April 2025
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2 Reads
The Journal of Arthroplasty
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April 2025
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2 Reads
The Journal of Arthroplasty
February 2025
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5 Reads
Arthroscopy The Journal of Arthroscopic and Related Surgery
February 2025
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14 Reads
Journal of Shoulder and Elbow Surgery
February 2025
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5 Reads
Arthroscopy The Journal of Arthroscopic and Related Surgery
October 2024
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7 Reads
Orthopaedic Journal of Sports Medicine
Objectives The aim of this study was to determine the comparative accuracy and precision of routine Magnetic Resonance Imaging (MRI) versus magnetic resonance (MR) arthrogram in measuring labral tear size as function of time from shoulder dislocation, and to identify a time threshold after which MR arthrogram supersedes MRI in diagnostic utility. Methods We retrospectively evaluated consecutive patients who underwent primary arthroscopic labral repair between 2012 and 2021 and completed a preoperative MRI or MR arthrogram of the shoulder within 60 days of injury, and subsequently underwent arthroscopic repair within 6 months of imaging. Arthroscopic labral tear size and location was used as standard comparison. Three musculoskeletal radiologists independently interpreted tear extent using clock-face convention. Accuracy and precision of MR labral tear measurements were defined by location and size of the tear, respectively. Accuracy and precision were compared between MRI and MR arthrogram, as a function of time from dislocation. Results Thirty-two MRI and 65 MR arthrogram (total n=97) were independently assessed by radiologists. Multivariate analysis demonstrated that intraoperative tear size, early imaging, and arthrogram status were associated with increased MR accuracy and precision (p<0.05). Ordering surgeons preferred arthrogram for delayed imaging (p=0.018). For routine MRI, error in accuracy increased by 3.4° per day and error in precision increased by 2.3° per day (p<0.001) from time of injury. MR arthrogram, however, was not temporally influenced (Figure 1). Significant loss of accuracy and precision of routine MRI compared to MR arthrogram occurs at 2 weeks after acute shoulder dislocation. Conclusions For determining shoulder labral tear size after acute dislocation, routine MRI has similar diagnostic value for measuring labral tear extent as MR arthrogram up to approximately 2 weeks postacute shoulder dislocation, after which it significantly loses accuracy and precision, possibly due to resolving posttraumatic effusion. MR arthrogram accuracy and precision were not temporally influenced.
September 2024
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2 Reads
August 2024
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47 Reads
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4 Citations
Clinical Orthopaedics and Related Research
Background The healthcare sector in the United States has increased its greenhouse gas emissions by 6% since 2010 and today has the highest per capita greenhouse gas emissions globally. Assessing the environmental impact and material use through the methods of life cycle assessment (LCA) and material flow analysis of healthcare procedures, products, and processes can aid in developing impactful strategies for reductions, yet such assessments have not been performed in orthopaedic surgery. We conducted an LCA and a material flow analysis on an ACL reconstruction (ACLR). The ACLR served as a test case on the assumption that, lessons learned, would likely prove relevant to other orthopaedic procedures. Questions/purposes (1) What are the life cycle environmental impacts of ACLR? (2) What is the material flow and material circularity of ACLR? (3) What potential interventions would best address the life cycle environmental impacts and material circularity of ACLR? Methods First, we conducted an LCA according to International Organization for Standardization standards for quantifying a product’s environmental impact across its entire life cycle. One result of an LCA is global warming potential measured in carbon dioxide equivalent (CO2eq), or the carbon footprint. Second, we conducted a material flow analysis of ACLR. Material flow analyses are used to quantify the amount of material in a determined system by tracking the input, usage, and output of materials, allowing for the identification of where materials are consumed inefficiently or lost to the environment. To contextualize the material flow analysis, we calculated the material circularity indicator (MCI) index. This is used to measure how materials are circulating in a system and to evaluate the extent to which materials are recovered, reused, and kept within the economic loop rather than disposed of as waste. These three methods are widely used in other fields, especially engineering, but are more limited in healthcare research. Three observations and data collection occurred during ACLRs at the University of Pittsburgh Medical Center Bethel Park Surgical Center in Pittsburgh, PA, USA, between 2022 and 2023. Data encompassing electricity usage, surgical equipment type, the use of heating, ventilation, and air conditioning (HVAC) systems, the production and reuse of reusable instruments and gowns, and the production and disposal of single-use surgical products were collected. Following data collection, we conducted the LCA and the material flow analysis and then calculated the MCI for a representation of a single ACLR. To identify strategies to reduce the environmental impact of ACLR, we modeled 11 possible sustainability interventions developed from our prior work and the work of others and compared those strategies against the impact of the baseline ACLR. Results Our results show that the ACLR generated an estimated life cycle greenhouse gas emissions of 47 kg of CO2eq, which is analogous to driving a typical gasoline-fueled passenger vehicle for 120 miles. The total mass of all products for one ACLR was 12.73 kg, including 7.55 kg for disposable materials and 5.19 kg for reusable materials. Concerning material circularity, ACLR had a baseline MCI index of 0.3. Employing LCA for the carbon footprint and the MCI for 11 sustainability interventions has indicated the potential to reduce greenhouse gas emissions by up to 42%, along with an increase in circularity (circularity describes how materials are circulating in a system and evaluates the extent to which materials are recovered, reused, and kept within the economic loop rather than disposed of as waste) of up to 79% per ACLR. Among the most impactful interventions are the reduction in the utilization of surgical pack products, reutilization of cotton towels and surgical gowns, maximization of energy efficiency, and increasing aluminum and paper recycling. Conclusion ACLR has a substantial carbon footprint, which can meaningfully be reduced by creating a custom pack without material wastage, reusing cotton towels, and maximizing recycling. Combining LCA, material flow analysis, and MCI can provide a thorough assessment of sustainability in orthopaedic surgery. Clinical Relevance Orthopaedic surgeons and staff can immediately reduce the environmental impact of orthopaedic procedures such as ACLR by opening fewer materials—via making custom packs and only opening what is needed in the operating room—and by incorporating more reusable materials such as towels. Larger scale medical center changes, such as implementing recycling programs and installing energy-efficient systems, also can make a meaningful difference in reducing environmental impact.
