Editorial Commentary: At Present, ChatGPT Cannot Be Relied Upon to Answer Patient Questions and Requires Physician Expertise to Interpret Answers for Patients.

ChatGPT is designed to provide accurate and reliable information to the best of its abilities based on the data input and knowledge available. Thus, ChatGPT is being studied as a patient information tool. This artificial intelligence (AI) tool has been shown to frequently provide technically correct information but with limitations. ChatGPT provides different answers to similar questions based on the prompts, and patients may not have expertise in prompting ChatGPT to elicit a best answer. (Prompting large language models has been shown to be a skill that can improve.) Of greater concern, ChatGPT fails to provide sources or references for its answers. At present, ChatGPT cannot be relied upon to address patient questions; in the future, ChatGPT will improve. Today, AI requires physician expertise to interpret AI answers for patients.

Type V superior labrum anterior to posterior repair: a systematic review.

BACKGROUND: The purpose of this study is to systematically review the evidence in the literature to ascertain the functional outcomes, recurrence rates, and subsequent revision rates following type V superior labrum anterior to posterior (SLAP) repair. METHODS: Two independent reviewers performed a literature search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, utilizing the EMBASE, MEDLINE, and the Cochrane Library Databases. Studies were included if they had clinical outcomes on the patients undergoing type V SLAP repair. Statistical analysis was performed using SPSS (IBM, Armonk, NY, USA). A P value of <.05 was considered to be statistically significant. RESULTS: Our review found 13 studies, including 451 shoulders meeting our inclusion criteria. The majority of patients were males (89.3%), with an average age of 25.9 years (range 15-58) and a mean follow-up of 53.8 months. The Rowe score was the most utilized functional outcome score, with a weighted mean of 88.5. Additionally, the mean Constant score was 91.0, the mean American Shoulder and Elbow Surgeons score was 88.3, the mean subjective shoulder value score was 85.5%, and the mean visual analog scale pain score was 1.2. The overall rate of return to play was 84.8%, with 80.2% returning to the same level of play. The overall reoperation rate was 6.1%, with a recurrent dislocation rate of 8.2%. In the studies comparing type V SLAP and isolated Bankart repair, there were statistically insignificant differences in visual analog scale pain scores (mean difference; 0.15, 95% confidence interval, -0.13 to 0.44, I2 = 0%, P = .29) and recurrence rates (risk ratio; 1.38, 95% confidence interval, 0.88-2.15, I2 = 0%, P = .16). CONCLUSION: Arthroscopic repair of type V SLAP tears results in excellent functional outcomes, with high return to play rates in athletes. There are low rates of reoperations and recurrent dislocations. Additionally, in comparison to an isolated Bankart repair, SLAP repair does not increase recurrence rates or postoperative pain.

Bone Marrow Stimulation for Arthroscopic Rotator Cuff Repair: A Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Bone marrow stimulation (BMS) has been proposed to augment healing at the time of arthroscopic rotator cuff repair (ARCR) by creating several bone marrow vents in the footprint of the rotator cuff, allowing mesenchymal stem cells, platelets, and growth factors to cover the area as a "crimson duvet." PURPOSE: To perform a meta-analysis of randomized controlled trials (RCTs) to compare the outcomes after BMS and a control for those undergoing ARCR. STUDY DESIGN: Meta-analysis; Level of evidence, 1. METHODS: A literature search of 3 databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RCTs comparing BMS and a control for ARCR were included. Clinical outcomes were compared, and a P value <.05 was considered to be statistically significant. RESULTS: A total of 7 RCTs with 576 patients were included. Overall, 18.8% of patients treated with BMS and 21.0% of patients treated with a control had a retear (I2 = 43%; P = .61). With BMS, the mean Constant score was 88.2, and with the control, the mean Constant score was 86.7 (P = .12). Additionally, there was no significant difference in the American Shoulder and Elbow Surgeons score (94.3 vs 93.2, respectively; P = .31) or visual analog scale score (0.9 vs 0.9, respectively; P = .89). CONCLUSION: The level 1 evidence in the literature did not support BMS as a modality to improve retear rates or clinical outcomes after ARCR.

Evaluation of information from artificial intelligence on rotator cuff repair surgery.

