Final Follow-up Mean Research Articles

Efficacy comparison and outcome predictors of GPi- and STN-targeted deep brain stimulation for Meige syndrome: a systematic review of individual patient data.

The aim of this study was to evaluate outcomes of deep brain stimulation (DBS) for Meige syndrome, compare the efficacy of globus pallidus internus (GPi) and subthalamic nucleus (STN) as targets, and identify potential outcome predictors. The PubMed, Embase, and Web of Science databases were systematically searched to collect individual data from patients with Meige syndrome receiving DBS. Outcomes were assessed using the Burke-Fahn-Marsden Dystonia Rating Scale motor (BFMDRS-M) and disability (BFMDRS-D) scores. Data were analyzed using pooled meta-analysis. The study is registered in the PROSPERO database. The analysis included 233 patients from 26 studies, with significant publication bias (p = 0.008, Egger's test), but showed significant improvements in BFMDRS-M (65.09% ± 26.65%) and BFMDRS-D (53.48% ± 42.44%) scores at the final follow-up (mean duration 27.10 ± 33.64 months). No significant differences were observed in BFMDRS-M score improvement (mean difference -2.58%, 95% CI -15.84% to 10.69%; p = 0.430) or risk difference for response (-0.97%, 95% CI -10.08% to 8.15%; p = 0.835) between the GPi and STN target groups at the final follow-up across all follow-up periods (0 to ≤ 6, > 6 to ≤ 12, > 12 to ≤ 24, > 24 to ≤ 36, and > 36 months). Multiple regression analysis revealed a negative correlation between disease duration and treatment efficacy and a positive correlation between preoperative BFMDRS score and treatment outcome. DBS significantly improves motor symptoms and disability in patients with Meige syndrome, with GPi and STN targets providing comparable efficacy. The efficacy of DBS diminishes with longer disease duration, underscoring the importance of early intervention.

P1108 Endoscopic Sleeve Gastroplasty for management of Obesity in patient suffer from Inflammatory Bowel Disease

Abstract Background Obesity is a multifactorial, chronic, and relapsing disease, and its prevalence among patients with inflammatory bowel disease (IBD) is increasing, affecting 15–40% of them1,2. Limited data are available on the outcomes of endoscopic sleeve gastroplasty (ESG), a non-malabsorptive, organ-sparing endoscopic procedure, in patients with IBD3,4. Methods We conducted a retrospective review of a prospective dataset of subjects who underwent ESG at a tertiary center, including all subjects affected by IBD. Weight loss and IBD outcomes were assessed during early- and medium-term follow-up. Results Ten subjects (80% women) with IBD (5 with ulcerative colitis and 5 with Crohn’s disease) underwent ESG between October 2019 and May 2024 (mean BMI 37.6 ± 3.75 kg/m², mean age 49.4 ± 12.3 years). Four patients (40%) had previously undergone IBD-related surgery. Seven patients (70%) had received biological therapy, and six (60%) were in clinical remission at the time of ESG. No perioperative adverse events occurred. At the 6-month follow-up, nine subjects experienced total body weight loss (TBWL) of >10%, with a mean excess weight loss (EWL) of 55.9 ± 29.6%. Nine patients reached the 12-month follow-up, with a TBWL of 17.3 ± 10.5% (6 of them with TBWL >10%). At the final follow-up (mean 20.25 ± 3.46 months), the mean TBWL was 12.3 ± 10.2%, and the mean EWL was 38.2 ± 31.8%. Three patients underwent endoscopic revision for recurrent weight gain after a mean of 21 months. Two of these patients reached the 6-month follow-up with a mean TBWL of 9.89 ± 0.15% and EWL of 46.83 ± 1.79%. Overall, eight (80%) patients had no change in their IBD medication, one (10%) required treatment escalation due to loss of response. One subject, affected by chronic kidney disease and with a history of ileocecal resection, required emergency surgery for bowel obstruction caused by an incisional hernia 16 months after ESG. Unfortunately, four months later, he died due to septic shock. At the last follow-up, eight (89%) of the nine patients were in clinical remission, and all patients were in steroid-free remission. Conclusion We present the largest series on ESG in patients with IBD and obesity. Based on these retrospective data, ESG appears to be a promising bariatric procedure for these complex patients due to its safety and efficacy. However, prospective studies and clinical trials are needed to confirm these findings.

Effectiveness and Safety of Resident-Performed Same-Day Bilateral 360-Degree Selective Laser Trabeculoplasty in Patients with Open-Angle Glaucoma.

