Preoperative Physical Therapy Is Protective From Construct Failure in Anterior Cruciate Ligament Reconstruction.

Background: Risk factors for anterior cruciate ligament reconstruction (ACLR) construct failure have been studied extensively. However, while some studies account for variables such as activity level, construct types, preoperative physical therapy, or patient demographics individually, comprehensive studies that control for all these factors simultaneously are scarce.

Hypothesis: By utilizing a robust multivariable analysis, the factors associated with an increased risk of ACLR construct failure can be determined.

The precise location of "Midshaft" clavicle fractures: Scrimmaging from the 42 yard-line.

Background: The realities of midshaft clavicle fracture distribution have not been described accurately. Consequently, a topographical depiction of midshaft clavicle fractures may help design implants that are more anatomically concordant with the fractured clavicle, leading to better outcomes and fewer complications.

Methods: This is a retrospective cohort study.

All-Suture Anchor Techniques for Biceps Tenodesis Are Noninferior in End-Cycle Stiffness to an Interference Screw Technique; However, Secondary Outcomes, Such as Ultimate Failure Load, Yield Load, Creep, and Load-to-Failure Stiffness, Are Inferior in an Ovine Model.

Purpose: To assess the biomechanical performance of 2 simplified loop-and-tack biceps tenodesis techniques, all-suture anchor and all-suture anchor with a button, compared with the interference screw technique in an ovine model.

Methods: Twenty-one biceps tenodesis procedures were executed on the humeri and flexor digitorum profundus tendons of skeletally mature, female sheep. Limbs were evenly randomized into 2 experimental groups (all-suture anchor with or without button) and 1 control group (interference screw).

The Effects of Unitizing Nail-Plate Constructs in Distal Femur Fractures: A Biomechanical Study.

Objectives: To assess the biomechanical differences between linked and unlinked constructs in young and osteoporotic cadavers in addition to osteoporotic sawbones.

Methods: Intraarticular distal femur fractures with comminuted metaphyseal regions were created in three young matched pair cadavers, three osteoporotic matched pair cadavers, and six osteoporotic sawbones. Precontoured distal femur locking plates were placed in addition to a standardized retrograde nail, with unitized constructs having one 4.

Provision of a Home-Based Video-Assisted Therapy Program Is Noninferior to In-Person Hand Therapy After Thumb Carpometacarpal Arthroplasty.

Background: In-person hand therapy is commonly prescribed for rehabilitation after thumb carpometacarpal (CMC) arthroplasty but may be burdensome to patients because of the need to travel to appointments. Asynchronous, video-assisted home therapy is a method of care in which videos containing instructions and exercises are provided to the patient, without the need for in-person or telemedicine visits. The purpose of the present study was to evaluate the effectiveness of providing video-only therapy (VOT) as compared with scheduled in-person therapy (IPT) after thumb CMC arthroplasty.

Total Intravenous Anesthesia with Propofol Reduces Discharge Times Compared with Inhaled General Anesthesia in Shoulder Arthroscopy: A Randomized Controlled Trial.

Background: Shoulder arthroscopy is commonly performed at ambulatory surgical centers (ASCs) with use of an interscalene block and inhaled general anesthesia (IGA). However, an alternative option known as total intravenous anesthesia with propofol (TIVA-P) has shown promising results in reducing recovery time for other surgeries. The objective of this study was to assess whether there is a clinically meaningful difference in post-anesthesia care unit phase-I (PACU-I) time following shoulder arthroscopy between patients receiving an interscalene block with IGA and those receiving an interscalene block with TIVA-P.

National Trends in Orthopaedic Pain Management from 2016 to 2020.

Introduction: Effective pain management is vital in orthopaedic care, impacting postoperative recovery and patient well-being. This study aimed to discern national and regional pain prescription trends among orthopaedic surgeons through Medicare claims data, using geospatial analysis to ascertain opioid and nonopioid usage patterns across the United States.

Methods: Physician-level Medicare prescription databases from 2016 to 2020 were filtered to orthopaedic surgeons, and medications were categorized into opioids, muscle relaxants, anticonvulsants, and NSAIDs.

