The Use of Multiple Imaging Studies Before Shoulder Stabilization Surgery Is Increasing.

Purpose: To determine the incidence of preoperative shoulder imaging, explore the prevalence of obtaining multiple advanced imaging studies, and identify patient characteristics associated with specific imaging studies before anterior versus posterior shoulder stabilization surgery. Methods: The PearlDiver database was queried for patients who underwent anterior or posterior shoulder stabilization surgery from 2010 to 2019. The incidence of imaging studies within a year of surgery was collected. Patient characteristics were compared between groups using one-way analysis of variance or χ2 test. Results: In total, 10,252 patients underwent anterior shoulder stabilization surgery, and 1,108 patients underwent posterior shoulder stabilization surgery. Imaging use before anterior and posterior shoulder stabilization surgery included plain radiographs (69%, 70%, respectively), magnetic resonance imaging (MRI; 43%, 33%), and computed tomography (CT; 22%, 22%). In total, 1,098 patients (11%) received MRI and CT before anterior stabilization surgery and 85 patients (8%) received MRI and CT before posterior stabilization surgery. Over time, the incidence of obtaining MRI and CT increased before anterior (z = 2.54, P = .011) and posterior (z = 2.36, P = .018) stabilization surgery. Conclusions: This study highlights the increasing use of multiple imaging studies before shoulder stabilization surgery over recent years, including plain radiographs, MRI, and CT imaging. In total, 45% of anterior shoulder stabilization patients and 41% of posterior shoulder stabilization patients obtained more than 1 imaging study within a year of surgery, with a recent increase in patients obtaining both MR and CT scans preoperatively. Statement of Clinical Relevance: The increasing use of multiple preoperative imaging studies observed in this study highlights an opportunity for new imaging technology to streamline and improve the preoperative workup.

Patients Aged 50 Years and Older Have Greater Complication Rates After Anterior Cruciate Ligament Reconstruction: A Large Database Study.

PURPOSE: To assess the use of anterior cruciate ligament (ACL) reconstruction in older adults and to compare postoperative complication and revision surgery rates between patients older than and younger than 50 years old. METHODS: Retrospective data were obtained using the PearlDiver database for patients who underwent arthroscopic ACL reconstruction from January 2010 to December 2017. Trends in the annual performance of ACL reconstruction were determined using nonparametric test of trends of ranks. Patients in each age group were matched based on sex and the Charlson Comorbidity Index. The incidence of postoperative complications within 90 days and subsequent knee surgery within 2 years of ACL reconstruction was collected. Postoperative complication rates were compared between matched age groups using the χ2 test. RESULTS: A total of 20,993 patients aged 50 years and older and 154,817 patients younger than 50 years underwent ACL reconstruction between 2010 and 2017. The use of ACL reconstruction in patients aged 50 years or older decreased over time (P = .044). Patients aged 50 years or older were more likely to experience at least 1 postoperative complication within 90 days compared to patients younger than 50 years (2.5% vs 2.1%, P = .007). Older patients were 1.3 times as likely to experience deep vein thrombosis (P = .002) and 1.8 times as likely to experience pulmonary embolism (P < .001). Younger patients were more likely to undergo subsequent ACL reconstruction and experience knee pain, stiffness, and wound infection postoperatively (P < .001, P < .001, P = .041). 1.6% of patients aged 50 years or older underwent total knee arthroplasty within 2 years. CONCLUSIONS: ACL reconstruction in patients aged 50 years or older is associated with greater complication rates but lower rates of subsequent knee surgery relative to patients younger than 50 years of age. Younger patients were more prone to surgical complications whereas older patients experienced more medical complications. The increased incidence of VTE in this population suggests that thrombotic prophylaxis may be considered. LEVEL OF EVIDENCE: Level III, retrospective comparative observational trial.

Manganese transporter Slc30a10 controls physiological manganese excretion and toxicity.

