Low Preoperative Brief Resilience Scale Scores Are Associated With Inferior Preoperative and Short-Term Postoperative Patient Outcomes Following Primary Autograft Anterior Cruciate Ligament Reconstruction.

Purpose: To assess preoperative Brief Resilience Scale (BRS) scores as they relate to postoperative patient outcomes following primary autograft anterior cruciate ligament reconstruction (ACLR). Methods: All patients who underwent primary autograft ACLR from 2016 to 2021 and had a patient-reported follow-up of 1 year and a clinical follow-up of 6 months were included in final data analysis. Patients completed validated PROMs pre- and postoperatively. All patients were objectively assessed with range of motion (ROM) and KT-1000 arthrometer testing. Return to sport (RTS) data were obtained for all applicable patients. Patients were divided into 3 groups based on ± ½ the standard deviation for the mean preoperative BRS score. Results: In total, 170 patients who underwent primary autograft ACLR with a mean age of 20.1 years (range, 13-57 years) and a mean final follow-up time of 2.9 years (range, 1.0-5.8 years) were included in the final analysis. The mean preoperative BRS scores for the high-resilience (HR, n = 67), average-resilience (AR, n = 42), and low-resilience (LR, n = 61) groups were 28.1 (95% CI, 27.8-28.9), 24.5 (95% CI, 24.3-24.6), and 21.1 (95% CI, 20.5-21.7), respectively (P < .001). The HR group demonstrated significantly higher preoperative and postoperative patient-reported outcome measures (PROMs) compared to the AR and LR groups, with more differences seen with the LR group. The HR group demonstrated better knee extension in postoperative month 3 compared to the LR group (0.6° [95% CI, -1.2° to 0.1°] vs -2.3° [95% CI, -3.3° to -1.3°], P = .006). The HR group demonstrated a faster RTS time compared to the LR group (6.4 months [95% CI, 6.1-6.7] vs 7.6 months [95% CI, 7.1-8.1], P = .002). No differences were seen in RTS rate, knee flexion, or KT-1000 arthrometer measurements between the 3 groups. Conclusions: Low preoperative BRS scores were associated with inferior PROMs preoperatively and in the short-term postoperative period compared to those with higher preoperative BRS scores. Additionally, patients with lower preoperative BRS scores demonstrated a higher degree of knee extension loss 3 months postoperatively as well as a slower RTS. Level of Evidence: Level III, retrospective cohort study.

Superior Capsular Reconstruction Using Dermal Allograft Is a Safe and Effective Treatment for Massive Irreparable Rotator Cuff Tears: 2-Year Clinical Outcomes.

PURPOSE: To evaluate functional, symptomatic, and diagnostic imaging outcomes after arthroscopic superior capsular reconstruction (SCR) using dermal allograft in patients with massive irreparable rotator cuff tears. METHODS: From 2015 to 2017, this multicenter study retrospectively evaluated patients undergoing arthroscopic SCR for treatment of symptomatic massive rotator cuff tears. Study criteria included the presence of a massive irreparable rotator cuff tear with retraction to the glenoid without diffuse bipolar cartilage loss, Grade 4 or 5 Hamada classification, and subscapularis pathology that could not be addressed. All SCR procedures were performed with neutral abduction of the arm at the time of implantation. Outcome measures included visual analog pain scale (VAS) score, the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and active forward elevation (FE) through 2 years postoperatively. Imaging analyses included radiographs, ultrasound, and magnetic resonance imaging at 6 months and 1 year. RESULTS: Fourteen patients met all study criteria including required follow-up. There were statistically significant improvements in VAS pain (3.3-0.6, P = .001), ASES (55.0-86.5, P < .0001), SANE (33.1-71.5, P < .0001), and active FE (128-172, P = .0005) with mean follow-up of 2.1 years. Twelve patients (86%) met the minimum clinically important difference in VAS pain, ASES, and SANE. Thirteen grafts (93%) had ultrasonographic evidence for vascularity by 1 year postoperatively. There were 2 graft complications (14%) with one (7%) requiring revision to reverse total shoulder arthroplasty. CONCLUSIONS: Arthroscopic SCR using dermal allograft can be a safe and effective treatment option for patients with massive irreparable rotator cuff tears with statistically significant improvements in VAS pain, ASES, SANE, and active FE at 2-years postoperatively, with 93% of grafts demonstrating vascularity at 1-year postoperatively. Neutral abduction of the arm at the time of implantation resulted in positive clinical outcomes and may decrease graft failure rate. LEVEL OF EVIDENCE: Level IV, case series.

