Anterior Cruciate Ligament Reconstruction Basics: Quadriceps Tendon (All-Soft Tissue) Autograft Preparation-Part 2.

Anterior cruciate ligament reconstruction with quadriceps tendon autograft is a reliable graft option that has recently increased in use. Varying harvesting and graft preparation techniques available and improved technology and implant design continue to make quadricep tendon preparation more efficient and reproducible. In this Technical Note, we describe our preferred technique for all-soft tissue quadriceps tendon autograft preparation after harvest for anterior cruciate ligament reconstruction.

Anterior Cruciate Ligament Reconstruction Basics: Quadriceps Tendon (All-Soft Tissue) Autograft Harvest-Part 1.

Anterior cruciate ligament reconstruction with quadriceps tendon autograft has become increasingly popular for primary and revision anterior cruciate ligament reconstruction surgery. Although there are a variety of techniques available for performing quadriceps tendon autograft harvest for anterior cruciate ligament reconstruction, a minimally invasive, all-soft tissue harvest technique can result in a reproducible, reliable graft while minimizing donor-site morbidity. In this Technical Note, we describe our preferred technique for quadriceps tendon autograft harvest for anterior cruciate ligament reconstruction.

Navigating the Orthopaedic Maze as a New Patient: A National Mystery Caller Study on Medicaid Coverage and Access to Specialized Surgeons.

Introduction: Medicaid coverage is associated with longer appointment wait times, decreased access to care, and poorer health outcomes compared with private insurance across medical subspecialties. The purpose of this study was to evaluate new patient appointment wait times for subspecialty Orthopaedic care based on insurance type and to identify factors influencing these wait times.

Methods: Orthopaedic physicians were identified using the American Academy of Orthopaedic Surgeons patient-facing database in the fields of Adult Reconstruction, Foot and Ankle, Hand, Sports Medicine, Spine, Pediatric, and General Orthopaedic surgery.

Evolving cartilage strain with pain progression and gait: a longitudinal study post-ACL reconstruction at six and twelve months.

Background: Anterior cruciate ligament (ACL) injuries are prevalent musculoskeletal conditions often resulting in long-term degenerative outcomes such as osteoarthritis (OA). Despite surgical advances in ACL reconstruction, a significant number of patients develop OA within ten years post-surgery, providing a patient population that may present early markers of cartilage degeneration detectable using noninvasive imaging.

Purpose: This study aims to investigate the temporal evolution of cartilage strain and relaxometry post-ACL reconstruction using displacement under applied loading MRI and quantitative MRI.

Tibial Tubercle Osteotomy: Indications, Outcomes, and Complications.

Purpose Of Review: The tibial tubercle osteotomy (TTO) is a versatile surgical technique used to treat a range of patellofemoral disorders, including patellar instability, painful malalignment, focal chondral defects, and patellar maltracking that have failed conservative therapies. TTO is a personalized procedure that can be tailored to the pathoanatomy of the patient based on physical examination and imaging. The complication rate associated with TTO strongly depends on the indication for surgery, the severity of the patient's condition, and the surgical approach.

Tibial Spine Avulsion Fracture Fixation Using a Re-tensionable All-Suture Construct.

Tibial spine avulsion injuries, including fractures, are a variant of anterior cruciate ligament injuries. Treatment historically consisted of open reduction and internal fixation of the avulsion fracture, with anterior cruciate ligament reconstruction considered in cases of failed open reduction and internal fixation or residual laxity. However, improved instrumentation has led to the advancement of various arthroscopic techniques for addressing these injuries.

Posterior Meniscus Root Repair Using a Retensionable Knotless All-Suture Anchor.

Meniscus root injuries lead to increased tibiofemoral contact pressures and rapid progression of osteoarthritis. Early recognition and treatment with a meniscal root repair can restore biomechanics and help preserve the joint. The transtibial pullout repair and suture anchor repair are the most commonly used techniques to achieve anatomic fixation of the meniscal root.

Frontline perspectives on barriers to care for patients with California Medicaid: a qualitative study.

