Purpose
This study aimed to evaluate posterolateral tibial plateau impaction fractures and how they contribute to rotatory knee laxity using quantitative pivot shift analysis. It was hypothesised ...that neither the presence of nor the degree of involvement of the plateau would affect rotatory knee laxity in the ACL-deficient knee.
Methods
A retrospective review of prospectively collected data on 284 patients with complete anterior cruciate ligament (ACL) injuries was conducted. Posterolateral tibial plateau impaction fractures were identified on preoperative MRI. The patients were divided into two cohorts: “fractures” or “no fractures”. The cohort with fractures was further categorised based on fracture morphology: “extra-articular”, “articular-impaction”, or “displaced-articular fragment”. All data were collected during examination under anaesthesia performed immediately prior to ACL reconstruction. This included a standard pivot shift test graded by the examiner and quantitative data including anterior tibial translation (mm) via Rolimeter, quantitative pivot shift (QPS) examination (mm) via PIVOT tablet technology, and acceleration (m/sec
2
) during the pivot shift test via accelerometer. Quantitative examinations were compared with the contralateral knee.
Results
There were 112 patients with posterolateral tibial plateau impaction fractures (112/284, 39%). Of these, 71/112 (63%) were “extra-articular”, 28/112 (25%) “articular-impaction”, and 13/112 (12%) “displaced-articular”. Regarding the two groups with or without fractures, there was no difference in subjective pivot shift (2 ± 0 vs 2 ± 0, respectively, n.s.), QPS (2.4 ± 1.6 mm vs 2.7 ± 2.2 mm, respectively, n.s.), anterior tibial translation measurements (6 ± 3 mm vs 5 ± 3 mm, respectively, n.s.), or acceleration of the knee during the pivot (1.7 ± 2.3 m/s
2
vs 1.8 ± 3.1 m/s
2
, respectively, n.s.). When the fractures were further subdivided, subgroup analysis revealed no significant differences noted in any of the measured examinations between the fracture subtypes.
Conclusion
This study showed that the posterolateral tibial plateau impaction fractures are commonly encountered in the setting of ACL tears; however, contrary to previous reports, they do not significantly increase rotatory knee laxity. This suggests that this type of concomitant injury may not need to be addressed at the time of ACL reconstruction.
Level of evidence
Level III.
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EMUNI, FIS, FSPLJ, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Understanding the etiology behind anterior cruciate ligament (ACL) reconstruction failure is a complex topic still being investigated heavily. The 3 classes of failure are technical, traumatic, and ...biologic. Technical errors are most common and most frequently reflect tunnel malposition. In addition, tibial slope has long been understood to be a risk factor for failed ACL reconstruction. Although not routinely performed at time of primary ACL reconstruction, osteotomy may be considered in the setting of failed ACL reconstruction. Relative quadriceps weakness is a risk factor, and we recommend sport-specific return-to-play testing as well as benchmarks for relative quadriceps strength before full return to activity. Revision ACL reconstruction is associated with both increased costs and worse patient outcomes, so every effort should be made to give patients the best chance of success after the index surgery. Whereas this begins with understanding the patient's history and risk factors for failure, it crescendos with careful attention to the individually variable factors that make each case unique, tailoring one's management to ensure that each patient receives an anatomic, individualized, and value-based ACL reconstruction.
Diabetic patients undergoing total joint arthroplasty (TJA) with postoperative hyperglycemia >200 mg/dL have increased the risk of prosthetic joint infection (PJI). We investigated the correlation ...between preoperative hemoglobin A1c (A1c) and postoperative hyperglycemia in diabetic patients undergoing TJA.
A retrospective review of 773 diabetic patients undergoing TJA was conducted. A Youden's J computational analysis determined the A1c where postoperative glucose levels >200 mg/dL were statistically more likely. Patients were then stratified into 3 groups: A1c <7%, A1c 7.0-8.0%, and A1c >8.0%. Outcomes included the highest postoperative in-hospital serum glucose level and PJI.
We determined an A1c >7.45% resulted in a greater chance of postoperative hyperglycemia >200 mg/dL. Average postoperative serum glucose increased with A1c (A1c < 7 = 167 mg/dL, A1c 7.0-8.0 = 240 mg/dL, and A1c > 8 = 276 mg/dL, P < .0001). PJI did not statistically increase with A1c (2.25%, 1.99%, and 4.55%, respectively, P = .4319).
Preoperative hemoglobin A1c levels correlate with postoperative glucose levels. We recommend using an A1c cutoff of 7.45% for patients undergoing TJA and suggest that caution should be exercised in patients with elevated A1c levels undergoing TJA.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK, ZRSKP
5.
Posterior tibial slope: the fingerprint of the tibial bone Winkler, Philipp W.; Godshaw, Brian M.; Karlsson, Jon ...
