Health-related quality of life does not deteriorate while waiting for anterior cruciate reconstruction.

PURPOSE: The aim of this study was to determine how preoperative health-related quality of life (HRQoL) is affected by the duration of the wait time (WT) for anterior cruciate ligament reconstruction (ACLR) once a decision is made to proceed with surgery. METHODS: This was a multi-centre prospective cohort study. One hundred and twenty-two patients 14 years of age and above waiting for ACLR completed the International Knee Documentation Committee (IKDC) demographic, current health assessment and subjective knee evaluation (SKF) forms on the day of decision to operate and the day of surgery. Changes in scores were analyzed for the entire cohort, adjusted for WTs and a subset was compared for patients with isolated anterior cruciate ligament (ACL) tears and ACL tears with concurrent meniscal involvement. Changes in HRQoL scores from the day of the decision to operate to the 9-month postoperative appointments were also assessed. RESULTS: Energy/Fatigue (p < 0.05), Pain (p < 0.05), General Health (p < 0.05) and the IKDC-SKF Score (p < 0.05) significantly increased between the day of the decision to operate and the day of surgery. Only the change in IKDC-SKF score remained significantly higher after adjusting for WT. Baseline HRQoL scores significantly improved by the 9-month postoperative appointment. CONCLUSION: The length of time waiting for ACLR did not adversely influence HRQoL in this study. However, low preoperative HRQoL and the significant improvement in HRQoL of patients followed postoperatively suggest that timely surgery is beneficial for this patient population. LEVEL OF EVIDENCE: Level II.

BitterMasS: Predicting Bitterness from Mass Spectra.

Bitter compounds are common in nature and among drugs. Previously, machine learning tools were developed to predict bitterness from the chemical structure. However, known structures are estimated to represent only 5-10% of the metabolome, and the rest remain unassigned or "dark". We present BitterMasS, a Random Forest classifier that was trained on 5414 experimental mass spectra of bitter and nonbitter compounds, achieving precision = 0.83 and recall = 0.90 for an internal test set. Next, the model was tested against spectra newly extracted from the literature 106 bitter and nonbitter compounds and for additional spectra measured for 26 compounds. For these external test cases, BitterMasS exhibited 67% precision and 93% recall for the first and 58% accuracy and 99% recall for the second. The spectrum-bitterness prediction strategy was more effective than the spectrum-structure-bitterness prediction strategy and covered more compounds. These encouraging results suggest that BitterMasS can be used to predict bitter compounds in the metabolome without the need for structural assignment of individual molecules. This may enable identification of bitter compounds from metabolomics analyses, for comparing potential bitterness levels obtained by different treatments of samples and for monitoring bitterness changes overtime.

Identification of Compounds That Impact Consumer Flavor Liking of American-European Hazelnut Hybrids Using Nontargeted LC/MS Analysis.

American-European (Corylus americana × Corylus avellana) hazelnut hybrids are being developed for the Midwest-growing region of the United States. However, an inadequate understanding of the compounds that impact the consumer acceptance of hazelnuts limits breeding programs. Nontargeted liquid chromatography/mass spectrometry (LC/MS) chemical profiles of 12 roasted hybrid hazelnut samples and the corresponding consumer flavor liking scores were modeled by orthogonal partial least squares with good fit and predictive ability (R2Y > 0.9, Q2 > 0.9) to identify compounds that impact nut liking. The five most predictive compounds (1-5) were negatively correlated to flavor liking, selected as putative markers, purified by multidimensional preparative LC/MS, structurally elucidated (nuclear magnetic resonance, MS), quantified, and validated for sensory relevance. Compound 1 was identified as 1″-O-3'-b-glucofuranosyl-1'-O-1-b-glucofuranosyl-(2,6-dihydroxyphenyl)-ethan-4-one. Compounds 2 and 4 were identified as rotamers of 2-(3-hydroxy-2-oxoindolin-3-yl) acetic acid 3-O-6'-galactopyranosyl-2″-(2″oxoindolin-3″yl) acetate, whereas compounds 3 and 5 were identified as rotamers of 1″-O-1'-b-glucofuranosyl-9-O-6'-b-glucopyranosyl-2″-(2″-oxoindolin-3″yl) acetate. Sensory evaluation determined that all compounds were characterized by bitterness and/or astringency. The sensory threshold values of compounds 1-5 were determined to be below the concentrations reported in 91, 83, 41, 25, and 41% of all 12 hybrid hazelnut samples, respectively, indicating they contributed to aversive flavor attributes.

