Minimum 2-year Follow-up Research Articles

Arthroscopic Lower Trapezius Tendon Transfer Effectively Relieves Pain and Improves Shoulder Function in Patients with Irreparable Infraspinatus Tears: Minimum 5-Year Follow-Up

Arthroscopic Lower Trapezius Tendon Transfer Effectively Relieves Pain and Improves Shoulder Function in Patients with Irreparable Infraspinatus Tears: Minimum 5-Year Follow-Up

Percutaneous Cryotherapy and Radiofrequency Ablation of Renal Masses: Multicenter Comparative Analysis with Minimum 3-Year Follow-up.

Different modalities of percutaneous thermal ablation (PTA) have been used as possible minimally invasive nephron-sparing treatments for small renal masses (SRMs). The present study aimed to compare long-term outcomes of two guidelines-recommended ablative techniques, cryotherapy (CRYO) and radiofrequency ablation (RFA). Data of patients with single cT1 solid renal mass undergoing CRYO or RFA between 2004 and 2020 were retrospectively retrieved from a multi-institutional international database. Oncologic outcomes included "technical success", local recurrence-free survival (RFS), distant metastasis-free survival (MFS), and overall survival (OS). Intraoperative and postoperative complications, length of stay (LOS), and re-admission rate within 30 days were registered. Major complications were defined as CD grade ≥III. Baseline features and treatment outcomes were analyzed using descriptive statistics. RFS, MFS, and OS were estimated using the Kaplan-Meier method. Overall, 643 patients were included, of which 492 (71.2%) underwent CRYO, and 151 (21.8%) RFA, with a median follow-up of 43 and 37 months, respectively (p=0.07). Technical success was achieved in 96.5% of CRYO vs 93.4% of RFA (p=0.09). No difference in terms of overall (CRYO: 10.4% vs RFA: 6%; p=0.1) and "major" (CRYO: 0.8% vs RFA: 1.3; p=0.06) post-operative complications were observed. RFS (CRYO:85.7%; RFA:84.9%, p=0.2), MFS (CRYO: 96.9%; RFA: 95.8%, p=0.4) and OS (CRYO: 89%; RFA: 87.4%; p=0.8) were comparable. CRYO and RFA are both valid minimally invasive options for the treatment of small renal tumors. They are particularly suitable for patients who are not good surgical candidates as they offer very low risk of major procedure-related complications. For the right indication, they both offer favorable mid to long term oncologic outcomes.

First-line (1L) tislelizumab (TIS) plus chemotherapy (CT) vs placebo (PBO) plus CT in advanced/metastatic esophageal squamous cell carcinoma (ESCC): RATIONALE-306 Japanese subgroup analysis with longer follow-up.

420 Background: In the global phase 3 RATIONALE-306 study (NCT03783442), TIS + CT showed a significant overall survival (OS) benefit vs PBO + CT as 1L therapy for advanced/metastatic ESCC. After a minimum 3-year follow-up, the hazard ratio (HR) for OS was 0.70 for all randomized patients (pts) and for pts with programmed death-ligand 1 (PD-L1) Tumor Area Positivity (TAP) score ≥10%.We report results for the Japanese subgroup. Methods: Eligible pts enrolled in Japan were randomized (1:1) to receive intravenous TIS 200 mg or PBO every 3 weeks + investigator-chosen CT (platinum + fluoropyrimidine/paclitaxel) until disease progression or intolerable toxicity. The primary endpoint was OS in the intent-to-treat (ITT) population. Secondary endpoints included progression-free survival (PFS), objective response rate (ORR), safety, and OS in pts with PD-L1 TAP score ≥10%. Results: Of 649 randomized pts, 66 (10.2%) were Japanese, median age was 67 years, 89.4% were male, and 28.8% had PD-L1 TAP score ≥10%. At study entry, Eastern Cooperative Oncology Group performance status was 0 for 77.3% pts and 97.0% had metastatic disease. As of Nov 24, 2023, 78.8% vs 84.8% Japanese pts on TIS + CT vs PBO + CT received post-systemic therapy (ITT: 51.5% vs 57.9%). After a minimum follow-up of 37.9 months, TIS + CT showed improvements vs PBO + CT in median OS (24.5 vs 15.1 months [mo]; HR: 0.75) in all pts and in pts with PD-L1 TAP score ≥10% (HR: 0.79), median PFS (HR: 0.77) and ORR (63.6% vs 45.5%) (Table). Treatment-related adverse events (TRAEs) with TIS + CT vs PBO + CT in Japanese pts were 45.5% vs 36.4% for any grade (ITT: 69.8% vs 60.7%); 27.3% vs 6.1% for grade ≥3 (ITT: 32.1% vs 20.2%); 24.2% vs 3.0% for serious TRAEs (ITT: 19.8% vs 8.4%); TRAEs led to treatment discontinuation in 3.0% vs 6.1% (ITT: 13.3% vs 6.5%). No TRAEs leading to death were reported in Japanese pts (ITT: 1.5% vs 0.6%). Conclusions: After 3 years, TIS + CT continued to demonstrate robust efficacy and a tolerable safety profile in Japanese pts as 1L therapy for advanced/metastatic ESCC in the RATIONALE-306 study, consistent with the overall population. Clinical trial information: NCT03783442 . Efficacy outcomes. JapanTIS + CT(n=33) JapanPBO + CT(n=33) OverallTIS + CT(n=326) OverallPBO + CT(n=323) Median OS, mo (95% CI) 24.5 (17.6, 26.9) 15.1 (8.0, 22.5) 17.2 (15.8, 20.1) 10.6 (9.3, 12.1) HR (95% CI) 0.75 (0.43, 1.30) - 0.70 (0.59, 0.83) b - PD-L1 TAP score ≥10%, n (%) 12 (36.4) 7 (21.2) 116 (35.6) 107 (33.1) Median OS by PD-L1 TAP score ≥10%, mo (95% CI) 25.5(10.9, NE) 16.8(0.9, NE) 16.6(15.3, 23.4) 10.0(8.6, 13.3) HR (95% CI) 0.79 (0.26, 2.36) - 0.70 (0.52, 0.95) b - Median PFS a , mo (95% CI) 6.8 (4.4, 8.5) 4.5 (4.1, 6.7) 7.3 (6.9, 8.3) 5.6 (4.9, 6.0) HR (95% CI) 0.77 (0.45, 1.32) - 0.60 (0.50, 0.72) b - ORR a , n (%) 21 (63.6) 15 (45.5) 207 (63.5) 137 (42.4) a Investigator assessed. b Stratified. CI, confidence interval; NE, not estimable.

