Repair Procedures Research Articles

Towards a reduced order model for EVAR planning and intra-operative navigation

IntroductionThe pre-operative planning and intra-operative navigation of the endovascular aneurysm repair (EVAR) procedure are currently challenged by the aortic deformations that occur due to the insertion of a stiff guidewire. Hence, a fast and accurate predictive tool may help clinicians in the decision-making process and during surgical navigation, potentially reducing the radiations and contrast dose. To this aim, we generated a reduced order model (ROM) trained on parametric finite element simulations of the aortic wall-guidewire interaction. MethodA Design of Experiments (DOE) consisting of 300 scenarios was created spanning over seven parameters. Radial basis functions were used to achieve a morphological parametrization of the aortic geometry. The ROM was built using 200 scenarios for training and the remaining 100 for validation. ResultsThe developed ROM estimated the displacement of aortic nodes with a relative error below 5.5% for all the considered validation cases. From a preliminary analysis, the aortic elasticity, the stiffness of the guidewire and the tortuosity of the cannulated iliac artery proved to be the most influential parameters. ConclusionsOnce built, the ROM provided almost real-time and accurate estimations of the guidewire-induced aortic displacement field, thus potentially being a promising pre- and intra-operative tool for clinicians.

Impact of ligation versus repair of isolated popliteal vein injuries on Deep Vein Thrombosis and Pulmonary Embolism incidence in trauma patients: a meta-analysis.

Traumatic injuries affecting the veins in the lower extremities have been correlated with both mortality and severe complications. Venous injuries are recognized as a contributing factor to the development of venous thromboembolism, commonly treated through procedures involving either vein ligation or repair. Despite previous efforts, substantial uncertainty remains when it comes to choosing between the execution of ligation versus various reparative techniques. The aim of this study was to evaluate the short-term results of surgically treating traumatic venous injuries through repair compared to ligation, specifically examining the resulting impacts on trauma patients in relation to DVT and PE occurrences. A comprehensive search strategy was employed until August 10, 2023, to systematically explore Scopus and PubMed databases. Following the removal of duplicates, two researchers independently assessed the titles and abstracts of the identified studies. Only studies meeting the project's requirements and inclusion criteria, as evaluated through their full texts, were included in our investigation. Our study exclusively focused on original articles, specifically those involving human trauma patients with isolated popliteal vein injuries. Excluded from consideration were review articles, meta-analyses, cellular and molecular research, animal studies, case reports, case series, letters to the editor, posters, duplicates, and publications in languages other than English. The implementation of this systematic review and meta-analysis conformed to the standards delineated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Conducting a thorough search, the inquiry identified 248 records. The assessment of titles and abstracts led to 51 studies that had the potential for eligibility. After reviewing the full texts of the chosen studies, 4 studies involving 1521 patients constituted the ultimate findings. We concluded that the ligation procedure had a higher incidence of pulmonary embolism compared to the repair of vein injuries, while the repair procedure had a higher incidence of deep vein thrombosis than ligation. Additional large-scale randomized controlled trials are still necessary to further support the findings of this meta-analysis.

Transanal circumferential pouch advancement for treatment of pouch vaginal fistulae

BackgroundIleal pouch anal anastomosis (IPAA) circumferential pouch advancement (CPA) involves full-thickness transanal 180–360° dissection of the distal pouch, allowing the advancement of healthy bowel to cover the internal opening of a vaginal fistula. We aimed to describe the long-term outcomes of this rare procedure.MethodsPatients with IPAA who underwent transanal pouch advancement for any indication between 2009 and 2021 were included. Demographics, operative details, and outcomes were reviewed. An early fistula was defined as occurring within 1 year of IPAA construction. Clinical success was defined as resolution of symptoms necessitating CPA, pouch retention, and no stoma at the time of follow-up. Figures represent the median (interquartile range) or frequency (%).ResultsOver a 12-year period, nine patients were identified; the median age at CPA was 41 (36–44) years. Four patients developed early fistula after index IPAA, and five developed late fistulae. The median number of fistula repair procedures prior to CPA was 2 (1–2). All patients were diagnosed with ulcerative colitis at the time of IPAA and all late patients were re-diagnosed with Crohn’s disease. Four (44.4%) patients had ileostomies present at the time of surgery, three (33.3%) had one constructed during surgery, and two (22.2%) never had a stoma. The median follow-up time was 11 (6–24) months. Clinical success was achieved in four of the nine (44.4%) patients at the time of the last follow-up.ConclusionsTransanal circumferential pouch advancement was an effective treatment for refractory pouch vaginal fistulas and may be offered to patients who have had previous attempts at repair.

