muscle training (PFMT) significantly benefited patient reported outcome measures (PROM) compared to educational material. One of three studies found significant improvement in PROM using biofeedback in addition to PFMT versus PFMT alone. Electrical stimulation with PFMT versus PFMT alone (one study) showed significant additional benefit of the combined treatment. Biofeedback and electrical stimulation in combination with PFMT versus PFMT alone (one study) was found to provide significant additional benefits. One compared pessary use to no intervention but stopped early due to slow recruitment. PFMT improves patient reported outcomes in younger women with POP. Electrical stimulation and biofeedback are useful adjuncts to PFMT. The gap in research investigating the effect of pessaries in younger women warrants further study.

The “suture-only” fixation in the treatment of proximal humerus fractures: A narrative review

Introduction: Surgical treatment of proximal humerus fractures (PHFs) is still associated with high complication and reoperation rates, most of them being implant related. In order to reduce such complications, a minimally-invasive technique was introduced by using only sutures for fixation of PHFs. Methods: For the arrangement of this narrative non-systematic review, an exploratory search in the MEDLINE (via PubMed) database using the keywords “proximal humeral fracture” and “sutures” was conducted. Results: The initial search in Pubmed yielded 254 studies, where only 8 were found to be possibly relevant. Following critical review, there were 6 studies that satisfied the inclusion criteria and were subject to further analysis. There were 325 patients with PHFs included in our study. The average age was 58 years (range 18–84 years). By fracture type there were 79 (24.3%) two-part greater tuberosity (GT) fractures with 36 (46%) of them associated with anterior dislocation, 9 (2.8%) two-part surgical neck (SN) fractures, 114 (35.1%) three-part fractures, and 124 (38.2%) four-part fractures, all of them being valgus impacted type. Conclusion: The “suture-only” technique obtains good clinical outcomes with lower complication and reoperation rates, but in selected types of unstable PHFs: two-part GT fractures with or without associated shoulder dislocation, and three- and four-part valgus-impacted fractures. While the indications for two-part SN fractures are contradictory, three- and four-part varus fractures, four-part fracture dislocations and split fractures are contraindicated for “suture-only” fixation. However, additional studies with a higher level of evidence are necessary to support the routine use of the “suture-only” technique in the treatment of these selected types of PHFs.

Arthrodesis Versus Ligament Reconstruction and Tendon Interposition for Thumb Carpometacarpal Joint Arthritis: A Systematic Review and Meta-Analysis.

Arthrodesis and ligament reconstruction and tendon interposition (LRTI) are commonly performed procedures for treatment of thumb carpometacarpal (CMC) osteoarthritis. Although LRTI is the most common surgical treatment, CMC arthrodesis has been performed because of its reported advantages. This systematic review and meta-analysis compared the differences between CMC arthrodesis and LRTI to better inform surgeons and patients when they are making treatment decisions. We searched MEDLINE, Embase, and the Cochrane Library for studies published up to 27 August 2023 that directly compared arthrodesis with LRTI for thumb CMC joint arthritis. The pooled analysis compared the visual analog scale; Quick Disabilities of the Arm, Shoulder, and Hand scores; grip strength; key pinch strength; reoperation rates; and postoperative complication rates. Six studies describing 285 thumbs, including 141 and 155 thumbs that underwent arthrodesis and LRTI, respectively, were included. Visual analog scale (standard mean difference [SMD],-0.05; 95% CI,-0.40 to 0.30; P= .78), Quick Disabilities of the Arm, Shoulder, and Hand score (SMD, 0.53; 95% CI,-1.12 to 2.17; P= .53), and grip strength (SMD,-0.67; 95% CI,-1.85 to 0.51; P= .27) showed no difference between the two groups. The arthrodesis group showed significantly higher key pinch strength (SMD, 0.61; 95% CI, 0.32-0.90), reoperation rate (odds ratio, 8.02; 95% CI, 2.00-32.16), and postoperative complication rate (odds ratio, 2.08; 95% CI, 1.11-3.91; I2= 0%) compared with the LRTI group. Carpometacarpal arthrodesis is associated with a better key pinch strength than LRTI. Nevertheless, no significant differences were observed in functional scores and grip strength. Patients who undergo arthrodesis have higher reoperation rates and incidence of postoperative complications than those who undergo LRTI. Thus, although arthrodesis may be a better operation for patients who require high pinch strength, surgeons should also consider the higher complication compared with LRTI. Therapeutic II.