Combined Medial Patellofemoral Ligament and Medial Quadriceps Tendon Femoral Ligament Reconstruction with Semitendinosus Allograft for Pediatric Patients with First-Time Patella Dislocation Yields Low Failure Rates and Improved Functional Outcomes Compared to Non-Operative Treatment.

The purpose of this cohort study is to evaluate the clinical outcomes of non-operative versus operative treatment, consisting of combined Medial Patellofemoral Ligament and Medial Quadriceps Tendon Femoral Ligament (MPFL/MQTFL) reconstruction, for first-time patellar dislocation in the skeletally immature population through a standardized, rigorous approach. This consecutive retrospective cohort is comprised of all skeletally immature patients that sustained a first-time patellofemoral dislocation. Patients were grouped into non-operative management (bracing and physical therapy) and operative management (MPFL/MQTFL reconstruction) cohorts. The primary outcome, failure, was defined as subsequent dislocation or subluxation. Additional outcomes included demographics, risk factors for patellofemoral instability, functional outcomes (Kujala and IKDC scores), return to sports, and complications. Minimum follow up was 2 years. A correlation analysis attempted to identify potential associations between failure and risk factors. 142 consecutive patients were included with 90 patients in the non-operative and 52 patients in the operative group. Failure rates differed by intervention; those receiving operative management had significantly lower failure rates than conservative management (15.4% versus 58.8%, p<.0001). Kujala and IKDC scores were significantly higher in the operative group, as compared to the non-operative group (91.5±7.8 versus 82.5±12.1, p<.0001 and 89.0±9.3 versus 78.4±12.9, p<.0001, respectively). Tegner activity level was also higher at the operative group (6.0±1.4 versus 4.0±1.4, p<.0001). Return to sport was significantly greater for those in the operative group (88.5% versus 66.2%, p<.001). Return to same level of activity was achieved in higher percentage of patients treated surgically (91.3% versus 69.6%, p=0.0075). Complication rates were more frequent in the operative group compared to the non-operative group (11.5% versus 1.1%, p<.001). MPFL/MQTFL reconstruction in skeletally immature patients with first-time patellofemoral dislocation demonstrated lower failure rates and improved functional outcomes at a minimum 2-year follow-up, as compared to non-operative management. III.

Can Surgery Be Proposed to Adolescent Idiopathic Scoliosis Patients With Structural Lumbar Curves Associated With Nonreducible Iliolumbar Angle?

Lower instrumented vertebra (LIV) selection for adolescent idiopathic scoliosis (AIS) with structural lumbar curves (Lenke 3, 5, and 6) remains debated. The iliolumbar angle (ILA) measurement is useful for assessing the lumbosacral junction flexibility. If it is nonreducible, surgeons need to make a difficult choice between a potential "imperfect" L4, associated with a residual lumbosacral curve, or a more distal fusion performed later in life due to poorer functional outcomes. The goal of this study was, therefore, to evaluate the postoperative radiographic and functional outcomes of AIS patients with nonreducible ILA. All consecutive AIS patients (2017 to 2022) with a structural lumbar curve and a posterior fusion ending on L4 were retrospectively included. Radiographic and functional outcomes (SRS-30 score) were reported with a minimum 2-year follow-up. Standing low dose stereoradiographs in both erect and maximum lateral bending positions were performed in all patients, and 2 groups of subjects were compared based on preoperative ILA flexibility [reducible group (R) or nonreducible group (NR)]. A total of 122 patients were included (30% NR and 71% R). At a mean follow-up of 2.3±0.1 years, surgery was efficient in correcting the major curve (77% reduction rate in the R group and 76% in the NR group, P<10-5), and significantly improved coronal balance (R, P<10-5 and NR, P=0.03) as well as the ILA [mean ILA gain 14 degrees (R group), P<10-5 and 16 degrees (NR group), P<10-5]. The proportion of excellent results was higher in the R group, but 97% of outcomes were either excellent or acceptable in the NR group, and only 1 case of poor result (residual ILA >10 degrees) was reported in each group. No significant difference was found in SRS 30 scores between groups, but scores were significantly improved in the NR group for the excellent outcomes' subgroup [self-image (P=0.04) and satisfaction (P=0.02) domains]. The current study confirms that posterior fusion ending on L4 can still be proposed to young AIS patients with structural lumbar curves, even if the lumbosacral flexibility is limited. Level III-comparative study.