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA,
06/2021, Volume:
29, Issue:
6
Journal Article
Peer reviewed
Open access
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Available for:
EMUNI, FSPLJ, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Objectives:
The Latarjet procedure is commonly used in management of anterior shoulder instability with bipolar bone deficiency. Persistent off-track Hill-Sachs (HS) lesions after Latarjet procedure ...is associated with significantly higher rates of failure and recurrent instability. Preoperative prediction of which lesions will remain off-track is crucial for improving outcomes and decreasing failure rates. The purpose of this study was to determine if preoperative advanced imaging can predict coracoid graft size and conversion of off-track to on-track Hill-Sachs lesions in patients undergoing Latarjet procedures.
Methods:
Patients who underwent Latarjet procedure for shoulder instability at a single institution from 2012-2020 were evaluated. Inclusion criteria consisted of pre- and post-operative advanced imaging - computerized topography or magnetic resonance imaging. Glenoid diameter, HS interval (HSI), and coracoid length, depth, and height were measured on preoperative imaging. Glenoid track (GT), percent glenoid bone loss, predicted restoration of glenoid track, and the difference between HSI and GT (DHSI-GT) were calculated. These values were then compared with postoperative measurements of the glenoid diameter and coracoid graft width and height.
Results:
Seventeen patients with a mean age of 24.6 ± 8.6 years met inclusion criteria. The average glenoid bone loss preoperatively was 23.6 ± 7.3% and the average HSI was 27.2 ± 4.9mm. The Latarjet procedure was able to reconstruct 115.8 ± 7.6% of the native glenoid, and 103.8 ± 7.9% of the predicted diameter. Of the 15 patients that had off-track lesions preoperatively, 11 were successfully converted to on-track lesions (73.3%). The 4 lesions that remained off-track postoperatively had a significantly higher HSI (32.4 ± 2.4 mm vs. 25.6 ± 4.3 mm, p=0.002) and 3 of these had insufficient coracoid graft to convert to an on-track lesion based on the preoperative DHSI-GT values in comparison to coracoid graft size. Preoperative measurements accurately predicted postoperative glenoid track status 94.1% of cases.
Conclusions:
The Latarjet procedure was able to reconstruct 115.8 ± 7.6% of the native glenoid and converted 73.3% of off-track lesions to on-track lesions. The glenoid was reconstructed to 103.8 ± 7.9% of the predicted diameter. Preoperative advanced imaging measurements accurately predicted graft size, restoration of the glenoid track, and ability to convert off-track to on-track lesions.
Objectives:
Rotator cuff tears may occur due to a traumatic event that causes acute tearing of the rotator cuff tendons or secondary to chronic tendon degeneration and subsequent atraumatic tearing. ...The role that tear etiology plays in outcomes after repair is not well understood. The purpose of this study is to determine if a difference exists in outcomes after rotator cuff repair based on tear etiology.
Methods:
221 consecutive patients who underwent arthroscopic rotator cuff repair were evaluated with prospectively collected preoperative and at least 2-year postoperative data via chart review. Shoulder range-of-motion, strength and standard shoulder physical exam findings were recorded both preoperatively and postoperatively. Outcome measures including visual acuity scale pain score (VAS), subjective shoulder value (SSV), Patient-Reported Outcomes Measurement Information System (PROMIS) scores (both mental and physical components), and American Shoulder and Elbow Surgeons Scores (ASES) were examined.
Results:
Of the 221 patients, 73 had traumatic tears and 148 had atraumatic/degenerative tears. There were no differences in age, body-mass-index, or Charlson comorbidity index between groups. Patients in the atraumatic cohort had significantly longer duration of symptoms prior to presentation (17.9 months vs 6.5 months, p<0.05). Preoperatively, the traumatic cohort had less motion to forward elevation (138.0° vs 151.7°, p<0.05). Postoperatively, both groups experienced significant improvements in VAS and SSV scores (p<0.05). However, only the traumatic cohort demonstrated improvements in ASES and the physical PROMIS scores. Patients with traumatic rotator cuff tears had greater improvements in SSV (40.6% vs 29.2%, p<0.05), forward elevation (21.6° vs 2.3°, p<0.05), and strength to forward elevation, external rotation, and internal rotation compared to those with atraumatic tears (p<0.05).
Conclusions:
Patients with traumatic rotator cuff tears experience greater improvements in range-of-motion, strength, and perceived shoulder function than those with degenerative/atraumatic tears.
Diabetic patients are at an increased risk of prosthetic joint infection (PJI) after total joint arthroplasty (TJA). The relationship between insulin-dependence and PJI has not been investigated. We ...aimed at evaluating whether insulin-dependent diabetes mellitus (IDDM) patients were more susceptible to postoperative hyperglycemia and PJI than their non–insulin-dependent diabetes mellitus (NIDDM) counterparts.
A retrospective review was conducted of diabetic patients undergoing TJA (hip or knee) from January 2011 to December 2016. Preoperative hemoglobin A1c (A1c) and postoperative glucose measurements were observed. Patients were stratified as IDDM or NIDDM. The A1c values that predicted hyperglycemia >200 mg/dL for each group were calculated. Primary end point was postoperative hyperglycemia >200 mg/dL and secondary end point was PJI.
