Allograft Anterior Cruciate Ligament Reconstruction Fails at a Greater Rate in Patients Younger Than 34 Years.

Purpose: To characterize the secondary anterior cruciate ligament (ACL) injury rates after primary allograft anterior cruciate ligament reconstruction (ACLR) and to identify the age cut-score at which the risk of allograft failure decreases. Methods: All patients who underwent primary ACLR within a single orthopaedic department between January 2005 and April 2020 were contacted at a minimum of 2 years post-ACLR to complete a survey regarding complications experienced post-surgery, activity level, and perceptions of knee health. Patients were excluded for incidence of previous ACLR (ipsilateral or contralateral) and/or age younger than 14 years. Relative proportions were calculated, binary regression analysis was performed, and receiver operating characteristic analysis was used to identify the threshold age for maximal sensitivity and specificity to predict high risk of allograft failure, defined as undergoing revision ACLR. Results: Of the 939 surveys completed, 398 patients underwent primary allograft ACLR (mean age 39.5 years; range 16.0-66.1 years; 54.3% female). The secondary ACL injury rate was 11.6% (5.8% ipsilateral revision ACLR, 5.8% contralateral ACL injury). Male and female patients had similar revision (5.5% male, 6.0% female, P = .82) and contralateral ACL injury rates (6.6% male, 5.1% female, P = .52). Receiver operating characteristic analysis indicated that age ≤34 years was threshold for differentiating high risk of allograft failure (area under the curve 0.65, 95% confidence interval 0.55-0.76; P = .014). Patients aged ≤34 years had a greater secondary injury rate than patients >34 years (20.4% (10.2% revision ACLR, 10.2% contralateral ACL injury) versus 6.9% (3.5% revision ACLR, 3.5% contralateral ACL injury; P < .001). Binary regression analysis demonstrated that decreasing age was associated with increased risk of graft failure (χ2 = 7.9, P = .02.). Conclusions: Allograft ACLR showed similar failure rates between sexes but displayed suboptimal graft failure outcomes in younger and active patients. By age 34 years, the increased revision risk for younger patients diminished. Level of Evidence: Level IV, therapeutic case series.

Isolated Rectus Femoris Rupture with Ipsilateral Femoroacetabular Impingement in a Collegiate Track Athlete: A Case Report.

Introduction: Quadriceps ruptures, especially isolated rectus femoris ruptures, are uncommon among young and healthy individuals. Case Report: We describe an 18-year-old collegiate sprinter with a rectus femoris tendon rupture who continued to have significant pain and dysfunction despite non-operative management. He was concurrently found to have femoroacetabular impingement and a labrum tear as well. Following an extensive trial of non-operative management, operative fixation of the rectus femoris rupture with Achilles allograft reconstruction was performed in addition to arthroscopic labrum fixation and femoroplasty. Postoperatively, he returned to sport with improved mobility and decreased pain. Conclusion: Surgical rectus femoris tendon reconstruction with Achilles allograft is a valid option for patients who fail conservative treatment.

Long-term outcome success after operative treatment for primary aldosteronism.

BACKGROUND: Primary aldosteronism is a common cause of secondary hypertension. Resolution of hypertension and hypokalemia after adrenalectomy for primary aldosteronism is variable. This study examines preoperative factors for persistent hypertension and long-term outcome after laparoscopic adrenalectomy in patients with primary aldosteronism. METHODS: We reviewed all patients who underwent laparoscopic resection for adrenal tumors from 2010 to 2018. Biochemical success was defined as normalization of hypokalemia and the aldosterone-to-renin ratio. Clinical success was defined as normalization of blood pressure requiring no antihypertensive medications. Descriptive statistics and binary logistic regression analysis were used. RESULTS: Of 202 patients who underwent unilateral laparoscopic adrenalectomy, 37 (18%) had biochemical and clinical confirmation of primary aldosteronism. Postoperatively, biochemical success was attained in all 37 patients with primary aldosteronism. Complete, partial, and absent clinical success was achieved in 41%, 38%, and 21% of patients, respectively. Number of antihypertensives (odds ratio, 2.30 per medication; 95% confidence interval, 1.07-4.93; P < .05), duration of hypertension (odds ratio, 1.11 per year; 95% confidence interval, 1.03-1.25; P < .05), and increased body mass index (odds ratio, 1.13; 95% confidence interval, 1.01-1.29; P < .05) were preoperative factors associated with absent clinical success. CONCLUSION: Biochemical success is more common than clinical resolution of hypertension after adrenalectomy for primary aldosteronism. The number of antihypertensive medications, longstanding hypertension, and high body mass index are preoperative factors associated with absent clinical success.