Patients Undergoing Manipulation under Anesthesia following Primary Total Knee Arthroplasty: Are Their Patient-Reported Outcome Measures Inferior?

Stiffness after total knee arthroplasty (TKA) can lead to decreased function and patient dissatisfaction. Manipulation under anesthesia (MUA) is often performed to improve range of motion (ROM); however, there is no consensus on indications or timing. The purpose of this study was to compare clinical results and patient-reported outcome measures (PROMs) between patients who underwent MUA versus those with an uncomplicated postoperative course following primary TKA. This was an institutional review board-approved retrospective review of 116 consecutive patients who underwent MUA from 2013 to 2019 following primary TKA due to stiffness. Indication for MUA was failure to achieve 105 degrees of knee flexion at 6 weeks following surgery. Five patients underwent revision surgery and 15 patients from the MUA group were excluded: 12 lost to follow-up and 3 deaths. The remaining 96 MUA patients were matched to 288 TKAs who did not require MUA or revision, all with a minimum 2-year follow-up. Patients who underwent MUA were younger (60.7 vs. 66.3 years, p < 0.001) and had less preoperative knee flexion (105.4 vs. 110.7 degrees, p < 0.001). There were five (4.9%) revisions in the MUA group: two instability, two chronic pain, and one arthrofibrosis. There were no differences between the groups with respect to postoperative Knee Society Knee Score, Western Ontario and McMaster Universities Osteoarthritis, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Forgotten Joint Score-12, satisfaction, or complications. Satisfaction rates were 88.5% among MUA patients and 89.6% among non-MUA patients (p = 1.0). Patients undergoing MUA following TKA, using the criteria of failure to achieve 105 degrees of flexion by 6 weeks postoperatively, were able to achieve similar PROMs and satisfaction compared with a control group with a low incidence of revision due to persistent arthrofibrosis.

Patients With Chronic Lateral Ankle Instability and Small Osteochondral Lesions of the Talus Obtain Good Postoperative Results: A Minimum 10-Year Follow-up With Radiographic Evidence.

Few studies reported the long-term clinical outcomes and joint degeneration of patients with chronic lateral ankle instability (CLAI) and small osteochondral lesions of the talus (OLTs) following simultaneous open modified Broström-Gould (MBG) surgery and arthroscopic bone marrow stimulation (BMS). The purpose of this study was to study the long-term results of patients after BMS and BMG surgery, and to further evaluate the potential effect of OLT size on postoperative results. In this retrospective study, 110 CLAI patients were divided into 57 patients with OLTs (including 24 patients having combined small osteochondral lesions of the tibial plafond) receiving simultaneous BMS and MBG surgeries (BMS+MBG group), and 53 patients without OLTs receiving isolated open MBG surgery (MBG group). The OLT size and pre- and postoperative Kellgren-Lawrence grade were assessed. The subjective scores (visual analog scale pain score, Tegner activity, and Karlsson-Peterson scores), surgical complications, and return to sports were also compared pre- and postoperatively. Patients were followed up at a mean of 144.2 ± 14.9 and 145.6 ± 11.4 months for the BMS+MBG and MBG groups, respectively. Subjective scores were significantly improved (P < .001), and no difference was found in subjective scores or surgical complications between the 2 groups (P > .05). Both groups showed progression of osteoarthritis grade (P < .001), but with no significant difference of changes from the preoperative to the final follow-up (BMS+MBG group: 0.84 ± 0.75 to 1.32 ± 0.80; MBG group: 0.32 ± 0.48 to 0.86 ± 0.56, changes: 0.48 ± 0.59 vs 0.55 ± 0.51, P = .575). For sports function, both groups had similar results in Tegner scores (5.8 ± 1.3 vs 6.2 ± 1.3, P = .081). However, in a subgroup analysis, we found that in the BMS+MBG group, patients exceeding the mean size of OLTs (50 mm2) were associated with an average lower postoperative Karlsson-Peterson score (P = .025) and higher postoperative osteoarthritis grade (P = .037), with more changes (P = .017) than those with OLTs <50 mm2. Patients with CLAI and small OLTs following simultaneous open MBG surgery and arthroscopic BMS showed good long-term outcomes and only mild progression of joint degeneration-overall similar to patients treated for CLAI with MBG surgery. Moreover, as OLT size increased, good outcomes were less predictable.

Long-Term Clinical Outcomes and Risk Indicator Analyses of Narrow-Diameter Implants in the Posterior Jaw: A Retrospective Cohort Study of 10 to 27 Years.

