Journal of orthopaedics最新文献

{"title":"Clinical outcomes following novel 5- or 6-strand ACL reconstruction with fixed or adjustable loop suspensory button femoral fixation","authors":"Brian R. Wolf ,&nbsp;Bruno Butturi Varone ,&nbsp;Cameron Barton ,&nbsp;Qiang An ,&nbsp;Matthew J. Bollier","doi":"10.1016/j.jor.2025.01.023","DOIUrl":"10.1016/j.jor.2025.01.023","url":null,"abstract":"<div><h3>Background</h3><div>Anterior cruciate ligament reconstruction (ACLR) hamstring (HS) autograft diameter &lt;8 mm is associated with an increased re-rupture rate. Efforts have been made to increase graft diameter by using more than 4 strands.</div><div>The purpose of this study was to report graft sizes and outcomes using a novel modified 5- or 6-strand HS ACLR.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted with patients who underwent primary ACLR through a 5-year period. Patients were divided into 2 groups based on graft choice: 5- or 6-strand HS versus the remainder of the cohort (BTB, QT, or 4-strand HS).</div></div><div><h3>Results</h3><div>There were 70 patients in group 5/6, and 48 patients in group CG (20 4-strand HS and 28 BTB/QT). The average follow-up was 47.7 months. Re-rupture rate in Group 5/6 was 2.9 % (2/70) compared to 8.3 % (4/48) (p = .2225) in group CG. The subsequent surgery rate for group 5/6 was 5.7 %, versus 12.5 % for group CG (p = .3128).</div></div><div><h3>Conclusion</h3><div>5 or 6 Strand ACLR provides graft sizes &gt;8 mm in 98.6 % of cases, good clinical outcomes including low re-rupture and subsequent surgery rates, and good patient-reported outcomes. At an average follow-up of 4 years, 5 or 6 Strand ACLR revealed trends of lower re-rupture rates, lower subsequent surgery rates, and lower cyclops lesion rates compared to BTB/Quad and 4-strand hamstring grafts; however, these results were not statistically significant.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 165-169"},"PeriodicalIF":1.5,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143154695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stress evaluation along the posterior annular circumferential tears on the L5-S1 spinal unit as an index of tear progression","authors":"Vinyas ,&nbsp;Subraya Krishna Bhat ,&nbsp;Hiroshi Yamada ,&nbsp;Nitesh Kumar ,&nbsp;Raviraja Adhikari ,&nbsp;Shyamasunder Bhat N","doi":"10.1016/j.jor.2025.01.026","DOIUrl":"10.1016/j.jor.2025.01.026","url":null,"abstract":"<div><div>Low back pain is a critical health issue related to the formation and growth of tears (or lesions), along with degenerative changes, which is commonly observed in the posterior regions of intervertebral discs (IVD) in the lower spine segments. Early and accurate prediction of growth of these tears is a challenging task with immense clinical significance. Finite element method is a promising technique in this direction, however, the combined effects of tears and degeneration in the posterior region of annulus has not been studied. The present work focuses on a numerical evaluation of the contribution of annulus material degeneration, the position of tear and regular physiological movements (extension, flexion, left and right lateral bending) on the growth of the posterior circumferential tear in the annulus of the L5-S1 spinal unit. The material models developed previously to describe degeneration effects were adopted for defining the annulus material. The tear is modelled by altering the mesh to determine its effects in the presence of degeneration in the annulus. Degeneration, which is a loss of functional ability due to age-related effects, influenced the stress response significantly across all types of movements. Flexion movement is found to have the most predominant damaging effect on the tears, evident by the higher stresses along the tear boundary. Tears near the outer periphery of the annulus were likely to experience higher magnitudes of stress for an applied load and, hence, were suggested to be more critical. Extension movement seemed to aid in the recovery of the tear, supporting the results of clinical studies. This study highlights the complex interaction between physiological movements and the progression of posterior circumferential tears under different stages of degeneration, which can enable clinicians to develop and implement suitable patient-specific treatment modalities.