Improvement In Outcome Scores Research Articles

Patients Undergoing Microfracture With Allograft Cartilage and autologous Platelet Rich Plasma Augmentation For Chondromalacia In The Hip Achieving High Rates Of Meaningful Outcomes At 2-Year Follow-Up.

To evaluate rates of achieving meaningful outcomes and clinical failure at 2 years after undergoing microfracture augmented with allograft cartilage with autologous PRP, and to identify predictors of conversion to total hip arthroplasty. Data from a prospective series of consecutive patients with Outerbridge grade IV chondromalacia of the acetabulum or femoral head who underwent hip microfracture augmented with allograft cartilage between January 2017 and June 2022 was analyzed. Patient-reported outcomes were collected preoperatively and at minimum 2 years postoperatively. The Hip Outcome Score- Activity of Daily Living (HOS-ADL), -Sports Subscale (HOS-SS), modified Hip Harris Score (mHHS), and Non-Arthritic Hip Score (NAHS) thresholds for achieving the minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) at 2-year after surgery were calculated. Logistic regression analysis was performed to identify any association between non-modifiable variables and clinical failure. A total of 108 hips (80.6%) among 106 patients had 2-year follow up and were included in the final analysis. The combined mean age and BMI were 37.9+10.1 years and 26.8+4.7 respectively, with a mean follow-up time of 31.9+8.4 months (range 24-53 months). There was a statistically significant improvement in all functional score averages over the 2 years (p<0.05). A total of 84.7%, 75.5%, and 70.4% reached at least one threshold for achieving MCID, PASS, and SCB, respectively. There were 11(10.2%) patients that underwent conversion to THA (Total Hip Arthroplasty), with increased age, BMI, and preoperative pain duration increasing the likelihood of requiring THA (p<0.05 for all). Lastly, chondromalacia size or chondromalacia index (e.g., Outerbridge grade x surface area) was not associated with clinical failure or achieving meaningful outcomes (p>0.05 for all). Patients undergoing microfracture with allograft cartilage and autologous PRP augmentation for acetabular or femoral head chondromalacia demonstrated statistically improved outcome scores and high rates of achieving meaningful outcomes at 2-year follow-up regardless of chondromalacia defect size. Conversion to THA was 10.2%, with increased age, BMI, and preoperative pain duration increasing the likelihood of requiring THA. Level 2, prospective cohort.

Staged Hip Arthroscopy and Periacetabular Osteotomy in Active Patients 45 Years and Older Produces Comparable Improvements in Outcome Scores to Younger Patients

To determine staged hip arthroscopy and periacetabular osteotomy (PAO) mid-term outcomes in active patients aged 45 years and older compared with a younger group. All patients aged 45 years and older who underwent staged arthroscopy and PAO between 2015 and 2021 were retrospectively analyzed and compared with a case-matched control group of younger patients. All patients underwent at least 6 months of nonoperative management prior to surgery. Prior to PAO, all patients underwent hip arthroscopy to address any intra-articular pathology. The experimental group consisted of patients with dysplasia aged 45 years and older without significant osteoarthritis who underwent PAO and reported patient-reported outcomes for a minimum of 1 year postoperatively. Patient-reported outcomes were quantified using the International Hip Outcome Tool 12 (iHOT-12) score and Non-arthritic Hip Score (NAHS). The cohort consisted of 35 patients (44 hips) with a mean age of 49.4 ± 3.8 years. The lateral center-edge angle significantly improved from preoperatively (20.1° ± 4.5°) to postoperatively (33.2° ± 3.2°, P < .001). The mean follow-up period in the PAO cohort aged 45 years and older was 2.80 years (standard deviation, 1.3 years) postoperatively. Patients reported significant improvements in the iHOT-12 score (36.6 ± 14.1 preoperatively vs 81.2 ± 21.0 at latest follow-up, P < .001) and NAHS (59.2 ± 15.5 preoperatively vs 87.4 ± 13.1 at latest follow-up, P < .001). The older cohort did not report significantly different iHOT-12 scores compared with the control group at any point, and age did not significantly affect either outcome score (P > .05). Patients aged 45 years and older reported a statistically significant improvement in hip function and pain after staged hip arthroscopy and PAO, with outcome scores comparable to a younger cohort. Our findings show that appropriately selected older patients with dysplasia without significant pre-existing hip osteoarthritis experience clinically meaningful improvements in hip pain and function after hip preservation surgery. Level III, retrospective, comparative case series.

EGb761 Trials for Mild-to-Moderate Dementia-What Have We Learned in the Past 18 years?

