Improved Outcomes After Reinforced Radial Meniscus Repair Augmented With Bone Marrow Aspirate Concentrate.

Purpose: To assess clinical outcomes of patients who have undergone surgical repair of radial meniscal tears with reinforced suture bar (rebar) technique augmented with bone marrow aspirate concentrate. Methods: This is a retrospective study of a single fellowship-trained sports medicine surgeon's experience on all patients who underwent a reinforced repair (rebar) of a radial meniscus tear from November 2016 to 2018, with a minimum of 12-month follow-up. Lysholm scores, IKDC (International Knee Documentation Committee) Subjective Knee Form scores, and Tegner scale were collected postoperatively at periods for at least 1 year and retrospectively studied. Results: Patients were followed for an average of 36.3 ± 25.0 months [range: 12.0-69.0 months]. Pain scores improved from 6.1 ± 2.1 to 0.4 ± 1.4 at 1 year (P < .001). IKDC Subjective Knee Form scores improved from 63 ± 26 to 90 ± 13 (P = .021). Lysholm scores improved from 64 ± 28 to 94 ± 9 (P = .025). Based on a calculated minimal clinical important difference (MCID) of 1.5, 100% of patients had improvement above the MCID. In addition, 88% of patients had a 1-year IKDC Subjective Knee Form score above the patient acceptable symptomatic state. Preoperative Tegner activity scale improved from 3 ± 1.5 to 8 ± 2.6 (P = .007). Patients returned to their preinjury activity with little difference in the Tegner activity scale when we compared preinjury and 1-year postoperative (8.1 ± 1.3 vs 8.0 ± 2.6 respectively, P = .317). Conclusions: The rebar repair technique for radial meniscus tears, with bone marrow aspirate concentrate augmentation, showed improved outcomes in both pain and function at minimum follow-up of 12 months. Patients were able to return to a high preinjury activity level by 1 year, and 100% of patients had improvement above the MCID and 88% met patient acceptable symptomatic state. Level of Evidence: Level IV, therapeutic case series.

Compressibility of Osteochondral Autograft Transfer Donor Grafts: A Comparison of Different Donor Regions and How Much Shortening Occurs of Plugs After Impaction.

Background: Osteochondral autograft transfer (OAT) is a useful technique for full-thickness cartilage lesions of the distal femur. Various techniques recommend harvesting a plug 2 mm longer than the recipient hole to allow for graft impaction. Grafts with limited compressibility may not sit flush when impacted. Purpose: To compare the compressibility/shortening of OAT donor plug regions from the distal femur of human cadaveric knees after impaction. Study Design: Controlled laboratory study. Methods: A total of 20 cadaveric knees (mean age, 70.3 ± 8.4 years) were divided into 4 donor regions: medial intercondylar (IC) notch, lateral IC notch, medial trochlea, and lateral trochlea. Each region was subdivided into 4 zones: far superior (FSZ), middle superior (MSZ), middle inferior (MIZ), and far inferior (FIZ). A total of 320 grafts (6-mm diameter, 15-mm depth) were extracted, and a custom-built machine was used to strike the graft 5 times using a predetermined energy of 0.11 J. The graft length was measured initially and after each impact. Statistical analysis of the compressibility for each of the 4 regions and all 16 zones was performed utilizing analysis of variance, with post hoc testing using the Fisher's least significant difference. Results: Compression in the lateral IC notch, medial IC notch, medial trochlea, and lateral trochlea was 2.4 ± 1.5, 2.1 ± 0.7, 3.1 ± 2.2, and 2.1 ± 0.6 mm, respectively, with significant differences between the 4 regions (P < .01) and the most compression in the medial trochlea (P < .01). Subgroup analysis showed that the lateral trochlea had higher compressibility for FIZ versus MIZ (P = .02) and the lateral IC notch had higher compressibility for FSZ versus FIZ and MIZ (P < .05 for both). Conclusion: Compressibility varied between OAT donor sites in the distal femur. OAT donor grafts showed the highest compressibility in the medial trochlea (3.1 mm) and lateral IC notch FSZ (3.0 mm). Clinical Relevance: The lateral trochlea, medial IC notch, and the lower zones of the lateral IC notch grafts should not be oversized more than 2 mm in length, as these grafts may not compress adequately.

