Hydrogen Peroxide May Reduce the Risk for Revision Surgery and Infection in Primary Shoulder Arthroplasty: Two-year Follow-up From a Prospective, Blinded, Controlled Trial.

BACKGROUND: The purpose of this study was to determine whether the addition of hydrogen peroxide to the preoperative skin preparation for primary total shoulder arthroplasty is associated with a difference in patient-reported outcomes, risk for postoperative infection, and risk for revision surgery at a minimum of 2-year follow-up. METHODS: This was a prospective, blinded, and controlled trial, which included a consecutive series of patients undergoing primary shoulder arthroplasty. The control group underwent standard sterile skin preparation using ethyl alcohol and ChloraPrep applicators, and the peroxide group had the same preparation with the addition of hydrogen peroxide between the alcohol and ChloraPrep applications. We then compared patient-reported outcome scores (American Shoulder and Elbow Surgeons Shoulder Score [ASES], simple shoulder test [SST], visual analog scale [VAS]), infections, and revision surgeries between the two groups at 2-year follow-up. RESULTS: Of the 61 patients included in the original study, 52 of 58 (85%) living patients agreed to participate in this study. No preoperative differences were observed between groups. No difference was observed in ASES, SST, or VAS scores at 2 years. More revision surgeries were done in the control group (7 versus 2, P = 0.268) and Cutibacterium acnes infections (2 versus 0, P = 0.168). CONCLUSION: The addition of hydrogen peroxide to the preoperative skin preparation before primary shoulder arthroplasty is safe, and additional research is warranted to investigate whether it may decrease the risk for revision surgery and postoperative C acnes infection. LEVEL OF EVIDENCE: III.

Symptomatic Coracoid Fracture Nonunion Treated with Arthroscopic Reduction and Suture Anchor Fixation: A Case Report.

CASE: A 15-year-old female rock climber presented with a traumatic coracoid process fracture of her dominant upper extremity that failed extensive nonoperative treatment. She was treated successfully by arthroscopic reduction and suture anchor fixation. CONCLUSION: A novel surgical technique for coracoid fracture that combines arthroscopic reduction with suture anchor fixation can result in expeditious and durable clinical improvement in a young, high-demand athlete.

How Do Functional Comorbidities Affect PROMIS-PF Scores Following Lumbar Fusion Surgery?

STUDY DESIGN: A retrospective review. OBJECTIVE: The purpose of this study is to trend PROMIS PF scores following lumbar fusion surgery, and to investigate how the presence of functional comorbidities affects PROMIS PF scores. Additionally, we compare trends in PROMIS PF scores to the Oswestry Disability Index (ODI) and to PROMIS Pain Interference (PI) scores. SUMMARY OF BACKGROUND DATA: National Institute of Health's (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) domain has been validated in spine surgery. However, little is known about how PROMIS-PF scores are affected by functional comorbidities and how these scores change in patients recovering from lumbar fusion surgery over time. In this study, we hypothesize that functional comorbidities negatively affect recovery. METHODS: We retrospectively identified 1,893 patients who underwent thoracolumbar, lumbar, or lumbosacral fusion for degenerative conditions between 01/02/2014 and 01/07/2022. We summarized PF at 3-month intervals for 2 years following surgery between those with and without functional comorbidity, defined as the presence of congestive heart failure (HF), chronic obstructive pulmonary disease (COPD), cerebrovascular disease (CVD), or paraplegia. Mixed effects multivariable regressions were used to model between group trends in PF through 2 years post-operatively controlling for age, gender, indication, and surgical invasiveness. The minimally clinically important difference (MCID) was defined as 5+ point improvement from baseline in PF. RESULTS: The cohort includes 1,224 (65%) patients without functional comorbidity and 669 (35%) with functional comorbidity. The mean age was 65.0 and Charlson index was 1.0 in the cohort without functional comorbidity compared to 65.4 and 3.8 in the cohort with functional comorbidity (P=0.552 and P<0.001 respectively). The groups were otherwise similar with respect to surgical invasiveness index, vertebral levels, and spine diagnosis (all P>0.05). At 24 months post operatively, the functional comorbidity group had a 2.5 point lower absolute PF score and a 1.3 point less improvement from baseline (P=0.012 and 0.190 respectively). 19.3% of patients in the functional comorbidity group achieved the MCID compared to 80.9% in patients without a functional comorbidity (P<0.001). CONCLUSION: Based on PROMIS PF scores, patients with functional comorbidities do not recover to the same extent and are less likely to achieve an MCID compared to patients without baseline functional comorbidities. PROMIS-PF can help benchmark patients along their recovery, and other metrics may be needed to better understand the recovery of patients with functional comorbidities.

