Demographic Factors Associated With an Increased Incidence of Intra-articular Injuries After Delayed Anterior Cruciate Ligament Reconstruction.

Background: Delays from the time of an anterior cruciate ligament (ACL) tear to surgical reconstruction are associated with an increased incidence of meniscal and chondral injuries. Purpose: To evaluate the association between delays in ACL reconstruction (ACLR) and risk factors for intra-articular injuries across 8 patient demographic subsets. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We performed a retrospective chart review of all patients who underwent ACLR from January 2009 to May 2015 at a single institution. Variables collected were age, sex, body mass index, time from injury to surgery, and presence of meniscal tears and chondral injuries. Demographic subsets were created according to sex, age (<27 vs ≥27 years), body mass index (<25 vs ≥25 kg/m2), and injury setting (sports vs non-sports related). Subsets were divided by time from injury to ACLR: 0 to <6 months (control group), 6 to <12 months, and ≥12 months. Multivariate logistic regression-generated odds ratios (ORs) were calculated. Results: Overall, 410 patients were included. ORs were significant for an increased incidence of medial meniscal tears (MMTs) (OR, 1.12-3.72; P = .02), medial femoral condyle (MFC) injuries (OR, 1.18-4.81; P = .02), and medial tibial plateau (MTP) injuries (OR, 1.33-31.07; P = .02) with surgical delays of 6 to <12 months. With ≥12-month delays, significance was found for MMTs (OR, 2.92-8.64; P < .001), MFC injuries (OR, 1.86-5.88; P < .001), MTP injuries (OR, 1.37-21.22; P = .02), lateral femoral condyle injuries (OR, 2.41-14.94; P < .001), and lateral tibial plateau injuries (OR, 1.15-5.27; P = .02). In the subset analysis, differences in the timing, location, rate, and pattern of chondral and meniscal injuries became evident. Female patients and patients with non-sports-related ACL tears had less risk of associated injuries with delayed surgery, while other demographic groups showed an increased injury risk. Conclusion: When analyzing patients who were symptomatic enough to eventually require surgery, an increased incidence of MMTs and medial chondral injuries was associated with ≥6-month delays in ACLR, and an increased incidence of lateral chondral injuries was associated with ≥12-month delays. Female patients and patients with non-sports-related ACL tears had less risk of injuries with delayed ACLR.

Outcomes of reverse shoulder arthroplasty following failed superior capsular reconstruction.

BACKGROUND: Superior capsular reconstruction (SCR) can be used for massive irreparable rotator cuff tears in the absence of significant degenerative changes; however, those who fail an SCR may require reverse shoulder arthroplasty (RSA). The effect of a previously performed SCR on outcomes following RSA remains unknown. METHODS: Subjects who underwent RSA from May 2015 to January 2021 at 2 separate institutions were retrospectively identified through prospectively collected databases. Patients who underwent RSA after failed SCR were matched to those who underwent RSA after failed rotator cuff repair (RCR) based on the number of previous ipsilateral shoulder procedures (n = 1, 2, ≥3) and secondarily by age within 5 years. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and Western Ontario Osteoarthritis of the Shoulder index (WOOS) scores were compared between groups. The minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) thresholds were calculated to determine clinically relevant differences between groups. RESULTS: Forty-five patients were included (32 RSA following RCR, 13 following SCR). There were more smokers (P = .001) and worker's compensation cases (P = .034) in the SCR group. The RCR cohort was older (P = .007) and had a greater incidence of mental health (P > .999) and somatic disorders (P = .698), although these did not reach statistical significance. The mean follow-up for the RCR and SCR groups were 24.2 ± 23.3 and 20.4 ± 14.9 months following RSA, respectively (P = .913). The time from index RCR or SCR to RSA were 94.4 ± 22.2 and 89.2 ± 5.3 months, respectively (P = .003). Pre- and postoperative range of motion were similar between groups, as was the overall change in forward flexion (P = .879), abduction (P = .971), and external rotation (P = .968) following RSA. The RCR group had lower postoperative VAS pain (P = .009), higher SANE (P = .015), higher ASES (P = .008), and higher WOOS (P = .018) scores. The percentage achieving the MCID (P = .676) and SCB (P > .999) were similar; however, 56.7% of the RCR group met the SANE PASS threshold compared with 0.0% in the SCR group (P = .005). There were no differences in postoperative complications (P = .698) or revision rates (P = .308) following RSA between cohorts. CONCLUSION: When matched for number of previous procedures to the ipsilateral extremity and age, patients who underwent RSA following failed SCR had worse clinical outcome scores than their RSA following failed RCR counterparts. No patient in the SCR group met the SANE PASS threshold, whereas more than half of the RCR group did.