Outcomes of internal fixation with Femoral Neck System (FNS) for intracapsular femoral neck fractures

Abstract Background: Internal fixation of hip fractures is associated with high reoperation rates. This study investigated the reoperation rates after internal fixation with the femoral neck system (FNS). Materials and Methods: A single-institution cohort study was conducted on patients aged 18 years or older who sustained intracapsular femoral neck fractures and underwent internal fixation with a fixed-angle implant. Surgeons, patients, and investigators were not blinded. The primary outcome was any hip reoperation at the final follow-up. Secondary outcomes were to characterize a cohort of patients regarding demographics, fracture classification, intraoperative findings, postoperative fracture complications and union rates, and postoperative pain. Results: This study found that internal fixation with FNS for intracapsular femoral neck fractures was associated with a 23% rate of revision surgery. Of the initial 94 patients who received FNS internal fixation, 44 patients were included for analysis; of those, 10 patients underwent revision surgery. Patients had a 22% rate of in-hospital medical adverse events with a 30-day readmission rate of 9%. Increasing body mass index was associated with increased revision rates (P = 0.037). Patients who sustained displaced femoral neck fractures had a significant decrease in SF-12 Mental Health Composite, SF-12 Physical Health Composite, and quality-of-life subscale scores. Conclusions: The FNS is a viable alternative for internal fixation of intracapsular femoral neck fractures. The observed rate of revision after internal fixation was comparable with previously published outcomes following fixation with cannulated screws and sliding hip screws. Level of Evidence: Level IV, Therapeutic Study.

Fibula fixation is not associated with a higher rate of wound complications during pilon fracture open reduction internal fixation

IntroductionThere is a lack of consensus regarding indications for fibula fixation in pilon fractures. Reduction of the fibula fracture can assist with restoring lateral column length and reduction of the tibial plafond during pilon ORIF. However, there are theoretical concerns with wound complications and soft tissue insult. The purpose of this study is to compare short-term outcome measures after tibial plafond ORIF with and without supplemental fibula fixation using a validated national database. Materials and methodsThe American College of Surgeons' NSQIP database was utilized to identify all patients undergoing tibial plafond ORIF with and without fibula fixation between January 1, 2015 and December 31, 2020 using Current Procedural Terminology (CPT) codes 27827 and 27828, respectively. Open fractures and cases with concurrent open procedures were excluded from analysis. Demographic data, medical comorbidities, surgical variables, and various 30-day outcome measures were compared between the two groups. Multivariate logistic regression was used to identify independent variables associated with various outcome measure of interest. ResultsA total of 3120 patients were included in the final cohort: 1530 patients underwent tibia fixation alone and 1590 patients underwent both tibia and fibula fixation. The supplemental fibula fixation group had a higher rate of reoperation (2.3 % vs. 1.1 %, p = 0.013) and non-home discharge (14.8 % vs. 11.2 %, p = 0.003). The rate of surgical site infection was comparable between groups. Supplemental fibula fixation was independently associated with unplanned reoperation (RR: 1.939 [1.081–3.477], p = 0.026). ConclusionsPatients undergoing supplemental fibula fixation during tibial plafond ORIF had a higher rate of 30-day reoperation and non-home discharge. Supplemental fibula fixation during pilon fracture ORIF was independently associated with a higher rate of 30-day reoperation. There was no difference in the rates of surgical site infection or wound dehiscence between the two groups. Level of evidence3.

The role of cannabis on total hip and knee surgeries outcomes: a systematic review and meta-analysis.

Cannabis refers to medications derived from the Cannabis plant. Cannabis has long been used to treat a wide range of conditions. The widespread legalization of cannabis has increased its use. This meta-analysis evaluates the effects of preoperative cannabis usage on TKA and THA outcomes and complications. This review follows CRD Guidance for Undertaking Reviews in Healthcare and PRISMA 2020 guidelines. On October 12, 2023, we extensively searched MEDLINE (PubMed), Scopus, Cochrane Central Register of Controlled Trials, and Web of Science. There were no time, place, or language restrictions. We also examined the references and citations in the included publications to find relevant research. We found 208 references in PubMed/Medline, Scopus, Web of Science, and other databases. After reviewing all publications, we identified 18 references that match the requirements for further assessment. The odds ratios (ORs) for reoperation and readmission are 1.35 (95% CI: 0.69, 2.66, and p-value = 0.38), and 0.89 (95% CI: 0.41, 1.92, and p-value = 0.76). Inpatient morphine milligram equivalent (MME) and length of stay (LOS) have a mean difference (MD) of -1.71 (95% CI: -13.46, 10.05, and p-value = 0.78), and - 0.13 (95% CI: -0.33, 0.08, and p-value = 0.23). The MD of the VAS pain score 24-72h after surgery is 0.40 (95% CI: -0.07, 0.87, and p-value = 0.10). The odds ratio for PTE and DVT is 1.54 (95% CI: 0.1, 23.24, and p-value = 0.75), and 1.38 (95% CI: 1.08, 1.77, and p-value = 0.01), respectively. Cannabis users experienced significantly higher rates of DVT following THA and TKA. Our subgroup analysis found that cannabis users who underwent TKA had considerably higher rates of reoperation (p-value = 0.10) and readmission (p-value ≤ 0.01), while those who underwent THA had significantly lower rates of PTE. These findings highlight the need to include cannabis use as a risk factor in surgical planning and patient care protocols, and further studies are warranted. This study design and protocol were performed in accordance with the PRISMA Statement. The protocol was registered previously on PROSPERO CRD42024551078.

