Rate Of Subsequent Surgery Research Articles

A Comparison of Clinical and Radiographic Outcomes Between Isolated Total Talus Replacement and Combined Total Talus Replacement with Total Ankle Arthroplasty or Hindfoot Arthrodesis

Total talus replacement (TTR) is a viable surgical option in the setting of talar avascular necrosis and collapse, as well as a revision option for failed total ankle arthroplasty with talar implant subsidence. The purpose of the present study was to compare the clinical and radiographic outcomes following isolated TTR and TTR combined with total ankle arthroplasty or hindfoot arthrodesis.Patients who underwent TTR were retrospectively reviewed, as a multicenter consecutive case series. Basic demographic data, comorbidities and surgical date were collected. Medical records were reviewed to obtain postoperative and preoperative visual analog scale (VAS) scores, American Orthopedic Foot and Ankle society (AOFAS) outcome scores, postoperative complications and radiographic measurements. Statistical analysis was conducted to compare radiographic and patient-reported outcomes pre- and postoperatively. Thirty-six patients underwent TTR with mean follow-up of 25.39 months.VAS pain scores improved postoperatively from 8.43 to 2.67 (P <0.001). AOFAS improved postoperatively from 36.33 to 81.78 (P < 0.001). There was an overall improvement in talar arc length (P = 0.035), talar width (P = 0.0037), talar height (P < 0.001), Bohler's (P < 0.001) and Gissane's angle (P = 0.004). The overall complication and subsequent surgery rate were each 16.7%. The TTR implant survivorship rate was found to be 94.5%. When comparing outcome scores between Isolated TTR and Combined TTR, no significant differences were detected in the degree of improvement.Both isolated and combined TTR provide a suitable and safe option for the treatment of advanced talar AVN or associated tibiotalar and hindfoot arthritis.

A randomized trial on three different minimally invasive decompression techniques for lumbar spinal stenosis. Five years follow-up from the NORDSTEN-SST.

The short-term clinical outcome for midline-preserving posterior decompression techniques was comparable. The aim of this study was to evaluate long-term clinical results after three different midline-preserving posterior decompression techniques. In the NORDSTEN spinal stenosis trial (NORDSTEN-SST) 437 patients were randomized to three different midline-retaining posterior decompression techniques: Unilateral laminotomy with crossover (UL), bilateral laminotomy (BL) and spinous process osteotomy (SPO). Primary outcome was the mean change in Oswestry disability index (ODI) score at five-years follow-up. Secondary outcomes were the proportion of patients classified as success, mean change in EQ-5D, ZCQ-score, NRS-score for leg and low back pain, a seven-point Global Perceived Effect (GPE) Scale and proportion of subsequential spinal surgery. The number of patients that completed follow-up data after five years was 358 (82%): In the UL, BL and SPO group the numbers were 122, 119 and 117, respectively. Mean age at baseline was 66.7 (SD 8.2) years, mean BMI was 27.8 (SD 4.1), and 172/358 (48%) were female. In the UL group the mean change was -18.2 (95% CI -21.0 -5.4), in the BL group it was -19.0 (95% CI -21.9-16.1) and in the SPO it was -18.6 (95% CI -21.6-15.7) (p = 0.917). No significant differences in the secondary outcomes between the three surgical groups were found, also the subsequent spinal surgery rates were similar. There were no significant differences in patient reported outcomes and subsequent spinal surgery rates after the three different decompression techniques at five-year follow-up.

Preoperative Anxiety: An Important Risk Factor of Postoperative Adverse Events and Increased Reoperation Rates in Patients Undergoing Single-Level Anterior Cervical Diskectomy and Fusion

Introduction: With the rising prevalence of mental health disorders, it is important to consider their correlation with surgical outcomes. Anxiety has been associated with adverse events after many surgical procedures, but its relationship relative to anterior cervical diskectomy and fusion (ACDF) regarding medical complications has not previously been assessed in a large database study. Methods: The 2010-Q3 2022 PearlDiver Mariner161 database was used to identify patients undergoing single-level ACDF. Those with versus without preoperative anxiety were matched 1:1 based on age, sex, and Elixhauser Comorbidity Index. Rates of 90-day adverse events were compared by multivariate regression analyses, and 5-year cervical revision surgery rates were compared. Results: Of 287,278 ACDF patients, preoperative anxiety was identified for 36.73%. After matching, patients with anxiety had greater odds ratios of all assessed individual 90-day adverse outcomes, as well as any (OR: 3.09), severe (OR: 2.07), and minor (OR: 3.39) adverse events (P &lt; 0.0001 for all). Those with preoperative anxiety had slightly greater 5-year rates of subsequent cervical spine surgery than those without (P &lt; 0.0001, at 5 years 12.9% versus 11.7%). Discussion: ACDF patients with a history of anxiety had higher odds of many 90-day adverse outcomes and slightly higher 5-year revision surgery rates. These findings may inform patient counseling and risk management strategies.