Dementia leads to cognitive decline affecting memory, thinking, and behavior. Current pharmaceutical treatments are symptomatic, with limited efficacy and significant drawbacks. Ginkgo biloba extract (EGb761) is being explored as an adjuvant therapy for dementia because of its potential neuroprotective effects.Areas of Uncertainty:Despite decades of study, EGb761 has not been incorporated into treatment guidelines for these conditions. This review evaluates research futility in EGb761 trials for dementia, analyzing efficacy and methodological challenges to inform future research directions. In this review, we investigate the efficacy and adverse reactions of Ginkgo biloba extract (EGb761) as a treatment for Alzheimer disease or vascular dementia. We searched the randomized controlled trials published between 2006 and 2023 on PubMed and ScienceDirect. The 7 selected studies have shown that the degree of improvement in standard cognitive assessment scores [Mini-Mental State Examination (MMSE), short cognitive performance test (SKT), neuropsychiatric inventory (NPI)] was not significant enough for a substantial proportion of patients. Improvements of the SKT score with at least 3 points in the Alzheimer disease/vascular dementia groups were found only in 2 out of 7 studies, changes of less than 2 points in MMSE score were found in 2 of the studies, while an improvement of at least 4 points in NPI scores was reported in 4 out of 7 studies. We aim to understand why this extract has not reached the level of evidence to be included in guideline recommendation despite extensive research and what have we learned from systematic reviews performed since 2010? Studies included in this review have shown some improvement in outcome scores with EGb761 treatment compared with placebo, but these improvements did not reach the threshold for clinically significant enhancement in MMSE/SKT/NPI scores. Limitations such as small sample sizes, minimal score changes, predominantly placebo comparisons, and short follow-up durations make it challenging to determine the usefulness of EGb761 in dementia treatment. The changes observed and methodological constraints underscore the uncertainty surrounding the efficacy of EGb761. The findings do not consistently demonstrate the clinical utility of EGb761, and improved scores on cognitive and neuropsychiatric assessments may not necessarily translate into meaningful clinical outcomes for patients with dementia. Starting from the question"What have we learned in the past 18 years?", the answer would be: not much. Consequently, the question raised is: how long should we go on with the same conclusion, continuing to spend time and financial resources to replicate these results? Research strategies should be refined to optimize decision making and advance evidence-based care for neurocognitive disorders.

Short-term Effects of Pulsed Electromagnetic Field Therapy for Achilles Tendinopathy: A Randomized Controlled Trial.

Pulsed electromagnetic field (PEMF) therapy is a potential nonoperative treatment for Achilles tendinopathy, but the current published literature on its effects is sparse. To evaluate the therapeutic efficacy of PEMF therapy and eccentric exercise for Achilles tendinopathy. Randomized controlled trial; Level of evidence, 1. A total of 65 participants met the inclusion criteria and were randomly assigned to either the active PEMF group (n = 33) or the sham group (n = 32). The PEMF group received biweekly PEMF therapy (10 minutes per session) for 8 weeks, plus eccentric exercise for 12 weeks. The sham group received the same eccentric exercise for 12 weeks minus active PEMF exposure. The primary outcome was the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire. The secondary outcomes were numeric pain rating scale (NPRS) score, tendon neovascularity, and total time spent on sports per week. A physical therapist assessed all outcomes at baseline and then 4, 8, and 12 weeks after the commencement of the PEMF treatment. The level of tendon neovascularity was determined by the Öhberg score (range, 0-3). VISA-A scores improved significantly from baseline to 12 weeks posttreatment in both the PEMF group (from 57.9 to 71.7) and the sham group (from 55.1 to 66.8) (P < .001 for both), with no significant difference in scores between treatment groups throughout the 12 weeks (P = .527). NPRS scores during sports also improved significantly from baseline to 12 weeks for the PEMF group (from 6.05 to 2.95) and the sham group (from 6.45 to 3.85) (P < .001), with no group differences (P = .346). PEMF therapy, in addition to eccentric exercise, did not improve outcome scores or tendon neovascularity compared with eccentric exercise alone in participants with Achilles tendinopathy. NCT05316961 (ClinicalTrials.gov identifier).

Outcomes Following Isolated Medial Meniscus Posterior Root Repair Using An Anatomic Transtibial Pull-Out Technique In Patients Aged &gt; 60 Years: A Matched Cohort Study

Objectives To compare patient-reported outcomes following anatomic transtibial pull-out repair for isolated medial meniscus posterior root (MMPR) tears in patients &gt; 60 versus ≤60 years of age, as well as the incidence of repair failures. Methods Patients aged ≥18 years undergoing isolated anatomic transtibial pull-out repair for MMPR tears at a single institution between January 2016 and September 2020 were analyzed. Patients with minimum 2-year follow-up were divided based on age: &gt;60 versus ≤60 years. Patients completed IKDC, KOOS JR, and VR12 surveys before surgery and at final follow-up. Differences in outcome scores between age groups, as well as repair failures, defined by the need for repeat arthroscopy, were analyzed. Results Twenty patients aged ≥60 with a mean age of 65.7 ± 4.1 years (range, 60.2 – 74.9 years) were compared to 40 patients ≤ 60 years of age with a mean age of 49.3 ± 9.0 years (range, 23.4 – 59.8). Significant improvement in all outcomes scores was observed in both groups at final follow-up relative to pre-operative values. No significant difference in IKDC, KOOS JR, or VR12-Physical scores was observed between groups. Revision repair was required in one patient (2.5%) under age 60, but no patients over age 60. Conclusion Anatomic transtibial pull-out repair for MMPR tears resulted in improved outcome scores at minimum 2-year follow-up, with no significant differences among our cohorts of patients &gt;60 or ≤60 years of age. While chronologic age should be accounted for when discussing expectations and management of MMPR tears, a specific age cut-off should not exclude consideration for root repair, as appropriately selected patients &gt;60 years of age exhibit non-inferior outcomes compared to patients aged ≤60 years.

