Faculty Bibliography

PURPOSE/UNASSIGNED:Vesicourethral anastomotic stenosis (VUAS) occurs after 1 to 3% of robotic-assisted radical prostatectomies (RARPs). Pelvic fascia-sparing techniques preserve more native anatomy and may reduce stenoses, but evidence is lacking. The aim of this study was to compare stenosis incidence, management, and outcomes after standard vs pelvic fascia-sparing RARP. MATERIALS AND METHODS/UNASSIGNED:We conducted a multi-institutional retrospective study of 910 standard, 409 Retzius-sparing, and 272 hood RARP during February 2012-September 2025. Standard and hood techniques used 18Fr urethral catheters, and the Retzius-sparing technique used 18Fr suprapubic catheters. The primary end point was cystoscopically confirmed VUAS requiring intervention within 12 months. Urinary continence was assessed using the validated Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP). Multivariable logistic regression assessed factors associated with VUAS. RESULTS/UNASSIGNED:= .046). CONCLUSIONS/UNASSIGNED:There were no VUAS after Retzius-sparing RARP, and Retzius-sparing vs standard approach was associated with lower odds of stenosis. Endoscopic management with structured self-catheterization achieved high success without worsening incontinence. Prospective studies are needed to validate our findings.

IntroductionTourniquet use for ankle fracture fixation surgery is a common but not universally accepted practice due to concerns regarding soft tissue complications. Although prior literature has demonstrated increased short-term postoperative pain, tourniquet use's association with other complications remains under-investigated.MethodsA retrospective cohort study was performed of adult patients undergoing open reduction and internal fixation of a closed rotational ankle fracture (OTA Type 44) between 2012 and 2024 at an urban academic health system. Patients were stratified by tourniquet use. Demographic information, injury characteristics, and operative variables were collected. The primary outcome was the development of postoperative complications-wound dehiscence, fracture-related infection, superficial wound infection, delayed wound healing, peripheral nerve injury, venous thromboembolism, and nonunion. Secondary outcomes were operative time and estimated blood loss. Multivariable logistic regression was used to evaluate the association between tourniquet use and postoperative complications.ResultsA total of 617 patients met the inclusion criteria, including 446 who had a tourniquet inflated during surgery and 171 who did not. No significant differences in baseline patient demographics or comorbidity were observed. After multivariable logistic regression, tourniquet use was not associated with higher odds of any wound complication, fracture-related infection, delayed wound healing, or peripheral nerve injury. Among patients in the tourniquet cohort, 4 developed venous thromboembolism and 7 developed a fracture nonunion. No such complications were observed among patients treated without a tourniquet. Tourniquet use was associated with a modest decrease in estimated blood loss (47.3 ± 44.2 vs 33.9 ± 36.0 mL, P < .001) with no significant increase in operative time.ConclusionTourniquet use during operative fixation of closed rotational ankle fractures was not associated with increased soft tissue or bony complications. The findings support the safety of continued tourniquet use per surgeon preference, provided that appropriate patient selection is employed.

PURPOSE/OBJECTIVE:To review adverse events and outcomes at least 1 year postoperatively from Bridge enhanced ACL restoration (BEAR) in the first 100 subjects of the Bridge registry, a postcommercialisation prospective cohort. METHODS:Consecutive BEAR patients were invited to enroll in the Bridge registry. Technique modifications, adverse events and reoperations were recorded. Physical examinations and patient reported outcomes (International Knee Documentation Committee [IKDC], knee injury and osteoarthritis outcome score [KOOS], Marx and return to sport index [RSI]) were reported at 0, 6, 9 and 12 months. RESULTS:Of the 100 subjects, 94 enrolled postoperatively. Four exited the study. Mean follow up was 15.3 ± 4.7 months. The mean age was 31.3 ± 14.3 years. 67% were female. Classic and modified techniques were each used in 50 cases. The rates of adverse events and reoperations at 1 year were: one deep venous thrombosis, two meniscal injuries without anterior cruciate ligament (ACL) retear and eight reoperations (one debridement, two manipulations, three suture removals, one partial lateral meniscectomy and one medial meniscus repair). Adverse events between 1 and 2 years included one recurrent ACL tear with associated meniscus tears, two meniscal injuries without ACL tear, and one isolated ACL tear. Overall reoperation rate was 8.3% (8/96) at 1 year and 11.5% (11/96) at final follow-up, with 0% ACL retear at 1 year and 2.1% (2/96) ACL retear at final follow-up. Mean IKDC, Marx and RSI scores at 12 months were (N = 79), respectively 82.7 ± 14.6, 7.5 ± 5.36 and 66.6 ± 24.06. Mean KOOS pain, function daily living and function sports and recreational activities were: 92.7 ± 8.6, 96.7 ± 6.0 and 82.0 ± 18.5. Lachman (N = 75) was 0-2 mm in 80.0% (60/75) and 3-5 mm in 20.0% (15/75). Pivot shift (N = 73) was negative in 90.4% (66/73), grade 1 in 8.2% (6/73) and grade 2 in 1.4% (1/73) at 12 months. CONCLUSION/CONCLUSIONS:The rates of adverse events of BEAR with and without modification are low at 1 year. Excellent stability and ROM are attained at 1 year. CLINICAL RELEVANCE/CONCLUSIONS:BEAR has promising results in postcommercial utilization and is as an alternative to reconstruction. LEVEL OF EVIDENCE/METHODS:Level II cohort study.