Eocene (50-55 Ma) greenhouse climate recorded in nonmarine rocks of San Diego, CA, USA.

Nonmarine rocks in sea cliffs of southern California store a detailed record of weathering under tropical conditions millions of years ago, where today the climate is much drier and cooler. This work examines early Eocene (~ 50-55 million-year-old) deeply weathered paleosols (ancient, buried soils) exposed in marine terraces of northern San Diego County, California, and uses their geochemistry and mineralogy to reconstruct climate and weathering intensity during early Eocene greenhouse climates. These Eocene warm spikes have been modeled as prequels for ongoing anthropogenic global warming driven by a spike in atmospheric CO2. Paleocene-Eocene thermal maximum (PETM, ~ 55 Ma) kaolinitic paleosols developed in volcaniclastic conglomerates are evidence of intense weathering (CIA > 98) under warm and wet conditions (mean annual temperature [MAT] of ~ 17 °C ± 4.4 °C and mean annual precipitation [MAP] of ~ 1500 ± 299 mm). Geologically younger Early Eocene climatic optimum (EECO, 50 Ma) high shrink-swell (Vertisol) paleosols developed in coarse sandstones are also intensely weathered (CIA > 80) with MAT estimates of ~ 20 °C ± 4.4 °C but have lower estimated MAP (~ 1100 ± 299 mm), suggesting a less humid climate for the EECO greenhouse spike than for the earlier PETM greenhouse spike.

Anterior Cruciate Ligament Reconstruction Plus Lateral Extra-articular Tenodesis Has a Similar Return-to-Sport Rate to Anterior Cruciate Ligament Reconstruction Alone but a Lower Failure Rate.

PURPOSE: To determine whether the addition of lateral extra-articular tenodesis (LET) to anterior cruciate ligament reconstruction (ACLR) would improve return-to-sport (RTS) rates in young, active patients who play high-risk sports. METHODS: This multicenter randomized controlled trial compared standard hamstring tendon ACLR with combined ACLR and LET using a strip of the iliotibial band (modified Lemaire technique). Patients aged 25 years or younger with an anterior cruciate ligament-deficient knee were included. Patients also had to meet 2 of the following criteria: (1) pivot-shift grade 2 or greater, (2) participation in a high-risk or pivoting sport, and (3) generalized ligamentous laxity. Time to return and level of RTS were determined via administration of a questionnaire at 24 months postoperatively. RESULTS: We randomized 618 patients in this study, 553 of whom played high-risk sports preoperatively. The proportion of patients who did not RTS was similar between the ACLR (11%) and ACLR-LET (14%) groups; however, the graft rupture rate was significantly different (11.2% in ACLR group vs 4.1% in ACLR-LET group, P = .004). The most cited reason for no RTS was lack of confidence and/or fear of reinjury. A stable knee was associated with nearly 2 times greater odds of returning to a high-level high-risk sport postoperatively (odds ratio, 1.92; 95% confidence interval, 1.11-3.35; P = .02). There were no significant differences in patient-reported functional outcomes or hop test results between groups (P > .05). Patients who returned to high-risk sports had better hamstring symmetry than those who did not RTS (P = .001). CONCLUSIONS: At 24 months postoperatively, patients who underwent ACLR plus LET had a similar RTS rate to those who underwent ACLR alone. Although the subgroup analysis did not show a statistically significant increase in RTS with the addition of LET, on returning, the addition of LET kept subjects playing longer by reducing graft failure rates. LEVEL OF EVIDENCE: Level I, randomized controlled trial.

Impact of rebaudioside A degradation compounds on flavor perception.