Purpose: The purpose of this study was to analyze the quality and readability of information regarding rotator cuff repair surgery available using an online AI software. Methods: An open AI model (ChatGPT) was used to answer 24 commonly asked questions from patients on rotator cuff repair. Questions were stratified into one of three categories based on the Rothwell classification system: fact, policy, or value. The answers for each category were evaluated for reliability, quality and readability using The Journal of the American Medical Association Benchmark criteria, DISCERN score, Flesch-Kincaid Reading Ease Score and Grade Level. Results: The Journal of the American Medical Association Benchmark criteria score for all three categories was 0, which is the lowest score indicating no reliable resources cited. The DISCERN score was 51 for fact, 53 for policy, and 55 for value questions, all of which are considered good scores. Across question categories, the reliability portion of the DISCERN score was low, due to a lack of resources. The Flesch-Kincaid Reading Ease Score (and Flesch-Kincaid Grade Level) was 48.3 (10.3) for the fact class, 42.0 (10.9) for the policy class, and 38.4 (11.6) for the value class. Conclusion: The quality of information provided by the open AI chat system was generally high across all question types but had significant shortcomings in reliability due to the absence of source material citations. The DISCERN scores of the AI generated responses matched or exceeded previously published results of studies evaluating the quality of online information about rotator cuff repairs. The responses were U.S. 10th grade or higher reading level which is above the AMA and NIH recommendation of 6th grade reading level for patient materials. The AI software commonly referred the user to seek advice from orthopedic surgeons to improve their chances of a successful outcome.

Outcomes After Revision Arthroscopic Rotator Cuff Repair: A Systematic Review.

BACKGROUND: Arthroscopic rotator cuff repair (ARCR) is one of the most commonly performed orthopaedic procedures; however, it is unclear how to manage patients with symptomatic retears. PURPOSE: To perform a systematic review to evaluate the outcomes of revision ARCR in the literature. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic literature search based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed utilizing the Embase, MEDLINE, and Cochrane Library databases. Eligible for inclusion were clinical studies reporting on revision rotator cuff repair. Clinical outcomes were recorded. RESULTS: The 17 included studies were composed of 888 shoulders in 885 patients. The mean age of the 885 patients was 58.6 ± 9.1 years, with a mean follow-up of 28.1 ± 22.1 months. The mean visual analog scale score was 2.1 ± 1.8, the mean American Shoulder and Elbow Surgeons score was 75.0 ± 18.3, and the mean Constant score was 67.4 ± 16.6. The overall rate of retears after revision was 25.3%, with an 8.0% reoperation rate including 2.7% undergoing reverse shoulder arthroplasty and 2.0% undergoing subsequent rotator cuff repair. Finally, the complication rate was 8.6%. CONCLUSION: Revision ARCR improved patient-reported outcomes, with 92% of patients free from reoperations at a mean follow-up of 2 years. Overall, 78.4% of patients were satisfied at final follow-up; however, the rate of retears was found to be higher than after primary ARCR.

Evaluation High-Quality of Information from ChatGPT (Artificial Intelligence-Large Language Model) Artificial Intelligence on Shoulder Stabilization Surgery.

PURPOSE: To analyze the quality and readability of information regarding shoulder stabilization surgery available using an online AI software (ChatGPT), using standardized scoring systems, as well as to report on the given answers by the AI. METHODS: An open AI model (ChatGPT) was used to answer 23 commonly asked questions from patients on shoulder stabilization surgery. These answers were evaluated for medical accuracy, quality, and readability using The JAMA Benchmark criteria, DISCERN score, Flesch-Kincaid Reading Ease Score (FRES) & Grade Level (FKGL). RESULTS: The JAMA Benchmark criteria score was 0, which is the lowest score, indicating no reliable resources cited. The DISCERN score was 60, which is considered a good score. The areas that open AI model did not achieve full marks were also related to the lack of available source material used to compile the answers, and finally some shortcomings with information not fully supported by the literature. The FRES was 26.2, and the FKGL was considered to be that of a college graduate. CONCLUSIONS: There was generally high quality in the answers given on questions relating to shoulder stabilization surgery, but there was a high reading level required to comprehend the information presented. However, it is unclear where the answers came from with no source material cited. It is important to note that the ChatGPT software repeatedly references the need to discuss these questions with an orthopaedic surgeon and the importance of shared discussion making, as well as compliance with surgeon treatment recommendations. CLINICAL RELEVANCE: As shoulder instability is an injury that predominantly affects younger individuals who may use the Internet for information, this study shows what information patients may be getting online.