Resident-performed same-day bilateral selective laser trabeculoplasty are safe and effective for patients with primary open-angle glaucoma or ocular hypertension. To assess the efficacy and safety of resident-performed same-day bilateral 360-degree selective laser trabeculoplasty (SLT). Retrospective chart review was performed for patients who received bilateral, resident-performed SLT at the University of Chicago from January 1, 2020 to December 31, 2022 under the supervision of one glaucoma surgeon (MQ). Patients were included in this analysis if they underwent same-day bilateral 360-degree SLT and had at least 6 months follow-up available. Data were collected on visual acuity, intraocular pressure (IOP), number of IOP-lowering medications, and complications for up to 2 years after the procedure. There were 48 patients included in this analysis, and the diagnosis was either primary open-angle glaucoma (85.4%) or ocular hypertension (14.6%). For patients whose SLT goal was to lower IOP (n=38), the mean baseline IOP in right eyes (OD) was 19.2 mmHg on 2.1 medications, and in left eyes (OS) was 19.5 mmHg on 2.1 medications. At final follow-up (mean 519 days), the mean IOP in right eyes was 15.8 mmHg on 2.0 medications, and in left eyes was 15.8 mmHg OS on 2.2 medications, resulting in an IOP reduction of 17.6% OD and of 18.8% OS. For patients whose SLT goal was to lower medication number (n=10), the mean baseline IOP in right eyes was 16.7 mmHg on 2.3 medications, and in left eyes was 16.4 mmHg OS on 2.3 medications. At final follow-up (mean 528 days), the mean IOP in right eyes was 17.6 mmHg on 1.1 medications, and in left eyes was 16.3 mmHg OS on 1.1 medications, resulting in a medication reduction of 1.1 fewer medications OD and 1.1 fewer medications OS. One patient experienced a 6 mmHg IOP rise above baseline 4 weeks after SLT, and another developed 2 small, focal areas of peripheral anterior synechiae. Six (12.5%) patients underwent additional IOP-lowering surgery during the chart review period. Resident-performed same-day bilateral 360-degree SLT is effective and associated with minimal complications, with rates comparable to those of attending-performed SLT in the literature. SLT can be individualized to patients' goals of IOP-lowering or medication reduction. Teaching institutions can consider incorporating this method of education for appropriate patients with primary open angle glaucoma or ocular hypertension.

Bilateral rib-to-pelvis growth-friendly spinal surgery for congenital kyphosis in the child with myelomeningocele delays but does not prevent a definitive procedure.

To determine the efficacy of bilateral rib-to-pelvis distraction instrumentation for the growth-friendly surgical treatment of congenital kyphosis in children with myelomeningocele. The clinical courses of nine children (five males, four females), mean age 4.3 years (range 1.4 years-10.0 years), with myelomeningocele and congenital kyphosis treated by the rib-to-pelvis surgical method were studied. Radiographic measurements established the extent of deformity corrections, spinal elongation and growth, and rib levels. Surgical complications were categorized as wound or instrumentation related. The mean follow-up was 5.2years (range, 2.4years-10.4years). Following the index procedure, a mean of seven procedures (range, 4-20), or 1.2 procedures per year, were performed on each child. The mean preoperative, postoperative, and final follow-up kyphotic deformity was 139° (range, 93°-180°), 86°(range, 45°-150°) and 98° (range, 50°-176°) respectively. Eight children lost some of the initial correction and the two youngest lost all correction. Six children were converted to spine-based procedures. The mean growth for the cohort was 0.6cm/year (range, -1.2cm-1.9cm). Twenty-two complications occurred in eight children-14 in the three youngest children. In two children the procedure was abandoned due to ulceration over the gibbus after 2.8 years and 5.6 years of treatment. The bilateral rib-to-pelvis surgical procedure produced modest deformity correction and spinal growth, and prevented deformity progression. It delayed but did not eliminate the need for spine-based deformity correction, and was associated with the significant morbidity of distraction-based growth-friendly spinal surgery. The rib-based technique may have a role in a child with myelomeningocele kyphosis when surgical intervention is required in the very young.

The PAUL Glaucoma Implant in the management of uveitic glaucoma-3-year follow-up.

