Hasil untuk "Orthopedic surgery"

Siddhart Yadav, K P Chiranjeevi, Akash Singh Jadon et al.

Introduction: Ipsilateral tibia and fibula shaft fractures with trimalleolar fracture are quite rare in clinical practice. Case Report: This is a case report of a 49-year-old female presented on March 6th, 2024, and was diagnosed to have an ipsilateral left comminuted distal tibia shaft and fibula shaft fracture with an anterior lacerated wound 2 cm over the fracture site with trimalleolar fracture after falling twice while walking. The patient was treated with wound debridement, intramedullary interlocking nailing for the left tibia shaft, and open reduction internal fixation with coracoclavicular screw for posterior malleolus, K-wires + FiberWire tension band wiring for medial malleolus, and K-wires for lateral malleolus on March 07th, 2024. K-wires from the lateral malleolus were removed and tibia nail dynamization was done on April 10th, 2024. All fractures united in 4 months and the patient was followed up for a period of 1 year post-operatively. Conclusion: Various treatment options were possible, of which we chose implants and a sequence of fixation based on the fracture pattern being comminuted and an open fracture.

Caleb Gottlich, Thomas Githens, Alex Drusch et al.

Abstract Background The sacroiliac joints (SIJ) are specialized articulations in the pelvis that allow load transfer between the upper and lower body. Traumatic pelvic disruption often requires surgical fixation of at least one of these joints. Subsequent SIJ pain is associated with asymmetries in joint laxity or stiffness. This pilot study examines SIJ stiffness in patients with intact sacroiliac screw fixation after posterior pelvic ring injuries. This information will prove valuable to informing surgeons about technique efficacy in SIJ injury stabilization. Questions/purposes This pilot study examined SIJ stiffness in patients with intact sacroiliac screw fixation to: (1) establish vibration energy color Doppler imaging (VECDI) SIJ intra-rater reliability; (2) measure SIJ stiffness in subjects following surgical fixation using VECDI; (3) compare stiffness data between post-surgical and healthy control subjects; (4) evaluate the relationship between stiffness data and pain and disability scores. Methods 13 reliability and 19 experimental subjects were tested using VECDI. Subjects were placed into a side-lying position on top of a shaker apparatus that transmitted vibration energy to the pelvic ring while color Doppler images were taken from the bilateral posterior SIJ. One investigator performed SIJ measurements on healthy subjects to establish reliability and then evaluated post SIJ fixation stiffness in experimental subjects at four-weeks (T1) and eight-weeks (T2). Visual analog scales were used to collect subjective pain scores at each time point. Results Healthy subject VECDI values suggested good intra-rater reliability (ICC = 0.819; CI 95% = 0.405–0.945). No significant differences in SIJ stiffness (ΔTU) were observed between healthy and experimental subjects at both time points (p > .05). Pearson correlation coefficients highlighted relationships between current pain at T1 and T2 (p = .004, r = .879), and Oswestry Disability Index (ODI) values at T1 and T2 (p = .003, r = .890). Conclusions Asymmetric laxity through the SIJ can be associated with pain resulting from either trauma or inherent physiologic variations. Prior to this study, the mainstay of evaluation was subjective indexes, such as the ODI. Here we propose VECDI as a potentially objective tool in SIJ assessment. Following surgical fixation necessitated by trauma, fixation using SI screws demonstrated similar stiffness values through the SIJ at four- and eight-weeks post-operatively when compared to healthy controls. Direct inferences regarding VECDI’s exact sensitivity to SIJ dysfunction cannot be concluded from our investigation due to small sample sizes. Future investigations should include a larger sample size to enhance our understanding of stiffness measurements obtained using VECDI, validate the technique, and determine the time-course of healing from SIJ surgical stabilization.

Marc Kegel, Misha Schmalian

We prove that for any non-trivial knot K, infinitely many r-surgeries K(r) along K have a unique surgery description along a knot. Moreover, we show that for any hyperbolic L-space knot K and infinitely many integer slopes n, the manifold K(n) has a unique surgery description. Here we say a 3-manifold M has a unique surgery description along a knot in S^3 if there is a unique pair (K,r) of a knot K and a slope r such that M is orientation-preservingly diffeomorphic to K(r). This generalises the notion of characterising slopes. Conversely, we provide new families of manifolds with several distinct surgery descriptions along knots. More precisely, we construct for every non-zero integer m a knot K_m such that for any integer n, the manifold K_m(m+1/n) can also be obtained by surgery on another knot.

