Explore the vast range of titles available.

Background: The drilling technique used to make a femoral tunnel is critically important for determining outcomes after anterior cruciate ligament (ACL) reconstruction. The 2 most common methods are the transtibial (TT) and anteromedial (AM) techniques. Purpose: To determine whether graft orientation and placement affect clinical outcomes by comparing clinical and radiological outcomes after single-bundle ACL reconstruction with the AM versus TT technique. Study Design: Systematic review; Level of evidence, 3. Methods: Articles in PubMed, EMBASE, the Cochrane Library, ISI Web of Science, Scopus, and MEDLINE were searched from inception until April 25, 2020, using the following Boolean operators: transtibial OR trans-tibial AND (anteromedial OR trans-portal OR independent OR three portal OR accessory portal) AND anterior cruciate ligament. Results: Of 1270 studies retrieved, 39 studies involving 11,207 patients were included. Of these studies, 14 were clinical, 13 were radiological, and 12 were mixed. Results suggested that compared with the TT technique, the AM technique led to significantly improved anteroposterior and rotational knee stability, International Knee Documentation Committee (IKDC) scores, and recovery time from surgery. A higher proportion of negative Lachman (P = .0005) and pivot-shift test (P = .0001) results, lower KT-1000 arthrometer maximum manual displacement (P = .00001), higher Lysholm score (P = .001), a higher incidence of IKDC grade A/B (P = .05), and better visual analog scale score for satisfaction (P = .00001) were observed with the AM technique compared with the TT technique. The AM drilling technique demonstrated a significantly shorter tunnel length (P = .00001). Significant differences were seen between the femoral and tibial graft angles in both techniques. Low overall complication and revision rates were observed for ACL reconstruction with the AM drilling technique, similar to the TT drilling technique. Conclusion: In single-bundle ACL reconstruction, the AM drilling technique was superior to the TT drilling technique based on physical examination, scoring systems, and radiographic results. The AM portal technique provided a more reproducible anatomic graft placement compared with the TT technique.

Background: Mechanical processing techniques are commonly employed to prepare adipose tissue for clinical applications in reconstructive and aesthetic procedures. However, their histological and immunohistochemical impact on adipose tissue remains incompletely characterized. Purpose: This systematic review aims to investigate the impact of mechanical processing on the histological and immunohistochemical properties of adipose tissue. Methods: A systematic search was conducted using PubMed, Ovid, and Cochrane Library databases, with publications up to December 2024, employing Boolean operators (“mechanically processed” OR “lipoaspirate” OR “fat graft” OR “gauze rolling” OR “decantation” OR “coleman fat” OR “celt” OR “nanofat” OR “lipofilling” OR “human fat”) AND (“histol*”). Included were English-language studies or studies with a recognized English translation which had been subject to peer review and reported quantitative or qualitative markers of mechanically processed human adipose tissue with histology or immunohistochemistry. Risk of Bias was assessed with the OHAT score. Results: A total of 15 studies (n = 15) were included. In 13 of 15 studies (87%), mechanically processed adipose tissue demonstrated an increased stromal vascular fraction (SVF) cell density compared to unprocessed fat. Twelve studies (80%) reported improved preservation of the extracellular matrix (ECM), while 11 studies (73%) observed a reduction in mature adipocytes. Immunohistochemical analyses in 10 studies (67%) revealed elevated expression of vascular markers (CD31, CD34) and perilipin. Adverse histological features such as oil cysts, fibrosis, and inflammatory infiltrates were reduced in 9 studies (60%). Considerable heterogeneity in processing techniques and staining protocols precluded meta-analysis. Conclusions: Mechanical processing of adipose tissue is associated with favorable histological and immunohistochemical profiles, including increased SVF cell density, improved ECM preservation, and reduced inflammatory and fibrotic features. These findings support the potential of mechanical processing to enhance graft quality; however, standardization of techniques and evaluation protocols is needed to strengthen clinical translation.

