Anchor-Based Meniscal Ramp Repair.

Ramp lesions of the medial meniscus are underdiagnosed because of difficulty in visualizing via magnetic resonance imaging and during arthroscopy. They most often occur simultaneously with anterior cruciate ligament (ACL) injury but may also be associated with posterior plateau contusions, steeper medial tibial plateau slope, and excess varus alignment. Upwards of 24% of ACL reconstructions have concomitant ramp lesions. Failure to repair the ramp lesion is associated with increased rotational laxity, tibial translocation, persistent pivot shift, and poorer outcomes after ACL reconstruction. The purpose of this article is to describe an all-suture anchor-based repair of a meniscal ramp lesion, which confers several advantages over traditional repair techniques.

Why Your Patient May Need an ACL Reconstruction Plus Lateral Extra-Articular Tenodesis Procedure.

Anterior cruciate ligament (ACL) tears are one of the most common knee injuries experienced by active individuals engaging in cutting sports. Despite improved surgical techniques and rehabilitation, the return to sport rate and re-tear rates remain unsatisfactory. Lateral extra-articular tenodesis (LET) is a procedure that has been growing in interest when performed in conjunction with ACL reconstruction. The benefits of adding an LET procedure to an ACL surgery may include greater rotational stability, decreased re-tear rates, and improved return to play. Level of evidence: V.

Obesity does not impact complications and conversion to total knee arthroplasty after high tibial osteotomy: A systematic review.

PURPOSE: The purpose of this systematic review is to consolidate outcomes of obese patients undergoing high tibial osteotomy and to investigate the effect of obesity on postoperative outcomes, including symptomatic relief and time to conversion to arthroplasty. METHODS: Medline, Embase and Cochrane Library were searched from database inception up to April 2023 according to PRISMA guidelines by two reviewers. Search terms including 'obesity', 'BMI', 'osteotomy' and 'high tibial osteotomy (HTO)' were included to identify all relevant articles. Only studies that explicitly reported outcomes for obese patients were included. Disagreements in study inclusion or quality assessment were resolved by a senior third reviewer. Metrics compared include time to arthroplasty, preoperative and postoperative mechanical tibiofemoral angle (mTFA), patient-reported satisfaction scores and postoperative complications. RESULTS: Nine studies comparing 973 patients were included. The mean age was 52.7 ± 4.2 years old and 38.4% were male. Six studies performed the medial opening-wedge HTO, and three utilized the medial wedge closing technique. Most studies indicated significant improvement following surgical intervention with satisfactory outcomes in obese and nonobese patients. In addition, differences in complication rates were minimal between obese and nonobese patients (n.s.), while functional scores did not vary significantly. Conversion to total knee arthroplasty was not found to increase in obese patients (n.s.). CONCLUSION: Obesity does not appear to carry a greater complication risk or worse outcomes following high tibial osteotomies, and surgeons should consider HTO a viable option for young obese patients with symptomatic unicompartmental chondral wear with coronal limb malalignment. LEVEL OF EVIDENCE: Level IV.

Inferior altitudinal visual loss and mask-wearing practices: A case series.

Face mask-wearing practices and their impact on the visual field bear particular importance in the coronavirus disease 2019 (COVID-19) pandemic era. This case series examines 10 participants with no history of ocular impairment or visual field defects who underwent age-corrected visual field testing in both eyes with different types of face masks. Wearing duckbill N95 masks was consistently associated with increased accuracy errors in the inferior altitudinal visual field when compared to wearing surgical masks or no masks. These findings support public health guidance that has previously attributed the risks of falls and accidents to face mask wearing.

Monomicrobial Joint Infection by Leclercia adecarboxylata in an Immunocompetent Patient After Knee Arthroscopy: A Case Report.

CASE: A 54-year-old immunocompetent man presented to the office with severe right knee pain and swelling 27 days after knee arthroscopy. Additional diagnostics identified a monomicrobial infection of the right knee joint by the bacterium Leclercia adecarboxylata, which was later confirmed by repeated aspiration of the joint and culture of the aspirated fluid. CONCLUSION: This case report details a postoperative monomicrobial infection with L. adecarboxylata after a knee arthroscopy in an immunocompetent host. Although infection by this bacterium is rare, this case demonstrates the possibility of L. adecarboxylata infection in the knee joint after orthopaedic surgery.

Time-Resolved Absorptance and Melt Pool Dynamics during Intense Laser Irradiation of a Metal.

High-irradiance lasers incident on metal surfaces create a complex, dynamic process through which the metal can rapidly change from highly reflective to strongly absorbing. Absolute knowledge of this process underpins important industrial laser processes such as laser welding, cutting, and metal additive manufacturing. Determining the time-dependent absorptance of the laser light by a material is important, not only for gaining a fundamental understanding of the light-matter interaction but also for improving process design in manufacturing. Measurements of the dynamic optical absorptance are notoriously difficult due to the rapidly changing nature of the absorbing medium. These data are also of vital importance to process modelers, whose complex simulations need reliable, accurate input data; yet, there are very few available. In this work, we measure the time-dependent, reflected light during a 10-ms laser spot weld using an integrating-sphere apparatus. From this, we calculate the dynamic absorptance for 1070-nm-wavelength light incident on 316L stainless steel. The time resolution of our experiment (less than 1 µs) allows the determination of the precise conditions under which several important physical phenomena occur, such as melt and keyhole formation. The average absorptances determined optically are compared with calorimetrically determined values, and it is found that the calorimeter severely underestimates the absorbed energy due to mass lost during the spot weld. Weld-nugget cross sections are also presented to verify our interpretation of the optical results, as well as to provide experimental data for weld-model validation.