Arthroscopic Lysis of Adhesions for Arthrofibrosis After Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Arthrofibrosis (AF) after anterior cruciate ligament reconstruction (ACLR) remains a challenge. There is a paucity of data on arthroscopic interventions for AF after ACLR. PURPOSE: To (1) describe the patient, injury, and surgical characteristics and patient-reported outcomes (PROs) of those requiring an arthroscopic intervention for loss of motion after ACLR and (2) compare outcomes between patients undergoing an early intervention (within 3 months) versus those undergoing a late intervention (after 3 months). STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patients with a history of ACLR and a subsequent operative procedure for postoperative AF at a single institution between 2000 and 2018 were retrospectively identified. Arthroscopic interventions included lysis of adhesions, capsular release with or without manipulation under anesthesia, and excision of cyclops lesions. Patients were excluded if they had a knee dislocation or multiple-ligament injury, a periarticular fracture, or less than 2-year follow-up from the arthroscopic intervention. PROs including the Tegner activity score, visual analog scale pain score, and International Knee Documentation Committee score as well as knee range of motion (ROM) were recorded. RESULTS: A total of 40 patients were included with a mean age of 27.2 years (range, 11.0-63.8 years) at surgery and a mean follow-up of 10.0 years (range, 2.9-20.7 years). The mean preoperative flexion and extension were 102° (range, 40°-150°) and 8° (range, 0°-25°), respectively. The mean postoperative flexion and extension were 131° (range, 110° to 150°) and 0° (range, -10° to 5°), respectively. After the arthroscopic intervention, the mean ROM improved from 94° (range, 40°-140°) preoperatively to 131° (range, 107°-152°) at final follow-up (P < .001), and the visual analog scale pain score improved from 3.0 preoperatively to 1.2 postoperatively (P = .001). Overall, 13 patients (32.5%) underwent an intervention within 3 months and 27 (67.5%) after 3 months. The early intervention group had a higher postoperative International Knee Documentation Committee score compared with the late intervention group (86.8 vs 71.7, respectively; P = .035). CONCLUSION: An arthroscopic intervention for AF after ACLR successfully improved knee ROM and pain. Patients who underwent either early or late surgery obtained satisfactory motion and function, although improved PROs were observed when the intervention occurred within 3 months of the primary procedure.

Reverse shoulder arthroplasty using an onlay humeral prosthesis, offset humeral tray, and augmented glenoid baseplate: surgical technique and review of the impact of prosthesis design on scapular fractures following reverse shoulder arthroplasty.

Reverse total shoulder arthroplasty (RSA) has become the most utilized form of arthroplasty of the shoulder. Acromial stress fractures and scapular spine stress fractures are rare, yet well-recognized complications of RSA with ongoing studies identifying whether patient factors or prosthetic designs serve as risk factors. Specifically, it remains unclear if or how the position of the humeral tray (inlay or onlay) in RSA affects rates of periscapular fractures. The purpose of this article is to describe our technique for RSA using an onlay prosthesis, a variable-offset humeral tray, and an augmented glenoid baseplate, as well as to review the published results of acromial and scapular spine fractures after RSA based on humeral implant design.

Comparing the Efficacy of Kneeling Stress Radiographs and Weighted Gravity Stress Radiographs to Assess Posterior Cruciate Ligament Insufficiency.

BACKGROUND: Kneeling posterior cruciate ligament (PCL) stress radiographs are commonly used to evaluate PCL laxity. Patients, however, report significant pain, and the method's reproducibility may be challenged due to its dependence on patient body weight distribution to produce posterior tibial displacement. Weighted gravity stress radiography may offer better reproducibility and comfort than the kneeling technique, but its efficacy has not been studied. HYPOTHESIS: Weighted gravity PCL stress radiographs will be more comfortable and produce similar measurements of side-to-side difference in posterior tibial displacement when compared with the kneeling technique. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: A total of 40 patients with nonoperatively or >6 months postoperatively treated PCL injuries (isolated or multiligamentous) underwent bilateral stress radiographs. Weighted gravity and kneeling stress radiographs were acquired, in random order, for each patient, as well as side-to-side difference in posterior tibial displacement between each knee, patient-reported visual analog scale knee pain (100 mm), time to acquire the images, and patient preference for technique. Paired t tests were used to compare the side-to-side difference, pain score, and time to complete the radiographs. RESULTS: There was no difference between the 2 radiographic methods in the mean side-to-side difference (gravity: 6.45 ± 4.61 mm, kneeling: 6.82 ± 4.60 mm; P = .72), time required to acquire radiographs (kneeling: 307.3 ± 140.5 seconds, gravity: 318.7 ± 151.1 seconds; P = .073), or number of radiographs taken to obtain acceptable images (kneeling: 3.6 ± 1.6, gravity: 3.7 ± 1.7; P = .73). Patients reported significantly less knee pain during the weighted gravity views (kneeling: 31.8 ± 26.6, gravity: 4.0 ± 12.0; P < .0001). Of the patients, 88% preferred the weighted gravity method. CONCLUSION: Weighted gravity stress radiographs produce similar side-to-side differences in posterior tibial translation compared with the kneeling stress technique, but do not rely on patient weightbearing and provide significantly better patient comfort. Clinicians should therefore consider the use of weighted gravity stress radiographs in clinical practice to minimize the pain associated with stress radiography while allowing for accurate decision making.

Relationship between Anatomical Risk Factors, Articular Cartilage Lesions, and Patient Outcomes Following Medial Patellofemoral Ligament Reconstruction.