Babcock versus Scissor Tensioning for Retropubic Mid-Urethral Slings: Comparing Two Intra-Operative Techniques Through 5 Years of Follow-Up.

The objective was to determine if mid-urethral sling (MUS) tensioning with a Mayo Scissor as a sub-urethral spacer compared with a Babcock clamp holding a loop of tape under the urethra results in differences in patient-reported outcomes and rates of repeat surgery over a 5-year follow-up. Follow-up 5 years after a randomized clinical trial, utilizing primary data collection linked to administrative health data, was carried out to create a longitudinal cohort. The primary outcome was participant-reported bothersome SUI symptoms, as defined by the Urogenital Distress Inventory (UDI-6) questionnaire. Secondary outcomes included participant-reported bothersome overactive bladder (OAB) scores, median scores of three validated urinary symptom questionnaires, and rates of subsequent surgery determined through patient report and administrative data. Two hundred and sixty (81.8%) of the original study participants provided participant-reported data at 5 years. Administrative data linkage was completed for all of the original participants (n = 318). Demographic characteristics remained similar in the two groups at the 5-year follow-up mark. No differences existed in the primary outcome of reported bothersome SUI symptoms (30.8% Scissors vs 26.8% Babcock, p = 0.559), proportion of participants with bothersome OAB, the median scores of three validated bladder questionnaires, or in rates and cumulative incidence of recurrent MUS surgery or surgical revision of mesh-related complications. Both the Scissor and Babcock tensioning techniques provided comparable outcomes at 5 years post-MUS surgery. The information from this study allows surgeons to better decide which technique to adopt in their practice, providing confidence in longer-term cure and safety.

Comparable Outcomes Between Autologous Chondrocyte Implantation and Osteochondral Allograft Transplantation in the Setting of Patellar Realignment

PurposeThe purpose of this study was to determine clinical and functional outcomes in patients treated with autologous chondrocyte implantation (ACI) or osteochondral allograft (OCA) transplantation for chondral defects secondary to patellar instability with concomitant medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle osteotomy (TTO) for patellar realignment. MethodsA retrospective review identified patients who underwent ACI or OCA transplantation with concomitant MPFL reconstruction and TTO . Patients were excluded if they did not have concomitant MPFL reconstruction and TTO, had the presence of other intra-articular pathologies, or failed to complete postoperative subjective outcome evaluations at a minimum of 2 years following surgery. Subjective outcome measures included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), International Knee Documentation Committee (IKDC) evaluation, and Short Form Health Survey (SF-12) physical scores, collected a minimum of 2 years after surgery. Defect location, size, complications, and rate of subsequent surgery were determined. ResultsEighteen total patients were included in this study. The ACI cohort included 11 patients with 13 total defects that were treated with ACI. The OCA cohort included 7 patients with 10 total defects that were treated with OCA. This was due to a number of patients in either group having multiple cartilage defects. Twenty-three total chondral defects were compared to analyze clinical and functional outcomes following surgical correction (ACI: n=13, OCA: n=10). Five defects were noted on the femoral condyle and 18 on the patellar facets/central ridge. Defects were comparable between groups including, size measured during index-arthroscopy (ACI = 3.34 cm2, 95% CI [2.3 cm2 - 4.4 cm2] vs OCA = 4.03 cm2, 95% CI [3.1 cm2 - 5.0 cm2]; P=.351), Outerbridge classification (ACI = 54.8% grade 4 vs OCA = 60.0% grade 4; P=1.000), and AMADEUS score (ACI = 47.1 vs OCA = 58.6; P=.298). Postoperative outcomes were comparable including revision rate (ACI = 15.4% vs OCA = 10.0%; P=1.000) and 2-year IKDC scores (ACI = 74.2, 95% CI [65.2 - 83.2] vs OCA = 51.2, 95% CI [30.3 - 72.1]; P=.077). ACI did have significantly higher 2-year KOOS JR (85.1, 95% CI [76.9 - 93.3] vs 63.7, 95% CI [49.1 - 78.3]; P=.031) and SF-12 scores (54.1, 95% CI [52.0 - 56.2] vs 42.6, 95% CI [35.8 - 49.4]; P=.007) compared to OCA. ConclusionACI or OCA transplantation for chondral defects with concomitant MPFL reconstruction and TTO can be safely performed in an outpatient setting with functional and clinical outcomes being comparable. Level of EvidenceRetrospective Case Series Study (Level 3)

Comparing outcomes of hip arthroscopy and periacetabular osteotomy for the treatment of borderline hip dysplasia: a systematic review