Evaluate the mid-term outcomes of the PAUL Glaucoma Implant (PGI) in the management of uveitic glaucoma. This was a single-centre, multi-surgeon, retrospective analysis of 50 consecutive cases of PGI for uveitic glaucoma performed between April 2019 and August 2021. Primary outcomes include: complete and qualified success (IOP ≥5 mmHg to ≤21 mmHg with ≥20% IOP reduction) or failure (IOP exceeding the success criteria, additional glaucoma procedures, no perception of light vision). Secondary outcomes included: visual acuity, IOP, medications, complications and intraluminal stent removal. We included 50 eyes of 41 patients. Mean age was 45.8 ± 19.8 years (range 6-81 years) in this heterogenous and complex cohort. Mean pre-op IOP was 30.6 ± 9.8 mmHg on 3.9 ± 0.9 medications. In total, 62% of patients were on acetazolamide, and 64% required systemic immunosuppression. At final follow-up (mean: 35.8 ± 9.8 months, range 5-58 months), IOP and medications were significantly reduced (12.2 ± 4.4 mmHg, requiring 1.1 ± 1.3 medications, p < 0.0001). Resulting in 48% complete and 92% qualified success rates. Failure occurred in 8% of cases, 6% due to hypertension but only one case of prolonged hypotony (2%). To date, this study represents the first publication looking specifically at the efficacy and safety of the PGI in the management of complex uveitic glaucoma. With an average follow-up of 3 years, it shows high levels of complete and qualified success with few complications.

Combined Superior Capsular Reconstruction Using Fascia Lata Autograft and Lower Trapezius Transfer Using Achilles Tendon Allograft Are Associated With Improved Surgical Outcomes in Patients With Chronic Posterosuperior Irreparable Massive Rotator Cuff Tears.

To evaluate the minimum 12-month clinical and radiologic outcomes of combined superior capsular reconstruction (SCR) and lower trapezius transfer (LTT) for posterosuperior irreparable massive rotator cuff tears (IMRCTs). Patients with posterosuperior IMRCTs and severe fatty infiltration (Goutallier grade ≥3) of the infraspinatus who underwent combined SCR and LTT were retrospectively reviewed. A double-folded fascia lata autograft with 1 layer of polypropylene mesh inside was used for SCR, and an Achilles tendon allograft was used to connect the tendon of the lower trapezius to the greater tuberosity. A thorough preoperative assessment with clinical history, physical examination, and imaging studies was critical for identifying tear patterns that were reparable or irreparable and to guide further treatment. American Shoulder and Elbow Surgeons (ASES), visual analog scale (VAS), Constant, Single Assessment Numeric Evaluation (SANE) scores, and range of motion were collected at a minimum 12-month follow-up postoperatively. Radiologic evaluation included graft integrity and the acromiohumeral distance at the final follow-up. Postoperative magnetic resonance imaging was used to assess graft integrity. The minimal clinically important difference was calculated as one-half of the standard deviation of the score change between the preoperative baseline and the latest follow-up. Fifteen patients were included in this study, with a mean follow-up period of 20.6 months (range, 12.2-31.2 months). Significant improvements in clinical and radiologic outcomes were found after surgery. The VAS score decreased from 4.1 to 0.7 (P= .001). The ASES, Constant, and SANE scores improved from 54.5 to 83.7 (P=.001), from 61.1 to 76.7 (P= .001), and from 48.7 to 74.0 (P= .001), respectively. External rotation improved from 26.0° to 45.7° (P= .009). Postoperative magnetic resonance imaging scans were obtained at a mean final follow-up of 14.2 months (range, 11.9-23.2). The acromiohumeral distance improved significantly from 4.9 mm to 8.1 mm after surgery (P= .003). In 2 patients (13.3%), both fascia lata and Achilles tendon graft tears developed during follow-up. The minimal clinically important difference was obtained in 80.0%, 66.7%, 53.3%, and 46.7% of patients for the ASES score, VAS score, Constant score, and SANE score, respectively. SCR-LTT contributes to significant pain relief and functional improvements with a graft healing rate of 86.7% at a minimum 12-month follow-up in patients with posterosuperior IMRCTs and high-grade fatty infiltration of the infraspinatus. Level IV, retrospective case series.

Surgical Treatment for Chronic Anterior Dislocation of the Radial Head.