All-cause claims analysis of the LATERA absorbable nasal implant vs surgical repair in patients with nasal valve collapse

Aims To compare all-cause claims associated with the LATERA Absorbable Nasal Implant and surgical repair of nasal vestibular stenosis in patients with nasal valve collapse. Methods This retrospective cohort study utilized data from STATinMED RWD Insights. A defined set of HCPCS, ICD-10-CM and CPT codes were used to identify patients with ≥1 claim for a LATERA procedure, and patients with ≥1 claim for surgical repair between June 1, 2015– March 31, 2023. Patients with continuous capture for at least 12 months before and at least 6 months after the index date were selected. The index date was defined as earliest date of encounter for a LATERA or surgical repair procedure. Inverse probability of treatment weighting (IPTW) was used to ensure balance between cohorts. Descriptive analyses were provided for all claims data using standard summary statistics. All-cause claims were assessed during the baseline, index date, and follow-up period. Chi-squared tests and independent sample t-tests were used to assess differences in cohorts for categorical and continuous variables, respectively. Results The study population included 5,032 LATERA patients and 26,553 surgical repair patients. During the baseline and follow-up periods, the matched cohorts exhibited similar all-cause claims. On the index date, LATERA patients incurred lower claims vs. surgical repair, likely due to LATERA’s ability to be implanted in the physician office setting. LATERA patients and surgical repair patients mean (SD) total costs were $9,612 [$14,930] vs $11,846 [$17,037] (p ≤ 0.0001), respectively. Conclusions Treatment with the LATERA Absorbable Nasal Implant is a potentially cost saving option for payers on the index date compared to traditional surgical repair in patients with nasal valve collapse due to the ability to be performed in the office. All-cause claims were similar in the baseline and follow-up periods. When performed with concomitant procedures, all-cause claims during follow-up were similar between groups.

Acute type B aortic dissection following transcatheter mitral valve edge-to-edge repair: a case report

Abstract Background Transoesophageal echocardiography is rarely reported as a possible cause of aortic dissection during the transcatheter edge-to-edge repair procedure. Herein, we present a case of type B aortic dissection following the transcatheter mitral valve edge-to-edge repair procedure, most likely related to the transoesophageal echocardiography probe. Case summary A 68-year-old Chinese man complained of exertional dyspnoea lasting over 2 years and had been diagnosed with severe mitral regurgitation. He was admitted to our hospital for the treatment of severe mitral regurgitation with transcatheter edge-to-edge repair. One MitraClip XTR (Abbott Vascular) was successfully implanted under the guidance of active transoesophageal echocardiography, and the mitral regurgitation became trace. However, the patient complained of persistent back pain after the treatment, and computed tomography angiography revealed a type B aortic dissection in the descending aorta. After 2 weeks of unsuccessful conservative treatment, he successfully underwent endovascular stenting and was discharged from the hospital. The patient recovered well and remained event free during the 6-month follow-up. Discussion Herein, we presented a rare complication following transcatheter mitral valve edge-to-edge repair that was most likely related to the transoesophageal echocardiography probe—type B aortic dissection. We postulated that repetitive flexion of the transoesophageal echocardiography probe led to compression-induced injury to the descending aorta wall at the mid-oesophageal level, which was the most probable aetiology of type B aortic dissection. Although this complication is rare, it is potentially fatal and therefore needs attention.

Effects of Er,Cr:YSGG Laser Surface Treatments and Composites with Different Viscosities on the Repair Bond Strength of CAD/CAM Resin Nanoceramic.