Abstract Hip arthroscopy (HA) and periacetabular osteotomy (PAO) are common hip preservation procedures pursued in borderline hip dysplasia (BHD), yet there is no consensus on the preferred treatment. This systematic review aims to synthesize the present literature on HA and PAO for the management of BHD. A review of multiple electronic databases was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies that reported outcomes of patients with BHD treated by PAO or HA with capsular closure were included. PROs, complications, and rates of subsequent surgery were evaluated. A total of 14 studies met criteria for inclusion. Eight reported outcomes following PAO and seven reported outcomes following HA. One study reported outcomes of both procedures. Both PAO and HA studies demonstrated significant improvement in PROs. Complication rates in PAO patients ranged from 0% to 7.8% compared to 0% in HA patients. Total hip arthroplasty (THO) conversion rates in PAO patients ranged from 0% to 10.5% compared to 0% to 23.7% in HA patients. Hardware removal was performed in 25–51% of PAO patients. PAO conversion following failed HA occurred in 0–6.1% of patients. Rates of other reoperation (excluding hardware removal) in PAO patients ranged from 0% to 22.2% compared to 0% to 7.9% in HA patients. Based on the current evidence, both PAO and HA demonstrate significant improvement in PROs with a low conversion rate to THA, yet additional long-term follow-up studies are required.

Poster 328: Effect of Knee Aspiration prior to ACL Reconstruction Surgery on Subsequent Surgery: A Randomized Clinical Trial

Objectives: The traumatic effusion associated with an acute anterior cruciate ligament (ACL) rupture contains pro-inflammatory cytokines, chemokines and matrix degrading enzymes. Aspiration of the effusion may help reduce the burden of joint inflammation. However, the short and mid-term implications of routine aspiration have not been well documented. The primary objective of this prospective, randomized control trial is to determine whether routine pre-operative aspiration upon presentation to the orthopaedic clinic impacts (a) all-cause re-operation rate in patients undergoing ACL reconstruction (ACLr) and, more specifically, (b) rate of surgical debridement for postoperative arthrofibrosis, a common clinical sequela of ACLr. Methods: Eligible patients presented to a single, academic sports surgeon with an acute ACL rupture and were clinically indicated for ACLr. Both sexes were included in this study. Exclusion criteria included pre-existing osteoarthritis (Kellgren-Lawrence grade 3 or greater), focal chondral injury (International Cartilage Repair Society grade 3 or higher), concurrent ipsilateral extra-articular injury, history of contralateral knee injury, or age greater than 62 years. Patients were randomized to either routine preoperative care or in-office aspiration of their traumatic effusion upon initial presentation. Patients underwent routine diagnostic arthroscopy at the time of ACLr to evaluate for concurrent chondral or meniscal pathology. Patients underwent standard postoperative rehabilitation and follow-up care. Results: Eighty-seven patients were enrolled in this study, with 46 (53%) patients randomized to and undergoing preoperative aspiration (Table 1). At a mean follow-up of 2.56 years, 14 patients (16%) underwent re-operation for any reason and 10 (11.5%) patients underwent debridement of arthrofibrosis (Table 2). Preoperative aspiration was not significantly associated with a decreased rate of arthrofibrosis (Figure 1) or re-operation (Figure 2). However, it was significantly associated with a longer time to debridement for arthrofibrosis (125 days vs 457 days, p = 0.0029). Conclusions: Preoperative aspiration does not modify rates of subsequent surgery following ACLr. In patients who develop arthrofibrosis after ACLr, preoperative aspiration is associated with a delay in the development of arthrofibrosis. This could be due to a decrease in burden of intraarticular inflammation after aspiration. Further study is needed to assess why aspiration delays the onset of arthrofibrosis and whether aspiration impacts long-term outcomes such as the development of post-traumatic OA.

Association Between Severity of Chondrolabral Junction Breakdown and Functional Outcomes After Hip Arthroscopy for Acetabular Labral Tears

Background: Despite focus on surgical preservation of the chondrolabral junction (CLJ), the transition zone between the acetabular cartilage and labrum, the association between severity of CLJ breakdown and functional outcomes after hip arthroscopy remains unexplored. Purpose: To assess the influence of CLJ breakdown on patient-reported outcome measures (PROMs) at a 24-month follow-up after hip arthroscopy for symptomatic labral tears. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of prospectively collected data was conducted to identify patients ≥18 years of age with a minimum 24-month follow-up who underwent hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears secondary to femoroacetabular impingement. The Beck classification of transition zone cartilage was used to grade CLJ damage; patients with grades 0 to 2 were stratified into the mild CLJ damage cohort, and those with grades 3 and 4 were stratified into the severe CLJ damage cohort. PROMs were collected at baseline and at 3, 6, 12 months, and annually thereafter postoperatively. Linear mixed-effects models were used to compare PROMs. Rates of achieving clinically meaningful thresholds and subsequent surgery rates were also compared. Results: In total, 198 patients met the inclusion criteria, with a mean follow-up of 3.54 ± 1.26 years. A total of 95 patients with severe CLJ damage (mean age, 34.9 ± 10.5 years) were compared with 103 patients with mild CLJ damage (mean age, 38.2 ± 11.9 years). Hip Outcome Score–Activities of Daily Living (HOS-ADL), Non-Arthritic Hip Score (NAHS), and visual analog score for pain were inferior in the severe CLJ group at enrollment and all follow-up time points (P≤ .05). However, patients with severe CLJ breakdown exhibited greater improvements in HOS-ADL and NAHS at the 24-month follow-up and achieved clinically meaningful thresholds at equivalent rates to patients with mild CLJ breakdown. Subsequent surgery rates were 6.8% and 12.6% in patients with mild versus severe CLJ damage, respectively (P = .250). Conclusion: Severe CLJ breakdown is associated with increased pain and decreased functional level preoperatively and up to 24 months after hip arthroscopy. Despite this, patients with severe CLJ breakdown experienced greater improvements in functional outcomes at a 24-month follow-up and achieved clinical thresholds at similar rates to patients with mild CLJ damage. Thus, while worse baseline pain and functional levels may indicate severe CLJ breakdown, these patients still benefit substantially from hip arthroscopy.

