Internal hemipelvectomy: A single institution's learning curve and longitudinal experience.

BACKGROUND AND OBJECTIVES: Wide margin resection for pelvic tumors via internal hemipelvectomy is among the most technically challenging procedures in orthopedic oncology. As such, surgeon experience and technique invariably affect patient outcomes. The aim of this clinical study was to assess how an individual surgeon's experiences and advancements in technology and techniques in the treatment of internal hemipelvectomy have impacted patient outcomes at our institution. METHODS: This study retrospectively examined a single tertiary academic institution's consecutive longitudinal experience with internal hemipelvectomy for primary sarcoma or pelvic metastases over a 26-year period between the years 1994 and 2020. Outcomes were assessed using two separate techniques. The first stratified patients into cohorts based on the date of surgery with three distinct "eras" ("early," "middle," and "modern"), which reflect the implementation of new techniques, including three-dimensional (3D) computer navigation and cutting guide technology into our clinical practice. The second method of cohort selection grouped patients based on each surgeon's case experience with internal hemipelvectomy ("inexperienced," "developing," and "experienced"). Primary endpoints included margin status, complication profiles, and long-term oncologic outcomes. Whole group multivariate analysis was used to evaluate variables predicting blood loss, operative time, tumor-free survival, and mortality. RESULTS: A total of 72 patients who underwent internal hemipelvectomy were identified. Of these patients, 24 had surgery between 1994 and 2007 (early), 28 between 2007 and 2015 (middle), and 20 between 2016 and 2020 (modern). Twenty-eight patients had surgery while the surgeon was still inexperienced, 24 while developing, and 20 when experienced. Evaluation by era demonstrated that a greater proportion of patients were indicated for surgery for oligometastatic disease in the modern era (0% vs. 14.3% vs. 35%, p = 0.022). Fewer modern cases utilized freehand resection (100% vs. 75% vs. 55%, p = 0.012), while instead opting for more frequent utilization of computer navigation (0% vs. 25% vs. 20%, p = 0.012), and customized 3D-printed cutting guides (0% vs. 0% vs. 25%, p = 0.002). Similarly, there was a decline in the rate of massive blood loss observed (72.2% vs. 30.8% vs. 35%, p = 0.016), and interdisciplinary collaboration with a general surgeon for pelvic dissection became more common (4.2% vs. 32.1% vs. 85%, p < 0.001). Local recurrence was less prevalent in patients treated in middle and modern eras (50% vs. 15.4% vs. 25%, p = 0.045). When stratifying by case experience, surgeries performed by experienced surgeons were less frequently complicated by massive blood loss (66.7% vs. 40% vs. 20%, p = 0.007) and more often involved a general surgeon for pelvic dissection (17.9% vs. 37.5% vs. 65%, p = 0.004). Whole group multivariate analysis demonstrated that the use of patient-specific instrumentation (PSI) predicted lower intraoperative blood loss (p = 0.040). However, surgeon experience had no significant effect on operative time (p = 0.125), tumor-free survival (p = 0.501), or overall patient survival (p = 0.735). CONCLUSION: While our institution continues to utilize neoadjuvant and adjuvant therapies following current guideline-based care, we have noticed changing trends from early to modern periods. With the advent of new technologies, we have seen a decline in freehand resections for hemipelvectomy procedures, and a transition to utilizing more 3D navigation and customized 3D cutting guides. Furthermore, we have employed the use of an interdisciplinary team approach more regularly for these complicated cases. Although our results do not demonstrate a significant change in perioperative outcomes over the years, our institution's willingness to treat more complex cases likely obscures the benefits of surgeon experience and recent technological advances for patient outcomes.

Lower Range of Recurrent Instability Rates Following Bankart Repair and Remplissage Compared to Isolated Bankart Repair in Patients With "Nonengaging/On-Track" Hill-Sachs Lesions and <20% Glenoid Bone Loss.

