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Abstract Next-generation site-specific cysteine-based antibody–drug-conjugates (ADCs) broaden therapeutic index by precise drug-antibody attachments. However, manufacturing such ADCs for clinical validation requires complex full reduction and reoxidation processes, impacting product quality. To overcome this technical challenge, we developed a novel antibody manufacturing process through cysteine (Cys) metabolic engineering in Chinese hamster ovary cells implementing a unique cysteine-capping technology. This development enabled a direct conjugation of drugs after chemoselective-reduction with mild reductant tris(3-sulfonatophenyl)phosphine. This innovative platform produces clinical ADC products with superior quality through a simplified manufacturing process. This technology also has the potential to integrate Cys-based site-specific conjugation with other site-specific conjugation methodologies to develop multi-drug ADCs and exploit multi-mechanisms of action for effective cancer treatments.

The fifth industrial revolution emphasizes human-robot collaboration to enhance transformation processes. While collaborative robots (cobots) are increasingly attracting interest in various industries, integrating them into assembly lines remains challenging. This paper aims to investigate whether cobots are replacing traditional robots or if a synergy between both technologies is essential in the era of Industry 5.0 to maximize benefits. The real case study presented provides a comparison between robots and cobots in an automotive factory using the Fuzzy AHP methodology. The results indicate that cobots are advantageous in production units with low-volume and high-variability tasks. However, they fall short of the reliability, precision, and productivity that traditional robots offer for repetitive tasks. Finally, a framework is proposed to guide decision makers in adopting the suitable solution to their needs while ensuring optimal performance as well as workers wellbeing. [ABSTRACT FROM AUTHOR]

Early epidemic reports have linked low average 25(OH) vitamin D levels with increased COVID-19 mortality. However, there has been limited updated research on 25(OH) vitamin D and its impact on COVID-19 mortality. This study aimed to update the initial report studying the link between vitamin D deficiency and COVID-19 mortality by using multi-country data in 19 European countries up to the middle of June 2023. COVID-19 data for 19 European countries included in this study were downloaded from Our World in Data from 1 March 2020, to 14 June 2023, and were included in the statistical analysis. The 25(OH) vitamin D average data were collected by conducting a literature review. A generalized estimation equation model was used to model the data. Compared to European countries with 25(OH) vitamin D levels of ≤50 nmol/L, European countries with 25(OH) vitamin D average levels greater than 50 nmol/L had lower COVID-19 mortality rates (RR = 0.794, 95% CI: 0.662–0.953). A statistically significant negative Spearman rank correlation was observed between 25(OH) vitamin D average levels and COVID-19 mortality. We also found significantly lower COVID-19 mortality rates in countries with high average 25(OH) vitamin D levels. Randomized trials on vitamin D supplementation are needed. In the meantime, the issue of vitamin D use should be debated in relation to the ongoing discussions of national post-COVID-19 resilience against future pandemics.

India is the world’s largest producer of sugar, with an annual production capacity of 29 million tonnes. Each crushing season, this intern produces over 10 million tonnes of pressmud, which is difficult to dispose of due to its inherent properties. The present study is part of larger investigation for treatment and disposal of pressmud and spentwash. Further, scope of this research article is confined to utilization of pressmud for aerobic composting of pressmud along with selected microbial consortium and stabilized spentwash. Composting was carried out in an open area with 50 kg of pressmud and 1% (w/w) dosage of microbial consortium. Stabilized spentwash was used at concentrations of 25, 50, 100, 150 and 200% (v/w) and applied at predetermined time intervals. The entire study lasted for 50 days and the results were compared to those recommended by the Fertilizer Control Order (FCO), Ministry of Agriculture, Government of India (1). In an organic compost, the FCO recommends a minimum concentration of 12%, 0.80%, 0.40%, and 0.40% in TOC, TKN, phosphorous and potassium, with a maximum C/N ratio of 20. During composting, the addition of 150% (CH5) stabilized spentwash resulted in a maximum nutrient concentration in the majority of the parameters analysed. CH5 showed that the concentration of TOC, TKN, C/N, phosphorous and potassium were 25.92±2.19%, 2.16±0.29%, 12.28±0.66, 6.55±0.11% and 15.90±1.37% respectively. Hence, it can be concluded that selected microbial consortium is capable of decomposing the organic matter found in pressmud. Additionally, the application of stabilized spentwash enhanced the nutritional content of end product.