Background: Surgical correction of chronic anterior dislocation of the radial head in paediatric patients is challenging, and they may experience re-dislocation or subluxation even after corrective surgery. We have been performing a radial shortening osteotomy combined with reconstruction of the annular and lateral collateral ligaments, and a corrective osteotomy of the ulna. The aim of this article is to describe our technique and outcomes at mid-term follow-up. Methods: This retrospective review included 10 paediatric patients with chronic anterior dislocation of the radial head that were surgically treated at our unit from January 2016 to July 2022. The dislocations were congenital in two patients, resulted from neglected Monteggia fractures in seven patients, and was idiopathic in one patient. The average age at surgery was 8.3 years. All patients underwent radial shortening osteotomy combined with reconstruction of the annular and lateral collateral ligaments, and a corrective osteotomy of the ulna. Outcomes with regards to period of follow-up, complications, arc of motion and the Kim elbow performance score were assessed. Results: The reduction of the radial head was maintained at the final follow-up (mean: 55 months). No acute or chronic complications occurred. The mean arc of flexion-extension improved from 124° to 140° while the arc of prono-supination decreased from 124° to 113°. The Kim elbow performance score was excellent in eight patients, fair in one and poor in one. Conclusions: A combination of radial shortening osteotomy, reconstruction of the annular and lateral collateral ligaments and corrective osteotomy of the ulna was able to maintain a stable reduction of the radial head with satisfactory elbow motion in the mid-term in paediatric patients with chronic anterior dislocation of the radial head regardless of the underlying cause. Level of Evidence: Level IV (Therapeutic).

"Surviving the dip" after subacromial balloon spacer implantation for massive rotator cuff tear treatment: a retrospective case series.

Subacromial balloon spacer implantation (SBSI) attempts to decrease glenohumeral joint (GHJ) pain and improve function in patients with an irreparable rotator cuff tear (RCT) and minimal osteoarthritis. Between 12 and 26 weeks post-SBSI, gradual implant resorption may create a "balloon dip" that decreases GHJ function and increases pain. This retrospective cohort study attempted to delineate shoulder function, active mobility, strength, pain, and functional task impairment during the "balloon dip" period. Sixty-five consecutive patients (55.9 ± 7years of age, 42 men) with an irreparable RCT treated by the same fellowship-trained shoulder surgeon participated in this study. Outcome measurements pre-SBSI, during Phase I (early pain control ≤ 3weeks post-SBSI), Phase II (early rehabilitation > 3-11weeks post-SBSI), Phase III (advanced rehabilitation-early balloon resorption > 11-16weeks post-SBSI), Phase IV (early strength training > 16-24weeks post-SBSI), and Phase V (advanced strength training > 24weeks post-SBSI) included the American Shoulder and Elbow Society (ASES) score for perceived bilateral shoulder function, visual analog scale (VAS) surgical shoulder pain score, active mobility, and shoulder manual muscle strength testing (p ≤ 0.05). The mean final follow-up time was 40weeks (range = 24.1-89.7weeks). The surgical shoulder had higher ASES scores at Phase V than pre-SBSI. Surgical shoulder pain was less during Phase V than pre-SBSI. The surgical shoulder had greater flexion during Phase V than at Phase II or pre-SBSI, and greater external rotation (adducted) during Phases V-III than pre-SBSI. Peak shoulder internal rotation to level 12 (thoracic spinous process #10) occurred during Phase V. Peak shoulder flexor, external rotator, and internal rotator strength occurred during Phase V. During Phase I, most subjects were unable to sleep on their surgical shoulder, wash their back/do up their bra, reach a high shelf, or lift 10-lbs overhead. Tasks that were impaired during the "balloon dip" (between Phase III and V) were lifting 10-lbs overhead, reaching a high shelf, and doing normal work. By the end of Phase V, however, most subjects could perform each task with minimal or no difficulty. Surgical shoulder function improved and pain decreased, however, specific perceived functional task impairments remained. During the "balloon dip" phase, the perceived ability to lift 10 lbs above shoulder level, to reach a high shelf, and to do usual work activities were the most impaired tasks.

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

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

Proximal Tibiofibular Joint Stabilization Using an Adjustable-Length Suspensory Fixation Device

Background: Proximal tibiofibular joint (PTFJ) injuries are rare injuries, and the optimal treatment is poorly understood. Surgical treatment options for PTFJ instability include reconstruction with allograft, stabilization with an adjustable-ength suspensory fixation device, open reduction and internal fixation with a screw, arthrodesis, and proximal fibular resection. Indications: In acute first-time PTFJ dislocations, nonoperative treatment may be trialed after closed reduction. Operative treatment is indicated for first-time dislocation with concomitant operative injury, an irreducible dislocation, and chronic symptomatic PTFJ instability. Taping or PTFJ injections can be helpful for diagnostic and therapeutic purposes and should be trialed before moving forward with surgical treatment. Technique Description: Multiple PTFJ stabilization and reconstruction techniques have been described for PTFJ instability. This technique describes a stabilization technique utilizing an adjustable-ength suspensory fixation device that is placed through a posterolateral approach to the knee. Results: A prior systematic review of PTFJ injuries found that approximately 59% of patients with a PTFJ dislocation were successfully treated nonoperatively with no symptoms at a mean final follow-up of 15.9 months. While multiple case reports and techniques have been reported for PTFJ stabilization using an adjustable-ength suspensory fixation device, there are limited data on outcomes of this procedure. Discussion/Conclusions: PTFJ stabilization using an adjustable-ength suspensory fixation device is a safe and technically feasible option for the treatment of PTFJ instability. It is critical to confirm the diagnosis of symptomatic PTFJ instability with either a taping trial or a diagnostic injection before proceeding with surgical treatment. 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.

