Search

Background: Augmented (internal braced) lateral ulnar collateral ligament (LUCL) repair has been biomechanically compared with reconstruction techniques in the elbow. However, LUCL repair alone has not yet been compared with augmented repair and reconstruction techniques. Hypothesis: Internal bracing of LUCL repair would improve time-zero stabilization regarding gap formation, stiffness, and residual torque as compared with repair alone and reconstruction techniques to restore native elbow stability. Study Design: Controlled laboratory study. Methods: Overall, 24 cadaveric elbows were used for either internal braced LUCL repair (Repair-IB) or single- and double-strand ligament reconstruction with triceps (Recon-TR) and palmaris longus tendon graft (Recon-PL), respectively. Laxity testing in external rotation was consecutively performed at 90° of elbow flexion on the intact, dissected, and repaired conditions and with the previously assigned techniques. First, intact elbows were loaded to 7.0-N·m external torque to evaluate time-zero ligament rotations at 2.5, 4.0, 5.5, and 7.0 N·m. Rotation-controlled cycling was performed (total of 1000 cycles) for each surgical condition. Gapping, stiffness, and residual torque were analyzed. Finally, these and 8 additional intact elbows underwent torque-to-failure testing (30 deg/min). Results: The dissected state showed the highest gap formation and lowest peak torques ( P < .001). While gap formation of Repair-IB ( P < .021) was significantly lower than that of repair without internal bracing at all rotation levels, gaps of Recon-PL were similar to and Recon-TR were significantly higher than those of Repair-IB except for the highest torsion level. Residual peak torques at specific rotation angles between native state and Recon-TR (α2.5), Recon-PL (α4.0), and Repair-IB (α5.5) were similar; all other comparisons were significantly different ( P < .027). Torsional stiffness of Repair-IB was significantly higher at all rotation angles measured. Analysis of covariance showed significantly less gap formation over residual peak torques for Repair-IB ( P < .001) as compared with all other groups. The native state failure load was significantly higher than Recon-PL and Recon-TR failure loads, with similar stiffness to all other groups. Conclusion: Repair-IB and Recon-PL of the LUCL showed increased rotational stiffness relative to the intact elbow for restoring posterolateral stability to the native state in a cadaveric model. Recon-TR demonstrated lower residual peak torques but provided near-native rotational stiffness. Clinical Relevance: Internal bracing of LUCL repair may reduce suture-tearing effects through tissue and provide sufficient stabilization for healing throughout accelerated and reliable recovery without the need for a tendon graft.

Background: Although initial studies have demonstrated that concentrated bone marrow aspirate (cBMA) injections promote rotator cuff repair (RCR) healing, there are no randomized prospective studies investigating clinical efficacy. Hypothesis/Purpose: To compare outcomes after arthroscopic RCR (aRCR) with and without cBMA augmentation. It was hypothesized that cBMA augmentation would result in statistically significant improvements in clinical outcomes and rotator cuff structural integrity. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients indicated for aRCR of isolated 1- to 3-cm supraspinatus tendon tears were randomized to receive adjunctive cBMA injection or sham incision. Bone marrow was aspirated from the iliac crest, concentrated using a commercially available system, and injected at the aRCR site after repair. Patients were assessed preoperatively and serially until 2 years postoperatively via the following functional indices: American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Simple Shoulder Test, 12-Item Short Form Health Survey, and Veterans RAND 12-Item Health Survey. Magnetic resonance imaging (MRI) was performed at 1 year to assess rotator cuff structural integrity according to Sugaya classification. Treatment failure was defined as decreased 1- or 2-year ASES or SANE scores as compared with preoperative baseline, the need for revision RCR, or conversion to total shoulder arthroplasty. Results: An overall 91 patients were enrolled (control, n = 45; cBMA, n = 46): 82 (90%) completed 2-year clinical follow-up and 75 (82%) completed 1-year MRI. Functional indices significantly improved in both groups by 6 months and were sustained at 1 and 2 years (all P < .05). The control group showed significantly greater evidence of rotator cuff retear according to Sugaya classification on 1-year MRI (57% vs 18%; P < .001). Treatment failed for 7 patients in each group (control, 16%; cBMA, 15%). Conclusion: cBMA-augmented aRCR of isolated supraspinatus tendon tears may result in a structurally superior repair but largely fails to significantly improve treatment failure rates and patient-reported clinical outcomes when compared with aRCR alone. Additional study is warranted to investigate the long-term benefits of improved repair quality on clinical outcomes and repair failure rates. Registration: NCT02484950 (ClinicalTrials.gov identifier).

