Meniscal tears occur at the time of anterior cruciate ligament (ACL) injury in 55% to 65% of patients. These tears exhibit different healing patterns and behavior compared with meniscal tears in a stable knee. The optimal management of different medial, lateral and bicompartmental tears during primary ACL reconstruction (ACLR) has yet to be defined. To evaluate the reoperation rates associated with different meniscal treatment strategies and analyze the effect of medial, lateral, and bicompartmental meniscal tears on ACLR outcomes. Cohort study; Level of evidence, 2. This investigation included 1137 patients undergoing primary ACLR with a concomitant meniscal injury. Patients with chondral defects and multiligament knee injuries were excluded. Meniscal treatments were divided into 3 categories: left in situ (LIS), partial meniscectomy (PM), and repair. Reoperation was defined as the primary endpoint, and multivariable analysis was conducted to identify patient and tear characteristics associated with reoperation. The influence of different treatment strategies on return to play (RTP), ACL reinjury rate, and patient-reported outcome measures (PROMs) was reported at 2 years. The PROMs recorded were the International Knee Documentation Committee (IKDC) score, the Marx Activity Rating Scale, and the Anterior Cruciate Ligament-Return to Sport after Injury score. The mean age was 24.0 ± 6.9 years, and 76% of patients were male. Most injuries were noncontact (64.9%), commonly resulting from pivoting/sidestepping (50.1%). No significant differences in injury mechanism, playing surface, or footwear type were found between medial, lateral, or bicompartmental tears. Reoperation rates for patients were low for lateral (1.3%), medial (2.6%), and bicompartmental tears (3.2%) LIS at the time of ACLR. The rate of reoperation/subsequent meniscectomy for medial meniscal repairs (14.8%) was significantly higher than for other medial treatments (hazard ratio 12.8; P < .001). Patients who underwent meniscal repair with a concomitant tear in the opposite compartment (repair + PM/LIS) had the highest reoperation rates (16.7%) and lowest RTP rates (60%). IKDC scores were significantly lower for patients who underwent lateral meniscal repair (81.1 ± 15.3) compared with other types of lateral meniscal management (P < .027). ACL reinjury rate was not influenced by meniscal treatment. A higher preoperative Marx score increased the risk of reoperation in all groups. Stable meniscal tears LIS during ACLR had low reoperation rates and good patient-reported outcomes, including patients with bicompartmental tears. Medial meniscal repairs had the highest risk of reoperation, particularly when another tear was present in the lateral compartment. Lateral meniscal repairs were associated with lower IKDC scores compared with other lateral meniscal treatment strategies.

There has been systematic review and meta analysis (SRMA) on comparison of hepaticoduodenostomy (HD) and hepaticojejunostomy (HJ) in choledochal cysts (CDC), which included both open and laparoscopic procedures. There is no SRMA, comparing them in pediatric CDC which were managed exclusively by laparoscopy. Studies comparing laparoscopic HD and HJ after CDC excision were identified from Medline, Ovid, Google Scholar, and Cochrane library. Suitable studies were reviewed and meta-analyzed. Outcomes evaluated included operative time, hospital stay, and incidence of postoperative bile leak, cholangitis, reflux/gastritis, anastomotic stricture, bleeding, intestinal obstruction, and re-operative rate. Nine retrospective studies were included, comprising total of 1903 patients, 457 of whom (24%) underwent HD, and 1446 (76%) underwent HJ. There was higher incidence of cholangitis in HJ (3.05%) than in HD (1.55%), though the difference was not statistically significant (P = .54). Reflux gastritis in the HD was 8.83% while that from the HJ was 0.87%. Meta-analysis favored HJ (odds ratio [OR]: 20.38, 95% confidence interval [CI]: 4.24 to 97.94; P = .002). For the mean operative time, Pooled Mean difference (MD: -56.93; 95% CI: -66.11, -45.75; P = .00001) was significant favoring HD. Outcomes such as hospital stay, bile leak, anastomotic stricture, bleeding, reoperation rate, and adhesive obstruction were comparable. Laparoscopic HD and HJ show comparable short-term safety after CDC excision, with no significant difference in bile leak or cholangitis. HD, however, carries a higher risk of bile reflux and gastritis, though the operative time is significantly shorter with HD, offering a technical advantage.