July 2024
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41 Reads
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2 Citations
Orthopaedic Journal of Sports Medicine
Background Despite increasing use of quadriceps tendon (QT) autograft in anterior cruciate ligament (ACL) reconstruction (ACLR), limited data exist regarding its outcomes in high-risk adolescent athletes. Purpose To (1) report the outcomes after QT ACLR in adolescent athletes and (2) identify patient-related and surgery-related factors that may influence failure rates after QT ACLR. Study Design Case series; Level of evidence, 4. Methods All patients aged 14 to 17 years who underwent primary anatomic, transphyseal, single-bundle QT ACLR between 2010 and 2021 with a minimum 2-year follow-up were included for analysis. Demographic and surgical data as well as preoperative International Knee Documentation Committee (IKDC) and Marx activity scores were collected retrospectively. All patients were also contacted to assess postoperative patient-reported outcomes (PROs), including IKDC and Marx activity scores, and return-to-sports (RTS) data. Outcomes of interest included rates of revision ACLR and ipsilateral complications, contralateral ACL tears, difference in pre- and postoperative PROs, and rates of RTS. Patient and surgical characteristics were compared between groups who required revision ACLR versus those who did not. Results A total of 162 patients met inclusion criteria, of which 89 adolescent athletes (mean age 16.2 ± 1.1 years, 64% female) were included for analysis at mean follow-up of 4.0 years. Postoperative IKDC scores were significantly higher than preoperative scores (88.5 vs 37.5; P < .001), whereas Marx activity scores decreased postoperatively (14.3 vs 12.2; P = .011). Successful RTS occurred in 80% of patients at a mean time of 9.7 ± 6.9 months, and 85% of these patients returned to the same or higher level of sports. The most common reasons for failure to RTS included lack of time (n = 7, 70%) and fearing reinjury in the operative knee (n = 5, 50%). The overall revision ACLR rate was 10% (n = 9), and contralateral ACL tears occurred in 14% (n = 12) of patients. The overall ipsilateral knee reoperation rate was 22.5% (n = 20). No statistically significant differences in patient or surgical characteristics were observed between patients who underwent revision ACLR and those who did not. Conclusion At a minimum 2-year follow-up after QT ACLR, adolescent athletes experienced significantly improved postoperative IKDC scores, high rates of RTS, and low rates of graft failure, despite a relatively high ipsilateral reoperation rate. Surgeons may utilize this information when identifying the optimal graft choice for adolescent athletes who have sustained an ACL injury and wish to return to high level of sporting activities.
April 2024
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93 Reads
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1 Citation
Knee Surgery Sports Traumatology Arthroscopy
Purpose To retrospectively compare strength outcomes of individuals undergoing postoperative rehabilitation following quadriceps tendon (QT) autograft anterior cruciate ligament reconstruction (ACLR) with and without blood flow restriction therapy. Methods A retrospective review of consecutive patients undergoing ACLR with QT autograft with a minimum of two quantitative postoperative isometric strength assessments via an electromechanical dynamometer (Biodex) was included. Demographics, surgical variables and strength measurement outcomes were compared between patients undergoing blood flow restriction therapy as part of postoperative rehabilitation versus those who did not. Results Eighty‐one (81) patients met the inclusion criteria. No differences were found in demographic and surgical characteristics between those who received blood flow restriction compared with those who did not. While both groups had improvements in quadriceps peak torque and limb symmetry index (LSI; defined as peak torque of the operative limb divided by the peak torque of the nonoperative limb) over the study period, the blood flow restriction group had significantly lower mean peak torque of the operative limb at first Biodex strength measurement (95.6 vs. 111.2 Nm; p = 0.03). Additionally, the blood flow restriction group had a significantly lower mean LSI than those with no blood flow restriction at the second Biodex measurement timepoint (81% vs. 90%; p = 0.02). No other significant differences were found between the strength outcomes measured. Conclusions Results of this study show that the ‘real world’ clinical implementation of blood flow restriction therapy to the postoperative rehabilitation protocol following QT autograft ACLR did not result in an increase in absolute or longitudinal changes in quadriceps strength measurements. A better understanding and standardisation of the use of blood flow restriction therapy in the rehabilitation setting is necessary to delineate the true effects of this modality on strength recovery after QT autograft ACLR. Level of Evidence Level III.
