Brian Grawe

Background: Hyperlipidemia (HLD) impairs tendon healing and is associated with increased revision risk following arthroscopic rotator cuff repair (ARCR). While statins may partially mitigate this effect, residual dyslipidemia may impair healing. Ezetimibe, through inhibition of intestinal cholesterol absorption, has demonstrated favorable effects on tendon healing in preclinical studies. Objectives: This study evaluated whether perioperative statin–ezetimibe therapy is associated with improved postoperative outcomes following ARCR compared with statin monotherapy and patients without HLD. Methods: A retrospective cohort study was conducted using the TriNetX Research Network. Adult patients undergoing ARCR were stratified into three cohorts based on HLD status and perioperative (± 6 months) lipid-lowering therapy: (1) documented HLD treated with statin–ezetimibe prescriptions, (2) patients without documented HLD or lipid-lowering therapy prescriptions, and (3) documented HLD treated with statin monotherapy prescriptions. Primary comparisons were predefined between cohort 1 and cohorts 2 and 3. Propensity score matching (1:1) adjusted for demographics and comorbidities. Tear size and presence of fatty atrophy and fatty infiltration were not adjusted for. Outcomes occurring within 5 years included revision rotator cuff repair (RCR), conversion to shoulder arthroplasty, and secondary shoulder arthroscopy. Results: After matching, 1,066 patients were included in cohorts 1 and 2 and 1,114 patients in cohorts 1 and 3. Compared with patients without HLD, statin–ezetimibe therapy demonstrated similar rates of revision RCR (5.4% vs. 6.4%; RR 0.853; p = 0.358), conversion to shoulder arthroplasty (RR 1.227; p = 0.470), and secondary arthroscopy (RR 0.846; p = 0.260). Compared with statin monotherapy, statin–ezetimibe therapy was associated with lower rates of revision RCR (5.6% vs. 8.0%; RR 0.697; p = 0.023) and secondary shoulder arthroscopy (7.3% vs. 9.6%; RR 0.757; p = 0.048), while arthroplasty rates remained similar (RR 1.261; p = 0.400). Conclusion: Among patients with HLD undergoing ARCR, perioperative statin–ezetimibe therapy was associated with lower reoperation rates compared with statin monotherapy and postoperative outcomes comparable to patients without HLD. These findings support further investigation of intensified lipid-lowering therapy, while accounting for tear size and fatty infiltration.

Rotator cuff tears are common, and although surgical repair is frequently performed, re-tear and complication rates remain substantial. The impact of selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) on postoperative outcomes after rotator cuff repair is not well understood. Using the TriNetX Research Network, adult patients undergoing arthroscopic rotator cuff repair were identified and stratified into SSRI/SNRI users (at least one prescription within 3 months preoperatively and continued use within 2 years postoperatively) and non-users. Propensity score matching was performed for demographic and medical comorbidities, yielding 2457 patients in each cohort. At 1-year follow-up, SSRI/SNRI users demonstrated lower rates of adhesive capsulitis compared with controls (3.1% vs. 5.8%; RR 0.53; 95% CI 0.41–0.70; p < 0.001), with similar revision rotator cuff repair rates. This pattern persisted at 2 years (3.6% vs. 6.1%; RR 0.58; 95% CI 0.45–0.75; p < 0.001), with comparable revision rates between groups. There were no differences in 30-day emergency department visits, readmissions, or 90-day postoperative infections. SSRI/SNRI users had lower early opioid use (21.0% vs. 29.5%; RR 0.71; p < 0.001) but higher prolonged (17.2% vs. 14.1%; RR 1.22; p = 0.003) and chronic opioid use (16.7% vs. 9.1%; RR 1.84; p < 0.001). In this large national cohort, SSRI/SNRI use was associated with lower rates of adhesive capsulitis and differences in postoperative opioid utilization, without differences in revision rotator cuff repair or short-term complications. These findings reflect associations rather than causation and highlight the need for further studies to clarify underlying mechanisms and clinical implications.