Distal fibula fractures are a common injury (1), often requiring surgical management. Surgical fixation techniques described include intramedullary fixation, tension band wiring, lateral plating, locking plate fixation, and posterolateral antiglide plating. Biomechanical studies have shown antiglide plating to be superior to lateral plating. Lateral implants can also result in soft-tissue irritation (2). Despite this, lateral plating remains the most commonly performed technique (1). This study aims to directly compare the outcomes of posterolateral antiglide fixation of distal fibula fractures simultaneously with those of lateral plating, dual plating, locking plate fixation, and intramedullary fixation for the first time. We hypothesized that the antiglide plating technique will have lower rates of implant removal, wound complication, infection, and overall secondary surgery rates. This novel data will inform the practice of orthopaedic surgeons for this common procedure, potentially helping improve patient outcomes and reduce unnecessary cost and reduce resource utilization incurred due to secondary surgery. A multi-centre retrospective observational cohort study was performed using data collected from a provincial healthcare data repository. Eligible patients were 18 years of age and older with an isolated ankle fracture that underwent surgical fixation within the province from July 1st to December 31st, 2016, and July 1st to December 31st, 2019. Patients had at minimum two follow-up visits after surgery. Those with multiple injuries, open fractures, pathologic fractures, and pre-existing ankle implants were excluded. Radiographic and chart reviews were performed on included patients. The primary outcome measure was the rate of secondary surgery for implant removal. Secondary outcomes included would complications and infection rate. Pearson's Chi-squared, ANOVA, Kruskal-Wallis rank sum, t-tests, and Fisher's exact tests were used as appropriate. The study included 1525 patients with a mean age of 47 years (std 17.2), 55.9% were female. Lateral plating was the most common fixation technique (74.2%). Secondary surgery for implant removal was performed on 364 patients (23.8%). Pain was the most frequent reason for removal. The mean age, rate of secondary surgery for implant removal, and rate of antibiotic use is listed in Table 1. Figure 1 shows the odds ratios for implant removal of the various fibula fixation types compared to posterolateral antiglide plating. Lateral plating continues to be the most used method of distal fibular fixation. The overall rate of reoperation for implant removal (23.8%) was similar to previously published rates of reoperation. Posterolateral antiglide plating had the lowest rate of reoperation for implant removal of all fixation types and was over 2-times less likely to be removed compared to lateral plating. Locking plates were 2.5-times more likely to require removal. For any figures or tables, please contact authors directly.

Valve characteristics and surgical options for severe rheumatic mitral stenosis with more than mild regurgitation: a dual-center retrospective study.

This study examines clinical outcomes of Ovine-Reinforced Hybrid Mesh (OviTex) in alloplastic breast reconstruction by a single surgeon. A retrospective chart review was conducted on patients who underwent immediate or delayed breast reconstruction with OviTex between 2019 and 2023 without indocyanine green angiography. Outcomes analyzed included reoperation rates, implant exposure, infection, seroma, and hematoma. Even in patients with thin mastectomy skin flaps, immediate reconstruction was essentially performed whenever planned. Seventy-nine patients (134 breasts) were included. The majority of reconstructions involved direct-to-implant procedures (65% vs 35% tissue expander), with a predominance of immediate reconstructions (97% vs 3% delayed) and prepectoral placement (72% vs 28% dual-plane). Reoperation occurred in 29 breasts (22%), all in immediate reconstructions, primarily due to exposure (20%), infection (10%), or a combination of both (8%). Four breasts (3%) developed a seroma, two of which also required surgical intervention for exposure. No hematomas were observed. Reoperation was significantly more likely on breasts treated direct-to-implant compared to those with tissue expanders (P < 0.001) and on the cancer side compared toprophylactic reconstructions (P < 0.001). No significant differences in reoperation were noted regarding placement location (prepectoral vs dual-plane) or radiation treatment. This study provides clinical outcomes on OviTex use in alloplastic breast reconstruction. Reoperation was significantly more likely in direct-to-implant reconstruction and on the side with cancer, likely due to skin flap perfusion rather than intrinsic mesh properties. The lack of access to indocyanine green angiography, as others have reported, in all likelihood contributed to the higher-than-expected rate of reoperation. In addition, significantly smaller implants might have led to a higher rate of reconstructive success.

Sporadic primary hyperparathyroidism is most commonly caused by a single parathyroid adenoma. Traditionally, bilateral neck exploration with assessment of all four glands was the gold standard, achieving cure rates up to 98%. This approach has largely been replaced by limited exploration (LE), in which a prelocalized hyperfunctioning gland is selectively removed using a small open, video-assisted, or endoscopic approach.Successful LE relies on accurate preoperative localization of single-gland disease. First-line imaging consists of high-resolution ultrasound combined with 99mTc-sestamibi scintigraphy with single-Photon Emission Computerized Tomograph (SPECT/CT). When results are negative or discordant, 18F-choline PET/CT is recommended, significantly improving localization and enabling targeted surgery..Because multiglandular disease cannot be definitively excluded preoperatively, intraoperative parathyroid hormone (IOPTH) monitoring has become an important adjunct. IOPTH confirms complete excision of hyperfunctioning tissue and aids detection of additional abnormal glands. Several interpretive criteria exist, including Miami, Vienna, Halle, and Rome, with Miami and Vienna most commonly used. Although routine IOPTH use in concordantly localized single-gland disease remains debated, evidence suggests it reduces persistent disease and reoperation rates, particularly when imaging is inconclusive.Endoscopic, extracervical, and robotic approaches offer superior cosmetic outcomes but involve greater dissection, higher costs, and increased technical demands, limiting widespread use. Overall, advances in imaging and intraoperative adjuncts have enabled minimally invasive parathyroidectomy to replace bilateral exploration while maintaining excellent long-term outcomes.

