Failure Of Repair Research Articles

Delayed surgical repair of a rupture of quadriceps tendons in a dog after failure of primary surgery

AbstractA 10‐month‐old female American bulldog presented for surgical revision of a left quadriceps injury that was sustained after running into a glass table. The wounds were initially repaired and tendons reattached at the referring practice. However, the dog remained non‐weight bearing following the initial surgery. A substantial gap could be palpated within the quadriceps, proximal to the stifle joint, indicating failure of the quadriceps mechanism repair. Radiography of the limb revealed a large joint effusion and soft tissue swelling around the stifle. Surgical revision of the quadriceps deficit was performed. The dog made a full recovery and no residual lameness was evident 6 months following surgery.

Study on the low‐velocity impact response of the repaired carbon fiber‐reinforced plastic laminates: Bonded versus scarf repair

AbstractExperimental and simulation studies of the response of bonded‐repaired and scarf‐repaired carbon fiber‐reinforced polymer laminates under the low‐velocity impact (LVI) were carried out. The center‐ and eccentric‐repaired laminates were prepared for experiments. The experimental results verify the validity of the finite element model in terms of the force response and different modes of damage. The effect of impact energy and the variation of repair position on the impact response of the laminate was investigated based on the benchmark model. The bonded repaired laminates have higher peak impact forces and lower energy absorption than the scarf‐repaired laminates; the damage of the bonded repaired laminate is mainly intralaminar damage and delamination damage of the patch; the adhesive of the scarf repair is prone to failure, leading to poor impact resistance. The relative positions of the impact point and the patch determine the impact response of a laminate repaired at different locations. The impact point at the edge of the patch has a detrimental effect on the repaired laminate. The impact point vertical position near the bottom hole edge of the parent plate in the scarf‐repaired case harms the impact resistance of the laminate.Highlights The low‐velocity impact response of bonded versus scarf‐repaired laminates was compared. Bonding repairs provide superior impact resistance to damaged laminates than scarf repairs. The risk of adhesive failure in scarf repair is significantly higher than in bonded repair. The relative position of the damage (repair) to the impact point critically influences the impact response. Impacts near the edge of the initial damage hole can cause severe damage to scarf‐repaired laminates.

Abstract IA020: Micronuclei are a nexus of DNA damage signaling and genomic instability

Abstract Micronuclei have classically been considered inert biomarkers of genomic instability arising from failed DNA damage repair and chromosome segregation errors in mitosis. Work from several groups including our own have now demonstrated that micronuclei are active contributors to the cellular response to DNA damage by driving chromothripsis and through induction of anti-viral gene expression programs mediated by the cGAS-STING pathway. We now show that the specific DNA damage type leading to micronuclei formation influences the capacity for cGAS localization and activation. This arises in part due to discrete chromatin features, present prior to DNA damage induction, that are retained in micronuclei several days after their formation. Together these data demonstrate that micronuclei connect the pre-damage chromatin status and the chromatin context of micronuclei-inciting lesions to the long-term signaling outcomes important for anti-tumor immunity. This finding implies that micronuclei represent archives for the nature of DNA repair failure and downstream signaling consequences. Based on this premise we will present our efforts in micronuclear proteomics where we uncover common features of micronuclei including splicing deficiencies. Such deficiencies presage exacerbated MN-associated DNA damage that is upstream of chromothripsis. These studies have direct implications for how cells sense the aftermath of DNA damage and how micronuclei contribute to ongoing genomic instability. Citation Format: Shane M. Harding. Micronuclei are a nexus of DNA damage signaling and genomic instability [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: DNA Damage Repair: From Basic Science to Future Clinical Application; 2024 Jan 9-11; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2024;84(1 Suppl):Abstract nr IA020.

