Superior load-to-failure in an all-suture anchor system for all-inside meniscal repair compared to a PEEK-cage anchor system in an experimental cadaveric test setting.

Purpose: The purpose of this study was to compare the biomechanical properties of a latest generation all-suture anchor repair device (ASARD) for meniscal repair with that of a latest generation PEEK-cage anchor repair device (PCARD) in an experimental setting using cadaveric menisci. Methods: Twenty-six menisci were obtained from the knees of fresh body donors. Artificially created meniscal lesions were treated randomly, using a single stitch with either an ASARD or a PCARD. Cyclic biomechanical testing, utilising a universal material testing machine and following an established protocol, was carried out and load-to-failure (LTF), displacement, stiffness, and mode-of-failure (MOF) reported. Results: Mean LTF was found to be 61% higher in the ASARD group at 107.10 N (standard deviation [SD], 42.34), compared to 65.86 N (SD, 27.42) in the PCARD group with statistical significance (p = 0.022). The ASARD exhibited a trend towards higher stiffness (10.35 N; SD, 3.92 versus 7.78 N; SD; 3.59) and higher displacement at cycles one, 100, and 499 (1.64, 3.27, and 4.17 mm versus 0.93, 2.19, and 2.83 mm) compared to the PCARD. Cheese wiring was the most common mode-of-failure in both groups (76.9%). Conclusions: This study demonstrates that an ASARD shows a higher mean LTF than a PCARD when compared in an experimental biomechanical setting. Level of evidence: Level III.

The accuracy of preoperative implant size prediction achieved by digital templating in total knee arthroplasty is not affected by the quality of lateral knee radiographs.

Background: Digital templating software can be used for preoperative implant size prediction in total knee arthroplasty (TKA). However, the accuracy of its prediction is reported to be low, and the impact of radiograph quality is unclear. Purpose: To investigate on the application of lateral knee radiograph quality criteria for knee rotation (KR) and knee abduction/adduction (KA) and their impact on the accuracy of final implant size prediction achieved by preoperative digital templating for TKA. Methods: A total of 191 radiographs of patients undergoing TKA were allocated into four groups according to their KR as measured at the posterior femoral condyles and their KA as measured at the distal femoral condyles on lateral knee radiographs: group A (KR ≤ 5 mm, KA ≤ 5 mm), B1 (KR > 5 mm, KA ≤ 5 mm), B2 (KR ≤ 5 mm, KA > 5 mm) and B3 (KR > 5 mm, KA > 5 mm). Preoperative templating of femoral and tibial implant size using digital templating software was carried out by two observers. Correlation coefficients (CCs) between planned and final implant size, percentage of cases with planned to final size match as well as percentage of cases within ±1 and ±2 of planned to final size were reported according to groups. Results: Group A showed the highest percentage of cases with matching planned to final femoral implant size (45%) and the highest percentage of cases with ±1 planned to final implant size (86%) as compared to B1 (match 28%, ±1 84%), B2 (match 41%, ±1 84%) and B3 (match 35%, ±1 78%). CCs for planned to final implant size were reported at >0.75 in all groups. No statistically significant difference in the CCs of planned to final implant size amongst groups was found. Conclusion: The accuracy of implant size prediction achieved by preoperative digital templating for TKA is neither affected by KR nor KA on lateral knee radiographs. Level of evidence: Level III.

Complications and Outcomes of Surgically Treated Pediatric Supracondylar Humerus Fractures.

This study describes the outcome of supracondylar humerus fractures in children using crossed K-wires after closed or open reduction with the medial, lateral or bilateral approach. Patients treated between January 2000 and December 2019 were classified according to the Von Laer classification, complications were classified according to the Sink classification and clinical outcomes were classified according to modified Flynn criteria. In total, 364 patients with a mean age of 5.23 ± 2.45 years were included. The majority were type IV fractures (156; 42.9%) and 94 (60.3%) needed an open reduction for which the medial approach (53; 56.4%) was predominantly used. Overall, of 50 complications (31 using closed reduction, 19 open reduction), 17/50 (34%) needed revision surgery. An excellent clinical outcome was achieved in 348/364 (95.6%) patients. The approach used for open reduction as such had no influence on the complication rate or clinical outcome. For severely displaced fractures, the data showed that an open approach for crossed K-wires tended to result in fewer complications and better clinical outcomes than a closed reduction. If an open reduction is indicated, the required approach (medial, lateral or bilateral) should be primarily selected according to the requirements of the fracture pattern and eventual cosmetic considerations.