To identify the most disruptive publications, which are those that are cited more frequently than their own references, in academic radiology journals and their characteristics, such as the number of authors and relative time to publication.A comprehensive literature search was undertaken to identify the 100 most disruptive publications in the field of radiology. Subsequently, statistical analysis was applied to establish the distribution of disruptive scores of the isolated publications using a non-parametric probability density function. The relation between disruptive scores and citation counts was then determined, with the aid of a correlation coefficient. Finally, data regarding any significant connection between disruption scores and time of publication, number of authors, and study design were examined.Analysing the top 100 papers in increments of 10-year periods showed no significant difference in the distribution of disruption scores over time. No correlation between an article's citation count and disruption score was established. Additionally, no significant relation between the number of authors/study design and disruption scores was identified.The disruption score highlights significant impact elements not entirely accounted for by citation count. Its potential benefit in assessing scientific impact should be contemplated.

The purpose of this investigation was to determine the effect of travel distance on achieving the minimal clinically important difference (MCID) on all three commonly used patient-reported outcome measures (PROMs) for the shoulder more than 1 year following total shoulder arthroplasty (TSA).Patients undergoing reverse or anatomic TSA at a high-volume tertiary referral center between September 2016 and August 2018 were retrospectively reviewed. Patients were divided into 2 groups: driving distance of50 miles from the location of surgery (referral group) and driving distance of50 miles (local group). Scores on preoperative and postoperative PROMs, including American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and Constant Score (CS) at minimum 1-year follow-up were assessed. Chi-square analysis was used to analyze the achievement of MCID on any PROM or a combination of PROMs. Logistic regression was performed to determine whether travel distance and other variables of interest had an effect on achieving MCID on all three PROMs.A total of 214 patients with minimum 1-year follow-up were included in the final analysis. Of these, 165 patients (77.1%) traveled50 miles to their orthopedic provider at the time of surgery. The local group demonstrated significantly inferior preoperative SANE scores (After controlling for age, sex, and adjusted gross income, distance traveled to a high-volume referral center did not have an effect on achieving the MCID on all three commonly used PROMs for the shoulder at least 1 year after undergoing TSA. Elevated body mass index, worker's compensation status, and higher preoperative ASES score were associated with an increased risk of failure to achieve all MCIDs after TSA.

To perform a systematic review of return to play (RTP) and return to previous level of performance (RPP) in competitive overhead athletes after SLAP repair to identify factors associated with failure to RTP.Systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Review was registered with PROSPERO International prospective register of systematic reviews (CRD42020215488). Inclusion criteria were literature reporting RTP or RPP following SLAP repair in overhead athletes were run in the following databases: PubMed/MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar. Categories for data collection for each full article included (1) article information; (2) patient demographics; (3) surgical techniques; (4) level of competition; (5) rotator cuff treatment; (6) player position; (7) patient-reported outcome measures; and (8) RTP and RPP rates. The Methodological Index for Non-randomized Studies checklist was used to evaluate quality of all included studies.Eight studies with 333 subjects were identified. Overall RTP and RPP rates were 50% to 83.6% and 35.3% to 64%, respectively. Patients with surgically treated rotator cuff pathology had lower RTP (12.5%-64.7%) rates compared with those without (80.0%-83.6%). Professional athletes had similar RTP rates (62.5%-81.5%) compared with high-school (75.0%-90.0%) and college athletes (12.5%-83.3%). However, professional athletes demonstrated the lowest relative range of reported RPP rates (27.7%-55.6%). Pitchers had lower RTP (62.5%-80.0%) and RPP (52.0%-58.9%) compared with position players (91.3% RTP, 76.3%-78.2% RPP).Studies reviewed reported moderate RTP and RPP rates following SLAP repairs in competitive overhead athletes. Those with associated rotator cuff tear requiring treatment, and baseball pitchers were less likely to RTP and RPP. Professional athletes had similar RTP to an amateur; however, they were less likely to RPP.Level IV, systematic review of Level III-IV studies.

