Introduction: Pediatric supracondylar humerus fractures are common and the most frequent pediatric fracture to require surgical intervention. After initial management, emergency department (ED) visits subsequent to this injury/surgery are not well characterized, but are of clinical interest. Methods: Pediatric patients (age >1 y old and <13 y old) with supracondylar humerus fractures were identified from the 2010 to 2021 PearlDiver M157 administrative database. These patients were stratified based on whether they visited the emergency department at least once within 90 days after their initial injury diagnosis/management. The timing of visits and reasons were determined, and predictive factors were assessed with multivariate logistical regression. Results: A total of 92,994 fractures were identified for which post-injury/post-operative ED visits were noted for 10,325 patients (11.1%). Nearly half of all ED visits occurred within the 2 weeks immediately after the fracture (46.1%), of which 54.7% of visits were not directly related to the elbow. On multivariate analysis, patients who utilized the ED after initial management of pediatric supracondylar humerus fracture were of greater odds ratio (OR) in decreasing order to have: had a history of ED visits before their initial injury (OR: 2.69), be diabetic (OR: 1.81), had surgical intervention for their fracture (OR:1.58), be obese (OR: 1.57), have asthma (OR:1.55), have Medicaid insurance (OR: 1.29), and be younger (OR: 1.11 per year decrease) (P<0.001 for all). Discussion: In the 90 days after pediatric supracondylar humerus fracture, more than 1 in 10 patients visited the ED. This data highlight the need for close following of such patients after their injury/surgery and suggests risk factors for which patients such quality improvement measures should be focused. Level of Evidence:III.

The Buford complex, defined as a cord-like middle glenohumeral ligament (MGHL) with an absence of the anterosuperior labrum, is the rarest anatomical labral variant of the shoulder and occurs in 1.5% to 6.5% of the general adult population. Misidentifying the Buford complex for a pathological anterosuperior labral tear can result in pain, stiffness, and limited external rotation if accidentally surgically repaired. While the Buford complex was historically thought to be a benign anatomical variant, recent evidence has suggested that patients with a Buford complex may be at a higher risk for sustaining superior labrum anterior-posterior (SLAP) tears compared to those without a Buford complex. In addition, it remains unknown if the Buford complex is a congenital variant or one that pathologically develops from untreated shoulder instability in early childhood. Given these recent findings and their potential implications on management, it is important for surgeons to have a thorough understanding of the Buford complex. The current review aims to describe the anatomy, development, preoperative imaging, technical considerations, and clinical significance of the Buford complex.

PURPOSE:To describe the medial-sided pathoanatomy and ligament injuries in acute MLKIs with medial-sided involvement andlook forassociated injury patterns based upon location of ligamentous injury. METHODS:Patients who underwent treatment for MLKI at two level-1 trauma centers were identified between January 2001 and May 2023. Only cases involvingcomplete disruption of the superficial medial collateral ligament (sMCL) were included. Zone of injury to the sMCL, the posterior oblique ligament (POL), the medial patellofemoral ligament (MPFL), the vastus medialis oblique (VMO) was recorded, as well as demographics,injury details, neurovascular status, and mechanism of injury.Data was summarized usingdescriptive statistics. RESULTS:A total of 92 patientswere included, with a mean age of 37.8 ± 12.7 years. Forty-four (47.8%) patients had a high velocity injury. Within sMCL tears, 39% were proximal avulsions, 29% were midsubstance tears, and 32% were distal avulsions. The medial-sided injury patterns were: 31 (33.7%) isolated sMCL tears, 24 (27.3%) combined sMCL, POL, and MPFL tears, 23 (25%) combined sMCL and MPFL tears, and 11 (12%) combined sMCL and POL tears. Most common location of sMCL injury varied based upon the number of associated medial knee ligaments injured: isolated sMCL (even distribution), sMCL & POL (distal), sMCL-MPFL (proximal), sMCL-POL-MPFL (proximal). CONCLUSION:Medial-sided ligament injuries seen MLKIs were found to occur in four injury patterns ranging from isolated sMCL or combined injury patterns of the adjacent medial structures. Additionally, location of sMCL injury varied based upon the number of medial-sided ligaments injured.

