Suture Anchor Fixation Has Less Gap Formation and No Difference in Complications or Revisions for Patellar Tendon Repair: A Systematic Review.

PURPOSE: To evaluate the literature on suture anchor (SA) usage for patellar tendon repair, summarize the overall biomechanical and clinical outcomes, and assess whether the cumulative research supports the adoption of this technique compared with transosseous (TO) repair. METHODS: A systematic literature review using the Preferred Reporting Items for Systematic and Meta-Analyses guidelines was performed. Multiple electronic databases were searched to identify studies focusing on surgical outcomes of patellar tendon repair with suture anchor usage. Cadaver and animal biomechanical studies, technical studies, and clinical studies were included. RESULTS: A total of 29 studies met the inclusion criteria: 6 cadaver, 3 animal, 9 technical, and 11 clinical reports. Four of the 6 cadaver studies and 1 of the 2 animal studies found significantly less gap formation from SA than from TO repair. Average gap formation in human studies ranged from 0.9 to 4.1 mm in the SA group compared with 2.9 to 10.3 mm in TO groups. Load to failure was significantly stronger in 1 of 5 cadaver studies and 2 of 3 animal studies, with human studies SA load to failure ranging from 258 to 868 N and TO load to failure ranging from 287 to 763 N. There were 11 clinical studies that included 133 knees repaired using SA. Nine studies showed no difference between complication rate or risk for reoperation, where one study reported a significantly lower re-rupture rate after SA repair compared with TO repair. CONCLUSIONS: SA repair is a viable option for patellar tendon repair and could have several advantages over TO repair. Multiple studies indicate that SA repair has less gap formation during biomechanical testing compared with TO repair in human cadaver and animal models. No differences in complications or revisions were found in the majority of clinical studies. CLINICAL RELEVANCE: Both animal and human models suggest SA fixation has potential biomechanical benefits when compared with TO tunnels for patellar tendon repair, whereas clinical studies show no difference in complications and revisions postoperatively.

Arthroscopic Shoulder Simulation Studies Reveal Improvements in Performance Metrics without Proven Transferability to the Operating Room: A Systematic Review.

PURPOSE: The purpose of this systematic review was to evaluate the use of shoulder arthroscopic simulation in Orthopaedic surgery trainees. METHODS: A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Medline (Ovid), and EMBASE library databases. Inclusion criteria were experimental studies reporting pre- and post-test results of shoulder arthroscopic simulation in orthopaedic trainees (studies reporting results of comparison between groups not within the groups were excluded). Participant demographics, type of simulator training, simulator tasks assessed and performance outcome measures were systematically reviewed. Each performance outcome measure was graphically represented in a Forest plot with point estimates of the incidence of performance outcomes with corresponding 95% confidence intervals and I2. RESULTS: Fifteen studies met inclusion criteria with a total of 353 participants. The most common procedures simulated were diagnostic shoulder arthroscopy (n=9 [60%]), arthroscopic Bankart repairs (n=3 [20%]), and rotator cuff repairs (n =2 [13%]). Simulations primarily utilized virtual reality (60%) and bench top models (40%). The primary outcomes measured were time to task completion and Arthroscopic Surgical Skill Evaluation Tool (ASSET) scores. Time to task completion improved significantly with training (range 13-439 seconds pre-test to 8-253.29 seconds post-test), with substantial heterogeneity across studies (I2=87%). ASSET scores improved in 60% of the studies (ranging from 14-20.9 pre-test to 17.9-28.5 post-test), with low heterogeneity (I2=20%). Additionally, both camera and probe distances decreased after simulation use, while the 14-point anatomic checklist showed no pre to post-test differences. CONCLUSION: Arthroscopic simulation training benefits technical skills in shoulder arthroscopy, but the quality, assessment, and validity of these protocols vary. The translation of simulation training into the operating room has yet to be conclusively demonstrated.

How does telementoring impact medical education within the surgical field? A scoping review.

BACKGROUND: Surgical education strongly involves the use of mentorship to improve the confidence and efficiency of trainees. Social distancing due to the COVID-19 pandemic may serve as a catalyst to promote the use of telementoring and other remote learning opportunities in medical education. METHODS: A comprehensive literature review was performed using the electronic databases PubMed, Embase, Web of Science, Scopus, and the Cochrane Library with respect to telementoring in the surgical field. RESULTS: The overall consensus of telementoring experience among all 25 studies was generally positive, citing "positive experience," "increased confidence," and "increased surgical skill." Using over 15 different technologies, a total of 12 simulations, 149 tasks, and 491 surgeries were conducted via telementoring. Eight mentor-mentee relationships were identified, with the most common relationship being surgeon-to-surgeon in 12 studies. CONCLUSIONS: The implementation of telementoring has been shown to be effective in improving surgical skills and learner experiences while overcoming financial and geographical barriers.

