Shawn A. Moore

Patellar tendon rupture and chronic extensor mechanism deficiency present significant reconstructive challenges, particularly in revision settings or when native tissue quality is poor. We describe a reproducible surgical technique for patellar tendon reconstruction using an Achilles allograft with traversing suprapatellar cerclage limbs. This construct helps facilitate controlled restoration of patellar height, immediate continuity of the extensor mechanism, and load sharing across the reconstruction during early healing.

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.

Purpose: To compare magnetic resonance imaging (MRI)‐based measurements of glenoid labral tears with intraoperative measurements. Methods: A retrospective review was performed of patients that underwent shoulder capsulorrhaphy between 2019 and 2024 at a single academic medical center. All patients with a single labrum tear, an MRI within 6 months of surgery, and historical tear measurements or measurable intraoperative photographs were included in the study. Glenoid labrum tear size was noted using the clockface convention described in “hours.” When clockface measurements were not reported on MRI reads, measurements were made by a radiologist. When clockface measurements were not reported in operative notes, measurements were made by an orthopaedic surgeon using intraoperative photographs. A paired t test was used to evaluate any difference between the MRI and intraoperative measurements. Results: Two hundred sixteen glenoid labral tears from 211 patients met inclusion criteria. Average age was 27.2 ± 11.8 years, 68.5% of patients were men, and 56.9% of glenoid labrum tears were right‐sided. On average, MRI measurements exceeded intraoperative measurements (4.15 ± 2.90 hours vs 2.80 ± 1.59 hours) with an average difference of 1.36 ± 3.09 hours (95% confidence interval = 0.94‐1.77, P < .001) and a correlation of 0.154 ( P = .023). A greater difference in measurement was observed among men compared with women (1.64 vs 0.74 hours, P = .044). Conclusions: MRI overestimated glenoid labrum tear size compared with intraoperative measurements and differed substantially between the 2 modalities on a case‐by‐case basis, with men displaying a larger discrepancy in measurement difference than women. These findings indicate that MRI may be more appropriately used as a categorical tool for confirming the presence of glenoid labral tears, rather than as a precise measure of tear size. Level of Evidence: Level III, retrospective diagnostic case series.

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: Accepted venous thromboembolism (VTE) prophylaxis after orthopedic trauma includes anticoagulants and aspirin, with selection varying by patient and injury factors. This study evaluates a single institution’s outcomes after transitioning from low–molecular-weight heparin to aspirin for postdischarge prophylaxis. Methods: This retrospective cohort study of adult patients (≥18 years) with lower extremity or pelvic orthopedic injuries who underwent operative treatment between 2020 and 2024 was identified from the trauma registry of a Level-1 trauma center. Patients were included if they underwent operative fixation during the index hospitalization. Exclusion criteria included a documented VTE or receipt of therapeutic anticoagulation/antiplatelet therapy within six months before admission. The primary outcome was 90-day postdischarge VTE, defined as deep vein thrombosis or pulmonary embolism. Secondary outcomes included 90-day readmission and mortality. Inverse probability of treatment weighting and doubly robust logistic regression were used to compare discharge chemoprophylaxis regimens (aspirin vs. enoxaparin), controlling for age, sex, body mass index, injury severity score, length of stay, comorbidities, and fracture location. Results: A total of 982 patients met inclusion criteria, including 456 (46.4%) patients discharged on aspirin and 526 (53.6%) patients discharged on enoxaparin. Among orthopedic trauma patients, discharge aspirin was associated with significantly higher odds of 90-day postdischarge VTE compared with low–molecular-weight heparin (OR, 4.704; 95% CI, 1.332–16.612; p = 0.016). No significant differences were observed between discharge chemoprophylaxis groups with respect to 90-day readmission or mortality. Conclusions: Low-molecular-weight heparin was associated with lower odds of postdischarge VTE compared with aspirin in this retrospective cohort of orthopedic trauma patients. Further investigation is needed to better define the optimal postdischarge prophylaxis strategy based on individual patient comorbidities and injury patterns. ( J Trauma Acute Care Surg 2026;00:000–000. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.) Level of Evidence: Retrospective, Therapeutic/Care Management; Level 3.

Purpose: Gabapentinoids are increasingly incorporated into multimodal analgesia after orthopaedic surgery, yet their impact on outcomes following fracture fixation remains unclear. This study evaluated the association between early postoperative gabapentinoid–opioid co-prescription and clinical outcomes after operative fixation of closed long bone fractures.Methods: Using the TriNetX Research Network, we identified opioid-naïve and gabapentinoid-naïve adults undergoing intramedullary or plate-and-screw fixation of isolated closed diaphyseal tibia, humerus, or femur fractures. Patients prescribed both gabapentin or pregabalin and opioids within three days after surgery were compared with patients receiving opioids alone. Propensity score matching (1:1) was used to control for demographics, medical comorbidities, fracture location, fixation method, mental health disorders, and substance use disorders. Primary outcomes were prolonged (30–90 days) and chronic (90–180 days) postoperative opioid use. Secondary outcomes included 30-day emergency department (ED) visits and readmissions, and 1-year nonunion and reoperation.Results: After matching, each cohort consisted of approximately 2,000 patients (range, 1,946-2,012). Gabapentinoid–opioid therapy was associated with higher rates of prolonged (21.0% vs 16.1%; RR 1.31; p<0.001) and chronic (9.8% vs 7.4%; RR 1.33; p=0.007) postoperative opioid use. Patients receiving gabapentinoid–opioid therapy had fewer 30-day ED visits (25.1% vs 42.5%; RR 0.59; p<0.001), while 30-day readmission rates were similar between groups (p=0.174). One-year rates of nonunion (4.3% vs 1.9%; RR 2.21; p<0.001) and reoperation (7.1% vs 4.2%; RR 1.68; p<0.001) were significantly higher among patients receiving gabapentinoid–opioid therapy.Conclusion: Early postoperative gabapentinoid–opioid therapy after long bone fracture fixation was associated with fewer ED visits but substantially higher risks of prolonged and chronic opioid use, nonunion, and the need for reoperation. These findings suggest that potential short-term analgesic benefits may be offset by adverse long-term outcomes, warranting caution and future study in the use of gabapentinoid prescribing to manage acute perioperative fracture pain.