Radiographic Appearance of Cosmetic Gluteal Injections in a Patient With Proximal Hamstring Tear: A Case Report.

CASE: A 45-year-old woman presented 6 months after a right proximal hamstring repair with worsening pain over her surgical site. Anterior-posterior pelvis x-rays revealed bilateral soft-tissue densities around the hips. Extensive workup revealed no medical basis for the radiographic appearance. It was discovered that the patient's cosmetic gluteal injections were, in fact, the cause. Follow-up x-rays revealed near-complete resolution of the densities 8 months later. CONCLUSIONS: We present this case to highlight the need to consider cosmetic injections as a potential cause of abnormal radiographic soft-tissue densities in the absence of other clear medical explanations in patients who present with musculoskeletal complaints.

Discoid Lateral Meniscus Saucerization and Treatment of Intrasubstance Degeneration Through an Accessory Medial Portal Using a Small Arthroscope.

Discoid lateral meniscus (DLM) is a rare meniscal variant characterized by an increased amount of meniscal tissue that resembles the shape of a disc as opposed to the typical crescent shape of the lateral meniscus. Surgical intervention is recommended for symptomatic DLM with persistent pain, mechanical symptoms, or motion impairment. The technique described is a reliable and reproducible method to identify and treat intrasubstance degeneration (ID) in the setting of DLM. A small arthroscope is used that allows more room for a meniscal repair device, as well as improved visualization and access of the lateral compartment. An accessory medial portal is used that allows perpendicular access to the anterior half of the body, as well as the posterior aspect of the anterior horn for repair. Successful surgery with this technique preserves meniscus and produces a strong reliable all-meniscal based repair of ID that allows early weight bearing and range of motion postoperatively.

Ulna Fractures After Elbow Arthrodesis: A Report of 3 Cases.

CASE: Two surgeons performed 3 elbow arthrodesis at 90° elbow flexion secured with a plate and screws. All 3 patients experienced fracture at the most distal aspect of the posterior plate, consistent with a stress riser in this location. CONCLUSION: The risk of fracture is likely related to vulnerability of the arm with no elbow flexion and may not be ameliorated by changes in operative technique or bone quality. Ulna fracture can be anticipated after elbow arthrodesis and might further limit enthusiasm for elbow arthrodesis.

Mechanical Considerations for Electrospun Nanofibers in Tendon and Ligament Repair.

Electrospun nanofibers possess unique qualities such as nanodiameter, high surface area to volume ratio, biomimetic architecture, and tunable chemical and electrical properties. Numerous studies have demonstrated the potential of nanofibrous architecture to direct cell morphology, migration, and more complex biological processes such as differentiation and extracellular matrix (ECM) deposition through topographical guidance cues. These advantages have created great interest in electrospun fibers for biomedical applications, including tendon and ligament repair. Electrospun nanofibers, despite their nanoscale size, generally exhibit poor mechanical properties compared to larger conventionally manufactured polymer fiber materials. This invites the question of what role electrospun polymer nanofibers can play in tendon and ligament repair applications that have both biological and mechanical requirements. At first glance, the strength and stiffness of electrospun nanofiber grafts appear to be too low to fill the rigorous loading conditions of these tissues. However, there are a number of strategies to enhance and tune the mechanical properties of electrospun nanofiber grafts. As researchers design the next-generation electrospun tendon and ligament grafts, it is critical to consider numerous physiologically relevant mechanical criteria and to evaluate graft mechanical performance in conditions and loading environments that reflect in vivo conditions and surgical fixation methods.

