Background:
An increased posterior tibial slope (PTS) is a risk factor for primary anterior cruciate ligament (ACL) tears and graft failure, but the PTS has not been well-defined in those who have ...experienced bilateral ACL injuries.
Purpose:
The primary aim was to compare the PTS, as well as the rate of an elevated PTS (>12° on lateral radiography; >7° on magnetic resonance imaging MRI), between patients who have undergone bilateral ACL reconstruction (ACLR) versus unilateral ACLR. A secondary purpose was to examine whether these associations remained consistent on both plain radiography and MRI.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
We retrospectively identified patients who underwent primary ACLR at our institution from the years 2012 to 2020. Patients who underwent nonsimultaneous bilateral ACLR (n = 53) were matched to those who underwent unilateral ACLR (n = 53) by age, sex, and body mass index. Exclusion criteria were rotated lateral radiographs, MRI scans of inadequate quality, and concomitant ligament injuries or fractures. Those who had undergone unilateral ACLR with <5-year follow-up were further excluded. There were 3 blinded readers who measured the PTS on lateral radiographs, while the medial PTS (MPTS) and lateral PTS (LPTS) were measured on MRI scans. Bivariate regression was performed to determine the correlation between radiographic and MRI measurements.
Results:
The PTS on radiography (11.26° vs 10.13°, respectively; P = .044) and the LPTS on MRI (7.32° vs 6.08°, respectively; P = .012) in the bilateral ACLR group were significantly greater than those in the unilateral ACLR group but not the MPTS on MRI (4.55° vs 4.17°, respectively; P = .590). The percentage of patients in the bilateral group with a radiographic PTS >12° was 41.0% compared with 13.2% in the unilateral group (P = .012). The bilateral group had a significantly higher rate of an LPTS >7° compared with the unilateral group (53.8% vs 32.1%, respectively; P = .016) but not for an MPTS >7° (P = .190). On MRI, the LPTS (6.90°± 2.73°) was significantly greater than the MPTS (4.41°± 2.92°) (P < .001). There was a weak correlation between MPTS and radiographic PTS measurements (R = 0.24; P = .021), but LPTS and radiographic PTS measurements were not significantly correlated (R = 0.03; P = .810).
Conclusion:
Patients who underwent bilateral ACLR had a significantly greater PTS on radiography and a significantly greater LPTS on MRI compared with those who underwent unilateral ACLR. The rate of a radiographic PTS >12° was 2.4 times greater among patients undergoing bilateral ACLR compared with those undergoing unilateral ACLR. PTS measurements on radiography demonstrated a weak to negligible correlation with PTS measurements on MRI, suggesting that future normative PTS values should be reported specific to the imaging modality.
Background:
Previous research has found that the incidence of neurovascular injury is greatest among multiligamentous knee injuries (MLKIs) with documented knee dislocation (KD). However, it is ...unknown whether there is a comparative difference in functional recovery based on evidence of a true dislocation.
Purpose:
To determine whether the knee dislocation-3 (KD3) injury pattern of MLKI with documented tibiofemoral dislocation represents a more severe injury than KD3 MLKI without documented dislocation, as manifested by poorer clinical outcomes at long-term follow-up.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
A multicenter retrospective cohort study was performed of patients who underwent surgical treatment for KD3 MLKI between May 2012 and February 2021. Outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner activity scale, and visual analog scale (VAS) for pain. Documented dislocation was defined as a radiographically confirmed tibiofemoral disarticulation, the equivalent radiology report from outside transfer, or emergency department documentation of a knee reduction maneuver. Subgroup analysis was performed comparing lateral (KD3-L) versus medial (KD3-M) injuries. Multivariable linear regression was conducted to determine whether documented dislocation was predictive of outcomes.