PURPOSE: To compare recurrent instability and return-to-sport rates along with external rotation differences between on-track (nonengaging) Hill-Sachs lesion patients undergoing either an isolated Bankart repair (IBR) or a Bankart repair augmented with a remplissage procedure (B+R). METHODS: A search was conducted using 3 databases (PubMed, EMBASE, CINAHL) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only clinical comparative (level of evidence I-III) studies were considered for inclusion. Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria. RESULTS: Six level of evidence III studies, totaling 537 patients (202 B+R and 335 IBR) were included for analysis. All patients had <20% glenoid bone loss and a nonengaging, on-track Hill-Sachs lesion. At a median final follow-up of 34.7 months, recurrent dislocation rates ranged from 0% to 7.7% and 3.5% to 30% in the B+R and IBR groups, respectively. Moreover, subjective instability and revision surgery rates presented lower ranges in the B+R upon comparison with the IBR cohort (0%-32% vs 5%-71.4% and 0%-5% vs 0%-35%, respectively). Furthermore, return to preinjury level of sports ranged from 64% to 100% in the remplissage-augmented group and 50% to 90% in the IBR cohort. Postoperative external rotation at side varied from 50° to 63° in the B+R and 55° to 63° in the IBR arm. Additional subgroup analysis revealed recurrent dislocation rates in athletes and patients with near-track Hill-Sachs lesions undergoing remplissage augmentation to be 0% to 5% and 2% to 47% while ranging from 8.8% to 30% and 9% to 66% for IBR patients, respectively. CONCLUSIONS: Upon qualitative analysis, ranges of recurrent instability measures, including recurrent dislocation rates, are higher in patients undergoing IBR in comparison to B+R. Activity level influences outcomes as athletes were found to have a higher range of recurrent dislocation rates in the IBR group. The addition of remplissage showed a higher range of return-to-sport rates with comparable postoperative external rotation between groups. LEVEL OF EVIDENCE: Level III, systematic review of Level III studies.

Capsular Management at the Time of Hip Arthroscopy for Femoroacetabular Impingement Syndrome Varies With Geography and Surgeon Subspecialty Training: A Cross-Sectional, Multinational Surgeon Survey.

PURPOSE: To perform a multinational survey and identify patterns in capsular management at the time of hip arthroscopy. METHODS: An anonymous, nonvalidated survey was distributed by the American Orthopaedic Society for Sports Medicine; Arthroscopy Association of North America; European Society of Sports Traumatology, Knee Surgery & Arthroscopy; International Society for Hip Arthroscopy; and Turkish Society of Sports Traumatology, Arthroscopy, and Knee Surgery. The questions were broken down into 6 categories: demographic characteristics, capsulotomy preference, traction stitches, capsular closure, postoperative rehabilitation, and postoperative complications. RESULTS: The survey was completed by 157 surgeons. Surgeons who performed half or full T-type capsulotomies had 2.4 higher odds of using traction sutures for managing both the peripheral and central compartments during hip arthroscopy for femoroacetabular impingement (P = .024). Surgeons who believed that there was sufficient literature regarding the importance of hip capsular closure had 1.9 higher odds of routinely performing complete closure of the capsule (P = .044). Additionally, surgeons who practiced in the United States had 8.1 higher odds of routinely closing the capsule relative to international surgeons (P < .001). Moreover, surgeons who received hip arthroscopy training in residency or fellowship had 2.4 higher odds of closing the capsule completely compared with surgeons who did not have exposure to hip arthroscopy during their training (P = .009). CONCLUSIONS: Geographic and surgeon-related variables correlate with capsular management preferences during hip arthroscopy. Surgeons who perform half or full T-capsulotomies more often use traction stitches for managing both the peripheral and central compartments. Surgeons performing routine capsular closure are more likely to believe that sufficient evidence is available to support the practice, with surgeons in the United States being more likely to perform routine capsular closure in comparison to their international colleagues. CLINICAL RELEVANCE: As the field of hip preservation continues to evolve, capsular management will likely continue to play an important role in access, instrumentation, and postoperative outcomes.

Platelet-Rich Plasma, Bone Marrow Aspirate Concentrate, and Hyaluronic Acid Injections Outperform Corticosteroids in Pain and Function Scores at a Minimum of 6 Months as Intra-Articular Injections for Knee Osteoarthritis: A Systematic Review and Network Meta-analysis.

