A Novel Machine Learning Model to Predict Revision ACL Reconstruction Failure in the MARS Cohort.

Background: As machine learning becomes increasingly utilized in orthopaedic clinical research, the application of machine learning methodology to cohort data from the Multicenter ACL Revision Study (MARS) presents a valuable opportunity to translate data into patient-specific insights.

Purpose: To apply novel machine learning methodology to MARS cohort data to determine a predictive model of revision anterior cruciate ligament reconstruction (rACLR) graft failure and features most predictive of failure.

Study Design: Cohort study; Level of evidence, 3.

Angiotensin II receptor blockers and their applications in orthopaedic surgery and musculoskeletal medicine.

Angiotensin II receptor blockers (ARBs) are commonly prescribed for hypertension and heart failure, and have well-described antifibrotic properties throughout medical literature. The etiology and pathogenesis of fibrosis is biologically complex with a multitude of factors playing a role in the process. Consequently, pathologic fibrosis may be significant within orthopaedics contributing to post-operative stiffness and, ultimately, negative patient outcomes.

Surgical Predictors of Clinical Outcome 6 Years After Revision ACL Reconstruction.

Background: Revision anterior cruciate ligament (ACL) reconstruction has been documented to have inferior outcomes compared with primary ACL reconstruction. The reasons why remain unknown.

Purpose: To determine whether surgical factors performed at the time of revision ACL reconstruction can influence a patient's outcome at 6-year follow-up.

Surgical management of glenohumeral instability in patients with Ehlers-Danlos syndrome/hypermobility spectrum disorder and their risk of reoperation.

Background: This study aims to characterize the types of procedures performed on patients previously diagnosed with Ehlers-Danlos syndrome (EDS)/hypermobility spectrum disorder (HSD) and investigate rates of revision surgery following open, arthroscopic, or bony stabilization procedures in patients with and without a preoperative diagnosis of EDS/HSD.

Methods: This is a retrospective comparative study utilizing a large nationwide claims database. Records were queried between January 2011 and December 2021 for patients undergoing surgical management for glenohumeral instability using Current Procedural Terminology codes.

Predictors of Anterior Cruciate Ligament Tears in Adolescents and Young Adults.

Background: Anterior cruciate ligament (ACL) injury in youth can lead to expensive treatment, lengthy rehabilitation, and long-term impairment. Injuries to the ACL are more common in adolescents who participate in organized sports.

Purpose: To examine whether there is an association between age, physical activity patterns, pubertal timing (Tanner stage), or body mass index (obesity/overweight status) and the risk of developing an ACL injury in youth.

Artificial Intelligence Large Language Models Address Anterior Cruciate Ligament Reconstruction: Superior Clarity and Completeness by Gemini Compared With ChatGPT-4 in Response to American Academy of Orthopaedic Surgeons Clinical Practice Guidelines.

Purpose: To assess the ability of ChatGPT-4 and Gemini to generate accurate and relevant responses to the 2022 American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines (CPG) for anterior cruciate ligament reconstruction (ACLR).

Methods: Responses from ChatGPT-4 and Gemini to prompts derived from all 15 AAOS guidelines were evaluated by 7 fellowship-trained orthopaedic sports medicine surgeons using a structured questionnaire assessing 5 key characteristics on a scale from 1 to 5. The prompts were categorized into 3 areas: diagnosis and preoperative management, surgical timing and technique, and rehabilitation and prevention.

Epidemiology of Testicular Trauma in Sports: Analysis of the National Electronic Injury Surveillance System Database.

Background: The epidemiology of testicular trauma in sports on a national scale has not been well studied. Timely management and treatment after testicular trauma is critical to avoid serious, long-term ramifications of mismanagement.

Objective: The aim was to analyze trends in sports-related testicular trauma based on specific sports and patient demographic characteristics over time.

Biomechanics and Pathoanatomy of Posterior Shoulder Instability.

Posterior glenohumeral instability represents a wide spectrum of pathoanatomic processes. A key consideration is the interplay between the posterior capsulolabral complex and the osseous anatomy of the glenoid and humeral head. Stability is dependent upon both the presence of soft tissue pathology (eg, tears to the posteroinferior labrum or posterior band of the inferior glenohumeral ligament, glenoid bone loss, reverse Hill Sachs lesions, and pathologic glenoid retroversion or dysplasia) and dynamic stabilizing forces.

The Statistical Fragility of Lateral Extra-articular Tenodesis Research: A Systematic Review.

Background: A value of <.05 is often used to denote statistical significance; however, in many scenarios, this threshold is vulnerable to a small number of outcome reversals. This study joins a body of studies within the orthopaedic literature that evaluate the statistical fragility of existing research via metrics such as fragility index (FI) and fragility quotient (FQ).