Construction of oxidized icariin functionalized collagen composite with promoting osteogenesis, vascularization and anti-inflammatory properties potential for bone repair application

Bone defects are mainly treated by transplanting bone scaffold, and lack of osteogenesis, vascularization and anti-inflammatory properties will reduce the ability of new bone tissue to grow into them, thus increasing the risk of bone repair failure. In this study, inspired by the composition of natural bone, COL-BG-MOF composite was first prepared (collagen (COL) as the organic component, aminated mesoporous bioactive glass (BG-NH2) as the inorganic non-metallic component, and mesoporous silica shell-coated Mg-MOF-74 (Mg-MOF-74@MSiO2) as the metallic trace element component). Subsequently, in order to further enhance the effectiveness of its bone repair application potential, COL-BG-MOF was functionalized by oxidized Icariin (OICA) as a “growth factor” component to endow it with simultaneous osteogenesis promoting, vascularization promoting, and anti-inflammatory properties. Notably, the –CHO of OICA can react with the –NH2 in COL-BG-MOF by Schiff base reaction, which can cross-link the COL, thus improving the interfacial binding of BG-NH2 to the COL and slowing down the release rate of OICA. The results showed that the obtained functionalized composite scaffold exhibited better compressive strength, anti-degradation and osteoconductivity, as well as sustained OICA release behavior. More importantly, the synergistic effect of OICA and Mg-MOF-74@MSiO2 greatly promoted its osteogenic differentiation, HUVEC migration and anti-inflammatory properties. Therefore, this study provided a strategy to prepare functionalized composites by using modified Chinese medicine, which has great application potential in the field of bone regeneration.

Reinterventions and sac dynamics after fenestrated endovascular aortic repair with physician-modified endografts for index aneurysm repair and following proximal failure of prior endovascular aortic repair

ObjectiveThe high frequency of reinterventions after fenestrated endovascular aortic repair (FEVAR) with physician-modified endografts (PMEGs) has been well-studied. However, the impact of prior EVAR on reinterventions and sac behavior following these procedures remains unknown. We analyzed 3-year rates of reinterventions and sac dynamics following PMEG for index aneurysm repair compared with PMEG for prior EVAR with loss of proximal seal. MethodsWe performed a retrospective analysis of 122 consecutive FEVARs with PMEGs at a tertiary care center submitted to the United States Food and Drug Administration in support of an investigational device exemption trial. We excluded patients with aortic dissection (n = 5), type I to III thoracoabdominal aneurysms (n = 13), non-elective procedures (n = 4), and prior aortic surgery other than EVAR (n = 8), for a final cohort of 92 patients. Patients were divided into those who underwent PMEG for index aneurysm repair (primary FEVAR) and those who underwent PMEG for rescue of prior EVAR with loss of proximal seal (secondary FEVAR). The primary outcomes were freedom from reintervention and sac dynamics (regression as ≥5 mm decrease, expansion as ≥5 mm increase, and stability as <5 mm increase or decrease) at 3 years. Secondary outcomes were perioperative mortality and 3-year survival. ResultsOf the 92 patients included, 56 (61%) underwent primary FEVAR and 36 (39%) underwent secondary FEVAR. Secondary FEVAR patients were older (78 years [interquartile range (IQR), 74.5-83.5 years] vs 73 years [IQR, 69-78.5 years]; P < .001), more frequently male (86% vs 68%; P = .048), and had larger aneurysms (72.5 mm [IQR, 65.5-81 mm] vs 59 mm [IQR, 55-65 mm]; P < .001). Perioperative mortality was 1.8% for primary FEVAR and 2.7% for secondary FEVAR (P = .75). At 3 years, overall survival was 84% for primary FEVAR and 71% for secondary FEVAR (P = .086). Freedom-from reintervention was significantly higher for primary FEVAR than secondary FEVAR, specifically 82% vs 38% at 3 years (P < .001). Primary FEVAR also had more desirable sac dynamics relative to secondary FEVAR at 3 years (primary: 54% stable, 46% regressed, 0% expanded vs secondary: 33% stable, 28% regressed, and 39% expanded; P = .038). ConclusionsFEVAR for primary aortic repair and FEVAR for rescue of prior EVAR with loss of proximal seal are two distinct entities. Following primary FEVAR, less than a quarter of patients have undergone reintervention at 3 years, and sac expansion was not seen in our cohort. Comparatively, 3 years after secondary FEVAR, over one-half of patients have undergone reintervention and over one-third have had ongoing sac expansion. Vigilant surveillance and a low threshold for further interventions are crucial following secondary FEVAR.