Funding Information: Funding for this work was received from State Nuclear Waste Management through the SAFIR2022 program and is gratefully acknowledged. Thanks are also extended to the OECD PRISME 3 project and its members for the full-scale cable tray fire experiment results. Funding Information: Funding for this work was received from State Nuclear Waste Management through the SAFIR2022 program and is gratefully acknowledged. Thanks are also extended to the OECD PRISME 3 project and its members for the full-scale cable tray fire experiment results. Publisher Copyright: © 2023 The Authors Nuclear power plants (NPPs) have an extensive network of electrical cables and associated trays to support daily operations. As electrical cables have combustible mass, their presence adds to the fire load in such plants. Thermal stress from cable fires can cause cable failures and spread fire to other redundant cables or other equipment, jeopardizing the safe operation of NPPs. Assessing the heat release rates (HRR) of cable fires is critical for the nuclear industry as HRR regulates the thermal stress in the surrounding of a fire and other fire products that can damage the facility. This paper presents a computational fluid dynamics-based method to model the HRR of such cable fire. The method is partly based on the FLASHCAT model (modified and adapted here) and the surface temperature ignition model of the Fire Dynamics Simulator (FDS) software. The simulation set up with validation objective replicates an experiment of OECD PRISME 3 program in which cables arranged over two horizontal trays are burnt. HRR obtained from the simulation had peak HRR underestimated by 4%, and the time to reach peak HRR overestimated by 5%. The result is encouraging as it provides confidence in using the method outlined in the paper.

The successful recovery of pressurized core samples from an unconventional HPHT reservoir is presented. Optimized methods and technologies such as implementation of Managed Pressure Drilling (MPD) technique as well as coring technology customization and adaptation are discussed. Results from offset wells are compared and a best practice method is described how to recover pressurized cores from the organic rich Najmah Kerogen in West Kuwait. A coring BHA was configured using a modified version of the LPC Core Barrel hence allowing for the first time to consider recovering pressurized core samples from a well with a very challenging operating envelope. Furthermore, the provided methodology ensures that well conditions are maintained to allow for a pressurized core recovery in most stable wellbore environment avoiding any unwanted subsurface problems. With three consecutive runs planned on for the pressurized coring using MPD each 10 ft., the results obtained showed a successful coring operation of which typical wellbore downhole issues were avoided with no loss time due to well ballooning, mud losses and well kicks. The successful coring operations as well as all subsequent on-site analysis procedures showed possibility to recover pressurized core samples from unconventional formations with high formation pressure in a safe and effective manner. Avoiding core damage due to petal-centerline fractures and disking is fundamental in quantifying natural fractures in this unconventional reservoir. This novelty approach of core barrel system modification and using MPD technique in acquiring the pressurized cores has made it possible to obtain representative near in-situ data to better reservoir interpretation and quantification of natural fractures. The method has a great potential to ensure high core recovery in high angle wells while delivering superior reservoir fluid and rock information which is not obtainable by other means.

SLAP lesions can be significant pain generators in the shoulder. These injuries are the most common shoulder injury in overhead athletes, as repetitive overhead motion is the most common etiology of SLAP lesions. These lesions present a diagnostic and treatment challenge to patients and physicians. Factors to consider when discussing treatment options for SLAP lesions include age, type of sports activity, level of sports participation, and degree of symptoms. Nonoperative management is the first-line treatment for most young, active patients without history of trauma, mechanical symptoms, and/or demand for overhead activities. These conservative measures include rest, avoidance of aggravating factors, injections, and physical therapy focusing on correcting scapular dyskinesis, restoring range of motion and strength, and evaluating the biomechanical throwing motion. It has been reported that 40% of professional baseball players can successfully return to play after rehabilitation alone. Alternatively, operative treatment is reserved for failure of nonoperative treatment and those with persistent symptoms that prevent individuals from participating in sports activities or activities of daily living. The two most common operative treatment options include arthroscopic repair versus biceps tenodesis. Arthroscopic repair can be considered in younger athletes (30 years old) and elite athletes who are involved in overhead sports (baseball, tennis, volleyball) and consists of repairing the labral anchor back to the superior glenoid rim with knotless anchor repair techniques. Alternatively, biceps tenodesis is the first-line treatment option for failed SLAP repairs, and as an index procedure, traditionally has been reserved for middle-aged individuals (30 years old), patients receiving workers' compensation, nonoverhead athletes, or in those with concomitant rotator cuff tears. However, due to a relatively high failure rate of SLAP repairs, biceps tenodesis as an index procedure is gaining more popularity, as emerging evidence suggests encouraging functional outcomes and return-to-sport rates even in younger athletes.