Descriptive study of patient outcome and satisfaction with telemedicine and physical consultation during and after the COVID-19 pandemic.

This study was conducted to assess patients' outcome and satisfaction with the eye care received with telemedicine and physical consultation at a tertiary care hospital during and after the coronavirus disease 2019 (COVID-19) pandemic. A descriptive study was carried out on 6052 patients who consulted for eye illness at a tertiary care hospital between April 2020 and December 2022. An outcome scoring system was developed and validated for the assessment of patient outcome after providing treatment on telemedicine consultation and physical consultation. Outcome scores for various symptoms were compared pretreatment and posttreatment. Telehealth Usability Questionnaire (TUQ) was used through an online survey to assess patients' satisfaction with teleophthalmology services during the COVID-19 pandemic. An 18-item Patient Satisfaction Questionnaire (PSQ-18) was used to assess the same with physical consultation. A total of 6052 patients were included in the study. Physical consultation group had 2485 patients (41.06%) and the telemedicine group had 3567 patients (58.93%). Male patients constituted 63.11% and females were 36.89%. There was a significant improvement in outcome scores for pain and redness in both physical and telemedicine consultation groups (P < 0.0001). All subgroups of TUQ had significantly high scores (including usefulness, ease of use and learnability, interface quality, interaction quality, and satisfaction and future use), except one subgroup (reliability). Uneducated patients were significantly more satisfied with telemedicine compared to educated patients (P = 0.044). Majority of patients expressed satisfaction with teleophthalmology services. The recent pandemic paved the way for the future integration of telemedicine in ophthalmology, especially if virtual eye examinations attain a higher level of reliability.

Effectiveness and Safety of Matrix-Associated Autologous Chondrocyte Implantation for the Treatment of Articular Cartilage Defects: A Real-World Data Analysis in Japan

Background: The effectiveness and safety of matrix-associated autologous chondrocyte implantation with an autologous periosteal flap (pMACI) remain unclear. The Japanese Ministry of Health, Labor, and Welfare requires postmarketing surveillance of all patients undergoing pMACI using the tissue-engineered product JACC. Purpose: To evaluate the effectiveness and safety of pMACI for large articular cartilage defects (≥4 cm2) in the knee joint using real-world data analysis. Study Design: Case series; Level of evidence, 4. Methods: Data were collected from patients who underwent pMACI between 2012 and 2019, with 2 years of follow-up. The primary outcomes were the Lysholm knee score and Knee injury and Osteoarthritis Outcome Score (KOOS) at 6, 12, and 24 months. Adverse events were assessed by physical examination, magnetic resonance imaging, and/or arthroscopy. Results: Overall, 232 knees in 225 patients who presented with trauma (198 knees) or osteochondritis dissecans (34 knees) in the medial (132 knees) and lateral (44 knees) femoral condyle, patella (25 knees), trochlea (86 knees), and tibial plateau (4 knees) were included. The mean age of the patients was 40.9 ± 15.0 years, with mean cartilage defects of 5.6 ± 2.4 cm2 in size. Concomitant surgeries, such as osteotomy (50 knees), ligament reconstruction (27 knees), meniscal procedures (28 knees), osteochondral autograft transplantation (24 knees), and microfracture (14 knees), were performed in 113 (48.7%) knees. The minimal clinically important difference in the Lysholm knee score and KOOS Symptoms subscale was achieved in 79.7% and 63.5% of patients, respectively, and the Patient Acceptable Symptom State was achieved in 90.1% and 73.7%, respectively. Substantial clinical benefit was achieved in the KOOS Sports/Recreation and Quality of Life subscales at 39.6% and 37.8%, respectively. Knees that underwent concomitant microfracture had significantly worse KOOS values than the remainder of the cohort. Complications, including effusion (16.8%), graft delamination (14.7%), knee contracture (9.1%), graft hypertrophy (8.2%), and ossification (3.4%), were observed in 86 (37.1%) knees. Osteochondritis dissecans was significantly associated with graft hypertrophy and ossification, whereas concomitant surgery was significantly associated with delamination and contracture. Treatment failure required additional cartilage procedures in 11 (4.7%) knees. Conclusion: Treatment of large cartilage defects (≥4 cm2) with pMACI resulted in improved outcome scores in approximately 75% of patients. However, complications occurred in one-third of patients, and 4.7% required reoperation.

Acromiohumeral Distance: Can Radiographic Factors Impact Outcomes after Reverse Shoulder Arthroplasty?