Improved Radiation Exposure Monitoring of Orthopaedic Residents After Institution of a Personalized Lead Protocol.

Radiation exposure of orthopaedic residents should be accurately monitored to monitor and mitigate risk. The purpose of this study was to determine whether a personalized lead protocol (PLP) with a radiation monitoring officer would improve radiation exposure monitoring of orthopaedic surgery residents. Materials and Methods: This was a retrospective case-control study of 15 orthopaedic surgery residents monitored for radiation exposure during a 2-year period (March 2017 until February 2019). During the first 12-month period (phase 1), residents were given monthly radiation dosimeter badges and instructed to attach them daily to the communal lead aprons hanging outside the operating rooms. During the second 12-month period (phase 2), a PLP (PLP group) was instituted in which residents were given lead aprons embroidered with their individual names. A radiation safety officer was appointed who placed the badges monthly on all lead aprons and collected them at the end of the month, whereas faculty ensured residents wore their personalized lead apron. Data collected included fluoroscopy use time and radiation dosimeter readings during all orthopaedic surgeries in the study period. Results: There were 1,252 orthopaedic surgeries using fluoroscopy during phase 1 in the control group and 1,269 during phase 2 in the PLP group. The total monthly fluoroscopy exposure time for all cases averaged 190 minutes during phase 1 and 169 minutes during phase 2, with no significant difference between the groups (p < 0.45). During phase 1, 73.1% of the dosimeters reported radiation exposure, whereas during phase 2, 88.7% of the dosimeters reported radiation exposure (p < 0.001). During phase 1, the average monthly resident dosimeter exposure reading was 7.26 millirems (mrem) ± 37.07, vs. 19.00 mrem ± 51.16 during phase 2, which was significantly higher (p < 0.036). Conclusions: Institution of a PLP increased the compliance and exposure readings of radiation dosimeter badges for orthopaedic surgery residents, whereas the actual monthly fluoroscopy time did not change. Teaching hospitals should consider implementing a PLP to more accurately monitor exposure. Level of Evidence: 3.

Ideal Donor Site for Osteochondral Autografting of the Distal Femur Using Radius of Curvature: A 3-Dimensional High-Resolution Scanner Comparison.

OBJECTIVE: To compare radius of curvature (RoC) of distal femur osteochondral autograft transfer (OAT) donor sites from the intercondylar notch and trochlear ridge with recipient sites on the distal and posterior condyles and evaluate differences between recipient sites. DESIGN: Nineteen cadaveric femurs were scanned with a 3-dimensional high-resolution sensor. Donor regions included the lateral (LTR) and medial trochlear ridges (MTR), and the lateral (LICN) and medial intercondylar notch (MICN). Recipient regions analyzed were the distal medial (DMFC), posterior medial (PMFC), distal lateral (DLFC), and posterior lateral femur condyle (PLFC). Six-millimeter OAT grafts were simulated, and average RoC of all regions was compared using an analysis of variance. Post hoc testing was performed using Fisher's least significant difference. RESULTS: We found no significant differences in RoC of the LICN compared with all 4 recipient sites (P = 0.19, 0.97, 0.11, and 0.75 for DLFC, PLFC, DMFC, and PMFC, respectively) or the LTR and MTR to the posterior condyles (LTR vs. PLFC and PMFC; P = 0.72, 0.47, MTR vs. PLFC and PMFC P = 0.39, 0.22, respectively). Significant differences were found for RoC of the MICN compared with each recipient site (P < 0.001) and between distal and posterior femoral condyles (DLFC vs. PLFC, P = 0.016; DMFC vs. PMFC, P = 0.023). CONCLUSION: The LICN is the ideal donor option for all recipient sites on the femoral condyles with respect to RoC of 6-mm OAT plugs. The MTR and LTR were acceptable donor sources for the posterior condyles, while the MICN was a poor match for all recipient sites. Additionally, the distal femur condyle and posterior femur condyle have different RoCs.

Noise contribution to the correlation between temperature-induced localized reflectance of diabetic skin and blood glucose.