To assess the long-term clinical outcomes and patient satisfaction with narrow-diameter implants (NDIs) in the posterior jaws and to identify the risk indicators for NDI failure. This retrospective study reviewed 479 patients with 666 NDIs (diameter ≤ 3.5 mm) -supported fixed prostheses in posterior jaws, with a minimum 10-year follow-up. Implant survival, success, complications, demographics, and implantation characteristics were collected. Risk indicators for posterior NDI failure were analyzed using multilevel Cox regression analyses with mixed effects. Patient satisfaction and oral health impact profile (OHIP) were surveyed in a random 10% sample. Over a mean follow-up of 14.0 ± 3.6 years, implant survival was 95.9% at the implant level and 94.6% at the patient level. Success rates were 93.5% at the implant level and 91.6% at the patient level. Multilevel Cox regression analysis identified an implant length of 10 mm or less (p = 0.001) and the use of single crowns (p = 0.005) as significant risk indicators for posterior NDI failure. Patients showed high satisfaction (4.54/5) with posterior NDIs, and the mean OHIP score of 1.15 reflected an acceptable level of oral health. NDIs in the posterior jaws demonstrated robust long-term success and high patient satisfaction. An implant length of 10 mm or less and the use of single crowns are potential risk indicators for posterior NDI failure. Chinese Clinical Trial Registry: ChiCTR2200062337 on 2022/08/02.

The Prevalence of Tear Patterns and Their Effects on Tendon Healing After Arthroscopic Surgery in Patients With Full-Thickness Rotator Cuff Tears.

To achieve successful anatomic rotator cuff repair with minimal tension, both the tear pattern and tear size should be considered. However, little information is available concerning the frequency of tear patterns and their effects on tendon healing. To evaluate the distribution of tear patterns in full-thickness rotator cuff tears and whether these patterns affect tendon healing after arthroscopic repair. Case-control study; Level of evidence, 3. Between 2014 and 2021, patients who underwent arthroscopic surgery for symptomatic full-thickness rotator cuff tears with a minimum 2-year follow-up with postoperative magnetic resonance imaging or ultrasound were retrospectively reviewed. After the debridement of degenerative tendon tissue during arthroscopic surgery, the tear pattern was classified as crescent, U, or anterior or posterior L shaped. Intergroup differences in clinical and radiological characteristics were analyzed. In the subgroup analysis, patients were divided into 2 subgroups: small-to-medium or large-to-massive tears. Among the 1037 patients with a full-thickness rotator cuff tear, the most common tear pattern was crescent shaped (39.6%), followed by posterior L, U, and anterior L shaped (26.0%, 21.4%, and 12.9%, respectively). In the subgroup analysis, 713 patients (68.8%) had small-to-medium tears, while 324 (31.2%) had large-to-massive tears. The proportion of large-to-massive tears was significantly higher for the anterior L-shaped tear pattern than for the other tear patterns (24.8%, 28.8%, 52.2%, and 32.6% for crescent, U, and anterior and posterior L shaped, respectively; P < .001). The anterior L-shaped tear pattern had a significantly higher retear rate than the other tear patterns in small-to-medium tears (7.8%, 13.0%, 28.0%, and 10.6% for crescent, U, and anterior and posterior L shaped, respectively; P < .001). The rate of revision surgery because of a symptomatic retear within 2 years after primary surgery was significantly higher for the anterior L-shaped tear pattern than for the other tear patterns (3.8%, 7.5%, 21.6%, and 0.0% for crescent, U, and anterior and posterior L shaped, respectively; P = .002). The prevalence of tear patterns varied depending on the tear size. In small-to-medium tears, the anterior L-shaped tear pattern had the lowest incidence among the tear patterns; however, it had a significantly higher retear rate. Furthermore, the anterior L-shaped tear pattern had a higher incidence of retears requiring early revision surgery than the other tear patterns.

Anatomic and Reverse Total Shoulder Arthroplasty for Osteoarthritis: Outcomes in Patients 80 Years Old and Older.

There has been an increase in both primary anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) over the last decade, with rates peaking for patients aged 75 years and older. Despite aTSA being the mainstay of treatment for patients with glenohumeral arthritis in the absence of rotator cuff insufficiency, there has been an upward trend of rTSA utilization in the elderly due to concerns about rotator cuff integrity, regardless of deformity. The purpose of this study is to evaluate outcomes including pain, function, range of motion, satisfaction, and complications in patients 80 years or older following primary anatomic and reverse total shoulder arthroplasty for osteoarthritis without full thickness rotator cuff tears. A retrospective query of our institution's shoulder and elbow surgery repository identified patients treated with aTSA or rTSA between 11/2006 and 2/2022. Patients > 80 years old with minimum 2-year follow-up who underwent surgery for a primary indication of osteoarthritis without a full thickness rotator cuff tear were included. Patient-reported outcome measures (PROMs; American Shoulder and Elbow Surgeons [ASES], Simple Shoulder Test [SST], Single Assessment Numeric Evaluation [SANE], Visual Analog Score [VAS] Function and VAS Pain scores), range of motion, and strength were evaluated at the visit immediately before surgery and at most recent follow-up. Patient satisfaction was also evaluated at most recent follow-up. Complications and revisions were reported. A total of 130 patients (77 aTSA and 53 rTSA) met inclusion criteria. There were no significant differences in demographics between cohorts. At most recent follow-up, there were no significant differences in PROMs between cohorts. aTSA patients achieved greater postoperative motion in external rotation (50o vs. 40o; p=.003) and internal rotation (8 vs. 5; p=.001), with no difference in forward elevation. There were six complications amongst aTSA patients (7.8%): four with subscapularis insufficiency, one humeral shaft periprosthetic fracture treated with open reduction and internal fixation, and one with prosthetic joint infection revised to a functional composite spacer. Three rTSA patients (5.6%) sustained complications - all acromion/scapular spine fractures (2 Type 2; 1 Type 3) which were treated non-operatively. There was no significant difference in the rate of complications or revisions between groups. Both anatomic and reverse shoulder arthroplasty for osteoarthritis yield similarly high patient satisfaction, good functional outcomes and low complication rates in patients over the age of 80 years.

