scholarly journals ISOLATED MPFL RECONSTRUCTION VS. TIBIAL TUBERCLE OSTEOTOMY AND MEDIAL RETINACULAR PLICATION FOR RECURRENT PATELLAR INSTABILITY: A MATCHED, COHORT ANALYSIS OF CLINICAL OUTCOMES COMPARING TWO TECHNIQUES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0013
Author(s):  
Benton E. Heyworth ◽  
Evan T. Zheng ◽  
Zaamin B. Hussain ◽  
Benjamin R. Wilson ◽  
Kianna D. Nunally ◽  
...  
Keyword(s):  
Propensity Score ◽  
Nearest Neighbor ◽  
Cohort Analysis ◽  
Patellofemoral Instability ◽  
Clinical Results ◽  
Significant Degree ◽  
Implant Removal ◽  
Tibial Tubercle ◽  
Return To Sports ◽  
Tibial Tubercle Osteotomy

Background: Historically, the most commonly utilized technique to address recurrent patellofemoral instability (PFI) was a combined proximal and distal realignment, specifically the tibial tubercle osteotomy (TTO) with a proximal medial retinacular plication/reefing/tightening/repair (MRP). Rising interest in the medial patellofemoral ligament reconstruction (MPFLR) over the last decade, now frequently performed as a more powerful isolated proximal realignment procedure, has prompted debate over the optimal technique to treat this common condition. Hypothesis/Purpose: The study hypothesis was that no difference would be detected in recurrent PFI rates or revision surgery rates between patients who underwent TTO-MRP vs. MPFLR. Methods: With cohorts derived from a large, single-center PFI database of 523 patients who underwent a variety of stabilization procedures, 114 eligible MPFLR patients were matched to 109 TTO patients based on age, gender, BMI, and TT-TG distance. Propensity score matching was conducted using logistic regression models to produce 1:1 matching, and a caliper of 0.2 standard deviations of the estimated propensity score was used to for the nearest neighbor matching algorithm. Final matching procedure resulted in 84 MPFLR patients and 84 TTO patients. These were compared on demographics and post-operative clinical results. Results: Demographic and radiologic comparisons of the cohorts are shown in Table 1, with the only difference between groups being an expected higher rate of patients with open physes in the MPFLR cohort. Table 2 shows the TTO-MRP group had longer follow up times, but comparable rates of return to sports. The MPFLR group had a higher rate of recurrent instability, but not to a significant degree, and a significantly higher incidence of revision patellar stabilization surgery (p<0.001). The TTO group had a higher rate of additional knee surgery, the majority of which were implant removal for TTO screws. Conclusion: The TTO-MRP shows equivalent or superior results to the MPFLR for treatment of PFI. However, implant removal may be common with TTO, though this may be somewhat technique-dependent. In the current landscape of increasing interest and utilization of MPFLR as an all-encompassing PFI surgery, the influence of distal bony realignment to minimize recurrence should not be underappreciated. Tables/Figures: [Table: see text][Table: see text]

Return to Sports After Tibial Tubercle Osteotomy for Patellofemoral Pain and Osteoarthritis

2018 ◽  
Vol 34 (4) ◽  
pp. 1022-1029 ◽  
Author(s):  
Joseph N. Liu ◽  
Hao-Hua Wu ◽  
Grant H. Garcia ◽  
Irene L. Kalbian ◽  
Sabrina M. Strickland ◽  
...  
Keyword(s):  
Patellofemoral Pain ◽  
Tibial Tubercle ◽  
Return To Sports ◽  
Tibial Tubercle Osteotomy

scholarly journals Treatment of the Objective Patellofemoral Instability

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0001
Author(s):  
Federico Alfano ◽  
Walter Spreafico
Keyword(s):  
Surgical Procedures ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Preoperative Planning ◽  
Patellofemoral Instability ◽  
Patellar Height ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
Axial View ◽  
Associated Abnormalities