Acellular Collagen Matrix Patch Augmentation of Arthroscopic Rotator Cuff Repair Reduces Re-Tear Rates: A Meta-analysis of Randomized Control Trials.

PURPOSE: To perform a meta-analysis of randomized controlled trials (RCTs) to compare the outcomes of arthroscopic rotator cuff repair (ARCR) with and without acellular collagen matrix patch (ACMP) augmentation. METHODS: A literature search of 3 databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RCTs comparing ACMP augmentation and a control for ARCR were included. Clinical outcomes were compared using Revman, and a P value < .05 was considered to be statistically significant. RESULTS: Five RCTs with 307 patients were included. Overall, 11% of patients treated with ACMP augmentation and 34% of patients in the control group had a re-tear (P = .0006). The mean Constant score was 90.1 with ACMP augmentation, and 87.3 in controls (P = .02). Additionally, there was a significant higher American Shoulder and Elbow Surgeons score with ACMP augmentation (87.7 vs 82.1, P = .01). CONCLUSIONS: The RCTs in the literature support the use of ACMP augment as a modality to reduce re-tear rates and improve outcomes after ARCR. LEVEL OF EVIDENCE: Level II, Meta-Analysis of Level II Studies meta-analysis of Level II studies.

Evaluation of Online Artificial Intelligence-Generated Information on Common Hand Procedures.

PURPOSE: The purpose of this study was to analyze the quality and readability of the information generated by an online artificial intelligence (AI) platform regarding 4 common hand surgeries and to compare AI-generated responses to those provided in the informational articles published by the American Society for Surgery of the Hand (ASSH) HandCare website. METHODS: An open AI model (ChatGPT) was used to answer questions commonly asked by patients on 4 common hand surgeries (carpal tunnel release, cubital tunnel release, trigger finger release, and distal radius fracture fixation). These answers were evaluated for medical accuracy, quality and readability and compared to answers derived from the ASSH HandCare materials. RESULTS: For the AI model, the Journal of the American Medical Association benchmark criteria score was 0/4, and the DISCERN score was 58 (considered good). The areas in which the AI model lost points were primarily related to the lack of attribution, reliability and currency of the source material. For AI responses, the mean Flesch Kinkaid Reading Ease score was 15, and the Flesch Kinkaid Grade Level was 34, which is considered to be college level. For comparison, ASSH HandCare materials scored 3/4 on the Journal of the American Medical Association Benchmark, 71 on DISCERN (excellent), 9 on Flesch Kinkaid Grade Level, and 60 on Flesch Kinkaid Reading Ease score (eighth/ninth grade level). CONCLUSION: An AI language model (ChatGPT) provided generally high-quality answers to frequently asked questions relating to the common hand procedures queried, but it is unclear when or where these answers came from without citations to source material. Furthermore, a high reading level was required to comprehend the information presented. The AI software repeatedly referenced the need to discuss these questions with a surgeon, the importance of shared decision-making and individualized care, and compliance with surgeon treatment recommendations. CLINICAL RELEVANCE: As novel AI applications become increasingly mainstream, hand surgeons must understand the limitations and ramifications these technologies have for patient care.

Microdrilling Resulted in Less Subchondral Bone Destruction Than a Traditional Microfracture Awl for Articular Cartilage Defect Bone Marrow Stimulation.

