Decreased prevalence of new-onset adhesive capsulitis in patients prescribed angiotensin receptor blockers.

BACKGROUND: Angiotensin receptor blockers (ARBs) are commonly prescribed antihypertensive agents that have well-known antifibrotic properties. The purpose of this study was to examine the association between ARB use and the rates of new-onset adhesive capsulitis as well as adhesive capsulitis requiring operative treatment. METHODS: Using a large national insurance database, a randomly generated cohort of patients with at least 3 continuous months of ARB use between January 2010 and December 2019 (n = 1,000,000) was compared to a separate randomly generated cohort without ARB use (n = 3,000,000). Rates of newly diagnosed adhesive capsulitis and associated manipulation under anesthesia (MUA) and/or arthroscopic capsulotomy were calculated over a 1- and 2-year period following the completion of at least 3 continuous months of ARB therapy. Rates were compared using multivariable logistic regression to control for demographics and comorbidities. Both unadjusted and adjusted odds ratios and 95% confidence intervals were calculated and reported for each comparison. Statistical significance was set at P <.05. RESULTS: The mean age in the ARB cohort was 61.8 years (standard deviation [SD] = 10.0), whereas in the control cohort, it was 54.8 years (SD = 12.3) (P < .001). The ARB cohort had significantly lower rates of newly diagnosed adhesive capsulitis compared with the control cohort at both 1 year (0.15% vs. 0.55%, P < .001) and 2 years (0.3% vs. 0.78%, P < .001). Similar findings were observed for the arthroscopic capsular release/MUA cohort associated with adhesive capsulitis. After adjusting for confounding factors, the lower rates of adhesive capsulitis and arthroscopic capsular release/MUA associated with adhesive capsulitis in the ARB cohort remained statistically significant (P < .001). CONCLUSION: Patients prescribed ARBs experienced a decreased rate of newly diagnosed adhesive capsulitis, as well as adhesive capsulitis requiring surgical intervention when compared to a control cohort. These findings suggest a potential protective effect of ARBs against the development of adhesive capsulitis. Further investigations are warranted to elucidate the underlying mechanisms and establish a causal relationship.

Incidence of Tibial Tubercle Fractures in Patients With and Without Osgood-Schlatter Disease.

BACKGROUND: Patients with Osgood-Schlatter disease (OSD) may be at increased risk of tibial tubercle fractures due to an underlying weakness of the tibial tubercle apophysis relative to the patellar tendon as a result of repetitive microtrauma. HYPOTHESIS/PURPOSE: The purpose of this study is to analyze the incidence of tibial tubercle fractures in patients with and without Osgood-Schlatter disease. We hypothesized that the incidence of tibial tubercle fractures would be higher in patients with Osgood-Schlatter disease. METHODS: A retrospective cohort analysis of the PearlDiver database was performed by querying all patients diagnosed with Osgood-Schlatter disease between January 2010 and October 2022. An OSD cohort of 146,672 patients was captured using International Classification of Diseases, Ninth Revision (ICD-9), Tenth Revision (ICD-10) billing codes, and age as inclusion/exclusion criteria. The Student t test and the χ 2 analyses were used to compare the demographics and obesity between the OSD and control cohorts. Multivariable logistic regressions, controlling for residual differences in age, sex, and obesity, were used to compare rates of tibial tubercle fractures. RESULTS: Patients with a recent history of OSD were found to have higher rates of tibial tubercle fractures than the control group at all measured time points ( P <0.001). The 1-year rate of tibial tubercle fractures was 0.62% in the OSD group. The incidence of tibial tubercle fractures in the OSD group was 627.3 cases per 100,000 person-years compared with 42.7 cases per 100,000 person-years in the control group ( P <0.001). Male sex and obesity were also associated with an increased risk of sustaining a tibial tubercle fracture within these patient populations ( P <0.001). CONCLUSION: We report a significantly higher incidence of tibial tubercle fractures among patients with OSD compared with controls. This increase was most significant at 1 month following OSD diagnosis, however, held true for all measured time points. In addition, male patients and those with obesity were also noted to have increased incidence of tibial tubercle fractures regardless of an OSD diagnosis.

Epidemiology of Acute Compartment Syndrome After Pediatric Tibial Tubercle and Tibial Shaft Fractures.

