The evolution of anesthetic management for total knee arthroplasty (TKA) patients: A hospital network experience.

Introduction: In the face of an ongoing opioid epidemic and an aging population, the utilization of a successful multimodal pain regimen in patients undergoing total knee arthroplasty (TKA) is vital. This study looks to explore the effect of different types of anesthesia in addition to a multimodal pain regimen on post-operative outcomes after undergoing TKA.

Materials And Methods: From January 2016 to December 2022, 783 charts of patients undergoing an elective TKA were reviewed.

A Biological Spacer to Treat Irreparable Rotator Cuff Tears: A Biomechanical Study Utilizing a Secured Versus Unsecured Tensor Fascia Lata Graft.

Background: Designed to help treat pain and loss of function after rotator cuff repair, allograft spacer procedures utilize a graft to act as a spacer in the subacromial space, decreasing pain from impingement of the greater tuberosity on the acromion at the extremes of overhead motion.

Purpose: To evaluate the biomechanical characteristics of secured versus unsecured tensor fascia lata allografts used in an allograft spacer procedure.

Study Design: Controlled laboratory study.

Accuracy of machine learning to predict the outcomes of shoulder arthroplasty: a systematic review.

Background: Artificial intelligence (AI) uses computer systems to simulate cognitive capacities to accomplish goals like problem-solving and decision-making. Machine learning (ML), a branch of AI, makes algorithms find connections between preset variables, thereby producing prediction models. ML can aid shoulder surgeons in determining which patients may be susceptible to worse outcomes and complications following shoulder arthroplasty (SA) and align patient expectations following SA.

Comparative analysis of acute blood loss anemia in robotic assisted vs. manual instrumented total knee arthroplasty.

Introduction: Robotic assisted total knee arthroplasty has become an increasingly popular technique over the past several years. Manual total knee arthroplasty can be associated with acute blood loss anemia. Instrumentation of the femoral canal with the alignment guide may in part contribute to this blood loss.

Performance-Based Outcomes after Revision Ulnar Collateral Ligament Surgery in Professional Pitchers.

Objective: To compare performance in baseball pitchers before and after revision ulnar collateral ligament (UCL) surgery using performance metrics.

Design: Case series.

Setting: Public online database.

Perceptions of Orthopaedic Sports Medicine Surgeons About Medical Cannabidiol Use: A Survey Study.

Introduction: Multiple studies exist identifying cannabidiol (CBD) as an effective part of an orthopaedic patient's pain regimen; however, there is a paucity of studies elucidating orthopaedic surgeons' perception of the use and prescription of CBD in the medical setting. This study surveys orthopaedic sports medicine surgeons about their previous education on and current perceptions and usage of CBD in their medical practice.

Methods: Between April 2023 and July 2023, orthopaedic sports medicine surgeons from across the country were surveyed.

Physician Trainees' Perception of Cannabidiol Use in Medicine: A Survey Study.

Purpose: Given the ongoing national opiate crisis, physicians have been challenged with mitigating the risk of opiate dependence in their patients. With current physician efforts to mitigate the risks of treating pain with opioid prescriptions, this study evaluates medical students' and residents' understanding and perceptions regarding cannabidiol (CBD) in current medical care and their future medical practice.

Methods: Orthopedic residents from all American programs and medical students from 50 medical schools, regardless of training year or future specialty plans, were eligible to participate in this survey-based study administered from December 2022 to March 2023.

A High Rate of Bacteriologic Culture-Positive Findings Is Seen After Revision Rotator Cuff Surgery.

Purpose: To determine the incidence of subclinical infections in patients undergoing revision arthroscopic rotator cuff repair and identify any risk factors for developing these infections.

Methods: Patients who underwent revision surgery by the senior author between January 2012 and December 2022 after a previous rotator cuff surgery were identified. All patients undergoing an open or arthroscopic revision of their previous rotator cuff surgery were included.

The incidence of subclinical infection in patients undergoing revision shoulder stabilization surgery: a retrospective chart review.

Background: Shoulder instability continues to be a common problem that is difficult to treat. Part of this difficulty can be attributed to the numerous postoperative complications that can impact the clinical course. Our study aims to primarily identify the incidence of subclinical infection in patients undergoing revision shoulder stabilization surgery and secondarily identify any risk factors for developing a subclinical infection.

Outcomes of Endoscopic Carpal Tunnel Release Surgery With Home Guided Hand Therapy Versus No Hand Therapy: A Prospective Randomized Controlled Trial After Endoscopic Carpal Tunnel Release.

Background: The most recent American Academy of Orthopaedic Surgeons Clinical Practice Guidelines found no high-quality evidence comparing home therapy to no therapy following carpal tunnel release surgery (CTRS). Therefore, this study's purpose is to compare the outcomes of patients receiving home therapy and patients receiving no therapy following endoscopic CTRS.

Methods: A single-blinded prospective randomized controlled trial was performed.

Rethinking the 10% strain rule in fracture healing: A distal femur fracture case series.

Since the 1970s, the 2%-10% rule has been used to describe the range of interfragmentary gap closure strains that are conducive for secondary bone healing. Interpreting the available evidence for the association between strain and bone healing remains challenging because interfragmentary strain is impossible to directly measure in vivo. The question of how much strain occurs within and around the fracture gap is also difficult to resolve using bench tests with osteotomy models because these do not reflect the complexity of injury patterns seen in the clinic.