Nosocomial resistance in staphylococci and enterococci is challenging. The aim of this work was to conduct a multipoint study using molecular detections, antimicrobial resistances profiles, patient demographics and disease patterns for objective assessments of Staphilococcus aureus and other Gram-positive pathogens recovered from clinical infections in the Ha’il region. We have surveyed 188 non-duplicate Gram-positives against 22 antimicrobials for molecular-differentiation, resistance, patient demographics, and disease patterns from January–April 2021. According to definitions for acquired resistance, Staphylococcus aureus was the most frequent with multidrug resistant (65.4%), where MRSA was 60% (n = 72 out of 121). In age-identified patients, 43% were seniors ≥50 years, 38% 21–49 years, and 19% 0–20 years. In gender-identified patients, 63% were males, and 37% were females. While 25% of specimens were from the ICU, the majority (60%) of specimens were from surgical infection in other wards. Staphylococcus epidermidis was the second (15.4%) species of infection identified with 81% from bloodstream infections at the ICU and other wards. The majority of S. epidermidis patients (69%) were seniors ≥50 years, while other age groups 0–20 and 21–49 each had 14% isolates. Although S. epidermidis was multidrug-resistant, it was susceptible to many drugs. Enterococcus faecalis (13%) ranked third with two major infections; bloodstream (64%) and urinary-tract infections (36%) in mainly seniors (86%). Its isolates were fully resistant to oxacillin, penicillin, cefoxitin, and cefotaxime but nearly 100% susceptible to seven others. Other Gram-positive bacteria (6%) were susceptible to many antibiotics. The use of combinations of objective criteria is a well thought out approach in infection control. While the low-frequency of Gram-positives is an impressive achievement, future large-scale investigations should include all private hospitals, clinics and other cities over a longer sampling time to gain more insights. Although geriatric susceptibility can be justified by age and comorbidities, the staphylococcal infections in young adults and children is a global concern and warrants more vertical studies.

Background: The incidence of anterior cruciate ligament (ACL) injuries has rapidly increased. Patients with ACL injuries frequently present with concomitant meniscal pathologies. Posterior medial meniscal root tears (PMMR) are less commonly seen with acute ACL injuries as compared with lateral tears and are often degenerative in nature or more rarely in an acute setting. Clinical studies have demonstrated medial meniscal deficiency to be a significant risk factor for graft failure and poor postoperative clinical outcomes. As such, given its demonstrated efficacy, there has been growing interest in transtibial meniscal repair mechanisms in combination with an ACL reconstruction as a potential solution to this challenging pathology. Indication: Patients are indicated for surgery when presenting with symptomatic ACL deficiency verified on provocative testing and advanced imaging and objective insufficiency of the medial meniscal root. Contraindications for this procedure include advanced osteoarthritis (Kellgren–Lawrence grade ≥3) on weight-bearing x-rays, age 30 as well as poor-quality meniscal tissue and unrepairable chondral defects. Technique Description: The ACL stump is debrided and a burr hole is created. A femoral aiming guide is used to drill the femoral tunnel. Following medial collateral ligament (MCL) release, a healing bony bed is prepared with a curette and shaver at the anatomic tibial footprint. An aiming device is then used through the anterior medial portal to create 2 transosseous tibial tunnels. A vertical mattress suture and simple suture are placed through the meniscal root, shuttled through the posterior and anterior transosseous tunnels, respectively. The tibial ACL tunnel is placed using a standard guide to avoid tunnel convergence with the root tunnels and prevent graft tunnel mismatch. After graft passage, interference screws are inserted while maintaining graft tension. The sutures are then tied over a cortical button over the tibia. Results: Within 2 years postoperatively, patients are expected to have improved overall knee-specific quality of life, reduced pain, and a successful return to activities with low rates of graft failure. Discussion/Conclusion: Recent advancements in our understanding of the relationship between the medial meniscus and the ACL should prompt surgeons to continue considering such combined treatments in indicated patients. 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.