PURPOSE: To compare the efficacy of common intra-articular injections used in the treatment of knee osteoarthritis, including corticosteroid (CS), hyaluronic acid (HA), platelet-rich plasma (PRP), and bone marrow aspirate concentrate (BMAC), with a minimum follow-up of 6-months. METHODS: A literature search was conducted using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in August 2022 in the following databases: PubMed/MEDLINE, Scopus, Cochrane Database of Controlled Trials, and the Cochrane Database of Systematic Reviews. Level I to II randomized clinical trials with a minimum follow-up of 6 months that investigated the treatments of interest were included. Patient-reported outcome scores for pain and function at baseline and at latest follow-up were extracted, and the change in scores was converted to uniform 0 to 100 scales. Arm-based Bayesian network meta-analysis using a random-effects model was created to compare the treatment arms in pain and function. RESULTS: Forty-eight studies comprising a total of 9,338 knees were included. The most studied intra-articular injection was HA (40.9%), followed by placebo (26.2%), PRP (21.5%), CS (8.8%), and then BMAC (2.5%). HA and PRP both led to a significant improvement in pain compared with placebo. HA, PRP, and BMAC all led to a significant improvement in function scores when compared with placebo. Surface under the cumulative ranking curves (SUCRAs) of the interventions revealed that PRP, BMAC, and HA were the treatments with the highest likelihood of improvement in both pain and function, with overall SUCRA scores of 91.54, 76.46, and 53.12, respectively. The overall SUCRA scores for CS and placebo were 15.18 and 13.70, respectively. CONCLUSIONS: At a minimum 6-month follow-up, PRP demonstrated significantly improved pain and function for patients with knee osteoarthritis compared with placebo. Additionally, PRP exhibited the highest SUCRA values for these outcomes when compared with BMAC, HA, and CS. LEVEL OF EVIDENCE: Level II, meta-analysis of Level I to II studies.

Correlation between articular cartilage status on outcomes and survivorship following meniscal allograft transplantation: A systematic review.

PURPOSE: To conduct a systematic review evaluating potential correlations between preoperative articular cartilage integrity on outcomes and survivorship in patients undergoing meniscal allograft transplantation (MAT). METHODS: A literature search was performed by querying SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials from database inception through May 2023 according to the 2020 PRISMA statement. Inclusion criteria were limited to studies reporting on outcomes and survivorship following MAT based on preoperative cartilage status. RESULTS: Sixteen studies, consisting of 1723 patients (n = 1758 total menisci), were identified in six level III and 10 level IV evidence studies. There was high heterogeneity in cartilage grading scales, reporting of concomitant cartilage procedures, and indications for MAT based on osteoarthritis. Patients with lower limb malalignment were either excluded or corrected with an osteotomy. MAT failure rate was reported in nine studies, with four studies reporting a greater rate of failure in knees with higher degrees of cartilage damage. Eight studies reported on clinical outcomes based on cartilage grade, with two studies reporting significant differences in clinical outcomes based on cartilage grade. Of the five studies reporting management of full-thickness chondral defects with cartilage surgery, three studies reported no significant difference in survivorship based on preoperative cartilage grade, while one study reported lower survivorship and one study reported unclear results. No studies found significant differences in survivorship and outcomes between medial and lateral MAT. CONCLUSIONS: Conflicting results and high variability in reporting of concomitant cartilage repair and indications for MAT exist in studies evaluating the efficacy of MAT based on articular cartilage status. The degree of preoperative chondral damage did not have a strong relationship with clinical outcomes following MAT. Higher degrees of cartilage damage were associated with higher MAT failure rates, with possible improvement in survivorship when treated with an appropriate cartilage procedure. LEVEL OF EVIDENCE: Level IV.

3-dimensionally printed patient-specific glenoid drill guides vs. standard nonspecific instrumentation: a randomized controlled trial comparing the accuracy of glenoid component placement in anatomic total shoulder arthroplasty.

BACKGROUND: Traditional, commercially sourced patient-specific instrumentation (PSI) systems for shoulder arthroplasty improve glenoid component placement but can involve considerable cost and outsourcing delays. The purpose of this randomized controlled trial was to compare the accuracy of glenoid component positioning in anatomic total shoulder arthroplasty (aTSA) using an in-house, point-of-care, 3-dimensionally (3D) printed patient-specific glenoid drill guide vs. standard nonspecific instrumentation. METHODS: This single-center randomized controlled trial included 36 adult patients undergoing primary aTSA. Patients were blinded and randomized 1:1 to either the PSI or the standard aTSA guide groups. The primary endpoint was the accuracy of glenoid component placement (version and inclination), which was determined using a metal-suppression computed tomography scan taken between 6 weeks and 1 year postoperatively. Deviation from the preoperative 3D templating plan was calculated for each patient. Blinded postoperative computed tomography measurements were performed by a fellowship-trained shoulder surgeon and a musculoskeletal radiologist. RESULTS: Nineteen patients were randomized to the patient-specific glenoid drill guide group, and 17 patients were allocated to the standard instrumentation control group. There were no significant differences between the 2 groups for native version (P = .527) or inclination (P = .415). The version correction was similar between the 2 groups (P = .551), and the PSI group was significantly more accurate when correcting version than the control group (P = .042). The PSI group required a significantly greater inclination correction than the control group (P = .002); however, the 2 groups still had similar accuracy when correcting inclination (P = .851). For the PSI group, there was no correlation between the accuracy of component placement and native version, native inclination, or the Walch classification of glenoid wear (P > .05). For the control group, accuracy when correcting version was inversely correlated with native version (P = .033), but accuracy was not correlated with native inclination or the Walch classification of glenoid wear (P > .05). The intraclass correlation coefficient was 0.703 and 0.848 when measuring version and inclination accuracy, respectively. CONCLUSION: When compared with standard instrumentation, the use of in-house, 3D printed, patient-specific glenoid drill guides during aTSA led to more accurate glenoid component version correction and similarly accurate inclination correction. Additional research should examine the influence of proper component position and use of PSI on clinical outcomes.