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 148-164"},"PeriodicalIF":1.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143154693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of infrapatellar fat pad injury severity on subsequent patellofemoral cartilage degeneration following acute ACL tear","authors":"Griffin Harris ,&nbsp;Nikhil Patel ,&nbsp;Richard Wang ,&nbsp;Anmol Patel ,&nbsp;Selina Deiparine ,&nbsp;Thomas M. Best ,&nbsp;Jean Jose","doi":"10.1016/j.jor.2025.01.027","DOIUrl":"10.1016/j.jor.2025.01.027","url":null,"abstract":"<div><h3>Objective</h3><div>The infrapatellar fat pad (IFP) is important in the homeostasis of the knee joint due to its structural and immune-modulating properties. This study investigates the relationship between IFP injury severity during acute Anterior Cruciate Ligament (ACL) tears, and the future development of Patellofemoral Compartment (PFC) chondrosis.</div></div><div><h3>Methods</h3><div>Adult participants aged 18–45 years old who were known to have first-time ACL tears between 01/01/2009 and 10/1/2022 were included. Patients with concomitant knee pathologies at the time of injury were excluded from the study. All participants received ACL reconstruction surgery and had follow-up MRIs conducted within two years postoperatively. Preoperative IFP edema levels were assessed alongside both pre-and postoperative PFC. We analyzed the relationship between the initial IFP edema and future PFC progression on subsequent MRI scans.</div></div><div><h3>Results</h3><div>A total of 69 participants were included in this study. No significant correlation was found between the severity of initial IFP injury and the initial presence of PFC chondrosis (r = −0.04, P = 0.61). However, a significant positive correlation was observed between the severity of initial IFP injury and the future progression of PFC chondrosis (r = 0.44, P &lt; 0.001). Additionally, a significant difference in the progression of PFC chondrosis was noted when comparing grade 1 to grade 2 IFP injuries (P = 0.001). No significant difference in PFC chondrosis development was identified when comparing grade 2 to grade 3 IFP injuries (P = 0.72).</div></div><div><h3>Conclusion</h3><div>Our study underscores the potential role of the IFP in preserving cartilage homeostasis by establishing a link between the severity of IFP injury and the subsequent development of PFC following ACL injury.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 170-176"},"PeriodicalIF":1.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143154694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tramadol-based multimodal pain protocols after arthroscopic rotator cuff repair are similarly effective as oxycodone-based protocols with fewer morphine milligram equivalents prescribed and lower risk of refills","authors":"William F. Baker ,&nbsp;Nabil Mehta ,&nbsp;Samantha A. Riebesell ,&nbsp;Dennis A. DeBernardis ,&nbsp;Luke S. Austin","doi":"10.1016/j.jor.2025.01.015","DOIUrl":"10.1016/j.jor.2025.01.015","url":null,"abstract":"<div><h3>Background</h3><div>Tramadol is a synthetic opioid prescribed to control postoperative pain while mitigating the harmful effects of stronger opioids, such as oxycodone. However, it is unknown whether tramadol can serve as an adequate substitute for oxycodone following shoulder surgery. Therefore, the primary purpose of this study was to compare early postoperative pain scores and prescribed narcotic between patients receiving tramadol and oxycodone after arthroscopic rotator cuff repair (ARCR). The secondary purpose was to identify risk factors related to experiencing increased postoperative pain or requiring increased postoperative prescriptions.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed evaluating 58 patients receiving a tramadol-based pain management protocol and 103 patients receiving an oxycodone-based protocol after ARCR. VAS pain scores were obtained preoperatively and at 2 weeks, 6 weeks, and 3 months postoperatively. The change in VAS score from preoperative to 3-month follow-up was calculated. Total milligram morphine equivalent (MMEs) prescribed, number and timing of refills, and the proportion of patients failing the tramadol protocol who required oxycodone were recorded. Multivariate regression analysis was performed to determine risk factors for having higher postoperative pain scores and requiring an increased number of prescriptions.