Background: Ulnar collateral ligament (UCL) reconstructions have become increasingly common, particularly in youth overhead throwing athletes. These injuries are most commonly due to overuse and repetitive trauma on the inner elbow. Throwers with a deficient UCL often report decreased pitching speeds in addition to elbow pain and instability. Indication: The indications for this procedure include symptomatic valgus elbow instability during overhead throwing motions and a verified rupture of the UCL on advanced imaging. Technique Description: The ipsilateral gracilis tendon is harvested and prepared as an autograft. A 5-cm incision is then made centered over the medial epicondyle. The ulnar nerve is identified and neurolysis is performed both proximally and distally. The fascia overlying the flexor carpi ulnaris is incised, and the two heads of the muscle are split. From this base, the sublime tubercle is identified, and the UCL is opened longitudinally in line with its fibers. A standard guide is used to drill holes in the posterior and anterior aspects of the sublime tubercle. These holes are then connected using a curved curette, and a suture is passed along the tunnels for later graft passage. A 15-mm blind-end tunnel is drilled two-thirds from the tip to the base of the epicondyle. Two smaller tunnels are then drilled with K-wires to pass sutures through the posterior aspect of the epicondyle. The native UCL is closed, and the graft is then passed through the sublime tubercle tunnels. One end of the graft is docked into the epicondylar tunnel, and a docking procedure is then undertaken so that both ends are docked within the humeral tunnel. Stay sutures are tied over a bone bridge, and the two limbs of the graft are sutured together to appropriately tension the graft. Results: In our experience, 94% of athletes return to previous levels of play and experience high patient-reported outcome scores. Discussion/Conclusion: Advancements in UCL reconstruction techniques and our understanding of elbow anatomy should prompt surgeons to continue considering this treatment for patients with significant throwing pain and a strong desire to return to high levels of throwing. 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.

Background: The incidence of anterior cruciate ligament (ACL) injuries, reconstructions, and re-ruptures has rapidly increased. Patients with failed ACL reconstructions have been reported to suffer from far worse outcomes as compared with those with primary reconstructions, prompting the advancement of surgical and biologic techniques. Effective treatment of re-tears has been shown to be achieved either utilizing a 1-stage or 2-staged approach, with the latter preferred if the patient presents with significant bone loss, previously malpositioned tunnels, or unacceptable tunnel expansion. Recent literature has shown the efficacy of bone marrow aspirate concentrate (BMAC) in improving clinical outcomes and graft integration as well as accelerated ligamentization. Indication: Patients are indicated for surgery when presenting with chronic ACL graft failure and objective insufficiency as well as concerns regarding tunnel overlap, enlargement, or interference. Contraindications for revision involve influences of concurrent injuries that may be secondary causes of the ACL injury. Technique Description: After bone marrow aspiration is performed, the tibial and femoral tunnel apertures are debrided of fibrous tissue with a combination of a shaver and curettes. A threaded guide wire is passed and the interference screws are removed, revealing the residual ruptured graft. A shaver and radiofrequency ablation device are utilized to clean off remaining graft remnants. Sequential debridement and reaming are performed to remove any residual fibrous tissue or sclerotic bone from the tunnel. The demineralized bone matrix is then combined with the prepared BMAC in a syringe with a cannula extension and subsequently injected into the tunnels. A freer elevate is used to tamp and smooth the graft to match the surrounding contour. A 12-mm cannulated allograft bone dowel is then passed up into the tibial tunnel and gently tamped into place. Results: Within 2 years postoperatively, patients are expected to have improved overall knee-specific quality of life, reduced pain, and a successful return to activities. No differences in outcomes have been noted in the literature between 1-staged and 2-staged ACL reconstructions. Discussion/Conclusion: Recent advancements in our understanding of the effects of BMAC in the setting of an ACL reconstruction should prompt surgeons to consider such treatments in indicated patients. 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.