Arthroscopic Posterior Glenoid Reconstruction With Distal Clavicle Bone-Block

Posterior glenoid bone loss is a potential cause for failure in arthroscopic capsulolabral repair. Although multiple techniques have been described to reconstruct posterior bone defects, they do not reliably yield improved patient outcomes and have high complication rates. We present a technique to reconstruct posterior glenoid bone loss using a distal clavicle autologous bone graft harvested by a mini-open approach and secured arthroscopically with suture buttons. The graft is positioned extra-articularly by repairing the posterior labral complex with a knotless fixation using labral tape.

Biomechanical Comparison of Coracoclavicular Fixation Using Metallic Versus All-Suture Anchors.

A coracoclavicular (CC) fixation technique using an all-suture anchor with the assistance of fluoroscopy can prevent iatrogenic anterior deltoid detachment from the clavicle; however, soft anchor pullout has been reported as a complication. To compare the biomechanical properties of conventional metallic and all-suture anchors for CC suture fixation. Controlled laboratory study. A total of 24 fresh-frozen cadaveric specimens were divided into 2 groups: metal anchor group (group M) and all-suture anchor group (group A). In group M, 5.0-mm metallic suture anchors were used for CC fixation, whereas 2.8-mm all-suture anchors were used in group A. The prepared specimens were mounted on a materials testing machine. After preconditioning at 0 to 20 N for 10 cycles, the specimens were subjected to cyclic loading from 20 to 70 N for 1000 cycles. Finally, all the specimens were loaded to failure. Cyclic elongation, linear stiffness, ultimate load, and failure modes were recorded, and the Mann-Whitney U test was used to compare nonparametric parameters between the 2 groups. All of the specimens completed the cyclic loading test. The elongation after cyclic loading in group M (1.6 ± 0.6 mm) was significantly smaller compared with that in group A (2.5 ± 1.2 mm) (P = .02). No between-group differences were found in linear stiffness (42 ± 17 N/mm in group M and 41 ± 17 N/mm in group A). The ultimate failure load in group M (263 ± 66 N) was significantly greater than that in group A (177 ± 76 N) (P = .02). All specimens failed because of suture anchor pullout. The use of all-suture anchors in CC fixation resulted in significantly greater cyclic displacement and smaller ultimate failure load than that of metallic anchors. Understanding the most biomechanically sound suture anchor may assist in lowering the risk of clinical failure in CC fixation and repair.

Transplantation of a bioengineered tissue patch promotes uterine repair in the sheep.

Innovative bioengineering strategies utilizing extracellular matrix (ECM) based scaffolds derived from decellularized tissue offer new prospects for restoring damaged uterine tissue. Despite successful fertility restoration in small animal models, the translation to larger and more clinically relevant models have not yet been assessed. Thus, our study investigated the feasibility to use a 6 cm2 graft constructed from decellularized sheep uterine tissue, mimicking a future application to repair a uterine defect in women. Some grafts were also recellularized with fetal sheep bone marrow-derived mesenchymal stem cells (SF-MSCs). The animals were followed for six weeks post-surgery during which blood samples were collected to assess the systemic immune cell activation by fluorescence-activated cell sorting (FACS) analysis. Tissue regeneration was assessed by histology, immunohistochemistry, and gene expression analyses. There was a large intra-group variance which prompted us to implement a novel scoring system to comprehensively evaluate the regenerative outcomes. Based on the regenerative score each graft received, we focused our analysis to map potential differences that may have played a role in the success or failure of tissue repair following the transplantation therapy. Notably, three out of 15 grafts exhibited major regeneration that resembled native uterine tissue, and an additional three grafts showed substantial regenerative outcomes. For the better regenerated grafts, it was observed that the systemic T-cell subgroups were significantly different compared with the failing grafts. Hence, our data suggest that the T-cell response play an important role for determining the uterus tissue regeneration outcomes. The remarkable regeneration seen in the best-performing grafts after just six weeks following transplantation provides compelling evidence that decellularized tissue for uterine bioengineering holds great promise for clinically relevant applications.