Purpose: The purpose of this study was to compare bone marrow stimulation using micro-computed tomography (micro-CT) analysis of an abrasion arthroplasty technique, drilling k-wire technique, traditional microfacture awl, or a microdrill instrument for subchondral bone defects. Methods: Eleven cadaveric distal femoral specimens were obtained and divided into 3 common areas of osteochondral defect: trochlea and weightbearing portions of the medial and lateral femoral condyles. Each area of interest was then denuded of cartilage using a PoweRasp and divided into quadrants. Each quadrant was assigned either a 1.6 mm Kirschner wire (k-wire), 1.25 mm microfracture awl, 1.5 mm fluted microdrill, PowerPick, or a curette (abrasion arthroplasty) to create 4 channels into the subchondral bone sing the same instrument. Subchondral bone and adjacent tissue areas were then evaluated using micro-CT to analyze adjacent bone destruction and extension into the bone marrow. Results: Overall, there was a significantly decreased area of bone destruction or compression using the microdrill (0.030 mm) as compared to the microfracture awl (0.072 mm) and k-wire (0.062 mm) (P < .05). Within the trochlea and the medial femoral condyle, there was significantly decreased bony compression with the microdrill as compared to the awl and k-wire (P < .05); however, when stratified, this was not significant among the lateral femoral condylar samples (P = .08). Conclusion: Bone marrow stimulation causes bony compression that may negatively impact subchondral bone and trabecular alignment. It is important to understand which tools used for bone marrow stimulation cause the least amount of damage to the subchondral bone. Clinical Relevance: This study demonstrates the decreased subchondral bony defects seen with the microdrill versus the traditional microfracture awl indicating that when performing bone marrow stimulation, the microdrill may be a less harmful tool to the subchondral bone.

Intramedullary nailing vs. open reduction-internal fixation for humeral shaft fractures: a meta-analysis of randomized controlled trials.

BACKGROUND: The purpose of this study was to perform a meta-analysis of randomized controlled trials (RCTs) to compare outcomes following intramedullary nailing (IMN) vs. open reduction-internal fixation (ORIF) for humeral shaft fractures. METHODS: A literature search of 3 databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RCTs comparing IMN and ORIF for humeral shaft fractures were included. Clinical outcomes were compared using RevMan. P < .05 was considered statistically significant. RESULTS: Ten RCTs with 512 patients were included. Overall, 8.4% of patients treated with IMN and 6.4% of patients treated with ORIF had nonunion (P = .57, I2 = 0%), with a significantly faster time to union with IMN (10 weeks vs. 11.9 weeks, P < .05). There was no significant difference in the rate of reoperation (11.6% in IMN group vs. 7.6% in ORIF group, P = .26) or radial nerve palsy (2.8% in IMN group vs. 4.2% in ORIF group, P = .58). A lower rate of infection was noted with IMN (1.2% vs. 5.3%, P < .05). Additionally, there was a lower operative time with IMN (61 minutes vs. 88 minutes, P < .05). CONCLUSIONS: The Level I evidence in the literature does not show a significant difference in rates of union, reoperation, or radial nerve palsy between IMN and ORIF for humeral shaft fractures. Overall, treatment with IMN results in a lower infection rate, less operative time, and a modestly quicker time to union. The optimal treatment strategy for humeral shaft fractures may be best informed by fracture pattern and surgeon preference.

Early clinical and patient-reported outcomes for arthroscopic and mini-open superior capsular reconstruction are similar for irreparable rotator cuff tears.

OBJECTIVES: The purpose of this study was to report and compare postoperative range of motion (ROM), patient-reported outcomes, and failure rates following superior capsular reconstruction (SCR) and to compare outcomes between arthroscopic and mini-open techniques. METHODS: All SCR procedures utilising dermal allograft with a minimum of 6 months of follow-up at multiple institutions between November 2015 and October 2019 were retrospectively reviewed. Preoperative patient demographics, imaging measurements, surgical technique (arthroscopic versus mini-open), and outcomes including pain scores, conversion to reverse shoulder arthroplasty, subsequent surgery, and postoperative ROM were recorded. Outcomes for arthroscopic versus mini-open approaches were compared via t-test, Fisher's exact test, or chi square test, as appropriate, with differences of p â€‹< â€‹0.05 considered significant. RESULTS: 180 total patients were included, including 98 who underwent arthroscopic SCR and 82 who underwent mini-open SCR. Final follow-up was at a mean of 32 months (standard deviation = 11 months). SCR improved pain (visual analog scale â€‹= â€‹4.4 pre-operatively vs. 1.4 post-operatively, p â€‹< â€‹0.0001) and ROMin active forward flexion (136° pre-operatively vs. 150° post-operatively, p â€‹= â€‹0.0012). No difference in post-operative pain visual analog scores was found between mini-open and arthroscopic cohorts (1.3 vs. 1.6, p â€‹= â€‹0.3432) at a mean of 14 months post-operatively. At a mean of 32 months post-operatively, there were no differences in ASES, QuickDASH, SST, WORC, or SANE scores between open and arthroscopic cohorts. There was no difference in rates of failure between mini-open and arthroscopic cohorts (15.9% vs. 17.3%, p â€‹= â€‹0.789). CONCLUSIONS: This study confirmed that SCR improves pain and ROM in the short term. Mini-open SCR appears to provide similar improvements in pain and ROM compared with arthroscopic SCR, as well as patient-reported outcomes at 3 years. No difference in failure rates was detected between the 2 procedures. LEVEL OF EVIDENCE: Level 3 evidence.

