Faculty Bibliography

BACKGROUND:Genu valgum is a known risk factor for recurrent patellar instability, and surgical correction of deformity can be utilized as part of the management strategy to improve tracking and optimize outcomes. Tibial tuberosity-trochlear groove (TT-TG) distance is a widely used objective measurement of the lateral quadriceps force vector in patients with patellar instability. The evidence documenting the effect of lateral opening wedge distal femoral osteotomy (LOWDFO) and medial closing wedge high tibial osteotomy (MCWHTO) on TT-TG is limited, with minimal data directly comparing the biomechanical implications of one versus the other. PURPOSE/HYPOTHESIS/OBJECTIVE:The purpose of this study was to directly compare LOWDFO and MCWHTO using a computer model to determine the effect of each osteotomy on TT-TG distance. It was hypothesized that LOWDFO would have a greater effect on TT-TG distance, given the position farther away from the tibial tubercle. STUDY DESIGN/METHODS:Descriptive laboratory study. METHODS:A total of 22 knees from 21 patients with patellar instability and valgus malalignment were processed using 3D Slicer (Version 5.4.0) to convert their respective DICOM images into .stl mesh files to be used with Fusion (Autodesk; Version 2601.1.37) computer-aided design software. LOWDFOs and MCWHTOs were then simulated from 0° to 12° in 2° increments. TT-TG distance was then measured after each osteotomy. RESULTS:< .001). CONCLUSION/CONCLUSIONS:LOWDFO results in a significantly larger magnitude of change in the TT-TG compared with MCWHTO, with distal femoral osteotomy at almost a 1:1 change with TT-TG compared with the correction angle, and high tibial osteotomy about 1:4. CLINICAL RELEVANCE/CONCLUSIONS:The LOWDFO may be a more effective procedure in reducing the TT-TG distance, which is important when addressing patellar instability in patients with valgus malalignment.

Patient-specific instrumentation (PSI) may help improve outcomes following high tibial osteotomy (HTO). Three-dimensional preoperative planning allows for multiplanar osteotomy templating that can precisely restore the mechanical axis while limiting unintended sagittal plane abnormalities, facilitating execution of complex biplanar corrections. Patient-specific cutting guides and anatomically contoured implants reduce risk for intraoperative complications and streamlines operative efficiency. Though lacking long-term data to establish clinical superiority of PSI over traditional HTO techniques, early reports demonstrate PSI is highly accurate, safe, and effective. Understanding the advantages and limitations of PSI is crucial in making informed decisions when implementing this new technology in osteotomy surgery.

BACKGROUND:To compare clinical outcomes, return to activities, and rates of revision surgery following arthroscopic glenoid labral repair in patients who were prescribed NSAIDs as part of their postoperative pain management regimen versus those who were not. METHODS:Patients aged 18-55 who underwent primary arthroscopic labral repair at a single academic institution from the years 2016-2020 were retrospectively reviewed. Patients who underwent concomitant rotator cuff repair, remplissage, or did not have minimum 2-year postoperative follow-up were excluded. Patients who were prescribed postoperative NSAIDs were matched 1:1 to those who were not based on age, sex, BMI, and number of suture anchors. Outcomes were assessed using the Visual Analog Scale (VAS) for pain, American Shoulder and Elbow Surgeons Shoulder Score (ASES), Simple Shoulder Test (SST), Single Assessment Numeric Evaluation rating (SANE), and satisfaction. Pre-injury sport and work activity information were recorded. RESULTS:Of 269 eligible patients, 224 patients were included. Patients prescribed NSAIDs postoperatively had similar levels of pain (1.2 vs 1.0, p=0.527) and function (ASES: 90.8 vs 89.9, p=0.824; SST: 91.9 vs 90.6, p=0.646; SANE: 83.8 vs 85.3, p=0.550) compared to those who were not. Rates of revision surgery (2.7% vs 0.9%, p=0.622) and recurrent instability (5.4% vs 8.0%, p=0.594) were similar between NSAID and non-NSAID groups. Rates of return to sport (83.5% vs 77.8%, p=0.318) and return to pre-injury level (59.3% vs 61.6%, p=0.177) were similar between NSAID and non-NSAID groups. Prescription of postoperative NSAIDs was not associated with delayed return to sport (OR:1.47, 95%CI [0.68,3.18], p=0.327) or return to work (OR:0.56, 95%CI [0.14,2.28], p=0.416). CONCLUSIONS:Patients who were prescribed NSAIDs as a part of a postoperative pain management regimen following primary arthroscopic labral repair for glenohumeral instability had similar patient-reported outcomes, revision rates, and rates of return to pre-injury activities compared to those who were not prescribed NSAIDs.