Objectives: The aim of this study is to show the different surgical procedures for treating the objective patellar instability, including the different tibial tubercle osteotomies and the sulcus deepening trochleoplasty. Methods: This study analyzed the Caton-Deschamps index used for assessment of patellar height, the distance from the tibial tubercle to the troclear groove (TT-TG) on CT Scan in the axial view, and the different trochlear and patellar morphotypes. This study included 19 knees (19 patients) treated in an objective and documented patellofemoral instability. Results: We have had good results with both the transfer of the tibial tuberosity as the trochleoplasty. A reconstruction of the medial patellofemoral ligament was performed in both procedures. Recurrence of instability is very rare after these procedures and this is more likely to result from missed associated abnormalities. Conslusion: Accurate preoperative planning of the patellar height and determining the location of the tibial tubercle and the trochlear and patellar morphotypes for satisfactory results are required. However, as with any surgical procedure, both tibial tubercle osteotomy and the sulcus deepening trochleoplasty are susceptible of complications.

scholarly journals SURGICAL TREATMENT OF PATELLAR INSTABILITY IN ADOLESCENT DANCERS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0012
Author(s):  
KD Nunally ◽  
LJ Micheli ◽  
E Zheng ◽  
Z Hussain ◽  
B Wilson ◽  
...  
Keyword(s):  
Female Athletes ◽  
Tertiary Care ◽  
Patellofemoral Instability ◽  
Implant Removal ◽  
Tibial Tubercle ◽  
Control Group ◽  
High Risk Population ◽  
Recurrent Instability ◽  
Adolescent Dancers ◽  
Stabilization Technique

Background: Adolescent dancers may be a high-risk population for patellofemoral instability (PFI), but the condition remains under-investigated, to date, in this sub-group of athletes. Purpose: The purpose of this study was to (1) investigate the descriptive epidemiology of PFI in adolescent dancers, (2) analyze the efficacy of various patellar stabilization procedures within this population, and (3) compare PFI in dancers to a larger control group of matched, non-dancer athletes. Methods: A retrospective review of athletes, ages 10 to 19, who presented to a single tertiary care center with PFI between 2008 and 2017 was performed. Based on each patient’s primary sport, the cohort was divided into a dancer and a non-dancer control group. Demographics, clinical and radiologic features, surgical stabilization technique, and postoperative course and clinical outcomes were collected. Independent categorical groups were tested using chi squared and Fisher exact tests. Results: 258 adolescent athletes were included, 41 of whom were dancers, all females. This group was therefore matched with a control group of similarly aged, all-female athletes with PFI (Table 1). 54 athletes had bilateral PFI, yielding 285 knees for analysis. There was no difference between dancer and non-dancer athletes’ age, BMI, laterality, mechanism of injury, nor number of preoperative instability events. However, dancers had lower Dejour Classifications (p=0.044), smaller patella inclination angles (20.9±8.14 versus 25.0±9.84; p=0.004), and smaller Caton-Deschamps Indices (1.18±0.161 versus 1.25±0.189; p=0.041). Among dancers, there was no association between surgical stabilization technique and rates of recurrent instability (p=0.418) nor re-stabilization procedures (p=1.0) (Table 2). However, dancers who underwent tibial tubercle osteotomy (TTO) had higher rates of subsequent, non-stabilization procedures (66.7%), all for implant removal, compared to those undergoing isolated medial retinacular repairs (MRP) (3.8%) (p<0.001). There was no difference between the dancer and non-dancer athletes’ rates of recurrent instability (p=0.297), re-stabilization procedures (p=0.061), nor subsequent non-stabilization procedures (p=0.242). Conclusions: Female dancers with PFI have similar demographic and clinical features as other female athletes with PFI, but have lower rates or less severe trochlear dysplasia, lateral tilt and patella alta. Therefore, the ligamentous laxity inherent in dancers may be a more powerful risk factor for PFI than other non-modifiable risk factors. Notably, the TTO was a powerful stabilization procedure for this sub-population with low rates of recurrent instability episodes and no revision stabilization procedures performed. Rates of implant removal surgery following TTO may be substantial, though this may be technique or surgeon dependent. Tables/Figures: [Table: see text][Table: see text]