Conversion to knee arthroplasty is more common after meniscectomy than meniscus repair in patients older than age 40.

To describe rates of conversion to unicompartmental or total knee arthroplasty (KA) in patients over the age of 40 years (at initial surgery) after partial meniscectomy (ME) or meniscal repair (MR). Patients over the age of 40 undergoing isolated ME or MR between 2016 and 2018 were extracted from a single healthcare provider database. Data on patient characteristics, type of initial surgery, number of returns to the operating room, as well as performed procedures, including conversion to KA, were recorded. Comparative group statistics as well as a Kaplan-Meier survival rate analysis were performed. A total of 3638 patients (47.8% female) were included, with 3520 (96.8%) undergoing ME and 118 (3.2%) MR. Overall, 378 (10.4%) patients returned to the OR at an average of 22.7 ± 17.3 months postoperatively. Conversion to KA was performed more frequently in patients after primary ME (n = 270, 7.7%) compared to those with MR (2.5%, n = 3, odds ratio [OR]: 3.2, p = 0.03). Compared to ME (2.3%, n = 82), two times as many patients undergoing MR returned for subsequent meniscus surgery (MR: 5.9%, n = 7, OR: 2.6, p = 0.02). Time from primary surgery to KA (ME: 22 ± 17 months, MR: 25 ± 15 months, p = 0.96) did not differ between the treatment groups. Survivorship was 95% for ME and 98.2% for MR after 24 months (p = 0.76) and 92.5% and 98.2% after 60 months (p = 0.07), respectively. The overall reoperation rate after meniscal surgery was 10.4% in patients over the age of 40 years. Patients treated with primary ME have over three times higher odds to undergo subsequent KA compared to those treated with MR. However, patients with primary MR have a higher rate of subsequent meniscus surgery compared to those undergoing primary ME. This information is important when considering and treating a patient over the age of 40 and meniscal injury. Level III study.

Proximal humerus open reduction internal fixation with and without biceps tenodesis: assessment of early clinical outcomes

BackgroundThe role of biceps tenodesis (BT) during open reduction and internal fixation (ORIF) of proximal humerus fractures (PHF) remains unclear. A subset of patients undergoing ORIF have persistent pain with unclear etiology. The purpose of our study was to compare outcomes of ORIF of proximal humerus fractures with and without concomitant biceps tenodesis (BT). We hypothesize patients undergoing biceps tenodesis at the time of ORIF will have improved patient-reported outcome scores with fewer secondary procedures related to treatment of the biceps. MethodsIn this retrospective cohort study, all patients undergoing ORIF for a PHF at a single level one trauma center from January 2019 to June 2022 were reviewed. Patients under the age of 18 were excluded. Primary outcomes were PROMIS physical function, depression, and pain interference scores at 5 time points up to final follow-up. Secondary outcomes included total operative time, complications, subsequent procedures, steroid injections, and range of motion. Chi-square tests were performed for categorical values and paired t-tests for continuous variables. Results71 patients met inclusion criteria: 41 undergoing ORIF without BT, and 30 undergoing ORIF with BT. Average follow-up was 11 months. There were no statistically significant differences in patient demographics between groups. There were no differences in PROMIS scores at any time point postoperatively. At final follow-up patients in the ORIF with BT group had higher forward flexion than those who did not undergo BT (142 vs. 123 degrees, respectively, p < .02). There were no differences in surgical time, revision rates, postsurgical complications, or postoperative injections between groups. ConclusionBiceps tenodesis performed during ORIF of PHFs did not result in significantly different functional or patient-reported outcomes between groups, except for greater forward flexion at final follow-up. Although BT was done more commonly in severe PHFs, patients in both groups had similar rates of subsequent biceps-related procedures and revision surgery.

