Publications by authors named "Bruce A Levy"

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.

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A small degree of increased varus laxity in acute anterior cruciate ligament (ACL)-disrupted knees often can be discovered on initial examination. Why this occurs is not always clear and is usually thought to be related to some degree of fibular collateral ligament injury. However, there may be another structure that demands our attention in an ACL-deficient knee with more laxity than isolated ACL injuries but less laxity than combined ACL and fibular collateral ligament injuries.

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Article Synopsis
  • The study analyzes the evolution and trends of hip arthroscopy procedures at three academic centers in the U.S. from 1988 to 2022.
  • Over the years, the annual number of surgeries dramatically increased from an average of 3.2 per year (1988-2008) to 285.9 per year (2016-2022), reflecting a growing acceptance of the procedure.
  • Key surgical techniques evolved, with a shift from primarily debridement (100%) in the early years to a predominance of labral repair (94%) and significant increases in cam resection (up to 86.9%) and capsular repair (up to 81%) by 2022.
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Background: Arthroscopic diagnosis and treatment of femoroacetabular pathology has experienced significant growth in the last 30 years; nevertheless, reduced utilization of orthopaedic procedures has been observed among the underrepresented population.

Purpose/hypothesis: The purpose of this study was to examine racial differences in case incidence rates, outcomes, and complications in patients undergoing hip arthroscopy. It was hypothesized that racial and ethnic minority patients would undergo hip arthroscopy at a decreased rate compared with their White counterparts but that there would be no differences in clinical outcomes.

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  • Previous research shows that repairing medial meniscus posterior root tears (MMPRTs) is more beneficial than just trimming the tissue (debridement), especially in terms of patient satisfaction and costs over time.
  • This study followed 26 patients who had partial meniscectomy for MMPRTs for at least 10 years to assess their long-term recovery and the likelihood of needing total knee replacement (TKA).
  • Results indicated that 72% of patients eventually needed TKA and 96% experienced poor outcomes, highlighting the challenges of managing MMPRTs with partial meniscectomy.
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Combined anterior cruciate ligament/medial collateral ligament (ACL/MCL) injuries are relatively common, and multiple factors are involved in surgical decision-making, particularly when it comes to the MCL. Historically, most surgeons treated the MCL conservatively and performed staged MCL reconstruction after MCL reconstruction only if there was persistent medial instability. This was followed by a nonoperative approach for the MCL (when reconstructing the ACL) unless there was evidence of extreme (grade III or >1 cm) valgus instability, valgus malalignment, or mid-substance or tibial-sided injury, avulsion, or Stener lesion.

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Article Synopsis
  • The study aimed to evaluate the outcomes and reoperation rates of arthroscopic iliopsoas release after total hip arthroplasty (THA) at two medical institutions, focusing on patient-reported outcomes (PROs).
  • A total of 60 hips from 58 patients were reviewed, revealing that 77% of patients experienced improvements in their condition, with notable pain reduction and increased hip flexion strength.
  • The findings indicated that while surgery satisfaction was relatively high (7.2 out of 10), there was no significant correlation between the preoperative acetabular component overhang and postoperative outcomes.
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Background: Patients with isolated anterior cruciate ligament (ACL) reconstruction have demonstrated an increased risk of ACL graft failure and lower patient-reported outcome (PRO) scores when increased posterior tibial slope (PTS) is present. However, there is a paucity of literature evaluating the effect of PTS on outcomes after combined bicruciate multiligamentous knee reconstruction.

Purpose: To determine whether differences exist for graft failure rates or PRO scores based on PTS after combined bicruciate multiligamentous knee reconstruction.

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Capsular management in hip arthroscopy has recently become a popular topic in the literature. Various approaches have been developed around the critical balance between safe and satisfactory exposure while maintaining hip joint stability and the restoration of capsular integrity at the conclusion of the case. Advocates for capsular closure recognize the role of the capsule in providing hip joint stability and aim to reestablish normal hip biomechanics through capsule preservation.

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Article Synopsis
  • The study investigates how increased posterior tibial slope (PTS) affects knee stability and outcomes after posterior cruciate ligament reconstruction (PCLR) in patients without prior anterior cruciate ligament reconstruction (ACLR).
  • Researchers hypothesized that higher PTS would correlate with less knee laxity, fewer graft failures, and improved patient-reported outcome (PRO) scores.
  • Analysis of 37 knees showed no significant correlation between PTS and PRO scores, with 32.4% of knees experiencing positive posterior drawer tests, but the difference in PTS between those with and without positive tests was not statistically significant.
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Background: Osteochondral allograft transplantation (OCAT) is an accepted knee joint-preserving treatment strategy for focal osteochondral lesions that is often conducted in combination with meniscal allograft transplantation (MAT). Despite its frequent and simultaneous utilization, there remains a lack in the literature reporting on outcomes and failure rates after concomitant procedures.