Introduction Reverse shoulder arthroplasty (RSA) has grown exponentially due to its effectiveness in restoring clinical function and reducing pain. With this growth, the priority has been placed to optimize outcomes and minimize complications. Radiographic measurements and biomechanical factors have emerged as possible tools to predict clinical outcomes and potential complications after RSA. Our study aimed to evaluate the relationship between acromiohumeral distance (AHD) lengthening and postoperative β angle, and patient outcomes following RSA. Methods Patients who underwent primary RSA from August 2017 to February 2020 by a single surgeon were retrospectively identified. Arm lengthening (AHDdelta), determined by preoperative and postoperative AHD, and the β angle were obtained from radiographs. Functional and patient-reported outcomes were measured preoperatively and at a minimum of 1 year postoperative. Radiographic measurements were correlated to clinical, functional, and patient-reported outcome scores using Pearson’s correlation coefficient tests. A subanalysis comparing outcomes in patients with ≤ 2cm of AHDdelta versus &gt; 2 cm of AHDdelta was performed. Results Sixty-three patients with a mean age of 73.3 ± 8.7 years were included. The mean arm lengthening and postoperative β angle were 2.4 ± 0.9 cm and 89.6° ± 10.6°, respectively. Arm lengthening was significantly correlated to the improvement of daily pain (r = 0.277, p = 0.030), with the most improvement observed in arm lengthening ranging from less than 0 cm to 1.5 cm. Patients with arm lengthening ≤ 2 cm had significantly reduced daily pain compared to patients with &gt; 2cm of arm lengthening (-5.9 vs -3.8; p = 0.02). Postoperative β angle significantly correlated with the improvement of SPADI and SST scores. # Conclusion The results of our study showed that AHD increased postoperatively after RSA and that less arm lengthening had the most significant decrease in pain and optimal glenoid inclination correlated with improved outcome scores.

A bone graft from the tibial resection or patella that rectified a tibial over-resection reliably healed and improved clinical outcome scores: A retrospective study of kinematically aligned TKA.

During kinematically aligned (KA) total knee arthroplasty (TKA), the surgeon may need to rectify an over-resection of the medial, lateral or posterior tibia. This study tested the hypothesis that a bone graft taken from the tibial resection or patella and impacted beneath a tibial baseplate would heal, regardless of whether the tibial component and knee were in outlier ranges according to mechanical alignment (MA) criteria. The study also tested the hypothesis that the Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) would improve beyond the substantial clinical benefit and that the source and thickness of the bone graft would not influence their improvement. This retrospective study radiographically assessed the healing of a bone graft from the tibial resection (n = 19) or patella (n = 10) in 29 KA TKAs (18 females, mean age 65 years). The tibial component and knee alignment were categorized as in-range or outliers based on reported MA criteria for bone graft healing and implant survival. The one-sample t test identified differences in the improvement of the OKS and KOOS JR from their reported substantial clinical benefit of 16 and 20 points, respectively. At an average follow-up of 37 months, all bone grafts healed even though ≥55% of tibial components and 34% of knees were varus outliers according to MA criteria for bone healing and implant survival. Amongst the 29 patients, the mean OKS and KOOS JR improvements of 25 ± 11 and 47 ± 21 points, respectively, surpassed the threshold of their respective substantial clinical benefit (p < 0.01) and were not influenced by the bone graft's source and thickness (p ≥ 0.51). During cemented KA TKA, the surgeon can use a bone graft from the tibial resection or patella to rectify a tibial over-resection. This technique led to consistent bone healing and improved outcome scores. Level IV.

Five-Year Results of the Salto XT Revision Ankle Arthroplasty.

The treatment of failed ankle replacements is debated, and little is published about the medium- and long-term results of revision implants. We wanted to examine prosthesis survival and physical function at least 5 years after insertion of the Salto XT revision prosthesis. All consecutive patients operated with a Salto XT revision prosthesis underwent clinical and radiologic examinations preoperatively and after 3, 12, 24, and 60 months. Complications and reoperations are described, and changes in patient-reported outcome measures and clinical scores are reported. Thirty patients were operated with a Salto XT revision prosthesis between March 2014 and March 2017. Three of these were revised (1 to a fusion and 2 to a new prosthesis), and 3 patients were reoperated with screw removal. A concurrent subtalar fusion was performed on 13 patients, and there was 1 case of likely nonunion after these procedures, but no reoperations. The mean AOFAS score increased from 39.2 (95% CI 30.8-47.5) preoperatively to 75.1 (95% CI 67.3-82.9) after 5 years, and the mean improvement was 34.2 points (95% CI 23.8-44.6). Mean EQ-5D increased from 0.36 (95% CI 0.30-0.42) preoperatively to 0.74 (95% CI 0.64-0.85) after 5 years, an improvement of 0.34 (95% CI 0.19-0.49). Radiolucent lines were present in all but 3 patients. Five-year prosthesis survival was 93% (83.6-100). This is the first study to present medium-term results of this implant. We found good improvement in outcome scores and good implant survival, but also a high prevalence of radiolucent lines.