Anteromedializing Tibial Tubercle Osteotomy for Patellofemoral Instability: Occupational and Functional Outcomes in U.S. Military Service Members

2017 ◽  
Vol 31 (04) ◽  
pp. 306-313 ◽  
Author(s):  
Philip Belmont ◽  
Julia Bader ◽  
Joseph Lanzi ◽  
Brett Owens ◽  
Brian Waterman ◽  
...  
Keyword(s):  
Military Service ◽  
Patellofemoral Instability ◽  
Active Duty ◽  
Service Members ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
Military Service Members ◽  
Patellar Subluxation ◽  
Pain Improvement

AbstractThis article sought to determine rates for return to work, pain relief, and recurrent patellofemoral instability for military service members undergoing tibial tubercle osteotomy (TTO) for persistent lateral patellar subluxation or dislocation. Patient demographic and surgical variables were isolated from the medical records of active duty service members with at least 2 years of postoperative follow-up, and correlated with return to work, pain improvement, recurrent patellofemoral instability, and perioperative complications. There were 51 service members (58 primary TTOs) with an average follow-up of 3.3 (range, 2.0–6.7) years. Service members had an average of 2.8 (1–12) instability events preoperatively. At a minimum of 2 years postoperatively, 41 (80%) military service members returned to full active duty service. Among the 58 TTOs, there was a 46% improvement in the patient-reported visual analog score from 4.1 to 2.2 (p < 0001). The postoperative recurrent instability rates were patellar dislocation (5.1%) and patellar subluxation (15.5%). Concomitant proximal realignment was performed in 48% of cases, which did not affect return to service, postoperative patellar instability events, or pain improvement (p > 0.05). The overall complication rate was 10%. Postoperative tibial fractures occurred in 6.9% of TTOs. At short- to mid-term follow-up, 80% of service members undergoing TTO for patellofemoral instability returned to military duty with significant improvement in pain scores and a moderate perioperative complication and postoperative instability rate. This study is a level IV therapeutic case series.

scholarly journals Tibial Tubercle Osteotomy and Medial Patellofemoral Ligament Imbrication for Patellar Instability Due to Trochlear Dysplasia

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986517
Author(s):  
Jonathan D. Hodax ◽  
Michael P. Leathers ◽  
David Y. Ding ◽  
Brian T. Feeley ◽  
Christina R. Allen ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Patellofemoral Instability ◽  
Recurrent Dislocation ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
The Mean

Background: The treatment of patellar instability in the setting of trochlear dysplasia is challenging. Purpose/Hypothesis: The purpose of this study was to evaluate outcomes for the treatment of recurrent patellar dislocations due to trochlear dysplasia using anteromedialization tibial tubercle osteotomy combined with medial patellofemoral ligament (MPFL) imbrication. We hypothesized that the treatment of patellar instability with tibial tubercle osteotomy and MPFL imbrication would result in improved patient satisfaction and decrease patellar instability events in patients with prior instability and trochlear dysplasia. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective analysis of patients who underwent MPFL imbrication and concomitant anteromedialization tibial tubercle osteotomy for recurrent patellofemoral instability at a single institution. The minimum follow-up was 1 year. Patient demographic information including age at the time of surgery, sex, body mass index (BMI), tibial tubercle–trochlear groove (TT-TG) distance, and grade of trochlear dysplasia was collected along with relevant operative data. Postoperatively, recurrent dislocation events as well as Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index, and Kujala scores were collected, and satisfaction was ascertained by asking patients whether they would undergo the procedure again. Results: A total of 37 knees from 31 patients (23 female) with a mean follow-up of 3.8 years (range, 1-8.9 years) were included. The mean patient age was 28.8 years (range, 14-45 years), the mean BMI was 24 kg/m2 (range, 20-38 kg/m2), and the mean preoperative TT-TG distance was 18.9 mm (range, 8.4-32.4 mm). Two knees were classified as low-grade trochlear dysplasia (Dejour A) and 35 as high-grade trochlear dysplasia (Dejour B-D). At final follow-up, patients reported mean KOOS subscale scores of 86.5 (Pain), 79.8 (Symptoms), 93.9 (Activities of Daily Living), 74.3 (Sports/Recreation), and 61.9 (Quality of Life), as well as a mean Kujala score of 81.3. Mean patient satisfaction was 8.3 of 10. The majority of knees (86.5%; 32/37) remained stable without recurrent instability after this procedure, while 13.5% (5 knees) suffered a recurrent dislocation, with 2 requiring revision surgery. Eight knees (21.6%) underwent subsequent hardware removal. Conclusion: Anteromedialization tibial tubercle osteotomy with MPFL imbrication can improve recurrent patellofemoral instability and provide significant clinical benefit to patients with trochlear dysplasia.