This study aims to evaluate the repair micro-shear bond strength of the CAD/CAM resin nanoceramic block treated using four different surface treatments and composite resins of different viscosities. For the current study, 96 samples with dimensions of 14 × 12 × 2 mm were obtained from a CAD/CAM resin nanoceramic block (Cerasmart) with a low-speed precision cutting saw under water cooling. The relevant samples were randomly divided into four groups according to the surface treatment processes: grinding with diamond bur, aluminum oxide airborne-particle abrasion, long-pulse laser, and short-pulse laser. Following silane application, universal adhesive was applied to all surface-treated samples and cured with an LED for 10 s. The samples prepared for the repair procedure were divided into two subgroups (microhybrid composite and injectable composite) according to the viscosity of the repair material to be used (n = 12). After the repair procedure, care was taken to keep the samples in distilled water in an incubator at 37 °C for 24 h. The repair micro-shear bond strength values (μSBSs) of CAD/CAM resin nanoceramic-composite resin complexes were tested. In addition, randomly selected samples from each group were examined with a scanning electron microscope to evaluate the surface topography after both surface treatments and the micro-shear bond strength test. Data were analyzed by two-way ANOVA and Bonferroni test. It was determined that the surface treatment preferred in the repair protocol significantly affected the μSBS value (p < 0.001). While the highest μSBS value was obtained with the short-pulse laser airradiation group, the lowest μSBS values were found in samples with long pulse laser irradiation. However, samples grinded with a bur and airborne-particle abrasion showed similar μSBS values (p > 0.05). The preferred composite viscosity in the repair procedure has a significant effect on the μSBS value (p < 0.001). However, the interaction between the surface treatment and the viscosity of the repair composite does not affect the μSBS values in a statistically significant way (p = 0.193). It may be recommended to clinicians to repair CAD/CAM resin nanoceramic restoration surfaces with injectable composites or after treatment with short-pulse lasers.

Low body mass index and risk of mortality after mitral transcatheter edge-to-edge repair procedure: The "obesity paradox".

Most patients undergoing the mitral transcatheter edge-to-edge repair (TEER) technique are elderly comorbid patients. Low body mass index (BMI) < 23 kg/m2 has been identified in other elderly populations as a risk factor, but has not been studied sufficiently in mitral TEER. We aimed to study the impact of low BMI (23 kg/m2) on the outcome after mitral TEER. Patients undergoing first-time TEER for mitral regurgitation at a single tertiary center were included, with the exclusion of patients with preprocedural hemodynamic instability or missing BMI. The primary endpoint was all-cause mortality. Secondary endpoints were long-term major bleeding or admission with heart failure. A total of 120 patients (mean age 76 ± 10 years, 76% men) were included in the study. Thirty-nine (31%) had low BMI. Patients with low BMI had a similar symptomatic benefit as patients with BMI ≥ 23 kg/m2 at 1 year regarding decrease in diuretics dose and decrease in New York Heart Association(NYHA)class (p > 0.05). In a multivariable Cox regression analysis, BMI as a continuous variable (hazard ratio [HR]: 0.93 [95% confidence interval, CI: 0.87-0.99],p = 0.03) and low BMI (HR: 1.99 [95% CI: 1.12-3.52], p = 0.02) were associated with the primary outcome. Low BMI was not significantly associated with major bleeding (subdistribution hazard ratio [SHR]:2.39 [95% CI: 0.96-5.97], p = 0.06) or admission with heart failure (SHR: 1.06 [95% CI: 0.61-1.88], p = 0.83) during follow-up with univariable competing risk regression analysis. Low BMI is a risk factor for mortality after mitral valve TEER, confirming the presence of an "obesity paradox" in this population and should receive attention in patient selection.

The necessity evaluation of distal bare stent for treating type B aortic dissection using image-based computational flow analysis

This study aims to verify the necessity of the provisional extension to induce complete attachment (PETTICOAT) technique, by comparing the clinical outcomes with traditional thoracic endovascular repair (TEVAR) procedure. 40 patients with a total of 120 computed tomography angiography examinations (including Pre, Post1, and Post2 for each case) were included and divided into PETTICOAT group (n = 20) and TEVAR group (n = 20) according to the employed intervention technique. The potential risk factors for distal stent-induced new entry (SINE) and morphological and hemodynamic indices related to the aortic remodeling were computed and compared between two groups. All computed potential risk factors for distal SINE showed insignificant difference between PETTICOAT and TEVAR groups. There is no statistically significant difference in the morphological parameters when assessing the aortic remodeling. Regarding hemodynamic factors, the percentage of high relative residence time of Post2 was greater in PETTICOAT group than that of TEVAR group (median, 0.22; interquartile range (IQR), [0.00–0.56] in PETTICOAT vs median, 0.01; IQR, [0.00–0.10] in TEVAR; p = 0.01). The first balance position of computed luminal pressure difference shifted more distally from Post1 to Post2 for patients underwent PETTICOAT than those underwent TEVAR (median, 1.04 cm; IQR, [0.00–6.29 cm] in PETTICOAT vs median, 0.00 cm; IQR, [−1.66 to 1.28 cm] in TEVAR; p = 0.02). PETTICOAT procedure could effectively enhance false lumen thrombosis and aortic remodeling when assessed from functional perspective. However, there is a lack of evidence to support that PETTICOAT can prevent distal SINE.