What Is a Surgical Site Infection After Carpal Tunnel Release?

Purpose: Considerable variation exists in the literature on published rates of surgical site infection (SSI) after carpal tunnel release, ranging over 20-fold, from 0.28% to 6.4%.

A feasibility cadaver study for placing screws in various pelvic osseous fracture pathways using a robotic arm.

Introduction: The use of a robotic system for the placement of pedicle screws in spine surgeries is well documented in the literature. However, there is only a single report in the United States describing the use of a robotic system to place two screws in osseous fixation pathways (OFPs) commonly used in the treatment of pelvic and acetabular fractures in a simulated bone model. The purpose of this study was to demonstrate the use of a robotic system to place screws in multiple, clinically relevant OFPs in a cadaveric model and to quantitatively measure accuracy of screw placement relative to the preoperative plan.

Neurogenic Thoracic Outlet Syndrome: A Primer for Hand and Peripheral Nerve Surgeons.

Neurogenic thoracic outlet syndrome is a complex condition and is commonly misunderstood. Historically, much of this confusion has been because of its grouping with other diagnoses that have little in common other than anatomic location. Modern understanding emphasizes the role of small unmyelinated C type pain and sympathetic fibers.

Robotic-Assisted Navigation for Stereotactic Neurosurgery: A Cadaveric Investigation of Accuracy, Time, and Radiation.

Background And Objectives: Despite frequent use, stereotactic head frames require manual coordinate calculations and manual frame settings that are associated with human error. This study examines freestanding robot-assisted navigation (RAN) as a means to reduce the drawbacks of traditional cranial stereotaxy and improve targeting accuracy.

Methods: Seven cadaveric human torsos with heads were tested with 8 anatomic coordinates selected for lead placement mirrored in each hemisphere.

Osteocutaneous Radial Forearm Flap: Harvest Technique and Prophylactic Volar Locked Plating.

Background: The osteocutaneous radial forearm (OCRF) flap is a variation of the traditional radial forearm flap with incorporation of an anterolateral segment of corticocancellous bone of the radius, periosteum, and overlying skin. The OCRF flap is indicated in traumatic injuries or extirpation defects with segmental bone loss and is well suited to foot and ankle reconstruction due to its thin pliable skin.

Methods: In this single-center case series, a retrospective review was conducted to identify patients who underwent OCRF free flap for foot and ankle reconstruction that required harvest of more than 50% of the cross-sectional area of the radius with prophylactic volar locked plating of the donor site.

Changes in Management at the Postoperative Visit After In-Office Wide Awake Local Anesthetic No Tourniquet Carpal Tunnel Release.

Purpose: Patients are commonly seen for two postoperative visits following carpal tunnel release (CTR), the first visit being at 1-2 weeks and the second at approximately 6 weeks. Our study aimed to determine if these visits led to changes in postoperative medical management.

Methods: A retrospective review was conducted of 748 procedures performed in an in-office procedure room under wide awake local anesthetic no tourniquet between August 2020 and December 2022.

An investigational time course study of titanium plasma spray on osseointegration of PEEK and titanium implants: an in vivo ovine model.

Background Context: Methods to improve osseointegration of orthopedic spinal implants remains a clinical challenge. Materials composed of poly-ether-ether-ketone (PEEK) and titanium are commonly used in orthopedic applications due to their inherent properties of biocompatibility. Titanium has a clinical reputation for durability and osseous affinity, and PEEK offers advantages of a modulus that approximates osseous structures and is radiolucent.

In vitro coupled motions of the whole human thoracic and lumbar spine with rib cage.

Study Design: In vitro biomechanical study investigating the coupled motions of the whole normative human thoracic spine (TS) and lumbar spine (LS) with rib cage.

Objective: To quantify the region-specific coupled motion patterns and magnitudes of the TS, thoracolumbar junction (TLJ), and LS simultaneously.

Background: Studying spinal coupled motions is important in understanding the development of complex spinal deformities and providing data for validating computational models.

Percutaneous Juxtapedicular Cement Salvage of Failed Spinal Instrumentation? Institutional Experience and Cadaveric Biomechanical Study.