Kohei Ando, Satoshi Miyahara, Shuhei Hanada et al.

ABSTRACT Bone and soft tissue infections caused by biofilm-forming bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), remain a significant clinical challenge. While the control of local infection is necessary, systemic treatment is also required, and biofilm eradication is a critical target for successful management. Topical antibiotic treatments, such as antibiotic-loaded bone cement (ALBC), have been used for some time, and continuous local antibiotic perfusion therapy, a less invasive method, has been developed by our group. However, the optimal antibiotics and concentrations for biofilms of clinical isolates are still not well understood. We examined the efficacy of high concentrations of gentamicin against MRSA biofilms and the role of gentamicin resistance genes in biofilm eradication. We collected 101 MRSA samples from a hospital in Japan and analyzed their gene properties, including methicillin and gentamicin resistance, and their minimum biofilm eradication concentration (MBEC) values. Our results showed that high concentrations of gentamicin are effective against MRSA biofilms and that even concentrations lower than the MBEC value could eliminate biofilms after prolonged exposure. We also identified three aminoglycoside/gentamicin resistance genes [aac(6′)-aph(2″), aph(3′)-III, and ant(4′)-IA] and found that the presence or absence of these genes may inform the selection of treatments. It was also found that possession of the aac(6′)-aph(2″) gene correlated with the minimum inhibitory concentration/MBEC values of gentamicin. Although this study provides insight into the efficacy of gentamicin against MRSA biofilms and the role of gentamicin resistance genes, careful selection of the optimal treatment strategy is needed for clinical application.IMPORTANCEOur analysis of 101 MRSA clinical isolates has provided valuable insights that could enhance treatment selection for biofilm infections in orthopedics. We found that high concentrations of gentamicin were effective against MRSA biofilms, and even prolonged exposure to concentrations lower than the minimum biofilm eradication concentration (MBEC) value could eliminate biofilms. The presence of the aac(6′)-aph(2″) gene, an aminoglycoside resistance gene, was found to correlate with the minimum inhibitory concentration (MIC) and MBEC values of gentamicin, providing a potential predictive tool for treatment susceptibility. These results suggest that extended high concentrations of local gentamicin treatment could effectively eliminate MRSA biofilms in orthopedic infections. Furthermore, testing for gentamicin MIC or the possession of the aac(6′)-aph(2″) gene could help select treatment, including topical gentamicin administration and surgical debridement.

Dong Wang, Wenzhe Chen, Jiali Chen et al.

In individuals afflicted with hemophilia, characterized by a deficiency of coagulation factor VIII (FVIII), the occurrence of spontaneous recurrent intra-articular hemorrhage precipitates the emergence of hemophilic arthropathy (HA). Although clotting factor replacement therapy reduces joint bleeding clinically, clotting factors need to be injected frequently due to the rapid diffusion of the drug. Hence, a novel drug delivery approach may be developed to improve the drug therapy. Platelet-derived extracellular vesicles (PEVs) are known to possess anti-inflammatory and hemostatic properties and could be used as a potential HA therapy. In this study, we constructed a PEV-LS@FVIII nanotherapeutic system by combining thioketal (TK), liposomes (LS), and FVIII to form the LS@FVIII complexes, and then hybridizing PEV with LS@FVIII. Our results demonstrated that PEV-LS@FVIII could efficiently facilitate FVIII delivery and specifically target the injured knee joint. Both in vitro and in vivo studies showed a reduction in the M1 phenotype of macrophages and an enhancement of the M2 phenotype, compared to FVIII free control. Furthermore, PEV-LS@FVIII appeared to alleviate HA-induced cartilage damage. In conclusion, our findings demonstrate that PEV-LS@FVIII could delay the progression of HA by targeting bleeding joints, modulating macrophage polarization to suppress inflammation, and mitigating cartilage damage.

Umile Giuseppe Longo, Alessandro Mazzola, Stefano Campi et al.