Background Surgical timing after distal radius fracture may impact patient outcome. This retrospective study assessed the timing of surgery after distal radius fracture and predictors of delayed surgery. Materials and Methods Patients who had distal radius fractures were identified from the PearlDiver M161Ortho dataset. Those who went on to have surgery in the subsequent 52 weeks were identified, with immediate surgery designated as occurring in weeks 0 to 2 after fracture and delayed surgery designated as occurring in weeks 3 to 52 after fracture. Demographics of patients with immediate and delayed surgery, including age, sex, comorbidity burden (measured by Elixhauser Comorbidity Index [ECI]), region of the country where surgery was performed, insurance (commercial, Medicare, Medicaid), and smoking status (non-smoker, cannabis, tobacco, both), were assessed and compared by multivariate analyses. Results A total of 90,570 patients undergoing surgery for distal radius fractures were identified, of whom immediate surgery was performed for 76,683 (88.0%) and delayed surgery was performed for 10,887 (12.0%). Independent predictors of delayed surgery included non-clinical factors (Medicaid [vs commercial insurance]: odds ratio [OR], 1.62, P <.0001; and region [vs Midwest]: West, OR, 1.39, P <.0001; Northeast, OR, 1.37, P =.0115; and South, OR, 1.21, P =.0001) as well as clinical factors (smoking tobacco [vs non-smoker]: OR, 1.31, P <.0001; and increased ECI: OR, 1.14 per 2-point increase, P <.0001). Conclusion In a large cohort of patients, 12% of distal radius fracture surgeries occurred outside the 2-week window. These cases were predicted by non-clinical and clinical factors that deserve attention to limit the delay of such surgeries. [ Orthopedics . 202x;4x(x):xx–xx.]

Background:Adolescent idiopathic scoliosis (AIS) surgery typically involves posterior spinal fusion (PSF) using rods contoured by the surgeon, which may be time-consuming and may not reliably restore optimal sagittal alignment. However, pre-contoured patient-specific rods may more optimally restore sagittal spinal alignment. This study evaluates the radiographic outcomes of AIS patients who underwent PSF utilizing surgeon contoured vs. pre-contoured rods. Methods:This is a retrospective cohort study of AIS patients who underwent PSF with either surgeon contoured or pre-contoured rods. Demographics, Lenke classification, fused levels, osteotomies, estimated blood loss (EBL), and surgical time were also obtained via chart review. Coronal curve magnitude, T5-T12 thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), PI-LL mismatch, and T1 pelvic angle (TPA) were obtained pre-operatively, postoperatively and at last follow up. Outcome measures included rate of achievement of postoperative radiographic alignment goals (TK between 20 and 40 degrees, PI-LL mismatch within 10 degrees, and TPA <14 degrees). Predicted post-operative sagittal alignment was also compared with observed measurements. Student's and paired t-tests were performed to determine significant mean differences for continuous variables, and chi-square for categorical variables. Results:No differences were found in demographics, Lenke classification, preop radiographic measurements, fused levels, osteotomies, EBL, and surgical time in the surgeon contoured cohort (n=36; average follow up 11.3 months) and pre-contoured cohort (n=22; average follow up 9.7 months). At last follow up, 95.5% of patients with pre-contoured rods vs. 61.1% of patients with surgeon contoured rods (P=0.004) met TK goal. During assessment of first standing postoperative X-ray, 72.7% of patients with pre-contoured rods vs. 33.3% of patients with surgeon contoured rods met PI-LL mismatch goal (P=0.004). Other radiographic measurements were similar. Artificial intelligence (AI) predicted and observed differences for the pre-contoured group were 3.7 for TK (P=0.005), -7.6 for PI-LL mismatch (P=0.002), and -2.6 for TPA (P=0.11). Conclusions:AI and pre-contoured rods help achieve global sagittal balance with high accuracy and improved kyphosis restoration and PI-LL mismatch than surgeon contoured rods in AIS patients.