Use of medialized trochanteric-entry intramedullary nail to improve alignment in proximal femur nonunions.

Proximal femur shaft nonunion is a challenging problem, often occurring after malreduction that results in postoperative malalignment and decreased healing potential. Correction of malalignment is critical to achieving osseous union. Here we present a novel technique for treating proximal femur nonunions with varus malalignment using an intramedullary nail inserted through a medialized trochanteric entry point. Patients who underwent a proximal femur shaft (subtrochanteric or proximal third shaft) nonunion operation at a single level 1 academic referral centre by two attending surgeons between 1/1/2014 and 1/1/2022 were identified. Radiographic imaging was reviewed to determine initial fracture classification and calculation of coronal plane alignment (CPA), which was measured on preoperative, immediate postoperative, and final follow-up radiographs. Postoperative complications, reoperations, infections, and osseous union were also collected. Twenty-one patients with a mean age of 49.9 years (66% male) were identified. Mean preoperative CPA was 125.6 degrees, immediate postoperative mean CPA was 132.6 degrees, and mean final follow-up CPA was 131.5 degrees. Mean change in CPA from immediate postoperative films to final follow-up was a decrease of 0.4 degrees. 17 patients had follow up for a minimum of 12 months or until osseous union, and all achieved union without any major complications. Exchange nailing with an antegrade trochanteric entry nail through a medialized trochanteric starting point is a safe and effective technique in the treatment of proximal femur nonunions. This technique results in improved postoperative alignment that is sustained throughout the postoperative course, and may lead to increased rates of osseous union.

Evaluating the Effectiveness of Ahmed Glaucoma Valve Implantation in Reducing Intraocular Pressure in Refractory Glaucoma in the Saudi Arabian Population at a Tertiary Care Centre

Objectives: To assess the efficacy of Ahmed glaucoma valve implantation (AGVI) in lowering intraocular pressure (IOP) in patients with refractory glaucoma. Methods: In this retrospective study, we analyzed the medical records of 60 patients who received AGVI for refractory glaucoma. Data collected included demographics, type of glaucoma, preoperative and postoperative IOP, number of glaucoma medications, and any surgical complications. Success was defined as achieving an IOP &lt;21 mmHg at the final follow-up visit. Results: At the final follow-up (mean duration of 11.6 months), AGVI achieved successful IOP control (IOP of &lt;21 mmHg) in 40 eyes (66.7%). The mean number of glaucoma medications decreased significantly from 2.95 preoperatively to 1.98 postoperatively (p &lt; 0.001). Neovascular glaucoma (NVG) had a lower success rate compared to other types of glaucoma. Prior glaucoma surgery was associated with a higher risk of failing to reach target IOP, although this trend was not statistically significant (p = 0.108). Conclusion: AGVI implantation effectively lowered IOP in patients with refractory glaucoma, especially in the short term. However, long-term success rates were lower, and NVG showed less favorable outcomes. AGVI is a valuable option for managing refractory glaucoma, but careful patient selection is essential. Further research is needed to evaluate long-term efficacy and refine treatment strategies.

Hand reanimation: functional free gracilis transfer or transfer of the distal tendon of the biceps to the flexor digitorum profundus and flexor pollicis longus as surgical options.

Hand reanimation for finger flexion in patients with total paralysis remains a reconstructive challenge, especially when tendon transfers or neurological reconstruction options are no longer viable. This study aimed to describe a series of patients without hand function by evaluating two hand reanimation techniques. This observational retrospective study used a case series of hand reanimation. Two techniques were performed-functional free gracilis muscle transfer with microsurgical reconstruction, and transfer of the recovered biceps to the flexor digitorum profundus and flexor pollicis longus with tendon graft augmentation. The two groups, each undergoing one of the techniques, were evaluated for the final functional results using the British Medical Research Council (BMRC) grading system. Six consecutive patients with total hand paralysis were included, with a mean final follow-up of 7.5 years. After intervention, two patients, one from each technique group, achieved a BMRC grade 2. In the group where tendon transfer of the biceps to the finger flexors was performed, two patients achieved a BMRC grade 3. Additionally, two patients who underwent functional free muscle transfer were achieved a BMRC grade 4. The transfer of biceps to the finger flexors using tendon grafts, which involves fewer technical difficulties and reduced demands from the surgical team compared to functional free muscle transfer, is a viable alternative for treating patients requiring hand reanimation. However, functional free muscle transfer is recommended as the first option when technically feasible and adequate donor nerves are available, due to its potential for achieving greater final muscular strength in the finger flexors. Reconstructive microsurgeons can use both techniques as viable surgical options for hand reanimation.

