Textured versus Smooth Tissue Expanders: A Comparison of Complications in 3526 Breast Reconstructions.

BACKGROUND: Increased understanding of breast implant-associated anaplastic large-cell lymphoma has led to a shift away from textured breast devices. A few small studies have compared the complication rates of textured and smooth tissue expanders (TEs). The aim of this study was to compare complication profiles in patients undergoing two-stage postmastectomy breast reconstruction with either textured or smooth TEs. METHODS: The authors performed a retrospective review of female patients who underwent immediate breast reconstruction with textured or smooth TEs from 2018 to 2020 at their institution. Rates of seroma, infection/cellulitis, malposition/rotation, exposure, and TE loss were analyzed in the overall cohort and subgroups undergoing prepectoral and subpectoral TE placement. A propensity score-matched analysis was used to decrease the effects of confounders comparing textured and smooth TEs. RESULTS: The authors analyzed 3526 TEs (1456 textured and 2070 smooth). More frequent use of acellular dermal matrix, SPY angiography, and prepectoral TE placement was noted in the smooth TE cohort ( P < 0.001). Univariate analysis suggested higher rates of infection/cellulitis, malposition/rotation, and exposure in smooth TEs (all P < 0.01). Rates of TE loss did not differ. After propensity matching, no differences were noted in infection or TE loss. Prepectoral smooth expanders had increased rates of malposition/rotation. CONCLUSIONS: TE surface type did not affect rates of TE loss, although increased rates of expander malposition were noted in the smooth prepectoral cohort. Further research is needed to examine breast implant-associated anaplastic large-cell lymphoma risk with temporary textured TE exposure to improve decision-making. CLINICAL QUESTION/LEVEL OF EVIDENCW: Therapeutic, III.

Minimum 2-Year Clinical Outcomes of Medial Meniscus Root Tears in Relation to Coronal Alignment.

BACKGROUND: The effect of coronal plane alignment on the outcomes of repairs of the medial meniscus root remains unclear. HYPOTHESIS: Increased preoperative varus alignment is associated with higher failure rates and lower patient-reported outcomes (PROs) after isolated repair of the medial meniscus root. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patients aged 18 years or older who underwent arthroscopy-assisted repair of the medial posterior meniscus root over a 7-year period were included. The mechanical axis of the knee was measured preoperatively. Osteoarthritis was assessed radiographically preoperatively and at the final follow-up according to the Kellgren-Lawrence grading scale. Failure was defined as any patient having to undergo revision root repair, partial meniscectomy of the previously repaired meniscus, debridement, lysis of adhesions, or conversion to arthroplasty. RESULTS: A total of 53 patients (29 women, 24 men) with a mean age of 51.3 years were included in the follow-up analysis. The mean time of follow-up after surgery was 3.3 years (range, 22-77 months). Significant improvements were observed in all PROs analyzed. Decreased varus as measured by alignment percentage was correlated with baseline Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain (P = .023) and WOMAC Stiffness (P = .022). Alignment percentage was also significantly negatively correlated with postoperative WOMAC Stiffness (P = .005) and positively correlated with Lysholm (P = .003) and International Knee Documentation Committee (P = .009) scores. Higher baseline Kellgren-Lawrence grade was correlated with worse postoperative PROs (P < .05), except 12-Item Short Form Health Survey Mental Component Summary and satisfaction. Eight patients who underwent a concomitant high tibial osteotomy (HTO) achieved lower PROs in all scales analyzed, regardless of their alignment. When excluding patients who underwent HTO, postoperative Lysholm score (P = .004) and postoperative WOMAC Stiffness (p = 0.014) were inferior among the patients with >5° of varus. CONCLUSION: Lower extremity alignment closest to neutral correlated with improved PROs. Patients who underwent a concurrent HTO had worse PROs than those who did not undergo HTO.