Efficacy and Outcomes of Para-Annular Plication in Mitral Valve Repair via Right Mini-Thoracotomy.

We aim to assess the efficacy and safety of left atrial plication (LAP), particularly para-annular plication, using a right mini-thoracotomy approach. Among 90 mitral valve repair (MVr) procedures performed at our institution between 2016 and 2023, 16 left atrial plication cases for left atrial enlargement (diameter: >50 mm) were assessed; nine cases underwent median sternotomy (conventional) (Group C), and seven cases underwent minimally invasive cardiac surgery (MICS) (Group M). The surgical protocol involved mitral valve repair via a right-sided left atrial approach, incorporating para-annular plication to suture the posterior wall. The mean follow-up duration was 3.3±2.4 years. Mortality within 30 days of surgery or during hospitalization did not occur. Postoperative complications included one case in each group that required reoperation for hemorrhage originating extraneously in the left atrium. Postoperative echocardiographic assessments revealed a comparable reduction in left atrial diameter (C/M: 80.3±7.0/80.7±14.6%; p=0.94), left atrial volume index (55.6±19.3/68.3±34.1%; p=0.36), and aorto-mitral angle (AMA) enlargement (113.8±7.3/107.5±12.2%; p=0.22). The three-year survival rate (88.9%/75.0%; p=0.33) was comparable between groups. The synergistic utilization of left atrial plication with para-annular plication via right mini-thoracotomy can enhance the postoperative outcomes of mitral valve repair.

Deep Learning Analysis of Surgical Video Recordings to Assess Nontechnical Skills

Assessing nontechnical skills in operating rooms (ORs) is crucial for enhancing surgical performance and patient safety. However, automated and real-time evaluation of these skills remains challenging. To explore the feasibility of using motion features extracted from surgical video recordings to automatically assess nontechnical skills during cardiac surgical procedures. This cross-sectional study used video recordings of cardiac surgical procedures at a tertiary academic US hospital collected from January 2021 through May 2022. The OpenPose library was used to analyze videos to extract body pose estimations of team members and compute various team motion features. The Non-Technical Skills for Surgeons (NOTSS) assessment tool was employed for rating the OR team's nontechnical skills by 3 expert raters. NOTSS overall score, with motion features extracted from surgical videos as measures. A total of 30 complete cardiac surgery procedures were included: 26 (86.6%) were on-pump coronary artery bypass graft procedures and 4 (13.4%) were aortic valve replacement or repair procedures. All patients were male, and the mean (SD) age was 72 (6.3) years. All surgical teams were composed of 4 key roles (attending surgeon, attending anesthesiologist, primary perfusionist, and scrub nurse) with additional supporting roles. NOTSS scores correlated significantly with trajectory (r = 0.51, P = .005), acceleration (r = 0.48, P = .008), and entropy (r = -0.52, P = .004) of team displacement. Multiple linear regression, adjusted for patient factors, showed average team trajectory (adjusted R2 = 0.335; coefficient, 10.51 [95% CI, 8.81-12.21]; P = .004) and team displacement entropy (adjusted R2 = 0.304; coefficient, -12.64 [95% CI, -20.54 to -4.74]; P = .003) were associated with NOTSS scores. This study suggests a significant link between OR team movements and nontechnical skills ratings by NOTSS during cardiac surgical procedures, suggesting automated surgical video analysis could enhance nontechnical skills assessment. Further investigation across different hospitals and specialties is necessary to validate these findings.