Poster 152: Clinical Outcomes for Dermal Allograft Glenoid Augmentation in Patients With Anterior Shoulder Instability and Subcritical Bone Loss

Objectives: To assess minimum 1-year magnetic resonance imaging (MRI) and clinical outcomes for 20 cases of dermal allograft augmentation of subcritical glenoid bony defects. Methods: Twenty patients with subcritical glenoid bone loss underwent arthroscopic dermal allograft augmentation along with labral repair. All patients were evaluated with postoperative MRI at a minimum of 12-month follow-up. Preoperative and postoperative patient-reported outcomes were collected including University of California Los Angeles Shoulder (UCLA) scores, Visual Analogue Scale (VAS) scores, and American Shoulder and Elbow Surgeons (ASES) scores. Scores were assessed for statistical significance using the analysis of variance test. Results: Average postoperative follow-up was 19 months (range 12-54 months). The average preoperative bony defect size was 16% (range 6.6-39%), with 19 of the patients having defects under 20%. Postoperative MRIs (Figure 1) revealed an average of 32% (range 27.7-37.4%) increase in glenoid diameter size and the average glenoid size was restored to 102.3% (range 94-114%), with excellent incorporation of the graft. There were statistically significant improvements in preoperative and postoperative scores with respect to UCLA scores (21.25 to 33.7, p &lt; 0.05), VAS scores (5.4 to 0.2, p &lt; 0.05) and ASES scores (58.6 to 96.4, p &lt; 0.05). One patient had a recurrent traumatic dislocation (5%) and underwent a Latarjet procedure at 13 months from the index surgery. At the time of the Latarjet, the dermal allograft was harvested and sent for histologic analysis. Histologic analysis of the glenoid augmentation graft at the time of revision surgery revealed recellularization with fibroblast-like cells, revascularization, and incorporation of the graft into the surrounding tissue with bony ingrowth. (Figure 2) Conclusions: Subcritical glenoid bone loss has been associated with high failure rates when treated with standard labral repair. While a Latarjet procedure can provide stability, high complication rates and the risk of long-term arthritis makes this procedure less than ideal when bone loss is under 20%. Arthroscopic labrum repair with the addition of a dermal allograft is a viable option in patients with subcritical bone loss. In the case series with 1-year follow-up, 20 patients who underwent arthroscopic labrum repair with the addition of a dermal allograft had a significant improvement in outcome scores, and excellent incorporation of the graft as seen on MRI at 12 months from the index procedure. In the 1 failure that later underwent revision surgery, histologic analysis demonstrated recellularization and revascularization, with incorporation of the graft.

Gender-based differences in mid-term clinical outcomes and patient acceptable symptomatic state attainment after arthroscopic rotator cuff repair: Minimum 2-year follow up

There is paucity of literature on the impact of patients' gender on recovery and treatment success after arthroscopic rotator cuff repair. This study investigates the effect of gender on patient-reported outcomes preoperatively and postoperatively (minimum 2 years), and to determine if gender affects the attainment of patient-acceptable symptomatic state (PASS) thresholds. 266 patients (117 males, 149 females), who underwent primary arthroscopic rotator cuff repair for atraumatic, full-thickness tears, were included. Functional outcomes and pain scores were collected preoperatively and postoperatively. Percentage of attainment of PASS for the various outcome scores was calculated and compared between males and females. Women had statistically significantly poorer functional outcome and pain scores preoperatively and at 1 and 2 years postoperatively (P​<​0.01). They also experienced less improvement in outcome scores throughout the postoperative period. Women had statistically significantly lower rates of PASS attainment at 2 years postoperatively. Women experience greater pain and poorer shoulder function compared with men preoperatively, and up to 2 years postoperatively. Women are less likely to achieve PASS thresholds postoperatively, compared to their male counterparts. Retrospective Cohort Study. III.

Glenoid structural bone grafting in reverse total shoulder arthroplasty: clinical and radiographic outcomes

Current options for reconstruction of large glenoid defects in reverse total shoulder arthroplasty (RTSA) include structural bone grafting, use of augmented components, or 3D-printed custom implants. Given the paucity in the literature on structural bone grafts in RTSA, this study reflects our experience on clinical and radiographic outcomes of structural bone grafts used for glenoid defects in RTSA. We identified 33 consecutive patients who underwent RTSA using structural bone grafts for glenoid bone loss between 2008 and 2019. Twenty-six patients with a mean clinical follow-up of 4.4±3.9 years and a mean radiographic follow-up of 2.7±3.2 years were included. Patient demographic data, perioperative functional outcomes, radiographic outcomes, complications, and reoperation rates were determined. Between 2008 and 2019, 26 RTSAs were performed using structural autograft or allograft for glenoid defects. There were 20 females (77%) and 6 males (23%), with a mean presenting age of 68 years (range 41-86), mean BMI of 29 (range 21-44), and mean Charlson Comorbidity Index of 3 (range 0-8). There were 19 cases of central glenoid defects, and 7 were combined central and peripheral defects. Structural grafts included humeral head autograft (7), proximal humerus autograft (7), iliac crest autograft (7), distal clavicle autograft (2), and femoral head allograft (3). All 18 revision RTSA cases had simultaneous humeral-sided revision. There was significant postoperative improvement in American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form scores (27.0±12.6 preoperation vs. 59.8±24.1 postoperation; P<.001) and visual analog scale scores (8.1±3.6 preoperation vs. 3.0±3.2 postoperation; P<.001). Range of motion improved significantly for active forward elevation (63°±36° preoperation vs. 104°±36° postoperation; P<.001) and external rotation (21°±20° preoperation vs. 32°±23° postoperation, P=.036). Eighty-eight percent of cases (23 of 26) had successful reconstruction of the glenoid, defined as no visible radiolucent lines nor glenoid component migration at final follow-up. The reoperation rate was 19% (5 of 26). Postoperative complications included 2 cases of acromial stress fractures that were treated nonoperatively, for a total complication rate (including reoperation) of 27% (7 of 26 cases). The use of structural bone autografts and allografts in RTSA was associated with improved outcome scores and range of motion. A reoperation rate of 19% and total complication rate of 27% were reported for these challenging cases. However, 86% of these complications were not related to structural glenoid reconstruction failure. Structural grafts are a reasonable option for glenoid reconstruction in RTSA cases with glenoid bone loss.