There were 773 patients meeting inclusion criteria. The IDDM cohort had a higher preoperative A1c (6.97% vs 6.28%, P < .0001) and postoperative glucose (235.2 vs 163.5, P < .0001). IDDM patients were more likely to have postoperative hyperglycemia (63.84% vs 20.83%, P < .0001; odds ratio, 5.2; 95% confidence interval, 3.66-7.4). Overall, an A1c of >7.45% predicted postoperative hyperglycemia >200 mg/mL (odds ratio, 6.94; 95% confidence interval, 4.32-11.45). When separating our 2 cohorts, an A1c of >6.59% in IDDM, and >6.60% in NIDDM, was associated with an increased risk of postoperative hyperglycemia (P < .0001). PJI was similar between the 2 cohorts (2.52% vs 2.38%, P = .9034).
IDDM patients undergoing TJA are 5.2 times more likely to have postoperative hyperglycemia >200 mg/dL than their NIDDM counterparts, although increased risk of PJI was not found in this study. Despite the higher A1c and postoperative hyperglycemia in IDDM patients, there was found to be no clinical difference between A1c cutoff values for postoperative hyperglycemia between IDDM and NIDDM patients.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
BACKGROUND:Hyperglycemia can blunt the cardioprotective effects of isoflurane in the setting of ischemia–reperfusion injury. Previous studies suggest that reactive oxygen species (ROS) and increased ...mitochondrial fission play a role in cardiomyocyte death during ischemia–reperfusion injury. To investigate the role of glucose concentration in ROS production and mitochondrial fission during ischemia–reperfusion (with and without anesthetic protection), we used the novel platform of human-induced pluripotent stem-cell (iPSC)–derived cardiomyocytes (CMs).
METHODS:Cardiomyocyte differentiation from iPSC was characterized by the expression of CM-specific markers using immunohistochemistry and by measuring contractility. iPSC-CMs were exposed to varying glucose conditions (5, 11, and 25 mM) for 24 hours. Mitochondrial permeability transition pore opening, cell viability, and ROS generation endpoints were used to assess the effects of various treatment conditions. Mitochondrial fission was monitored by the visualization of fragmented mitochondria using confocal microscopy. Expression of activated dynamin-related protein 1, a key protein responsible for mitochondrial fission, was assessed by Western blot.
RESULTS:Cardiomyocytes were successfully differentiated from iPSC. Elevated glucose conditions (11 and 25 mM) significantly increased ROS generation, whereas only the 25-mM high glucose condition induced mitochondrial fission and increased the expression of activated dynamin-related protein 1 in iPSC-CMs. Isoflurane delayed mitochondrial permeability transition pore opening and protected iPSC-CMs from oxidative stress in 5- and 11-mM glucose conditions to a similar level as previously observed in various isolated animal cardiomyocytes. Scavenging ROS with Trolox or inhibiting mitochondrial fission with mdivi-1 restored the anesthetic cardioprotective effects in iPSC-CMs in 25-mM glucose conditions.
CONCLUSIONS:Human iPSC-CM is a useful, relevant model for studying isoflurane cardioprotection and can be manipulated to recapitulate complex clinical perturbations. We demonstrate that the cardioprotective effects of isoflurane in elevated glucose conditions can be restored by scavenging ROS or inhibiting mitochondrial fission. These findings may contribute to further understanding and guidance for restoring pharmacological cardioprotection in hyperglycemic patients.
Background:
While rotator cuff repair has generally produced good to excellent outcomes, re-tear rates remain variable, with rates ranging from 20% to 50%. The ideal rotator cuff repair includes 3 ...main components: restoration of the humeral footprint contact area, appropriate compression of the tendon to the humeral footprint, and minimal motion at the bone-tendon interface until bone-tendon healing is completed. This video takes a well-established knotless double-row technique for rotator cuff repair and augments it with a modification to promote additional compression of the medial row tendon to the humeral footprint.
Indications:
This compression SpeedBridge technique is indicated for repair of T-type rotator cuff tears involving the supraspinatus and infraspinatus tendons in patients that have failed conservative management, including physical therapy, activity modification, and corticosteroid injections. This technique can also be applied to U-shaped or L-shaped tears by removing the initial step, which involves side-to-side repair of the “T” portion of the T-type tear. Of note, findings such as advanced muscle atrophy (Goutalier III/IV) and advanced glenohumeral arthritis are concerning for irreparable tears and may be contraindications for surgical repair.
Technique Description:
With the patient in the lateral decubitus position, a diagnostic arthroscopy is performed, the rotator cuff tear is debrided, and the footprint prepared. Two side-to-side stitches are placed to repair the “T” portion of the tear. The medial row anchors are then sequentially placed, and the pre-loaded sutures are passed through the tendon in 4 sequential locations in specific fashion. After placement of looped sutures in the anterior and posterior rotator cables, the passed sutures are then incorporated into the lateral row anchors. The medial row compression is provided by shuttling previously placed compression stitches through the knotless mechanism in the medial row anchors and terminally tensioned.
Results:
This technique provides additional medial row compression to an already-established knotless double-row rotator cuff repair technique to facilitate improved bone-tendon healing and construct strength.
Discussion/Conclusion:
The compression SpeedBridge technique is a unique method to apply additional medial row compression to a double-row rotator cuff repair.
Patient Consent Disclosure Statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Graphical Abstract
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