Compensatory thoracic curve correction in lumbar anterior vertebral body tether (VBT) versus lumbar posterior spinal fusion (PSF).

Anterior vertebral body tethering (VBT) is a non-fusion surgical option for skeletally immature patients with idiopathic scoliosis. Prior studies demonstrated compensatory correction of the thoracic curve after lumbar posterior spinal fusion (PSF); however, no studies have examined thoracic curve correction after lumbar VBT. Patients with Lenke 5 + 6 lumbar scoliosis who underwent VBT and at least 2years' follow-up were compared to matched lumbar PSF patients. Groups were compared for major lumbar (L) and compensatory thoracic (T) curve correction, coronal/sagittal balance, and complications. 24 AVBT and 24 PSF patients were matched 1:1 for skeletal maturity and curve flexibility. There were no significant differences between VBT and PSF for average pre-operative or 2year post-operative major L or compensatory T curves. Average final L curve correction was 50% VBT and 60% PSF (p = 0.08); average T curve correction was 17% VBT and 20% PSF (p = 0.18). Compared to pre-operative flexibility radiographs, the final post-op thoracic curves were 6° (VBT) and 5° (PSF) larger. PSF had better coronal balance by average of 17mm (p < 0.0001). There were seven (24%) reoperations in the VBT group: two overcorrections relaxed, two T adding-on (extended to T by PSF-1, VBT-1), one broken tether converted to PSF. There was one (4%) reoperation in the PSF group (10-year post-op extension). Compensatory thoracic correction was achieved to a similar degree for lumbar VBT and PSF patients. There was little change in thoracic curve magnitude over time, and, on average, the correction did not reach the pre-operative flexibility curve measurement. There was better coronal balance by PSF, and a higher rate of re-operation in VBT patients. III.

Synthetic medial meniscus implant demonstrates high reoperation rates: Patients who retain implant or require implant exchange show improvement in post meniscectomy knee pain and clinical function

PurposeThe purpose of this study was to evaluate the clinical outcomes in the use of a synthetic medial meniscus implant in patients symptomatic after medial meniscectomy and not responsive to other treatment methods. and not responded to non-operative treatment. MethodsThis single-arm, multicenter, prospective study enrolled subjects between ages 30-75 with post-meniscectomy pain. Changes from baseline to 24-months were measured in the pain subscale of the knee injury and osteoarthritis outcome score (KOOS) and in KOOS overall (average of all five subscales) in patients that had received a medial meniscus implant. Success was a 20-point improvement at 24-months, reoperation rates, and implant failures were recorded. VAS, IKDC, and WOMET scores were also measured. ResultsOf the 115 treated patients 3 (2.6%) were either lost to follow-up or missed the 24-month visit, 48 (43%) patients had at least one subsequent surgery, 12 (10.7%) had the implant permanently removed. Of the remaining 100 patients, the mean KOOS pain improved 28.4 points at 24 months (P <0.001), and mean KOOS overall improved 28.3 points (P < 0.001). Seventy-six percent of subjects had mean scores for KOOS pain above the minimal clinically important difference (MCID) threshold, and 72% of subjects met or exceeded this threshold for KOOS overall. There were 29 patients (25.9%) who underwent implant exchange. The 24-month clinical outcomes were similar between subjects who had an implant exchange and patients who did not have any subsequent implant procedure (P < 0.2). ConclusionThe synthetic medial meniscus demonstrates high reoperation and failure rates. Patients who retained the implant or required implant exchange showed significantly improved pain, function, and quality of life at 24-month follow-up in patients symptomatic following partial medial meniscectomy and failed non-operative management. The high reoperation rate is a concern, and further evaluation is needed to determine any contributing factors.