BACKGROUND:Chondral/osteochondral knee lesions are commonly encountered and often associated with progression of osteoarthritis (OA). Nevertheless, knee repair trials have traditionally excluded patients with concurrent mild to moderate OA. PURPOSE/OBJECTIVE:To compare the clinical and safety outcomes of knee repair with an aragonite-based osteochondral implant with outcomes of surgical standard of care (SSOC) in patients with chondral/osteochondral knee lesions, including those with mild to moderate OA. STUDY DESIGN/METHODS:Randomized controlled trial; Level of evidence, 1. METHODS:, bony defect depth ≤8 mm, and Kellgren-Lawrence knee OA score of 0 to 3. Patients were randomized 2:1 to receive an aragonite-based implant or SSOC (arthroscopic debridement or microfracture) and followed for 5 years. The primary endpoint was improvement in overall Knee injury and Osteoarthritis Outcome Score (KOOS). Secondary endpoints included percentage of responders (minimum overall KOOS improvement ≥ 30 points), patient-reported outcomes (KOOS subscale values and International Knee Documentation Committee subjective score), treatment failure (ie, need for any secondary treatment), and treatment-emergent adverse events. A covariate analysis compared primary/secondary outcomes between patients with no to minimal and mild to moderate OA. RESULTS:< .001) than the SSOC group. CONCLUSION/CONCLUSIONS:The results confirmed that the aragonite-based scaffold is both safe and superior to SSOC in improving clinical outcomes at up to 5 years' evaluation, as well as in patients with mild to moderate OA.

BACKGROUND/UNASSIGNED:There has been increased interest in the biologic augmentation of osteochondral allografts (OCAs), specifically the use of autologous bone marrow, to decrease failure rates. The iliac crest is a common donor site, but its use is associated with increased pain separate from the primary surgical site and increased complexity in the operating room setup and draping. Local bone marrow aspirate (BMA) from the proximal tibia or femoral condyle addresses these limitations, but the quality of the aspirate may be lower. It has not been determined whether this difference in aspirate quality influences the postoperative imaging appearance of OCA grafts. PURPOSE/UNASSIGNED:To determine whether bone marrow aspirate augmentation from the iliac crest versus the proximal tibia affected 6-month postoperative magnetic resonance imaging (MRI) appearance of OCA grafts. STUDY DESIGN/UNASSIGNED:Cohort study; Level of evidence, 3. METHODS/UNASSIGNED:Patients undergoing OCA transplantation for grade IV chondral defects of the distal femur from January 2018 to June 2021, with 6-month (±2 months) postoperative knee MRI, were included in the study. Patients without knee postoperative MRI, patients with multiple plugs on different surfaces of the knee, and patients with patellar OCA plugs were excluded. Osteochondral Allograft Magnetic Resonance Imaging Scoring System (OCAMRISS) scores were calculated and compared for patients undergoing OCA with either ipsilateral iliac crest BMA augmentation or ipsilateral proximal tibia BMA augmentation. RESULTS/UNASSIGNED:> .05 for all). CONCLUSION/UNASSIGNED:BMA augmentation does not affect the 6-month postoperative MRI appearance of OCA grafts.

BACKGROUND:The biomechanical consequences of the repair of medial meniscus posterior root (MMPR) tear-whether anatomic or nonanatomic-during simulated gait have not been quantified. HYPOTHESIS/OBJECTIVE:Medialized root repair would result in increased peak contact stress and proportion of compartment load acting through the meniscus and decreased contact area compared with anatomic root repair throughout simulated gait. STUDY DESIGN/METHODS:Controlled laboratory study. METHODS:Six human cadaveric knees were mounted on a robotic test system programmed to apply dynamic forces, moments, and flexion angles to mimic level walking. Contact area, peak contact stress, and proportion of compartment force acting through the meniscus were measured throughout the stance phase of the simulated gait cycles for the following nonrandomized conditions: (1) native meniscus-"intact" condition, (2) root repair at the anatomic location, and (3) root repair 10 mm medially. The difference between the anatomic and medialized repair conditions was calculated for each metric, and then the mean and 95% CI were computed. RESULTS:compared with anatomic repair. This change is on average 15% of the magnitude of change in area as previously quantified to occur with medial meniscectomy and as such is deemed a small and a potentially clinically insignificant change. CONCLUSION/CONCLUSIONS:Medialized repair of MMPR tear led to a small decrease in contact area compared with an anatomic repair during the early stance phase of simulated gait, with no difference in peak contact stress or proportional force through the meniscus throughout the simulated gait cycle. CLINICAL SIGNIFICANCE/CONCLUSIONS:This study provides unique data about the mechanical effects of anatomic and medialized root repair throughout simulated gait in a cadaveric model. With minimal changes between the 2 repair states, even at peak compressive and anterior load, there is mechanical justification that a medialized root repair may be an appropriate intervention if an anatomic repair is not possible.