Effect of magnetic microbeads on sustained and targeted delivery of transforming growth factor-beta-1 for rotator cuff healing in a rat rotator cuff repair model

Structural failure is a well-established complication of rotator cuff repair procedures. To evaluate the effect of magnetic microbeads, designed for precise drug delivery via magnetic force, on sustained transforming growth factor-beta-1 (TGF-β1) release and rotator cuff healing in a rat rotator cuff repair model. TGF-β1 laden microbeads were prepared, and baseline in vitro experiments included the magnetization of the microbeads and TGF-β1 release tests. In an in vivo experiment using a rat rotator cuff repair model on both shoulders, 72 rats were randomly assigned to three groups (24 per group): group A, conventional repair; group B, repair with and simple TGF-β1 injection; and group C, repair with magnet insertion into the humeral head and TGF-β1 laden microbead injection. Delivery of TGF-β1 was evaluated at 1 and 7 days after the intervention using PCR, Western blot, and immunohistochemistry. At 6 weeks post-intervention, rotator cuff healing was assessed using biomechanical and histological analysis. The in vitro experiments confirmed the magnetization property of the microbeads and sustained delivery of TGF-β1 for up to 10 days. No difference in the TGF-β1 expression was found at day 1 in vivo. However, at day 7, group C exhibited a significantly elevated expression of TGF-β1 in both PCR and Western blot analyses compared to groups A and B (all P < 0.05). Immunohistochemical analysis revealed a higher expression of TGF-β1 at the repair site in group C on day 7. At 6 weeks, biomechanical analysis demonstrated a significantly higher ultimate failure load in group C than in groups A and B (P < 0.05) and greater stiffness than in group A (P = 0.045). In addition, histological analysis showed denser and more regular collagen fibers with complete continuity to the bone in group C than in groups A and B, a statistically significant difference according to the semi-quantitative scoring system (all P < 0.05). The use of the TGF-β1 laden magnetic microbeads demonstrated sustained delivery of TGF-β1 to the repair site, improving rotator cuff healing.

An Unusual Third Root of the Median Nerve from the Musculocutaneous Nerve: A Case Report

Nerve variations in the brachial plexus, particularly the median nerve, are clinically significant due to their implications in surgeries and nerve compression syndromes. This case report details an anatomical variation observed during the routine dissection of a 72-year-old male cadaver. A third root of the median nerve originating from the musculocutaneous nerve was found in the right upper limb. This finding aligns with previous studies on brachial plexus variations and underscores their importance in surgical planning and nerve repair procedures. Knowledge of such anomalies is crucial for preventing iatrogenic injuries and improving outcomes in reconstructive surgeries. Keywords: Prosection; Brachial plexus; Median nerve; Musculocutaneous nerve

Electrochemical Mineralization Regulates Hydroxyapatite Deposition of Silk Fibroin Nanofibers for Promoting Osteogenic Differentiation of Human Mesenchymal Stem Cells

ABSTRACTScaffold and stem cells are the key elements in the procedure of bone repair. Bombyx mori silk fibroin (SF) is the proper material for bone tissue engineering due to its biocompatibility and its easy to obtain nanofiber structure. The suitable cell substrate is also an important factor because different cells have different adaptations to composite. For this case, selecting a scaffold that can promote osteogenic differentiation of various cells is crucial and meaningful. In this work, hydroxyapatite (HA) was deposited precisely onto each silk nanofiber by electrochemical mineralization (EC) to form SF/HA. SF/HA can promote the proliferation and osteogenic differentiation of both human bone marrow mesenchymal‐derived stem cells (hMSCs) and human adipose‐derived mesenchymal stem cells (hAMSCs). It also promot the expression of alkaline phosphatase (ALP) and osteogenic differentiation related genes. Western blot analyses show mitogen‐activated protein kinase (MAPK) signal pathway is regulated by SF/HA. Therefore, the study provides a proper method to obtain a good composite SF/HA and it promotes the osteogenic differentiation of both hMSCs and hAMSCs.

Paediatric laceration repair in the emergency department: post-discharge pain and maladaptive behavioural changes

BackgroundPaediatric laceration repair procedures are common in the ED; however, post-discharge recovery remains understudied. Perioperative research demonstrates that children exhibit maladaptive behavioural changes following stressful and painful medical procedures. This...