Accurate surgical posterior tibial slope alteration can be achieved in total knee arthroplasty regardless of surgeon skill level or local soft tissue thickness-A retrospective radiograph-based study.

PURPOSE: To retrospectively report on the impact of local soft tissue thickness and surgeon skill level on the accuracy of surgical posterior tibial slope (PTS) alteration achieved in patients undergoing total knee arthroplasty (TKA) utilising lateral knee radiographs. METHODS: Pre- and postoperative radiographs of 82 patients undergoing primary TKA using conventional mechanical alignment technique were measured by two observers and subjected to quality criteria for accurate measurement of the PTS. All patients underwent a standardised surgical approach for PTS alteration: cruciate-retaining (CR) cases with preoperative PTS ≤ 10° were set for reconstruction of the preoperative PTS. Cases indicated for posterior-stabilised (PS) design and/or with a preoperative PTS > 10° were set for 3° of postoperative PTS. Pretibial subcutaneous fat (PSF) and surgeon skill level were analysed for their predictive quality regarding the accuracy of surgical PTS alteration achieved. RESULTS: The overall mean postoperative PTS was significantly lower than the preoperative values (6.2°, SD 2.7 vs. 7.7°, SD 3.2; p = 0.002103). Neither local soft tissue thickness, namely PSF, nor surgeon skill level was found to be a predictor of the accuracy of surgical PTS alteration achieved. Among cases set for PTS reconstruction, 25.9% and 42.6% achieved a postoperative PTS within ±1° and ±2° of preoperative values, respectively. In patients with a PTS > 10° or those indicated for PS design, slope reduction was achieved with a mean postoperative PTS of 6.5°. Furthermore, 14.3% and 32.1% of cases were within ±1° and ±2° of 3, respectively. CONCLUSION: This study demonstrates that accurate surgical alteration of the PTS is possible in TKA regardless of local knee soft tissue thickness or surgeon skill level. This proves the clinical feasibility of both targeted reduction as well as reconstruction of the PTS in TKA. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Surgical site infection after trochanteric and subtrochanteric fractures: a single centre retrospective analysis.

Surgical site infection (SSI) following osteosynthesis of trochanteric or subtrochanteric fractures is a rare but serious complication with incidence rate ranging from 1 to 3%. SSIs are associated with higher mortality and increased length of hospital stay resulting in higher healthcare costs and loss of life quality. In this retrospective analysis all patients with SSI following osteosynthesis of trochanteric or subtrochanteric fractures at the Department of Trauma Surgery were identified. We included all surgical procedures performed from 1992 to 2018, using data from electronic health records and SSI-Trauma-Registry. The aim was to describe epidemiological data, as well as to identify parameters correlating with the occurrence of SSI and mortality. Of 2753 patients, 53 (1.9%) developed SSI. Longer operative time was demonstrated among patients with SSI (P = 0.008). Mortality during the first postoperative year was significantly higher in the SSI group (32.1% vs. 19.1%; P = 0.018), with detection of methicillin-sensitive (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA; HR 4.13, CI 95% 1.24-13.80; P = 0.021) or Enterococcus spp. (HR 5.58, CI 95% 1.67-18.65; P = 0.005) being independent risk factors. Male sex (HR 2.25, 95% CI 1.86-2.73; P < 0.001) and higher mean age (HR 1.05, 95% CI 1.04-1.06; P < 0.001) were found to be predictors for 1-year mortality in non-infected patients. SSI rate was low with 1.9% and longer duration of surgery was associated with infection. Patients with SSI had a higher 1-year mortality, with detection of MSSA, MRSA and enterococci significantly increasing the risk of dying. Male sex and higher age were risk factors for one-year mortality in patients without SSI.

Microbial spectrum, patient-specific factors, and diagnostics in implant-related postoperative spondylodiscitis.