Surgical site infection following isolated lumbar discectomy increases odds of revision lumbar surgery within first 6 months, but not beyond

BACKGROUND CONTEXTLumbar discectomy is a commonly performed surgery following which surgical site infection (SSI) may occur. Prior literature has suggested that, following SSI related to lumbar fusion, the rate of subsequent lumbar surgeries is increased over prolonged periods of time. This has not been studied specifically for lumbar discectomy. PURPOSETo define factors associated with SSI following lumbar discectomy and determine if subsequently matched cohorts with and without SSI have differential rates of subsequent lumbar surgery beyond irrigation and debridement (I&Ds) over time. STUDY DESIGN/SETTINGRetrospective cohort study. PATIENT SAMPLEAdult patients undergoing isolated primary lumbar laminotomy/discectomy were identified from the 2010-2021 M157 PearlDiver database. Exclusion criteria included: age<18 years, preoperative diagnosis of infection, neoplastic, or traumatic diagnoses within 90 days prior to index surgery, additional spinal surgeries on the same day as lumbar discectomy, and not being active in the database for at least 90 days postoperative.From this study population, those who developed SSI were identified based on undergoing I&D within 90 days after surgery. Those with versus without SSI were then matched 1:4 based on age, sex, Elixhauser Comorbidity Index (ECI), and obesity. OUTCOME MEASURESFollowing initial I&D, incidence of revision lumbar surgery (revision lumbar discectomy, lumbar laminectomy, lumbar fusion) out to 5 years after lumbar discectomy. METHODSFollowing index isolated lumbar discectomy, those with versus without SSI requiring I&D were matched and compared for incidence of secondary surgery in defined time intervals (0–6 months, 6–12 months, 1–2 years, 2–5 years) using multivariable logistic regression, controlling for patient age, sex, ECI, and obesity status. RESULTSOf 323,025 isolated lumbar discectomy patients, SSI requiring I&D was identified for 583 (0.18%). Multivariable analysis revealed several independent predictors of these SSIs: younger age (odds ratio [OR] 0.85 per decade increase), ECI (OR 1.22 per 2-point increase), and obesity (OR 1.30).Following matching of those with versus without SSI requiring I&D, rates of subsequent surgery beyond I&D were compared. Those with SSI had significantly increased odds of lumbar revision in the first six months (OR 5.26, p<.001), but not 6–12 months (p=.462), 1–2 years (p=.515), or 2–5 years (p=.677). CONCLUSIONSOverall, SSI requiring I&D is a rare postoperative complication following lumbar discectomy. If occurring, subsequent surgery beyond I&D was higher in the first 6 months, but then not increased at subsequent time points out to five years.

Molecular Testing for Bethesda III Thyroid Nodules: Trends in Implementation, Cytopathology Call Rates, Surgery Rates, and Malignancy Yield at a Single Institution.

Background: Molecular testing (MT) has become standard practice to more accurately rule out malignancy in indeterminate Bethesda III (BIII) thyroid lesions. We sought to assess the adoption of this technology and its impact on cytology reporting, malignancy yield, and rates of surgery across community and academic sites affiliated with a tertiary medical center. Methods: We performed a retrospective cross-sectional study including all fine-needle aspirations (FNAs) analyzed at our institution from 2017 to 2021. We analyzed trends in MT utilization by platform and by community or academic site. We compared BIII call rates, MT utilization rates, rates of subsequent surgery, and malignancy yield on final pathology before and after MT became readily available using chi-square analysis and linear regression. Results: A total of 8960 FNAs were analyzed at our institution from 2017 to 2021. There was broad adoption of MT across both community and academic sites. There was a significant increase in both the BIII rate and the utilization of MT between the pre- and post-MT periods (p < 0.001 and p < 0.001). There was no significant change in the the malignancy yield on final pathology (57.1% vs. 50.0%, p = 0.347), while the positive predictive value of MT decreased from 85% to 50% (p = 0.008 [confidence interval 9.5-52.5% decrease]). Conclusions: The use of MT increased across the institution over the study period, with the largest increase seen after a dedicated pass for MT was routinely collected. This increased availability of MT may have led to an unintended increase in the rates of BIII lesions, MT utilization, and surgery for benign nodules. Physicians who use MT should be aware of potential consequences of its adoption to appropriately counsel patients.

Influence of Surgeon Experience and Clinic Volume on Subjective Knee Function and Revision Rates in Primary ACL Reconstruction: A Study from the Swedish National Knee Ligament Registry.