Background: The meniscal roots are essential for preserving the structural and biomechanical properties of the tibiofemoral joint. Posterior meniscal root avulsions can cause meniscal extrusion, joint space narrowing, and progressive knee arthritis. Iatrogenic avulsions after malpositioning of the transtibial tunnels during anterior cruciate ligament (ACL) reconstruction have previously been reported in the literature to account for poor long-term outcomes seen in some patients following ACL reconstruction. Therefore, correct transtibial tunnel placement during ACL reconstruction is essential to avoid iatrogenic meniscal damage. Indication: Patients are indicated for surgery when presenting with a verified, symptomatic, complete meniscal root tear seen on advanced imaging or diagnostic arthroscopy. Contraindications for a root repair include the development of advanced osteoarthritis in the ipsilateral compartment, older age, and malalignment in the affected compartment. Technique Description: The ACL graft was appreciated and noted to be vertical and posterior relative to its native anatomical position, violating the lateral posterior horn root attachment. A full lateral posterior meniscal root avulsion was then confirmed directly adjacent to the graft tunnel. A curette was used to prepare the footprint of the lateral meniscal root on the posterolateral tibia for the 2-tunnel transtibial pull-out tunnels, and a grasper was used to position the torn meniscal root back into its anatomical site. Two ultrabraided sutures were passed through the posterior horn of the lateral meniscus using a suture passer. These were then passed through the tunnels into the body of the meniscal root and reduced to its native anatomical position. The suture repair was then secured over an Endobutton Fixation Device at 90° of knee flexion through each tunnel into its native anatomical position while confirming its adequate tension by viewing arthroscopically. Results: Within 2 years postoperatively, patients are expected to have improved overall knee-specific quality of life, reduced pain, and a successful return to activities. Discussion/Conclusion: This injury underscores the importance of an accurate tibial tunnel placement during ACL reconstruction to avoid posterior meniscal root injuries and other associated complications. Physicians should consider such pathology in the differential diagnosis of patients presenting with persistent pain and instability following a primary ACL reconstruction. 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.

Cellulosic biofibers’ surface modification and its utilization for the development of polyester matrix-based biocomposites.

Engineering microfluidic devices relies on the ability to manufacture sub-100 micrometer fluidic channels. Conventional lithographic methods provide high resolution but require costly exposure tools and outsourcing of masks, which extends the turnaround time to several days. The desire to accelerate design/test cycles has motivated the rapid prototyping of microfluidic channels; however, many of these methods (e.g., laser cutters, craft cutters, fused deposition modeling) have feature sizes of several hundred microns or more. In this paper, we describe a 1-day process for fabricating sub-100 µm channels, leveraging a low-cost (USD 600) 8K digital light projection (DLP) 3D resin printer. The soft lithography process includes mold printing, post-treatment, and casting polydimethylsiloxane (PDMS) elastomer. The process can produce microchannels with 44 µm lateral resolution and 25 µm height, posts as small as 400 µm, aspect ratio up to 7, structures with varying z-height, integrated reservoirs for fluidic connections, and a built-in tray for casting. We discuss strategies to obtain reliable structures, prevent mold warpage, facilitate curing and removal of PDMS during molding, and recycle the solvents used in the process. To our knowledge, this is the first low-cost 3D printer that prints extruded structures that can mold sub-100 µm channels, providing a balance between resolution, turnaround time, and cost (~USD 5 for a 2 × 5 × 0.5 cm3 chip) that will be attractive for many microfluidics labs.