Purpose Upper third tears of the subscapularis tendon can be repaired successfully with a single anchor according to previous literature. The aim of the present study was to compare three single anchor repair techniques regarding fixation strength, footprint coverage and contact pressure in a biomechanical test set-up on human cadaveric shoulders. Methods Eighteen human cadaveric shoulders were randomized in three groups with respect to the repair technique; group 1: knotted lasso-loop mattress, group 2: knotted mattress and group 3: knotless tape repair. Upper third tears of the subscapularis tendon (Lafosse type 2) were created and repairs were performed with additional contact pressure and area measurement using a pressure mapping system. Cyclic testing was performed by loading the subscapularis from 10 to 100 N for 300 cycles. A position-controlled ramp protocol up to 30 and 50 N was used to allow for pressure measurements. Finally, specimens were loaded to failure and failure modes were recorded. Results The three groups were not significantly different regarding age, gender, bone mineral density at the lesser tuberosity, subscapularis footprint size and defect area created at the upper subscapularis insertion. A significant difference was detected between group 1 (48.6 ± 13.8%) and group 2 (25.9 ± 5.7%) regarding pressurized footprint coverage ( p  = 0.028). Ultimate load to failure was 630.8 ± 145.3 N in group 1, 586.9 ± 220.7 N in group 2 and 678.2 ± 236.5 N in group 3, respectively. Cyclic displacement was similar in all three groups with an average displacement of 1.2 ± 0.6 mm. The highest stiffness was found in group 1 with 88 ± 30.3, which was not statistically significantly different to group 2 (65 ± 27 N/mm) and group 3 (83.9 ± 32.9 N/mm). The most common mode of failure was suture cut-through at the suture–tendon interface (44%). Failures in group 3 were less common associated with suture cut-through (33% vs. 50% in group 1 and 2), but no significant differences were found. Conclusions All three tested single anchor repair techniques of upper third subscapularis tears were able to provide sufficient biomechanical stability. Knotted lasso-loop mattress and knotless tape repair were superior regarding pressurized footprint coverage compared to a knotted horizontal mattress technique and are, therefore, preferable techniques for upper subscapularis repair.

Background: Histological and immunohistochemical analyses of adipose tissue are essential for evaluating the quality and functionality of lipoaspirates in regenerative medicine and fat grafting procedures. These methods provide insights into tissue viability, cellular subtypes, and extracellular matrix (ECM) composition—all factors influencing graft retention and clinical outcomes. Purpose: This scoping review aims to summarize the most commonly used staining methods and their applications in the histology and immunohistochemistry of adipose tissue. By exploring qualitative and quantitative markers, we seek to guide researchers in selecting the appropriate methodologies for addressing experimental and translational research. Methods: A systematic search was conducted using PubMed, Ovid, and the Cochrane Library databases from inception to 2024, employing Boolean operators (“lipoaspirate” OR “fat graft” OR “gauze rolling” OR “decantation” OR “coleman fat” OR “celt” OR “nanofat” OR “lipofilling” OR “human fat” AND “histol*”). Studies were included if they utilized histology or immunohistochemistry on undigested human adipose tissue or its derivatives. The inclusion criteria focused on peer-reviewed, English-language studies reporting quantitative and qualitative data on adipose tissue markers. Results: Out of 166 studies analyzed, hematoxylin–eosin (H&E) was the most frequently employed histological stain (152 studies), followed by Masson Trichrome and Sudan III. Immunohistochemical markers such as CD31, CD34, and perilipin were extensively used to distinguish stromal vascular fraction (SVF) cells, adipocytes, and inflammatory processes. Studies employing semiquantitative scoring demonstrated enhanced comparability, particularly for fibrosis, necrosis, and oil cyst evaluation. Quantitative analyses focused on SVF cell density, mature adipocyte integrity, and ECM composition. Methodological inconsistencies, particularly in preparation protocols, were observed in 25 studies. Conclusions: This review highlights the critical role of histological and immunohistochemical methods in adipose tissue research. H&E staining remains the cornerstone for general tissue evaluation in the clinical context, while specialized stains and immunohistochemical markers allow for detailed analyses of specific cellular and ECM components in experimental research. Standardizing preparation and evaluation protocols will enhance interstudy comparability and support advancements in adipose tissue-based therapies.