Aims: Implant-related postoperative spondylodiscitis (IPOS) is a severe complication in spine surgery and is associated with high morbidity and mortality. With growing knowledge in the field of periprosthetic joint infection (PJI), equivalent investigations towards the management of implant-related infections of the spine are indispensable. To our knowledge, this study provides the largest description of cases of IPOS to date. Methods: Patients treated for IPOS from January 2006 to December 2020 were included. Patient demographics, parameters upon admission and discharge, radiological imaging, and microbiological results were retrieved from medical records. CT and MRI were analyzed for epidural, paravertebral, and intervertebral abscess formation, vertebral destruction, and endplate involvement. Pathogens were identified by CT-guided or intraoperative biopsy, intraoperative tissue sampling, or implant sonication. Results: A total of 32 cases of IPOS with a mean patient age of 68.7 years (37.6 to 84.1) were included. Diabetes, age > 60 years, and history of infection were identified as risk factors. Patient presentation upon admission included a mean body temperature of 36.7°C (36.1 to 38.0), back pain at rest (mean visual analogue scale (VAS) mean 5/10) and when mobile (mean VAS 6/10), as well as elevated levels of CRP (mean 76.8 mg/l (0.4 to 202.9)) and white blood cell count (mean 9.2 units/nl (2.6 to 32.8)). Pathogens were identified by CT-guided or conventional biopsy, intraoperative tissue sampling, or sonication, and Gram-positive cocci presented as the most common among them. Antibiotic therapy was established in all cases with pathogen-specific treatment in 23 (71.9%) subjects. Overall 27 (84.4%) patients received treatment by debridement, decompression, and fusion of the affected segment. Conclusion: Cases of IPOS are rare and share similarities with spontaneous spondylodiscitis. While procedures such as CT-guided biopsy and sonication are valuable tools in the diagnosis of IPOS, MRI and intraoperative tissue sampling remain the gold standard. Research on known principles of PJI such as implant retention versus implant exchange need to be expanded to the field of spine surgery.

Consistently High Frequency of Scooter Injuries in Children-Retrospective Data Analysis in a Level I Trauma Centre.

The aim of this retrospective study was to present an epidemiological overview of paediatric nonelectric-scooter-related injuries, focusing on changes in injury mechanism and frequency. A retrospective, descriptive data analysis at a Level I trauma centre, including patients aged from 0 to 18 years injured by riding nonelectric scooters, was performed. The observation period ranged from January 2015 to December 2022. The total study population consisted of 983 (mean age: 7.9 ± 4.0 years) children and adolescents, with most patients being male (800/983; 81.4%). The frequency of nonelectric scooter injuries was relatively consistent over the observation period. Patients sustained mostly minor injuries (lacerations, bone contusions, sprains) (527/983; 53.6%), followed by head injuries (238/983; 24.5%), limb fractures (166/983; 16.9%) and trunk injuries (52/983; 5.3%). However, a few patients sustained severe injuries, including skull fractures (7/238; 2.9%), intracranial haematoma (4/238; 1.7%) or lacerations of abdominal organs (4/52; 7.7%). This study presented a consistently high frequency of scooter injuries in children. Children under 15 years were the most affected by scooter-related injuries. Although most injuries were minor, serious injuries occurred that should not be underestimated. Hence, we emphasise the use of protection gear and recommend raising awareness among parents and children.

Functional outcome of an 'all-inside' technique in female anterior cruciate ligament reconstruction at long-term follow-up: A gender-sensitive analysis.

BACKGROUND: As the awareness towards gender-specific therapies continues to increase among all fields of medicine, so does the need for gender-sensitive evaluations of established surgical techniques. With a higher likelihood of anterior cruciate ligament injury in women, a critical assessment of the functional outcome of anterior cruciate ligament reconstruction regarding patient sex is indispensable. Almost all pre-existing literature on this subject is based on anterior cruciate ligament reconstructions carried out before 2008, when 'all-inside' techniques did not exist. This implicates the need to investigate this technique towards its differences in outcome between male and female patients. OBJECTIVES: The purpose of this study was to determine whether there is a difference concerning the functional outcome of an 'all-inside' technique for anterior cruciate ligament reconstruction in female patients when compared to a cohort of male patients matched for body mass index and age. DESIGN: Retrospective analysis. METHODS: All female patients who underwent anterior cruciate ligament reconstruction using an all-inside technique between 2011 and 2012 were examined for inclusion. Functional outcome parameters investigated included the Lysholm Knee Score, International Knee Documentation Committee score, Visual Analogue Scale score and the Tegner Activity Scale. All parameters were documented before surgery and at 3-, 6-, 12- and >24 months follow-up. At 24-month follow-up, anterior-posterior knee laxity was tested using the KT-2000 arthrometer device. For comparison, an equivalent group of male patients who underwent the same procedure was matched. RESULTS: 27 female patients were matched with 27 male patients. The average age was 29 years, and a mean follow-up of 90 months could be achieved with 27 of patients reaching a follow-up of > 10 years. The evaluated scores showed no significant difference between female and male patients. Women presented with poorer functional outcome at 3- as well as 6-month follow-ups compared to men, without reaching statistical significance. After 12 months, no further differences could be found. CONCLUSION: This study proved that an all-inside technique for anterior cruciate ligament reconstruction is able to produce the same functional outcome in female as in male patients at long-term follow-up. The results on short-term outcome indicate the need for further research towards gender-specific differences after anterior cruciate ligament reconstruction, their potential causes and potential of improvement. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Radiographic Outcomes of Conservative and Operative Treatment in Isolated L1 Fractures.