Background: While insurance is integral for accessing healthcare in the US, coverage alone may not ensure access, especially for those publicly insured. Access barriers for Medicaid-insured patients are rooted in social drivers of health, insurance complexities in the setting of managed care plans, and federal- and state-level policies. Elucidating barriers at the health system level may reveal opportunities for sustainable solutions.

MRI-derived Articular Cartilage Strains Predict Patient-Reported Outcomes Six Months Post Anterior Cruciate Ligament Reconstruction.

Key Terms: Multicontrast and Multiparametric, Magnetic Resonance Imaging, Osteoarthritis, Functional Biomechanical Imaging, Knee Joint Degeneration dualMRI has been used to quantify strains in a healthy human population and in cartilage explant models. Previously, OA severity, as determined by histology, has been positively correlated to increased shear and transverse strains in cartilage explants. This is the first use of dualMRI in a participant demographic post-ACL reconstruction and at risk for developing osteoarthritis.

Anterior Cruciate Ligament Repair Using a Re-tensionable All-Suture Construct.

Anterior cruciate ligament (ACL) tears are among the most common injuries to the knee. With recent improvements in imaging that allow for more precise identification of ACL tear patterns, improved techniques for repair, and advancements in biological augmentation, there has been a re-emerging interest in primary ACL repair, especially for acute proximal ACL tears. This article aims to describe a surgical technique for primary ACL repair using a re-tensionable all-suture-based construct.

Editorial Commentary: Meniscus Repair Technique Must Be Determined on a Tear-by-Tear Basis: Hybrid Techniques Plus Biologics Are Optimal.

Bucket-handle meniscus tears alter knee biomechanics and significantly elevate the risk of osteoarthritis when the tissue is not preserved. Consequentially, meniscus repair is preferred whenever possible to optimize load distribution and knee stability, with the overall goal of joint preservation. Bucket-handle meniscus tears have a higher rate of repair failure compared with many other tear patterns, and both the inside-out (IO) and all-inside (AI) techniques are acceptable options, each with distinct advantages and disadvantages.

Preparing for and Executing the Ideal Posterior Labral Repair.

Posterior labral tears are a source of pain and instability of the shoulder. Despite being relatively uncommon (reported in approximately 10% of instability cases), the incidence of posterior labral tear is increasingly recognized as underestimated in highly active populations. Posterior labral tears can result from a traumatic posterior dislocation or repetitive microtrauma, leading to posterior chondral/labral attrition.

Arthroscopic Repair and Reconstruction of Coracoclavicular Ligament.

Acromioclavicular joint separations are common shoulder injuries that require prompt recognition, diagnosis, and treatment. Deciding on a treatment algorithm relies on a detailed knowledge of anatomy and a thorough understanding of the specific functional demands of the patient in question. When a repair or reconstruction is indicated, arthroscopic assistance can be a helpful tool to ensure a safe, anatomic reconstruction that minimizes morbidity and maximizes the potential return to high-level function.

Rotator Cuff Repair with Knotless All-Suture Medial Row Anchors and Biceps Autograft Augmentation.

Incomplete healing and/or functional failure following rotator cuff tear repair remains a challenging problem for both patients and surgeons. Augmentation strategies are growing to increase healing through biologic and mechanical mechanisms to improve functional results after arthroscopic rotator cuff repair. The majority of currently described augmentation techniques use allograft tissue.

Experts Achieve Consensus on a Majority of Statements Regarding Platelet-Rich Plasma Treatments for Treatment of Musculoskeletal Pathology.

Purpose: To establish consensus statements on platelet-rich plasma (PRP) for the treatment of musculoskeletal pathologies.

Methods: A consensus process on the treatment of PRP using a modified Delphi technique was conducted. Thirty-five orthopaedic surgeons and sports medicine physicians participated in these consensus statements on PRP.

Low-Profile Cartilage Repair With Knotless All-Suture Anchors: Surgical Technique.

Osteochondral and pure chondral lesions of the knee are common after patellar dislocations. There are multiple described techniques for the fixation of these lesions, including metallic screws, bioabsorbable screws, bioabsorbable implants, and suture devices. The purpose of this article is to describe a surgical technique for surgical fixation of a lateral condyle chondral lesion using knotless all-suture anchors, with second-look knee arthroscopy illustrating healing of the cartilage repair.