Consistent Indications and Good Outcomes Despite High Variability in Techniques for Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review.

PURPOSE: To systematically review the current literature regarding the indications, techniques, and outcomes after 2-stage revision anterior cruciate ligament reconstruction (ACLR). METHODS: A literature search was performed using SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta Analyses statement. Inclusion criteria was limited to Level I-IV human studies reporting on indications, surgical techniques, imaging, and/or clinical outcomes of 2-stage revision ACLR. RESULTS: Thirteen studies with 355 patients treated with 2-stage revision ACLR were identified. The most commonly reported indications were tunnel malposition and tunnel widening, with knee instability being the most common symptomatic indication. Tunnel diameter threshold for 2-stage reconstruction ranged from 10 to 14 mm. The most common grafts used for primary ACLR were bone-patellar tendon-bone (BPTB) autograft, hamstring graft, and LARS (polyethylene terephthalate) synthetic graft. The time elapsed from primary ACLR to the first stage surgery ranged from 1.7 years to 9.7 years, whereas the time elapsed between the first and second stage ranged from 21 weeks to 13.6 months. Six different bone grafting options were reported, with the most common being iliac crest autograft, allograft bone dowels, and allograft bone chips. During definitive reconstruction, hamstring autograft and BPTB autograft were the most commonly used grafts. Studies reporting patient-reported outcome measures showed improvement from preoperative to postoperative levels in Lysholm, Tegner, and objective International Knee and Documentation Committee scores. CONCLUSIONS: Tunnel malpositioning and widening remain the most common indications for 2-stage revision ACLR. Bone grafting is commonly reported using iliac crest autograft and allograft bone chips and dowels, whereas hamstring autograft and BPTB autograft were the most used grafts during the second-stage definitive reconstruction. Studies showed improvements from preoperative to postoperative levels in commonly used patient reported outcomes measures. LEVEL OF EVIDENCE: Level IV, systematic review of Level I, III, and IV studies.

Medial Collateral Ligament Reconstruction and Repair Show Similar Improvement in Outcome Scores, But Repair Shows Higher Rates of Knee Stiffness and Failure: A Systematic Review.

PURPOSE: To compare patient-reported outcomes and complications in patients with medial collateral ligament (MCL) injuries undergoing repair versus reconstruction with a minimum 2-year follow-up. METHODS: A literature search was conducted using the PubMed, Scopus, and Embase-computerized databases from database inception to November 2022, according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies evaluating clinical outcomes and complications at a minimum of 2 years following MCL repair versus reconstruction were included. Study quality was assessed using the MINORS criteria. RESULTS: A total of 18 studies published from 1997 to 2022, consisting of 503 patients were identified. Twelve studies (n = 308 patients; mean age: 32.6 years) reported outcomes following MCL reconstruction, and 8 studies (n = 195 patients; mean age: 28.5 years) reported results following MCL repair. Postoperative International Knee Documentation Committee, Lysholm, and Tegner scores ranged from 67.6 to 91, 75.8 to 94.8, and 4.4 to 8, respectively, in the MCL reconstruction group, compared to 73 to 91, 75.1 to 98.5, and 5.2 to 10, respectively, in the MCL repair group. Knee stiffness was the most commonly reported complication following MCL repair (range: 0% - 50%) and reconstruction (range: 0% - 26.7%). Failures occurred in 0% to 14.6% of patients following reconstruction versus 0% to 35.1% of patients undergoing MCL repair. Manipulation under anesthesia (MUA) for postoperative arthrofibrosis (range: 0% - 12.2%) and surgical debridement for arthrofibrosis (range: 0% - 20%) were the most commonly reported reoperations in the MCL reconstruction and repair groups, respectively. CONCLUSIONS: MCL reconstruction versus repair both demonstrate improved International Knee Documentation Committee, Lysholm, and Tegner scores. MCL repair demonstrates higher rates of postoperative knee stiffness and failure at a minimum 2-year follow-up. LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.