Clinical and radiological outcomes of transverse process hooks versus pedicle screws at the upper instrumented vertebra in adult spinal deformity patients undergoing three-column osteotomy: A retrospective comparative study.

A systematic review examining the clinical evidence for the elbow internal joint stabilizer and associated complications.

Long-term outcomes of tricuspid valve plasty vs. replacement after cardiac surgery: Mortality, reoperation, and anticoagulation complications in patients with postoperative tricuspid regurgitation.

Doppler ultrasound versus computed tomography angiography prior to deep inferior epigastric perforator flap breast reconstruction: An updated systematic review and meta-analysis.

The classic from Shelbourne and Nitz (1990) on accelerated rehabilitation after anterior cruciate ligament reconstruction.

Cement-augmented cephalomedullary nail fixation for femoral trochanteric fractures: A modified delphi consensus amongst japanese expert surgeons.

Is failure to rescue an appropriate quality indicator in a pancreatic surgery unit?

Intramedullary Arthrodesis for Periprosthetic Joint Infection after Total Knee Arthroplasty: A Systematic Review of Constructs, Fusion Rates, and Clinical Outcomes.

Surgical management of atypical femoral fracture non-unions - strategies and outcomes.

Retrospective cohort study. Anterior cervical discectomy and fusions (ACDF) have become a common and effective means of decompression and stabilization of the cervical spine. Anterior instrumentation with plates and screws (ACDF-P) are increasingly utilized to increase rates of union. However, concerns with plate-related risks have led to the evolution of stand-alone ACDF (ACDF-S) constructs in hopes of reducing adjacent segment degeneration from plate prominence though critics have pointed out potential for subsidence, instability, and nonunions. We sought to evaluate reoperation risk following ACDF-S compared with ACDF-P in a multicenter US-based cohort. Adult patients who underwent primary one to two-level ACDF between C3 and C7 for degenerative disc disease were identified using a health care system's spine registry (2009-2022). Three thousand nine hundred fifty-eight ACDF comprised the final study sample, 278 (7.0%) were ACDF-S. Procedures were performed by 59 surgeons at 16 hospitals. Multivariable Cox proportional-hazards regression was used to evaluate ACDF-S versus ACDF-P and risk of reoperation for any cause with confounder adjustment. Reoperation for adjacent segment disease (ASD) or nonunion were also evaluated. Secondary analysis stratified by one and two-level ACDF procedures. In adjusted analyses, no differences in all-cause reoperation risk [hazard ratio (HR)=0.97, 95% CI=0.58-1.64] or reoperation for ASD (HR=1.11, 95% CI=0.61-1.99) was observed when comparing ACDF-S to ACDF-P. No differences in reoperation risks were also found when restricted to one-level procedures (all-cause: HR=0.92, 95% CI=0.50-1.68; ASD: HR=0.88, 95% CI=0.44-1.78). For two-level procedures, there were 49 ACDF-S and 1,886 ACDF-P. There were too few events observed for regression analysis. In this large, comparative study including a cohort of nearly 4000 patients, differences in reoperation rates for ACDF-S compared with ACDF-P constructs were not observed. This information could be used to better inform surgeons, patients, administrators, and policy makers between the 2 ACDF options.

Complications and Reoperation Rates of Total Knee Arthroplasty After High Tibial Osteotomy: A Matched Cohort Analysis From a Nationwide Database.

Preoperative depression is associated with higher reoperation rates following anterior cervical discectomy and fusion: a multidimensional evaluation in the post-COVID-19 era.

Impact of hyperthermic intrathoracic chemotherapy during cytoreductive surgery with diaphragmatic resection.

To compare postoperative outcomes of flap maturation (FMT) and conventional tracheotomy techniques in pediatric patients. A retrospective cohort study was performed using data from the American College of Surgeons National Surgical Quality Improvement Program Pediatric database (2020-2021). Pediatric patients ≤ 18 years who underwent FMT (CPT 31610) or conventional tracheotomy (CPT 31600, 31,601) were included. Primary outcomes were 30-day reoperation, surgical site infection, pneumonia, seizures, mortality, unplanned reintubation, readmission, and length of stay. Among 2353 patients (mean age 2.9 years, 95% CI 2.7-3.1), 381 (16.2%) underwent FMT and 1972 (83.8%) underwent conventional tracheotomy. An FMT was associated with lower odds of 30-day reoperation (0.5% vs. 3.3%, p = 0.003; adjusted OR = 0.17, 95% CI 0.1-0.6, p = 0.005). Rates of surgical site infection, pneumonia, and seizures did not differ significantly between groups after adjustment. No differences were observed in mortality, reintubation, readmission, or length of stay. FMT is independently associated with lower reoperation rates without increased postoperative complications. FMT may be a favorable tracheotomy option for select patients and warrants consideration during surgical decision-making to optimize outcomes.