</div></div><div><h3>Results</h3><div>The average total number of MMEs prescribed for patients who received oxycodone was over 8 times greater than for patients who received tramadol (993 vs. 120 MMEs). Both groups demonstrated improvements in pain scores at all time points. Patients receiving tramadol had a greater change in VAS score from pre to postoperative at all timepoints. Patients who were prescribed oxycodone received a greater number of refills and were 2.7 times more likely to need a refill within 3 months than those receiving tramadol. Only 4 patients (6.9 %) receiving tramadol required oxycodone within 3 months of surgery.</div></div><div><h3>Conclusion</h3><div>As part of a multimodal protocol, tramadol provides equivalent pain relief after ARCR compared to oxycodone while requiring fewer MMEs. Patients prescribed oxycodone exhibit a smaller magnitude of improvement in VAS pain and require more refills than those prescribed tramadol. Our findings can be used to improve opioid prescription practices to reduce dependency and over prescription of narcotics.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 126-131"},"PeriodicalIF":1.5,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Finite element analysis of Scarf osteotomy for precise treatment of hallux valgus","authors":"Min Zhang ,&nbsp;Ling Zhang ,&nbsp;Shitao Fang ,&nbsp;Yun Wang ,&nbsp;Jinkun Guo ,&nbsp;Lei Mi","doi":"10.1016/j.jor.2025.01.020","DOIUrl":"10.1016/j.jor.2025.01.020","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The treatment of hallux valgus is currently in face of many challenges in clinical practice. Although conventional surgical procedures can correct deformities to a certain extent, some key parameters such as osteotomy displacement and angle are often difficult to determine, leading to increased uncertainty in surgical outcomes and a relatively high incidence of postoperative complications.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Hallux valgus is a common foot deformity that often leads to pain, difficulty in walking, and other health problems, seriously affecting the quality of life of patients. In order to provide patients with more precise treatment, we aimed to simulate the Scarf osteotomy for the treatment of hallux valgus using the finite element method, and comparatively analyze the mechanical performance indicators under different distal osteotomy displacements. We hoped to provide scientific and reasonable treatment plans for clinical practice and better treatment outcomes for patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A volunteer with moderate hallux valgus was selected as the research subject in this study. Preoperative plantar pressure test was conducted, and the CT data of the patient's affected foot was collected to create the finite element model using finite element software. After verifying the validity of the model, it was used to simulate the translational Scarf osteotomy under different settings. Specifically, the distal end of the bone fragment was pushed outwards by varying distances (2 mm, 4 mm, 6 mm, and 8 mm) and was fixed with screws. The maximum Von Mises stresses on the first to fifth metatarsal bones, the sole and the heel under four different surgical settings were compared with the preoperative values, and the changes in the maximum Von Mises stress on the screws were examined.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;When the distal end of the bone fragment was pushed outwards by 6 mm, the maximum Von mises stress on the first metatarsal bone (9.4711 MPa) reached its highest value, while the maximum Von mises stresses on the second and third metatarsal bones (0.34062 MPa and 1.6246 MPa, respectively) and on the screws (40.99 MPa) were at the lowest values. The maximum plantar pressure detected during static test was 0.292 MPa, while the maximum plantar stress observed in the finite element model was 0.25733 MPa, indicating comparable values between the two.