Suture Augmentation in Orthopaedic Surgery Offers Improved Time-Zero Biomechanics and Promising Short-Term Clinical Outcomes.

Ligament and tendon ruptures have historically been addressed with varying techniques involving either repair or reconstruction. More recently, the potential biomechanical benefits of suture augmentation (SA), also known as internal brace, have attracted substantial attention and helped renew interest in ligament repair surgery. We evaluated the biomechanical and clinical outcomes of SA-based techniques in the following sports medicine procedures: medial ulnar collateral ligament repair of the elbow, thumb collateral ligament repair, anterior cruciate ligament repair, Achilles' tendon repair, and deltoid ligament repair. Published data on the use of SA to augment repairs of the ulnar collateral ligament, thumb collateral ligament, anterior cruciate ligament, Achilles' tendon, and deltoid ligament repair demonstrate improved time-zero biomechanical and promising short- to mid-term clinical outcomes. However, surgeons must be wary of potential complications, including joint overconstraint, nerve paresthesia, and infection. LEVEL OF EVIDENCE: Level V, expert opinion.

Acellular Dermal Allograft and Tensor Fascia Lata Autograft Show Similar Patient Outcome Improvement and High Rates of Complications and Failures at a Minimum 2-Year Follow-Up: A Systematic Review.

PURPOSE: To compare clinical and radiologic outcomes following superior capsular reconstruction (SCR) using dermal allograft versus tensor fascia lata (TFL) autograft for massive rotator cuff tears with a minimum 2-year follow-up. METHODS: A literature search was performed by querying Scopus, EMBASE, and PubMed computerized databases from database inception through September 2022 in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies evaluating clinical and radiologic outcomes, as well as complications following SCR for the treatment of massive rotator cuff tears were included. Study quality was assessed via the Newcastle-Ottawa Scale and the National Institutes of Health Quality Assessment. The mean change from preoperative to postoperative values (delta) was calculated for each outcome. RESULTS: Seventeen studies, consisting of 519 patients were identified. Mean duration of follow-up ranged from 24 to 60 months. Mean reduction in visual analog scale pain score ranged from 2.9 to 5.9 points following use of dermal allograft, and 3.4 to 7.0 points following TFL autograft reconstruction. Mean improvements in American Shoulder and Elbow Surgeons score were similar between groups (dermal allograft: 28.0-61.6; TFL autograft: 24.7-59.3). The mean increase in forward flexion ranged from 31° to 38° with dermal allograft, versus 19° to 69° with TFL autograft. Average improvement in active external rotation with dermal allograft ranged from -0.4° to 11° and from 2° to 22.4° using TFL autograft. A similar change in acromiohumeral distance following SCR (dermal allograft: 0.9-3.2 mm; TFL autograft: 0.3-3.6 mm) was appreciated. The rate of complications within the dermal allograft group ranged from 4.5% to 38.2% versus 13.3% to 86.4% following TFL autograft. Failure rate ranged from 4.5 to 38.2% following dermal allograft versus 4.5 to 86.4% with TFL autograft. CONCLUSIONS: Acellular dermal allograft versus TFL autograft for SCR both demonstrate improved VAS and American Shoulder and Elbow Surgeons scores, with increased values in flexion and external rotation, and increased visual analog scale, although with high variability. Both grafts demonstrate high rates of complications and failures at minimum 2-year follow-up. LEVEL OF EVIDENCE: IV; systematic review of level II-IV studies.

Minimal inter-surgeon agreement on the diagnosis of pseudoparalysis in patients with massive rotator cuff tears.