Outcomes of Concomitant Glenohumeral Stabilization After Arthroscopic Rotator Cuff Repair in Military Patients Younger Than 40 Years.

While concomitant rotator cuff and inferior labral tears are relatively uncommon in young civilians, military populations represent a unique opportunity to study this injury pattern. To (1) evaluate the long-term outcomes after combined arthroscopic rotator cuff and inferior labral repair in military patients <40 years and (2) compare functional outcomes with those after isolated arthroscopic rotator cuff repair. Cohort study; Level of evidence, 3. Military patients who underwent arthroscopic rotator cuff repair between January 2011 and December 2016 and had a minimum of 5-year follow-up data were included in this study. The patients were categorized into those who had undergone combined arthroscopic rotator cuff and inferior labral repair (RCIL cohort) and those who had isolated arthroscopic rotator cuff repair (ARCR cohort). Pre- and postoperative outcome measures-visual analog scale for pain, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons shoulder score, Rowe Instability Score, and range of motion-were compared between the groups. A total of 50 shoulders (27 in the RCIL cohort and 23 in the ARCR cohort) were assessed. The RCIL and ARCR groups were similar in terms of age (mean, 33.19 years [range, 21-39 years] vs 35.39 years [range, 26-39 years], respectively) and sex (% male, 88.46% vs 82.61%, respectively). All patients were active-duty military at the time of surgery. The mean final follow-up was at 106.93 ± 16.66 months for the RCIL group and 105.70 ± 7.52 months for the ARCR group (P = .75). There were no differences in preoperative outcome scores between groups. Postoperatively, both groups experienced statistically significant improvements in all outcome scores (P < .0001 for all), and there were no significant group differences in any final postoperative outcome measures. At the final follow-up, 26 (96.30%) patients in the RCIL cohort and 20 (86.96%) in the ARCR cohort had returned to unrestricted active-duty military service (P = .3223). The study findings indicate that concomitant glenohumeral stabilization does not prevent worse outcomes after arthroscopic rotator cuff repair in this military cohort. Combined repair produced statistically and clinically significant improvements in outcome scores at the long-term follow-up, indicating that simultaneous repair of combined lesions was an appropriate treatment option in this patient population.

Prospective 5-year follow-up of L5-S1 versus L4-5 midline decompression and interspinous-interlaminar fixation as a stand-alone treatment for spinal stenosis compared with laminectomies.

Spinal stenosis treatment includes laminectomies with or without fusion or with interspinous distraction with or without fixation. Lack of published data on interspinous fixation devices (IFD) at L5-S1 is less considered as an option due to the smaller anatomical S1 spinous process and the higher stresses from the immobile sacrum. Our objective was to evaluate the outcomes of an IFD used as a stand-alone treatment for spinal stenosis at L5-S1 and L4-5 compared to historical data on open laminectomies. Prospective comparative cohort study (Level 2) looking at collected preoperatively and postoperatively Visual Analog Scores (VAS) and Oswestry Disability Index (ODI) data, complications, and revision rates on 100 consecutive patients with spinal stenosis treated with midline decompression and InSpan (InSpan LLC, Malden, MA, USA) IFD, at L5-S1 and L4-5, up to five-year follow-up. All patients were treated by a single surgeon in an academic private practice. Historical published outcome data for open laminectomies were compared. Among the 100 patients, 45 underwent surgery at L5-S1 with a mean VAS pain score that decreased by 75% and ODI improved by 63% (P<0.001). Fifty-five patients had surgery at L4-5 with mean VAS and ODI scores improved by 80% and 66% (P<0.001) respectively. Preoperative and postoperative ODI and preoperative VAS scores were similar at L5-S1 and L4-5, however, postoperative VAS scores were significantly less for L4-5 versus L5-S1 (P<0.01). All surgeries were completed in less than one hour. There was a total of one L4-5 revision (1.8%) and two L5-S1 revisions (4.4%). Comparable laminectomy data showed decrease in VAS and ODI scores by 51% and 62% (P<0.05). The reoperation rate for laminectomies at five to ten years varied up to 24%. Spinal stenosis patients treated with midline decompression and InSpan IFD, used as a stand-alone treatment for interspinous-interlaminar fixation, at L4-5 and L5-S1, showed improved outcome scores and low complication and revision rates at five years and were comparable to historical open laminectomy data. InSpan is a successful substitute for laminectomies in selected patients and was performed in less than 60 minutes. We recommend choosing the appropriately sized implant to achieve adequate distraction decompression to avoid recurrent symptoms.