BACKGROUND:Following carpal tunnel release (CTR), patients may be indicated for subsequent hand surgery (contralateral CTR and/or trigger finger release [TFR]). While surgeons typically take pride in patient loyalty, the rate of returning to the same hand surgeons has not been previously characterized. METHODS:Patients undergoing CTR were isolated from 2010-2021 PearlDiver M151 dataset. Subsequent CTR or TFR were identified and characterized as being performed by the same or different surgeon, with patient factors associated with changing to a different surgeon determined by multivariable analyses. RESULTS:In total, 1,121,922 CTR patients were identified. Of these, subsequent surgery was identified for 307,385 (27.4%: CTR 289,455 [94.2%] and TFR 17,930 [5.8%]). Of the patients with a subsequent surgery, 257,027 (83.6%) returned to the same surgeon and 50,358 (16.4%) changed surgeons. Multivariable analysis found factors associated with changing surgeon (in order of decreasing odds ration [OR]) to be: TFR as the second procedure (OR 2.98), time between surgeries greater than 2-years (OR 2.30), Elixhauser-Comorbidity Index (OR 1.14 per 2-point increase), and male sex (OR 1.06), with less likely hood of changing for those with Medicare (OR 0.95 relative to commercial insurance) (p<0.001 for each). Pertinent negatives included: age, Medicaid, and having a 90-day adverse event after the index procedure. CONCLUSIONS:Over fifteen percent of patients who required a subsequent CTR or TFR following CTR did not return to the same surgeon. Understanding what factors lead to outmigration of patients form a practice may help direct efforts for patient retention.

Introduction This study evaluates the effectiveness of a comprehensive hip fracture protocol, with a focus on specific readmission reasons. Methods A retrospective cohort study of hip fracture patients aged 60 and older who underwent surgery before (control) and after (intervention) implementation of a comprehensive hip fracture program. Objectives included identifying readmission reasons and rates, time to operating room (TOR), length of stay (LOS), reoperation, and mortality rates. Logistic regression was utilized to determine significance. Results One hundred and sixty-three patients (control) vs. 238 patients (intervention) were identified. The intervention group had higher odds of 90-day readmission for a medical reason (OR = 1.735, p = 0.028). Thirty-three out of forty-two patients (79%) in the control group and 68/78 patients (87%) in the intervention group were readmitted secondary to a medical reason (pulmonary etiology being the most common). Surgical-related readmissions (surgical site infections and dislocations are most common) were lower in the intervention group compared with the control group, with 10/78 patients (13%) and 9/42 patients (21%), respectively. Twenty-four-hour TOR was achieved in 125 patients (52.5%) in the intervention group vs. 70 patients (42.9%) in the control group. LOS was shorter by 1.1 days for the intervention group (p = 0.010). Mortality was lower in the intervention group. Discussion A comprehensive hip fracture protocol can reduce LOS, TOR, mortality rate, and even surgical-related readmissions. Readmission rates are mainly due to medical problems, which may be unavoidable and thus may not be an adequate hip fracture effectiveness metric. Potential areas of improvement and additional study may include closer internal medicine oversight and primary care follow-up after discharge.

Background Total hip arthroplasty (THA) is a common procedure following which postoperative visits are important to optimize outcomes. The associated global billing period includes the 90 postoperative days (or approximately 13 weeks), during which professional billing is included with the surgery itself. The current study assessed clinical practice patterns relative to the global billing period. Methods Using the PearlDiver M91Ortho dataset, the incidence and timing of Evaluation and Management (E&M) codes in the 26 weeks following THA were assessed. The follow-up visits within and beyond the global billing period, and those conducted by surgeons versus non-surgeon advanced practice providers (APPs) were determined. Results 77,843 THAs were identified. Follow-up visits peaked at postoperative weeks 3, 7, and 14. The greatest week-to-week variation in the number of follow-ups was from weeks 13 to 14 immediately following the global billing period (representing a greater than 4-fold increase in visits.) During the first 13 postop weeks, 73.8% of patients were seen by orthopedic surgeons (as opposed to APPs). In the following 13 weeks, a significantly greater percentage of visits were with surgeons (86.8%, p<0.0001). Conclusions Following the THA global billing period, there was marked increase in the number of follow-ups and transition to a greater percentage being performed by the surgeons. These results provide interesting insight into the potential impact of the billing structure on how practice is pursued.

CONTEXT:While healthcare disparities related to race and ethnicity are well reported for non-emergent conditions, the literature on disparities in outcomes of emergent spinal conditions such as cauda equina syndrome (CES) remains sparse. OBJECTIVE:To evaluate racial disparities in complication, mortality, and readmission rates following surgical intervention for CES. METHODS:This retrospective analysis of The Statewide Planning and Research Cooperative System (SPARCS) database demonstrates that among patients surgically treated for CES in New York between 2015 and 2020. Bivariate and multivariate logistic regression analysis was performed to analyze the association of race and outcome variables after controlling for age, sex, comorbidities, length of stay, insurance, and hospital characteristics. RESULTS:Overall, 2,114 patients who underwent lumbar surgery for CES were identified. The study population was comprised of Black patients (177, 8%), White patients (79%, 1680), and Asian patients (257, 12%). Options for surgery included lumbar decompression (821, 38.8%), fusion (746, 35.3%), or both (547, 25.9%). On multivariate analysis, the odds of 30-day mortality were 2.98-fold greater in Black patients than in other patients (P = 0.029). By 180 and 360 days, the odds of mortality were 4.27 and 3.05-fold greater in Black patients than in other patients, respectively (P < 0.001 each). Thirty-day readmissions were 1.87-fold greater in Black patients than others (P = 0.004). No difference in overall complication rate was found between Black patients and all other race groups (P = 0.306). CONCLUSIONS:Black patients surgically treated for CES face significantly higher rates of mortality and readmission than their non-Black counterparts.