Results:
A total of 42 patients (25 male, 17 female) were assessed at a mean 6.5-year follow-up (range, 2.1-10.7 years). Twenty patients (47.6%) were found to have a documented KD; they reported significantly lower IKDC (49.9 vs 63.0; P = .043), Lysholm (59.8 vs 74.5; P = .023), and Tegner activity level (2.9 vs 4.7; P = .027) scores than the patients without documented dislocation. VAS pain was not significantly different between groups (36.4 vs 33.5; P = .269). The incidence of neurovascular injury was greater among those with documented dislocation (45.0% vs 13.6%; P = .040). Subgroup analysis found that patients with KD3-L injuries experienced a greater deficit in Tegner activity level than patients with KD3-M injuries (Δ: –3.4 vs −1.2; P = .006) and had an increased incidence of neurovascular injury (41.7% vs 11.1%; P = .042). Documented dislocation status was predictive of poorer IKDC (β = −2.15; P = .038) and Lysholm (β = −2.85; P = .007) scores.
Conclusion:
Patients undergoing surgical management of KD3 injuries with true, documented KD had significantly worse clinical and functional outcomes than those with nondislocated joints at a mean 6.5-year follow-up. The current MLKI classification based solely on ligament involvement may be obscuring outcome research by not accounting for true dislocation.
Objectives:
Women of reproductive age are among the most frequent recipients of hip arthroscopic procedures in the U.S., and anecdotal evidence suggests that some female patients consider pregnancy a ...factor in their decision to undergo, delay, or avoid such surgeries. In addition, anatomical changes during pregnancy may exacerbate existing hip pathologies such as femoroacetabular impingement (FAI) and labral tears, potentially leading to greater pain and risk of complications during gestation, labor, and delivery. However, the impact of hip pain and arthroscopy on pregnancy-related decision-making and outcomes is poorly understood. The aims of this study were to determine (1) how pregnancy planning affected patients’ decisions to pursue hip arthroscopy, (2) whether undergoing hip arthroscopy affected hip pain before and after pregnancy, and (3) whether hip arthroscopy was associated with any pregnancy-related complications.
Methods:
We retrospectively studied female patients aged 18-45 years who underwent hip arthroscopy for the treatment of FAI and/or labral tears at our center from 2010-2021. Subjects were identified using a prospectively-collected single-surgeon database. Eligible subjects were administered an electronic survey that assessed obstetrical history, concerns about how their hip pain and/or the process of undergoing hip arthroscopy could affect future pregnancies, location and intensity of hip pain at various time points (before surgery, after surgery, during pregnancy), and complications experienced during pregnancy. Hip pain intensity was reported on a 10-point Visual Analog Scale (VAS). Subjects also completed the modified Harris Hip Score (mHHS). Continuous variables were compared within groups with Wilcoxon signed rank test and between groups with Kruskal-Wallis test. Fisher’s exact test was used to compare categorical variables between groups. P-values < 0.05 were considered significant.
Results:
A total of 86 patients completed the survey. Mean age at time of surgery was 32.3 ± 6.4 years (range 18 - 45), mean BMI was 24.5 ± 4.7 (range 18.7 – 39.8), and mean follow-up time was 52.0 ± 34.3 months (range 6 – 146). 47 patients (54.7%) had been pregnant at least once. Half of the cohort reported moderate or high concern that their hip pain would worsen during a future pregnancy, while a slight majority felt that hip surgery would not raise their risk of complications during pregnancy (56.0%) or impair hip function after pregnancy (51.2%). 27 patients (31.4%) had become pregnant after hip surgery at an average of 6.3 ± 1.4 months (range 2 – 8) postoperative, of whom 13 (48.2%) cited hip pain as a factor in getting surgery before pregnancy and 9 (33.3%) reported delaying a planned pregnancy to undergo surgery. Patients who became pregnant after surgery experienced a significant increase in VAS hip pain during pregnancy (p = 0.02), most commonly during the third trimester, though pain resolved after pregnancy in most (19 of 27, 70.4%). Five patients (5 of 27, 18.5%) experienced a miscarriage and the most common complication reported was vaginal/perineal tear (13 of 27, 48.1%). Of the 39 nulligravid patients, 28 (71.2%) were considering a future pregnancy and 32 (84.2%) did not consider hip pain to be a factor in their nulligravid status. There was no significant difference in mHHS at latest follow-up between nulligravid patients, patients who had not been pregnant since hip surgery, and patients who got pregnant after hip surgery (mean 79.6 vs 80.0 vs 79.6, p = 0.94).