BACKGROUND:Risks associated with graft transplantation due to donor-recipient sex differences have been reported in whole organ transplantation literature but are not well-described in meniscal allograft transplantation (MAT). This study assessed the effect of donor-recipient sex mismatch on patient-reported outcomes (PROs) following MAT. METHODS:A retrospective review of patients <50 years of age that underwent unicompartmental MAT from 2010 to 2023 at a single institution with minimum 2-year follow up was conducted. Exclusion criteria were revision procedures or insufficient donor information. PROs collected included: Knee Injury and Osteoarthritis and Outcome Score (KOOS), Visual Analog scale (VAS) for pain and satisfaction, and return to sport (RTS). PROs were compared between donor-recipient graft matching groups (same-sex (SS) or different-sex (DS)) and by donor sex. RESULTS:, and follow up of 73.4 ± 29.2 months. Donors were mostly male (77.2 %). Thirty-six patients (63.3 %) received SS grafts and 21 (36.8 %) received DS grafts. There were no significant differences between groups in KOOS subscores, VAS pain, satisfaction scores, or RTS rates (P > 0.05). Donor sex also showed no association with PROs. Linear and logistic regression models controlling for age, BMI, and average follow up demonstrated that graft mismatch was not associated with KOOS scores, RTS, or graft failure. Decreasing patient age was associated with improved KOOS-pain (β: -0.376; 95 % CI (-1.892, -0.155); P = 0.022). CONCLUSIONS:Patients that undergo MAT with grafts from a different sex had similar outcomes to patients receiving grafts from a donor of the same sex. Sex-mismatch was not associated with functional outcomes or RTS. The results of this paper support the use of geometrically matched donor grafts, independent of donor sex, which should expand available graft options when matching a patient for MAT.

High tibial osteotomy shifts the weight-bearing axis of the lower limb away from a diseased medial compartment. It has been associated with high rates of return to work and sport and high midterm to long-term survivorship. However, appropriate patient selection is paramount for achieving optimal outcomes. Factors that can affect outcomes include severity of medial cartilage damage, age, body mass index, and smoking status.

BACKGROUND/UNASSIGNED:The utility and safety of patient-specific cutting guides (PSCGs) in osteotomies about the knee is uncertain. PURPOSE/UNASSIGNED:To compare the cost, accuracy of radiographic correction, and safety of PSCG versus standard cutting guide (SCG) corrective osteotomies about the knee. STUDY DESIGN/UNASSIGNED:Cohort study; Level of evidence, 3. METHODS/UNASSIGNED:Patients undergoing high tibial osteotomy (HTO) or distal femoral osteotomy (DFO) were retrospectively reviewed from 2017 to 2022. Those who underwent 3-dimensional PSCG osteotomy were propensity matched to patients undergoing traditional osteotomies. Procedure time and fluoroscopic details were extracted from operative notes. Hip-knee-ankle (HKA) angle, posterior tibial slope (PTS), and mechanical axis deviation were measured on pre- and postoperative radiographs. Intraclass correlation coefficients were calculated to determine the reliability between the intended and resultant correction of HKA. Time-driven activity-based costing (TDABC) analysis was performed to compare procedure costs. RESULTS/UNASSIGNED:= .01) were lower in the PSCG group. TDABC analysis demonstrated a total cost of $27,026 for PSCG and $27,100 for SCG. The rate of hinge fractures (9.5% vs 33.3%) and return to the operating room (4.8% vs 19.0%) were lower in the PSCG group, although these differences were nonsignificant. CONCLUSION/UNASSIGNED:Both traditionally guided osteotomies and PSCG-guided osteotomies accurately corrected lower extremity malalignment. Utilization of PSCG resulted in similar procedure times and cost, as well as less fluoroscopy and lower tourniquet time, compared with conventional osteotomy. PSCG trended toward a decreased rate of postoperative complications.