scholarly journals The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients – a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Guido Mazzinari ◽  
◽  
Ary Serpa Neto ◽  
Sabrine N. T. Hemmes ◽  
Goran Hedenstierna ◽  
...  
Keyword(s):  
Propensity Score ◽  
Adverse Events ◽  
Abdominal Surgery ◽  
Las Vegas ◽  
Cohort Analysis ◽  
Risk Difference ◽  
Pulmonary Complications ◽  
Driving Pressure ◽  
Postoperative Pulmonary Complications ◽  
Open Abdominal Surgery

Abstract Background It is uncertain whether the association of the intraoperative driving pressure (ΔP) with postoperative pulmonary complications (PPCs) depends on the surgical approach during abdominal surgery. Our primary objective was to determine and compare the association of time–weighted average ΔP (ΔPTW) with PPCs. We also tested the association of ΔPTW with intraoperative adverse events. Methods Posthoc retrospective propensity score–weighted cohort analysis of patients undergoing open or closed abdominal surgery in the ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery’ (LAS VEGAS) study, that included patients in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs. The secondary endpoint was a composite of intraoperative adverse events. Results The analysis included 1128 and 906 patients undergoing open or closed abdominal surgery, respectively. The PPC rate was 5%. ΔP was lower in open abdominal surgery patients, but ΔPTW was not different between groups. The association of ΔPTW with PPCs was significant in both groups and had a higher risk ratio in closed compared to open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P <  0.001 versus 1.05 [95%CI 1.05 to 1.05], P <  0.001; risk difference 0.05 [95%CI 0.04 to 0.06], P <  0.001). The association of ΔPTW with intraoperative adverse events was also significant in both groups but had higher odds ratio in closed compared to open abdominal surgery patients (1.13 [95%CI 1.12– to 1.14], P <  0.001 versus 1.07 [95%CI 1.05 to 1.10], P <  0.001; risk difference 0.05 [95%CI 0.030.07], P <  0.001). Conclusions ΔP is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery. Trial registration LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).

scholarly journals Cigarette smoking may accelerate the progression of IgA nephropathy

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Siqing Wang ◽  
Aiya Qin ◽  
Gaiqin Pei ◽  
Zheng Jiang ◽  
Lingqiu Dong ◽  
...  
Keyword(s):  
Risk Factor ◽  
Propensity Score ◽  
Cigarette Smoking ◽  
Independent Risk Factor ◽  
Cox Regression ◽  
Cohort Analysis ◽  
Cox Proportional Hazards ◽  
Study Endpoint ◽  
Cox Regression Analysis ◽  
Ckd Stage