Septal perforation

Aim: This study isolates septal perforations due to nasal surgery for clinical analysis and their effect on bilateral mucosal flap repair. Methods: This is a retrospective review of a single surgeon’s 20-year experience with endonasal perforation repair utilizing bilateral mucosal advancement flaps supported with an autologous tissue interposition graft. Patients with a minimum of 4-month postoperative follow-up were included in the study. Comparative analyses of repair failure rates and perforation size of failures between surgical and non-surgical etiologies were performed. Results: Three hundred ninety-two patients met the criteria for inclusion in the study. The incidence of perforation and prior septal surgery was 40.6%. Overall repair closure in patients with a minimum of 4 months follow-up was 94.8%. Failures were noted in 5.7% of surgical and 4.7% of non-surgical perforation etiologies (P = 0.816). Mean differences in perforation length and height in failed repairs between non-surgical and surgical etiologies (19.4 vs. 13.7 and 15.5 vs. 9.3 mm, respectively) were significant (P = 0.048 length, P = 0.006 height). Conclusion: Post-surgical nasal septal perforations can be repaired with a low rate of failure. However, this study found that the size of perforations in failed repairs was significantly smaller in patients with a history of septal surgery, suggesting that prior septal surgery increases the technical difficulty of a bilateral flap perforation repair.

Revision Transtibial Medial Meniscal Root Repair With Concomitant Medial Opening-Wedge Proximal Tibial Osteotomy

Background: Complete meniscal root tears disrupt dispersion of axial loading forces through hoop stresses. This increases point-loading on tibiofemoral cartilage and leads to chondromalacia and accelerated osteoarthritis (OA). Posterior root tears may be treated successfully with a transtibial pullout repair. Varus malalignment also leads to increased medial compartment pressures, increasing the risk of early OA and putting increased stress on the meniscus and stabilizing knee ligaments. In particular, revision medial meniscal root repairs without correction of varus malalignment are at increased risk of failure. Genu varum may be corrected with a medial opening-wedge proximal tibial osteotomy (OW PTO). Indications: Meniscal root repairs are indicated for acute or chronic tears in active patients with healthy cartilage. OW PTO is indicated for varus malalignment in ambulatory patients with healthy cartilage, or who are at risk for failure of meniscal or ligamentous procedures. Technique Description: After exposure of the osteotomy site, arthroscopy is performed through the incision and the revision posterior meniscus root repair is performed via a double-tunnel transtibial pullout technique. The positioning of these tunnels is modified superiorly so as to not cross the planned osteotomy site. The osteotomy is then performed by drilling 2 guide pins under fluoroscopy to delineate the plane of the cut. An OW plate is placed, and the root repair is tensioned last. Results: Double-tunnel transtibial pullout repairs increase meniscal fixation contact surface and have been shown to be biomechanically superior to all-inside fixation techniques. Medial OW PTO restores knee alignment and reduces supra-anatomic stresses in the medial compartment, additionally decreasing the risk of a revision medial meniscus repair failure. Discussion: Biomechanical studies have shown that meniscal root tears are functionally equivalent to complete meniscectomy. Varus malalignment increases the risk of medial meniscal tears, and reduces the risk of a successful long-term repair. We describe a technique for a revision transosseous posterior root repair with concomitant proximal tibial osteotomy, with discussion of surgical pearls and pitfalls. This technique restores anatomic position and native function of the medial meniscus while correcting tibiofemoral malalignment that could jeopardize the repair. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.