April 2024
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32 Reads
... In a study by Dadoo S et al. (2024), 80% of patients successfully returned to sports at a mean time of 9.7 months, of which 85% of patients returned to the same or a higher level of activity postoperatively [27]. The rate of return to sports (RTS) was similar to previously reported rates of RTS among adolescent athletes after ACLR with QT and other autografts, ranging from 60% to 100% [28][29][30][31]. ...
July 2024
Orthopaedic Journal of Sports Medicine
... Another clinical study [25] found that the implementation of BFRT after ACLR surgery did not lead to an increase in the absolute or longitudinal changes in quadriceps strength measurements. This study has practical significance and shows the trend of clinical practice, which has reference value. ...
April 2024
Knee Surgery Sports Traumatology Arthroscopy
... 1,13 Previous studies have reported a positive association between larger ACL graft diameter or harvest width and loss of extension. 8,24 Similarly, a narrow notch may increase the risk for loss of extension due to an association with cyclops syndrome, although this relationship is described in cohorts receiving primarily hamstring tendon autograft ACLR. 4,6 In 1 retrospective series of patients undergoing all-soft tissue QT autograft ACLR, a femoral tunnel diameter .9.25 mm was associated with postoperative loss of extension among male patients. ...
March 2024
Orthopaedic Journal of Sports Medicine
... The results revealed no statistically significant difference between the two groups, suggesting that in revision patients, the OTT technique could serve as a valuable alternative. The most prevalent complications observed in the OTT group included graft failure, followed by arthrofibrosis and cyclops lesion [57]. ...
July 2023
Orthopaedic Journal of Sports Medicine
... Most ACL injuries occur when a sudden change in acceleration, deceleration, landing, or pivoting maneuvers is repeatedly performed. These injuries are also known as the injuries that occur without physical contact between athletes, which are called non-contact ACL injuries [2]. ...
July 2023
... Nevertheless, the criteria for acceptable LLD post-THA is not well defined, with 1 review finding that up to 10mm of LLD is well tolerated by most patients [40]. Femoral offset, the perpendicular distance from the center of rotation of the femoral head to the long axis of the femur, was found to adversely affect implant longevity and side-to-side imbalance of abductor muscle strength [42]. This strength imbalance was suggested to be a plausible explanation for post-THA patient-perceived LLD [42]. ...
June 2023
Arthroplasty Today
... 19 Additionally, delay in effective treatment causes further damage to the joint, increasing the surgical complexity and associated risk of subsequent treatment failure, as well as potentially increasing the risk of future shoulder arthropathy. 14,20,34,37,57 Arthroscopic Bankart repair (ABR) is a soft tissue stabilization procedure commonly used to treat anterior shoulder instability, particularly in the setting of minimal bone loss. 24,39 Arthroscopic techniques are minimally invasive and have evolved to demonstrate comparable postoperative outcomes when compared with open techniques. ...
December 2022
Arthroscopy The Journal of Arthroscopic and Related Surgery
... T he quadriceps tendon (QT) is becoming a standard option for anterior cruciate ligament reconstruction (ACLR) because of the possibility of harvesting a large-diameter graft with low donor-site morbidity and equivalent superior clinical outcomes compared with those of other autografts. 1,2 Similar clinical outcomes between QT autografts of all-soft tissue and bone block 3,4 have been reported; however, full-thickness QT autografts with bone blocks (QTB) are thought to be theoretically ideal on the basis of morphologic, biological, and biomechanical reasons. 5,6 Recent studies have shown patellar fracture of the harvesting site and cosmetic problems associated with longitudinal skin incisions when harvesting the QTB. ...
November 2022
Knee Surgery Sports Traumatology Arthroscopy
... Rotator cuff repair retear rates are influenced by factors such as surgical technique, postoperative rehabilitation, and patient characteristics, including age, tear size, and tendon quality [5,6]. The double-row suture bridge technique is widely adopted due to its biomechanical advantages, such as increased structural integrity, load strength, and tendon-to-bone contact area, which promote better biological healing [7][8][9][10]. ...
August 2022
Knee Surgery Sports Traumatology Arthroscopy
... "Augmented Humans" proved to be core for the home-based treatment, which is at the forefront of this transformative shift, offering the opportunity to receive medical care, therapy, and rehabilitation within the comfort and familiarity of patients' own homes. Home-based treatments are a comprehensive range of medical and therapeutic services that are specifically tailored to meet each patient's individual needs, whether it be for managing chronic illnesses [12], recovering from surgery [13], getting palliative care [14], or even addressing mental health issues [15]. This approach to healthcare has gained prominence for several compelling reasons. ...
August 2022
Sports Health A Multidisciplinary Approach