To assess the effect of bone marrow aspiration concentrate (BMAC) augmentation on clinical outcomes and magnetic resonance imaging (MRI) findings in anterior cruciate ligament (ACL) reconstruction (ACLR) with bone-patellar tendon-bone (BTB) allografts.A double-blinded, randomized controlled trial was conducted on 80 patients undergoing ACL reconstruction using BTB allografts. Patients were randomized to 2 groups: (1) bone marrow aspirate was collected from the iliac crest, concentrated, and approximately 2.5 mL was injected into the BTB allograft, or (2) a small sham incision was made at the iliac crest (control). MRI was performed at 3 months and 9 months postoperatively to determine the signal intensity ratio of the ACL graft.Seventy-three patients were available for follow-up at 1-year postoperatively (36 BMAC, 37 control). International Knee Documentation Committee (IKDC) scores were significantly greater in the BMAC group versus the control at the 9-month postoperative period (81.6 ± 10.5 vs 74.6 ± 14.2, P = .048). There was no significant difference in the proportion of patients who met the minimal clinically important difference for IKDC between the BMAC and control groups at 9 months (89% vs 85%; P = .7). Three months postoperatively, signal intensity ratio of the inferior third of the ACL graft was significantly greater in the BMAC group versus the control group (3.2 ± 2.2 vs 2.1 ± 1.5; P = .02).Patients who received BMAC augmentation of the BTB allograft during ACL reconstruction demonstrated greater signal intensity scores on MRI at 3 months, suggesting increased metabolic activity and remodeling, and potentially accelerated ligamentization. Additionally, patients in the BMAC group had greater patient-reported outcomes (IKDC) at 9 months postoperatively when compared with those who underwent a standard surgical procedure. There was no significant difference in the proportion of patients who met the minimal clinically important difference for IKDC between the BMAC and control groups at 9 months, suggesting limited clinical significance at this time point.I, randomized control trial.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for multimodal pain control after surgery. These medications work by selective or nonselective inhibition of cyclooxygenase, which has downstream effects on thromboxanes, prostaglandins, and prostacyclins. Clinical studies have shown beneficial effects for alleviating pain and reducing opioid consumption after surgery. Within hip arthroscopy, there is evidence that postoperative NSAIDs can also reduce the risk of symptomatic heterotopic bone formation. However, preclinical and animal studies have raised concern over the effect of NSAIDs on bone and soft-tissue healing. In addition, selective and nonselective cyclooxygenase 2 inhibitors may have different safety profiles regarding postoperative soft-tissue healing. The purpose of this review was to outline the mechanisms of action, efficacy, and effect on soft-tissue healing of postoperative NSAIDs and to provide evidence-based recommendations for appropriate use.

Background: This study analyzed questions entered online by rotator cuff patients and determined types and quality of websites providing information at the top of queries. Methods: Three strings related to rotator cuff repair were explored in Google Search. The result pages were manually collected under the “People also ask” function for frequent questions and associated webpages. Questions were categorized using Rothwell’s classification with further topical subcategorization. Webpages were evaluated by Journal of American Medical Association (JAMA) benchmark criteria for source quality. Results: One hundred twenty “People also ask” questions were collected with their associated webpages. Based on the Rothwell classification of questions, queries were thematically organized into fact (41.7%), value (31.7%), and policy (26.7%) categories. The most common webpage categories were academic (28.3%) and medical practice (27.5%). The most common question subcategories were timeline of recovery (21.7%), indications/management (21.7%), and pain (18.3%). The average JAMA score for all 120 webpages was 1.50. Journal articles had the highest average JAMA score (3.77), while commercial websites had the lowest JAMA score (0.91). The most common suggested question for rotator cuff repair/surgery was, “Is rotator cuff surgery worth having?,” while the most common suggested question for rotator cuff repair pain was, “What happens if a rotator cuff is not repaired?” Conclusions: The most common questions asked on Google pertaining to rotator cuff repair evaluate management options and relate to the timeline of recovery and pain management. Most information is provided by medical practice, academic, and medical information websites, which have highly variable reliability. By understanding the questions that rotator cuff repair patients are asking online, surgeons can tailor preoperative education to common patient concerns and improve postoperative outcomes.Level of evidence: IV.

Background: Common questions about shoulder arthroplasty (SA) searched online by patients and the quality of this content are unknown. The purpose of this study is to uncover questions SA patients search online and determine types and quality of webpages encountered. Methods: The “People also ask” section of Google Search was queried to return 900 questions and associated webpages for general, anatomic, and reverse SA. Questions and webpages were categorized using the Rothwell classification of questions and assessed for quality using the Journal of the American Medical Association (JAMA) benchmark criteria. Results: According to Rothwell classification, the composition of questions was fact (54.0%), value (24.7%), and policy (21.3%). The most common webpage categories were medical practice (24.6%), academic (23.2%), and medical information sites (14.4%). Journal articles represented 8.9% of results. The average JAMA score for all webpages was 1.69. Journals had the highest average JAMA score (3.91), while medical practice sites had the lowest (0.89). The most common question was, “How long does it take to recover from shoulder replacement?” Conclusions: The most common questions SA patients ask online involve specific postoperative activities and the timeline of recovery. Most information is from low-quality, non-peer-reviewed websites, highlighting the need for improvement in online resources. By understanding the questions patients are asking online, surgeons can tailor preoperative education to common patient concerns and improve postoperative outcomes.

