Rising rates of anterior cruciate ligament reconstruction in Australian adults: An analysis of Australian Medicare Benefits Schedule database.

PURPOSE: Anterior cruciate ligament (ACL) reconstruction is an evolving field, though there remains sparse epidemiological data on the treatment of ACL ruptures. The objective of this study is to analyse the trends in the rate of ACL reconstruction (ACLR) in adult patients over the past two decades in the Australian population. METHODS: The incidence of ACLR between 2001 and 2020 in patients 15 years and over was analysed using the Australian Medicare Benefits Schedule (MBS) database. The data reflect patients with private health coverage (45% of the Australian population). An offset term was introduced using national population data to account for population changes over the study period. RESULTS: A total of 160,353 ACLRs were performed in Australia under the MBS in the 20-year period from 2001 to 2020. An annual increase in the total volume and per capita rate of ACLRs was found (p < 0.05). The annual volume of cases increased by 82%, from 5512 in 2001 to a peak of 10,011 in 2017. This increase was seen across all age groups (p < 0.05) and both sexes (p < 0.05), with a greater proportion of reconstructions performed on males (n = 102,357, 64%) than females (n = 57,996, 36%). In 2020, the rate of adult ACLRs decreased to a level last seen in 2004, likely due to the effects of COVID-19. CONCLUSIONS: The incidence of ACLR in adult patients has increased in Australia over the 20-year study period. The trends noted provide information that can be used to guide resource allocation and health provision in the future. LEVEL OF EVIDENCE: Level IV.

Trends in Pediatric Anterior Cruciate Ligament Reconstruction in Australia: An Analysis of Australian Medicare Benefits Schedule Database From 2001 to 2020.

BACKGROUND: Anterior cruciate ligament (ACL) injuries are common and increasingly prevalent in the pediatric population. However, there remain sparse epidemiological data on the surgical treatment of these injuries. The objective of this study is to assess the trends in the rate of pediatric ACL reconstruction in Australia over the past 2 decades. METHODS: The incidence of ACL reconstruction from 2001 to 2020 in patients 5 to 14 years of age was analyzed using the Australian Medicare Benefits Schedule (MBS) database. Data were stratified by sex and year. An offset term was introduced using population data from the Australian Bureau of Statistics to account for population changes over the study period. RESULTS: A total of 3719 reconstructions for the management of pediatric ACL injuries were performed in Australia under the MBS in the 20-year period from 2001 to 2020. There was a statistically significant annual increase in the total volume and per capita volume of pediatric ACL reconstructions performed across the study period ( P <0.0001). There was a significant increase in the rate of both male and female reconstructions ( P <0.0001), with a greater proportion of reconstructions performed on males (n=2073, 56%) than females (n=1646, 44%). In 2020, the rate of pediatric ACL reconstructions decreased to a level last seen in 2015, likely due to the effects of COVID-19. CONCLUSIONS: The incidence of ACL reconstruction in skeletally immature patients has increased in Australia over the 20-year study period. This increase is in keeping with evidence suggesting poor outcomes with nonoperative or delayed operative management.

Risk of early revision in total hip arthroplasty: the relative contribution of the surgeon versus the hospital.

BACKGROUND: Early revision for total hip arthroplasty is a serious adverse outcome. There are multiple contributing risk factors for early revision. Risk factors can exist at the level of the surgeon and the level of the institution. The primary research question of this study was to determine the relative contribution of surgeon-level and hospital-level variance to rates of early revision (overall and for infection) after primary total hip arthroplasty. METHODS: This is a registry-based study from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Data for the most commonly used stem (Exeter V40) were used to reduce prosthesis variation from the analysis. A mixed effects Cox Model (also known as a frailty model) with crossed random effects for surgeon and hospital was used. Outcomes were early revision (within 2 years) for all causes and for infection. This model allowed for the risk of early revision to be explained by the variability at the surgeon level or hospital level. RESULTS: There were 32 031 procedures performed by 735 surgeons across 250 hospitals between 1 January 2015 and 31 December 2019. Surgeon variability significantly contributed to overall variation in revision for any cause and revision for infection (P < 0.0001). There was no significant contribution of hospital-level variation to overall revision or for infection. CONCLUSIONS: Surgeon-level factors play a more important role than institution-level factors in early revision after primary total hip arthroplasty. If surgeons are identified as having a higher risk of revision, there is potential for surgeon-level practice change to reduce the risk of early revision.

C1-C2 sublaminar taping for displaced odontoid synchondrosis fracture in an infant: A case report and novel surgical technique.

