Losartan May Prevent Clinically Significant Postoperative Fibrosis, But Large Database Studies May Not Provide an Answer.

Losartan and other modulators of the Renin-Angiotensin System (RAS) have been used for their anti-fibrotic effects by non-surgeons for decades where suppression of maladaptive scar deposition is helpful, such as heart failure and chronic kidney disease. Only recently have orthopaedic surgeons begun to explore whether these medications might reduce or prevent post-operative joint stiffness. The relationship between orthopaedic surgeons and fibrosis is a more complicated.

Evaluating Failure Rates of Primary Quadriceps Tendon Repairs Across Different Surgical Techniques.

Background: Quadriceps tendon ruptures occur infrequently in the general population. Biomechanical data suggest advantages with the use of suture anchor fixation for major tendon repair. Clinical studies of quadriceps tendon repair have been limited to small case series.

Editorial Commentary: Biomedical Research Investigating Artificial Intelligence Large Language Models Needs to Move Beyond Measuring Accuracy and Focus on Improving Patient Care.

Orthopaedic surgeons are fascinated with artificial intelligence (AI). Since the release of ChatGPT to the general public on November 30, 2022, there have been a flurry of articles regarding use of large language models (LLMs) in our field. Most of these revolve around the accuracy of the models regarding orthopaedic topics (spoiler alert: the accuracy is good, yet unreliable, but improving).

The inferior sacral iliac line as a horizontal reference plane in paediatric pelvic radiographs.

Background: While often used, Hilgenreiner's line may not always be a reliable reference plane following triple innominate pelvic osteotomy or trauma to the triradiate cartilage. The inferior sacral-iliac line is a horizontal line connecting the sclerotic corners of the inferior sacral-iliac joints. This is a consistent landmark in the ossifying infant pelvis as well as the fully developed adult pelvis.

Low Tensile Strength Suture With Transosseous Tunnels and Suture Anchors 5 mm in Diameter or Greater Are Associated With Higher Failure Rates in Primary Patellar Tendon Repair.

Purpose: To determine the rate of and risk factors for clinical failure and return to military duty following primary patellar tendon repair with either transosseous trunnel repair or suture anchor repair.

Methods: The Military Health System Data Repository (MDR) was queried to identify all adult patients undergoing surgical treatment of a patellar tendon rupture in the Military Health System from 2014 to 2018. Patients who underwent either transosseous tunnel repair or suture anchor repair were included.

Disparities in Demographics in Hip Arthroplasty Between U.S. Active Duty Military and the ACS-NSQIP Clinical Registry.

Introduction: Patient demographics, such as sex and age, are known risk factors for undergoing revision following primary total hip arthroplasty (THA). The military population is unique because of the increased rates of primary and secondary osteoarthritis of the hip. Treatment options are limited for returning patients to their line of duty; however, THA has been shown to be an effective option.

Editorial Commentary: Endoscopic Hip Abductor Repair Results in Excellent Outcomes in Challenging Patients: Surgical Indications Require Additional Clarification.

Hip abductor pathology exists on a spectrum, potentially involving symptoms of pain, weakness, loss of active motion, and disordered movement. Imaging findings may include tendinosis, detachment of a portion of the footprint, fluid imbibition with undersurface tearing at the footprint, or full-thickness detachment of 1 or both tendons with or without evidence of fatty infiltration or atrophy of the associated muscle bellies. Yet, sometimes there are no imaging findings at all.

The Adductor Sling Technique for Pediatric Medial Patellofemoral Ligament Reconstruction Better Resists Dislocation Loads When Compared With Adductor Transfer at Time Zero in a Cadaveric Model.

Purpose: To characterize the ability of the intact medial patellofemoral ligament (MPFL) and the adductor transfer and adductor sling MPFL reconstruction techniques to resist subluxation and dislocation in a cadaveric model.

Methods: Nine fresh-frozen cadaveric knees were placed on a custom testing fixture with the femur fixed parallel to the floor, the tibia placed in 20° of flexion, and the patella attached to a load cell. The patella was displaced laterally, and subluxation load (in newtons), dislocation load (in newtons), maximum failure load (in newtons), patellar displacement at failure, and mode of failure were recorded.

A Lack of Generalizability-Total Knee Demographics in the Active Duty Population.

Introduction: Age and sex are known demographic risk factors for requiring revision surgery following primary total knee arthroplasty (TKA). Military service members are a unique population with barriers to long-term follow up after surgery. This study aims to compare demographic data between active duty military personnel and a nationwide sample to identify differences that may impact clinical and economic outcomes.

Oral opioid prescribing to active duty US military personnel: a cross-sectional population.

Introduction: While civilian opioid prescriptions have seen a dramatic decline in recent years, there are few studies investigating trends in opioid prescription in the active duty military population. We evaluated oral opioid prescribing patterns to active duty military personnel in the Military Health System (MHS) from 2017 to 2020 to determine the incidence of opioid prescriptions as well as demographic and military-specific risk factors for receiving an oral opioid prescription.

Methods: The MHS Data Repository was queried from 2017 to 2020 to identify all outpatient oral opioid prescriptions to active duty military personnel in August of each year as well as demographic information on the study population.

Grit and postoperative opioid use after total joint arthroplasty.

Introduction: Perioperative multimodal protocols following total joint replacements have significantly decreased the amount of perioperative and postoperative opioids. Further identification of those requiring more or less opioids through individualisation, may further aid in reducing the amount prescribed. Therefore, the purpose of the study was to evaluate whether a patient's grit, the measurable psychological strength of character to persevere during hardship, measured by postoperative opioid consumption.