Arthroscopic Microdrilling for Full-thickness Trochlear Cartilage Defects in Patients Undergoing High Tibial Osteotomy Confers Improved Cartilage Status at 1 year and Rate of Minimal Clinically Important Difference at Short-term Follow-up.

To compare the patient-reported outcome improvements and cartilage status of trochlear cartilage defects (TCDs) after additional arthroscopic microdrilling versus no treatment for TCDs during medial open-wedge high tibial osteotomy(MOWHTO) METHODS: Patients who underwent MOWHTO with either microdrilling (Group M) or no treatment (Group N) for near full-thickness TCDs (International Cartilage Repair Society[ICRS] grade≥3B) from March 2010 to September 2022 were retrospectively reviewed, with a minimum 2-year follow-up. 1:1 Propensity score matched-Group N was created. Comparative analyses were conducted using patient-reported outcomes(PROs) and minimal clinically important difference (MCID). Trochlear cartilage status was visually assessed via second-look arthroscopy 1 year postoperatively and categorized as deteriorated, maintained, or improved. Overall, 30 for group M and 84 patients for group N were included. The mean follow-up period of the matched groups was 32.8 and 32.0 months for groups M and N. The preoperative and postoperative radiographic parameters did not differ between the groups (Kellgren-Lawrence grade, pre- and postoperative alignment, medial proximal tibia angle). Both groups achieved significant clinical improvement in patients with medial compartment osteoarthritis and combined full-thickness TCD (p<0.001). PROs and improved PROs at final follow-up were not significantly different between groups, except for the Final Kujala anterior knee pain scale (70.4 [95% CI: 66.0-74.8] vs. 59.8 [95% CI: 53.0-67.6], p=0.018). MCID achievement rates in pain visual analogue scale (VAS), Knee injury and Osteoarthritis Outcome Scores (KOOS)-Pain, and KOOS-activity of daily living (ADL) were significantly higher in group M compared to group N (VAS, 93.3% vs. 63.3%, p=0.005; KOOS-Pain, 96.7% vs. 80.0%, p=0.044; KOOS-ADL, 86.7% vs. 63.3%, p=0.037). A significantly larger proportion of patients in group M demonstrated improvement in their TCD status compared to those in group N (93.1% vs. 44.8%, p<0.001). Arthroscopic microdrilling for near full-thickness TCD during MOWHTO improved trochlear cartilage status at 1 year but did not enhance final PROs at short-term follow-up, though it increased MCID achievement rates in some PROs (VAS, KOOS pain, KOOS ADL) compared to untreated patients. Level III, therapeutic retrospective cohort study.

P1092 Real-life durability and utilization of biologics in pediatric inflammatory bowel disease: results from Italian society of pediatric gastroenterology, hepatology and nutrition (SIGENP) IBD registry

Abstract Background Long-term data on the efficacy and safety of biologics in pediatric inflammatory bowel disease (IBD) are crucial for guiding clinicians in optimizing their use. This study aims to evaluate real-life durability, usage patterns, and factors influencing treatment discontinuation in pediatric IBD. Methods This registry-based study analyzed data of patients from the IBD registry of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) who started biologic therapy between 2009 and 2022, with a minimum 1-year follow-up. Results 1184 patients (749 Crohn’s Disease [CD], 437 Ulcerative Colitis or IBD-undetermined [UC/IBD-U]) were retrieved. The median follow-up was 43 months (IQR 28-64). Infliximab was the first biologic in 807 patients (68%) followed by adalimumab in 378 patients (31%). 393 patients (33%) received a second-line biologic, 107 (9%) a third-line and 24 (2%) a fourth-line. At last follow-up, 544 patients (47%) had discontinued the first biologic, with a median time to discontinuation of 14 months (IQR 5-27). Main reasons were loss of response (36%) followed by primary non-response (33%) and infusion reactions (13%). For first-line biologics, treatment durability was superior in patients who received adalimumab compared to infliximab (Figure 1a) and in patients managed with TDM (Figure 2b). In the multivariate analysis risk factors for first biologic discontinuation were age &amp;lt; 6 years (HR 1.8, 95%CI 1.3-2.4), UC/IBD-U (HR 1.4, 95%CI 1.1-1.8), moderate/severe disease activity (HR 1.3, 95%CI 1.1-1.6) and Infliximab vs adalimumab (HR 2.1; 95% CI 1.6-2.7) while the use of TDM emerged as protective, significantly lowering the risk (HR 0.50; 95% CI 0.40-0.63). Combination therapy did not influence biologic durability (HR 0.95; 95% CI 0.77-1.18). Conclusion strategies for optimizing treatment efficacy of biologics in pediatric IBD should be tailored considering patients age, IBD type and severity and integrating TDM in patients’ management. The contribution of concomitant immunomodulation in the pediatric setting might be negligible.