Posterior Labral Repair Using Knotless "All-Suture" Suture Anchors.

Isolated posterior instability is well described but relatively uncommon, accounting for less than 10% of all shoulder instability cases. When nonoperative management fails, surgical outcomes demonstrate improved patient-reported outcomes with a high level of return to sport. Knotless suture anchor and "all-suture" suture anchor technology are now available and used for instability procedures in the shoulder.

On-Field Sports Emergencies: Preparation and Readiness.

The foundation of preventing and treating an on-field emergency is preparation and readiness. The sideline medical team should coordinate the utilization of an emergency action plan (EAP). A successful EAP is accomplished through attention to detail, rehearsal, and self-assessments.

Physical Therapy for the Treatment of Shoulder Instability.

Shoulder instability is the separation of the humeral head from the glenoid. Injury to the static and dynamic stabilizers can result in instability. Anterior shoulder instability is the predominant form of instability.

Partisan Differences in Legislators' Discussion of Vaccination on Twitter During the COVID-19 Era: Natural Language Processing Analysis.

Background: The COVID-19 era has been characterized by the politicization of health-related topics. This is especially concerning given evidence that politicized discussion of vaccination may contribute to vaccine hesitancy. No research, however, has examined the content and politicization of legislator communication with the public about vaccination during the COVID-19 era.

Association Between Crowdsourced Health Care Facility Ratings and Mortality in US Counties.

Importance: Mortality across US counties varies considerably, from 252 to 1847 deaths per 100 000 people in 2018. Although patient satisfaction with health care is associated with patient- and facility-level health outcomes, the association between health care satisfaction and community-level health outcomes is not known.

Objective: To examine the association between online ratings of health care facilities and mortality across US counties and to identify language specific to 1-star (lowest rating) and 5-star (highest rating) reviews in counties with high vs low mortality.

Comparative Outcomes of Budesonide MMX versus Prednisolone for Ulcerative Colitis: Results from a British Retrospective Multi-Centre Real-World Study.

During the COVID-19 pandemic many IBD units chose Budesonide MMX (Cortiment) as the first-line treatment for flares of ulcerative colitis (UC) in outpatients for its favourable side effect profile. This retrospective study of all UC patients treated with oral steroids between 1 March 2019-30 June 2019 and 1 March 2020-30 June 2020 aimed to compare Cortiment with Prednisolone in routine clinical practice. Outcomes included the need for hospitalisation for acute severe ulcerative colitis, symptoms at four weeks and end of treatment, and the need for rescue Prednisolone.

Online Reviews of Mental Health Treatment Facilities: Narrative Themes Associated With Positive and Negative Ratings.

Objective: Previous studies indicate that patients' satisfaction with mental health care is correlated with both treatment outcomes and quality of life. The aims of this study were to describe online reviews of mental health treatment facilities, including key themes in review content, and to evaluate the correlation between narrative review themes, facility characteristics, and review ratings.

Methods: United States National Mental Health Services Survey (N-MHSS) facilities were linked to corresponding Yelp pages, created between March 2007 and September 2019.

Changes in legislator vaccine-engagement on Twitter before and after the arrival of the COVID-19 pandemic.

Widespread SARS-CoV-2 vaccine uptake will be critical to resolution of the COVID-19 pandemic. Politicians have the potential to impact vaccine sentiment and uptake through vaccine-related communication with the public. We used tweets (n = 6,201), abstracted from Quorum, a public affairs software platform, to examine changes in the frequency of vaccine-related communication by legislators on the social media platform, Twitter.

Who is Biking for? Urban Bikeshare Networks' Responses to the COVID-19 Pandemic, Disparities in Bikeshare Access, and a Way Forward.

Black, Latinx, and Indigenous people have contracted the SARS-CoV-2 virus and died of COVID-19 at higher rates than White people. Individuals rated public transit, taxis, and ride-hailing as the modes of transportation putting them at greatest risk of COVID-19 infection. Cycling may thus be an attractive alternative for commuting.