Lipofilling has far more applications than cosmetic surgery alone. Due to its high content of stromal vascular fraction (SVF) cells, lipoaspirate can also be used to treat wounds, as its cellular components may accelerate wound healing. Using our CELTPLUS protocol, we can increase the number of SVF cells per volume. Unfortunately, some patients require more than one treatment to achieve an optimal outcome, but would unnecessarily suffer from repeated liposuction. Therefore, our objective was to test whether cryopreserving CELTPLUS fat could offer a solution, potentially avoiding the need for repeated liposuction procedures. DMSO was used as a cryoprotective agent for proof-of-principle testing, although other non-toxic cryoprotective agents should be considered in the future. The rest of our freezing protocol is a clinically friendly attempt to facilitate the translation into clinical practice. We tested the cryopreserved tissue using histological evaluation, metabolism measurement, SVF cell yield estimation, PCRs from both whole tissue and from cultured SVF cells, and Oil Red “O” staining. We found that freezing CELTPLUS fat with DMSO yields better results than without cryoprotection in all evaluated methods. Until non-toxic cryoprotective agents are tested on CELTPLUS fat, we do not recommend initiating animal or human testing.

Background Post-operative shoulder stiffness (POSS) is one of the most frequent complications after arthroscopic rotator cuff repair (ARCR). Factors specifying clinical prediction models for the occurrence of POSS should rely on the literature and expert assessment. Our objective was to map prognostic factors for the occurrence of POSS in patients after an ARCR. Methods Longitudinal studies of ARCR reporting prognostic factors for the occurrence of POSS with an endpoint of at least 6 months were included. We systematically searched Embase, Medline, and Scopus for articles published between January 1, 2014 and February 12, 2020 and screened cited and citing literature of eligible records and identified reviews. The risk of bias of included studies and the quality of evidence were assessed using the Quality in Prognosis Studies tool and an adapted Grading of Recommendations, Assessment, Development and Evaluations framework. A database was implemented to report the results of individual studies. The review was registered on PROSPERO (CRD42020199257). Results Seven cohort studies including 23 257 patients were included after screening 5013 records. POSS prevalence ranged from 0.51 to 8.75% with an endpoint ranging from 6 to 24 months. Due to scarcity of data, no meta-analysis could be performed. Overall risk of bias and quality of evidence was deemed high and low or very low, respectively. Twenty-two potential prognostic factors were identified. Increased age and male sex emerged as protective factors against POSS. Additional factors were reported but do require further analyses to determine their prognostic value. Discussion Available evidence pointed to male sex and increased age as probable protective factors against POSS after ARCR. To establish a reliable pre-specified set of factors for clinical prediction models, our review results require complementation with an expert's opinion.

Background: Total hip (THA) and total knee arthroplasty (TKA) are becoming an increasingly standard procedure in the whole world. In conjunction with an aging population and increased prevalence of osteoporosis, proper management of periprosthetic, and interprosthetic fractures is of great interest to orthopedic surgeons. This study aims to report the clinical and radiographic outcomes, complications and reoperations of IFFs in geriatric patients. Methods: A retrospective single-institution case series study was conducted. Between 2011 and 2019, 83 patients underwent surgical treatment for periprosthetic femoral fractures. Thirteen fractures were identified as IFFs. Patient demographics and comorbidities were collected preoperatively, and fractures were classified with the Vancouver and AO unified classification system (AO-UCS). Results: We included 12 patients (13 hips) with IFFs (AO-UCS type IV.3 B (2/13) type IV.3 C (3/13), type IV.3 D (8/13)). The average patient age was 86.54 (range, 79-89) years. There were 10 females and 2 males. Perioperative morbidity has been identified in 10 of the 12 patients, and the 3-month and 1-year mortality were reported in 2 and 3 patients, respectively. Cerclage cables were used in 9 of 12 patients. One of 12 patients showed a local complication, with no documented implant failure or revision. Patients achieved complete union and returned to their preoperative ambulatory status, and full weight-bearing at an average of 5 (range, 2 to 7) months later. Conclusion: Management of IFF can be challenging because these fractures require extensive surgical expertise. Locking plate seems to be a valuable treatment option for geriatric patients with IFFs. Despite the complexity of this type of fracture, the overall complication and revision rate, as well as the radiographic outcome are good to excellent. Level of Evidence: Level III, Therapeutic study.