Conclusions:
Most female hip arthroscopy patients were not concerned that their surgery would have a negative impact on their pregnancy outcomes or hip function after pregnancy. Within the hip arthroscopy population, although hip pain was exacerbated during pregnancy, most patients experienced a resolution of pain following delivery. Pregnancy-related complications did not occur more frequently in the hip arthroscopy cohort compared to the wider U.S. population. Patient-reported hip outcomes were comparable between nulligravid women and those who had only been pregnant prior to surgery.
Little is known about how bacterial endosymbionts colonize host tissues. Because many insect endosymbionts are maternally transmitted, egg colonization is critical for endosymbiont success. Wolbachia ...bacteria, carried by approximately half of all insect species, provide an excellent model for characterizing endosymbiont infection dynamics. To date, technical limitations have precluded stepwise analysis of germline colonization by Wolbachia. It is not clear to what extent titer-altering effects are primarily mediated by growth rates of Wolbachia within cell lineages or migration of Wolbachia between cells.
The objective of this work is to inform mechanisms of germline colonization through use of optimized methodology. The approaches are framed in terms of nutritional impacts on Wolbachia. Yeast-rich diets in particular have been shown to suppress Wolbachia titer in the Drosophila melanogaster germline. To determine the extent of Wolbachia sensitivity to diet, we optimized 3-dimensional, multi-stage quantification of Wolbachia titer in maternal germline cells. Technical and statistical validation confirmed the identity of Wolbachia in vivo, the reproducibility of Wolbachia quantification and the statistical power to detect these effects. The data from adult feeding experiments demonstrated that germline Wolbachia titer is distinctly sensitive to yeast-rich host diets in late oogenesis. To investigate the physiological basis for these nutritional impacts, we optimized methodology for absolute Wolbachia quantification by real-time qPCR. We found that yeast-rich diets exerted no significant effect on bodywide Wolbachia titer, although ovarian titers were significantly reduced. This suggests that host diets affects Wolbachia distribution between the soma and late stage germline cells. Notably, relative qPCR methods distorted apparent wsp abundance, due to altered host DNA copy number in yeast-rich conditions. This highlights the importance of absolute quantification data for testing mechanistic hypotheses.
We demonstrate that absolute quantification of Wolbachia, using well-controlled cytological and qPCR-based methods, creates new opportunities to determine how bacterial abundance within the germline relates to bacterial distribution within the body. This methodology can be applied to further test germline infection dynamics in response to chemical treatments, genetic conditions, new host/endosymbiont combinations, or potentially adapted to analyze other cell and tissue types.
Objectives:
The etiology of isolated patellofemoral (PF) cartilage defects without patellar instability is currently incompletely understood. The purpose of the present study was to evaluate the ...variation in knee sagittal alignment in patients with and without PF cartilage wear.
Methods:
This was a single-center, retrospective review of patients that underwent a cartilage restoration procedure for isolated PF cartilage wear from 2014-2020. Patients were matched in a 1:2:2 ratio for age, sex, and BMI to anterior knee pain diagnosis and meniscectomy procedure cohorts as controls. Exclusion criteria included knee flexion angle >10°, elevated Caton-Deschamps index (CDI>1.3), increased sulcus angle (>145°), increased patellar tilt (>5°), elevated coronal TT-TG (>15mm), varus/valgus malalignment (>5°), or ICRS patellofemoral cartilage defects of ≥3 in either control group. The sagittal TT-TG (sTT-TG) distance was measured on preoperative axial T2 magnetic resonance imaging (MRI) and was defined as the distance between a point at the nadir of the trochlear cartilage and the most anterior point of the tibial tubercle. Comparisons between the 3 groups were made using ANOVA testing with Bonferroni corrections. Reliability was assessed with the interclass correlation coefficient (ICC). Odds ratios were calculated based on a sTT-TG measurement threshold obtained from a receiver operative characteristic curve graph.