Viabahn endoprosthesis for femoropopliteal aneurysm repair: safety, success rates, and long-term patency

BackgroundThe Viabahn endoprosthesis has become a vital option for endovascular therapy, yet there is limited long-term data on its effectiveness for peripheral aneurysm repair. This study aimed to evaluate the safety, technical and clinical success, and long-term patency of the Viabahn endoprosthesis for treating femoropopliteal aneurysms.MethodsThis retrospective tertiary single-center study analyzed patients who underwent a Viabahn endoprosthesis procedure for femoropopliteal aneurysm repair from 2010 to 2020. Intraoperative complications, technical and clinical success rates, and major adverse events (MAE, including acute thrombotic occlusion, major amputation, myocardial infarction, and device- or procedure-related death) at 30 days were assessed. Incidence of clinically-driven target lesion revascularisation (cdTLR) was noted. Patency rates were evaluated by Kaplan–Meier analysis.ResultsAmong 19 patients (mean age, 72 ± 12 years; 18 male, 1 female) who underwent aneurysm repair using the Viabahn endoprosthesis, there were no intraoperative adverse events, with 100% technical and clinical success rates. At the 30-day mark, all patients (19/19, 100%) were free of MAE. The median follow-up duration was 1,009 days [IQR, 462–1,466]. Popliteal stent graft occlusion occurred in 2/19 patients (10.5%) after 27 and 45 months, respectively. Consequently, the primary patency rates were 100%, 90%, 74% at 12, 24, and 36–72 months, respectively. Endovascular cdTLR was successful in both cases, resulting in sustained secondary patency at 100%.ConclusionThe use of Viabahn endoprostheses for femoropopliteal aneurysm repair demonstrated technical and clinical success rates of 100%, a 0% 30-day MAE rate, and excellent long-term patency.

The Impact of Administration of Chlorpheniramine/Paracetamol versus Paracetamol Only on the Postoperative Agitation after Orofacial Cleft Repair Procedures in Pediatrics

Abstract Background term “emergence delirium” first appeared in medical literature in early 1960s. While it is frequently used interchangeably with emergence agitation, it is described as temporary dissociated state of consciousness following anaesthesia discontinuation. Aim and Objectives aim was to study the role of pre-emptive Chlorpheniramine as an adjuvant to paracetamol in the prevention of emergence agitation in orofacial cleft repair surgeries. Studied cases&amp; techniques: study was prospective, Randomized, Double-Blind Clinical research done at Ain-shams University Hospitals, Cairo, Egypt for 6 months after Medical Ethical Committee approval for children within 3 month up to 18 years with cleft lip or/with cleft palate. Results On comparison of facial express score between group A &amp; group B, group A showed significant decrease in facial express score compared to group B as the median (IQR) facial express score in group A was 2.0 (2.0- 4.0) and 4.0 (2.0-8.0) in group B. Conclusion We deduced that preoperative chlorpheniramine 0.2 mg/kg and paracetamol 15mg/kg before skin incision is effective medication that can be used to stop or decrease severity of emergence agitation while causing minimal cardio- respiratory depression. It also enhanced quality of healing in post-anesthesia care unit.

Good clinical outcomes and low recurrence rate in patients undergoing arthroscopic revision Latarjet for failed arthroscopic Bankart repair

BackgroundThe role of arthroscopic Latarjet stabilization after failed arthroscopic Bankart repair has yet to be definitively established and merits further investigation. ObjectiveTo assess clinical and radiological outcomes after arthroscopic Latarjet stabilization as a revision procedure for failed Bankart repair, as well as the return to athletic activity and complication rates. MethodsBetween 2009 and 2020, patients with a previous failed arthroscopic Bankart repair who were treated with an arthroscopic Latarjet were retrospectively evaluated. Clinical outcomes at a minimum of 24 months postoperatively included Rowe score, Western Ontario Shoulder Instability Index (WOSI), Constant-Murley Shoulder Outcome score (CS), and Single Assessment Numeric Evaluation (SANE). Dislocations, subluxations, complications, pre and postoperative level of activity and degree of osteoarthritis were also assessed. ResultsA total of 77 patients, mean age at revision surgery 31.2 ± 9.1 and with either one (n = 59), two (n = 13), or three (n = 4) arthroscopic previous stabilizations underwent revision surgery using arthroscopic Latarjet procedure were studied. Postoperatively, the mean ROWE and CS scores increased from 41.8 ± 16 to 90.7 ± 14.3 (p<0.001) and from 50.5 ± 13.8 to 90.5 ± 10.3 (p<0.001), respectively. WOSI decreased from 1247 ± 367.6 to 548.9 ± 363 at the final follow-up (p<0.001). After a mean follow-up of 39.6 ± 23.1 months, 64 shoulders (83.1%) were subjectively graded as good to excellent using SANE score. Grade 1, 2, and 3 osteoarthritis, according to Ogawa et al were found in 18 (23.4%), 6 (7.8%), and 3 (3.9%) shoulders, respectively. Six dislocations after revision surgery were reported (7.8%). In four failed cases an Eden-Hybinette procedure was conducted and in remaining two patients an arthroscopic extraarticular anterior capsular reinforcement was performed. Significantly decreased level of athletic activity was observed postoperatively (p= 0.01). ConclusionsArthroscopic Latarjet for revision of failed arthroscopic Bankart repair provides satisfactory patient-reported subjective outcomes with low rate of recurrences and complications. However, decreased level of athletic activity is expected.