Which Lenke type curve is most appropriate for vertebral body tethering in adolescent idiopathic scoliosis?

Clinical trials have studied the effects of curve magnitude and flexibility, age, and skeletal immaturity on the outcomes of VBT. No studies have assessed the effect of Lenke curve type on the outcomes of VBT. This study compares outcomes in patients who underwent VBT with Lenke type 1, 3, 5, and 6 curves. Single center retrospective review of patients undergoing mini-open thoracoscopic-assisted two row vertebral body tethering (2RVBT) for the correction of AIS with a minimum 2-year follow-up were included. Patients were grouped by Lenke type, which yielded 4 groups; types 1, 3, 5, or 6. Analysis included preoperative demographic parameters, as well as radiographic and clinical outcome measures. 156 2RVBT (Lenke 1, N = 61; Lenke 3, N = 35; Lenke 5, N = 37; Lenke 6, N = 23) patients met inclusion criteria. The mean preoperative apex Cobb angle in the Lenke type 1, 3, 5, and 6 groups were 50.2 ± 9.1, 50.5 ± 10.1, 45.0 ± 8.6, and 49.0 ± 10.8, respectively. This corrected to 21.2 ± 10.2, 19.2 ± 8.5, 13.6 ± 7.2, 18.5 ± 8.3 in Lenke type 1, 3, 5, and 6 groups, respectively, demonstrating that Lenke type 5 saw greatest correction following 2RVBT. With regards to revision recommendation following tether breakage, Lenke type 3 curves were most frequently indicated for fusion, whereas Lenke type 1 curves were most frequently not indicated for revision surgery. Lenke type 5 curves are the most amenable to correction via 2RVBT, as evident by their lower post-operative apex Cobb angles and lowest rate of recommendation for revision to posterior spinal fusion.

Sex-Based Differences in the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: 10-Year Outcomes With a Nested Propensity-Matched Comparison

Background: Sex has been associated with different pathologic characteristics in painful hips undergoing hip arthroscopic surgery. Purpose: To compare minimum 10-year patient-reported outcomes (PROs) and survivorship in patients who underwent primary hip arthroscopic surgery for femoroacetabular impingement syndrome and labral tears according to sex. Study Design: Cohort study; Level of evidence, 3. Methods: Data from patients who underwent primary hip arthroscopic surgery between March 2009 and May 2011 were reviewed. Patients with minimum 10-year PROs for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain were eligible. Exclusion criteria included previous ipsilateral hip conditions or surgical procedures, Tönnis grade >1, or dysplasia (lateral center-edge angle <25°). In the subanalysis, female patients were matched to male patients using a 1:1 ratio by age, sex, and body mass index. Results: A total of 375 hips had a minimum 10-year follow-up. There were 249 female (mean age, 36.8 ± 13.1 years) and 126 male (mean age, 38.9 ± 13.1 years) hips. Survivorship was defined as no conversion to total hip arthroplasty. Female and male hips exhibited similarly high rates of survivorship (80.3% vs 72.2%, respectively; P = .076). Female hips underwent secondary arthroscopic surgery at a statistically higher rate of 14.5% (P = .021) and had higher rates of capsular repair and iliopsoas fractional lengthening (P < .0001 and P < .001, respectively). Male hips had a significantly higher rate of acetabular labrum articular disruption/Outerbridge grade 3 and 4 damage at 54.0% compared with female hips (both P < .001) and underwent femoroplasty and acetabular microfracture at significantly higher rates of 88.1% versus 51.0%, respectively, and 16.7% versus 4.8%, respectively (both P < .001). In the subanalysis, both groups showed significant improvements in all PROs from baseline (all P < .001). Even though female patients demonstrated a higher rate of secondary arthroscopic surgery, they had a higher self-reported mean satisfaction score of 9.0 compared with 8.4 (P = .003) and a greater magnitude of improvement in 10-year PROs (ΔmHHS: 29.3 ± 17.5 vs 23.1 ± 19.8, respectively [P = .036]; ΔNAHS: 33.2 ± 21.3 vs 25.1 ± 19.5, respectively [P = .012]; ΔHOS-SSS: 47.0 ± 32.0 vs 32.7 ± 31.9, respectively [P = .008]; and ΔVAS: –4.6 ± 2.7 vs −3.5 ± 2.0, respectively [P = .009]). However, all PROs at a minimum 10-year follow-up were similar between the groups. Conclusion: After undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome, both female and male patients reported significant improvements in all PROs at a minimum 10-year follow-up and high patient satisfaction, with similar final functional scores. Even though female patients demonstrated a higher rate of secondary arthroscopic surgery, they had a higher satisfaction score and a greater magnitude of improvement in PROs postoperatively.

Functional alignment in robotic-assisted total knee arthroplasty for valgus deformity achieves safe coronal alignment and excellent short-term outcomes.