Superficial Digital Flexor Tendon Contracture in a Dog with Gastrocnemius Tendon Avulsion

AbstractAvulsion of the gastrocnemius component of the Achilles tendon is a well-documented condition in dogs. The most common treatment is to restore tendon function with surgical reattachment to the tuber calcanei. However, repair can fail. Pantarsal arthrodesis cannot only salvage a failed repair but is also a first-line treatment that may have a more predictable outcome. We describe a case of contracture of the superficial digital flexor tendon (SDFT) in the hindlimb of a dog with avulsion of the gastrocnemius component of the Achilles tendon, treated previously by pantarsal arthrodesis. Digital flexion and lameness persisted despite non-surgical treatment, and tenotomy of the SDFT was performed at the level of distal calcaneus to allow digit extension. The dog was re-examined 2 weeks and more than 2 years after surgery. No complications occurred, and the dog maintained an excellent long-term improvement in limb function.

Initial Experience Implementing a Mitral Plasty Program: Is It a Technique with Reproducible Results?

Background: Repairing the mitral valve has demonstrated a significant advantage over managing severe mitral insufficiency over mitral valve replacement. Therefore, the clinical practice guidelines considered it the first therapeutic option for treating valvular pathologies. Consequently, it should be widely adopted as a standard procedure by cardiac surgeons worldwide. Objective: To establish the reproducibility of mitral valve repair within our hospital in terms of techniques and outcomes, we aim to compare our performance with data published by leading international medical institutions. This comparative analysis will allow us to evaluate our proficiency and quality of care in the field of mitral valve surgery in line with global standards. Methods: Between January 2018 and January 2022, 63 patients with severe mitral insufficiency due to degenerative or functional disease who met surgical criteria were operated at Luis Vernaza Hospital. Of these, 22 patients underwent mitral valve repair. We conducted a retrospective longitudinal study and assessed the postoperative progression, focusing on key outcomes, including valve patency, reintervention rates, and mortality. The patients’ follow-up was made by telephone communication, and they underwent at least one annual echocardiogram as a part of the monitoring process. Results: As a result, 22 patients (73% males) with an average age of 48 years (ranging from 36 to 72 years) were analyzed. All patients presented severe mitral insufficiency, with 91% of cases attributed to primary etiology. In our experience, severe primary mitral insufficiency was successfully repaired in 55% of cases, with the P2 segment involvement being the most common cause. On the other hand, only two patients required reoperation, one due to ring dehiscence and the other due to rupture of new chordae tendineae. In contrast, we had one case of hospital mortality associated with immediate reoperation due to repair failure, and three patients passed away later due to non-cardiovascular causes. Finally, the remaining patients are asymptomatic, maintain regular activities, have no residual mitral insufficiency, and maintain a left ventricular function with more than 45% ejection fraction. Conclusion: Mitral valve repair with an annuloplasty ring is a technique that can be successfully replicated in our hospital and provided by cardiac surgeons with adequate training. This approach yields outcomes similar to those achieved in globally renowned centers with higher surgical volumes and extensive experience in mitral valve repairs.

The Boyd approach: a valuable alternative to treating simple to complex elbow fractures and dislocations.