BACKGROUND: While acute compartment syndrome (ACS) is a well-reported complication after pediatric tibial shaft fractures, prior literature has suggested that pediatric patients with tibial tubercle fractures may be at increased risk of ACS due to the proximity of the tibial tubercle to the anterior tibial recurrent artery. However, this theory was largely based on a series of early case reports without substantiation in larger-scale studies. HYPOTHESIS/PURPOSE: The purpose of this study is to conduct a population-level analysis of the incidence and risk factors of acute compartment syndrome following pediatric tibial tubercle and tibial shaft fractures. We hypothesize that the rate of ACS would be lower in patients with tibial tubercle fractures when compared with those with tibial shaft fractures. METHODS: A retrospective cohort analysis of the PearlDiver Mariner database was performed by querying all patients diagnosed with tibial tubercle and tibial shaft fractures between January 2010 and October 2022. Matched cohorts (n=25,483) of patients with pediatric tibial tubercle and tibial shaft fractures were captured using International Classification of Diseases, Ninth Revision (ICD-9), Tenth Revision (ICD-10) billing codes, and age as inclusion/exclusion criteria. Rates of subsequent compartment syndrome were calculated by querying for insurance claims with associated CPT codes for fasciotomy and/or ICD-9/ICD-10 billing codes for compartment syndrome. Student t test and χ2 analyses were used to compare demographics between the tibial tubercle and tibial shaft cohorts. RESULTS: The rate of ACS was significantly lower in the tibial tubercle cohort (0.46%) than in the tibial shaft cohort (0.70%, P<0.001). Male sex and increased age were associated with an increased risk of developing ACS in both cohorts (P<0.001). In addition, polytrauma was found to be a risk factor for ACS among patients with tibial shaft fractures (P<0.001). CONCLUSION: We report a low rate of ACS following both pediatric tibial tubercle fractures and pediatric tibial shaft fractures. Among patients with tibial tubercle fractures, male sex, and increased age were noted to be risk factors for ACS, whereas male sex, older age, and polytrauma were risk factors for ACS among patients with tibial shaft fractures.

Single-center, consecutive series study of the use of a novel platelet-rich fibrin matrix (PRFM) and beta-tricalcium phosphate in posterolateral lumbar fusion.

PURPOSE: To evaluate the radiographic and clinical outcomes of the combination of platelet-rich fibrin matrix (PRFM) with beta-tricalcium phosphate (ß-TCP) and bone marrow aspirate (BMA) as a graft alternative in posterolateral lumbar fusion procedures. METHODS: Researchers evaluated 50 consecutive patients undergoing one-level to three-level posterolateral lumbar fusion procedures, resulting in a total of 66 operated levels. The primary outcome was evidence of radiographic fusion at 1-year follow-up, assessed by three independent evaluators using the Lenke scoring system. Secondary outcomes included back and leg VAS scores, incidence of reoperations and complications, return-to-work status, and opioid use. RESULTS: At 1-year follow-up, radiographic fusion was observed in 92.4% (61/66) of operated levels. There was significant improvement in VAS scores for both back and leg pain (p < 0.05). Compared to baseline figures, the number of patients using opioid analgesics at 12-months decreased by 38%. The majority (31/50) of patients were retired, yet 68% of employed patients (n = 19) were able to return to work. No surgical site infections were noted, and no revision surgery at the operated level was required. CONCLUSIONS: This is the first report to analyze the combination of PRFM with ß-TCP and BMA for PLF procedures. Our results indicate a rate of fusion similar to those reported using iliac crest bone graft (ICBG), while avoiding donor site morbidity related to ICBG harvesting such as hematoma, pain, and infection. These slides can be retrieved under Electronic Supplementary Material.

Do Obese Patients Have Worse Outcomes in Adult Spinal Deformity Surgeries? A Meta-Analysis.

STUDY DESIGN: Meta-Analysis. OBJECTIVE: This meta-analysis evaluates the difference in surgical outcomes between obese and non-obese patients undergoing adult spinal deformity (ASD) corrective surgery. BACKGROUND: ASD encompasses a wide range of debilitating spinal abnormalities. Concurrently, obesity is on the rise globally and has been shown to influence the outcomes of ASD management. The relationship between obesity and surgical outcomes in ASD has been the focus of recent studies, yielding various results. METHODS: We conducted a comprehensive search of PubMed, Cochrane, and Google Scholar (page 1-20) through June of 2024. The surgical outcomes assessed included post-operative complications, revision rates, wound infections, thromboembolic events, implant-related complications, and non-home discharge. Surgical parameters such as operative time, length of stay (LOS), and estimated blood loss (EBL), as well as functional outcomes like the Oswestry Disability Index (ODI) and pain scores were analyzed. RESULTS: Nine studies met inclusion criteria. Non-obese patients exhibited a lower rate of implant-related complications (OR=0.25; 95% CI: 0.12-0.52, P=0.0002) and non-home discharge (OR=0.52; 95% CI: 0.32-0.84, P=0.007). Additionally, non-obese patients had reduced LOS (MD=-0.29; 95% CI: -0.53 - -0.05, P=0.02) and EBL (SMD=-0.68; 95% CI: -1.19 - -0.18, P=0.008). No statistically significant differences were observed for the remaining outcomes. CONCLUSION: Non-obese patients undergoing ASD corrective surgery are associated with fewer implant-related complications, a lower EBL, shorter LOS, and a higher likelihood of being discharged home compared to their obese counterparts.