Surgical Treatment and Outcomes of Trans-Ulnar Basal Coronoid Fracture-Dislocations

Trans-ulnar fracture-dislocations of the elbow are complex injuries that can be difficult to classify and treat. Trans-ulnar basal coronoid injuries, in which the coronoid is not attached to either the olecranon or the metaphysis, present substantial challenges to achieve anatomic reduction and stable internal fixation. The purpose of this study was to analyze the outcome of surgical treatment of trans-ulnar basal coronoid fracture-dislocations. Between 2002 and 2019, 32 consecutive trans-ulnar basal coronoid fracture-dislocations underwent open reduction and internal fixation (ORIF) at our institution. Four elbows were lost to follow-up within the first 6 months after surgery and were excluded. Among the 28 elbows remaining, there were 13 females and 15 males with a mean age of 56 (range 28-78) years at the time of injury. The mean clinical and radiographic follow-up times were 37 months and 29 months, respectively. Radiographs were reviewed to determine rates of union, Hastings and Graham heterotopic ossification (HO) grade, and Broberg and Morrey arthritis grade. Union occurred in 25 elbows. Union could not be determined for 1 elbow at most recent follow-up and the remaining 2 elbows developed nonunion of the coronoid. Complications occurred in 10 elbows (36%): deep infection (4), ulnar neuropathy (2), elbow contracture (2), and nonunion (2). There were reoperations in 11 elbows (39%): irrigation and débridement with hardware removal (4), hardware removal (2), ulnar nerve transposition (2), contracture release with HO removal (2), and revision ORIF with iliac crest autograft (1). At most recent follow-up, the mean flexion-extension arc was 106° (range 10-150°), and the mean pronation-supination arc was 137° (range 0-170°). The mean Quick Disabilities of Arm, Shoulder, and Hand score was 11 (range 0-39) points with a mean Single Assessment Numeric Evaluation-Elbow score of 81 (range 55-100) points. At final radiographic follow-up, 16 elbows (57%) had HO (8 class I and 8 class II), and 20 elbows (71%) had arthritis (8 grade 1, 6 grade 2, and 6 grade 3). Trans-ulnar basal coronoid fracture dislocations are severe injuries associated with high rates of reoperation, heterotopic ossification, and post-traumatic arthritis. However, the majority of elbows achieve union, a functional range of motion, and reasonable patient reported outcome measures. Over the study period, surgeons were more likely to utilize multiple deep approaches and separate fixation of the coronoid (either with lag screws or anteromedial plates) to ensure anatomic reduction.

Is the anconeus epitrochlearis muscle a predictor for ulnar nerve compression?

BackgroundThe role of the anconeus epitrochlearis (AE) in cubital tunnel syndrome, either as protector or potential compressor of the ulnar nerve, as well as its prevalence in both symptomatic and asymptomatic patients are still unclear. This study aimed to assess the prevalence of the AE in a large cohort using 3-dimensional imaging and to investigate any association of the AE with preoperative or postoperative features of patients undergoing cubital tunnel surgery. MethodsFrom a database of 1240 elbow MRIs, all patients with an AE were retrospectively screened for major criteria of cubital tunnel syndrome. A matching cohort without AE was then similarly assessed to deduct the prevalence of AE and evaluate potential correlations. Next, 344 ulnar nerve surgeries were reviewed. Data including pre- and postoperative physical exam findings, electromyographic study results, reason for compression or (sub)luxation, presence of AE, time to improvement and need for reoperations were collected. The prevalence of AE in the symptomatic population was determined and possible associations were explored. ResultsThe overall prevalence of AE in the population, based on MRI data, was 5,9% which closely matched the 5,8% prevalence observed in the operative population. Among the AE group of 13 patients, all were treated with myotomy and in situ decompression during surgery. No higher reoperation rate was seen in the AE group compared to the non-AE group. ConclusionThe contribution of the AE to the compression neuropathy or protection of the ulnar nerve could not be discerned for the standard population. Therefore, in the routine practice, the AE should be considered as a rare and non-pathological anatomical variant, devoid of any surgical implications.

Spondylolisthesis in Young Patients in a Large National Cohort: Reoperation Rate Depends on Surgical Approach.