Single anterior shoulder dislocation patients demonstrate higher rates of posterior labral repair and biceps procedures than multiple dislocators at the time of arthroscopic stabilization surgery

IntroductionThe purpose of this study is to identify and compare demographic, clinical, historical, and intra-operative variables in patients who have received arthroscopic treatment for single versus multiple anterior shoulder dislocations. MethodsThis is a retrospective chart review of patients who underwent arthroscopic labral repair of the shoulder by six surgeons at a single institution between 2012-2020. Patients with a documented anterior shoulder dislocation were included. Patients with pain-only, subluxation-only, multi-directional or posterior instability, and prior shoulder surgeries of any kind were excluded. Studied variables included age, sex, laterality, body mass index, contact/collision sports, Charlson Comorbidity Index, tobacco use, number of dislocations (1, >1), labral tear size, time from first dislocation to surgery, anchor number, and concomitant procedures. Study groups were compared using student’s t-tests and Mann-Whitney U test for continuous variables and Chi-Square or Fisher’s Exact tests for discrete variables with a significance of 0.05. Results633 patients were identified and 351 [85 single dislocators (SD), 266 multiple dislocators (MD)] met inclusion criteria (mean age: 27 years; range: 14-71 years). There were no demographic differences between study groups. SD received surgery significantly sooner at 17 ± 44 months after injury, while MD received surgery 53 ± 74 months post-initial dislocation. SD (30/85, 35%) were significantly more likely than MD (56/266, 21%) to receive concomitant posterior labrum repair. MD (46/266, 17%) were significantly more likely than SD (5/85, 6%) to receive a Remplissage. SD (11/85, 13%) were significantly more likely than MD (11/266, 4%) to receive a concomitant biceps tenotomy/tenodesis. There were no other significant differences in injury or surgery characteristics. ConclusionMD will have more time between their initial dislocation and arthroscopic labral repair and were more likely to receive a Remplissage procedure, yet were less likely than SD to receive a concomitant posterior labral repair or biceps tenodesis/tenotomy despite no differences in age, sex, and activity level. Whether the greater extent of labrum injury in SD is due to a more severe initial injury versus earlier recognition and intervention requires further study.

Return to sport after arthroscopic xenograft bone block associated with Bankart repair and subscapularis augmentation in competitive contact athletes with recurrent anterior shoulder instability

BackgroundOpen Bankart repair and Latarjet stabilization are two of surgical procedures used in the treatment of shoulder instability in contact athletes. The aim of this study is to evaluate the outcomes of bone block arthroscopic procedure, performed with xenograft, in combination with Bankart repair and selective subscapularis augmentation (ASA) for contact athletes with recurrent anterior shoulder instability. MethodsWe retrospectively assessed contact athletes who underwent arthroscopic bone block with xenograft and Bankart repair with selective augmentation of subscapularis for recurrent anterior shoulder instability between January 2017 and December 2021. Shoulders with posterior instability or multidirectional instability were excluded. Recurrence, complications, return to sport, and functional scores (Rowe score, WOSI score, ASES score) were assessed. A CT scan at 2-year follow-up was performed to assess the status of Bone block integration, its displacement and restoration of glenoid surface. Results16 patients were included in the study with a mean age of 24. None of the patients treated with arthroscopic bone block and ASA presented new dislocation episodes. An increase in preoperative scores was observed at the last follow-up, in particular the ASES, Rowe, and WOSI scores increased from 69±7, 31±9 , 1235±46 respectively to 96.1±3.2, 94±6, 119±51. All athletes returned to sporting activity at or near the same level as pre-surgery. The glenoid bone surface increase from 83% to 116% at last follow-up. ConclusionBone block treatment with Xenograft combined with Bankart repair and ASA procedures has been shown to be effective in treating instability in contact athletes with significant glenoid deficit. All athletes returned to athletic activity at a level similar to the pre-intervention period.