Rebaudioside A, a sweet-tasting steviol glycoside, is known to degrade in food products during storage and thought to contribute to flavor instability. The impact of rebaudioside A degradation compounds on flavor perception was investigated. Sensory descriptive analysis indicated rebaudioside A degradation compounds, at concentrations below detection thresholds, modified the perception of taste, somatosensorial, and retronasal aroma attributes of a strawberry-flavored model beverage. Gas chromatography/mass spectrometry analysis and orthonasal sensory tetrad tests further indicated the addition of the degradation compounds did not significantly alter the volatile aroma composition or orthonasal perception, respectively. Altogether, subthreshold unimodal and cross-modal integration of multisensory percepts were supported to impact the flavor performance of rebaudioside A.

Characterization of the impact of chlorogenic acids on tactile perception in coffee through an inverse effect on mouthcoating sensation.

Coffee "body" is acknowledged by coffee industry professionals to be an attribute which contributes meaningfully to overall coffee quality and is defined as the collective tactile sensation imparted by the beverage. Currently, there is limited knowledge of the chemical compounds that contribute to tactile attributes in coffee. In the present work, coffee body was determined to be comprised of 4 sub-attributes including mouthcoating, astringency, chalkiness, and thickness and the specific constituents contributing to the tactile sensation of mouthcoating were further pursued using sensory-guided fractionation via preparative-scale liquid chromatography. Signal detection-based sensory methodologies were employed to characterize the sensory effects elicited by selected compounds in water and coffee matrices. Two chlorogenic acids, 3-O-caffeoylquinic acid (3-CQA) and 4-O-caffeoylquinic acid (4-CQA), were observed to impart subtle but significantly perceptible mouthcoating effects in water and/or coffee. Counterintuitively, sensory perception was inversely related to compound concentration. Complex receptor-ligand interactions or salivary lubrication dynamics are discussed as two potential mechanisms to explain this inverse relationship. Taken together, the outcomes of the present study (1) provide new targets for coffee tactile sensation optimization and modulation, (2) identify a novel dimension of sensory impact for two compounds of the chlorogenic acid family, and (3) present a need for deeper investigation into 3-CQA and 4-CQA mechanisms of sensation.

A History of Musculoskeletal Medicine and Its Place and Progress in Undergraduate Medical Education.

Musculoskeletal diseases are responsible for some of the most prevalent conditions affecting population health in the world. Despite the prevalence of these conditions, musculoskeletal medicine has a fraught history within the world of undergraduate medical education. We review the origins of musculoskeletal medicine, its evolution in undergraduate medical education, and progress that has been made over the last decade as a result of global initiatives such as the Bone and Joint Decade. Understanding the history of musculoskeletal medicine is essential to contextualizing the problems that exist today and creating comprehensive solutions to fill the gaps that persist in musculoskeletal curricula.

Identification of compounds contributing to umami taste of pea protein isolate.

The umami taste of pea protein ingredients can be desirable or undesirable based on the food application. The compounds contributing to the umami perception of pea protein isolate (PPI) were investigated. Sensory-guided prep-liquid chromatography fractionation of a 10% aqueous PPI solution revealed one well-known compound, monosodium glutamate (MSG), however, it was reported at a subthreshold concentration. Two umami enhancing compounds 5'-adenosine monophosphate (AMP) and 5'-uridine monophosphate (UMP) were subsequently identified after the LC fractions were re-evaluated with MSG. Sensory recombination studies, utilizing the aqueous PPI solution as the base, confirmed AMP and UMP were umami enhancers of MSG and contributed approximately 81% of the perceived umami intensity. However UMP was only reported to enhance umami perception in combination with AMP (not individually) indicating synergistic interactions were observed between the two enhancer compounds. Therefore the presence of all three compounds are important for umami perception and provide an improved basis to tailor the flavor profile in PPI products.

Identification of a Bitter Peptide Contributing to the Off-Flavor Attributes of Pea Protein Isolates.