Concomitant Biceps Tenodesis Does Not Portend Inferior Outcomes After Anterior Glenohumeral Stabilization

Background: Military patients are known to suffer disproportionately high rates of glenohumeral instability as well as superior labrum anterior to posterior (SLAP) tears. Additionally, a concomitant SLAP tear is frequently observed in patients with anterior shoulder instability. Even though biceps tenodesis has been demonstrated to produce superior outcomes to SLAP repair in military patients with isolated SLAP lesions, no existing studies have reported on outcomes after simultaneous tenodesis and anterior labral repair in patients with co-existing abnormalities. Purpose: To evaluate outcomes after simultaneous arthroscopic-assisted subpectoral biceps tenodesis and anterior labral repair in military patients younger than 40 years. We also sought to compare these outcomes with those after repair of an isolated anterior labral tear. Study Design: Cohort study; Level of evidence, 3. Methods: This study is a retrospective analysis of all military patients younger than 40 years from a single base who underwent arthroscopic anterior glenohumeral stabilization with or without concomitant biceps tenodesis between January 2010 and December 2019. Patients with glenoid bone loss of >13.5% were not eligible for inclusion. Outcome measures including the visual analog scale (VAS) for pain, the Single Assessment Numeric Evaluation (SANE), the American Shoulder and Elbow Surgeons (ASES) shoulder score, the Rowe instability score, and range of motion were administered preoperatively and postoperatively, and scores were compared between groups. Results: A total of 82 patients met inclusion criteria for the study. All patients were active-duty service members at the time of surgery. The mean follow-up was 87.75 ± 27.05 months in the repair + tenodesis group and 94.07 ± 28.72 months in the isolated repair group (P = .3085). Patients who underwent repair + tenodesis had significantly worse preoperative VAS pain (6.85 ± 1.86 vs 5.02 ± 2.07, respectively; P < .001), ASES (51.78 ± 11.89 vs 62.43 ± 12.35, respectively; P = .0002), and Rowe (26.75 ± 7.81 vs 37.26 ± 14.91, respectively; P = .0002) scores than patients who underwent isolated repair. Both groups experienced significant improvements in outcome scores postoperatively (P < .0001 for all), and there were no statistically significant differences in postoperative outcome scores or range of motion between groups. There were no differences in the percentage of patients who achieved the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state for the VAS pain, SANE, ASES, and Rowe scores between groups. Overall, 37 of the 40 (92.50%) patients in the repair + tenodesis group and 40 of the 42 (95.24%) patients in the isolated repair group returned to unrestricted active-duty military service (P = .6045). In addition, 38 (95.00%) patients in the repair + tenodesis group and 40 (95.24%) patients in the isolated repair group returned to preinjury levels of sporting activity (P = .9600). There were no significant differences in the number of failures, revision surgical procedures, or patients discharged from the military between groups (P = .9421, P = .9400, and P = .6045, respectively). Conclusion: The findings of this study indicate that simultaneous biceps tenodesis and labral repair was a viable treatment option for the management of concomitant SLAP and anterior labral lesions in young, active military patients younger than 40 years.

Effects of Arthroscopic Atelocollagen Insertion in High-Grade Partial Articular Supraspinatus Tendon Avulsion Lesions: A Retrospective Cohort Study With Propensity Score Matching.

This study sought to evaluate the effect of atelocollagen insertion into the bone-tendon interface of the repaired tendon after arthroscopic rotator cuff repair for high-grade partial articular supraspinatus tendon avulsion (PASTA) lesions. To compare clinical and radiological outcomes of atelocollagen-inserted rotator cuff repair and atelocollagen-noninserted rotator cuff repair in the high-grade PASTA lesions. Cohort study; Level of evidence, 3. The data from 301 consecutive patients who underwent arthroscopic rotator cuff repair of PASTA lesions between January 2017 and June 2020 were retrospectively reviewed. Patients with minimum 2-year follow-up data were included and divided into 2 groups: those treated with transtendon suture-bridge repair without additional augmentation (group 1) and those with atelocollagen-inserted transtendon suture-bridge repair (group 2). Patients in group 2 were matched 1:1 to patients in group 1 using propensity score matching (n = 68 per group); and pain visual analog scale, American Shoulder and Elbow Surgeons, University of California, Los Angeles, Korean Shoulder Scoring System, Simple Shoulder Test, and range of motion scores were compared between these groups. Also, repaired tendon integrity and thickness were compared immediately, 6 months, and 1 year after surgery on magnetic resonance imaging (MRI) using the vertical distance from the midpoint footprint of the greater tuberosity. In most comparisons, there were no significant differences in outcome measures and range of motion between groups. However, less residual discomfort at the final follow-up was also documented in group 2 (P = .043). Also, the difference in forward flexion was 3.7° at 1 year and 5.4° at final follow-up, and the difference in abduction was 2.2° at final follow-up, which were all significantly greater in the experimental group. Group 2 showed significant greater tendon thickness of the repaired tendon immediately, 6 months, and 1 year after surgery on MRI (P≤ .001). Addition of atelocollagen did not improve outcome scores. However, there was slightly greater flexion and abduction at final follow-up. Also, there was less residual discomfort at final follow-up.