# Introduction Avulsion fracture of the ischial tuberosity is uncommon. Patients typically present with symptoms consistent with hamstring strain. The purpose of this case report is to describe an avulsion fracture of the ischial tuberosity and subsequent recovery in an athlete with an endocrine disorder. # Case Description A 15-year-old United States of America Gymnastics level 9 gymnast presented with right hamstring pain after regular practice. She had been diagnosed with isolated growth hormone deficiency at age 4 and was treated with growth hormone replacement therapy until age 14. Six months before presentation, she experienced the insidious onset of dull, aching pain in her right hamstring, near the junction of the thigh and buttocks, that was believed to be the result of a chronic hamstring strain. The pain increased gradually over a year and was relieved with rest, massage, and dry needling. Two days before presentation, she felt a "snap" and pain while performing a switch leap during regular practice. She had sharp localized pain in the proximal hamstring with walking and sitting. She was diagnosed with a minimally displaced avulsion fracture of the ischial tuberosity. # Outcome With nonoperative treatment, the fracture healed at three months, which is longer than the expected six weeks. Although return to sports is expected three months after this injury, it did not occur until six months in this patient. She was unable to participate in competitive level 9 gymnastics until 12 months after injury. # Discussion This case highlights that delayed recovery can occur after avulsion fracture of the ischial tuberosity in adolescent athletes with a history of growth hormone deficiency and treatment using growth hormone. # Level of Evidence 5

Purpose: To compare social media attention and citation rates between technique articles and matched original research articles (ORAs) regarding surgical procedures. Methods: All technique articles published from August 2019 through July 2020 in the free, electronic versions of Arthroscopy Techniques and JBJS Essential Surgical Techniques were matched by topic to articles in the “Original Research” sections of Arthroscopy, Sports Medicine, and Rehabilitation and JBJS Open Access in a 4:1 ratio within this time frame. The primary outcome was the Altmetric Attention Score (AAS). Secondary outcomes included citations, bibliometrics, and social media metrics. Independent t tests were used to compare primary and secondary outcomes between technique articles and ORAs. A multivariate linear regression analysis was performed to determine the association between article type and social media attention while controlling for confounding bibliometric characteristics. Results: A total of 285 matched research articles (n = 57, 20.0%) and technique articles (n = 228, 80.0%) were included. The mean AAS among all technique articles was 3.63 ± 10.08 (range, 0-96) whereas the mean AAS among all ORAs was 1.30 ± 3.98 (range, 0-25), representing a statistically significant difference (P = .016). The mean citation rate among all technique articles was not significantly different from that among ORAs (P = .73). Multivariate linear regression analysis showed a statistically significant positive association between AAS and article type, with an additional mean increase in the AAS of 2.91 (95% confidence interval, 0.04-5.77; P = .047) for every technique article compared with an ORA. Furthermore, a significant positive relation was noted between the article origin and the AAS, with an increase in the AAS of 3.00 (95% confidence interval, 0.82-5.17; P = .007) for every article published in North America compared with an article originating from another continent. Conclusions: Technique articles resulted in significantly greater AASs and social media attention in comparison with open-access ORAs on similar topics. Publications that described technical procedures in a technique journal and studies from North America were positively associated with greater AASs and greater numbers of citations received by articles. Clinical Relevance: An improved understanding of how much attention is given to technique articles versus matched ORAs by social media may influence the methods authors and journals use for distributing content. The present study suggests that one option to increase the amount of social media attention received for a particular study may be to utilize an accompanying surgical technique video or illustrations as these are easily shareable on social media and offer rapid dissemination of knowledge, similar to that of an infographic. However, physicians who view multimedia within technique articles should be encouraged to review the accompanying articles and the supporting original research as a primary source before making changes in their clinical practice.

Aims: The study aims to evaluate the blood level changes of basic Fibroblast Growth Factor (bFGF) during pulp cell homing procedure of teeth with incomplete apices in dogs, and to evaluate the root canal disinfection recommendation of American Association of Endodontist protocol used in pulp revascularization procedure. Materials and Methods: Twelve local breed dogs randomly selected form different areas of Mosul City. The study was included four stages, the bFGF levels in the blood samples were measured by canine bFGF ELISA kit, stage I control (Induce infection),stage II (Disinfection),stage III (Treatment),and stage IV (3 month follow up).In stage II there are two microbial samples have taken from the root canals before and after AAE disinfection protocol ,and also after final irrigation in stage III by the aid of paper point These microbial samples were diluted and spread on blood agar and after 24hr the colony forming unit per milliliter was calculated CFU/ml to evaluate the effectiveness of AAE disinfection protocol. Results: The aid of ANOVA for Repeated Measure Statistical Test, the levels of bFGF in all stages were statistically analyzed. The result show significance at 5% level of significant P-value=0.04. The microbial counting result showed a highly significant difference at 1% P-value=0.000. These three samples have been statistically analyzed by one-way analysis of variance (ANOVA). Conclusion: There is a difference in the levels of bFGF in the blood between the stages during pulp cell homing, also AAE protocol for disinfection is an effective method to disinfect the open apex root canal system.