Metal Hypersensitivity Following Total Ankle Arthroplasty: Case Series and Literature Review.

Metal hypersensitivity following total ankle arthroplasty (TAA) is an underreported complication that can manifest as dermal, systematic, and orthopaedic-specific symptoms. It is critical to recognize that metal hypersensitivity is a diagnosis of exclusion; only after all other potential sources of failure, such as loosening or infection are ruled out, can this diagnosis be considered. Aside from imaging and common laboratory analysis, skin patch testing, leukocyte migration inhibition test (LMIT), and lymphocyte transformation test (LTT) are the testing options available for metal allergy. With regards to management of metal hypersensitivity, nonoperative modalities involving topical dermatological management are generally preferred. Severe cases of metal allergy may necessitate operative management consisting of explantation of the implant and either revision TAA with a custom hypoallergenic implant or conversion to an ankle fusion. We present 3 cases of presumed metal hypersensitivity following TAA. In all 3 cases, other forms of TAA failure were carefully ruled out. One patient underwent explantation and conversion to hypoallergenic implant, 1 patient underwent explantation and ankle arthrodesis with hypoallergenic hardware, and 1 patient elected for conservative care. In patients who underwent explantation and conversion to hypoallergenic hardware, no further symptoms associated with metal allergy were noted. Additional research is necessary to improve diagnostic accuracy of metal allergy and make treatment options more effective and accessible.Level of Evidence: Retrospective case series, IV.

Operative Versus Nonoperative Treatment of Acute Achilles Tendon Rupture: A Propensity Score-Matched Analysis of a Large National Dataset.

Background: No consensus exists regarding the superiority of operative versus nonoperative management for Achilles tendon ruptures, as multiple randomized controlled trials conducted since the advent of early mobilization protocols have found outcomes for these 2 interventions to be more similar than were previously held. Purpose: To use a large national database to (1) compare reoperation and complication rates between operative and nonoperative treatment of acute Achilles tendon ruptures and (2) evaluate trends in treatment and cost over time. Study Design: Cohort study; Level of evidence, 3. Methods: The MarketScan Commercial Claims and Encounters database was used to identify an unmatched cohort of 31,515 patients who sustained primary Achilles tendon ruptures between 2007 and 2015. Patients were stratified into operative and nonoperative treatment groups, and a propensity score-a matching algorithm-was used to establish a matched cohort of 17,996 patients (n = 8993 per treatment group). Reoperation rates, complications, and aggregate treatment costs were compared between groups with an alpha level of .05. A number needed to harm (NNH) was calculated from the absolute risk difference in complications between cohorts. Results: The operative cohort experienced a significantly larger total number of complications within 30 days of injury (1026 vs 917; P = .0088). The absolute increase in cumulative risk was 1.2% with operative treatment, which resulted in an NNH of 83. Neither 1-year (1.1% [operative] vs 1.3% [nonoperative]; P = .1201) nor 2-year reoperation rates (1.9% [operative] vs 2% [nonoperative]; P = .2810) were significantly different. Operative care was more expensive than nonoperative care at 9 months and 2 years after injury; however, there was no difference in cost between treatments at 5 years. Before matching, the rate of surgical repair for Achilles tendon rupture remained stable, from 69.7% to 71.7% between 2007 and 2015, indicating little change in practice in the United States. Conclusion: Results indicated no differences in reoperation rates between operative and nonoperative management of Achilles tendon ruptures. Operative management was associated with an increased risk of complications and higher initial costs, which dissipated over time. Between 2007 and 2015 the proportion of Achilles tendon ruptures managed operatively remained similar despite increasing evidence that nonoperative management of Achilles tendon rupture may provide equivalent outcomes.

Auto-segmentation of the tibia and femur from knee MR images via deep learning and its application to cartilage strain and recovery.