Manganese (Mn), an essential metal and nutrient, is toxic in excess. Toxicity classically results from inhalational exposures in individuals who work in industrial settings. The first known disease of inherited Mn excess, identified in 2012, is caused by mutations in the metal exporter SLC30A10 and is characterized by Mn excess, dystonia, cirrhosis, and polycythemia. To investigate the role of SLC30A10 in Mn homeostasis, we first generated whole-body Slc30a10-deficient mice, which developed severe Mn excess and impaired systemic and biliary Mn excretion. Slc30a10 localized to canalicular membranes of hepatocytes, but mice with liver Slc30a10 deficiency developed minimal Mn excess despite impaired biliary Mn excretion. Slc30a10 also localized to the apical membrane of enterocytes, but mice with Slc30a10 deficiency in small intestines developed minimal Mn excess despite impaired Mn export into the lumen of the small intestines. Finally, mice with Slc30a10 deficiency in liver and small intestines developed Mn excess that was less severe than that observed in mice with whole-body Slc30a10 deficiency, suggesting that additional sites of Slc30a10 expression contribute to Mn homeostasis. Overall, these results indicated that Slc30a10 is essential for Mn excretion by hepatocytes and enterocytes and could be an effective target for pharmacological intervention to treat Mn toxicity.

Acute Fixation of Type IV and V Acromioclavicular Separations: An Internal Splint Technique.

BACKGROUND: There is no standard method for the surgical treatment of acromioclavicular (AC) joint separations. Current techniques have associated complications, including need for device removal, coracoid fracture, and inadequate reduction. PURPOSE: To evaluate the clinical outcomes of an internal splint technique without graft augmentation or rigid fixation to treat acute Rockwood type IV and V AC joint injuries. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective analysis was performed of 26 patients who underwent a novel internal splint fixation technique between 2011 and 2016. Patients had type IV (n = 2) and type V (n = 24) acute AC separations. The mean time to surgery was 13.7 days (range, 1-28 days). The surgical technique included an open approach with coracoclavicular suture and tape fixation and AC suture fixation. Range of motion, strength, and radiographs were evaluated after surgery. Patient follow-up included the DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire at a mean 3.3 years postoperatively (range, 6 months-8.6 years). DASH questionnaires were obtained for all patients via email. Patients were also surveyed on cosmetic appearance and willingness to undergo the operation again. RESULTS: All patients regained full strength and range of motion following surgery. All postoperative radiographs demonstrated well-maintained reduction of the AC joint. The mean DASH score was 3.4 at final follow-up, and 23 of 26 respondents were satisfied with their postoperative shoulder appearance. There were no reoperations, and all patients stated that they would have the operation again given the same circumstances. CONCLUSION: The results of this study demonstrate a reliable new technique for acute fixation of type IV or V AC joint injuries via an internal splint construct. This technique enables reduction in the coronal and sagittal planes without the need for graft augmentation or a rigid implant, allowing healing of the coracoclavicular and AC ligaments.

Effects of cemented versus press-fit primary humeral stem fixation in the setting of revision shoulder arthroplasty.

BACKGROUND: The influence of primary humeral stem fixation method (cemented or press fit) on intraoperative or postoperative outcomes in the setting of revision shoulder arthroplasty is unknown. METHODS: A retrospective analysis of a prospectively collected cohort of revision shoulder arthroplasty patients from a single tertiary center was performed. Demographic variables, intraoperative data, and 90-day complication rates were compared between cemented and press-fit primary stem fixation cohorts. Follow-up radiographs were graded and compared using a modified Gruen system for humeral lucencies. RESULTS: Eighty-six primary shoulder replacements (34 hemiarthroplasties, 39 anatomic total shoulder arthroplasties, 13 reverse total shoulder arthroplasties) underwent revision arthroplasty with humeral stem removal between 2004 and 2017. Forty-five patients had cemented primary humeral fixation and 41 had press-fit fixation. The cemented cohort was older than the cementless cohort (66.6 vs. 61.4 years; P = .03) but otherwise demonstrated no difference in gender, body mass index, type of primary prosthesis (hemi, total, or reverse), or time between primary and revision operations. The cemented and cementless cohorts showed similar rates of humeral osteotomy (28.9% vs. 29.3%; P = .97), operative time (133.5 vs. 121.3 minutes; P = .16), and 90-day complication rates (13.3% vs. 9.8%; P = .61). Cemented vs. press-fit primary stems also had similar rates of humeral lucencies seen on follow-up radiographs after revision (77.1% vs. 60.6%; P = .14). CONCLUSION: Humeral stem fixation with or without cement during primary shoulder arthroplasty demonstrated similar operative time, need for intraoperative humeral osteotomy, and postoperative complication rates in the setting of revision arthroplasty.