Purpose: To determine (1) the midterm clinical success rate after OCAT+MAT in comparison with a matched-pair cohort undergoing isolated OCAT, (2) whether patient-specific and procedural variables influence the risk of failure, and (3) patient-reported outcome measures over time.

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Background: Hip arthroscopy is rapidly advancing, with positive published outcomes at short- and midterm follow-up; however, available long-term data remain limited.

Purpose: To evaluate outcomes of primary hip arthroscopy at a minimum 10-year follow-up at 2 academic centers by describing patient-reported outcomes and determining reoperation and total hip arthroplasty (THA) rates.

Study Design: Case series; Level of evidence, 4.

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The rise of online platforms like YouTube for health information has prompted scrutiny over the quality of medical/surgical-related video content. Recent research on YouTube videos regarding anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon autograft shows low educational quality and reliability using established assessment tools. Physicians primarily published content, with longer videos, and physician-generated videos, generally correlating with higher quality.

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Article Synopsis
  • * Traditional PCL reconstructions sometimes lead to continuing looseness in the knee, but new research suggests suture tape augmentation could address this issue.
  • * Studies indicate that using suture tape in PCL surgeries can improve stability and recovery, and this method is becoming more popular due to its safety and effectiveness.
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The medial collateral ligament serves as the primary stabilizer to valgus stress on the medial side of the knee and is the most commonly injured ligament in the knee. Medial collateral ligament reconstruction can provide improved stability and clinical outcomes for patients. Advancements in techniques, including the use of an adjustable-length-loop suspensory fixation device through a longitudinal incision, have been introduced in recent years.

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Background: Multiligamentous knee injuries (MLKIs) are devastating injuries with concomitant injuries that complicate treatment and recovery. Short-term studies have shown satisfactory patient outcomes after surgical treatment; however, evaluations of long-term outcomes remain scarce.

Purpose: To evaluate long-term outcomes after surgically reconstructed MLKIs and further investigate the relationship between patient age on clinical outcomes.

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  • Patellar tendon grafts are popular in the U.S. for ACL reconstruction, but hamstring autografts are preferred worldwide due to their benefits.
  • Advantages of hamstring grafts include easy and quick harvesting, lower complications, smoother rehabilitation, and less pain compared to patellar tendon grafts.
  • Traditionally, both the semitendinosus and gracilis tendons are harvested, but recent studies show no significant difference in recovery outcomes whether one or both tendons are used.
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  • Iliopsoas tendinitis can occur after total hip replacement, especially if the acetabular cup is positioned incorrectly, leading to anterior overhang.
  • In cases with severe misalignment, revision surgery is usually recommended, but even slight overhang can cause pain and issues for many patients.
  • An innovative arthroscopic method using an iliopsoas air bursogram allows for safe tendon lengthening, minimizing risks to surrounding nerves and blood vessels.
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Background: Meniscal allograft transplantation (MAT) is an accepted and effective treatment option in the context of unsalvageable menisci, particularly in young and active patients. It has been shown to reduce pain and improve knee function in previously symptomatic patients. However, there is still limited knowledge about the long-term survival rates of allografts, the durability of clinical results, and the influence of patient-specific parameters, such as leg alignment, tibial slope, and preoperative International Cartilage Regeneration & Joint Preservation Society (ICRS) grade.

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Background: Recently, the posterior horn lateral meniscal oblique radial tear (LMORT) was identified in 12% of acute anterior cruciate ligament (ACL) injuries. However, patient-reported outcomes for repair of this relatively common tear have not been reported.

Purpose: To determine the minimum 2-year functional outcomes after LMORT repair at the time of ACL reconstruction (ACLR) compared to a matched cohort of patients who underwent isolated ACLR (iACLR).

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Background: Little is known about the specific risk of knee injuries due to trampoline accidents in adults compared with children.

Purpose: To investigate the differences in trampoline-related knee injuries between children and adults and identify risk factors and protective strategies to reduce injury incidence.

Study Design: Cross-sectional study; Level of evidence, 3.

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Objective: Randomized controlled trials (RCTs) are a gold standard for estimating the benefits of clinical interventions, but their decision-making utility can be limited by relatively short follow-up time. Longer-term follow-up of RCT participants is essential to support treatment decisions. However, as time from randomization accrues, loss to follow-up and competing events can introduce biases and require covariate adjustment even for intention-to-treat effects.

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