Surgery:

CONCLUSIONS: The overall refracture rate in children was approximately 0.5%, with the highest rates in both-bone diaphyseal forearm fractures. The median time to refracture varied significantly by anatomic location, and displaced fractures treated with closed reduction were associated with a higher refracture risk.

CONCLUSIONS: This bibliometric analysis underscores the growing interest in ALL research, peaking between 2016 and 2017. While foundational studies on ALL anatomy and biomechanics appear saturated, future research should prioritize clinical outcomes in terms of failure rate, reoperation, the long-term efficacy of ACL-ALL reconstruction, and advancements in imaging techniques.

➢ Risk stratification in orthopaedic surgery is complex and depends on the outcome of interest and multiple interdependent factors. Effective risk stratification has uses for limiting and predicting adverse events in patients undergoing discretionary surgery, avoiding the penalization of surgeons for operating on candidates whose health is situated in more difficult circumstances, and ensuring that inordinate attention is not placed on discrete musculoskeletal pathophysiology when there are other pressing health priorities.➢ For individual patient decision-making, no comprehensive risk-stratification tool currently exists, in part due to the heterogeneity of orthopaedic procedures performed and the diverse patient population treated. The Elixhauser Comorbidity Measure and the Risk Stratification Index 3.0 appear to be most promising.➢ At a population level, risk stratification may be useful in alternative payment models to ensure that hospitals that treat a disproportionate number of high-risk patients are not penalized and that cherry-picking (preferentially selecting only healthier patients with a lower risk of complications) does not occur. Any attempt to risk-stratify may have unintended consequences.➢ Orthopaedic surgeons must be aware of the tools available, their strengths, and their limitations in order to be included in decision-making as payment models and public health policies are implemented.

CONCLUSIONS: dd-cfDNA found good discrimination between cardiac recipients with and without rejection. Absolute quantification of dd-cfDNA with ddPCR is a fast and effective method to monitor graft health. Analyzing absolute dd-cfDNA levels helps identify other factors, besides rejection, that may influence cfDNA levels, potentially reducing the need for EMB.

CONCLUSIONS: Osteoporosis occurred spontaneously at the proximal humerus with age. Glutamine supplementation effectively mitigated age-related osteoporosis and enhanced RCR in elderly rats. These findings support the potential of glutamine, the most abundant amino acid in the body, as a valuable therapeutic intervention for improving RCT outcomes in the aging population, warranting further investigation in clinical settings.

CONCLUSIONS: Lead glasses were most effective (∼100% reduction), followed by surgical loupes (97%), whereas plastic face shields showed no significant reduction in radiation dose. Surgical loupes can substantially reduce ocular radiation exposure.

CONCLUSIONS: The PROMIS PF domain has value in assessing patients 10 years after revision ACL reconstruction. Because of floor and ceiling effects, using the PI and PM domains may not allow for precision when measuring long-term changes in pain and mobility. Although the PROMIS measures correlated with the legacy measures, with effect sizes ranging from fair to moderate, the legacy scores were not accurately predicted by the PROMIS. The results suggest that knee-specific legacy measures should not be eliminated from long-term follow-up when the goal is to capture the specific knee-related information that they provide.

CONCLUSIONS: Based on our findings, a macroscopically normal-appearing biceps tendon should be released when treating stage-1 supraspinatus tendon tears.

CONCLUSIONS: In this study of patients ≥60 years of age with a femoral neck fracture, the rates of all-cause revision and mortality were found to be similar between the FNS and multiple cannulated screws.