The Boyd approach is a single-incision posterior approach to the proximal radius and ulna based on a lateral anconeus muscle reflection and release of the lateral collateral ligamentous complex. This approach remains a lesser-used technique following early reports of proximal radioulnar synostosis and postoperative elbow instability. Although limited by small case series, recent literature does not support these early reported complications. This study presents a single surgeon's outcomes using the Boyd approach for the treatment of simple to complex elbow injuries. Following institutional review board approval, a retrospective review of all patients with simple to complex elbow injuries treated consecutively using a Boyd approach by a shoulder and elbow surgeon was conducted from 2016 to 2020. All patients with at least 1 postoperative clinic visit were included. Data collected included patient demographics, injury description, postoperative complications, elbow range of motion, and radiographic findings including heterotopic ossification and proximal radioulnar synostosis. Categorical and continuous variables were reported using descriptive statistics. A total of 44 patients were included with an average age of 49 years (range 13-82 years). The most commonly treated injuries were Monteggia fracture-dislocations (32%) and terrible triad injuries (18%). Average follow-up was 8 months (range 1-24 months). Final average elbow active arc of motion was from 20° (range 0°-70°) of extension to 124° (range 75°-150°) of flexion. Final supination and pronation were 53° (range 0°-80°) and 66° (range 0°-90°), respectively. There were no cases of proximal radioulnar synostosis. Heterotopic ossification contributing to less than functional elbow range of motion occurred in 2 (5%) patients who elected conservative management. There was 1 (2%) case of early postoperative posterolateral instability due to repair failure of injured ligaments that required revision using a ligament augmentation procedure. Five (11%) patients experienced postoperative neuropathy, including 4 (9%) with ulnar neuropathy. Of these, 1 underwent ulnar nerve transposition, 2 were improving, and 1 had persistent symptoms at final follow-up. This is the largest case series available demonstrating the safe utilization of the Boyd approach for the treatment of simple to complex elbow injuries. Postoperative complications including synostosis and elbow instability may not be as common as previously understood.

Biomechanical Comparison of Proximal Hamstring Reconstruction Using Distal Hamstring Graft Versus Fascia Lata Graft for Treatment of Chronic Hamstring Injury

Background: Surgical reconstruction using autografts is often required in treating chronic proximal hamstring injuries where the hamstring has retracted >5 cm. There is a paucity of evidence that evaluates reconstructive procedures using the 2 most popular autografts, distal hamstring and fascia lata. Purpose: To (1) compare failure load and elongation at failure between the proximal hamstring tendon reconstruction with distal hamstring and fascia lata grafts and (2) compare the stiffness between these reconstructions and the native state. Study design: Controlled laboratory study. Methods: Seven pairs of human cadaveric hemipelvises (mean age, 60.4 ± 5.0 years; 6 male, 1 female) with no evidence of previous injury or abnormality were dissected to the proximal hamstring origin. Through use of a dynamic tensile testing system, each specimen underwent preconditioning followed by a distraction test to determine the native specimen stiffness. Each pair of specimens was assigned to undergo proximal hamstring reconstruction with distal hamstring and reconstruction with fascia lata. Each specimen then underwent preconditioning followed by pull to failure. The failure load, elongation at failure, mode of failure, and stiffness were determined for each repair. Results: The distal hamstring group exhibited a greater failure load (mean, 334 ± 108 N; P = .031) and higher stiffness (mean, 47.6 ± 16.0 N/mm; P = .009) compared with the fascia lata group (mean, 179 ± 78 N and 23.0 ± 11.2 N/mm, respectively). Although the stiffness of the repair state in the distal hamstring group (mean, 61.4 ± 13.4 N/mm) was not significantly different from that of the native state (mean, 47.6 ± 16.0 N/mm), the stiffness of the repair state in the fascia lata group (mean, 23.0 ± 11.2 N/mm) was significantly lower than that of the native state (mean, 60.1 ± 17.7 N/mm) (P < .0001). The elongation at failure of the distal hamstring graft group (mean, 33.0 ± 6.6 mm) was not significantly different from that of the fascia lata graft group (mean, 29.2 ± 14.9 mm) (P = .58). The most common modes of failure for the distal hamstring group (29% each) were at the repair site, at the graft-muscle interface, and at the muscle, while the most common modes of failure for the fascia lata graft were at the tendon-graft interface. Conclusion: The distal hamstring group achieved higher failure load and stiffness than the fascia lata group, and stiffness of the distal hamstring group was not significantly different from that of the native tendon. Elongation at failure was not different between repair techniques. Although distal hamstring graft failure predominantly occurred in 3 distinct locations, failure of the fascia lata repair occurred predominantly at the tendon-graft interface. These cadaveric results suggest that it may be more clinically appropriate to use distal hamstring versus fascia lata for proximal hamstring reconstruction. Clinical Relevance: Our time-zero study suggests that the proximal hamstring reconstruction with distal hamstring could be the preferred surgical treatment for chronic hamstring injury over reconstruction with fascia lata. The failure load of reconstruction with distal hamstring was inferior to that of primary suture anchor, suggesting that rehabilitation after reconstruction should not be more aggressive than the standard postoperative rehabilitation protocol for acute repair.