Two-Stage Revision ACL Reconstruction with Arthroscopic Tunnel Bone Grafting

Background: Anterior cruciate ligament (ACL) reconstruction is a common orthopedic surgery, and due to the increased number of primary reconstructions being performed, the number of revision ACL reconstructions is also increasing. Indications: Two-stage revision ACL reconstruction has lower failure rates compared to 1-stage and is indicated when significant tunnel expansion has occurred or malpositioned tunnels prohibit an adequate reconstruction. In this presentation, 2-stage revision ACL reconstruction was performed with an arthroscopic bone grafting technique of both the femoral and tibial tunnels secondary to tunnel osteolysis. Technique Description: Standard diagnostic arthroscopy is performed, and any chondral or meniscal pathology is addressed. The remnant ACL graft and all hardware are removed. The tunnels are debrided thoroughly. Using a modified syringe, the tunnels are packed with a mixture of cancellous bone chips and cortical fibers that have been hydrated with whole blood and platelet-rich plasma (PRP). The patient is placed into a brace postoperatively, and a computed tomography (CT) is obtained approximately 4 to 6 months postoperatively to assess for bone healing. Revision ACL reconstruction is performed once indicated with standard rehabilitation and return to play protocol. Results: Both 1-stage and 2-stage revision ACL reconstructions have been demonstrated to have significant improvement in outcomes scores preoperatively to postoperatively. However, 2-stage has lower failure rates compared to single-stage and has a high return to level of play. Discussion/Conclusion: Revision ACL reconstruction is becoming more commonly performed, and 2-stage revision is frequently required due to multiple factors. In this video, we demonstrate bone grafting for revision ACL reconstruction for tunnel osteolysis. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Faster improvement in outcome scores in posterior stabilised total knee arthroplasty compared to medial congruent system with posterior cruciate ligament retained.

Most studies comparing medial pivot to the posterior stabilised (PS) systems sacrifice the PCL. It is unknown whether retaining the PCL in the Medial Congruent (MC) system may provide further benefit compared to the more commonly used PS system. A retrospective review of a single-surgeon's registry data comparing 44 PS and 26 MC with PCL retained (MC-PCLR) TKAs was performed. Both groups had similar baseline demographics. The PS and MC-PCLR groups had similar pre-operative range of motion (ROM) (PS:104º ± 20º vs. MC-PCLR: 101º ± 19º, p = 0.70), Oxford Knee Score (OKS) (PS: 27 ± 6 vs. MC-PCLR: 26 ± 7, p = 0.62), and Knee Society Scoring System (KS) Function Score (KS-FS) (PS: 52 ± 24 vs. MC-PCLR: 56 ± 23, p = 0.49). The pre-operative KS Knee Score (KS-KS) was significantly lower in the PS group (PS: 44 ± 14 vs. MC-PLR: 53 ± 18, p < 0.05). At 12-months post-operation, there was significant improvement in all parameters (p < 0.01). Both groups had similar ROM (PS: 115º ± 13º vs. MC-PCLR: 114º ± 10º, p = 0.98), OKS (PS: 41 ± 5 vs. MC-PCLR: 40 ± 4, p = 0.50), KS-FS (PS: 74 ± 22 vs. MC-PCLR: 77 ± 16, p = 0.78), and KS-KS (PS: 89 ± 10 vs. MC-PCLR: 89 ± 10, p = 0.89). The PS group had significant improvement in all parameters from preoperation to 3-month postoperation (p < 0.05), but not from 3-month to 1-year postoperation (p ≥ 0.05). The MC-PCLR group continued to have significant improvement from 3-month to 1-year postoperation (p < 0.05). Preserving the PCL when using MC may paradoxically cause an undesired additional restrain that slows the recovery process of the patients after TKA. Compared to MC-PCLR, a PS TKA may expect significantly faster improvement at 3months post operation, although they will achieve similar outcomes at 1-year post operation.

Radiographic parameters of pelvic and proximal femoral morphology do not predict outcomes for direct anterior total hip arthroplasty

Radiographic predictors of outcomes associated with direct anterior approach (DAA) total hip arthroplasty (THA) are largely unknown. Anecdotally, some surgeons limit surgery to patients with low body mass index (BMI) or "favorable" bony morphology. Objective data on the impact of these factors is limited. We sought to determine radiographic and demographic predictors of outcomes after DAA arthroplasty. A consecutive series of patients undergoing unilateral, elective DAA THA, who had linked pre- and post-operative patient reported outcome scores, from January 1, 2017 to March 30, 2019 were included. Radiographic measurements, including proxies for pelvic overhang, femoral canal access, acetabular morphologic changes, and markers of disease severity, were performed on calibrated radiographs. Intra-observer consistency was also evaluated. Outcome measures included disease specific and general health patient-reported outcomes scores, while surgical difficulty was approximated by estimated blood loss and surgical time. Multivariate analyses were performed to determine statistically significant correlations. 168 patients were included. Overall, patients experienced significant improvement in outcome scores (mean ∆ HOOS-JR 39.4, PROMIS-physical 12.3). There were two reoperations (1.2%), for recurrent dislocation. Female sex (p=0.015) and increasing age (p==0.019) were associated with shorter surgical times. No statistically significant correlations were found between the radiographic parameters and outcome measures. Intraclass correlation coefficients of the radiographic measurements were overall strong (0.73-1.0). We demonstrated consistent results in this series of patients despite variation in bony morphology. Our findings suggest that DAA THA can be safely performed on a broader patient population.