Graft failure within 2 years of isolated anterior cruciate ligament reconstruction is associated with increased risk of secondary meniscus tears.

PURPOSE: A debilitating complication following anterior cruciate ligament reconstruction is a secondary meniscus tear. Currently, the literature is mixed regarding the risk factors associated with the incidence of secondary meniscus tears. The aim of this study was to investigate risk factors associated with meniscus tears following an isolated primary anterior cruciate ligament reconstruction. ACL graft failure was hypothesized to be the strongest risk factor for secondary meniscal injury occurrence. METHODS: A retrospective cohort analysis was performed using the PearlDiver Database. Patients with a primary anterior cruciate ligament reconstruction were identified in the database. Patients with concomitant knee ligament injury or meniscus injury present at the time the index procedure were excluded. Patients were grouped to those who had a secondary meniscus tear within 2 years following anterior cruciate ligament reconstruction and those who did not. Univariate analysis and multivariable regression analysis was conducted to identify significant risk factors for a secondary meniscus tear. RESULTS: There were 25,622 patients meeting criteria for inclusion in this study. Within 2 years from the primary anterior cruciate ligament reconstruction, there were 1,781 patients (7.0%) that experienced a meniscus tear. Graft failure had the highest odds of having a postoperative meniscus tear within 2 years (OR: 4.1; CI 3.5-4.8; p < 0.002). Additional significant risk factors included tobacco use (OR: 2.0; CI 1.0-3.1; p < 0.001), increased Charlson Comorbidity Index (OR: 1.2; CI 1.1-1.4), male gender (OR: 1.1; CI 1.1-1.2; p < 0.001), obesity (OR: 1.1; CI 1.1-1.2; p < 0.001), delayed surgery (OR:1.1; CI 1.1-1.2; p < 0.002), and patients age 30 and older (OR: 1.0; CI 1.0-1.0; p < 0.001). CONCLUSIONS: This study found that anterior cruciate ligament graft failure is the strongest predictor of post-operative meniscus tears. Other risk factors, including tobacco use, increased CCI, male gender, obesity, delayed surgery, and age 30 and older, were established, with several being modifiable. Therefore, targeted preoperative optimization of modifiable risk factors and postoperative protocols may reduce the risk of secondary meniscus tears. LEVEL OF EVIDENCE: Level III, prognostic trial.

Chronic obstructive pulmonary disease is an independent risk factor for postoperative complications following operative treatment of distal radius fracture.

PURPOSE: This study aimed to investigate the relationship between chronic obstructive pulmonary disease (COPD) and postoperative complications for patients receiving distal radius fracture (DRF) open reduction internal fixation (ORIF). METHODS: From 2007 to 2018, patients undergoing operative treatment for distal radius fracture were identified in the National Surgical Quality Improvement Program database. Patients were separated into 2 cohorts: non-COPD and COPD patients. In this analysis, thirty-day postoperative complications evaluated included wound, cardiac, pulmonary, renal, thromboembolic, sepsis, mortality, urinary tract infections, postoperative transfusion, extended length of stay, reoperation, and readmission. Bivariate and multivariate analyses were performed. RESULTS: Of 12,424 total patients who underwent operative treatment for distal radius fracture, 11,957 patients (96.2%) did not have a diagnosis of COPD and 467 (3.8%) had COPD. Following adjustment, compared to patients who did not have COPD, those with COPD had an increased risk of any postoperative complications (OR 2.160; p = 0.010), postoperative transfusion requirement (OR 17.437; p = 0.001), extended length of hospital stay greater than 3 days (OR 1.564; p = 0.038), and readmission (OR 2.515; p < 0.001). CONCLUSION: COPD is an independent risk factor for any postoperative complication including transfusions, extended length of stay, and readmission for patients receiving DRF ORIF. Pulmonary evaluation would be a critical step in preoperative management and counseling of these patients before DRF ORIF.

Asphyxia-activated corticocardiac signaling accelerates onset of cardiac arrest.

The mechanism by which the healthy heart and brain die rapidly in the absence of oxygen is not well understood. We performed continuous electrocardiography and electroencephalography in rats undergoing experimental asphyxia and analyzed cortical release of core neurotransmitters, changes in brain and heart electrical activity, and brain-heart connectivity. Asphyxia stimulates a robust and sustained increase of functional and effective cortical connectivity, an immediate increase in cortical release of a large set of neurotransmitters, and a delayed activation of corticocardiac functional and effective connectivity that persists until the onset of ventricular fibrillation. Blocking the brain's autonomic outflow significantly delayed terminal ventricular fibrillation and lengthened the duration of detectable cortical activities despite the continued absence of oxygen. These results demonstrate that asphyxia activates a brainstorm, which accelerates premature death of the heart and the brain.

Trends in utilization of meniscal allograft transplantation between 2010 and 2019.

OBJECTIVES: The aim of this study was to observe the trends in (1) utilization of meniscus allograft transplantation (MAT), (2) demographics and comorbidities of patients undergoing transplants and (3) reimbursements for this procedure between the years of 2010 and 2019. METHODS: Using a national database, patients who underwent MAT were observed. Incidence of MAT, percentage of female patients, average age, and average Charlson comorbidity index (CCI) were analyzed between 2010 and 2019. Average reimbursement during the index and postoperative 90-day bundle period were also calculated from 2010 to 2019. Compound annual growth rate (CAGR) of change in incidence, demographic and reimbursement was calculated, and linear regressionwas conducted for each trends analysis. RESULTS: In total, 744 patients underwent a MAT between the years of 2010 and 2019. The incidence of MAT increased from 0.12 per 100,000 to 0.15 per 100,000 during this period but was not statistically significant (p=0.345). There was no significant difference in age (p=0.462) and gender (p=0.831) among the patients, but the average CCI significantly increased from 2010 to 2019 (CAGR: +15.30; p=0.001). The total reimbursement in the index (p=0.451) and 90-day bundle period (p=0.191) did not significantly change from 2010 to 2019. CONCLUSIONS: Although MAT has been shown to be a safe and reliable surgery for the treatment of meniscus deficient knees, the incidence of MAT as well as the population undergoing MAT has minimally increased from 2010 to 2019. Future studies should seek to identify why the utilization of this efficacious surgery has not increased. LEVEL OF EVIDENCE: IV; Descriptive Epidemiology Study.