Alpha-2-Macroglobulin Attenuates Posttraumatic Osteoarthritis Cartilage Damage by Inhibiting Inflammatory Pathways With Modified Intra-articular Drilling in a Yucatan Minipig Model.

Background: Posttraumatic osteoarthritis (PTOA) arises secondarily to joint trauma and is driven by catabolic inflammatory pathways. Alpha-2-macroglobulin (αM) is a naturally occurring proteinase inhibitor found in human serum and synovial fluid that binds proteases as well as proinflammatory cytokines involved in the pathogenesis of PTOA.

Purpose: (1) To investigate the therapeutic potential of intra-articular αM injections during the acute stages of PTOA by inhibiting inflammatory pathways driven by the cytokines expressed by the synovium in a large preclinical Yucatan minipig model and (2) to determine if 3 intra-articular αM injections have greater chondroprotective effects compared with 1 intra-articular injection.

Readability and Reliability of Online Information Regarding Patellar Instability.

Background: Assessment of readability and reliability of online resources for orthopedic patients is an area of growing interest, but there is currently limited reporting on this topic for patellar instability (PI) and medial patellofemoral ligament reconstruction (MPFLR).

Methods: Utilizing the Searchresponse.io dataset, we analyzed inquiries related to PI and MPFLR.

Structure and Function Are Not the Same: The Case for Restoring Mechanoreceptor Continuity Following Anterior Cruciate Ligament Injury.

Anterior cruciate ligament (ACL) injury, particularly in increasingly young and active adolescents, continues to pose a clinical challenge with re-injury rates reported as high as 30%. Evidence also suggests that current standard-of-care ACL reconstruction (ACLR) does not mitigate post-traumatic osteoarthritis (PTOA) risk. Bridge- enhanced ACL restoration (BEAR) is a recently developed and tested ACL surgery that promotes primary healing of the native ACL with excellent early results.

Latest Advances in Chondrocyte-Based Cartilage Repair.

Chondrocyte-based cell therapy has been used for more than 30 years and is still considered to be a promising method of cartilage repair despite some limitations. This review introduces the latest developments of four generations of autologous chondrocyte implantation and current autologous chondrocyte products. The regeneration of cartilage from adult chondrocytes is limited by culture-induced dedifferentiation and patient age.

Outcomes of arthroscopic stabilization for posterior shoulder instability: a systematic review.

Background: Posterior shoulder instability makes up approximately 10% of all shoulder instability cases and its diagnosis and treatment is less well understood. Recently, however, there has been increased recognition of posterior instability and posterior stabilization. The purpose of this study was to systematically review the literature to ascertain the outcomes on arthroscopic stabilization of posterior shoulder instability.

Kartogenin Induces Chondrogenesis in Cartilage Progenitor Cells and Attenuates Cell Hypertrophy in Marrow-Derived Stromal Cells.

Introduction: Kartogenin (KGN) is a synthetic small molecule that stimulates chondrogenic cellular differentiation by activating smad-4/5 pathways. KGN has been proposed as a feasible alternative to expensive biologic growth factors, such as transforming growth factor β, which remain under strict regulatory scrutiny when it comes to use in patients.

Method: This study reports the previously unexplored effects of KGN stimulation on cartilage- derived mesenchymal progenitor cells (CPCs), which have been shown to be effective in applications of cell-based musculoskeletal tissue regeneration.

Management of Bone Loss in Posterior Glenohumeral Shoulder Instability: Current Concepts.

» Posterior glenohumeral instability is relatively uncommon compared with anterior instability, but is becoming an increasingly recognized and surgically managed shoulder pathology.» Soft-tissue stabilization alone may not be sufficient in patients who present with substantial bone loss to the posterior glenoid and/or the anterior humeral head.» For posterior glenoid defects, posterior glenoid osteoarticular augmentation can be used, and posterior glenoid opening wedge osteotomy can be considered in cases of posterior instability with pathologic retroversion.

Open treatment of posterior glenoid bone loss and bipolar bone loss.

Posterior glenohumeral instability is an increasingly common and challenging orthopaedic problem. While an arthroscopic soft tissue stabilization procedure (i.e.

Preoperative planning with three-dimensional CT vs. three-dimensional magnetic resonance imaging does not change surgical management for shoulder instability.

Background: This study aims to determine the effect of time and imaging modality (three-dimensional (3D) CT vs. 3D magnetic resonance imaging (MRI)) on the surgical procedure indicated for shoulder instability. The hypothesis is there will be no clinical difference in procedure selection between time and imaging modality.