Pediatric cervical spine injuries are rare, and the diagnosis and management can be challenging. Surgical intervention has been recommended in unstable odontoid synchondrosis injuries or those that have failed nonoperative measures. However, the literature remains sparse on the operative management of severe injuries due to the low incidence. An 18-month-old female sustained an unstable odontoid synchondrosis fracture from a motor vehicle accident. Due to ongoing instability after initial immobilization in a halo, the decision was made to proceed with surgical management. With the patient positioned prone and neural monitoring throughout, a posterior approach was utilized. Subperiosteal exposure of the C1 posterior arch was performed bilaterally. A spinal fixation band was passed under the right C1 posterior arch, around the C2 spinous process, under the left C1 posterior arch, and finally back under the C2 spinous process. The C1-C2 distraction was reduced using intraoperative imaging, and the sublaminar tape construct was secured and reinforced. The halo was then reattached. Postoperative recovery was complicated by a halo pin-site infection which was treated with oral antibiotics. The halo was removed after 3 months, following a computerized tomography that demonstrated union. X-rays at 6 months revealed anatomical alignment with the union. Surgery is recommended in pediatric odontoid synchondrosis fractures refractory to nonoperative management. Sublaminar taping of C1-C2 with a spinal fixation band has been demonstrated to be an effective surgical technique in the management of an unstable odontoid synchondrosis fracture.

Examining the role of ChatGPT in the management of distal radius fractures: insights into its accuracy and consistency.

BACKGROUND: The optimal management of distal radius fractures remains a challenge for orthopaedic surgeons. The emergence of Artificial Intelligence (AI) and Large Language Models (LLMs), especially ChatGPT, affords significant potential in improving healthcare and research. This study aims to assess the accuracy and consistency of ChatGPT's knowledge in managing distal radius fractures, with a focus on its capability to provide information for patients and assist in the decision-making processes of orthopaedic clinicians. METHODS: We presented ChatGPT with seven questions on distal radius fracture management over two sessions, resulting in 14 responses. These questions covered a range of topics, including patient inquiries and orthopaedic clinical decision-making. We requested references for each response and involved two orthopaedic registrars and two senior orthopaedic surgeons to evaluate response accuracy and consistency. RESULTS: All 14 responses contained a mix of both correct and incorrect information. Among the 47 cited references, 13% were accurate, 28% appeared to be fabricated, 57% were incorrect, and 2% were correct but deemed inappropriate. Consistency was observed in 71% of the responses. CONCLUSION: ChatGPT demonstrates significant limitations in accuracy and consistency when providing information on distal radius fractures. In its current format, it offers limited utility for patient education and clinical decision-making.

2-Substituted (N)-Methanocarba A3 Adenosine Receptor Agonists: In Silico, In Vitro, and In Vivo Characterization.

2-Arylethynyl (N)-methanocarba adenosine 5'-methylamides are selective A3 adenosine receptor (AR) agonists containing a preestablished receptor-preferred pseudoribose conformation. Here, we compare analogues having bulky 2-substitution, either containing or lacking an ethynyl spacer between adenine and a cyclic group. 2-Aryl compounds 9-11, 13, 14, 19, 22, 23, 27, 29, 31, and 34, lacking a spacer, had human (h) A3AR K i values of 2-30 nM, and others displayed lower affinity. Mouse (m) A3AR affinity varied, with 2-arylethynyl having a higher affinity than 2-aryl analogues (7, 8 > 3c, 3d > 3b). However, 2-aryl-4'-truncated derivatives had greatly reduced hA3AR affinity, even containing affinity-enhancing N 6-dopamine-derived substituents. Molecular modeling, including molecular dynamics simulation, predicted stable poses in the canonical A3AR agonist binding site, but 2-aryl (ECL2 interactions) and 2-arylethynyl (TM2 interactions) substituents have different conformations and environments. In a hA3AR miniGαi recruitment assay, 31 (MRS8062) was (slightly) more potent compared to a ß-arrestin2 recruitment assay, both in engineered HEK293T cells, and its maximal efficacy (E max) was much higher (165%) than reference agonist NECA's. Thus, in the 2-aryl series, A3AR affinity and selectivity were variable and generally reduced compared to the 2-arylethynyl series, with a greater dependence on the specific aryl group present. Selected compounds were studied in vivo in an ischemic model of peripheral artery disease (PAD). Rigidified 2-arylethynyl analogues 3a-3c were protective in this model of skeletal muscle ischemia-reperfusion injury/claudication, as previously shown only for moderately A3AR-selective ribosides or (N)-methanocarba derivatives. Thus, we have expanded the A3AR agonist SAR for (N)-methanocarba adenosines.