Abstract: Biliary drainage in patients with distal malignant biliary obstruction (DMBO) carries a higher risk of difficult biliary cannulation (DBC) during endoscopic retrograde cholangiopancreatography (ERCP). After the failure of standard cannulation, endoscopists may proceed with advanced cannulation techniques and/or with endoscopic ultrasound-guided biliary drainage (EUS-BD).This was a retrospective study of consecutive patients with DMBO and a dilated common bile duct (CBD; >12 mm) who underwent ERCP for endoscopic biliary drainage in four European centers. The rates of DBC, technical and clinical success, and procedure-related adverse events (AEs) were assessed. The predictive factors for AEs were also investigated through regression analysis. The EUS-BD approach was considered either as the first option after standard cannulation failure or as the final option after advanced cannulation failure.1016 patients with DMBO were included in the study, with 524 (51.6%) matching the definition of DBC. Clinical success was achieved in 956 patients (94.1%). Procedure-related AEs were experienced by 167 patients (16.4%). Patients with DBC had a higher risk of AEs (=0.003); however, patients undergoing "early" EUS-BD showed a risk of AEs comparable with those managed with standard cannulation (=0.38). An attempt at any advanced cannulation technique was independently associated with the occurrence of AEs (=0.001).The risk of AEs is higher in patients with DMBO and DBC, this appears to be mainly related to the advanced cannulation techniques. In patients with a dilated CBD (>12 mm), "early" EUS-BD may minimize the risk of AEs.

CONCLUSIONS: Different statistical approaches resulted in substantial variation in the MCID threshold value, which affected the number of patients who reached the MCID. This study demonstrates the ambiguity of the MCID and casts some doubt regarding its utility for assessing the surgical benefit of total joint arthroplasty.

No abstract available

CONCLUSIONS: Tourniquet use was associated with more patients achieving the MCID for the KOOS JR at 1 month compared with no tourniquet use. This difference disappeared at 3 and 6 months. At 1, 3, and 6 months, there were no differences in opioid consumption, health-care utilization, or complications between patients undergoing TKA with a tourniquet versus without a tourniquet. Tourniquet use did not have a clinically meaningful impact on PROMs in the multivariable analysis. Arthroplasty surgeons may use these data during preoperative discussions with patients regarding tourniquet use as it relates to the surgeon's preference and how it could influence postoperative function.

As we have previously shown, Idiopathic pulmonary fibrosis lung transplant recipients (IPF-LTRs) with short-telomere length (STL) are prone to develop significant cytopenias and poor tolerance to cell cycle inhibitors, specifically Mycophenolate mofetil (MMF), post-transplant. We investigated the use of Belatacept as an alternative immunosuppressive agent in a prospective, open-label cohort of 9 ST-IPF-LTRs at our institution. These patients were either challenged with MMF (majority) or immediately started on Belatacept post-transplant with the goal to bridge to Everolimus, an mTOR inhibitor that is commonly used post-transplant. We describe outcomes in the first-year post-transplant including the incidence of Acute Cellular Rejection (ACR), Epstein-Barr Virus (EBV) viremia, and one case of Post-Transplant Lymphoproliferative Disorder (PTLD) at 13 months. The use of Belatacept post-lung transplant may be an acceptable short-term alternative therapy to cell cycle inhibitors in ST-IPF-LTRs with cytopenias but may lead to higher risk of EBV viremia and PTLD when Belatacept is used long-term in these patients.

Access to organ transplantation for HIV-positive individuals is expanding, yet the outcomes of HIV-positive patients requiring multiorgan transplant are not well-defined. Adult individuals in the United Network for Organ Sharing (UNOS) registry who were HIV-positive and received HT between 2010 and 2023 were included. The primary outcome was patient survival. During the study period, 175 HIV-positive patients were transplanted. Twenty-six (14.8%) underwent dual organ transplantation (20 heart/kidney, 4 heart/lung, and 2 heart/liver) at 23 centers. Median age at the time of HT was 56 years (IQR 47-60), majority were male (n=18, 69%), and 46% identified as Black (n= 12). Dilated cardiomyopathy was the most common etiology of heart failure (n=13, 50%). All patients received organs from HIV-negative donors. The probability of surviving at least one year was 87.6% (95% CI 81.0- 92.0) for single-organ recipients and 82.9% for dual organ recipients (95% CI 60.0-93.4). There was no difference in overall survival between HIV-positive and HIV-negative matched controls among dual organ recipients (log-rank p-value = 0.8). Over the last decade, only a small number of HIV-positive individuals with end-stage heart failure have undergone dual organ transplantation with encouraging short-term outcomes.