OBJECTIVE: The purpose of this study was (1) to determine which risk factors for patellar instability were associated with the presence of patellofemoral cartilage lesions and (2) to determine how cartilage lesion presence, size, and grade affect postoperative disease-specific quality of life. DESIGN: Preoperative, intraoperative, and postoperative demographic, anthropometric (body mass index, Beighton score, hip rotation), radiographic (crossover sign, trochlear bump), cartilage lesion morphology (presence, size, location, grade), and outcomes data (Banff Patella Instability Instrument 2.0 [BPII 2.0]) were prospectively collected from patients undergoing isolated medial patellofemoral ligament reconstruction. For all knees (n = 264), single and multivariable logistic regression was used to determine if any patellar instability risk factors affected the odds of having a cartilage lesion. In patients with unilateral symptoms (n = 121), single variable linear regression was used to determine if the presence, size, or ICRS (International Cartilage Regeneration & Joint Preservation Society) grade of cartilage lesions could predict the 12 or 24+ month postoperative BPII 2.0 score. RESULTS: A total of 84.5% of knees had patellofemoral cartilage lesions (88.3% involved the distal-medial patella). Trochlear dysplasia (high grade: odds ratio = 15.7, P < 0.001; low grade: odds ratio = 2.9, P = 0.015) was associated with the presence of a cartilage lesion. The presence, size, and grade of cartilage lesions were not associated with 12 or 24+ month postoperative BPII 2.0 scores. CONCLUSIONS: Trochlear dysplasia was a risk factor for the development of patellofemoral cartilage lesions in this patient population. Cartilage lesions most commonly involve the distal-medial patella. There was no significant relationship between patellofemoral cartilage lesion presence, size, or grade and postoperative BPII 2.0 scores in short-term follow-up.

New onset alcohol use disorder following bariatric surgery.

BACKGROUND: Bariatric surgery is the most effective treatment for morbid obesity; however, there may be significant unanticipated psychosocial effects following surgery. Prior studies have identified a threefold increase in the incidence of alcohol use disorder (AUD) after Roux-en-Y gastric bypass (RYGB). With sleeve gastrectomy (SG) now comprising over 50% of primary bariatric operations, the degree to which patients who undergo SG develop AUD remains unknown. We sought to characterize the patients and incidence of AUD following SG compared to RYGB. METHODS: This study used prospectively collected data from a state-wide quality collaborative. The presence of AUD was determined using the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C), with a score ≥ 4 in men and ≥ 3 in women suggestive of AUD. We used bivariate Chi-square tests for categorical variables and independent samples t tests for continuous variables. We used multivariable logistic regression to identify patient characteristics that may predispose patients to development of AUD at 1 and 2 years after surgery. RESULTS: The overall prevalence of AUD in our population (n = 5724) was 9.6% preoperatively, 8.5% at 1 year postoperatively, and 14.0% at 2 years postoperatively. The preoperative, 1-year, and 2-year prevalence of AUD for SG were 10.1%, 9.0%, and 14.4%, respectively. The preoperative, 1-year, and 2-year postoperative prevalence of AUD for RYGB were 7.6%, 6.3%, and 11.9%, respectively. Predisposing patient factors to AUD development included higher educational level (p < 0.01) and higher household income (p < 0.01). CONCLUSIONS: This is first large, multi-institutional study of AUD following SG. The prevalence of alcohol use disorder in patients undergoing SG and RYGB was similar pre- and postoperatively. The majority of patients developed AUD following their second postoperative year. Understanding the timing and incidence of alcohol use disorder in patients undergoing SG-the most commonly performed bariatric operation in the United States-is critical to providing appropriate counseling and treatment.

Thermal biology of Pacific cicada killers, Sphecius convallis Patton, in the Upper Sonoran Desert.

A comprehensive investigation of the Pacific cicada killer, Sphecius convallis Patton, was undertaken to examine the behavioral and physiological mechanisms by which they are able to complete their life cycle in the thermal extremes of the Upper Sonoran Desert. S. convallis were endothermic, exhibiting elevated and relatively constant thorax temperatures during many activities. Males basked in trees at dawn to warm up, then used a variety of behaviors and perching strategies to maintain thorax temperature during territorial behavior. The thorax temperature of females was highest during provisioning and orientation flights, somewhat lower while investigating burrows, and lowest while digging burrows. The optimal thorax temperature for flight was about 40°C, which was approximated most closely by males resting in the shade during the afternoon. In mating clusters, the mated male was the hottest, the female was coolest and the other males were intermediate. Wasps lost about 5% of body mass during heating treatments, and may use evaporative water loss for cooling. Pacific cicada killers use a complex suite of behavioral and physiological adaptations to regulate body temperature during their nesting season.

Near-Optimal Foraging in the Pacific Cicada Killer Sphecius convallis Patton (Hymenoptera: Crabronidae).

This study evaluated foraging effectiveness of Pacific cicada killers (Sphecius convallis) by comparing observed prey loads to that predicted by an optimality model. Female S. convallis preyed exclusively on the cicada Tibicen parallelus, resulting in a mean loaded flight muscle ratio (FMR) of 0.187 (N = 46). This value lies just above the marginal level, and only seven wasps (15%) were below 0.179. The low standard error (0.002) suggests that S. convallis is the most ideal flying predator so far examined in this respect. Preying on a single species may have allowed stabilizing selection to adjust the morphology of females to a nearly ideal size. That the loaded FMR is slightly above the marginal level may provide a small safety factor for wasps that do not have optimal thorax temperatures or that have to contend with attempted prey theft. Operational FMR was directly related to wasp body mass. Smaller wasps were overloaded in spite of provisioning with smaller cicadas, while larger wasps were underloaded despite provisioning with larger cicadas. Small wasps may have abandoned larger cicadas because of difficulty with carriage.