Background and Objectives: The adequate therapy of thoracolumbar fractures in the elderly population is still controversially discussed. The aim of this study was to evaluate and compare the results of conservatively and surgically treated younger (≤60a) and elderly patients (>60a) with fractures of L1. Materials and Methods: Patients (231) with isolated L1 fractures were included and treated at the University Clinic of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, during the observation period of 2012-2018. Results: Conservative treatment led to a significant increase in the vertebral and bi-segmental kyphosis angle in both age groups (young vertebral: p = 0.007; young bi-segmental: p = 0.044; old vertebral: p = 0.0001; old bis-segmental: p = 0.0001). A significant reduction in the vertebral angle in both age groups was achieved after operative treatment (young: p = 0.003, old: p = 0.007). The bi-segmental angle did not significantly improve after surgery in both age groups (≤60a: p = 0.07; >60a: p = 1.0). Conclusions: The study shows that conservative treatment does not seem to be sufficient for a correction of radiological parameters in young and elderly patients. In contrast, operative treatment led to a significant improvement of the vertebral kyphosis angle, without changing the bi-segmental kyphosis angle. These results suggest a greater benefit from operative treatment in patients ≤ 60a than in older patients.

Correlation of Fall Height, Fracture Severity and Clinical Outcome in Pediatric Supracondylar Fractures-A Retrospective Analysis with an Observation Period of 20 Years.

The most common cause leading to supracondylar humerus fractures in children is falling onto an outstretched arm. A correlation between fall height and fracture severity may be assumed but has not yet been described. The aim of this study was to show that fracture severity increases with fall height. Furthermore, the correlation between fracture severity and outcome was examined. A total of 971 children with supracondylar humerus fractures between January 2000 and December 2019 were included in this study. The correlations between fall height and fracture severity and between fracture severity and outcome were assessed. Increasing fall height correlates with fracture severity (p < 0.001; r = 0.24). Furthermore, the incidence of complications increases with fracture severity and a correlation was present accordingly (p < 0.001; r = 0.28). A total of 30 (3.1%) patients showed limitations in range of motion and/or persistent neurologic deficits at the latest follow-up. Type I fractures rarely lead to subsequent limitations. The correlation between increasing fall height and fracture severity was significant. Furthermore, children with type III and IV supracondylar fractures are more likely to develop complications or restrictions in movement than children with type I and II fractures. Hence, the initial fall height may be an indirect indicator of a more or less favorable outcome.

Functional Outcome of All-Soft-Tissue Quadriceps Tendon Autograft in ACL Reconstruction in Young and Athletic Patients at a Minimum Follow-Up of 1 Year.

To investigate the functional outcome in young and athletic patients with ACL injuries, treated with an all-soft-tissue quadriceps tendon autograft at a minimum follow-up of 12 months. Methods: Patients who received a QT autograft ACL reconstruction between August 2018 and December 2020 were included in this study. Range of motion in the operated knee was described at 6 and 18 weeks after surgery and the functional outcome parameters (Lysholm score, IKDC score and Tegner activity scale) were calculated at 6 and ≥ 12 months after surgery. Results: Forty patients were included in this study, of which 29 identified as male and 11 as female. The average age was 31.3 years (range 16 to 57 years) and the mean follow-up time was 16.8 months (range 12 to 30 months). All functional outcome scores showed improvement over the course of the follow-up: Lysholm score 94.2 to 95.5 (n.s.), IKDC score 90.1 to 93.9 (n.s.), Tegner activity scale 3.7 to 5.0 (p > 0.001), all at six months and ≥12 months. No reruptures happened during the time of the follow-up. Conclusions: This study shows that the all-soft-tissue quadriceps tendon autograft technique can improve functional outcome in young and athletic patients with an ACL injury at short to intermediate follow-up.