Abstract Background Whether cigarette smoking is associated with the progression of immunoglobulin A nephropathy (IgAN) remains uncertain; therefore, we aimed to evaluate the effect of cigarette smoking on the prognosis of IgAN. Methods We divided 1239 IgAN patients from West China Hospital of Sichuan University who met the inclusion criteria into smoker (current or former) and non-smoker groups. The endpoint was end-stage renal disease (ESRD: eGFR < 15 mL/min/1.73 m2 or undergoing renal replacement treatment) and/or eGFR decreased by > 50%. Kaplan–Meier, correlation, logistic regression and Cox proportional hazards analyses were performed. The association between cigarette smoking and IgAN was further verified by propensity-score-matched cohort analysis. Results During the mean follow-up period of 61 months, 19% (40/209) of the smoker group and 11% (110/1030) of the non-smoker group reached the study endpoint (p < 0.001). Multivariate Cox regression analysis revealed that cigarette smoking (hazard ratio (HR) = 1.58; p = 0.043) was an independent risk factor predicting poor renal progression in IgAN, and that IgAN patients with chronic kidney disease (CKD) stage 3–4 were more susceptible to cigarette smoking (p < 0.001). After propensity score matching (PSM), a significant correlation between cigarette smoking and renal outcomes in IgAN patients was seen. Furthermore, Spearman’s correlation test revealed that smoking dose was negatively correlated with eGFR (r = 0.141; p < 0.001) and positively related with proteinuria (r = 0.096; p = 0.001). Conclusions Cigarette smoking is an independent risk factor for IgAN progression, especially for advanced patients.

Distalising tibial tubercle osteotomy decreases patellar tendon force — A treatment rationale for recalcitrant patellar tendinopathy

The Knee ◽  
2020 ◽  
Vol 27 (3) ◽  
pp. 871-877 ◽  
Author(s):  
Michael J. Dan ◽  
Joseph Cadman ◽  
James McMahon ◽  
William C.H. Parr ◽  
David Broe ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Patellar Tendinopathy ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
Tendon Force

scholarly journals Ampicillin-Ceftriaxone vs Ampicillin-Gentamicin for Definitive Therapy of Enterococcus faecalis Infective Endocarditis: A Propensity Score–Matched, Retrospective Cohort Analysis

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Niyati H Shah ◽  
Kathleen A Shutt ◽  
Yohei Doi
Keyword(s):  
Infective Endocarditis ◽  
Propensity Score ◽  
Adverse Events ◽  
Cohort Analysis ◽  
Hospital Readmissions ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Aminoglycoside Resistance ◽  
Definitive Therapy ◽  
Significant Difference

Abstract Background Ampicillin-ceftriaxone (AC) has emerged as an alternative antibiotic regimen for enterococcal infective endocarditis (EIE) with reduced toxicity compared with ampicillin-gentamicin (AG), but evidence regarding its success in reducing EIE-associated death in the United States is limited. Methods We conducted a retrospective, propensity score–matched cohort analysis of EIE patients treated with AC or AG between 2010 and 2017 at 3 hospitals in Pittsburgh, Pennsylvania. We assessed all-cause 90-day mortality as the primary outcome and in-hospital mortality, length of hospital stay, hospital readmissions, adverse events, and relapse of bacteremia as the secondary outcomes. Results A total of 190 patients with EIE (100 treated with AC and 90 with AG) were included. Ninety-day mortality was significantly higher with AC than AG (21% vs 8%; P = .02). After propensity score matching, 56 patients in each group remained for the outcomes analysis. Documented aminoglycoside resistance, presence of annular or aortic abscess, and complete pacemaker removal were the significantly different variables between the 2 matched cohorts. We observed no statistically significant difference in 90-day mortality between the 2 treatment groups (11% vs 7%; P = .55). Adverse events were more common in patients treated with AG (25 vs 39; P = .0091), and more patients in the propensity score–matched AG cohort switched antibiotic regimens than in the AC group (10% vs 49%; P &lt; .0001). Conclusions Patients treated with AC demonstrate no significant differences in mortality, treatment failure, or bacteremia relapse compared with AG in a propensity score–matched EIE cohort.

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