Functional alignment (FA) in total knee arthroplasty (TKA) prioritizes soft tissue balancing and anatomical restoration without systematic correction to neutral alignment. Most studies have focused on varus deformity, with little evidence available about FA in valgus deformity. The hypothesis of the present study was that FA in robotic-assisted TKA for valgus deformity would demonstrate correction of the coronal alignment and yield satisfactory short-term outcomes. This retrospective study included 58 patients with valgus coronal alignment (hip-knee-angle [HKA] ≥ 183°) who underwent robotic-assisted TKA using the FA technique with a minimum of 1-year follow-up. Outcomes were assessed through the Knee Society Score (KSS), Oxford Knee Score (OKS), Forgotten Joint Score (FJS) and radiographic measurements of alignment and phenotypes. Complication and revision rates were also analyzed. The cohort included 39 females and 19 males with a median age of 70. Post-operatively, 86.2% of cases achieved coronal alignment within the safe zone (HKA 177-183°). Significant improvements were observed in KSS (part 1: 69.5-95, part 2: 65-94, p < 0.001), while OKS and FJS exhibited optimal outcomes. Two complications were recorded: one aseptic loosening (1.7%) and one early infection (1.7%). Kaplan-Meier survival analysis indicated favourable implant survivorship at a median follow-up of 18 months. FA in image-based robotic TKA is a safe and effective approach for patients with valgus deformity. This procedure resulted in a modest correction of the coronal alignment, where no soft tissue releases were needed. The majority of the cases fell within the target coronal alignment boundaries by only accommodating the individual laxities, suggesting the aim of FA to restore each knee's pre-pathological alignment. Level IV.

Impact of skeletal muscle mass of the trunk and extremities on standing spine parameters before and after surgery for adult spinal deformity with a minimum 2-year follow-up.

The effect of skeletal muscle mass of the trunk and extremities on sagittal imbalance of the spine before and after surgery for adult spinal deformity (ASD) has not been elucidated. The purpose of this study was to examine the correlation between reduced skeletal muscle mass of the trunk and extremities, as well as spinopelvic parameters, preoperatively, postoperatively and at least 2years after surgery for ASD. This retrospective observational study included 140 consecutive patients who had undergone surgery for ASD and were followed-up for at least 2years and whose skeletal muscle mass could be measured preoperatively using whole-body dual-energy X-ray absorptiometry. Correlations between skeletal muscle mass and spinopelvic parameters were assessed preoperatively, postoperatively, and after 2years of follow-up. All spinopelvic parameters were significantly improved postoperatively compared with preoperatively. Between the postoperative period and two years post-surgery, a significant loss of correction was observed in SVA and GT. Trunk muscles mass showed significant negative correlations with preoperative PT, SS, PI-LL, SVA, GT, and TPA, but there was no significant correlation with postoperative parameters. Through univariate and multivariate regression analysis, lower limb skeletal muscle mass showed a significant negative correlation with SVA at two years postoperatively and the loss of corrected SVA (ΔSVA) over two years. This study revealed that lower extremity muscle mass was implicated in the loss of corrected SVA 2years after surgery. This study is clinically meaningful as it suggests that strength training for the lower extremities, performed preoperatively and/or postoperatively, can improve sagittal imbalances of the spine in patients with severe ASD or maintain SVA after corrective surgery.

Efficacy of Renuvion Helium Plasma to Improve the Appearance of Loose Skin in Patients Undergoing Abdominoplasty After Massive Weight Loss: A Prospective Controlled Randomized Study.

Renuvion was the first FDA approved helium plasma device utilized for subdermal tissue heating to reduce skin laxity. The purpose of this study was to demonstrate that the use of Renuvion improves the outcomes, skin quality and reduces the edema faster after lipoabdominoplasty. Patients with abdominal skin laxity after a weight loss of at least 20kg, nonsmokers, without major comorbidities, with a minimum 2-year follow-up and standardized pre- and postoperative photographs were included in this study. They were randomly divided in two groups: group 1, lipoabdominoplasty alone; group 2, lipoabdominoplasty and Renuvion. Both the patients and two of the authors measuring outcomes were blinded to the treatment methods. Postoperatively, all patients were administered the BODY-Q satisfaction with abdomen and appraisal of excess skin scales. Two independent plastic surgeons reviewed photographs, rating the outcomes on a 1-5 visual analog scale (VAS). Pinch test and ultrasound of the subcutaneous tissue were also performed. Seventy-six patients were enrolled, 33 males and 43 females, aged between 20 and 50 years. The BODY-Q satisfaction with abdomen scores were higher in group 2 in the 6-month (p=0.007), 1-year (p=0.021) and 2-year (p=0.024) evaluations. The BODY-Q appraisal of excess skin scores were significantly higher in group 2 in the 6-month (p<0.0001), 1-year (p<0.0001) and 2-year (p<0.0001) postoperative evaluations. The VAS scale reported higher scores in group 2 (p=0.01). Ultrasound at 6 months postoperatively demonstrated lower subcutaneous thickness in group 2 (31mm±2.8SD) compared to group 1 (42mm±1.4SD) implying a faster edema reabsorption. Data showed a significantly greater improvement of abdominal skin laxity in patients treated with Renuvion compared to those who underwent lipoabdominoplasty alone. This is the first prospective randomized study about Renuvion and lipoabdominoplasty and could be considered a pilot study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

What is the clinical importance of radiographic changes around the humeral component in anatomic shoulder arthroplasty? A minimum 4-year follow-up study.