The ability to efficiently and reproducibly generate subject-specific 3D models of bone and soft tissue is important to many areas of musculoskeletal research. However, methodologies requiring such models have largely been limited by lengthy manual segmentation times. Recently, machine learning, and more specifically, convolutional neural networks, have shown potential to alleviate this bottleneck in research throughput. Thus, the purpose of this work was to develop a modified version of the convolutional neural network architecture U-Net to automate segmentation of the tibia and femur from double echo steady state knee magnetic resonance (MR) images. Our model was trained on a dataset of over 4,000 MR images from 34 subjects, segmented by three experienced researchers, and reviewed by a musculoskeletal radiologist. For our validation and testing sets, we achieved dice coefficients of 0.985 and 0.984, respectively. As further testing, we applied our trained model to a prior study of tibial cartilage strain and recovery. In this analysis, across all subjects, there were no statistically significant differences in cartilage strain between the machine learning and ground truth bone models, with a mean difference of 0.2 ± 0.7 % (mean ± 95 % confidence interval). This difference is within the measurement resolution of previous cartilage strain studies from our lab using manual segmentation. In summary, we successfully trained, validated, and tested a machine learning model capable of segmenting MR images of the knee, achieving results that are comparable to trained human segmenters.

Direct versus indirect posterior malleolar fixation in the treatment of trimalleolar ankle fractures: Is there a difference in outcomes?

Purpose: The purpose of this study was to examine the differences in functional outcomes between direct and indirect surgical fixation methods of the posterior malleolus in the setting of trimalleolar fractures and identify any variables affecting patient outcomes. Methods: Primary outcomes were evaluated by PROMIS scores for short-term outcomes regarding total pain (TP) and total function (TF) comparing 40 patients with direct fixation with 77 with indirect fixation. Continuous variables were analyzed using t tests for parametric variables and the Mann-Whitney U test for nonparametric variables. Categorical variables were analyzed using a χ2 test. Univariate and multivariate linear regression models were performed to analyze factors that affect outcomes of TP and TF. Results: There was no difference in TP or TF between groups (P = 0.65 vs. P = 0.19). On univariate linear regression for TP, BMI, incidence of complication, tobacco use, and open injury showed significance in increasing pain levels with open injuries providing the greatest effect (coef = 11.8). On multivariate analysis, BMI, incidence of complication, open injury, and tourniquet time all significantly increased pain. For TF, univariate analysis showed age, BMI, incidence of complication, and diabetes to decrease function, and use of external fixator and tourniquet time increased function. In the multivariate model, increased BMI, open injuries, and increasing tourniquet time all decreased TF while use of an external fixator increased TF. Conclusion: This study showed no difference in TP and TF using the PROMIS outcome scores when comparing direct fixation versus indirect fixation under univariate and multivariate models. Level of Evidence: Therapeutic III.

Erratum to 'Corynebacterium Total Hip and Knee Arthroplasy Prosthetic Joint Infections' [Arthroplasty Today 6 (2020) 163-168].

[This corrects the article DOI: 10.1016/j.artd.2020.03.008.].

Patient Factors Associated With Increased Risk for Complications After the Latarjet Procedure.

BACKGROUND: The open Latarjet has become the most common method of addressing significant glenoid bone loss in patients with recurrent glenohumeral instability. PURPOSE: To describe national trends in Latarjet procedures and risk factors for complications associated with this procedure. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Eligible patients were identified through the National Surgical Quality Improvement Program (NSQIP) data set over the years 2014 to 2018 by using the Current Procedural Terminology (CPT) code for "capsulorrhaphy anterior with coracoid process transfer" (CPT 23462). Patient and surgical outcome variables were extracted and analyzed from the NSQIP database. Logistic regression analysis and odds ratios (ORs) were performed to evaluate the relative risk of complications. RESULTS: The authors identified 458 patients (399 men and 59 women) from the data set. The mean body mass index was 27.4 kg/m2, and mean operative time was 130.2 minutes. Statistically significant variables included smoking status and sex, which were further stratified. Smokers were 2.19 times more likely to experience at least 1 adverse outcome, including deep vein thrombosis (DVT), pulmonary embolism, reoperation, wound infection, unplanned readmission, or readmission (95% CI, 0.62-7.82). Specifically, smokers were 7.8 times more likely to have a DVT (95% CI, 0.58-105.96), 1.4 times more likely to undergo reoperation (95% CI, 0.14-5.73), and 2.4 times more likely to have an unplanned readmission (95% CI, 0.19-28.68). Women were 2.2 times more likely to experience at least 1 adverse outcome. Specifically, women were found to be 6.4 times more likely to have a DVT (95% CI, 0.76-54.87), 4.1 times more likely to have an unplanned readmission (95% CI, 0.00-106.21), and 4.7 times more likely to have a readmission (95% CI, 0.00-13.92). CONCLUSION: The results indicate that smokers and female patients are at a higher risk of experiencing adverse outcomes and may require additional pre- and postprocedural precautions when undergoing the Latarjet procedure. With the increase in frequency, providers should be aware of patient-related factors that may lead to adverse outcomes.