Background: 25-hydroxy Vitamin D (25[OH]D) level has been shown to have antimicrobial and wound healing effects in animal models. Low preoperative 25(OH)D has been shown to correlate with surgical site infection (SSI) in thoracolumbar spine surgery. Methods: This study involved 545 patients undergoing thoracolumbar spine surgery from 2012 to 2019 at an academic medical center. We evaluated the serum 25(OH)D level (i.e., adequate level = level 30–60 ng/dL), along with SSI, body mass index, and smoking status. Statistical analysis was done using bivariate analysis with Fisher’s exact, Wilcoxon rank-sum test and multivarible logisitic regression analyses. Results: We included 545 patients in the study, and there were no statistical differences in the average preoperative 25(OH)D between SSI and non-SSI groups. The average 25(OH)D in the non-SSI group was 31.6 ng/dL ± 13.6, and the SSI group was 35.7 ng/dL ± 20.2 ( P = 0.63). Conclusion: SSI rates following thoracolumbar spine surgery were not affected by preoperative 25(OH)D levels.

BACKGROUND:This study compared trends in use, predictive factors, and reimbursement of endoscopic carpal tunnel release (ECTR) withthose of open carpal tunnel release (OCTR) from 2010 to 2021 using a national administrative database. METHODS:ECTR and OCTR patients were identified in the PearlDiver M151Ortho data set. Numeric and proportional utilization of these procedures was characterized for each year of study. Multivariate analysis was conducted to identify predictive factors for having ECTR performed. The average 90-day reimbursement of ECTR and OCTR was determined. RESULTS:From 2010 through 2021, 441,023 ECTR and 1,767,820 OCTR procedures were identified. The proportional use of ECTR compared with OCTR rose from 2010 (15.7% of procedures) to 2021 (26.1%). Independent predictors of having ECTR performed rather than OCTR included geographic variation (compared with having surgery in the Midwest, Northeast odds ratio [OR], 1.53; West OR, 1.62; and South OR, 1.66), having Medicare or commercial insurance (compared with commercial, Medicare OR, 0.94, and Medicaid OR, 0.69), female sex, and fewer comorbidities. The average 90-day reimbursement for ECTR was $3,114.82, compared with $3,087.62 for OCTR. DISCUSSION:As of 2021, over one-fourth of carpal tunnel releases are done endoscopically. Several factors independently predict whether patients receive ECTR or OCTR.

Background: Tibial tubercle osteotomy (TTO) is a commonly utilized surgery in the treatment of patellofemoral instability and chondrosis. A number of case series studies have reported on the mid- and long-term outcomes with varying complication rates. Purpose: To report the incidence of major complications after TTO and the rate of progression of knee osteoarthritis at midterm follow-up. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent primary TTO between January 1, 2010 and December 31, 2015, and who had ≥5 years of clinical follow-up data were included. Patient demographics and clinical and radiographic outcomes were recorded. Risk factors for complications were identified using multivariate logistic regression analysis. Results: A total of 72 patients were included. The mean follow-up period was 104.8 months (range, 67-138 months). The overall complication rate was 38.9% (28/72 patients), and the incidence of major complications was 6.9%. Univariate logistic regression analysis revealed that patients with a history of smoking were more likely to experience a complication (odds ratio = 4.33 [95% CI, 1.29-14.53]; P = .02). Multivariate analysis with TTO as the main predictor indicated that complication rates were not affected by TTO procedure (TTO vs TTO+other), number of screws, or distalization. There was also no difference between anteromedialization and medialization TTO techniques. The rate of patients with Kellgren-Lawrence grade 3 to 4 increased from 12.0% preoperatively to 23.9% at the final follow-up. New osteophyte formation was detected in 5.8% of patients on anteroposterior radiographs and in 9.1% of patients on lateral radiographs. Conclusion: In the current study, TTO was found to have a major complication rate of 6.9% at midterm follow-up. Smoking was a risk factor for major complications. Only 11.9% of patients had progression in tibiofemoral osteoarthritis at midterm follow-up.