A Case of Atraumatic Acute Compartment Syndrome: Beware of the Existence of This Orthopaedic Emergency: A Case Report.

CASE: We present a 44-year-old man diagnosed with atraumatic, idiopathic acute compartment syndrome (ACS) of the left lower extremity treated with an emergent single incision fasciotomy with the release of the anterior and lateral compartments. The patient's condition was diagnosed without delay and successfully treated, resulting in a full recovery. CONCLUSION: Immediate diagnosis and emergent surgical treatment of atraumatic ACS is critical in preventing surgical complications and preserving function of the limb. Recognition of this condition existing in the absence of the typical history of an inciting event or underlying predisposition is important to avoid missing the need for emergent surgical intervention.

Impact of Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features on Revised Bethesda System Malignancy Rates at a Single Institution.

BACKGROUND: The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) standardizes thyroid cytopathology reporting in six tier diagnostic categories. In recent years, noninvasive encapsulated follicular variant of papillary thyroid carcinoma was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This study examines the impact of NIFTP on the BSRTC risk of malignancy (ROM). METHODS: This was a retrospective review of prospectively collected data from 565 patients who underwent fine needle aspiration and thyroidectomy at a single institution. ROM for each Bethesda category was analyzed and calculated with NIFTP classified as a malignant and nonmalignant lesion. Absolute and relative differences between ROM were compared. RESULTS: Of 565 patients, 19 were Bethesda I, 159 were Bethesda II, 178 were Bethesda III, 46 were Bethesda IV, 42 were Bethesda V, and 121 were Bethesda VI. ROM differences with NIFTP classified as malignant versus nonmalignant for each class were as follows: Bethesda I, no change; Bethesda II, 18%-14%; Bethesda III, 55%-48%; Bethesda IV, 50%-35%; Bethesda V, 93%-91%; and Bethesda VI, 99%-98%. Absolute ROM differences for each category were as follows: Bethesda I, 0%; Bethesda II, 4%; Bethesda III, 7%; Bethesda IV, 15%; Bethesda V, 2%; and Bethesda VI, 1%. CONCLUSIONS: A decreasing trend in absolute and relative ROM was seen in Bethesda II, III, and IV categories; however, exclusion of NIFTP as a malignant lesion did not significantly alter the ROM of BSRTC categories. Surgeons should assess their respective institution's experiences with NIFTP and the BSRTC.

Subscapularis function after primary tendon to tendon repair in patients after replacement arthroplasty of the shoulder.

HYPOTHESIS: We studied the results of tendon-to-tendon repair of the subscapularis during total shoulder arthroplasty (TSA) to compare its clinical results relative to more recent studies looking at osteotomy of the lesser tuberosity. MATERIALS AND METHODS: This study analyzed the postoperative integrity of the subscapularis by a tendon-to-tendon repair in 45 arthroplasties in 43 patients. RESULTS: Preoperatively, 23 patients had a negative lift-off test; 22 could not perform the test. Postoperatively, 41 patients had a negative lift-off test; four could not reach behind themselves to do the test. All 45 shoulders had a negative belly-press test pre-operatively and post-operatively. DISCUSSION: Tendon-to-tendon repair is simpler, quicker, and avoids the possibility of an osteotomy nonunion. Tendon-to-tendon repair of the subscapularis tenotomy in shoulder arthroplasty remains an option in the presence of reasonable quality tendon, utilizing relaxing sutures (partial closure of the lateral rotator interval), and limiting early postoperative passive external rotation. LEVEL OF EVIDENCE: Level 4; Retrospective case series, no control group.