Analysis of Risk Factors, Complications, Reoperations, and Demographics Associated With Open and Arthroscopic Rotator Cuff Repair: An Analysis of a Large National Database.

PURPOSE: To assess the national trends in arthroscopic and open rotator cuff repair surgery and the associated demographics, complications, and risk factors specific to each procedure. METHODS: A retrospective cohort study was performed using the National Surgical Quality Improvement Program (NSQIP) dataset between the years 2007 and 2018. Patients were identified using Common Procedural Terminology codes for open and arthroscopic rotator cuff repair. Variables collected including basic demographics, procedural, and outcome specific variables as available through the NSQIP repository. Appropriate statistical measures were used to compare the groups, with the χ2 test used for categorical variables and t test for continuous variables. RESULTS: The arthroscopic cohort comprised 39,013 patients; the open group consisted of 8,664. Reported arthroscopic and open cases increased significantly between 2007 and 2018 from 135 to 7,269 and 65 to 1,168, respectively. Average operative time for arthroscopic procedure was 89 minutes and 76 minutes for open. The open group consisted of a slightly greater percentage of smokers, 18.3% versus 15.2%, and patients with diabetes, 18.2% versus 15.9%, both of which were statistically significant (P < .001). Open cases had an odds ratio of 3.05 for superficial infections and 7.40 for deep infections, both of which were statistically significant (P < .001). The open cohort also had an odds ratio of 1.71 for unplanned readmissions when compared with the arthroscopic cohort, which was also statistically significant (P < .001). CONCLUSIONS: According to the NSQIP database, the increase in arthroscopic procedures is significantly outpacing the increase in open procedures during this study period, which matches the trends seen in previous studies. Patients with diabetes and who smoke also represent a greater risk group for postoperative complications when undergoing open surgery. These findings suggest that perhaps the decision to pursue one technique over the other may be influenced both by provider preference and patient-related factors. LEVEL OF EVIDENCE: III, retrospective comparative trial.

Effect of walking on in vivo tibiofemoral cartilage strain in ACL-deficient versus intact knees.

Anterior cruciate ligament (ACL) rupture alters knee kinematics and contributes to premature development of osteoarthritis. However, there is limited data regarding the in vivo biomechanical response of tibiofemoral cartilage to activities of daily living (ADLs) in ACL-deficient knees. In this study, eight otherwise healthy participants with chronic unilateral ACL deficiency completed a stress test to assess the effect of 20 min of level treadmill walking at a speed of 2.5 mph on tibiofemoral cartilage in their ACL-deficient and contralateral ACL-intact knees. Three-dimensional surface models developed from pre- and post-activity magnetic resonance (MR) images of the injured and uninjured knees were used to determine compressive strain across multiple regions of tibiofemoral cartilage (medial and lateral tibial plateaus, medial and lateral femoral condyles, medial aspect of femoral condyle adjacent to intercondylar notch of the femur). In the ACL-deficient knees, we observed significantly increased cartilage strain in the region of the medial femoral condyle adjacent to the intercondylar notch (6% in deficient vs. 2% in contralateral, p = 0.01) as well as across the medial and lateral tibial plateaus (4% vs. 3%, p = 0.01) relative to the contralateral ACL-intact knees. Increased compressive strain at the medial intercondylar notch and tibial plateau suggests alterations in mechanical loading or the response to load in these regions, presumably related to altered knee kinematics. These changes may disrupt cartilage homeostasis and contribute to subsequent development of osteoarthritis.