Anterior cruciate ligament reconstruction (ACLR) performed by high-volume surgeons/clinics has been associated with increased graft individualization and decreased operating times, complication rates, and total costs. To investigate the influence of surgeon/clinic volume on subjective knee function and revision surgery rates at 2 years after primary ACLR. Cohort study; Level of evidence, 3. Data from the Swedish National Knee Ligament Registry were used to study patients who underwent primary ACLR between 2008 and 2019. Surgeons/clinics were categorized based on a combination of total caseload volume (cutoff: 50 ACLRs/surgeon, 500 ACLRs/clinic) and annual volume (cutoff: 29 ACLRs/year/surgeon, 56 ACLRs/year/clinic). The thresholds of minimal important change (MIC), Patient Acceptable Symptom State (PASS), and treatment failure (TF) relative to the Knee injury and Osteoarthritis Outcome Score (KOOS) and KOOS4 (mean score of the KOOS Pain, Symptoms, Sports/Rec, and QoL subscales) were applied. Adjusted multivariable logistic regression was performed to assess variables influencing the MIC, PASS, or TF of the KOOS and KOOS4. Adjusted Cox regression analysis was conducted to determine the hazard ratio of subsequent ACLR. Of 35,371 patients, 16,317 had 2-year follow-up outcome data and were included. Patients who underwent primary ACLR by high-volume surgeons had significantly higher MIC and PASS rates and lower TF rates when compared with patients who underwent the procedure by low-volume surgeons: MICKOOS4: 70.6% vs 66.3%; PASSKOOS4: 46.0% versus 38.3%; and TFKOOS4: 8.7% versus 11.8% (all P < .02). Significantly decreased odds of achieving MICKOOS4 (OR, 0.74; 95% CI, 0.62-0.88) and PASSKOOS4 (OR, 0.71; 95% CI, 0.60-0.84) were found for ACLRs performed by low-volume surgeons. Clinic volume did not influence the odds of reaching MIC, PASS, or TF. Overall, 804 patients (2.3%) underwent subsequent ACLR at <2 years, with significantly higher revision rates among patients operated on at high-volume clinics (2.5% vs 1.7%; P < .001). However, in the adjusted Cox regression, surgeon/clinic volume had no influence on subsequent ACLR rates. High-volume surgeons/clinics had decreased time to surgery, operating time, perioperative complication rates, and use of thromboprophylaxis and nonroutine antibiotics (P < .001). Patients who underwent primary ACLR by high-volume surgeons experienced increased improvement and satisfaction regarding subjective knee function. Factors other than surgical volume influenced subsequent surgery rates. Patients might benefit from undergoing primary ACLR by high-volume providers.

Superior labrum anterior to posterior (SLAP) repair is associated with increased rate of subsequent rotator cuff diagnoses and revision surgery: a propensity-matched comparison

Surgical management of superior labral anterior to posterior (SLAP) tears remains controversial. Current management utilizes 2 well-established procedures: biceps tenodesis and SLAP repair. This study evaluates the complications associated with arthroscopic SLAP repair vs. an open or arthroscopic biceps tenodesis to further elucidate optimal surgical management. In this retrospective cohort study, the TriNetX database was utilized to evaluate patients who underwent repair of SLAP lesions (International Classification of Diseases, Tenth Revision code: S43.43) from May 15, 2003, to May 15, 2023. Three patient cohorts were evaluated: those who underwent arthroscopic SLAP repair (Current Procedural Terminology [CPT] code: 29807), those who underwent arthroscopic biceps tenodesis (CPT code: 29828), and those who underwent open tenodesis of the biceps (CPT code: 23430). Cohorts were propensity matched for type 2 diabetes, nicotine dependence, alcohol-related disorders, body mass index, and demographic factors such as age at event, ethnicity, race, and sex. The outcomes evaluated were disruption of surgical wound, deep vein thrombosis, mononeuropathy of upper limb, shoulder contusion, humeral fracture, sepsis, deceased, acute postoperative pain, revision, shoulder stiffness, and rotator cuff strain. All outcomes were evaluated within 1 year postprocedure. A total of 11,081 arthroscopic SLAP repairs, 9960 arthroscopic biceps tenodesis, and 9420 open biceps tenodesis were matched. Compared with patients who underwent arthroscopic biceps tenodesis, those who underwent arthroscopic SLAP repair were 1.8 times more likely to undergo revision (2.9% vs. 1.6%, P<.0001). Compared with those who underwent open biceps tenodesis, patients who had SLAP repair performed were 1.4 times more likely to undergo revision (3.1% vs. 2.3%, P=.013) and 1.6 times more likely to have a subsequent rotator cuff strain diagnosis (5.1% vs. 3.2%, P=.0002). Compared with patients who underwent SLAP repair, those who underwent arthroscopic biceps tenodesis exhibited 1.3 times more instances of acute postoperative pain (5.2% vs. 4.0%, P=.011). Similarly, open biceps tenodesis exhibited 1.8 times more instances of acute postoperative pain (6.9% vs. 3.8%, P<.0001) and 1.3 times more shoulder stiffness (11.8% vs. 9.0%, P<.0001). In the last 20 years, patients who underwent SLAP repair were associated with higher risk of revision surgery and subsequent rotator cuff strain diagnosis. Conversely, patients who underwent biceps tenodesis were associated with higher rates of acute postoperative pain and shoulder stiffness.

Is single-level cervical disc arthroplasty associated with a lower reoperation rate than anterior cervical discectomy and fusion?