Increasing the Knee Arc of Motion in Patients With Arthrogryposis: Minimum 2-year Follow-up.

Surgery for knee flexion contractures in patients with arthrogryposis multiplex congenital (AMC) have achieved extension to redirect the arc of motion and improve ambulation but has not demonstrated maintained increases in total range of motion (ROM). This study aimed to review the clinical outcomes of combined posterior knee release, proximal femoral shortening, and nerve decompression in patients with arthrogryposis. A retrospective chart and radiographic review were performed on patients with AMC who underwent treatment for knee flexion deformities ≥30 degrees. ROM, ambulation status, and orthotic use were reviewed and analyzed. Complications were recorded. Twenty-nine patients with 51 knees and a mean age of 5.7 years were included. The mean follow-up was 36.9 months. The mean ROM increased from 49 to 80 degrees between pre-op and latest follow-up (P<0.0001). The mean final follow-up flexion deformity was 10 degrees (P<0.0001). Preoperative ROM was moderately correlated with final ROM (rs=0.51). The percentage of ambulatory patients improved from 39% to 93%. Five limbs experienced a fracture either intraoperatively or postoperatively, and 5 limbs required a return trip to the operating room. Improved ambulation and knee ROM can be maintained in patients with AMC at a minimum 2-year follow-up. Prospective investigation and longer follow-up are required to validate these findings. Level IV-therapeutic.

Unbalanced metaphyseal fixation is associated with an increased aseptic loosening of revision total knee arthroplasty at mean 4-year follow-up.

The total number of total knee arthroplasty performed is rising, and the number of revisions is rising accordingly. Periprosthetic joint infection emerged in recent years as a leading cause of total knee revisions. Bone loss is a real challenge when facing septic knee revisions since radical debridement is crucial to overcome infection. Many devices have already demonstrated to reliably address bone loss and guarantee enhanced fixation. However, the role of balancing metaphyseal fixation and its interplay with the level of constraint has not been elucidated yet. An institutional arthroplasty registry was retrospectively reviewed looking for patients who underwent two-stage revision of the knee and metaphyseal cones implantation. Patients were divided into two groups based on the presence of cones only on one side (femoral or tibial, Group U) or both femoral and tibial side (Group B). Failure, aseptic loosening, and revision rates were compared between groups, as were values of patient-reported outcome measure. Kaplan-Meier analysis was used to assess survival of implants. A total of 65 patients were included in the analysis and were evaluated at a mean final follow-up of 4years (range, 2-7). Mean age was 67 (range, 43-81) years. Mean BMI was 27.4 (range, 20-37) kg/m2. The overall mean KSS, OKS, ROM significantly increased from baseline values to last follow-up (p < 0.001). Kaplan-Meier analysis demonstrated that patients included in Group U had a significantly lower rate of implant survival compared to those included in Group B. Patients undergoing revision total knee arthroplasty for periprosthetic infection present considerable rates of complication and failure. Management of bone loss represents a concern for the surgeon, who must achieve a stable fixation. Our study demonstrated that implants characterized by an unbalanced metaphyseal fixation are at higher risk of aseptic loosening and consequent revision, especially when coupled with hinged inserts.

Transfibular Approach in Treating Malunited Ankle Fracture

Category: Trauma; Ankle Introduction/Purpose: The surgical treatment of malunited ankle fracture is challenging. This study investigated the results of reconstruction for malunited ankle fracture involving lateral and posterior malleolus via transfibular approach. Methods: Between Jan 2015 and Feb 2017, 10 patients underwent reconstruction surgeries for malunited ankle fracture involving lateral and posterior malleolus were followed up. All the ten surgeries were performed via transfibular approach. The mean final follow-up was 26.2 months (range 24–36). American Orthopaedic Foot and Ankle Society (AOFAS)score, Visual Analogue Scale (VAS) for pain, and patients’ subjective satisfaction were used to measure clinical outcomes. Results: The mean AOFAS-AH score and VAS score improved from 43±10.7 to 79±7.8 points (p &lt; 0.05), 6.7±1.0 to 2.0±1.2 points (p &lt; 0.05), respectively. Five patients rated the result as excellent, 4 as good and 1 as fair. Conclusion: The transfibular approach can expose and reduce both the posterior and lateral malleolar malunion with minimal additional soft tissue disruption. It is a useful method to correct the malunited ankle fracture involving lateral and posterior malleolus.