Index Surgery Cost of Fluoroscopic Freehand Versus Robotic-Assisted Pedicle Screw Placement in Lumbar Instrumentation: An Age, Sex, and Approach-Matched Cohort Comparison.

BACKGROUND: Spine surgery costs are notoriously high, and there are already criticisms and concerns over the economic effects. There is no consensus on cost variation with robot-assisted spine fusion (rLF) compared with a manual fluoroscopic freehand (fLF) approach. This study looks to compare the early costs between the robotic method and the freehand method in lumbar spine fusion. METHODS: rLFs by one spine surgeon were age, sex, and approach-matched to fLF procedures by another spine surgeon. Variable direct costs, readmissions, and revision surgeries within 90 days were reviewed and compared. RESULTS: Thirty-nine rLFs were matched to 39 fLF procedures. No significant differences were observed in clinical outcomes. rLF had higher total encounter costs (P < 0.001) and day-of-surgery costs (P = 0.005). Increased costs were mostly because of increased supply cost (0.0183) and operating room time cost (P < 0.001). Linear regression showed a positive relationship with operating room time and cost in rLF (P < 0.001). CONCLUSION: rLF is associated with a higher index surgery cost. The main factor driving increased cost is supply costs, with other variables too small in difference to make a notable financial effect. rLF will become more common, and other institutions may need to take a closer financial look at this more novel instrumentation before adoption.

Utilization of the Free Fibular Flap for First Metatarsal Reconstruction.

Beyond being aesthetically unpleasing, metatarsal defects have been known to lead to several patient concerns such as intermetatarsal malpositioning and metatarsalgia. There are several reconstructive techniques that have been utilized for reconstruction of bony defects in the foot, including the free dorsal toe flap and dorsal metatarsal perforator flap. Our institution has utilized the free fibular flap for surgical management pertaining to tarsal reconstruction. Our study looks to evaluate the work of a single plastic surgeon and identify patient postoperative outcomes. A retrospective chart review was conducted at Beaumont Health System, Royal Oak for patients who underwent first metatarsal reconstruction with a free fibular flap between the years 2015 and 2022. Demographic data, operative details, complications, medical comorbidities, and patient outcomes were retrospectively gathered and analyzed. A total of two patients were isolated after chart review. Both patients were found to have tolerated the procedure well and had no intraoperative complications. In addition, all patients had clinically viable flaps and were satisfied with their surgical results. The free fibular flap may be used effectively in the management of metatarsal defects that have failed prior therapy. In our study, both patients who underwent surgical management with a free fibular flap were noted to have successful long-term results. With the right expertise and patient population, a free fibular flap can be highly successful in the repair of metatarsal defects.

Utilization of the Pedicled and Free Fibula Flap for Ankle Arthrodesis.

Ankle arthrodesis has become a common surgical procedure for individuals with end-stage ankle arthritis, chronic infection, and bony misalignment. Although arthrodesis is typically managed with arthrodesis in situ or realignment, reconstruction may be utilized for patients with more complicated cases that involve metatarsal defects. Our institution utilizes both the pedicled and free fibula flaps for surgical management pertaining to ankle arthrodesis. Our study looks to evaluate the work of a single plastic surgeon and identify patient postoperative outcomes. Methods: A retrospective chart review was conducted at Beaumont Health System, Royal Oak, for patients who underwent ankle arthrodesis with a pedicled fibula flap for nonunion or avascular necrosis of the talus between the years 2014 and 2022. Demographic data, operative details, complications, medical comorbidities, and patient outcomes were retrospectively gathered and analyzed. Results: A total of six patients were isolated, with three patients undergoing a free fibula approach and three patients undergoing the pedicled fibula approach. All patients were found to have tolerated the procedure well and had no intraoperative complications. In addition, all patients had clinically viable flaps and were satisfied with their surgical result. Conclusions: Both free and pedicled free fibula flaps may be used effectively in the management of ankle arthrodesis in patients who have failed prior therapy. In our study, free fibula flaps were utilized in a medial approach, while the pedicled fibula flap was utilized in a lateral approach. With the right expertise and patient population, the free and pedicled fibula flaps can be highly successful in the repair of ankle defects.