Poster 336: Reliability of Preoperative MRI in the Prediction of ACL Tear Type

Objectives: Anterior cruciate ligament (ACL) tears are among the most frequent ligament injuries in the United States. Most of these injuries are treated surgically, depending on patient-specific factors. Management of these injuries includes nonoperative management with stepwise rehabilitation or surgical treatment with ACL repair or reconstruction. Patient goals, a clinical evaluation, and preoperative MRI imaging are generally assessed to inform the choice of treatment. Classification of ACL tear-type based on stump morphology is critical to preoperative planning, as it can determine a patient’s eligibility for ACL preservation techniques. We aim to determine the efficacy of preoperative magnetic resonance imaging (MRI) in predicting ruptured ACL stump morphology and thus assist in preoperative planning and decision-making. Methods: This retrospective observational study utilized chart review from the case log of a single surgeon at an urban tertiary institution. The review identified patients who underwent the Bridge Enhanced ACL Repair (BEAR) procedure between January 1, 2022 and August 31, 2023. The inclusion criteria included patients who underwent a primary ACL repair with the BEAR technique and had adequate intraoperative and MRI images available for review. Patients excluded were those with inadequate intraoperative imaging or MRI imaging that was unavailable for review. For each patient included, the two senior authors assessed the morphology of the ACL stump on MRI (sagittal T2, coronal T2) and intraoperative arthroscopy images in a blinded manner and assigned a classification grade to each. The MRI-based morphology and the intraoperative image morphology of the tears were classified based on a system validated by DeFelice et al, which includes types 1 to 5 based on the location of the tear from most proximal to most distal. The correlation between the preoperative MRI assessment and the intraoperative arthroscopic assessment was interrogated using simple linear regression quantified with the Pearson correlation coefficient. Results: A total of 35 patients that underwent the BEAR procedure were identified. One patient was excluded due to inadequate intraoperative images. Of the remaining patients, 13 (38.2%) were male and 21 (61.8%) were female. The average patient age was 31, with a median age of 28. Most patients were injured while skiing (32.4%), while the second and third most prevalent mechanisms of injury were nonsports-related (23.4%) and soccer injuries (17.6%), respectively. Of the MRI tears that were analyzed, 9 (26.5%) were classified as type 1, 19 (55.9%) were type 2, and 5 (14.7%) were type 3. There were no tears identified as types 4 or 5 tears. Of the arthroscopic images that were analyzed, 21 (61.8%) were classified as type 1, 10 (29.4%) were type 2, 3 (8.8%) were type 3. Similarly, there were no tears identified as types 4 or 5. MRI accurately predicted the ACL tear type seen arthroscopically 55.9% (19/34) of the time. Of the (15) cases in which MRI did not correlate with the arthroscopic tear type, the MRI classification grade was within 1 grade of the arthroscopic grade 93.3% of the time (14/15). In the cases in which MRI was not correct in its grading, 93.3% of them (14/15) were classified as too high of a grade (MRI perceiving the tear to be more distal than it was in actuality). The Pearson correlation coefficient assessing the correlation between MRI identified tear type and arthroscopy identified tear type was 0.56. Conclusions: MRI accurately predicted the ACL tear type seen arthroscopically in only 55.9% of patients. In &gt;90% of incorrect predictions, arthroscopy determined the ACL tear to be one classification more proximal than predicted by MRI. Our results demonstrate that while preoperative MRI can be useful in identifying approximate ACL tear location, it is essential to examine the ACL at time of arthroscopy for final determination of ACL stump size and viability for ACL restoration procedures. Moreover, a greater percentage of patients may be eligible for an ACL restoration procedure than predicted by preoperative MRI, highlighting the importance of discussing both ACL repair and ACL reconstruction with patients preoperatively. [Figure: see text]