Surgical cervicothoracic-flap repair of neoesophagus–airway fistula after esophagectomy for esophageal cancer: A retrospective cohort study

ObjectiveTo evaluate outcomes of surgical repair of postesophagectomy neoesophagus–airway fistulas (NEAFs). MethodsWe retrospectively included consecutive patients with NEAF managed by various techniques at our center between August 2009 and July 2021. ResultOf the 11 patients (median age, 60 years; interquartile range, 58, 62), 4 had received induction chemoradiotherapy and 4 others induction chemotherapy. NEAF was mainly a complication of anastomotic leakage (n = 6) or attempted stenosis treatment (n = 3). The airway mainly involved was the trachea (n = 8). Airway defects were repaired by resection–anastomosis (n = 5), perforator flaps (n = 4), pedicled pericardium (n = 1), and/or direct suturing (n = 2). Gastric conduit defects were repaired by perforator flaps (n = 6), direct suturing (n = 2), or pedicled pericardium (n = 1). Of the 7 perforator flaps, 4 were internal mammary–artery, two dorsal intercostal–artery, and one supraclavicular–artery flaps. After a median follow-up of 100 months, 2 patients died on early postoperative course from NEAF repair failure and 3 from late NEAF recurrence at 4, 11, and 33 months. Among the remaining 6 patients, 1 died from local tumoral recurrence at 13 months, 1 was last on follow-up at 27 months, alive and eating normally. The other 4 were free from NEAF recurrence and dysphagia or swallowing disorder at 50 months’ follow-up. These 4 results were obtained thanks to perforator flap interposition and airway resection anastomosis. ConclusionsSurgical NEAF repair using perforator flap interposition may provide satisfactory long-term function after strong prehabilitation.

ARTHROSCOPIC AND RADIOLOGICAL FINDINGS AT TIME OF LATARJET SCREW REMOVAL

The Latarjet procedure is a well described method to stabilize anterior shoulder instability. There are concerns of high complication rates, one of these being a painful shoulder without instability due to screw irritation. The arthroscopic changes in the shoulder at time of screw removal compared to those pre-Latarjet have not been described in the literature.We conducted a retrospective review of arthroscopic videos between 2015 and 2022 of 17 patients at the time of their Latarjet screw removal and where available (n=13) compared them to arthroscopic findings at time of index Latarjet. Instability was an exclusion criterion. X-rays prior to screw removal were assessed independently by two observers blinded to patient details for lysis of the graft. Arthroscopic assessment of the anatomy and pathological changes were made by two shoulder surgeons via mutual consensus. An intraclass correlation coefficient (ICC) was analyzed as a measure for the inter-observer reliability for the radiographs.Our cohort had an average age of 21.5±7.7 years and an average period of 16.2±13.1 months between pre- and post-arthroscopy. At screw removal all patients had an inflamed subscapularis muscle with 88% associated musculotendinous tears and 59% had a pathological posterior labrum. Worsening in the condition of subscapularis muscle (93%), humeral (31%) and glenoid (31%) cartilage was found when compared to pre-Latarjet arthroscopes. Three failures of capsular repair were seen, two of these when only one anchor was used. X-ray review demonstrated 79% of patients had graft lysis. Excellent inter-rater reliability was observed with an ICC value of 0.82.Our results show a high rate of pathological change in the subscapularis muscle, glenoid labrum and articular cartilage in the stable but painful Latarjet. 79% of patients had graft lysis with prominent screws on X-ray.