Cortical Trajectory versus Traditional Pedicle Screw Trajectory in Open Transforaminal Lumbar Interbody Fusion: Meta-Analysis of Complications and Clinical Outcomes.

BACKGROUND: Lumbar degenerative disease imposes a substantial burden on global health care expenditures. Transforaminal lumbar interbody fusion (TLIF) using either traditional trajectory (TT) pedicle screws or cortical bone trajectory (CBT) pedicle screws has become increasingly common. This meta-analysis evaluated outcomes and safety of open TLIF with TT compared with CBT. METHODS: PubMed, Cochrane, and Google Scholar were searched up to April 2024. The studied outcomes included complications, revision surgeries, operating room time, estimated blood loss, length of hospital stay (LOS), incision length, Visual Analog Scale, Oswestry Disability Index, and Japanese Orthopedic Association. RESULTS: This meta-analysis included 5 studies; 770 patients undergoing TLIF were included, with 415 in the CBT group and 355 in the TT group. No statistically significant differences were found in the rate of overall complications, including specific complications, rate of revision surgeries, patient-reported outcome measures, operating room time, and estimated blood loss. However, the CBT group demonstrated shorter LOS (P = 0.05) and shorter incision lengths (P < 0.001) compared with the TT group. CONCLUSIONS: TT and CBT in TLIF procedures demonstrated comparable rates of complications, reoperations, and patient-reported outcome measures. Despite similar operating room times and estimated blood loss, the CBT group exhibited shorter incision lengths and shorter LOS than the TT group. Both CBT and TT pedicle screws are safe and effective options for TLIF. There are potential benefits to CBT such as shorter incision and LOS, although TT remains an essential tool for spinal instrumentation techniques.

Osteoporosis and Fragility Fractures.

Osteoporosis and fragility fractures (FFs) are closely intertwined as the former is a common predisposing factor to the latter. This causal relationship is due to low bone density of osteoporosis and compromised bone microarchitecture, leading to structural failure, decreased ability to withstand applied stresses, and increased propensity to fracture. Osteoporosis can be idiopathic or due to a variety of secondary causes, and numerous treatment strategies are available. FFs are common injuries among the elderly and are caused by factors both intrinsic and extrinsic to the patient. The clinical and economic significances of osteoporosis and FFs are substantial, with considerable associated morbidity and mortality, and billions spent on healthcare expenditures in the US annually. Osteoporosis and FFs are two of the most important topics related to fracture liaison services (FLSs), and their understanding is integral to appreciating the benefits an FLS can provide for patients and providers.

Prevalence of Occult Infections in Posterior Instrumented Spinal Fusion.

STUDY DESIGN: This is a prospective observational study. OBJECTIVE: The aim of this study is to determine the rate of occult infection after instrumented spine surgery in presumed aseptic patients. SUMMARY OF BACKGROUND DATA: The reported incidence rate of delayed/occult infection determined by positive culture swabs after instrumented spine surgery in prospective studies is 0.2%-6.9%. However, this rate may be higher as delayed infections are challenging to diagnose. Fever can be absent and inflammatory markers are often normal. If indolent organisms exist in low concentrations surrounding the instrumentation, these organisms can possibly avoid detection and disrupt bone formation leading to instrumentation loosening, pain generation, and/or failure of a solid fusion. MATERIALS AND METHODS: This study included 50 consecutive presumed aseptic patients undergoing a posterior revision requiring removal of instrumentation at least 6 months following their index procedure. Common markers of infection were examined preoperatively. Multiple culture swabs were taken directly from the removed instrumentation and cultured for 14 days. RESULTS: Of the 50 patients, 19 (38%) were culture-positive (CP) for bacteria upon removal of their instrumentation, with 14 patients (28%) having ≥2 positive specimens of the same organism. The average length of time between the index procedure and the revision surgery was 4.55 years (range: 0.53-21 y). Polymicrobial infections were found in 26% (5/19) of CP patients. The most prevalent microorganism found was Propionibacterium acnes, in 63% (12/19) of CP patients. There was no significant difference between CP and culture-negative patients regarding preoperative markers for infection, age, or length between index and revision procedures. CONCLUSIONS: The results of this study indicate a positive culture rate of 38% in presumed aseptic patients who had previously undergone instrumented spine surgery. These results are consistent with other retrospective studies and are >6 times greater than any previous prospective study utilizing culture swabs. LEVEL OF EVIDENCE: Level-III.