Evidence of Altered Mitochondrial Protein Expression After Chronic Ethanol Consumption in the Aged Estrogen-Deficient Female Rat Heart.

BACKGROUND: Estrogen loss has been implicated to increase the risk of alcoholic cardiomyopathy in postmenopausal women. The purpose of this study was to identify novel mitochondrial protein targets for the treatment of alcoholic cardiomyopathy in aged women using a state-of-the-art proteomic approach. We hypothesized that chronic ethanol (EtOH) ingestion exacerbates maladaptive mitochondrial protein expression in the aged female heart. METHODS: Adult (3 months) and aged (18 months) F344 ovary-intact or ovariectomized (OVX) rats were randomly assigned an EtOH or control Lieber-DeCarli "all-liquid" diet for 20 weeks. Proteomic analyses were conducted in mitochondria isolated from left ventricles using isobaric tags for relative and absolute quantification (iTRAQ) 8plex labeling and mass spectrometry (n = 3 to 5/group). RESULTS: After EtOH, significant differences (false discovery rate <5%) were observed in electron transport chain components (NADH dehydrogenase [ubiquinone] flavoprotein 2) as well as proteins involved in lipid metabolism (2,4 dienoyl-CoA reductase) and cellular defense (catalase), suggesting a possible link to congestive heart failure. Directional changes in protein levels were confirmed by Western blotting. Additionally, EtOH significantly reduced state 3 mitochondrial respiration in all groups, yet only reduced respiratory control index in the aged OVX rat heart (p < 0.05). CONCLUSIONS: Collectively, the data reveal that EtOH-induced changes in the mitochondrial proteome exacerbate cardiac dysfunction in aged and estrogen-deficient hearts, but not in adult. In conclusion, iTRAQ is a powerful tool for investigating new mitochondrial targets of alcoholic cardiomyopathy.

Comparison of the agar block and Lieber-DeCarli diets to study chronic alcohol consumption in an aging model of Fischer 344 female rats.

INTRODUCTION: Post-menopausal women have a greater risk of developing alcoholic complications compared to age-matched men. Unfortunately, animal models of chronic ethanol consumption with estrogen deficiency are lacking. Here, we characterize the ability of the agar block and Lieber-DeCarli models of chronic ethanol consumption to produce elevated blood alcohol content (BAC) and liver pathology in the F344 postmenopausal animal model of aging. METHODS: Adult (3 mo) and aged (18 mo) F344 ovary-intact or ovariectomized rats were administered ethanol for 14-20 weeks as follows: diet 1, standard chow access, 10% ethanol in drinking water, and 40% ethanol in agar blocks; diet 2, diet 1 plus low phytoestrogen chow (known to affect ethanol metabolism) for the final 4 weeks; diet 3, Lieber-DeCarli all liquid diet with 36% kcal ethanol. Control animals were matched isocalorically with dextrin. RESULTS: For the agar block diet, average BAC was 13±4 mg/dL across groups. BAC was unaffected by reducing dietary phytoestrogen content (12±4 mg/dL), which is known to interfere with ethanol metabolism. Liver pathology was unaffected by the agar block diet. In contrast, the Lieber-DeCarli diet resulted in BAC of 45±5 mg/dL in conjunction with more severe hepatopathology.223 DISCUSSION: We conclude that the Lieber-DeCarli diet produces greater BAC and hepatopathology to study the effects of chronic ethanol administration in the F344 postmenopausal rodent model of aging when compared to an ethanol agar block diet.