Background/Objectives: Tranexamic acid (TXA) is widely used to reduce bleeding in orthopedic surgery, but its safety and impact on outcomes in arthroscopic rotator cuff repair (ARCR) remain unclear. The purpose of this study was to evaluate the safety and effects of injectable TXA on short- and long-term postoperative outcomes and opioid use following ARCR. Methods: The TriNetX Research Network, an insurance claims-based database, was utilized to conduct this retrospective, propensity-matched cohort study. Patients aged ≥18 years undergoing ARCR were identified and divided into TXA (n = 5855) and non-TXA (n = 5855) groups after propensity score matching. Outcomes assessed included 30-day hospital utilization, complications (infection, thromboembolism, hemarthrosis, blood transfusion), one-year revision and shoulder surgery rates, and early, prolonged, and chronic postoperative opioid use. Results: No significant differences were observed between groups in 30-day emergency department visits (2.0% vs. 1.8%, p = 0.502), readmissions, infections, wound dehiscence, blood transfusions, hemarthrosis, or one-year revision and shoulder surgery rates. TXA use was associated with significantly lower rates of early (24.8% vs. 26.8%, p = 0.011), prolonged (9.5% vs. 12.8%, p < 0.001), and chronic opioid use (6.6% vs. 9.6%, p < 0.001). Conclusions: Injectable TXA is safe in ARCR, with no increase in postoperative complications or hospital utilization. Furthermore, TXA use is linked to reduced postoperative opioid consumption, suggesting benefits in pain management and recovery. Prospective studies are warranted to further explore these findings.

D reduce complication rates while increased staff turnover will decrease efficiency and increase complications. Methods: This is a single-center, retrospective study focused on determining the effects of staffing on operating room time and efficiency in total shoulder arthroplasty. The study included patients who underwent total shoulder arthroplasty by a single fellowship-trained orthopaedic surgeon from 2018 to 2023. Results: Four hundred twenty-three patients were included in the study from August 2018 to April 2023, 264 of which were reverse total shoulder arthroplasty (rTSA) and 159 were anatomic total shoulder arthroplasty (aTSA). In both rTSA and aTSA, the presence of surgeon-preferred staff markedly decreased operating room time. In rTSA, staff turnover increased risk of 90-day complications. Conclusion: Because the presence of surgeon-preferred staff affects operating room time and efficiency, orthopaedic surgeons should train multiple surgical teams so that efficiency is not affected by the loss of personnel during a case. To reduce 90-day complication rates in rTSA, staff breaks and turnover should be minimized as much as possible because this has a direct effect on patient outcomes. Effort from hospital administration and management should be put toward reducing turnover to improve patient outcomes....

We report a 45-year-old man who presented with a rotator cuff tear and scapular dyskinesis of his left shoulder and underwent a pectoralis major split transfer with an allograft to the inferior border of his scapula. The patient reported significant improvement in shoulder function and decreased severity of his scapular dyskinesis. Combined arthroscopic rotator cuff repair and allograft scapula stabilization is a novel technique for the unusual clinical presentation reported in this case report. To the best of our knowledge, this is the first reported surgical management of a patient with rotator cuff repair and non-palsy-related scapular dyskinesis.

A 34-year-old female sustained a 1.8 cm full-thickness chondral defect of the right lateral trochlear surface as the result of intramedullary tibial nailing via a suprapatellar portal to treat a displaced right sided open comminuted spiral fracture of the distal tibial shaft. An osteochondral allograft was used to treat the chondral defect. Iatrogenic injury to intraarticular structures is a potential complication when inserting a tibial nail via a suprapatellar portal. Using proper technique with cannula systems and guide pins is essential to lowering the risk of damage to intraarticular structures.