Dispersal Pattern of Injectate After Cervical Epidural Steroid Injection Evaluated With Magnetic Resonance Imaging.

STUDY DESIGN: Prospective, nonrandomized, clinical study. OBJECTIVE: Epidural steroid injections (ESIs) are an important diagnostic and treatment modality for spine pathology. The success of these injections has been attributed to the anatomic location reached by the injectate. This study evaluates injectate dispersal patterns after cervical interlaminar ESI using magnetic resonance imaging (MRI). METHODS: Patients between the ages of 18 and 85 years with cervical radiculopathy were identified. After obtaining consent for study participation, a gadolinium-enhanced cervical ESI was administered via an interlaminar approach under fluoroscopic guidance. Study participants underwent a cervical spine MRI within 15 minutes of administering the injection. Craniocaudal dispersal and the presence or absence of circumferential dispersal was assessed. RESULTS: The injectate dispersed a mean of 8.11 cm in the cranial direction, 6.63 cm in the caudal direction, and 360° circumferentially. No adverse events related to the ESI were reported. CONCLUSIONS: Fluoroscopy-guided cervical interlaminar ESI resulted in nearly uniform circumferential dispersal within the epidural space with multilevel migration in the cranial and caudal directions. MRI is a safe and accurate tool to evaluate spinal injectate dispersal.

Reliability of a Condensed Computer-Based Patient Outcomes Scoring Tool in Orthopaedic Trauma Patients.

OBJECTIVES: To determine the reliability of a condensed computer-based patient-centered outcome score system versus multiple standard uncondensed validated outcome scores used in orthopaedic trauma. DESIGN: Prospective. SETTING: Level I Trauma Center. PATIENTS/PARTICIPANTS: One hundred patients older than 18 years with various orthopaedic injuries were evaluated at a Level I Trauma Clinic. INTERVENTION: Study participants were randomly assigned to complete the paper-based and computer-based versions of the EQ-5D and musculoskeletal functional assessment at different times during the same visit. MAIN OUTCOME MEASUREMENTS: Score variability between the computer-based and paper-based versions. RESULTS: The average score difference between the computer-based and paper-based musculoskeletal functional assessment was 0.50, with an SD of 6.03 and a 95% confidence interval of -0.71 to 1.71. For the EQ-5D, the average score difference was 0.12 with an SD of 0.20 and a 95% confidence interval of -0.05 to 0.05. CONCLUSIONS: Because patient-centered outcomes drive the direction of orthopaedic care, it is critical to collect patient data efficiently while minimizing responder burden. This condensed web-based adaptive outcome tool reliably produced similar scores when compared with individual paper scores, and it decreased responder burden and error.

Analysis of the s2 alar-iliac screw as compared with the traditional iliac screw: does it increase stability with sacroiliac fixation of the spine?