In nature and engineering, fluid movements involving swirling patterns, or vortices, are common occurrences. Some flows involve free-surface vortices that can potentially lead to a phenomenon termed gas entrainment (GE). There is no validated tool that can predict the free-surface profile of the gas core prior and subsequent to the GE. This study focuses on experimental and numerical investigation of flows with unsteady free-surface vortices that can potentially lead to gas entrainment. An extensive experimental work, performed in a dedicated experimental setup built in the present study, yields two main contributions. First, a new GE onset criterion, based on implementing dimensional analysis to the experimental results, is developed. The onset criterion is found to be suitable also for other experiments in the literature. Second, the experimental acquisition of the free-surface profiles, obtained with a high-speed camera, is used for validating the numerical approach. This three-dimensional numerical tool incorporates Large Eddy Simulation to capture turbulence, with Volume-of-Fluid approach to simulate free-surface profiles. The model predicts with high accuracy the free-surface profiles in cases with and without GE, observed experimentally. Then, the detailed simulation results for this type of flows are analyzed quantitatively for the first time in the available literature, using radial, axial, and tangential velocity components. The present study sheds new light on free-surface vortex flows, in general. The experimental and numerical achievements in this study can serve as a tool both to predict the free-surface flow profiles with high accuracy and to prevent gas entrainment in the engineering systems. [ABSTRACT FROM AUTHOR]

Background: The indirect head of the rectus femoris (IHRF) tendon has been used as an autograft for segmental labral reconstruction. However, the biomechanical properties and anatomic characteristics of the IHRF, as they relate to surgical applications, have yet to be investigated. Purpose: To (1) quantitatively and qualitatively describe the anatomy of IHRF and its relationship with surrounding arthroscopically relevant landmarks; (2) detail radiographic findings pertinent to IHRF; (3) biomechanically assess segmental labral reconstruction with IHRF, including restoration of the suction seal and contact pressures in comparison with iliotibial band (ITB) reconstruction; and (4) assess potential donor-site morbidity caused by graft harvesting. Study Design: Descriptive laboratory study. Methods: A cadaveric study was performed using 8 fresh-frozen human cadaveric full pelvises and 7 hemipelvises. Three-dimensional anatomic measurements were collected using a 3-dimensional coordinate digitizer. Radiographic analysis was accomplished by securing radiopaque markers of different sizes to the evaluated anatomic structures of the assigned hip.Suction seal and contact pressure testing were performed over 3 trials on 6 pelvises under 4 different testing conditions for each specimen: intact, labral tear, segmental labral reconstruction with ITB, and segmental labral reconstruction with IHRF. After IHRF tendon harvest, each full pelvis had both the intact and contralateral hip tested under tension along its anatomic direction to assess potential site morbidity, such as tendon failure or bony avulsion. Results: The centroid and posterior apex of the indirect rectus femoris attachment are respectively located 10.3 ± 2.6 mm and 21.0 ± 6.5 mm posteriorly, 2.5 ± 7.8 mm and 0.7 ± 8.0 mm superiorly, and 5.0 ± 2.8 mm and 22.2 ± 4.4 mm laterally to the 12:30 labral position. Radiographically, the mean distance of the IHRF to the following landmarks was determined as follows: anterior inferior iliac spine (8.8 ± 2.5 mm), direct head of the rectus femoris (8.0 ± 3.9 mm), 12-o'clock labral position (14.1 ± 2.8 mm), and 3-o'clock labral position (36.5 ± 4.4 mm). During suction seal testing, both the ITB and the IHRF reconstruction groups had significantly lower peak loads and lower energy to peak loads compared with both intact and tear groups (P =.01 to.02 for all comparisons). There were no significant differences between the reconstruction groups for peak loads, energy, and displacement at peak load. In 60° of flexion, there were no differences in normalized contact pressure and contact area between ITB or IHRF reconstruction groups (P >.99). There were no significant differences between intact and harvested specimen groups in donor-site morbidity testing. Conclusion: The IHRF tendon is within close anatomic proximity to arthroscopic acetabular landmarks. In the cadaveric model, harvesting of the IHRF tendon as an autograft does not lead to significant donor-site morbidity in the remaining tendon. Segmental labral reconstruction performed with the IHRF tendon exhibits similar biomechanical outcomes compared with that performed with ITB. Clinical Relevance: This study demonstrates the viability of segmental labral reconstruction with an IHRF tendon and provides a detailed anatomic description of the tendon in the context of an arthroscopic labral reconstruction. Clinicians can use this information during the selection of a graft and as a guide during an arthroscopic graft harvest. [ABSTRACT FROM AUTHOR]