Purpose To evaluate whether graft-type and tunnel location in ACL reconstruction impact patient-reported outcomes in individuals over the age of 45. Methods From 2015 to 2018, patients over 45 years old undergoing primary ACL reconstruction without multi-ligamentous injuries were enrolled in an institutional registry. Baseline International Knee Documentation Committee (IKDC) subjective scores, Knee Injury and Osteoarthritis Outcome Scores (KOOS), Marx Activity Scale, and patient characteristics were collected. Follow-up occurred at a minimum of two years to obtain patient-reported outcomes. Results Of the 51 patients who qualified for the study, 44 (86.3%) patients were available at a minimum of two years after surgery date (range 24–60 months). Average age at time of surgery of the available patients was 51.6 ± 4.87 (range 45–66). Between femoral tunnel drilling methods, there were no differences in the proportion of patients achieving clinically significant improvement or post-operative outcome scores. While patients who received patellar tendon autografts were more likely to achieve clinically significant improvement in the KOOS sports subscale, there were no other differences in outcomes measures between graft types. Two patients had a retear of their graft, and an additional five patients complained of subjective instability. Conclusions In patients over the age of 45, neither the method used to create the femoral tunnel nor the graft type used in ACL reconstruction caused a significant difference in post-operative PROMs with a minimum of two years of follow-up. Level of Evidence Therapeutic IV, Case Series.

A growing number of studies utilizing wearable technologies are examining the influence of the autonomic nervous system (ANS) on intense training, recovery, and injury risk. Exercise biometric (EB) data were collected on collegiate, female soccer players during a preseason camp. One player sustained an anterior cruciate ligament (ACL) injury. Baseline anthropometric and EB data were compared to non-injured, position-matched teammates. All players had similar baseline testing. The injured athlete had a higher body mass index (BMI) and slower vision reaction time (RT). On the day of her injury (DOI), relative percentage heart rate recovery (tHRR) between intense training sets was calculated. Relative percentage tHRR was much lower for the injured athlete, indicating reduced recovery between training sets immediately prior to the injury. Also on DOI, the injured athlete had a lower glomerular filtration rate (GFR). In addition to BMI and RT differences, the lower relative percentage tHRR and GFR on the DOI observed for the injured athlete may reflect an imbalanced ANS recovery, and potentially to risk factors leading to her ACL injury.

Purpose The purpose of this study was to determine patient factors that influence patient compliance to fill out anterior cruciate ligament reconstruction (ACLR) registry forms. Methods Patients prospectively enrolled in the ACLR registry at a single institution were retrospectively reviewed. Patients who were followed up for at least 6 months were included. Patients who did not fill out initial registry forms were excluded. Patients were asked to fill out forms preoperatively and at 6, 12 and 24 months postoperatively. The impacts of age, race, employment status, medical insurance, smoking status, driving distance to the hospital and importance to return to the same level of sporting activity were analyzed against patient compliance (yes/no) to complete registry forms at the respective follow-ups. Multivariate analysis was performed to analyze variables at 6 and 12 months postoperatively. The numbers of patients who were followed up for more than 24 months were too low to run a multivariate analysis, so only univariate analysis was performed on this cohort. Results A total of 221 patients filled out the initial preoperative forms at least 6 months before data gathering was commenced and were included. At 6 months postoperatively, none of the variables significantly influenced patient compliance. At 12 months, younger age and longer driving distance to the hospital had a significant negative impact on compliance [OR per year: 0.92 (0.85–0.99), p = 0.0237; OR per mile: 1.01 (1, 1.01), p = 0.0297]. Patients who filled out registry forms at 6 months were significantly more compliant at 12 months postoperatively (p < 0.0001). At 24 months, the influence of age remained significant (p = 0.0262) and, additionally, patients who initially noted that it was important for them to return to the same level of sports were significantly less compliant (p = 0.0367). Conclusion Younger age and longer driving distance to the hospital were significantly associated with less compliance to fill out ACLR registry forms at 12 months postoperatively. Patient perspectives on the importance to return to the same level of sports were inversely related to compliance at 24 months postoperatively. This information can be utilized to improve compliance in future studies as we have potentially identified patients that can be viewed as “at-risk” for registry noncompliance.