Results:
Two hundred and thirty-five patients (47 cartilage restoration, 94 anterior knee pain, 94 meniscectomy) were included. Mean age, BMI, and height were 33.8 +/- 8.7 and 26.7 +/- 5.7, 170.6 +/- 24.3 respectively, with 130 males (55%) and 105 females (45%). There were no significant differences between groups for age, BMI or sex(p>0.05). Mean sTT-TG was significantly more posterior in the cartilage restoration group compared to the meniscectomy group (-2.5 mm +/-5.9 vs 1.72 mm +/- 5.3, p<0.001). The anterior knee pain group sTT-TG was between the meniscectomy and cartilage restoration groups, but was not significantly different from either (p=0.067, p=0.13). Interrater reliability was excellent (ICC=0.927, p<0.001). Patients with a posterior translation of -2.15 or greater were 2.12 times more likely to undergo a cartilage restoration procedure (OR 2.12, 95% CI 1.1 to 4.1).
Conclusions:
Cartilage restoration procedure patients had a significantly more posterior tibial tubercle than partial meniscectomy controls. Anterior knee pain patient sagittal TT-TG was between both groups, but was not significantly different from either. Patients with sTT-TG of <-2.15 mm were 2.12 x more likely to have a cartilage restoration procedure.
Objectives:
Setting appropriate expectations for orthopedic surgery functional outcomes can contribute to postoperative motivation and satisfaction. For hip arthroscopy, the literature is limited ...regarding patients’ expectations for returning to sport. This study aims to compare preoperative expectations with postoperative return-to-sport status in patients who underwent primary hip arthroscopy.
Methods:
We conducted a prospective cohort study of patients who underwent primary hip arthroscopy. Return to sport expectations were recorded preoperatively. Return to preinjury sport status was assessed along with updated sport expectations at a minimum of 1 year follow-up after surgery (range 1.1 to 2.6 years; mean 2.0 years). The proportion of patients who expected to return was compared to actual return rates.
Results:
Thirty-five patients who underwent hip arthroscopy were prospectively recruited. Preoperatively, 31 patients (88.6%) expected to return to their preinjury sport level, while only 16 (45.7%) actually returned to that level. 34 (97.1%) expected to return to their main sport and 22 (62.9%) actually returned. 9/35 returned to their preinjury primary sport at a lower level. 10/35 patients had completely given up their original sport by time of follow-up. All 11 patients who reported a change in their primary sport chose a lower impact sport, transitioning from tennis, running, kickboxing, frisbee, volleyball to cycling, pilates, walking, and yoga. Logistical regression found no significant difference between expectations and return to sport level when controlling for age, BMI, gender.
Conclusions:
This study found a significant difference between preinjury return-to-sport expectations and actual return rates following hip surgery. Although patients had high expectations for recovery, a majority did not return to their preinjury sport level and a high portion did not return at all. All patients that took up a different sport went from one of high impact to low impact. These data can provide more realistic return-to-sport expectations for patients undergoing hip arthroscopy.
Females of reproductive age constitute one of the largest demographics of the hip arthroscopy population, but it is unclear as to how pregnancy planning affects decision-making regarding surgery or ...vice versa. The purpose of this study was to assess perceived risks to pregnancy from hip pain and/or hip arthroscopy among reproductive-age females who underwent arthroscopic treatment of femoroacetabular impingement syndrome (FAIS). A cross-sectional study was conducted involving females aged 18–44 years who underwent hip arthroscopy for the treatment of FAIS, with a single surgeon included in the study. Subjects completed a survey that assessed obstetric and gynecologic history, decision-making regarding the planning and timing of hip surgery and pregnancy, and perceived risks to pregnancy from hip pain and/or hip surgery. Subjects were classified as nulligravid (Group 1), pregnant at least once before hip surgery but never again following hip surgery (Group 2), or pregnant at least once following hip surgery (Group 3). A total of 85 patients were enrolled with a mean age of 32.3 ± 6.5 years at the time of surgery. The mean follow-up time was 51.9 ± 34.5 months. There were 39 subjects in Group 1 (45.9%), 20 in Group 2 (23.5%), and 26 in Group 3 (30.6%). About half of all subjects expressed “some” to “a lot of” concern that their hip pain could get worse during pregnancy (49.4%), and about half had “no concern” that hip arthroscopy would affect the health of their fetus/baby (54.1%). Reproductive-age females undergoing hip arthroscopy for FAIS generally consider the procedure to be safe with respect to future pregnancy outcomes.