Long-term meta-analysis of cervical disc arthroplasty (CDA) trials report lower rates of subsequent cervical spine surgical procedures with CDA compared with anterior cervical discectomy and fusion (ACDF). The objective of this study was to compare the rate of subsequent cervical spine surgery in single-level CDA-treated patients to that of a matched cohort of single-level ACDF-treated patients by using records from 2010 to 2021 included in a large national administrative claims database (PearlDiver). This retrospective matched-cohort study used a large national insurance claims database; 525,510 patients who had undergone a single-level ACDF or CDA between 2010 and 2021 were identified. Patients with other same-day spine procedures, as well as those for trauma, infection, or tumor, were excluded, yielding 148,531 patients. ACDF patients were matched 2:1 to CDA patients on the basis of clinical and demographic characteristics. The primary outcome was the overall incidence of all-cause cervical reoperation after index surgery. Secondary outcomes included readmission, any adverse event within 90 days, and overall reintervention after index surgery. Multivariable logistic regression analyses were adjusted for covariates and were employed to estimate the effect of the index ACDF or CDA procedure on patient outcomes. Survival was assessed using Kaplan-Meier estimation, and differences between ACDF- and CDA-treated patients were compared using log-rank tests. After the patients were matched, 28,795 ACDF patients to 14,504 CDA patients were included. ACDF patients had higher rates of 90-day adverse events (18.4% vs 14.6%, adjusted odds ratio [aOR] 0.77, 95% CI 0.73-0.82, p < 0.001) and readmission (11.5% vs 9.7%, aOR 0.87, 95% CI 0.81-0.93, p < 0.001). Over a mean 4.3 years of follow-up, 5.0% of ACDF patients and 5.4% of CDA patients underwent reoperation (aOR 1.09, 95% CI 1.00-1.19, p = 0.059). The rate of aggregate reintervention was higher in CDA patients than in ACDF patients (11.7% vs 10.7%, aOR 1.10, p = 0.002). The Kaplan-Meier 10-year reoperation-free survival rate was worse for CDA than ACDF (91.0% vs 92.0%, p = 0.05), as was the rate of reintervention-free survival (81.2% vs 82.0%, p = 0.003). Single-level CDA was associated with a similar rate of reoperation and higher rate of subsequent injections when compared with a matched cohort that underwent single-level ACDF. CDA was associated with lower rates of 90-day adverse events and readmissions.

Rates of subsequent surgeries after meniscus repair with and without concurrent anterior cruciate ligament reconstruction.

The purpose of this study was to compare the rates of secondary knee surgery for patients undergoing meniscus repair with or without concurrent anterior cruciate ligament reconstruction (ACLr). Utilizing a large national database, patients with meniscal repair with or without concurrent arthroscopic ACLr were identified. The two cohorts were then queried for secondary surgical procedures of the knee within the following 2 years. Frequency, age distribution, rates of secondary surgery, and type of secondary procedures performed were compared. In total, 1,585 patients were identified: meniscus repair with ACLr was performed for 1,006 (63.5%) and isolated meniscal repair was performed for 579 (36.5%). Minimum of two year follow up was present for 487 (30.7% of the overall study population). Secondary surgery rates were not significantly different between meniscus repair with concurrent ACLr and isolated meniscus repairs with an overall mean follow up of 13 years (1.5-24 years) (10.6% vs. 13.6%, p = 0.126). For the 2 year follow up cohort, secondary surgery rates were not significantly different (19.3% vs. 25.6%, p = 0.1098). There were no differences in survivorship patterns between the two procedures, both in the larger cohort (p = 0.2016), and the cohort with minimum 2-year follow-up (p = 0.0586). The current study assessed secondary surgery rates in patients undergoing meniscus repair with or without concurrent ACLr in a large patient database. Based on this data, no significant difference in rates of secondary knee surgery was identified.

135. Single-level cervical disc arthroplasty associated with a higher rate of subsequent cervical spine surgery than a matched cohort undergoing anterior cervical discectomy and fusion

135. Single-level cervical disc arthroplasty associated with a higher rate of subsequent cervical spine surgery than a matched cohort undergoing anterior cervical discectomy and fusion

Comparisons of different treatment outcomes in IVF/ET patients with hydrosalpinx: a retrospective study

Aims To explore suggestions for clinicians on the most effective treatment for hydrosalpinx undergoing IVF-ET. Materials and Methods We reviewed 936 women with hydrosalpinx and 6715 tubal infertile women without hydrosalpinx who underwent IVF/ICSI between January 2014 and August 2019 in our center. Hydrosalpinx patients received different treatments including laparoscopic surgery (only salpingectomy and proximal tubal occlusion/ligation were included), ultrasonic-guided aspiration and hysteroscopic tubal occlusion. Outcomes were analyzed by One-way ANOVA, Chi-Square test and logistic regression. Results The live birth rate (LBR) of laparoscopic surgery was significantly higher compared with hydrosalpinx aspiration (48.3% vs 39.6%, p = .024). The cumulative live birth rate (CLBR) of subsequent laparoscopic surgery was significantly higher compared with subsequent hysteroscopic occlusion (65.1% vs 34.1%, p = .001) and no subsequent treatment (65.1% vs 44.9%, p < .005). Subsequent laparoscopic surgery significantly improved the CLBR of hydrosalpinx patients who received ultrasonic-guided aspiration and didn't get clinical pregnancy in fresh cycles (Odds Ratio (OR) =1.875; 95%CI = 1.041–3.378, p = .036). Conclusions Laparoscopic surgery leads to significantly higher LBR than ultrasonic-guided aspiration and significantly higher CLBR than hysteroscopic occlusion and no treatment.