To date, no meta-analysis has been performed on the efficacy of fibular allograft augmentation for the management of proximal humerus fractures. The purpose of this study was to evaluate the radiographic and clinical outcomes of proximal humerus fractures treated with a locking compression plate (LCP) with or without fibular allograft augmentation.The Cochrane Database of Systematic Reviews, the Cochrane Register of Controlled Trials, PubMed, MEDLINE, Web of Science, and SCOPUS were queried in June of 2021 for literature comparing the radiographic and clinical outcomes for patients with proximal humerus fractures that were treated with an LCP only or an LCP augmented with a fibular allograft. Data describing study design, level of evidence, demographic information, final follow-up, radiographic changes in humeral head height (HHH), radiographic changes in neck shaft angle (NSA), final American Shoulder and Elbow Surgeons (ASES) scores, final Constant-Murley scores, and major complications were collected. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORS). A meta-analysis was performed using pooled weighted mean differences (WMD) to compare changes in HHH, NSA, final ASES and final Constant-Murley scores between the 2 groups; a pooled odds ratio (OR) was used to compare complications between the groups.Ten studies with a total of 802 patients were identified. There was a significant difference that favored patients augmented with a fibular allograft for change in HHH (WMD = -2.40; 95% confidence interval [CI], -2.49 to -2.31; P .00001), change in NSA (WMD = -5.71; 95% CI, -6.69 to -4.72; P .00001), final ASES scores (WMD = 5.08; 95% CI, 3.69-6.48; P .00001), and OR for developing a major complication (OR = 0.37; 95% CI, 0.23-0.59; P .0001). There was no significant difference in final Constant-Murley scores (WMD = 3.36; 95% CI, -0.21 to 6.93; P = .06) or revision surgery rate (P = .182) between the 2 groups.The pooled WMD and prediction interval suggest that 95% of patients with proximal humerus fractures treated with an LCP augmented with a fibular allograft will have improved radiographic outcomes, improved ASES clinical outcome scores, and decreased odds of a major complication when compared with patients treated with an LCP alone. Limitations of this study include a relatively short average final follow-up time (2 years) and a potential lack of standardization for radiographic outcomes among included studies.

BACKGROUND A number of patient-reported outcome measure (PROMs) instruments are used to assess shoulder pain, function, and postoperative satisfaction. Computer adaptive tests (CAT) have been developed in an effort to tailor question delivery, decrease time to completion and floor/ceiling effects, and increase compliance. Previous investigations have demonstrated excellent correlation between Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity CAT (UE-CAT) and American Shoulder and Elbow Surgeons (ASES) instruments, indicating that the PROMIS UE-CAT may be an acceptable alternative to the ASES. Prior to widespread adoption, however, rigorous psychometric validation must be performed. Thus, the purpose of this study was to evaluate the psychometric properties of PROMIS UE-CAT relative to the ASES score in patients undergoing primary rotator cuff repair (RCR). METHODS A retrospective study of an institutional RCR registry was performed from July 2018 through March 2019. Preoperative PROMIS UE-CAT and ASES scores were collected. Floor and ceiling effects were determined, and convergent validity was established through Pearson correlations. Rasch partial credit modeling was used for psychometric analysis of the validity of PROMIS UE-CAT and ASES question items, a previously established methodology for assessing shoulder PROMs. Person-item maps were generated to characterize the distribution of question responses along the latent dimension of shoulder disability. RESULTS Responses from 107 patients (107 shoulders) were included. PROMIS UE-CAT had a strong correlation to ASES (r=0.684; P