BACKGROUND:This study aims to investigate the effect of donor-recipient sex-mismatch on graft survival, patient-reported outcomes (PROs), and return to sport (RTS) following knee osteochondral allograft (OCA) transplantation. METHODS:Patients who underwent knee OCA transplantation between 2011 and 2022 with minimum 2-year clinical follow-up were divided into two cohorts (same-sex (SS) and different-sex (DS) donor). Cumulative survival was compared via multivariable Cox regression analyses controlling for age, graft size, and body mass index (BMI). A sub-analysis comparing PROs between groups was performed, including the Visual Analog Scale (VAS) for pain and satisfaction, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and RTS rates. RESULTS:285 patients were included (189 SS, 96 DS) with mean follow-up of 4.8 ± 2.0 years. There was a graft failure rate of 6.0% with no significant difference in graft survival rate between DS and SS groups (p = 0.70). Sub-analyses between the four donor-recipient groups (male-male, female-male, male-female, and female-female) and between female and male donor groups demonstrated no significant differences in graft survival. Among patients who failed the procedure, time to failure was significantly shorter for those with sex-mismatched grafts (353 days vs. 864 days, p = 0.002). Sub-analysis of a 71-patient cohort with two-year PROs demonstrated no differences between SS and DS groups with respect to satisfaction, pain, or KOOS scores after controlling for sex (p > 0.05). CONCLUSION/CONCLUSIONS:Patients undergoing knee OCA transplantation demonstrated no observable differences in graft survivorship based on donor-recipient graft sex-matching, suggesting that surgeons can use sex-mismatched grafts and expect limited effect on graft survivorship. LEVEL OF EVIDENCE/METHODS:IV.

PURPOSE/OBJECTIVE:The purpose of this study is to assess the association between sagittal tibial tuberosity-trochlear groove (sTT-TG) distance and patellofemoral chondral lesion size in patients undergoing cartilage restoration procedures. METHODS:A retrospective cohort analysis of patients who underwent an osteochondral allograft transplantation or matrix-induced autologous chondrocyte implantation in the patellofemoral compartment, from 2010 to 2020, were included if they had patellofemoral high-grade lesions, magnetic resonance imaging (MRI) and minimum 2-year follow-up. The preoperative sTT-TG distance was measured independently on axial T2-weighted MRI sequences by two authors, each at least two weeks apart. Intraoperative lesion size was reported according to operative report measurements by the attending surgeon. An interclass correlation coefficient (ICC) was calculated to assess intra- and inter-rater reliability, and categorical data analysis and linear regression models were used to assess the relationship between sTT-TG and lesion size. RESULTS:. Intra- (ICC: 0.99,0.98) and inter-rater reliability (ICC: 0.96) were excellent for both MRI defect size and sTT-TG measurements. The mean sTT-TG was -4.8 ± 4.9 mm and was significantly inversely related to MRI defect size (-0.45, p < 0.01), intraoperative patellar lesion size (-0.32, p = 0.01), total lesion area (-0.22, p = 0.04), but not trochlear lesion size (-0.09, p = 0.56). Multivariable regression demonstrated a more negative sTT-TG remained an independent variable correlated with larger MRI-measured patellofemoral defect sizes and intraoperative patellar lesions. CONCLUSION/CONCLUSIONS:A more negative sTT-TG was an independent variable correlated with larger patellofemoral lesions in patients undergoing patellofemoral cartilage restoration. LEVEL OF EVIDENCE/METHODS:Level III, Diagnostic.