Green Sea Turtles (Chelonia mydas) Accumulate Heavy Metals Near a Former Skeet Shooting Range in Kailua, O'ahu, Hawai'i.

The present study determined if green sea turtles (Chelonia mydas) in Kailua Bay, Oahu, in the Hawaiian Islands have elevated blood and scute lead (Pb), arsenic (As), and antimony (Sb) concentrations resulting from lead deposition at a historic skeet shooting range. Blood and scute samples were collected and analyzed for Pb, As, and Sb via inductively coupled plasma-mass spectrometry. Prey, water, and sediment samples were also analyzed.

A history of shoulder instability is more common in young patients undergoing total shoulder arthroplasty.

Background: Previous studies have shown an association between shoulder instability and the development of glenohumeral arthritis leading to total shoulder arthroplasty (TSA). The primary goal of this study was to evaluate if a history of shoulder instability was more common in patients aged <50 years undergoing TSA. The secondary objective was to determine if a history of prior surgical stabilization is more common in patients aged <50 years undergoing TSA.

Machine Learning to Predict Discharge Destination After Total Knee Arthroplasty and Total Hip Arthroplasty.

Discharge destination impacts costs and perioperative planning for primary total knee (TKA) or hip arthroplasty (THA). The purpose of this study was to create a tool to predict discharge destination in contemporary patients. Models were developed using more than 400,000 patients from the National Surgical Quality Improvement Program database.

Prospective Evaluation of Push-up Performance and Patient-Reported Outcomes Following Open Dorsal Wrist Ganglion Excision in the Active-Duty Military Population.

 Dorsal wrist ganglia (DWG) are a common wrist pathology that affects the military population. This study prospectively evaluates push-up performance, functional measures, and patient-reported outcomes 6 months after open DWG excision in active-duty patients.  Twenty-seven active-duty patients were enrolled and 18 had complete follow-up.

Machine-learning Models Predict 30-Day Mortality, Cardiovascular Complications, and Respiratory Complications After Aseptic Revision Total Joint Arthroplasty.

Background: Aseptic revision THA and TKA are associated with an increased risk of adverse outcomes compared with primary THA and TKA. Understanding the risk profiles for patients undergoing aseptic revision THA or TKA may provide an opportunity to decrease the risk of postsurgical complications. There are risk stratification tools for postoperative complications after aseptic revision TKA or THA; however, current tools only include nonmodifiable risk factors, such as medical comorbidities, and do not include modifiable risk factors.

Bony Edema and Clinical Examination Findings Predict the Need for Distal Clavicle Excision at the Time of Shoulder Arthroscopy.

: Deciding to perform a distal clavicle excision for acromioclavicular joint arthritis, especially in conjunction with other arthroscopic shoulder procedures, is challenging for surgeons. Studies have reported mixed results on the value of magnetic resonance imaging (MRI) in decision making. : We sought to correlate MRI findings with clinical symptoms and the surgeon's decision to perform a distal clavicle excision.

Characterization of Halogenated Organic Compounds in Pelagic Sharks and Sea Turtles Using a Nontargeted Approach.

Halogenated organic compounds (HOCs) in marine species collected from the Atlantic Ocean [3 shortfin mako () and 1 porbeagle ()], and 12 sea turtles collected from the Pacific Ocean [3 loggerhead (), 3 green (), 3 olive ridley (), and 3 hawksbill ()] were analyzed with a nontargeted analytical method using two-dimensional gas chromatography coupled to high-resolution time-of-flight mass spectrometry. Sharks and sea turtles had distinct HOC profiles. Halogenated methoxyphenols (halo-MeOPs) were the most abundant compound class identified in sea turtle livers, while polychlorinated biphenyls (PCBs) were the most abundant in shark livers.

A Machine-Learning Algorithm to Predict the Likelihood of Prolonged Opioid Use Following Arthroscopic Hip Surgery.

Purpose: To develop a machine-learning algorithm and clinician-friendly tool predicting the likelihood of prolonged opioid use (>90 days) following hip arthroscopy.

Methods: The Military Data Repository was queried for all adult patients undergoing arthroscopic hip surgery between 2012 and 2017. Demographic, health history, and prescription records were extracted for all included patients.

Species and population specific gene expression in blood transcriptomes of marine turtles.

Background: Transcriptomic data has demonstrated utility to advance the study of physiological diversity and organisms' responses to environmental stressors. However, a lack of genomic resources and challenges associated with collecting high-quality RNA can limit its application for many wild populations. Minimally invasive blood sampling combined with de novo transcriptomic approaches has great potential to alleviate these barriers.

Opioid prescribing in the U.S. Military Health System, 2014 to 2018: fewer prescriptions, fewer pills, and shorter treatment duration.

Prescription opioids remain an important driver of the opioid crisis in the United States. The purpose of this study was to examine recent changes in opioid prescribing patterns in the Military Health System (MHS) which is a nationwide health system service active duty military personnel and civilian beneficiaries. All patients prescribed opioid analgesics by MHS providers and filled at MHS pharmacies between 2014 and 2018 were identified.

Sea turtles across the North Pacific are exposed to perfluoroalkyl substances.

Perfluorinated alkyl substances (PFASs) are global, persistent, and toxic contaminants. We assessed PFAS concentrations in green (Chelonia mydas) and hawksbill (Eretmochelys imbricata) turtles from the North Pacific. Fifteen compounds were quantified via liquid chromatography tandem mass spectrometry from 62 green turtle and 6 hawksbill plasma samples from Hawai'i, Palmyra Atoll, and the Northern Marianas Islands.