Preoperative Skull Traction, Anterior Debridement, Bone Grafting, and Internal Fixation for Cervical Tuberculosis with Severe Kyphosis.

Cervical tuberculosis (CTB) readily causes local kyphosis, and its surgical strategy remains controversial. Although some previous studies suggested that the anterior approach could effectively treat CTB, patients in these studies only suffered mild to moderate kyphosis. Therefore, little is known about whether the anterior approach can achieve satisfactory outcomes in CTB patients with severe kyphosis. This study was performed to evaluate the safety and efficacy of preoperative skull traction combined with anterior surgery for the treatment of CTB patients with a severe kyphosis angle of more than 35°. In this retrospective study, we enrolled 31 CTB patients with severe kyphosis who underwent preoperative skull traction combined with anterior surgery from April 2015 to January 2021. Patients were followed up for at least 2 years. Clinical data, such as operative time, blood loss, and postoperative hospital stay, were collected. The clinical outcomes included American Spinal Injury Association (ASIA) spinal cord injury grade, Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and related complications. The radiological outcomes included the Cobb angle of cervical kyphosis at each time point and the bony fusion state. Clinical efficacy was evaluated by paired Student's t-test, Mann-Whitney U-test, and others. Six patients had involvement of one vertebra, 21 had involvement of two vertebrae, and four had involvement of three vertebrae. The most common level of vertebral involvement was C4-5, whereas the most common apical vertebra of kyphosis was C4. The mean kyphosis angle was 46.1° ± 7.7° preoperatively, and the flexibility on dynamic extension-flexion X-rays and cervical MRI was 17.5% ± 7.8% and 43.6% ± 11.0%, respectively (p = 0.000). The kyphosis angle significantly decreased to 13.2° ± 3.2° after skull traction, and it further corrected to -6.1° ± 4.3° after surgery, which was well maintained at the final follow-up with a mean Cobb angle of -5.4° ± 3.9°. The VAS and JOA scores showed significant improvement after surgery. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels normalized at 3 months after surgery. All patients achieved solid bone fusion, and no complications related to the instrumentation or recurrence were observed. Preoperative skull traction combined with anterior debridement, autologous iliac bone grafting, and internal plate fixation can be an effective and safe surgical method for the treatment of cervical tuberculosis with severe kyphosis. Skull traction can improve the safety and success rate of subsequent anterior corrective surgery.

Poster 338: Analysis of Patient Reported Outcomes and Subsequent Surgery Rate following Quadriceps Tendon Anterior Cruciate Ligament Reconstruction and Lateral Extra-articular Tenodesis in Skeletally Immature Patients: Two Year Follow-Up

Objectives: The incidence of anterior cruciate ligament reconstruction (ACLR) in pediatric and adolescent patients is increasing significantly and many patients possess risk factors that predispose to ACL re-tear. Lateral extra-articular tenodesis (LET) may be performed in conjunction with ACLR to reduce the risk of ACL re-tear. The purpose of this study is to evaluate the 2-year clinical outcomes of ACLR with soft tissue quadriceps tendon (QUAD) autograft and a lateral extra-articular tenodesis (LET) using a modified Lemaire technique in skeletally immature patients. Methods: A consecutive series of patients who underwent QUAD tendon autograft ACLR and LET with a minimum of 2-year follow-up data was analyzed retrospectively. ACLR techniques included all- epiphyseal (AE) and complete transphyseal (CT) and were indicated based on skeletal age. Outcome measures included participants’ return to sports (RTS), concomitant or subsequent surgical procedures and multiple patient-reported outcome measures, including Single Assessment Numeric Evaluation (SANE), Pediatric International Knee Documentation Committee (Pedi-IKDC) and HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores. Results: The final cohort included 50 consecutive adolescent patients aged 11 to 16 years (mean 14.2 ± 1 years) with a minimum follow-up of 2 years. Two patients were lost to follow-up. Of the patients included in the study (n=48), 98% participated in high-risk competitive sports (Table 1). Two patients (4%) were revision ACLR. Ten (21%) patients underwent AE and 38 (79%) underwent CT ACLR. Sixteen patients (33%) had subsequent surgical procedures, including 5 contralateral ACLR, 4 meniscus surgeries, 4 QUAD autograft scar revision, 4 irrigation and debridement (2 patients, 2 each) and 3 hardware removal procedures (2 for hemi-epiphysiodesis and 1 tibial socket button removal). The rate of graft failure was 0%. At two-year follow-up, mean SANE score was 93, mean Pedi-IKDC score was 90, and mean HSS-Pedi-FABS score was 23. RTS rate was 100%. Conclusions: A LET when performing an ACLR is safe and should be considered as a concomitant procedure for adolescent patients that are at high risk of re-tear. [Table: see text]