Posterior scoliosis fusion (PSF) for adolescent idiopathic scoliosis (AIS) is considered a highly successful surgery with excellent outcomes. However, especially as many patients “graduate” from their pediatric surgeons, there is the need to quantify the long-term outcomes of such surgeries. The 2010–2022 Pearldiver M161 dataset was queried for those who were 10 to 18 years old with AIS undergoing PSF with at least 10 years follow-up. Patient characteristics were abstracted. Reoperations were identified based on coding for any subsequent thoracic/lumbar surgery/revision. The 10-year reoperation rate and reasons for reoperation were determined, and multivariate regression was performed to determine risk factors. In total, 3,373 AIS PSF patients were identified. Of the study cohort, 324 (9.6

Performing laminectomies in patients with achondroplasia—a common skeletal dysplasia—can present unique challenges. There are a limited number of studies that have reported on the adverse effects of laminectomies in patients with achondroplasia. To compare the 90-day postoperative adverse events following laminectomy in patients with and without achondroplasia. Retrospective cohort study using the 2010–2020 PearlDiver Mariner 91 administrative database was used to identify patients who underwent thoracic, thoracolumbar, or lumbar laminectomy. Patients with achondroplasia were matched 1:4 to patients without achondroplasia based on age, sex, insurance, and ECI. Univariate and multivariate logistic regression analyses assessed and compared 90-day adverse events. Odds ratios (OR), 95

Purpose:To identify the mean morphine milligram equivalent (MME) opioid prescriptions for opioid-naïve patients undergoing isolated anterior cruciate ligament reconstruction (ACLR) between 4 weeks before surgery and the first 90 days after surgery and to describe opioid prescriptions filled per patient and mean MMEs per year within 90 days following ACLR.Methods:Exclusion criteria were patients having concurrent other cruciate or collateral ligament repair or reconstruction, meniscus procedures (repair and debridement), any cartilage procedure, lower-extremity osteotomy, or knee procedures for fracture, infection, or neoplasms; patients with substance use disorder or chronic pain also were excluded. Opioid use between 4 weeks before surgery and the first 90 days after surgery was recorded. Prescribing physician specialty also was tracked. The correlation of patient factors and prescriber specialty of MME were compared using the Student's t-test. Significance was defined at P < .05.Results:Opioid-naïve patients undergoing isolated ACLR were included. Isolated arthroscopic ACLRs performed between 2010 and Q3 2020 in opioid-naïve patients were identified within the PearlDiver M91 national database. A total of 37,200 patients were identified. Mean MME per patient was 340.9 ± 198.2, with an average MME per day of 59.9. Factors associated with increased opioid use during the 90 days following ACLR were older age (P < .001) and preoperative diagnosis of depression (P < .001). Orthopaedic surgeons were primarily responsible for the number of opioid prescriptions after ACLR (n = 29,326, 73.0%) but 27% (n = 10,797) of prescriptions came from nonorthopaedic surgeon medical providers who prescribed significantly greater MMEs of opioids than orthopaedic surgeons (456.5 vs 339.2, P < .001) per patient. Lastly, decreasing yearly opioid prescriptions per patient (2.4 to 1.6 prescriptions) and the mean MME per patient (428.4 to 257.1) occurred from 2010 to 2020.Conclusions:Older age and preoperative diagnosis of depression are associated with greater opioid doses after ACLR. In addition, the vast majority of opioid prescriptions are written by orthopaedic surgeons on the day of ACLR and decreased considerably by four weeks after surgery. Patients receiving opioid prescriptions by nonorthopaedic surgeon medical providers receive significantly greater doses.Level of Evidence:Level IV, retrospective cohort study.