We used the effect of temperature on the localized reflectance of human skin to assess the role of noise sources on the correlation between temperature-induced fractional change in optical density of human skin (DeltaOD(T)) and blood glucose concentration [BG]. Two temperature-controlled optical probes at 30 degrees C contacted the skin, one was then cooled by -10 degrees C; the other was heated by +10 degrees C. DeltaOD(T) upon cooling or heating was correlated with capillary [BG] of diabetic volunteers over a period of three days. Calibration models in the first two days were used to predict [BG] in the third day. We examined the conditions where the correlation coefficient (R2) for predicting [BG] in a third day ranked higher than R2 values resulting from fitting permutations of randomized [BG] to the same DeltaOD(T) values. It was possible to establish a four-term linear regression correlation between DeltaOD(T) upon cooling and [BG] with a correlation coefficient higher than that of an established noise threshold in diabetic patients that were mostly females with less than 20 years of diabetes duration. The ability to predict [BG] values with a correlation coefficient above biological and body-interface noise varied between the cases of cooling and heating.

Moisture vapor transport channels for the improved attachment of a medical device to the human body.

Attachment of a small, medical device to the human body for an extended period of time in an ambulatory setting requires the careful consideration of the physical form of the device and the physiological constraints limiting the time a device will stay on the skin. Factors such as the size of the device, the area of the device available for attachment to the skin, and the occlusive nature of the materials in the device are likely to affect adhesion. Here, plastic acrylic disks, 25 mm in diameter, containing a crisscross pattern of air-filled channels were tested on the forearm and abdomen using a moderately aggressive, unsupported, pressure-sensitive transfer adhesive in a pilot human clinical study. After vigorous exercise, droplets of moisture were observed in the channels followed by evaporation of the droplets over time. Disks without channels remained attached to the skin for about a day and a half, while disks containing 450 microm deep channels remained on the skin about three times longer. Little difference was found when the channel-to-channel spacing was increased from 1.3 to 1.6 mm, however 230 microm deep channels were less effective than 450 microm deep channels. Overall, the moisture vapor transport channels appear capable of reducing the moisture content of the outermost stratum corneum layer of the skin, increasing the strength of the stratum corneum, and increasing the time a device remains attached to the skin. The median trial-to-trial relative standard deviation of 45% observed in the pilot study can be used to design appropriately powered studies for the comparison of different device designs.

Temperature modulation of the visible and near infrared absorption and scattering coefficients of human skin.

We determine temperature effect on the absorption and reduced scattering coefficients (mu(a) and mu(s)(')) of human forearm skin. Optical and thermal simulation data suggest that mu( a) and mu(s)(') are determined within a temperature-controlled depth of approximately 2 mm. Cutaneous mu(s)(') change linearly with temperature. Change in mu(a) was complex and irreversible above body normal temperatures. Light penetration depth (delta) in skin increased on cooling, with considerable person-to-person variations. We attribute the effect of temperature on mu(s)(') to change in refractive index mismatch, and its effect on mu(a) to perfusion changes. The reversible temperature effect on mu (s)(' ) was maintained during more than 90 min. contact between skin and the measuring probe, where temperature was modulated between 38 and 22 degrees C for multiple cycles While temperature modulated mu(s)(' ) instantaneously and reversibly, mu(a) exhibited slower response time and consistent drift. There was a statistically significant upward drift in mu(a) and a mostly downward drift in mu( s)(') over the contact period. The drift in temperature-induced fractional change in mu(s)(') was less statistically significant than the drift in mu(s)('). Deltamu( s)(') values determined under temperature modulation conditions may have less nonspecific drift than mu(s)(') which may have significance for noninvasive determination of analytes in human tissue.

Effect of the speed of sound in Sensar acrylic lenses on pseudophakic axial length measurements.

PURPOSE: To evaluate adjusting for the change in sound velocity through an intraocular lens (IOL) to determine axial length measurements in pseudophakic eyes. SETTING: Allergan, Inc., Irvine, California, USA. METHODS: The effect of sound velocity through the Sensar (Allergan) acrylic IOL was evaluated using a previously published methodology. RESULTS: The analysis yielded the correction factors for pseudophakic axial length measurements for Sensar acrylic and SLM-2 silicone (Allergan) IOLs. CONCLUSION: The sound speed for the Sensar acrylic IOL differs significantly from that of PMMA and various silicone materials. Corrections for material sound speed must be made to obtain correct pseudophakic axial lengths.