The aversive bitter taste of pea protein ingredients limits product acceptability. Compounds contributing to the bitter perception of pea protein isolates were investigated. Off-line multi-dimensional sensory-guided preparative liquid chromatography fractionation of a 10% aqueous PPI solution revealed one main bitter compound that was identified by Fourier transform ion cyclotron resonance mass spectrometry and de novo tandem mass spectrometry (MS/MS) sequencing as the 37 amino acid peptide PA1b from pea albumin and further confirmed by synthesis. Quantitative MS/MS analysis reported that the concentration of the bitter peptide was 129.3 mg/L, which was above the determined bitter sensory threshold value of 3.8 mg/L and in agreement with the perceived bitter taste of the sample.

Patellofemoral Instability in the Pediatric Population.

PURPOSE OF REVIEW: This review focuses on the etiology, diagnosis, and management of patellar instability in pediatric patients. RECENT FINDINGS: Radiological outcomes such as tibial-tubercle to trochlear groove (TT-TG) distance used in diagnosis are subject to factors of influence such as femoral anteversion and knee flexion angle, and new measure such as tibial-tubercle to posterior cruciate ligament distance as well as TT-TG/trochlear width (TT-TG/TW) are under investigation. To prevent recurrent instability, surgical intervention for acute patellar dislocations may be advantageous compared to conservative management. Patellar instability is a common pathology found in pediatric cohorts. Diagnosis can be performed via a combination of history, physical examination maneuvers, and radiological risk factors such as patella alta, patellar tilt, trochlear dysplasia, and elevated TT-TG distances. Current literature advocates the usage of additional radiological measures to TT-TG such as TT-TG/TW, especially as TT-TG varies with age in younger patients. Recent literature potentially suggests the utilization of surgical procedures such as MPFL reconstruction or repair for acute dislocations in the hope of preventing recurrent instability. Special indications for pediatric patients include osteochondral fracture identification to help prevent patellofemoral osteoarthritis. A comprehensive workup and understanding of current literature can aid clinicians in aiming to prevent recurrent patellar dislocation in pediatric patients.

Identification of compounds that enhance bitterness of coffee brew.

The bitterness perception of coffee is a key attribute that impacts consumer acceptance. Nontargeted liquid chromatography/mass spectrometry (LC/MS) flavoromics analysis was applied to identify compounds that enhance the bitter perception of roasted coffee brew. Orthogonal partial least squares (OPLS) analysis was used to model the comprehensive chemical profiles and sensory bitter intensity ratings of fourteen coffee brews with good fit and predictivity. Five compounds that were highly predictive and positively correlated to bitter intensity were selected from the OPLS model, further isolated, and purified using preparative LC fractionation. Sensory recombination testing demonstrated that five compounds significantly enhanced the bitter perception of coffee when presented as a mixture, but not when presented individually. In addition, a set of roasting experiments revealed the five compounds were generated during the coffee roasting process.

Mono-n-butyl Malate-Derived Compounds from Camu-camu (Myrciaria dubia) Malic Acid: The Alkyl-Dependent Antihyperglycemic-Related Activity.

Malic acid derivatives from camu-camu (Myrciaria dubia) fruit exhibited a strong in vitro inhibitory activity toward pancreatic α-amylase and α-glucosidase enzymes. During a bioguided chromatographic fractionation process of the whole fruit (pulp and peelings) polar extract, isomers (S)-4-butoxy-2-hydroxy-4-oxobutanoic acid (1) and (S)-4-butoxy-3-hydroxy-4-oxobutanoic acid (2) (84:16) were isolated and identified as a potent inhibitor of α-amylase (IC50= 11.69 ± 1.75 µg/mL) and α-glucosidase (IC50 = 102.69 ± 4.16 µg/mL). The chemical structures were confirmed by HPLC-ESIMS and 1H and 13C NMR (one- and two-dimensional) analyses. The structure-based virtual screening demonstrated that the aliphatic moiety plays a significant role in the binding mode of the test alkyl malate esters. Compound 1 exhibited the best interaction profile to bind both enzymes, having key structural features to form relevant contacts by involving adequate enzyme-ligand complex stabilization and compactness over time.

Performance of 5-Strand Hamstring Autograft Anterior Cruciate Ligament Reconstruction in the STABILITY Study: A Subgroup Analysis.