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Based on precise and customized preoperative design and finite element analysis, it was found that the Scarf osteotomy with the distal end of the bone fragment pushed outwards for 6 mm could yield the best treatment effect for hallux valgus. Under this setting, the stress on the first metatarsal bone was the highest, while the stresses on the second and third metatarsal bones were the lowest, suggesting that it can relieve the stress on lateral metatarsal bones and improve the stress distributio","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 132-139"},"PeriodicalIF":1.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patellar tendon repair restores extensor mechanism function with a low complication rate: A systematic review","authors":"Udit Dave ,&nbsp;Jared Rubin ,&nbsp;Nicole Chang ,&nbsp;Andrew S. Bi ,&nbsp;Myles Atkins ,&nbsp;Fernando Gómez-Verdejo ,&nbsp;Nikhil N. Verma ,&nbsp;Jorge Chahla","doi":"10.1016/j.jor.2025.01.011","DOIUrl":"10.1016/j.jor.2025.01.011","url":null,"abstract":"<div><h3>Introduction</h3><div>The patellar tendon plays a crucial role in knee extension and lower extremity mobility. Although PT ruptures are rare, they result in severe loss of function when untreated. The purpose of this study was to evaluate clinical and functional outcomes and complications following primary, acute patellar tendon (PT) repair.</div></div><div><h3>Methods</h3><div>In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Embase, and Cochrane Library databases were searched in August 2024 for studies published after 2004. Studies were included if they met these criteria: evaluated patients who underwent acute PT repair with any technique including for mid-substance tear or avulsion, were prospective or retrospective studies, and reported functional outcomes or complications. Studies not written in English were excluded.</div></div><div><h3>Results</h3><div>The initial screen identified 1737 studies, 9 of which were included in this systematic review. There were three retrospective cohort studies, three retrospective case series, one retrospective case control study, and two prospective case series. Each study had low risk of bias. A total of 970 patients (93.8 % males) were included. Mean age across studies ranged from 32.1 to 44.6 years. Five included studies reported on mean extension at follow-up, ranging from 0 to 6.4 degrees of extension. Five included studies reported on mean flexion at follow-up, ranging from 128.5 to 143.3 degrees of flexion. The range of re-rupture and re-operation were 0–21.4 % with an overall re-rupture rate of 3.9 % and an overall re-operation rate of 5.7 %. Only one study reported a significant difference in re-rupture rates with transosseous repair versus suture anchor repair (7.5 % versus 0 % respectively). Other complications identified were venous thromboembolism (VTE) (0–5.0 %), stiffness (0–35.0 %), hardware discomfort (0–5.0 %), and infection (0–5.0 %).</div></div><div><h3>Conclusions</h3><div>Patellar tendon repair with both transosseous and suture anchor technique restores range of motion in patients post-operatively with a low complication rate. Decisions regarding operative technique should be tailored to individual patient characteristics and surgeon preferences.</div></div><div><h3>Level of evidence</h3><div>Level IV, systematic review of level III-IV studies.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 146-153"},"PeriodicalIF":1.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All-inside technique for isolated posterior cruciate ligament tears: Surgical technique and outcomes","authors":"Stefano Petrillo ,&nbsp;Filippo Migliorini ,&nbsp;Fabrizio Bertelle ,&nbsp;Piero Volpi","doi":"10.1016/j.jor.2025.01.010","DOIUrl":"10.1016/j.jor.2025.01.010","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this paper is to describe all-inside posterior cruciate ligament (aiPCL) reconstruction surgical technique and to report complications and outcomes in female patients with isolated posterior cruciate ligament (PCL) tears.</div></div><div><h3>Methods</h3><div>Preoperative and postoperative evaluations included posterior drawer test, dial test at 30^o and 90^o of knee flexion, Tegner score, and Lysholm score. The mean follow-up was 33.12 months (range 12–74).