En este trabajo se propone un método para la optimización de los hiperparámetros de una máquina de regresión de soporte vectorial mediante la adaptación de la metaheurística de enjambre de ...partículas. El método se utiliza para pronosticar la serie de tiempo del total de casos positivos acumulados de la reciente enfermedad COVID-19 en la ciudad de Bogotá, Colombia. Para validar el rendimiento del método se establece una comparación con la máquina de regresión de soporte vectorial sin hiperparámetros optimizados, en términos de métricas de medición del rendimiento como lo son el error cuadrático medio, error absoluto medio y el coeficiente de determinación. Con un valor en el error cuadrático medio de 0,000045, un coeficiente de determinación de 0,998884 y el valor-p de 0,0015, para la prueba no paramétrica de Wilcoxon, el método propuesto presenta un mejor desempeño en el pronóstico. Finalmente se pone a discusión la aplicabilidad de este tipo de métodos en el pronóstico de casos en las epidemias.
Objectives:
Expansion of chondral defect size and clinical outcomes in patients with cartilage lesions are thought to be modulated by several risk factors. Previous studies suggest that time delay ...until implantation may be a risk factor for an increase in the number and size of chondral lesions at the time of implantation. Reports on the effect of time delay on clinical outcomes, however, remain limited. Therefore, the purpose of this study was to evaluate the effect of time delay from cartilage biopsy to implantation on patient satisfaction, return to sport (RTS), and clinical outcomes following autologous chondrocyte implantation.
Methods:
A retrospective review was performed among patient who underwent autologous chondrocyte implantation (ACI) and matrix-associated autologous chondrocyte implantation (MACI) at a single institution between the years 2012 to 2020 with minimum 2-year clinical follow-up. Clinical outcomes were measured using the Visual Analog Scale (VAS) for pain and satisfaction and the Knee Injury and Osteoarthritis Outcome Score (KOOS; subscores: symptoms, pain, sport, and quality of life (QOL)). Time delay was calculated as the elapsed time between cartilage biopsy and implantation. Cartilage lesions were categorized based on the Outerbridge classification of chondral lesions. The number of high-grade lesions (Outerbridge grade 3 or 4) and size of lesions were analyzed at time of biopsy and implantation. T-tests or non-parametric tests and Chi-squared tests were used to analyze continuous variables and categorical variables, respectively. A one-way ANOVA was used to compare outcomes based on RTS status, using a post-hoc Tukey’s HSD test for multiple comparisons. Bivariate linear regression was used to determine the impact of the time interval from biopsy to implantation on the change in size of the largest high-grade lesion and RTS.
Results:
A total of 36 patients, mainly female (55.6%) aged 29.25 (± 9.49) with a mean follow-up of 6.51 ± 2.5 years were included in our analysis. Thirteen patients (36.1%) did not RTS. Of the 23 patients (63.9%) who returned to sport, 11 (30.6%) returned at their preoperative level or higher, and 12 (33.3%) returned at a lower level. VAS pain scores were significantly higher in patients who did not RTS vs those who did (42.85 vs. 9.35, p <0.001). All KOOS subscores (Symptom: 56.54 vs. 81.96, Pain: 72.22 vs. 91.74, Sports: 40.38 vs. 79.3, QOL: 35.58 vs. 70.38, p <0.001) were significantly lower in patients who did not RTS compared to those who returned. Increase in time delay from biopsy to implantation was associated with an increase in VAS pain score (OR 95% CI; 1.42 0.16 to 2.69, p=0.02) and inversely related to KOOS pain scores (OR 95% CI; -1.01 -1.83 to -0.01, p= 0.01. Furthermore, when comparing time from biopsy to implantation and expansion of the largest highgrade lesion, it was found that for every month increase in time, lesion surface area increased by 0.588 cm2; however, this correlation did not reach significance (p=0.09). The number of high-grade lesions at time of implantation were significantly higher in those that returned to sport at a lower level than those who did not return (1.67 vs. 1.23, p=0.02). The average surface area of the defect at biopsy and implantation were 3.13 cm2 and 4.38 cm2 respectively. The number of patients who had an increase in the number of high-grade lesions from biopsy to implantation was significantly higher in those who returned to sport at a lower level compared to those who did not return (4 vs. 1, p=0.05). Logistic regression demonstrated no significant relationship between time interval and rate of return to sport (p=3.59). No other associations were observed between time from biopsy to implantation and clinical outcomes.