To determine the effect of travel distance on achieving the minimal clinically important difference (MCID) on patient-reported outcome measures (PROMs) at least 1 year after arthroscopic rotator cuff repair (RCR).Patients undergoing primary arthroscopic RCR with a minimum 1-year follow-up at a high-volume tertiary referral center between May 2017 and June 2019 were retrospectively reviewed. Patients were divided into two groups: driving distance of50 miles from the institution (referral group) and50 miles (local group). American Shoulder and Elbow Score (ASES), Single Assessment Numeric Evaluation (SANE) score and Constant score at minimum 1-year follow-up were assessed. Chi-square analysis was used to analyze achievement of MCID on any PROM. Subgroup analysis by tear complexity (1 tendon vs.2 tendons torn) was conducted. Logistic regression was performed to determine whether travel distance and other variables of interest had an effect on achieving MCID.Of 996 patients reviewed, 385 patients (38.7%) had minimum 1-year follow-up. Of these, 62 (16%) traveled50 miles to their orthopedic provider, and 212 (55%) had a complex tear. MCID for at least one PROM was reached by 305 (94%) patients in the local group and 56 (90%) patients in the referral group. There was no significant difference between groups in reaching MCID for any PROM. Subgroup analysis by tear complexity revealed no significant difference in preoperative PROMs or achieving MCID postoperatively between referral groups. There was no significant difference between groups when controlling for age, sex, adjusted gross income (AGI), primary health insurance, tear chronicity, and tear complexity.When controlling for age, sex, AGI, primary health insurance, tear chronicity, and tear complexity, distance to a high-volume shoulder arthroscopy surgery center did not have an effect on achieving the MCID for any PROM at least 1 year after arthroscopic RCR.Level III, retrospective cohort study.

The purpose of this study was to establish clinically significant outcome values for the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) after anterior cruciate ligament reconstruction (ACLR) in the pediatric and adolescent populations and to assess factors that were associated with achieving these outcomes.Patients between the age of 10 to 21 who underwent ACLR between 2016 and 2018 were identified and patient-reported outcomes (PROs) were collected preoperatively and postoperatively. Intraoperative variables collected included graft choice, graft size (diameter), graft fixation method, and concomitant procedures. PROs collected for analysis were the International Knee Documentation Committee Score (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS). MCID and PASS were calculated using receiver operating characteristic with area under the curve analyses for delta (ie, baseline-to-postoperative change) and absolute postoperative PRO scores, respectively.A total of 59 patients were included in the analysis. Of the entire study population, 53 (89.8%) reported satisfaction with their surgical outcome. The established MCID threshold values based on the study population were 33.3 for IKDC, 28.6 for (KOOS) Symptoms, 19.4 for Pain, 2.9 for activities of daily living (ADL), 45.0 for Sport, and 25.0 for Quality of Life (QoL). Postoperative scores greater than the following values corresponded to the PASS: 80.5 for IKDC, 75.0 (KOOS) Symptoms, 88.9 for Pain, 98.5 for ADL, 75.0 for Sport, and 68.8 for QoL.Clinically meaningful outcomes including MCID and PASS were established for pediatric ACLR surgery using selected PRO measures, IKDC, and KOOS. Patient age, sex, graft type, and graft size were not associated with greater achievement of these outcomes. In contrast, collision sports, fixed-object high-impact rotational landing sports, and concomitant meniscectomy surgery were associated with a decreased likelihood of achieving clinically significant improvement. However, findings must be interpreted with caution due to limitations in follow-up and sample size.Level IV: case series.

The present study was carried on Dahlem Red chicken breed to assess the effect of age on egg quality traits. Total 250 eggs were collected from birds at different age groups, i.e. 21, 28, 40, 52 and 64 weeks of age for studying the external and internal egg quality parameters. The external characters like egg weight, egg length and egg width were measured. Thereafter, the egg was broken and the internal traits like albumen length, height, width of albumen, yolk height, yolk width, shell thickness were recorded using standard procedure. The derived traits like shape index, albumen index, yolk index and Haugh unit, were estimated. Most of the egg quality traits differed significantly at different age of measurements. Egg weight increased as the age of bird advanced and egg weight varied from 39.35±0.69 at 21 week of age to 59.3±1.22 at 64 week of age. Analysis of variance revealed that shape index did not differ significantly with age. Length, width and height of albumen increased as the age of bird progressed. Albumin index was significantly higher at 21 and 40 weeks of age. Similarly, yolk height and width increased as the age of bird advanced. The differences for Haugh unit scores were non-significant among the different age groups and varied within a very narrow range (96.94–98.94) at different ages indicating uniform internal egg quality over the age. Significant differences in shell thickness were observed among different age groups. Correlation coefficient between egg weight with egg length, egg width, albumen length, albumen height and yolk width were positive. Albumen index and Haugh unit were negatively correlated with egg weight at 21, 52 and 64 week of age. The result indicate that the age of bird significantly affects the egg quality parameters.