</div></div><div><h3>Results</h3><div>Twenty-five female patients with grade II or grade III isolated lesions of the PCL underwent aiPCL reconstruction. The mean age of the patients at the time of surgery was 29.7 ± 12.9 years, while the mean time from injury to surgery was 11 months (range 12–324). No intraoperative/postoperative complications occurred. At the last follow-up, 16 (69.5 %) and 5 (21.5 %) patients had a grade A and B posterior drawer test, respectively, while the dial test (30^o and 90^o of knee flexion) was negative in all patients. The mean preoperative Lysholm score was 64.08 ± 13.06 points (range 37–85 points), while the mean postoperative Lysholm score was 88.12 ± 13.33 points (range 50–100 points) (<em>p&lt;</em>0.0001). No statistically significant differences were found comparing preoperative and postoperative Tegner score results.</div></div><div><h3>Conclusions</h3><div>The arthroscopic aiPCL reconstruction seems safe and effective.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 54-58"},"PeriodicalIF":1.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining preoperative expectations and postoperative met expectations to predict patient-reported outcomes after knee surgery","authors":"Brandon Leon,&nbsp;Dominic J. Ventimiglia,&nbsp;Evan L. Honig,&nbsp;Leah E. Henry,&nbsp;Andrew Tran,&nbsp;Michael A. McCurdy,&nbsp;Jonathan D. Packer,&nbsp;Sean J. Meredith,&nbsp;Natalie L. Leong,&nbsp;R. Frank Henn III","doi":"10.1016/j.jor.2025.01.024","DOIUrl":"10.1016/j.jor.2025.01.024","url":null,"abstract":"<div><h3>Introduction</h3><div>Both preoperative expectations and postoperative met expectations can independently influence patient-reported outcomes (PROs), however, their combined effect on PROs is not well understood. This study aimed to determine the prognostic significance of categorizing non-arthroplasty knee surgery patients into clusters based on both preoperative expectations and postoperative met expectations.</div></div><div><h3>Methods</h3><div>638 patients who underwent non-arthroplasty knee surgery from June 2015 to May 2021 at a single academic institution were analyzed. Patients were grouped based on both preoperative expectations and two-year postoperative met expectations scores using cluster analysis. Four distinct expectations cluster groups were formed: high preoperative-high met expectations (HIGH-HIGH), low preoperative-high met expectations (LOW-HIGH), high preoperative-low met expectations (HIGH-LOW), and low preoperative-low met expectations (LOW-LOW). Socioeconomic data and PROs were compared based on cluster group, and logistic regression was performed to determine the likelihood of achieving a patient-perceived “completely better” status based on cluster group.</div></div><div><h3>Results</h3><div>Patients with high met expectations, regardless of preoperative expectations, reported better two-year PROs compared to patients with low met expectations. Patients with high preoperative expectations achieved better outcomes only when those expectations were met postoperatively. Low preoperative expectations did not preclude patients from achieving good outcomes, as long as those expectations were met. The HIGH-HIGH group had increased odds of achieving completely better status compared to the LOW-HIGH group (OR = 1.68, p = .02), HIGH-LOW group (OR = 16.69, p &lt; .001), and LOW-LOW group (OR = 5.17, p &lt; .001). The HIGH-LOW group had decreased odds of achieving completely better status compared to the LOW-LOW group (OR = .31, p = .01).</div></div><div><h3>Conclusion</h3><div>Met expectations may be a stronger predictor of postoperative outcomes than preoperative expectations in non-arthroplasty knee surgery. This study highlights the importance of setting realistic preoperative expectations and focusing on achieving expectations postoperatively. These findings offer valuable insights for clinicians to manage patient expectations effectively based on individual characteristics and expected treatment outcomes.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 140-147"},"PeriodicalIF":1.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental impact of TKA: Waste audit of hospital operating room compared to ambulatory surgery center","authors":"Christopher E. Bejcek ,&nbsp;Jeffrey R. Baker ,&nbsp;Anthony G. Sleiman ,&nbsp;Sowmyanarayanan V. Thuppal ,&nbsp;Kristin Delfino ,&nbsp;D. Gordon Allan","doi":"10.1016/j.jor.2025.01.014","DOIUrl":"10.1016/j.jor.2025.01.014","url":null,"abstract":"<div><h3>Introduction</h3><div>The implications of global warming are ever increasing in today's society. As the number of total knee arthroplasties (TKA) performed in the USA increases annually, the total waste produced from them will proportionally increase. This study hopes to quantify and compare the amount of waste created by a TKA in a hospital operating room (OR) and ambulatory surgery center (ASC) to evaluate for any differences in the amount and types of waste created.