The current literature investigating surgical treatments for lumbar spondylolisthesis in adolescent patients is limited by small sample sizes. There are high reoperation rates, and posterior interbody fusion has not been reported to help. The current study aimed to utilize a nationwide database to investigate outcomes of spinal fusion for spondylolisthesis in young patients. The PearlDiver database was queried for patients <21 years old who had undergone lumbar spinal fusion for spondylolisthesis between 2010 and 2020. Patients were divided into 4 cohorts based on surgical approach: (1) posterior spinal fusion with posterior instrumentation (PSF), (2) posterior spinal fusion with posterior instrumentation plus interbody (PSF+I), (3) anterior spinal fusion without posterior instrumentation (ASF), and (4) anterior spinal fusion plus posterior instrumentation (A+PSF). Patients with <2 years of follow-up were excluded. The primary outcome was reoperation. Of 33,945 patients with spondylolisthesis, 578 (1.7%) underwent lumbar spinal fusion: 236 (40.8%) had PSF, 219 (37.9%) had PSF+I, 66 (11.4%) had ASF, and 57 (9.9%) had A+PSF. The mean age was 16.5 ± 1.1 years, and the mean follow-up was 5.4 ± 2.9 years. A higher percentage of girls underwent surgery compared with boys (2.0% versus 1.4%). Survival analysis using all-cause reoperation as the end point demonstrated an overall 5-year reoperation-free survival rate of 85.5% (95% confidence interval [CI]: 82.5% to 88.6%). The overall reoperation rate within 5 years was significantly different depending on the approach, with A+PSF being the lowest at 7.0% (PSF = 11.9%, PSF+I = 10.5%, and ASF = 31.8%). This is the largest reported series of spondylolisthesis surgery in young people. The lowest rate of revisions within 5 years was for a combined approach of A+PSF. The 5-year risk of reoperation of 31.8% for a stand-alone ASF appeared to be unacceptably high compared with other approaches, and was over 4 times higher than A+PSF (7.0%). Consistent with previous clinical series, the addition of an interbody fusion to a PSF did not decrease the reoperation rate and did not appear to offer any advantages to a PSF alone. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Endoscopic dacryocystorhinostomy outcomes in pediatric patients with nasolacrimal duct obstruction

ABSTRACT Purpose To determine the risk factors impacting the surgical success of endonasal dacryocystorhinostomy (eDCR) in pediatric patients. Methods This is a retrospective interventional case series of patients 18 years and younger treated over a 16-year period via eDCR for nasolacrimal duct obstruction (NLDO). Data were extracted on surgical outcomes, follow-up duration, and comorbidities (i.e. punctal agenesis, trisomy 21, dacryocystitis). Functional success was defined as the resolution of NLDO symptoms postoperatively. Results Of 356 cases in 281 patients (median age: 3.32 years), 78.9% of cases in 79.0% of patients achieved functional success after initial eDCR. The median follow-up duration without tearing symptoms as observed by an ophthalmologist and non-ophthalmology trained clinician was 11.0 months and 62.1 months, respectively. Patients with punctal agenesis and those requiring bilateral surgery had significantly higher rates of failure (p = .01; p < .001, respectively). Age at operation was not significantly associated with failure (p = .30). Excluding cases of trisomy 21 and punctal agenesis, functional success was achieved in 82.7% of 295 cases. Conclusions Endonasal DCR is effective in resolving NLDO symptoms in pediatric patients, with success rates comparable to the adult population and to an external approach. Despite a higher reoperation rate in patients with trisomy 21 and punctal agenesis, trisomy 21 and age at operation were not significant risk factors for failure.

Outcomes at mean follow-up of four years following AO type-C distal humerus fractures managed with fixation or arthroplasty.

To compare outcomes between open reduction internal fixation (ORIF), total elbow replacement (TER) and distal humerus hemiarthroplasty (DHH) for AO type-C (AOC) fractures of the distal humerus in patients aged 50 years or older. A retrospective analysis of acute AOC distal humerus fractures in patients aged 50 years or older between 2016 and 2022. Outcomes measured: Oxford Elbow Score (OES), Mayo Elbow Performance Score (MEPS), complication rate, re-operation rate and range of movement (ROM). Sixty-five patients met the inclusion criteria (20 males, 45 females). Mean age was 64.4, 77.1 and 61.3 years old for ORIF, TER and DHH respectively. Logistic model analysis revealed a statistically significant increased complication rate in the ORIF group compared to the TER and DHH groups (ORIF vs TER p = 0.01; ORIF vs DHH p = 0.048). There was a higher re-operation rate in the ORIF group compared to the DHH group (p = 0.03). There were no differences in OES, MEPS or ROM between groups. This supports the use of TER in elderly patients with AOC distal humerus fractures. In the younger patient, DHH may have lower rates of complications and re-operations compared to ORIF, but function remains similar. We propose a prospective randomised control trial.