BACKGROUND: Anterior cruciate ligament (ACL) reconstructions (ACLRs) with graft diameters <8mm have been shown to have higher revision rates. The 5-strand (5S) hamstring autograft configuration is a proposed option to increase graft diameter. PURPOSE: To investigate the differences in clinical outcomes between 4-strand (4S) and 5S hamstring autografts for ACLR in patients who underwent ACLR alone or concomitantly with a lateral extra-articular tenodesis (LET) procedure. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Data from the STABILITY study were analyzed to compare a subgroup of patients undergoing ACLR alone or with a concomitant LET procedure (ACLR + LET) with a minimum graft diameter of 8mm that had either a 4S or 5S hamstring autograft configuration. The primary outcome was clinical failure, a composite of rotatory laxity and/or graft failure. The secondary outcome measures consisted of 2 patient-reported outcome scores (PROs)-namely, the ACL Quality of Life Questionnaire (ACL-QoL) and the International Knee Documentation Committee (IKDC) score at 24 months postoperatively. RESULTS: Of the 618 patients randomized in the STABILITY study, 399 (228 male; 57%) fit the inclusion criteria for this study. Of these, 191 and 208 patients underwent 4S and 5S configurations of hamstring ACLR, respectively, with a minimum graft diameter of 8mm. Both groups had similar characteristics other than differences in anthropometric factors-namely, sex, height, and weight, and Beighton scores. The primary outcomes revealed no difference between the 2 groups in rotatory stability (odds ratio [OR], 1.19; 95% CI, 0.77-1.84; P = .42) or graft failure (OR, 1.13; 95% CI, 0.51-2.50; P = .76). There was no significant difference between the groups in Lachman (P = .46) and pivot-shift (P = .53) test results at 24 months postoperatively. The secondary outcomes revealed no differences in the ACL-QoL (P = .67) and IKDC (P = .83) scores between the 2 subgroups. CONCLUSION: At the 24-month follow-up, there were no significant differences in clinical failure rates and PROs in an analysis of patients with 4S and 5S hamstring autografts of ≥8mm diameter for ACLR or ACLR + LET. The 5S hamstring graft configuration is a viable option to produce larger-diameter ACL grafts.

Identification of subthreshold chlorogenic acid lactones that contribute to flavor instability of ready-to-drink coffee.

Flavor instability of ready-to-drink (RTD) coffee during storage negatively impacts product quality. Untargeted liquid chromatography/mass spectrometry (LC/MS) analysis was applied to identify chemical compounds that degraded during storage and impacted the flavor attributes of RTD coffee. LC/MS chemical profiles of non-aged and aged coffee samples were modeled against the degree of difference sensory scores by orthogonal partial least squares with good fit (R2Y = 0.966) and predictive ability (Q2 = 0.960). The top five predictive chemical features were subsequently purified by off-line multidimensional Prep-LC, revealing ten coeluting chlorogenic acid lactones (CGLs) compounds that were identified by LC/MS and nuclear magnetic resonance (NMR). The concentrations of eight CGLs significantly decreased in the coffee during the 4-month storage. Sensory recombination testing revealed the degradation of 3-O-caffeoyl-É£-quinide and 4-O-caffeoyl-É£-quinide significantly impacted the flavor stability of RTD coffee at subthreshold concentrations.

Identification of Non-Volatile Compounds Generated during Storage That Impact Flavor Stability of Ready-to-Drink Coffee.

Coffee brew flavor is known to degrade during storage. Untargeted and targeted LC/MS flavoromics analysis was applied to identify chemical compounds generated during storage that impacted the flavor stability of ready-to-drink (RTD) coffee. MS chemical profiles for sixteen RTD coffee samples stored for 0, 1, 2, and 4 months at 30 °C were modeled against the sensory degree of difference (DOD) scores by orthogonal partial least squares (OPLS) with good fit and predictive ability. Five highly predictive untargeted chemical features positively correlated to DOD were subsequently identified as 3-caffeoylquinic acid, 4-caffeoylquinic acid, 5-caffeoylquinic acid, 3-O-feruloylquinic acid, and 5-O-feruloylquinic acid. The increase in the six acidic compounds during storage was confirmed by sensory recombination tests to significantly impact the flavor stability of RTD coffee during storage. A decrease in pH, rather than an increase in total acidity, was supported to impact the coffee flavor profile.