BACKGROUND CONTEXT: Arthrodesis of the lumbosacral junction continues to be a challenge in pediatric and adult spinal deformity surgery. PURPOSE: To evaluate the biomechanical rigidity of two types of lumbosacral fixation. Our hypothesis was that the use of S2 alar-iliac (S2AI) fixation will result in statistically similar biomechanical fixation as compared with use of an iliac screw with a 95% confidence interval. STUDY SETTING: Controlled biomechanical laboratory METHODS: Ten human cadaveric lumbosacral specimens were separated into two test groups: (1) S2AI (n=5) and (2) iliac screw (n=5). S2AI and iliac screws were placed according to current clinical practice techniques. Specimens were mounted in an unconstrained dual leg stance configuration for testing in flexion, extension, lateral bending, and axial rotation. These loads were induced by moving the offset loading arm 10 mm in the respective direction from the point of neutral motion with displacement control up to a 10 N-m moment, except axial rotation which used a 4 N-m moment. Optical tracking was used to monitor motion of the vertebra, pelvis, and fixation instrumentation during testing. Specimens were tested in intact and instrumented states. The stiffness values between S2AI and iliac screw configurations were compared. DISCLOSURE: The present study received external research support (>$50,000 -<$75,000) from Stryker Spine (Allendale, NJ, USA). RESULTS: There was a consistent trend of increased construct stiffness for all S2AI samples compared with the iliac screw group. However, none of the groups tested reached statistical significance for a 95% confidence interval. CONCLUSIONS: S2AI screws are just as stable as iliac screws with biomechanical testing in flexion, extension, rotation, lateral bending, and axial rotation. Given the similarities of biomechanical testing to human movements, these findings support S2AI screws as a viable option for lumbosacral fixation.

Hyaluronic acid versus saline intra-articular injections for amelioration of chronic knee osteoarthritis: A canine model.

The objective of this study was to assess the safety and efficacy of intra-articular injections of hyaluronic acid (HA) versus saline for symptomatic treatment of osteoarthritis (OA). Twenty-five adult purpose-bred dogs underwent meniscal release of one knee. Clinical, arthroscopic, and radiographic signs of OA were confirmed in all dogs prior to treatment. Dogs were randomized into five groups: HA-1 (n = 5), HA-3 (n = 5), HA-5 (n = 5), Saline-1 (n = 5), and Saline-3 (n = 5). Each dog received intra-articular injections of the respective substance into the affected knee at the pre-determined time points. Dogs were assessed for heat, swelling, and erythema after each injection and for lameness, pain, effusion, range of motion, kinetics, radiographic OA scoring, and arthroscopic scoring prior to treatment and for 6 months after injection. Dogs were then humanely euthanatized and the knees assessed grossly and histologically. Only mild heat, swelling, and/or erythema were noted in some dogs following injection and resolved within 1 week. Dogs treated with HA-1, HA-3, and HA-5 were significantly (p < 0.05) better than dogs treated with Saline-1 and Saline-3 at the 4, 8, and 12 week time points based on at least one outcome measure. OA severity was not significantly different among groups at any time point, but increased in severity over time in all groups. Gross and histologic OA scores were not significantly different among groups. These data suggest the three HA injection protocols were safe, superior to saline for short-term amelioration of symptoms associated with chronic OA, and can be translated to human OA treatment. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1772-1779, 2016.

Murine model for cystic fibrosis bone disease demonstrates osteopenia and sex-related differences in bone formation.

As the incidence of cystic fibrosis (CF) bone disease is increasing, we analyzed CF transmembrane conductance regulator (CFTR) deficient mice (CF mice) to gain pathogenic insights. In these studies comparing adult (14 wk) CF and C57BL/6J mice, both bone length and total area were decreased in CF mice. Metaphyseal trabecular and cortical density were also decreased, as well as diaphyseal cortical and total density. Trabecular bone volume was diminished in CF mice. Female CF mice revealed decreased trabecular width and number compared with C57BL/6J, whereas males demonstrated no difference in trabecular number. Female CF mice had reduced mineralizing surface and bone formation rates. Conversely, male CF mice had increased mineralizing surface, mineral apposition, and bone formation rates compared with C57BL/6J males. Bone formation rate was greater in males compared with female CF mice. Smaller bones with decreased density in CF, despite absent differences in osteoblast and osteoclast surfaces, suggest CF transmembrane conductance regulator influences bone cell activity rather than number. Differences in bone formation rate in CF mice are suggestive of inadequate bone formation in females but increased bone formation in males. This proanabolic observation in male CF mice is consistent with other clinical sex differences in CF.