BACKGROUND: Pseudoparalysis is commonly used to describe patients with severe loss of active elevation associated with advanced rotator cuff disease, but its definition in the literature has been variable. This study aimed to determine how 15 expert shoulder surgeons use the term "pseudoparalysis" when presented with clinical cases and assess clinical agreement on the diagnosis of pseudoparalysis. METHODS: Fifteen expert shoulder surgeons were surveyed regarding 18 patients with magnetic resonance imaging-diagnosed massive rotator cuff tears, restricted active range of motion (ROM), full passive ROM, and without advanced rotator cuff arthropathy (Hamada grade <3). The survey included 18 patient vignettes with key clinical details and a deidentified video demonstrating the physical examination of the patient. For all patients, surgeons were instructed to assume that the patient has a full passive ROM. An anteroposterior radiograph and T2 sequences of the patient's coronal, axial, and sagittal magnetic resonance imaging were also provided. After each case, the surgeons were asked: (1) does the patient have pseudoparalysis, and (2) if so, how severe it is. At the end of the patient vignettes, surgeons were asked to define pseudoparalysis using a checklist with predefined options. Surgeons were also asked if there was a difference between the term pseudoparalysis and pseudoparesis. Fleiss' kappa (κ) correlation coefficient was used to determine intersurgeon agreement. RESULTS: There was minimal inter-rater agreement on the diagnosis of pseudoparalysis (κ = 0.360) and no agreement on describing the severity of pseudoparalysis (κ = -0.057). Although 80% of surgeons stated that an active glenohumeral elevation less than 90° was a diagnostic feature of pseudoparalysis, there was disagreement on the remaining criteria, leading to no agreement on a set of universal criteria that defines pseudoparalysis. A total of 67% included maintained full passive elevation, 33% included the absence of pain, 67% included elevation causing anterosuperior escape, and 27% included an additional unlisted factor. There was minimal agreement among the 15 surgeons on the diagnostic criteria of pseudoparalysis (κ = 0.092). Finally, 7 surgeons stated that pseudoparalysis and pseudoparesis are identical, whereas 8 surgeons stated that they are 2 different clinical diagnoses. CONCLUSION: Among this panel of expert shoulder surgeons, there was a lack of consensus on the definition of pseudoparalysis and minimal agreement on the diagnosis of pseudoparalysis based on clinical scenarios. In addition, half the surgeons believed that pseudoparalysis and pseudoparesis are identical, whereas the other half believed that they represent 2 separate clinical entities. A standardized definition of pseudoparalysis would be of value to facilitate communication and research efforts.

Establishing the Minimal Clinically Important Difference and Patient Acceptable Symptomatic State following Patellofemoral Inlay Arthroplasty for Visual Analog Scale Pain, Western Ontario and McMaster Universities Arthritis Index, and Lysholm Scores.

BACKGROUND: The purposes of the study were to define the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) after patello-femoral inlay arthroplasty (PFA) and to identify factors predictive for the achievement of clinically important outcomes (CIOs). METHODS: A total of 99 patients who underwent PFA between 2009 and 2019 and had a minimum of 2-year postoperative follow-up were enrolled in this retrospective monocentric study. Included patients had a mean age of 44 years (range, 21 to 79). The MCID and PASS were calculated using an anchor-based approach for the visual analog scale (VAS) pain, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Lysholm patient-reported outcome measures. Factors associated with CIO achievement were determined using multivariable logistic regression analyses. RESULTS: The established MCID thresholds for clinical improvement were -2.46 for the VAS pain score, -8.5 for the WOMAC score, and + 25.4 for the Lysholm score. Postoperative scores corresponding to the PASS were <2.55 for the VAS pain score, <14.6 for the WOMAC score, and >52.5 points for the Lysholm score. Preoperative patellar instability and concomitant medial patello-femoral ligament reconstruction were independent positive predictors of reaching both MCID and PASS. Additionally, inferior baseline scores and age were predictive of achieving MCID, whereas superior baseline scores and body mass index were predictive of achieving PASS. CONCLUSION: This study determined the thresholds of MCID and PASS for the VAS pain, WOMAC, and Lysholm scores following PFA implantation at 2-year follow-up. The study demonstrated a predictive role of patient age, body mass index, preoperative patient-reported outcome measure scores, preoperative patellar instability, and concomitant medial patello-femoral ligament reconstruction in the achievement of CIOs. LEVEL OF EVIDENCE: Prognostic Level IV.

SPE based soil processing and aptasensor integrated detection system for rapid on site screening of arsenic contamination in soil.

Rapid industrialization and urbanization have resulted in serious environmental deterioration, especially in terms of heavy metal contamination in soil. Arsenic is one of the primary heavy metal contaminants in the soil and possesses a severe threat to all the plants and animals including humans. The conventional methods for analyzing arsenic contamination in soil have tedious, time-consuming sample preparation steps and require laboratory equipped instruments and skilled personnel. The present work demonstrates a novel method for arsenic As(III) detection in the contaminated soil based on field applicable sample preparation and smartphone-based optical sensing. Soil sample preparation has been simplified and optimized using acid extraction and serial application of different solid phase extraction (SPE) cartridges for the removal of interfering ions with high arsenic yield in one step. The acidic extraction and SPE efficiencies were found to be 35.4% and 54.0%, respectively, for arsenic contaminated field soil samples. The quantification of As(III) was performed by aptamer-AuNPs based colorimetric assay with a smartphone coupled optical unit. This aptasensor integrated detection system (ADS) has shown a detection limit of 14.44 ppb for aqueous samples and 1.97 ppm for field soil samples. In the accuracy comparison with ICP-MS, arsenic contaminated field soils from various sources have been tested and the results depicted a highly significant correlation coefficient of 0.997 with an average difference of 1.67 ppm. By integrating all the required analytical steps into a portable format, the presented setup enables on-site tests of arsenic contamination in soil.