Stabilization of Vancouver B Periprosthetic Femur Fractures With Cerclage Wiring: A Retrospective Chart Review.

Background: While biomechanical and clinical studies detailing the equivalence and, sometimes, the superiority of cerclage wiring fixation compared to plate fixation in select fractures (Vancouver B1 and C) exist, no studies exist detailing outcomes after cerclage wiring fixation in all Vancouver B fracture types. This study explores whether there is a difference in clinical outcomes between Vancouver B fractures fixed with cerclage wiring and those without.

Methods: This retrospective multicenter study reviewed 295 patients from 2007 to 2018 with periprosthetic femur fractures.

Biomechanical properties of common graft choices for anterior cruciate ligament reconstruction: A systematic review.

Background: This systematic review explores the differences in the intrinsic biomechanical properties of different graft sources used in anterior cruciate ligament (ACL) reconstruction as tested in a laboratory setting.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two authors conducted a systematic review exploring the biomechanical properties of ACL graft sources (querying PubMed, Cochrane, and Embase databases). Using the keywords "anterior cruciate ligament graft," "biomechanics," and "biomechanical testing," relevant articles of any level of evidence were identified as eligible and included if they reported on the biomechanical properties of skeletally immature or mature ACL grafts solely and if the grafts were studied in vitro, in isolation, and under similar testing conditions.

Liposomal Bupivacaine in Adductor Canal Blocks Before Total Knee Arthroplasty Leads to Improved Postoperative Outcomes: A Randomized Controlled Trial.

Background: This study compares the use of liposomal bupivacaine (Exparel) versus ropivacaine in adductor canal blocks (ACB) before total knee arthroplasties (TKAs).

Methods: From the months of April 2020 to September 2021, 147 patients undergoing unilateral primary TKA were asked to participate in this prospective, double-blinded randomized controlled trial. Each patient received an iPACK block utilizing ropivacaine and was additionally randomized to receive an ACB with Exparel or Ropivacaine.

The effect of COVID-19 on adult traumatic orthopedic injuries: a database study.

Purpose: This study compares orthopedic injuries, procedures, and hospital outcomes of patients presenting to trauma centers in Pennsylvania before and during the COVID-19 pandemic.

Methods: A retrospective review of adult patients presenting to hospitals with Pennsylvania Trauma Systems Foundation (PTSF) designations was performed. All patients 18 years of age and older who presented with orthopedic injuries were included.

Flexible Flat Foot, Short Tendo-Achilles, and Altered Gait.

Background Pediatric patients often present with vague complaints involving the anterolateral foot and ankle, the medial knee, the lower back, and the hip. In our experience, closer examination of these patients reveals a constellation of symptoms that involve pathology in the ankle, knee, back, and hip. This study aimed to detail the identification and treatment of patients with the triad of flexible flat feet, tight Achilles complex, and altered gait, and their clinical course over time.

Bone density and its relation to the development of acromial stress fracture following reverse total shoulder arthroplasty.

Background: Postoperative acromial stress fracture is a troublesome postoperative complication after reverse shoulder arthroplasty. Our study aims to utilize routinely performed preoperative computed tomography scans to identify differences in the material properties of the acromion in patients who did and did not develop a postoperative acromial stress fracture.

Methods: Treatment records and computed tomography scans for 99 reverse shoulder arthroplasties were collected.

Boundary Conditions Matter-Impact of Test Setup on Inferred Construct Mechanics in Plated Distal Femur Osteotomies.

The mechanics of distal femur fracture fixation has been widely studied in bench tests that employ a variety of approaches for holding and constraining femurs to apply loads. No standard test methods have been adopted for these tests and the impact of test setup on inferred construct mechanics has not been reported. Accordingly, the purpose of this study was to use finite element models to compare the mechanical performance of a supracondylar osteotomy with lateral plating under conditions that replicate several common bench test methods.

The Effect of COVID-19 on Pediatric Traumatic Orthopaedic Injuries: A Database Study.

Introduction: Stay-at-home orders and other social distancing restrictions had a profound effect on the lives of children during the pandemic. This study characterizes pediatric orthopaedic injuries and in-hospital outcomes during the COVID-19 pandemic and compares them with pre-COVID patterns.

Methods: A retrospective review of pediatric patients presenting to hospitals with Pennsylvania Trauma Systems Foundation designations was performed.

Surgical timing for torsional ankle fractures is not associated with post-operative complications in patients with type II diabetes mellitus.

Introduction: Surgical stabilization of ankle fractures is one of the most commonly performed procedures in orthopedics, but these injuries can prove difficult to manage in patients with type II diabetes mellitus (DMII). The goal of this study is to determine if a correlation exists between surgical timing and complication rates among diabetic patients with ankle fractures.

Methods: This is a retrospective case-control study spanning from 2012 to 2019 including patients with DMII undergoing operative fixation for ankle fractures.

The role of acromial morphometry in the development of acromial stress fracture following reverse total shoulder arthroplasty.

Background: Indications for reverse total shoulder arthroplasty are expanding, and postoperative acromial stress fractures are a troubling postoperative complication. The purpose of this study was to determine if differences in acromial morphometry were present between cohorts with and without this complication.

Methods: A retrospective review of 101 reverse total shoulder arthroplasty procedures met criteria for the study.