Extrusion After Meniscal Allograft Transplantation Is Lower or Equal With Bony Compared With Soft-Tissue Root Fixation: A Systematic Review.

PURPOSE: To provide an update on the incidence and extent of graft extrusion after meniscal allograft transplantation (MAT) and to systematically review the literature to identify whether the type of root fixation or additional surgical techniques may reduce the risk of graft extrusion development. METHODS: A systematic search, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, was conducted using the MEDLINE database, EMBASE database, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials (CENTRAL) database. Patients undergoing medial meniscal allograft transplantation (MMAT) or lateral meniscal allograft transplantation (LMAT) were included. The primary outcome measure was meniscal extrusion measured on postoperative magnetic resonance imaging scans taken more than 6 weeks after MAT. The following extrusion outcomes were investigated: absolute extrusion (AE), relative percentage of extrusion (RPE), and proportion of major extrusion (PME). Additional surgical techniques that reduced the risk of graft extrusion development in the included comparative studies were identified. RESULTS: For MMAT, the pooled mean extrusion outcomes for soft-tissue versus bony fixation were as follows: AE of 3.2 mm versus 3.36 mm and RPE of 44.43% versus 33.18%. The pooled mean PME for MMAT with soft-tissue fixation was 51.62%. For LMAT, the pooled mean extrusion outcomes for soft-tissue versus bony fixation were as follows: AE of 3.72 mm versus 2.78 mm, RPE of 31.89% versus 29.47%, and PME of 64.37% versus 35.80%. Additional capsulodesis was identified as a technique to reduce LMAT extrusion. CONCLUSIONS: This study highlights that graft extrusion is a common finding after MMAT and LMAT, independent of the root fixation technique. However, MAT extrusion with bony fixation was, depending on the outcome measurement, lower than or equal to that with soft-tissue fixation. LEVEL OF EVIDENCE: Level IV, systematic review of Level I, III, and IV studies.

Machine learning models can predict subsequent publication of North American Spine Society (NASS) annual general meeting abstracts.

BACKGROUND CONTEXT: Academic meetings serve as an opportunity to present and discuss novel ideas. Previous studies have identified factors predictive of publication without generating predictive models. Machine learning (ML) presents a novel tool capable of generating these models. As such, the objective of this study was to use ML models to predict subsequent publication of abstracts presented at a major surgical conference. STUDY DESIGN/SETTING: Database study. METHODS: All abstracts from the North American Spine Society (NASS) annual general meetings (AGM) from 2013-2015 were reviewed. The following information was extracted: number of authors, institution, location, conference category, subject category, study type, data collection methodology, human subject research, and FDA approval. Abstracts were then searched on the PubMed, Google Scholar, and Scopus databases for publication. ML models were trained to predict whether the abstract would be published or not. Quality of models was determined by using the area under the receiver operator curve (AUC). The top ten most important factors were extracted from the most successful model during testing. RESULTS: A total of 1119 abstracts were presented, with 553 (49%) abstracts published. During training, the model with the highest AUC and accuracy metrics was the partial least squares (AUC of 0.77±0.05, accuracy of 75.5%±4.7%). During testing, the model with the highest AUC and accuracy was the random forest (AUC of 0.69, accuracy of 67%). The top ten features for the random forest model were (descending order): number of authors, year, conference category, subject category, human subjects research, continent, and data collection methodology. CONCLUSIONS: This was the first study attempting to use ML to predict the publication of complete articles after abstract presentation at a major academic conference. Future studies should incorporate deep learning frameworks, cognitive/results-based variables and aim to apply this methodology to larger conferences across other fields of medicine to improve the quality of works presented.

Key Stakeholder Perceptions of Standard vs. Total Cost of Ownership: A Procurement Analysis for Orthopaedic-Powered Instruments.

This study compares standard procurement methodology (SPM) with total cost of ownership (TCO) methodology for the procurement of orthopaedic-powered instruments. The authors conducted semi-structured standardized interviews with key hospital procurement stakeholders following consolidated criteria for reporting qualitative research. Of the 33 hospital procurement stakeholders interviewed, all (100%) reported that SPM would be easier to use than TCO. However, only six (18%) preferred SPM over TCO. Barriers to the adoption of TCO emerged as a theme. Creating TCO frameworks can help to simplify the process for procurement agents and facilitate its adoption in the healthcare sector.

The Superficial "Swing-Down" Quadriceps Tendon Autograft Is a Viable Option for Medial Patellofemoral Ligament Reconstruction: A Systematic Review.

PURPOSE: The purpose of this systematic review is to ascertain the reported clinical outcomes and complication profiles of medial patellofemoral ligament (MPFL) reconstruction performed using a superficial "swing-down" quadriceps tendon autograft. METHODS: Three databases (PubMed, EMBASE, and MEDLINE) were searched from January 1, 2000, to April 06, 2020. Keywords used in the search included: "medial patellofemoral ligament" and "reconstruction". After screening based on inclusion and exclusion criteria, patient demographics, graft type, outcomes, and complications were extracted. Methodological Index for Non-Randomized Studies criteria were used to assess the quality of each included study. RESULTS: Eleven studies were included, comprising data from 226 patients with mean follow up ranging from 12 to 38 months. All reconstructions used a superficial "swing-down" quadriceps tendon autograft fixed at 20-30 degrees of knee flexion where reported. Eight of eleven studies reported significant improvement in patient reported outcomes such as Kujala score, Lysholm score, and Tegner score. The mean preoperative Kujala score ranged from 35.8 to 82.1 (167 patients), while the mean postoperative Kujala score ranged from 88.4 to 94.8 (197 patients). The mean of the preoperative Lysholm score ranged from 43.3 to 79.3 (77 patients), while the mean of the postoperative Lysholm score ranged from 81.9 to 90.9 (99 patients). The I2 statistic for Lysholm and Kujala scores was 94% and 97%, respectively. Across data reported on 194 patients, there was no incidence of patellar redislocation, patellar fracture, or graft site morbidity. CONCLUSION: The quadriceps tendon produced improved clinical outcomes with low rates of recurrent postoperative patellar dislocation. These data suggest that the quadriceps tendon remains a suitable alternative for MPFL reconstruction and should remain part of the arsenal of knee ligament surgeons. LEVEL OF EVIDENCE: Systematic review of Level III and IV studies.

Traumatic contralateral chylothorax in a patient with penetrating neck injury: a case report.

Chylothorax is defined as a collection of chyle within the pleural cavity secondary to injury of the thoracic duct. We describe a rare case of a contralateral chylothorax resulting from a penetrating wound to the left lower anterior neck region. A 37-year-old male presented to the emergency room with a penetrating stab wound of the left neck. Upon clinical exam, the wound measured about 3-4 cm with minimal bleeding and no expanding hematoma or other hard sign of vascular injury. Subsequently, his right chest tube output developed a milky appearance with a total volume of 260 cc over 24 h. The specimen was sent for triglyceride analysis and confirmed diagnosis of chylothorax. He was managed with conservative therapy not requiring surgical intervention. The anatomical variations arising in the thoracic duct warrant the consideration of possible chylothorax in both right and left pleural effusions secondary to penetrating trauma.