AI, especially ChatGPT, is impacting healthcare through applications in research, patient communication, and training. To our knowledge, this is the first study to examine ChatGPT-4’s ability to analyze images of lower leg defects and assesses its understanding of complex case reports in comparison to the performance of board-certified surgeons and residents. We conducted a cross-sectional survey in Switzerland, Germany, and Austria, where 52 participants reviewed images depicting lower leg defects within fictitious patient profiles and selected the optimal reconstruction techniques. The questionnaire included cases with varied difficulty, and answer options did not always include the most obvious choices. Findings highlight that ChatGPT-4 successfully evaluated various reconstruction methods but struggled to determine the optimal solution based on the available information in visual and written forms. A chi-squared test of independence was performed to investigate the overall association between answer options (A, B, C, and D) and rater group (board-certified surgeons, ChatGPT-4, and resident). Inter-group rater associations showed significant overall test results (p < 0.001), with high agreement among board-certified surgeons. Our results suggest that board-certified plastic surgeons remain essential for patient-specific treatment planning, while AI can support decision-making. This reaffirms the role of AI as a supportive tool, rather than a replacement, in reconstructive surgery.

BackgroundTo achieve an optimal clinical outcome in reverse total shoulder arthroplasty (RSA), accurate placement of the components is essential. The recently introduced navigation technology of augmented reality (AR) through head-mounted displays (HMD) offers a promising new approach to visualize the anatomy and navigate component positioning in various orthopedic surgeries. We hypothesized that AR through HMD is feasible, reliable, and accurate for guidewire placement in RSA baseplate positioning.MethodsTwelve human cadaver shoulders were scanned with computed tomography (CT) and RSA baseplate positioning was 3-D planned using dedicated software. The shoulders were prepared through a deltopectoral approach and an augmented reality hologram was superimposed using the HMD Microsoft HoloLense. The central guidewire was then navigated through the HMD to achieve the planned entry point and trajectory. Postoperatively, the shoulders were CT-scanned a second time and the deviation from the planning was calculated.ResultsThe mean deviation of the entry point was 3.5 mm  ± 1.7 mm (95% CI 2.4 mm; 4.6 mm). The mean deviation of the planned trajectory was 3.8°  ± 1.7° (95% CI 2.6°; 4.9°).ConclusionAugmented reality seems feasible and reliable for baseplate guidewire positioning in reverse total shoulder arthroplasty. The achieved values were accurate.

BackgroundPrimarily posterior bone deficient (dysplastic) (Walch type C) or secondarily eroded (Walch type B2 or B3) glenoids represent a surgical challenge for shoulder arthroplasty. Due to the posteriorly static decentered head, reverse total shoulder arthroplasty (RTSA) is often considered as the treatment of choice. The purpose of this study is to report the clinical and radiographic outcomes, complications and reoperations of RTSA for posteriorly deficient glenoids.Materials and methodsAll patients who underwent RTSA for osteoarthritis secondary to underlying glenoid deficiency (Walch type B2, B3 and C) between 2005 and 2018 (study group), were identified from our institutional shoulder arthroplasty database and gender- and age-matched to a cohort of patients with normal glenoid bone stock (control group). Longitudinal pre- and postoperative clinical [Constant–Murley (CS) score, Subjective Shoulder Value (SSV)] and radiographic outcomes were assessed.ResultsWe included 188 patients (94 in each group). The median follow-up was 43 ± 26 (24–144) months in the study group and 59 ± 32 (24–124) months in the control group. The glenoid deficiency was addressed by using glenoid bone reconstruction. The surgical site complication and revision rate of RTSA in patients with bony deficient glenoids were 17% and 7%. Although glenoid loosening was slightly higher in the study group (5 vs. 2), overall no significant differences were found between the study and control groups in satisfaction scores, preoperative and postoperative absolute and relative Constant scores, complication and revision rates, respectively.ConclusionReverse total shoulder arthroplasty (RTSA) seems to be a valuable treatment option for patients with primary (dysplasia) or secondary (wear) posterior glenoid deficiency. Although severe glenoid bone loss seems to be a risk factor for glenoid component failure, the overall complication and revision rates as well as clinical and radiographic outcome are comparable to RTSA in patients without compromised glenoid bone stock.Level of evidenceLevel III: case–control study