Study Design. Retrospective database evaluation. Objectives. To study the association between race, health care insurance, mortality, postoperative visits, and reoperation within a hospital setting in patients with cauda equina syndrome (CES) undergoing surgical intervention. Summary of Background Data. CES can lead to permanent neurological deficits if the diagnosis is missed or delayed. Evidence of racial or insurance disparities in CES is sparse. Materials and Methods. Patients with CES undergoing surgery from 2000 to 2021 were identified from the Premier Health care Database. Six-month postoperative visits and 12-month reoperations within the hospital were compared by race (i.e., White, Black, or Other [Asian, Hispanic, or other]) and insurance (i.e., Commercial, Medicaid, Medicare, or Other) using Cox proportional hazard regressions; covariates were used in the regression models to control for confounding. Likelihood ratio tests were used to compare model fit. Results. Among 25,024 patients, most were White (76.3%), followed by Other race (15.4% [ 8.8% Asian, 7.3% Hispanic, and 83.9% other]) and Black (8.3%). Models with race and insurance combined provided the best fit for estimating the risk of visits to any setting of care and reoperations. White Medicaid patients had the strongest association with a higher risk of 6-month visits to any setting of care versus White patients with commercial insurance (HR: 1.36 (1.26,1.47)). Being Black with Medicare had a strong association with a higher risk of 12-month reoperations versus White commercial patients (HR: 1.43 (1.10,1.85)). Having Medicaid versus Commercial insurance was strongly associated with a higher risk of complication-related (HR: 1.36 (1.21, 1.52)) and ER visits (HR: 2.26 (2.02,2.51)). Medicaid had a significantly higher risk of mortality compared with Commercial patients (HR: 3.19 (1.41,7.20)). Conclusions. Visits to any setting of care, complication-related, ER visits, reoperation, or mortality within the hospital setting after CES surgical treatment varied by race and insurance. Insurance type had a stronger association with the outcomes than race. Level of Evidence. Level—III

Background:Surgical techniques and associated outcomes in treating acute and chronic extra-articular ligament knee injuries are in evolution, and there is question as to whether repair or reconstruction is optimal. Purpose/Hypothesis:The purpose of this study was to compare the subsequent surgery rate between surgical repair versus reconstruction for all extra-articular ligament injuries of the knee utilizing a large database. Our hypothesis was that overall surgical repair of both lateral and medial extra-articular knee injuries would have a higher revision rate than those treated by reconstruction. Study Design:Cohort study; Level of evidence, 3. Methods:The PearlDiver Mariner data set (2010-2019), with 122 million patients, was utilized to generate 2 patient cohorts: those who underwent surgical repair and those who underwent surgical reconstruction of a knee extra-articular ligament injury. All patients had a minimum of 2 years follow-up. Rates of concomitant or subsequent cruciate ligament reconstruction and rates of secondary procedures were assessed and compared between the 2 cohorts. Results:In total, 3563 patients were identified: extra-articular ligament reconstruction was performed for 2405 (67.5%), and repair was performed for 1158 (32.5%). Cruciate ligament reconstruction was performed for 986 (27.7%), of which 888 of 986 (90.1%) were performed on the same day as their extra-articular ligament procedure. At 2-year follow-up, the reconstruction cohort had higher rates of revision surgery compared with the repair cohort (8.2% vs 2.5%; P < .001). Conclusion:Using a large national database, knee extra-articular ligamentous reconstructions (those on both the lateral and the medial side) had a 3.3 times higher rate of revision surgery compared with repair at 2-year follow-up. Further study is needed to investigate the causes leading to revision surgery and to determine the optimal surgical treatment for both medial and lateral extra-articular knee ligament injuries.

Background: Total knee arthroplasty (TKA) is a common procedure for late-stage degenerative changes, a situation for which magnetic resonance imaging (MRI) is typically not considered useful. In an era attempting to contain healthcare expenditures, the rate, timing, and predictors for MRI before TKA were assessed in a large, national, administrative data set. Methods: The 2010 to Q3 2020 MKnee PearlDiver data set was used to identify patients undergoing TKA for osteoarthritis. Those with lower extremity MRI for knee indications within 1 year before TKA were then defined. Patient age, sex, Elixhauser Comorbidity Index, region in the country, and insurance plan were characterized. Predictors of having had an MRI were assessed by univariate and multivariate analyses. The costs and timing of the obtained MRIs were also assessed. Results: Of 731,066 TKAs, MRI was obtained within 1 year prior for 56,180 (7.68%) with 28,963 (51.9%) within the 3 months of TKA. Independent predictors of having had an MRI included younger age (odds ratio [OR], 0.74 per decade increase), female sex (OR, 1.10), higher Elixhauser Comorbidity Index (OR, 1.15), region of the country (relative to South, Northeast OR, 1.08, West OR, 1.22, Midwest OR, 1.36), and insurance (relative to Medicare, Medicaid OR, 1.36 and Commercial OR, 1.35) with P < 0.0001 for each. The total cost of MRIs among patients who received a TKA is $44,686,308. Conclusion: Noting that TKA is typically done for advanced degenerative changes, MRI should rarely be indicated in the preoperative period for this procedure. Nonetheless, this study found that MRI was done within the year before TKA for 7.68% of the study cohort. In an era striving for evidence-based medicine, the almost $45 million dollars spent on MRI in the year before TKA may represent overutilization.