Progress in antibiotic susceptibility tests: a comparative review with special emphasis on microfluidic methods.

Antibiotic susceptibility test (AST) is an umbrella term for techniques to determine the susceptibility of bacteria to antibiotics. The antibiotic-resistant bacteria are a major threat to public health and a directed therapy based on accurate AST results is paramount in resistance control. Here we have briefly covered the progress of conventional, molecular, and automated AST tools and their limitations. Various aspects of microfluidic AST such as optical, electrochemical, colorimetric, and mechanical methods have been critically reviewed. We also address the future requirements of the microfluidic devices for AST. Cumulatively, we have outlined the overview of AST that can help to expand and improve the existing techniques and emphasize that microfluidics could be the future of AST and introduction of microtechnologies in AST will be extremely advantageous, especially for point-of-care testing.

Interaction of melatonin and gonadotropin-inhibitory hormone on the zebrafish brain-pituitary-reproductive axis.

Circadian cycles and photoperiod are known to influence reproductive physiology in several animals. Neuropeptides, such as gonadotropin-inhibitory hormone (GNIH) and gonadotropin-releasing hormone (GNRH), are influenced by melatonin in birds and mammals. The present study demonstrates the role of melatonin in oocyte maturation in the zebrafish (Danio rerio), via the brain-pituitary-reproductive axis, under different photic conditions. Melatonin was significantly higher both in the whole brain and ovary under continuous dark (DD) compared to continuous light (LL) conditions. Transcription of gnih in the brain was high in LL, but low in DD; similarly, melatonin exogenous treatment reduced gnih in cultured brain in a dose-dependent manner. Expression of gnrh3, however, was high in both continuous photic conditions (DD and LL), whereas fshb and lhb were high only during DD. kiss2, another neuropeptide, was high in LL, but kiss1 remain unchanged among the conditions. At the gonad level, expression of fshr, lhcgr, mtnr1aa, and mtnr1ab tracked with the expression of their respective ligand in DD and LL. The expression of mprb is high in DD ovary, although intra-ovarian growth factors (tgfb1a and bmp15) were low. The measured increased percentages of germinal vesicle breakdown, expression of Cyclin B1, and reduced Cdc2p34 phosphorylation are consistent with increased maturation in the dark. Our study thus links melatonin to the inhibition of gnih in the brain-pituitary-reproductive axis of zebrafish in response to photic conditions.

Evaluating the Reliability and Quality of YouTube Videos Regarding Medial Collateral Ligament Knee Injury as a Patient Education Resource.

OBJECTIVES: The purpose of this study was to assess the educational reliability and quality of videos shared on YouTube regarding medial collateral ligament (MCL) injuries of the knee. METHODS: Using the search keywords "medial collateral ligament" on YouTube, the first 50 videos were evaluated by two independent reviewers. Video characteristics were extracted, and each video was categorized by upload source and content type. Three scoring systems were used to evaluate the videos: the Journal of the American Medical Association (JAMA) Benchmark Score to assess a video's reliability; the Global Quality Score (GQS) to assess educational quality; the novel MCL Specific Score (MCL-SS) to assess MCL-specific content quality. Linear regression analyses were conducted to explore relationships between video characteristics and scores. RESULTS: Collectively, the videos were viewed 5,759,427 times with a mean number of views per video of 115,189 ± 177,861. The mean JAMA score was 1.8, GQS was 2.1, and MCL-SS was 5.6, indicating both poor reliability and quality. Only videos uploaded by physicians showed a statistically significantly higher mean MCL-SS (P = .032) but were still of low quality with a mean MCL-SS of 9.2 ± 5.9. Multivariate linear regression revealed that videos uploaded by physicians were statistically significant predictors of greater MCL-SS (ß = 4.108; P = .029). Longer video durations were statistically significant predictors of greater GQS (ß = .001; P = .002) and MCL-SS (ß = .007; P < .001). CONCLUSIONS: YouTube videos regarding MCL injuries, despite their popularity, were found to be on average of poor overall reliability and quality as measured by JAMA, GQS, and MCL-SS. LEVEL OF EVIDENCE: III - Cross-sectional Study.

Complex Pathological Femoral Fracture in a Multiple Myeloma Patient Undergoing Intertrochanteric Fixation: A Case Report.