Purpose To evaluate the rate and duration of return to work in patients undergoing Latarjet for failed soft-tissue stabilization or glenoid bone loss. Methods Consecutive patients undergoing Latarjet from 2005 to 2015 at our institution were retrospectively reviewed at a minimum of 2 years postoperatively. Patients completed a standardized and validated work questionnaire, Western Ontario Shoulder Instability Index Survey, and a satisfaction survey. Results Of 89 eligible patients who had Latarjet, 67 patients (75.3%) responded to the questionnaire, of whom 51 patients (76.1%) were employed within 3 years before surgery (mean age: 29.9 ± 11.8 years; mean follow-up: 54.6 ± 11.9 months) and had an average glenoid bone loss of 14.5 ± 6.1%. Fifty patients (98.0%) returned to work by 2.7 ± 3.0 months postoperatively; 45 patients (88.2%) patients returned to the same level of occupational intensity. Those who held sedentary, light, moderate, or heavy intensity occupations returned to their previous occupation at a rate of 100.0%, 93.3%, 90.0%, and 66.7% (P = .2) at a duration of 1.2 ± 1.6 months, 1.8 ± 1.9 months, 3.1 ± 3.5 months, and 6.5 ± 4.1 months (P = .001), respectively. The average postoperative Western Ontario Shoulder Instability Index score was 70.9 ± 34.2. Fifty patients (98.0%) noted at least “a little improvement” in their quality of life following surgery, with 35 patients (68.6%) noting great improvement. Furthermore, 49 patients (96.1%) reported being satisfied with their procedure, with 25 patients (49.0%) reporting being very satisfied. Four patients (7.8%) returned to the operating room, with 1 patient (2.0%) requiring arthroscopic shoulder stabilization. Conclusions Approximately 98% of patients who underwent Latarjet returned to work by 2.7 ± 3.0 months postoperatively. Patients with greater-intensity occupations had a longer duration of absence before returning to their preoperative level of occupational intensity. Information regarding return to work is imperative in preoperative patient consultation to manage expectations. Level of Evidence IV, case series.

Despite advances in techniques designed to make arthroscopic sports medicine procedures simple, complications still arise in the operating room; even in the most trained hands. However, what marks a skilled surgeon is not just the ability to steer the ship amidst smooth seas, but a knack for getting out of trouble once things deviate from the set course. Each surgical case presents a unique challenge, and no 2 are the same. For this reason, a true expert surgeon must know how to deal with "complications" ranging from a mild swell to a raging storm. In this review we present strategies to prevent and navigate some of the most common, and fearsome complications a sports medicine surgeon may face during surgery. A great surgeon is one that acknowledges that throughout their career it is not a question of "if" these situations will arise, but "when"; and preparation is the key to success.

The transition from inpatient to outpatient shoulder arthroplasty critically depends on appropriate patient selection, both to ensure safety and to counsel patients preoperatively regarding individualized risk. Cost and patient demand for same-day discharge have encouraged this transition, and a validated predictive tool may help decrease surgeon liability for complications and help select patients appropriate for same-day discharge. We hypothesized that an accurate predictive model could be created for short inpatient length of stay (discharge at least by postoperative day 1), potentially serving as a useful proxy for identifying patients appropriate for true outpatient shoulder arthroplasty.A multicenter cohort of 5410 shoulder arthroplasties (2805 anatomic and 2605 reverse shoulder arthroplasties) from 2 geographically diverse, high-volume health systems was reviewed. Short inpatient stay was the primary outcome, defined as discharge on either postoperative day 0 or 1, and 49 patient outcomes and factors including the Elixhauser Comorbidity Index, sociodemographic factors, and intraoperative parameters were examined as candidate predictors for a short stay. Factors surviving parameter selection were incorporated into a multivariable logistic regression model, which underwent internal validation using 10,000 bootstrapped samples.In total, 2238 patients (41.4%) were discharged at least by postoperative day 1, with no difference in rates of 90-day readmission (3.5% vs. 3.3%, P = .774) between cohorts with a short length of stay and an extended length of stay (discharge after postoperative day 1). A multivariable logistic regression model demonstrated high accuracy (area under the receiver operator characteristic curve, 0.762) for discharge by postoperative day 1 and was composed of 13 variables: surgery duration, age, sex, electrolyte disorder, marital status, American Society of Anesthesiologists score, paralysis, diabetes, neurologic disease, peripheral vascular disease, pulmonary circulation disease, cardiac arrhythmia, and coagulation deficiency. The percentage cutoff maximizing sensitivity and specificity was calculated to be 47%. Internal validation showed minimal loss of accuracy after bias correction for overfitting, and the predictive model was incorporated into a freely available online tool to facilitate easy clinical use.A risk prediction tool for short inpatient length of stay after shoulder arthroplasty reaches very good accuracy despite requiring only 13 variables and was derived from an underlying database with broad geographic diversity in the largest institutional shoulder arthroplasty cohort published to date. Short inpatient length of stay may serve as a proxy for identifying patients appropriate for same-day discharge, although perioperative care decisions should always be made on an individualized and holistic basis.