Background And Objectives: Instrumented spinal fusion constructs sometimes fail because of fatigue loading, frequently necessitating open revision surgery. Favorable outcomes after percutaneous juxtapedicular cement salvage (perc-cement salvage) of failing instrumentation have been described; however, this approach is not widely known among spine surgeons , and its biomechanical properties have not been evaluated. We report our institutional experience with perc-cement salvage and investigate the relative biomechanical strength of this technique as compared with 3 other common open revision techniques.

The Clinical Outcomes of Radiocapitellar Reconstruction With Radiocapitellar Arthroplasty: A Systematic Review and Meta-Analysis.

Background: Radiocapitellar arthroplasty fills a treatment void for young patients who experience isolated capitellar fractures or radiocapitellar osteoarthritis who are not candidates for total elbow arthroplasty. The outcomes of this procedure are sparsely reported. We designed a meta-analysis to determine the utility of radiocapitellar arthroplasty with respect to functional and patient reported outcomes.

Are modular pedicle screws associated with a high complication rate following posterior spinal fixation?

Background: Modular pedicle screws have a separate head that can be intraoperatively assembled to the inserted shank. The aim of this study was to report associated intra- and post-operative complications and reoperation rates of posterior spinal fixations with modular pedicle screws at a single center.

Methods: A retrospective, institutional chart review was performed on 285 patients who underwent posterior thoracolumbar spinal fusion with modular pedicle screw fixation between January 1, 2017, and December 31, 2019.

Decreasing the Pedicle Screw Misplacement Rate in the Thoracic Spine With Robot-guided Navigation.

Study Design: A retrospective chart review.

Objective: The aim of this study was to evaluate the screw accuracy of thoracic pedicle screws placed with a robot-guided navigation system.

Summary Of Background Data: Thoracic pedicles are smaller in diameter than lumbar pedicles, making pedicle screw placement difficult.

The effect of operative time on surgical-site infection following total shoulder arthroplasty.

Background: Many factors contribute to the risk of surgical-site infection (SSI) following total shoulder arthroplasty (TSA). Operative time is a modifiable factor that may contribute to SSI occurrence after TSA. This study aimed to determine the correlation between operative time and SSI following TSA.

Does design change in total knee arthroplasty implants affect patient-reported outcomes?

Purpose: The purpose of this study is to compare the early results of patient-reported outcomes between two generations of a total knee system.

Methods: Between June 2018 and April 2020, 121 first-generation, cemented TKAs (89 patients) and 123 s-generation, cemented TKAs (98 patients) were performed by a single surgeon. Demographic and surgical data were collected from all patients.

An investigation of range of motion preservation in fusionless anterior double screw and cord constructs for scoliosis correction.

Purpose: To evaluate the motion-preserving properties of vertebral body tethering with varying cord/screw constructs and cord thicknesses in cadaveric thoracolumbar spines.

Methods: In vitro flexibility tests were performed on six fresh-frozen human cadaveric spines (T1-L5) (2 M, 4F) with a median age of 63 (59-to-80). An ± 8 Nm load was applied to determine range of motion (ROM) in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) in the thoracic and lumbar spine.

An In Vitro Biomechanical Analysis of Contralateral Sacroiliac Joint Motion Following Unilateral Sacroiliac Stabilization with and without Lumbosacral Fixation.

Study Design: Cadaveric biomechanics study.

Purpose: This study investigated the effects of unilateral sacroiliac joint (SIJ) fixation for fusion with/without L5-S1 fixation on contralateral SIJ range of motion (ROM).

Overview Of Literature: SIJ fusion raises concerns that unilateral SIJ stabilization for fusion may increase contralateral SIJ mobility, leading to accelerated SIJ degeneration.

A Dual-Screw Technique for Vertebral Compression Fractures via Robotic Navigation in the Osteopenic Lumbar Spine: An Biomechanical Analysis.

Study Design: Biomechanical cadaveric study.

Objectives: Multi-rod constructs maximize posterior fixation, but most use a single pedicle screw (PS) anchor point to support multiple rods. Robotic navigation allows for insertion of PS and cortical screw (CS) within the same pedicle, providing 4 points of bony fixation per vertebra.