While stress shielding and adaptive bone changes around the humeral component are often observed after shoulder arthroplasty, the potential causative factors and clinical significance of these findings at mid-term follow-up have not been well elucidated. The purpose of this study was to investigate the frequency, patterns and clinical significance of radiographic findings around the humeral component of total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) at minimum 4-year follow-up. The 6-week and minimum 4-year radiographs of patients who underwent HA and TSA were evaluated for filling ratios, changes in the humeral bone surrounding the component, and component shift or subsidence. All procedures were performed using a traditional-length, smooth stem fixed by impaction autografting with the goal of secure fixation with a relatively low filling ratio. Radiographs after TSA were evaluated for high-grade radiolucencies around the glenoid component. The clinical outcomes of interest were revision for humeral fixation failure and Simple Shoulder Test (SST) score. 170 patients met the study criteria (91 TSA and 79 HA). The mean radiographic and clinical follow-up was 7.0 years [interquartile range (IQR), 5.3 to 8.6 years]. No patients were revised for loose humeral components during the study period. For both HA and TSA, the most common zones of cortical thinning or resorption involved the medial calcar, greater tuberosity and lateral humerus diaphysis. The mean metaphyseal filling ratio (MFR) was higher in patients with bone changes in ≥3 zones (p < 0.001) and resorption of the calcar (p = 0.051). The frequency and degree of bone changes around the humeral component were higher in TSA patients with high-grade radiolucencies around the glenoid component. These findings in TSA patients with high-grade radiolucencies around the glenoid component had a stronger correlation with inferior SST scores than in patients who did not have a high-grade radiolucencies around the glenoid component. At minimum 4-year and mean 7-year follow-up, greater bone changes around the humeral component were associated with higher metaphyseal filling ratios. The association of glenoid component radiolucency with the degree and clinical impact of these bone changes should be considered when interpreting mid-term radiographs after TSA and may represent the effects of other processes - such as osteolytic reaction to particulate debris - in addition to stress shielding. Level IV; Case Series; Treatment Study.

Diagnostic evaluation and management of recurrent urinary tract infections in the spinal cord injury population - a retrospective evaluation at a tertiary care center.

Retrospective review. While most individuals with spinal cord injury (SCI) are expected to have 1-2 urinary tract infections (UTIs) per year, there is a subset with higher incidence. We evaluate our practice to characterize common causes of recurrent UTIs, hypothesizing that more frequent infections typically have addressable risk factors. Tertiary urology clinic, San Jose, CA. We reviewed patients with SCI referred to a tertiary urology clinic for evaluation and management of "recurrent UTIs" during the years 2015-2020. Following workup, the suspected cause of recurrent UTIs and number of post-specialty evaluation UTIs (patient reported) were noted. Forty persons with SCI with a mean of 4.8 UTI treatments in the prior year comprised our cohort with most performing CIC (80%). After workup, 37/40 (92.5%) had a likely cause for their reported recurrent UTIs. In 16/40 (40%), careful questioning determined that the patient was not having UTIs based on guideline definitions. In those with confirmed recurrent UTIs, a bladder diary (62.5%) or urodynamic study (64%) was more likely to identify a cause compared to imaging (2.6%) or cystoscopy (8%). With a minimum 1-year follow-up, 90% of our population had a 50% or more reduction in UTI incidence, mostly using non-antibiotic strategies. In a referral SCI population with a chief complaint of "recurrent UTIs", over a third were not having UTIs. In addition to detailed history, a bladder diary +/- urodynamics are most useful in finding the cause and improving UTI.

AIS patients have improved total SRS-22r self-image and satisfaction scores relative to pre-op at 10-year follow-up regardless of Lenke type.

Few studies have investigated quality-of-life (QoL)-related outcome measures in adolescent idiopathic scoliosis (AIS) patients over long-term follow-up. We investigated whether patients with any given Lenke type improved relative to other types and whether selective fusions resulted in better QoL-related outcome measures. We utilized the Harms Study Group database to select patients with AIS who underwent posterior spinal fusion (PSF) with Scoliosis Research Society questionnaire-22 revised (SRS-22r) scores at minimum 10-year follow-up. Characteristics and SRS-22r were quantified by Lenke type and compared using ANOVA and Tukey post hoc tests. Multivariate analyses were conducted to identify the predictive value of Lenke types on QoL-related outcomes. Sub-group analysis split cohorts into those who underwent selective vs. non-selective fusion(s). 110 patients were available at minimum 10-year follow-up. Types 3, 4, and 6 curves generally demonstrated lower SRS-22r scores both preoperatively and at long-term follow-up. Independent of Lenke type, total SRS-22r, along with self-image and satisfaction, showed consistent improvement relative to pre-op at 10-year follow-up, whereas pain, mental health, and general function showed a slight worsening. Sub-group analyses revealed no significant differences in SRS-22r scores between selective and non-selective fusion groups. At 10-year follow-up, total SRS-22r, self-image, and satisfaction scores stayed consistently improved relative to preoperative status over time, while pain, general function, and mental health declined from 2years onward. Increased age may play a role in enhancing self-image and satisfaction while worsening general function, pain, and mental health. Selectively vs. non-selectively fusing a patient should not hinge on fear of impacting patients' QoL-related measures, as our data suggest improvement in total SRS-22r, self-image, and satisfaction regardless. III.