Objective To determine if posteromedial tibial plateau (PMTP) bone bruising on pre-operative MRI is significantly associated with a ramp lesion identified during arthroscopy in patients with concomitant ACL ruptures. Methods PubMed, CINAHL, Scopus, Web of Sciences, EMBASE, and Cochrane Library were searched systematically for studies that investigated the association between PMTP bone bruises on preoperative MRI and ramp lesions confirmed during arthroscopy. Eight studies met inclusion criteria. The Methodological Index for Nonrandomized Studies (MINORS) checklist was used to assess quality. A meta-analysis was performed to analyze odds of a ramp lesion after PMTP bone bruising identified on magnetic resonance imaging (MRI). Publication bias was assessed by funnel plot and Egger's linear regression test. Results There are 2.05 greater odds of medial meniscal ramp lesions in patients with an ACL rupture when PMTP bone bruising is found on preoperative MRI (95% CI, 1.29-3.25; p = 0.002). Heterogeneity of the pooled studies may be substantial (I-2 = 65%; p = 0.006). Funnel plot analysis and Egger's linear regression test (p > 0.5) determined no publication bias among the studies included in the meta-analysis. Conclusion Patients with acute ACL injuries and PMTP bone bruising on MRI have 2.05 times greater odds of a concomitant medial meniscal ramp lesion than those without this bone bruise pattern.

BACKGROUND CONTEXT: Morbid obesity (MO) has been associated with increased risk of adverse events following procedures such as posterior lumbar fusion (PLF). While preemptive bariatric surgery (BS) has been considered for those with MO (body mass index [BMI] >= 35 kg/m(2)), not all undergoing such intervention have significant weight loss, and the impact of BS has been shown to correlate with weight loss after different related procedures.PURPOSE: To examine outcomes following isolated single level PLF among patients with history of BS who subsequently did and did not transition out of the morbidly obese category.STUDY DESIGN/SETTING: Retrospective case-control study. PATIENT SAMPLE: The PearlDiver 2010-Q1 2020 MSpine database was used to identify adult patients undergoing elective isolated PLF. Patients were excluded if they had a history of infection, neoplasm, or trauma in the 90-days prior to their PLF and if they were not active in the database for at least 90 days following their surgery.Three sub-cohorts were defined: 1) MO controls without a history of BS (-BS+MO), 2) patients with prior BS procedure who remained MO (+BS+MO), and 3) patients with prior BS who were no longer MO at the time of PLF (+BS-MO). Matched 1:1:1 populations were created for these three sub-cohorts based on age, sex and Elixhauser Comorbidity Index (ECI).OUTCOME MEASURES: Ninety-day adverse events and readmission rates were assessed and compared between the three sub-cohorts (-BS+MO, +BS+MO, +BS-MO).METHODS: Univariable analyses and multivariable logistic regression were performed on the matched population to compare 90-day adverse events and readmission rates controlling for age, sex, and ECI.RESULTS: The current study identified PLF patients who were MO at the time of surgery but did not have a history of BS (-BS+MO, n=34,236), those who had BS and remained MO (+BS+MO, n=564), and those who had MS and were no longer MO (+BS-MO, n=209 which was only 27% of those who had BS).On multivariable analysis of the matched populations, those that had BS but remained MO (+BS +MO) were not at reduced odds of 90-day adverse events. However, those that had BS and were no longer MO (+BS-MO) were at reduced odds of 90-day any, severe, and minor adverse events (OR 0.41, 0.51, and 0.37, respectively with p<0.05 for all).CONCLUSIONS: Only 27% of those with a history of BS prior to PLF transitioned out of the MO category. Compared to those who were morbidly obese without BS, those who had BS were only at reduced risk of 90-day adverse events if they actually lost weight sufficient to drop out of morbidly obesity. These findings should be taken into account when counseling patients and interpreting prior studies.(c) 2023 Elsevier Inc. All rights reserved.