Anatomic total shoulder arthroplasty (TSA) and reverse TSA are the standard of care for end-stage shoulder arthritis. Advancements in implant design, perioperative management, and patient selection have allowed shorter inpatient admissions. Unplanned readmissions remain a significant complication. Identification of risk factors for readmission is prudent as physicians and payers prepare for the adoption of bundled care reimbursement models. The purpose of this study was to identify characteristics and risk factors associated with readmission following shoulder arthroplasty using a large, bi-institutional cohort.A total of 2805 anatomic TSAs and 2605 reverse TSAs drawn from 2 geographically diverse, tertiary health systems were examined for unplanned inpatient readmissions within 90 days following the index operation (primary outcome). Forty preoperative patient sociodemographic and comorbidity factors were tested for their significance using both univariable and multivariable logistic regression models, and backward stepwise elimination selected for the most important associations for 90-day readmission. Readmissions were characterized as either medical or surgical, and subgroup analysis was performed. A short length of stay (discharge by postoperative day 1) and discharge to a rehabilitation or skilled nursing facility were also examined as secondary outcomes. Parameters associated with increased readmission risk were included in a predictive model.Within 90 days of surgery, 175 patients (3.2%) experienced an unanticipated readmission, with no significant difference between institutions (P = .447). There were more readmissions for surgical complications than for medical complications (62.9% vs. 37.1%, P.001). Patients discharged to a rehabilitation or skilled nursing facility were significantly more likely to be readmitted (13.1% vs. 8.8%, P = .049), but a short inpatient length of stay was not associated with an increased rate of 90-day readmission (42.9% vs. 41.3%, P = .684). Parameter selection based on predictive ability resulted in a multivariable logistic regression model composed of 16 preoperative patient factors, including reverse TSA, revision surgery, right-sided surgery, and various comorbidities. The area under the receiver operator characteristic curve for this multivariable logistic regression model was 0.716.Risk factors for unplanned 90-day readmission following shoulder arthroplasty include reverse shoulder arthroplasty, surgery for revision and fracture, and right-sided surgery. Additionally, there are several modifiable and nonmodifiable risk factors that can be used to ascertain a patient's readmission probability. A shorter inpatient stay is not associated with an increased risk of readmission, whereas discharge to post-acute care facilities does impose a greater risk of readmission. As scrutiny around health care cost increases, identifying and addressing risk factors for readmission following shoulder arthroplasty will become increasingly important.

Purpose To establish an infection rate following primary arthroscopic rotator cuff repair (ARCR) from a single institutional database and to ascertain whether there is a relationship between the use of preoperative corticosteroid injection (CSI) and the risk of postoperative infection. Methods All medical records at a single institution were retrospectively reviewed to identify patients who had undergone arthroscopic repair from January 2016 to December 2018. Patient charts were reviewed for CSI treatment within 6 months of surgery, superficial or deep infection within 2 months postoperatively, and specific treatment of the infection. Patient characteristics were summarized by descriptive statistics using means with standard deviations for continuous variables and frequencies with percentages for categorical variables. A χ2 correlation analysis was performed to determine the association between receiving an injection and having an infection. Results A total of 1773 patients were included for analysis with an average age of 59.24 ± 9.4 years. The overall infection rate was 0.11% (2/1773 patients). Both patients were treated with oral antibiotics. Of the included patients, 616 had a preoperative CSI within 6 months of their surgery, and 102 injections were administered within 1 month of surgery. None of these patients had a postoperative infection. A χ2 correlation analysis showed a negligible relationship between preoperative injections and postoperative infection (φ = 0.02, χ2 = 0.84). Conclusions Through this single-institution, large cohort retrospective review, we found an overall 0.11% rate of postoperative infection following primary arthroscopic RCR. In addition, we found no correlation between the use of preoperative CSI ahead of elective ARCR at any time point and risk of developing a postoperative infection. Infection is uncommon following ARCR, and preoperative steroid injection did not increase infection risk in our study population. Level of Evidence Level IV, therapeutic case series.