Anticoagulant Usage After Anterior Cruciate Ligament Reconstruction Is Associated With Increased Rate of Manipulation Under Anesthesia.

BACKGROUND: Arthrofibrosis after anterior cruciate ligament reconstruction (ACLR) is a notable but uncommon complication of ACLR. To improve range of motion after ACLR, aggressive physical therapy, arthroscopic/open lysis of adhesions, and revision surgery are currently used. Manipulation under anesthesia (MUA) is also a reasonable choice for an appropriate subset of patients with inadequate range of motion after ACLR. Recently, the correlation between anticoagulant usage and arthrofibrosis after total knee arthroplasty has become an area of interest. The purpose of this study was to determine whether anticoagulant use has a similar effect on the incidence of MUA after ACLR. METHODS: The Mariner data set of the PearlDiver database was used to conduct this retrospective cohort study. Patients with an isolated ACLR were identified by using Current Procedural Terminology codes. Patients were then stratified by MUA within 2 years of ACLR, and the use of postoperative anticoagulation was identified. In addition, patient demographics, medical comorbidities, and timing of ACLR were recorded. Univariate and multivariable analyses were used to model independent risk factors for MUA. RESULTS: We identified 216,147 patients who underwent isolated ACLR. Of these patients, 3,494 (1.62%) underwent MUA within 2 years. Patients who were on anticoagulants after ACLR were more likely to require an MUA (odds ratio [OR]: 2.181; P < 0.001), specifically low-molecular-weight heparin (OR: 2.651; P < 0.001), warfarin (OR: 1.529; P < 0.001), and direct factor Xa inhibitors (OR: 1.957; P < 0.001). DISCUSSION: In conclusion, arthrofibrosis after ACLR is associated with the use of preoperative or postoperative thromboprophylaxis. Healthcare providers should be aware of increased stiffness among these patients and treat them aggressively.

Racial Disparities in Outcomes Following Open Treatment of Pediatric Femoral Shaft Fractures.

Introduction Femoral shaft fractures are a common pediatric injury that can require non-operative or operative management. Several studies have shown that race impacts pain management and a number of emergency department visits in the pediatric femur fracture population. This study aimed to investigate any association between pediatric patient race and number of comorbidities, 30-day postoperative outcomes, and length of stay following open surgical treatment of femoral shaft fractures. Methods Pediatric patients who underwent open treatment of femoral shaft fracture were identified in the National Surgical Quality Improvement Program-Pediatric database from 2012-2019. Patients were categorized into two cohorts: White and underrepresented minority (URM). URM groups included Black or African American, Hispanic, Native American or Alaskan, and Native Hawaiian or Pacific Islander. Demographics, comorbidities, and postoperative complications were compared using bivariate and multivariable regression analyses. Results Of the 5,284 pediatric patients who underwent open treatment of femoral shaft fracture, 3,650 (69.1%) were White, and 1,634 (30.9%) were URM. Compared to White patients, URM patients were more likely to have a higher American Society of Anesthesiologists score (p=0.012), more likely to have pulmonary comorbidities (p=0.005), require preoperative blood transfusion (p=0.006), and have an increased risk of prolonged hospital stay (OR 2.36; p=0.007). Conclusion Pediatric URM patients undergoing open treatment of femoral shaft fractures have an increased risk of extended hospital stay postoperatively compared to White patients. As the racial and ethnic constitution of the pediatric population changes, understanding racial and ethnic health disparities will be crucial to providing equitable care to all patients.

Neural network prediction of 30-day mortality following primary total hip arthroplasty.

PURPOSE: The purpose is to utilize an artificial neural network (ANN) model to determine the most important variables in predicting mortality following total hip arthroplasty (THA). METHODS: Patients that underwent primary THA were included from a national database. Demographic, preoperative, and intraoperative variables were analyzed based on their contribution to 30-day mortality with the use of an ANN model. RESULTS: The five most important factors in predicting mortality following THA were preoperative international normalized ratio, age, body mass index, operative time, and preoperative hematocrit. CONCLUSION: ANN modeling represents a novel approach to determining perioperative factors that predict mortality following THA.

Deep Vein Thrombosis after Cement Intravasation during Hip Hemiarthroplasty.

Cement intravasation occurs in hemiarthroplasty when pressurization of cement through the medullary canal backflows through the nutrient vessels. This case report describes a 70-year-old woman who underwent hip hemiarthroplasty for a displaced left femoral neck fracture. Postoperative radiographs demonstrated radio-opacity consistent with local cement intravasation. A Doppler ultrasound study subsequently revealed a mobile thrombus at the confluence of the femoral and profunda femoris veins, as well as a nonmobile thrombus within the profunda femoris vein. The more proximal thrombus was determined to be cement that had intravasated during the index operation. The cement likely impeded venous flow, ultimately leading to the development of deep vein thrombosis just distal to the site of cement occlusion.