Background: Root tears are functionally compromising injuries that require an anatomic repair for functional restoration of native joint mechanics. Posterior root tears of the lateral meniscus are commonly associated with anterior cruciate ligament (ACL) ruptures as lateral root tears contribute to anterolateral rotational instability. Two-tunnel transtibial root repair allows for root repair with superior pullout strength and can be combined with ACL reconstruction to treat this injury pattern. Indications: Two-tunnel transtibial root repair is indicated in active patients with meniscal root tears that have low-grade chondromalacia (grade II or less). It is contraindicated in patients with advanced degenerative changes (grade III-IV), severe mal-alignment, and extrusion related to advanced degenerative changes; those who cannot complete postoperative rehabilitation; and patients with significant medical comorbidities. Technique Description: After repairing a vertical horn tear of the posterior medial meniscus, a vertical tear of the posterior root of the lateral meniscus was observed. Following preparation of the anatomic footprint, 2 transtibial tunnels were drilled and sutures were passed and secured using a surgical button over the anterior tibial cortex. Horizontal repair of the tear was then performed using 2 all-inside devices. Subsequently, an ACL reconstruction was performed. Results: At 11 months postoperative, the patient has continued to progress as expected. She was able to ambulate without pain, had a symmetric and balanced gait, and was able to return to running. Discussion/Conclusion: Lateral meniscal root repairs using 2 transtibial tunnels and concomitant ACL reconstruction have yielded good and reliable clinical outcomes with low failure rates and low rates of revision surgery.

Background: Patellofemoral arthroplasty (PFA) is a salvage procedure for patients presenting with bone-on-bone isolated patellofemoral osteoarthritis. Previous studies comparing PFA with total knee arthroplasties found that patients recover more quickly and have better average knee function following PFA, as care is taken to spare healthy cartilage, bone, and ligaments during the procedure. This allows preservation of native knee kinematics, resulting in better patient-reported outcomes, as well as mid-term and long-term results. Indication: PFA is indicated in patients with isolated primary or post-traumatic patellofemoral osteoarthritis. In some cases, the procedure may be indicated in patients suffering from patellar instability or trochlear dysplasia with associated arthritis. Contraindications for PFA include multicompartmental arthritis in the medial or lateral tibiofemoral compartments, inflammatory joint disease, tibiofemoral instability, malalignment, or lesions of 6 mm or more in diameter. Technique Description: After the initial lateral patellofemoral approach, degenerative changes in the patellofemoral joint were observed. Following preparation of the patella and femur, the trochlear implant is impacted on the prepared femoral surface. Cement is digitally impacted into the reamed patella, followed by placement of the final patellar implant and compression until the cement is dried. Results: Within 2 years postoperatively, patients are expected to have improved overall knee-specific quality of life, reduced pain, and a successful return to activities. Discussion/Conclusion: New PFA techniques have yielded significant improvement in patient-reported outcomes and high rates of survivorship following surgery.