Transcriptomic analysis of kidney biopsies has demonstrated potential to improve diagnosis of allograft rejection. Here, we developed a molecular assessment of antibody-mediated rejection (AMR) and T-cell-mediated rejection (TCMR) based on the Banff-Human-Organ-Transplant (B-HOT) consensus gene panel. Expression assays of formalin-fixed paraffin-embedded kidney biopsies from well-phenotyped cohorts were used to develop prediction models for AMR and TCMR and an automated report of gene expression-based diagnosis. The study population consisted of 950 kidney allograft biopsies from 10 transplantation centers in Europe and North America. The development cohort included 664 renal allograft biopsies split into a training (n=537) and test set (n=127), and two external validation cohorts (n=286). We performed gene selection using regularized regression and developed several different base models based on B-HOT expression data, which were combined into a single ensemble model for each rejection diagnosis. Model performance was assessed in the test set and the two external validation cohorts, showing good discriminative abilities (respective PR-AUC AMR=0.811, 0.891, 0.832 and TCMR=0.736, 0.810, 0.782). We identified challenging biopsies with histology below diagnostic thresholds for which gene expression-based probability can refine rejection diagnosis. This automated molecular diagnostic system shows potential for improving kidney allograft rejection diagnosis in routine practice and clinical trials.

CONCLUSIONS: Overall, patients undergoing primary TKA returned to driving considerably earlier than previously reported. Patient-related factors and postoperative physical performance significantly affect return-to-driving time. Using the novel preoperative clinical prediction tool, individual patients can be advised when to expect to return to driving. After surgery, the novel postoperative physical performance-based instrument can inform patients when they may be ready to return to driving.

PURPOSE: The purpose of this study is to perform a Markov model-based cost-effectiveness analysis comparing arthroscopic Bankart repair (ABR) to open Latarjet for first-time shoulder dislocations.

According to the Banff classification, intimal arteritis (v-lesion) contributes to diagnosing T cell-mediated rejection (TCMR) and antibody-mediated rejection (AMR), and signifies more severe TCMR. This multicenter cohort study (N=5323 kidney transplants, N=16774 post-transplant biopsies) evaluated the impact of v-lesions (N=707 v-positive biopsies in N=534 transplants) on biopsy classification and outcomes. The first v-positive biopsy of each transplant was categorized by additional Banff TCMR/(p)AMR-MVI criteria: 166 (31.1%) isolated v, 87 (16.3%) borderline changes with v, 66 (12.4%) TCMR grade I (TCMR-I) with v, 148 (27.7%) (p)AMR-MVI ((probable) AMR/DSAnegC4dneg MVI) with v, and 67 (12.5%) TCMR-I + (p)AMR-MVI with v. Cases with additional TCMR/(p)AMR-MVI criteria were more often indication biopsies, had lower eGFR, and were more frequently HLA-DSA positive than isolated v. While borderline changes with v had borderline higher 10-year graft failure rates than isolated v, TCMR-I, (p)AMR-MVI, and TCMR-I + (p)AMR-MVI with v were associated with significantly worse outcomes, although variably treated. Matching N=534 v-positive cases to v-negative controls showed no significant impact of v-lesions on outcomes. These findings question the role of isolated v-lesions in rejection diagnosis and emphasize the greater prognostic value of additional TCMR and (p)AMR-MVI criteria. Reconsideration of v-lesions in the Banff classification may be appropriate.

CONCLUSIONS: CHLT in Fontan patients demonstrates promising survival rates, but graft rejection and postoperative complications pose challenges. The rate of renal complications is particularly notable and requires further evaluation. Future research should prioritize comparative different management strategies and long-term follow-up to refine protocols and optimize outcomes.