Identification of Non-Volatile Compounds That Impact Flavor Disliking of Whole Wheat Bread Made with Aged Flours.

Whole wheat flour has a shorter shelf life than refined wheat flour due to off-flavor development. An untargeted liquid chromatography/mass spectrometry (LC/MS) flavoromics approach was applied to identify compounds that negatively impact the flavor liking in whole wheat bread made from aged flours. The chemical profiles of thirteen breads made from aged flours were obtained using LC/MS and modeled by orthogonal partial least squares (OPLS) to predict flavor liking. Top predictive chemical features (negatively correlated) were identified as pinellic acid (9S,12S,13S-trihydroxy-10E-octadecenoic acid), 12,13-dihydroxy-9Z-octadecenoic acid, and 1-(9Z,12Z-octadecadienoyl)-sn-glycero-3-phosphocholine. The sensory analysis confirmed the three compounds increased the bitterness intensity of the bread samples. The formation of the trihydroxy fatty acid bitter compound, pinellic acid (9S,12S,13S-trihydroxy-10E-octadecenoic acid), was impacted by the lipoxygenase activity of the flour; however, there was no influence on the formation of 12,13-dihydroxy-9Z-octadecenoic acid or 1-(9Z,12Z-octadecadienoyl)-sn-glycero-3-phosphocholine. Additionally, the concentrations of all bitter compounds were significantly higher in bread made from aged flour versus non-aged flour.

Mechanisms of Rebaudioside A Degradation and Ingredient-Sweetener Interactions in Beverages during Storage.

The instability of rebaudioside A (Reb A) in food product applications during storage challenges their utilization. The pathways of Reb A degradation in aged acidic beverages were investigated. Three Reb A degradation compounds of known sensory importance were monitored, consisting of (1) a rearrangement, (2) a hydration, and (3) an epoxidation/rearrangement product. Using deuterium-labeled water (D2O) experiments, compounds 1-2 were reported to be generated by acid-catalyzed mechanisms involving the formation of a carbocation on carbon position 16, followed by either deprotonation via E1 elimination on C15 to form the more thermodynamically stable trisubstituted alkene (compound 1), or by the Markovnikov addition of water via SN1 substitution to form a tertiary alcohol (compound 2). Compound 3 was generated by epoxidation of the exomethylene at the C16-17 positions, followed by the opening and rearrangement of the ring to form a new alkene bond between C15-C16 and a primary alcohol on C17. Further analysis of the effect of beverage ingredients indicated the addition of caramel color significantly increased (p < 0.0001) the concentrations of compounds 1-2 compared to the aged control by 89 and 83%, respectively, whereas a specific coffee flavor and caramel color were reported to significantly reduce (p < 0.0001) the formation of compound 3 compared to the aged control during storage by 90 and 79%, respectively.

Thromboprophylaxis after knee arthroscopy does not decrease the risk of deep vein thrombosis: a network meta-analysis.