Current State of Data and Analytics Research in Baseball.

PURPOSE OF REVIEW: Baseball has become one of the largest data-driven sports. In this review, we highlight the historical context of how big data and sabermetrics began to transform baseball, the current methods for data collection and analysis in baseball, and a look to the future including emerging technologies. RECENT FINDINGS: Machine learning (ML), artificial intelligence (AI), and modern motion-analysis techniques have shown promise in predicting player performance and preventing injury. With the advent of the Health Injury Tracking System (HITS), numerous studies have been published which highlight the epidemiology and performance implications for specific injuries. Wearable technologies allow for the prospective collection of kinematic data to improve pitching mechanics and prevent injury. Data and analytics research has transcended baseball over time, and the future of this field remains bright.

Comparison of Synthetic vs. Biogenic Polymeric Process-Directing Agents for Intrafibrillar Mineralization of Collagen.

With the aging population, there is a growing need for mineralized tissue restoration and synthetic bone substitutes. Previous studies have shown that a polymer-induced liquid-precursor (PILP) process can successfully mineralize collagen substrates to achieve compositions found in native bone and dentin. This process also leads to intrafibrillar apatitic crystals with their [001] axes aligned roughly parallel to the long axis of the collagen fibril, emulating the nanostructural organization found in native bone and dentin. When demineralized bovine bone was remineralized via the PILP process using osteopontin (OPN), the samples were able to activate mouse marrow-derived osteoclasts to similar levels to those of native bone, suggesting a means for fabricating bioactive bone substitutes that could trigger remodeling through the native bone multicellular unit (BMU). In order to determine if OPN derived from bovine milk could be a cost-effective process-directing agent, the mineralization of type I collagen scaffolds using this protein was compared to the benchmark polypeptide of polyaspartic acid (sodium salt; pAsp). In this set of experiments, we found that OPN led to much faster and more uniform mineralization when compared with pAsp, making it a cheaper and commercially attractive alternative for mineralized tissue restorations.

Implant-Free Subpectoral Biceps Tenodesis Is Biomechanically at Higher Risk of Spiral Fracture of the Humerus Compared With Implant-Free Suprapectoral Biceps Tenodesis.

PURPOSE: To compare the likelihood of spiral fracture of the humerus using torsional load to failure after intraosseous biceps tenodesis at the position of the arthroscopic suprapectoral tenodesis versus the subpectoral meta-diaphyseal location. METHODS: Eight matched pairs of humeri were dissected. Unicortical tenodesis holes were drilled, either at the bottom of the bicipital groove (group 1) or just below the pectoralis major tendon insertion (subpectoral) in the humeral diaphysis (group 2). Tenodesis was performed in a 7-mm bone tunnel, with suture fixation distal to this site using 2 separate 2-mm holes, secured with No. 2 polyester suture. Each humerus was potted in plaster and mounted to a hydraulic torsional load frame, consistent with previously validated models for creating humeral spiral fractures. External rotation torque was applied to each humerus distally until fracture occurred. The paired t test was used to compare the 2 groups. RESULTS: Fracture occurred at the subpectoral cortical drill hole in all 8 specimens in group 2. In group 1, only 2 fractures occurred through the tenodesis hole, with spiral fracture resulting in the diaphysis of the humerus in 6 of 8 specimens. Average torque to failure measured 31.35 Nm in group 1 and 25.08 Nm in group 2; the difference was statistically significant (P < .0001). CONCLUSIONS: Subpectoral cortical drill holes for biceps tenodesis were shown to be a stress riser for humeral spiral fracture. Suprapectoral cortical drill holes were shown to be significantly less of a stress riser. The amount of torque required to fracture the humerus through the subpectoral drill holes was less than with the suprapectoral drill holes. Only 2 fractures occurred through the suprapectoral tenodesis holes, and significantly more torque was required to create these fractures. CLINICAL RELEVANCE: Clinically, the difference between suprapectoral and subpectoral tenodesis fracture potential should be considered when selecting a tenodesis location.