Comparison of failure risk and outcome scores following meniscus repair among adolescent and adult patients

Background:There are few studies assessing the impact of age at time of surgery on meniscus repair failure risk and patient-reported outcome scores. We sought to determine whether age at time of meniscus repair surgery affects failure risk and patient-reported outcome scores.Methods:Patients who underwent meniscus repair during 2006-2013 were evaluated for meniscus repair failure and patient-reported outcome scores using the Knee Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, and Marx Activity score at mean follow-up 6.5±2.0 yr post-operative. A multivariable linear regression analysis was used to assess the influence of patient age on patient-reported outcome scores following meniscus repair.Results:A total of 170 patients with mean age 27.8±10.1 yr (59% male) were identified, including 29 patients age 18 and younger and 141 patients over 18. Increasing patient age was associated with significantly lower IKDC (P=0.027), KOOS-ADL (P=0.003), and Marx activity scores (P&lt;0.001). Repair failure occurred in 46 patients (27.1%) overall, including 7 failures (24.1%) in patients 18 and under and 39 failures (27.7%) in patients over 18. The logistic regression analysis demonstrated no association between age and meniscus repair failure risk when controlled for ACL reconstruction and BMI (P=0.69).Conclusion:Increased age is associated with poorer IKDC, KOOS-ADL, and Marx Activity scores following meniscus repair. However, there is no difference in failure of healing of meniscus repair between adolescent patients and adults.Level of Evidence:III

Carrying the Load Together: The Role of the Therapeutic Alliance in a Patient With Bilateral Achilles Tendon Repair With Unilateral Failure and Subsequent Infection: A Case Report

BACKGROUND: Adverse events can complicate the rehabilitation process. In complex clinical situations, the therapeutic alliance can aid the therapist and patient in navigating clinical challenges and facilitate a successful outcome. CASE PRESENTATION: A 38-year-old male presented to physical therapy after sequential bilateral Achilles tendon repairs following a 2-year history of chronic bilateral Achilles tendinopathy that did not respond to limited conservative care. The patient subsequently experienced traumatic failure and infection of the left Achilles tendon repair, necessitating prolonged medical management and physical therapy care over 56 weeks. His goals were to return to high-level physical activity and collegiate basketball officiating. OUTCOME AND FOLLOW UP: Approximately 80 weeks following initial physical therapy evaluation, the patient had returned to collegiate basketball officiating and was fully participating in high-intensity interval-based circuit training, including strength training, plyometric training, and sprint training, 3 times per week. DISCUSSION: The primary physical therapist in this case sought to intentionally develop the therapeutic alliance with the patient through use of core components of the therapeutic alliance and components of psychologically informed practice. Specific strategies were utilized to develop the therapeutic alliance and leverage it in ways that positively influenced outcomes. This case report demonstrates the theories of the therapeutic alliance in practice and serves as an example to clinicians managing complex clinical cases. JOSPT Cases 2023;3(4):235-244. Epub 13 October 2023. doi:10.2519/josptcases.2023.11557

Mitral valve re-repair after failed repair with artificial chordae

Mitral valve re-repair after failed repair with artificial chordae

Potential therapeutic effect of olfactory ensheathing cells in neurological diseases: neurodegenerative diseases and peripheral nerve injuries.

Neurological diseases are destructive, mainly characterized by the failure of endogenous repair, the inability to recover tissue damage, resulting in the increasing loss of cognitive and physical function. Although some clinical drugs can alleviate the progression of these diseases, but they lack therapeutic effect in repairing tissue injury and rebuilding neurological function. More and more studies have shown that cell therapy has made good achievements in the application of nerve injury. Olfactory ensheathing cells (OECs) are a special type of glial cells, which have been proved to play an important role as an alternative therapy for neurological diseases, opening up a new way for the treatment of neurological problems. The functional mechanisms of OECs in the treatment of neurological diseases include neuroprotection, immune regulation, axon regeneration, improvement of nerve injury microenvironment and myelin regeneration, which also include secreted bioactive factors. Therefore, it is of great significance to better understand the mechanism of OECs promoting functional improvement, and to recognize the implementation of these treatments and the effective simulation of nerve injury disorders. In this review, we discuss the function of OECs and their application value in the treatment of neurological diseases, and position OECs as a potential candidate strategy for the treatment of nervous system diseases.