Pathological fractures commonly occur in patients with metastatic bone diseases, particularly multiple myeloma. The current optimal management for metastatic pathological lesions affecting the proximal femur is surgical intervention. Surgical planning and appropriate use of imaging modalities are pivotal in the appropriate treatment of pathological fractures. Impending fractures create added layers of complexity in the decision-making process. The appropriateness of different surgical interventions involves a multi-disciplinary approach and the importance of holistic healthcare is paramount in these circumstances.

Bone Marrow Aspirate Concentrate Harvest Techniques for the Sports Medicine Surgeon.

The use of bone marrow aspirate concentrate (BMAC) as a surgical augment to enhance biologic healing has been gaining popularity in a variety of sports medicine procedures. Due to its reliable availability from multiple sites, including the proximal tibia, proximal humerus, and anterior superior iliac spine, BMAC can be harvested at a location selected to be adjacent to the primary procedure. This Technical Note aims to highlight 3 different harvest sites for BMAC, allowing orthopaedic sports medicine surgeons to localize their harvest site based on the proximity of the planned procedure and ultimately increase efficiency.

Association Between Social Media Activity and Ratings on Physician Review Websites Among Orthopaedic Surgeons With an Active Online Media Presence.

Background: Social media has the potential to play a substantial role in the decision-making of patients when choosing a physician for care. Purpose: The purpose of this study was to determine whether an association exists between physician social media activity and patient satisfaction ratings on physician review websites (PRWs) as well as number of reviews. It was hypothesized that there would be a significant association between physician social media utilization and patient satisfaction ratings. Study Design: Cross-sectional study. Methods: The American Orthopaedic Society for Sports Medicine database was queried for the complete membership list. The online media profile and level of activity of the members were evaluated, and an online media presence score was calculated. The surgeons with the approximately top 10% of online media presence scores were compiled to assess the relationship between social media usage (Twitter, Instagram, YouTube, and Facebook) and patient satisfaction ratings on the Google Reviews, Healthgrades, and Vitals PRWs. Bivariate analysis was performed to compare demographic variables and level of online presence. Results: A total of 325 surgeons were included in the analysis. The most common platform used was Facebook (88.3%). There was no significant relationship between active social media use and overall ratings on any of the PRWs. Active Twitter use was associated with a greater number of ratings on all review websites, a greater number of comments on Google Reviews and Healthgrades, and shorter patient-reported clinic wait times on Healthgrades. Active Instagram use was associated with a greater number of comments on Vitals. No relationships were observed for YouTube or Facebook. Conclusion: For the included sports medicine surgeons who were most active on social media, no significant relationships were found between social media use and overall ratings on PRWs. Of all the platforms assessed, active use of Twitter was the only significant predictor of more reviews on PRWs. Thus, when deciding which form of social media engagement to prioritize in building one's practice, Twitter may serve as a relatively low-demand, high-reward option.

A Systematic Review of Adverse Events and Complications After Isolated Posterior Medial Meniscus Root Repairs.

BACKGROUND: Medial meniscus posterior root (MMPR) tears are recognized as a substantial cause of disability and morbidity. However, meniscus root repair, regardless of technique, is not without potential complications. PURPOSE: To evaluate the reported incidence of complications and adverse events after isolated MMPR repair. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using Embase, PubMed, and Scopus databases with the following search terms combined with Boolean operators: "meniscus,""root," and "repair." Inclusion criteria consisted of level 1 to 4 human clinical studies in English or English-language translation reporting complications and adverse events after isolated posterior medial meniscus root repairs. The overall incidence of specific complications was estimated from the pooled sample of the included studies. RESULTS: Eleven studies with a total pooled sample of 442 patients were identified. The mean patient age was 58.1 years, while the mean final follow-up time was 37.2 months (range, 12-84.8 months). The overall incidence of complications was 9.7% (n = 43/442), with the most commonly reported complication being progressive degenerative changes within the knee (10.4%; n = 25/240; n = 5 studies). A total of 1.25% (n = 3/240) of patients who experienced degenerative changes required conversion to total knee arthroplasty. Repair failures were reported in 3.1% (n = 10/327; n = 8 studies) of patients. CONCLUSION: Repairing MMPR tears is critical in preventing accelerated progression of knee osteoarthritis in patients without significant knee osteoarthritis preoperatively. While this repair is still recommended and necessary in appropriate patients, this review found that the incidence of complications after isolated posterior medial meniscus root repair was 9.7%, primarily involving the presence of progressive degeneration, while repair failure was reported in 3% of patients.