Conclusions:
An increase in time delay from biopsy to graft implantation is associated with worse pain after surgery. Both the number of high-grade lesions at the time of implantation and an increase in time delay were not associated with lower rates of return to sport. Further studies are needed to evaluate the effects of time delay until implantation and its potential role as a risk factor for worse clinical outcomes in patients undergoing autologous chondrocyte implantation procedures.
Objectives:
In an effort to reduce reliance on opioid analgesics, an increased emphasis has been placed on peripheral nerve blocks for pain control following ACL reconstruction. The commonly used ...adductor canal block may provide inadequate post-operative analgesia, as it spares sensory function to the posterior aspect of the knee. This region can be specifically targeted using an IPACK (Interspace Between the Popliteal Artery and the Capsule of the Posterior Knee) block potentially leading to improved pain control. The purpose of the current study was to compare clinical outcomes of an isolated standard adductor canal block versus combined ACB and IPACK blocks with respect to level of post-operative pain, opioid consumption, and satisfaction in patients undergoing ACL reconstruction using a bone-patellar tendon-bone (BPTB) autograft.
Methods:
We prospectively recruited patients undergoing ACL reconstruction with BPTB autograft at a single institution. Subjects were randomized pre-operatively to either control or experimental groups using a pre-established block randomization and were blinded to their treatment group. Patients in the control group received the standard-of-care ACB consisting of 15-ml of Bupivacaine (0.25%). Patients in the experimental group received 20-ml of Bupivacaine (0.25%) injected into the interspace between the popliteal artery and capsule of the knee in addition to the 15-ml Bupivicaine ACB. Post-operative pain level, pain control, and pain satisfaction were collected at 24hrs, 48hrs, 72hrs and one week postoperatively. Satisfaction with pain control was assessed using a 0-10 numeric scale with 0 equal to not satisfied and 10 equal to completely satisfied. Pain level was measured using a Visual Analog Scale (VAS) from no pain to extreme pain. The type and quantity of pain medications including 325-5 mg Percocet, Tylenol, and other pain medications were recorded at each time point. Variables were assessed using Shapiro-Wilks test for normality and T-test or non-parametric tests for continuous variables and Chi-squared tests for categorical variables.
Results:
A total of 20 patients were preliminarily analyzed with all patients having at least 1 week of post-operative follow-up. The mean age of the cohort was 28.75 ± 9.15 years, mean body mass index (BMI) was 24.0 ± 4.82 kg/m2 and 55% (n=11) were Male. The two arms consisted of 12 patients randomized to the control arm and 8 to the experimental arm. There were no statistically significant differences between the groups with respect to age, BMI, or sex (p > 0.05). Patients who received the IPACK block had significantly higher satisfaction with pain control at 24hrs post-operatively compared to those who did not (7.62 vs. 5.25, p=0.01). Patients who received the IPACK block used less total number of prescribed opioids tablets than those in the control arm (8.5 vs. 11.15, p=0.52), and had less pain at 24 hours (51.12 vs. 65.17, p=0.24) and 48 hours (51.00 vs. 57.92, p=0.55). (Table 1)
Conclusions:
Patients who received combined IPACK and ACB blocks exhibited better pain control and higher satisfaction with their care compared to those who received the standard-of-care ACB alone following ACL reconstruction using autograft tissue.
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