Outcomes of One-Stage Arthroscopic Ankle and Tibiotalocalcaneal Arthrodesis with External Fixation for Septic Ankle and Hindfoot Arthritis: A Case-Series Study

Category: Hindfoot; Arthroscopy Introduction/Purpose: The occurrence of infection in the ankle and hindfoot presents a formidable surgical challenge. Currently, there is a lack of consensus regarding its treatment strategies. The purpose of this study is to investigate the outcomes of one-stage arthroscopic ankle and tibiotalocalcaneal (TTC) arthrodesis in the treatment of septic ankle and hindfoot arthritis. Methods: A retrospective consecutive case-series study was conducted involving 6 patients diagnosed with acute or chronic septic ankle or hindfoot arthritis, who underwent operative intervention entailing thorough debridement, arthroscopically assisted one-stage ankle or TTC fusion, and external fixation. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS) pain score were determined preoperatively and at the final follow-up. Demographic and clinical data, inclusive of perioperative and postoperative complications, were recorded. Results: The study cohort comprised 2 males and 4 females, with a mean age of 48.7 years (range, 26-75) at the time of surgical intervention. At the final follow-up (mean, 26.5 months; range, 16-48), the AOFAS scores exhibited a significant improvement, ascending from an initial mean of 38.8 (range, 12-57) to 80.0 (range, 54-92) (P = .007). VAS scores indicated a substantial reduction in pain, decreasing from 6.5 (range, 4-9) to 0 (range, 0-5) (P = .046). All patients had achieved osseous consolidation, with an hindfoot infection control rate of 100%. Conclusion: One-stage arthroscopic ankle and TTC arthrodesis with external fixation stands as an effective therapeutic choice for septic ankle or hindfoot arthritis. This approach yields favorable outcomes characterized by effective infection control, favorable osseous consolidation, and significant functional restoration of the affected limb.

Chronic Isolated Fracture of the Metatarsal Head in Lesser Toes Treated with Open Reduction and Internal Fixation

Category: Lesser Toes; Trauma Introduction/Purpose: Isolated fractures of a metatarsal head in the lesser toes are uncommon in clinical practice and are prone to being overlooked, potentially leading to chronic fractures or mal-union. This study aims to report the clinical and imaging characteristics, as well as treatment results, of these fractures. Methods: A retrospective consecutive case-series study was performed on 5 patients with symptomatic chronic isolated shear fracture of a metatarsal head in the lesser toes from January 2018 to April 2021. There were 4 males and 1 female, with a mean age of 26.2±6.7(range, 19-36) years at the time of surgery. Two of them (40%) were not diagnosed initially. The main symptom was limited dorsiflexion of the MTPJ. Preoperative X-rays and CT scans revealed dorsal displacement of the fragment without dislocation of the MTP joint.All patients were operatively treated using open reduction and internal fixation (ORIF). The American Orthopaedic Foot &amp; Ankle Society-lesser metatarsophalangeal-interphalangeal (AOFAS-LMI) score, visual analog scale (VAS) score, and passive dorsiflexion range of motion (ROM) of the metatarsophalangeal joint (MTPJ) were determined preoperatively and at final follow-up. Postoperative complications were also recorded. Results: All of the chronic fractures achieved union. At the final follow-up (mean, 27.8±15.5 months; range 6-45), the mean AOFAS-LMI scores was 90.6±8.4 (range, 82 - 100) points, the median VAS score was 0 (range, 0 - 2.0) points, and the median MTPJ passive dorsiflexion ROM was 40.0 (range, 35 - 45) degree, which were improved compared with preoperatively [(70.6±7.4) (range, 59 - 79) points, 4.0 (range, 2.0 - 5.0) points, 10.0 (range, 5.0 - 10.0) degree, respectively)]. All patients returned to their respective preinjury activity levels. Three patients developed metatarsophalangeal joint arthritis. Conclusion: Patients with a chronic isolated shear fracture of a metatarsal head in the lesser toes treated by ORIF achieved good short-term and mid-term clinical outcomes. Figure 1 The male patient, aged 27, fell from a height of 1.5 meters, resulting in injury with a duration of 6 months. He complained of localized obscure pain in the right fourth metatarsophalangeal joint, with restricted dorsiflexion. Plain radiograph revealed narrowing of the fourth metatarsophalangeal joint space and overlapping shadows between the base of the proximal phalanx and the metatarsal head (A); oblique radiograph showed dorsal displacement and angular deviation of the fracture fragment, with loss of normal joint morphology (B); CT imaging demonstrated dorsal displacement of the metatarsal head fragment (C); physical examination indicated restricted dorsiflexion of the metatarsophalangeal joint (D); intraoperatively, a dorsal approach to the metatarsophalangeal joint was utilized (E); exposure revealed fracture of the metatarsal head, with dorsal displacement and deformity (F); osteotomy was performed along the original fracture line, and the fracture fragment was temporarily removed for debridement (G); fracture reduction was achieved, followed by temporary fixation with two Kirschner wires (H); definitive fixation was accomplished using a headless compression screw (I); the incision was closed layer by layer (J); manual manipulation confirmed full range of motion and smooth movement of the metatarsophalangeal joint (K); intraoperative fluoroscopy with a C-arm machine showed satisfactory reduction and optimal screw positioning (L, M); postoperative radiographs at 6 weeks (N, O) demonstrated fracture healing; at the final follow-up, anteroposterior (P) and lateral (Q) radiographs showed excellent fracture consolidation with mild signs of arthritis.