PURPOSE: The primary aim of this network meta-analysis (NMA) is to compare the incidence of venous thromboembolisms (VTE) and bleeding risk following the use of pharmacological and non-pharmacological thromboprophylaxis for arthroscopic knee surgery (AKS). This study assumed the null hypothesis which was that there will be no difference in the incidence of VTE and bleeding risk when comparing no treatment, pharmacological treatment, and non-pharmacological treatment for preventing VTE events following AKS. METHODS: A systematic electronic search of CENTRAL, Medline, Embase, and ClinicalTrials.gov was carried out. All English language prospective randomized clinical trials published from date of database inception to November 21, 2021 were eligible for inclusion. All papers addressing arthroscopic knee surgery were eligible for inclusion regardless of timing of surgery, operation, surgical technique, or rehabilitation. Multiple random effects NMAs were conducted to compare all treatments for each outcome. The primary outcome was the incidence of pulmonary embolism (PE) and secondary outcomes consisted of overall deep vein thrombosis (DVT), symptomatic DVT, asymptomatic DVT, and all-cause mortality. Adverse outcomes consisted of major and minor bleeding, as well as adverse events. RESULTS: A total of nine studies with 4526 patients were included for analysis. There were 1054 patients in the no treatment/placebo group (NT/Placebo), 1646 patients in the graduated compression stockings, 810 patients in the extended-duration (> 10 days) low molecular weight heparin (Ext-LMWH) group, 650 patients in the short-duration (< 10 days) LMWH group (Short-LMWH), and 356 patients in the rivaroxaban group. GCS, Ext-LMWH, Short-LMWH and rivaroxaban all demonstrated low risks of PE, symptomatic DVT, asymptomatic DVT, combined DVT and all-cause mortality. Similarly, all interventions demonstrated a low risk of major bleeding. CONCLUSION: There is no significant difference in the risk reduction of PEs, symptomatic DVTs, major/minor bleeding, and/or all-cause mortality when using LWMH (including short or extended regimens), rivaroxaban, graduated compression stockings or no treatment following arthroscopic knee surgery. Future primary research on the efficacy of thromboprophylaxis following arthroscopic knee surgery should stratify outcomes based on key patient (i.e., age, sex, comorbidities) and surgical (i.e., major vs. minor surgery) characteristics and should include acetylsalicylic acid as an intervention. LEVEL OF EVIDENCE: I, network meta-analysis of Level I studies.

Predictors of Graft Failure in Young Active Patients Undergoing Hamstring Autograft Anterior Cruciate Ligament Reconstruction With or Without a Lateral Extra-articular Tenodesis: The Stability Experience.

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction (ACLR) has higher failure rates in young active patients returning to sports as compared with older, less active individuals. Augmentation of ACLR with an anterolateral procedure has been shown to reduce failure rates; however, indications for this procedure have yet to be clearly defined. PURPOSE/HYPOTHESIS: The purpose of this study was to identify predictors of ACL graft failure in high-risk patients and determine key indications for when hamstring ACLR should be augmented by a lateral extra-articular tenodesis (LET). We hypothesized that different preoperative characteristics and surgical variables may be associated with graft failure characterized by asymmetric pivot shift and graft rupture. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Data were obtained from the Stability 1 Study, a multicenter randomized controlled trial of young active patients undergoing autologous hamstring ACLR with or without a LET. We performed 2 multivariable logistic regression analyses, with asymmetric pivot shift and graft rupture as the dependent variables. The following were included as predictors: LET, age, sex, graft diameter, tear chronicity, preoperative high-grade knee laxity, preoperative hyperextension on the contralateral side, medial meniscal repair/excision, lateral meniscal repair/excision, posterior tibial slope angle, and return-to-sports exposure time and level. RESULTS: Of the 618 patients in the Stability 1 Study, 568 with a mean age of 18.8 years (292 female; 51.4%) were included in this analysis. Asymmetric pivot shift occurred in 152 (26.8%) and graft rupture in 43 (7.6%). The addition of a LET (odds ratio [OR], 0.56; 95% CI, 0.37-0.83) and increased graft diameter (OR, 0.62; 95% CI, 0.44-0.87) were significantly associated with lower odds of asymmetric pivot shift. The addition of a LET (OR, 0.40; 95% CI, 0.18-0.91) and older age (OR, 0.83; 95% CI, 0.72-0.96) significantly reduced the odds of graft rupture, while greater tibial slope (OR, 1.15; 95% CI, 1.01-1.32), preoperative high-grade knee laxity (OR, 3.27; 95% CI, 1.45-7.41), and greater exposure time to sport (ie, earlier return to sport) (OR, 1.18; 95% CI, 1.08-1.29) were significantly associated with greater odds of rupture. CONCLUSION: The addition of a LET and larger graft diameter were significantly associated with reduced odds of asymmetric pivot shift. Adding a LET was protective of graft rupture, while younger age, greater posterior tibial slope, high-grade knee laxity, and earlier return to sport were associated with increased odds of graft rupture. Orthopaedic surgeons should consider supplementing hamstring autograft ACLR with a LET in young active patients with morphological characteristics that make them at high risk of reinjury.