</div></div><div><h3>Methods</h3><div>Waste audits were performed on 10 TKAs both at hospital OR and ASC OR. Waste was organized into 6 categories: normal solid waste, recyclable plastics, biohazard waste, laundered linens, sharps, and polypropylene blue sterile wrap. Weight and volume for each waste stream were recorded using a digital scale and ruler.</div></div><div><h3>Results</h3><div>The total mass of waste produced was higher in hospital based TKAs than in the ASC cases (17.3 kg vs. 14.0 kg, p-value = 0.0028). There was significantly more mass of sterile, normal, and sharps waste at the hospital-based cases. Sterile waste was the largest contributor to the mass of waste in both settings. No difference existed in volume of waste between the hospital and ASC cases (305,866 cm³ vs 260,052 cm³, p-value = 0.2494).</div></div><div><h3>Discussion</h3><div>TKAs in both settings produce a large amount of waste. Performing TKAs at ASCs could be used to lower the amount of waste produced, resulting in long term benefits to both the environment and the healthcare system.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 90-92"},"PeriodicalIF":1.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143418871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superior capsular reconstruction vs. Latissimus dorsi transfer for posterosuperior irreparable rotator cuff tears without arthritic change: Mid-term Crossover study","authors":"Chang Hee Baek,&nbsp;Chaemoon Lim,&nbsp;Jung Gon Kim,&nbsp;Bo Taek Kim,&nbsp;Seung Jin Kim","doi":"10.1016/j.jor.2025.01.013","DOIUrl":"10.1016/j.jor.2025.01.013","url":null,"abstract":"<div><h3>Background</h3><div>Latissimus dorsi transfer (LDT) is a well-known tendon-transfer technique with long-term clinical follow-up results, whereas superior capsular reconstruction (SCR) has recently emerged as a treatment option for posterosuperior irreparable rotator cuff tears (PSIRCTs). However, only a few small short-term comparative studies have evaluated SCR and LDT. We evaluated the clinical and radiological outcomes of SCR and LDT in PSIRCTs without arthritic changes.</div></div><div><h3>Methods</h3><div>This retrospective clinical comparative study evaluated patients who underwent SCR or LDT for PSIRCTs and had a mid-term (at least 5 years) follow-up. 28 patients in the SCR group and 31 in the LDT group were included. The visual analog scale (VAS) score, patient-reported clinical outcome scores, and active range of motion (aROM) were used for assessing clinical outcomes. The radiologic outcomes including progression of glenohumeral osteoarthritis and graft integrity were evaluated using Hamada grade and Sugaya classification, respectively.</div></div><div><h3>Results</h3><div>Significant improvements in VAS scores and aROM were observed in both groups. The LDT group reported significant improvements in all patient-reported outcome scores. However, SCR group showed no significant improvement in patient-reported outcome scores except for American Shoulder and Elbow Surgeons score. In radiologic outcomes, AHD was significantly decreased, and the Hamada grade was significantly increased postoperatively in both groups. Moreover, the progression of arthritic change was significantly greater in the LDT group, while the rate of graft retear was markedly higher in the SCR group.</div></div><div><h3>Conclusions</h3><div>Although both SCR and LDT improved clinical outcomes, LDT was superior to SCR in terms of patient-reported outcome scores. However, progression of osteoarthritis is more common in LDT whereas graft retear is more common in SCR. Therefore, SCR or LDT could be considered as a surgical treatment in PSIRCTs without arthritic changes, but clinical outcomes as well as complications (osteoarthritis and graft re-tear) must be considered.</div></div><div><h3>Level of evidence</h3><div>Level of evidence, III.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"69 ","pages":"Pages 10-17"},"PeriodicalIF":1.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}