Visual and surgical outcomes of childhood glaucoma following cataract surgery

PurposeTo evaluate frequency of surgery and post-treatment outcomes in glaucoma following cataract surgery (GFCS). MethodsThe medical records of patients with GFCS were reviewed retrospectively. Lensectomy and glaucoma surgery details and final examination findings were collected. Inclusion criteria included history of lensectomy at <1 year of age, diagnosis of glaucoma, and at least 1 year of follow-up. ResultsOf 169 eyes of 127 GFCS patients (66 male, 58 bilateral cases), 88 eyes (52%) of 73 (57%) patients underwent glaucoma surgery (median, 3.5 years of age at first glaucoma surgery; median of two glaucoma surgeries). At final follow-up (mean, 13.6 ± 7.0 years), eyes requiring glaucoma surgery had worse visual acuity (P = 0.01) and greater cup:disk ratio (P < 0.01). GFCS patients with history of bilateral congenital cataracts had better visual acuity in affected eyes than those with history of unilateral congenital cataract (P < 0.01). Angle surgery (n = 56), Baerveldt devices (n = 38), Ahmed valves (n = 19), and cycloablation (n = 21) showed 1-year survival rates between 64% and 75%. Baerveldt implants showed the highest 5- and 10-year survival rates, at 65% and 43%, respectively. ConclusionsMore than 50% of eyes with GFCS in our study cohort required at least one glaucoma surgery. Glaucoma surgery and history of unilateral cataract were associated with worse visual acuity outcomes.

Initial Outcomes following Fresh Meniscus Allograft Transplantation in the Knee.

Based on recent evidence-based advances in meniscus allograft transplantation (MAT), fresh (viable) meniscus allografts have a potential for mitigating key risk factors associated with MAT failure, and preclinical and clinical data have verified the safety of fresh meniscus allografts as well as possible efficacy advantages compared to fresh-frozen meniscus allografts. The objective of this study was to prospectively assess clinical outcomes for the initial cohort of patients undergoing MAT using fresh meniscus allografts at our center. Patients who were prospectively enrolled in a dedicated registry were included for analyses when they had undergone primary MAT using a fresh meniscus allograft for treatment of medial and/or lateral meniscus deficiency with at least 1-year follow-up data recorded. Forty-five patients with a mean final follow-up of 47.8 months (range = 12-90) were analyzed. Mean patient age was 30.7 years (range = 15-60), mean BMI was 29.7 kg/m2 (range = 19-48), and 14 patients (31%) were female. In total, 28 medial, 13 lateral, and 4 combined medial and lateral MATs with 23 concurrent ligament reconstructions and 2 concurrent osteotomies were included. No local or systemic adverse events or complications related to MAT were reported for any patient in the study. Treatment success rate for all patients combined was 91.1% with 3 patients requiring MAT revision and 1 patient requiring arthroplasty. Treatment failures occurred 8 to 34 months after MAT and all involved the medial meniscus. None of the variables assessed were significantly different between treatment success versus treatment failure cohorts. Taken together, the data suggest that the use of fresh (viable) meniscus allografts can be considered a safe and effective option for medial and lateral meniscus allograft transplantation. When transplanted using double bone plug suspensory fixation with meniscotibial ligament reconstruction, fresh MATs were associated with a 91% success rate, absence of local or systemic adverse events or complications, and statistically significant and clinically meaningful improvements in patient-reported measures of pain and function at a mean of 4 years postoperatively.