<i>Background and Objectives:</i> Knee osteoarthritis is a serious burden for modern countries. Timing of surgery and treatment choice are still a matter of controversy in the orthopedic literature. The purpose of this study was to ascertain the incidence and hospitalization trends of high tibial osteotomy in Italy from 2001 to 2016. <i>Materials and Methods:</i> Data are sourced from the National Hospital Discharge Reports (SDO) of the Italian Ministry of Health between 2001 and 2016. <i>Results:</i> A total of 34,402 high tibial osteotomies were performed over the study period in Italy. The cumulative incidence was 3.6 cases per 100,000 residents. The age classes 50–54, 55–59 showed the higher number of procedures. In pediatric patients (0–19 years), high tibial osteotomies are also largely performed. The majority of patients having surgery were men with a M/F ratio of 1.5. The mean age of patients was 44.2 ± 19.2 years. Males were significantly younger than females (43.3 ± 20.7 vs. 45.6 ± 17.7). The average length of hospitalization was 6.1 ± 7.3 days. Over the course of the analysis, a declining trend in hospital stay length was seen. The main primary diagnosis codes were “Varus knee” (736.42 ICD-9-CM code, 33.9%), “Osteoarthrosis, localized, primary, leg region” (715.16 ICD-9-CM code, 9.5%). <i>Conclusions:</i> Over the study period, high tibial osteotomies in Italy almost halved. Varus deformity and knee osteoarthritis are the leading causes requiring high tibial osteotomy. Except for the pediatric setting, results showed that from the 20–24 age class to the 50–54 age class, there was an increasing request for knee osteotomy, whereas in those aged >60 years, the incidence progressively decreased. The evident decline in HTO performed over the years in Italy seems to reflect a minor role for knee osteotomy in the management of knee OA, as it seems to be primarily reserved for younger male patients.

Steven M. Hadley BA, John J. Peabody MD, Sarah Westvold MPH et al.

Category: Ankle; Trauma Introduction/Purpose: It remains unclear whether ankle fracture pattern as described by the Weber classification—a reproducible method describing the level of fracture with respect to the distal tibiofibular syndesmosis—impacts outcomes. Patient Reported Outcome Measurement Information System (PROMIS) is a validated measure of outcomes after foot and ankle surgery. To our knowledge, no study has compared PROMIS scores between Weber subtypes. Our study thus examines whether Weber fracture subtype impacts surgical outcomes as measured by PROMIS scores. We hypothesize that both Weber B and Weber C fracture patterns will not have a significant difference in PROMIS scores when anatomically reduced during operative repair. This study is the largest evaluating PROMIS scores of Weber fracture subtypes. Methods: All 782 patients who underwent surgical repair of an ankle fracture at Northwestern between January 1, 2016 and December 31, 2021 were retrospectively reviewed. Two foot and ankle fellowship trained orthopedic surgeons independently reviewed all radiographs and stratified them by Weber fracture subtype, fixation technique, and reduction quality at final follow-up. Patients with multiple injuries at time of presentation, pilon variants, and who identified as a part of vulnerable populations were excluded. Of the 703 patients included, 218 completed a post-operative PROMIS physical function (PF) and pain interference (PI) computerized adaptive test. Subsequently, only the 200 closed Weber B and Weber C fractures were included for final analysis. The Mann-Whitney U test was used to compare differences in PROMIS scores. The Kruskal-Wallis test was used when comparisons were between three or more groups. Results: No significant difference existed between Weber B and Weber C fractures anatomically reduced intraoperatively in terms of mean PF (52.19 ± 9.84 vs. 53.59 ± 9.46, p=0.52) and PI (48.30 ± 8.74 vs. 46.77 ± 7.86, p=0.33). Analysis of those with anatomic reduction at minimum one-year follow-up found no significant difference between Weber B’s and Weber C’s with regard to mean PF (51.46 ± 9.97 vs. 53.67 ± 9.51, p=0.32) and PI (47.76 ± 9.15 vs. 47.68 ± 7.75, p=0.67). Compared to lower BMIs, BMIs of 30 or greater had significantly worse mean PF (p=0.02) and PI (p=0.01). Compared to males, females had worse mean PF (49.88 ± 7.99 vs. 57.92 ± 10.78, p< 0.001) and PI (49.10 ± 8.56 vs. 45.54 ± 8.03, p< 0.01). Conclusion: Weber classification remains a reliable method for categorizing fracture subtypes. We can conclude that anatomic reduction and fixation can return patients with both Weber C and Weber B fractures back to population mean functional outcomes. Although Weber C fractures with known syndesmotic injury result in larger soft tissue trauma, anatomic surgical reduction and fixation can achieve equivalent outcomes to patients with lower energy Weber B fractures. BMI, sex, and age affect functional outcomes following operative repair and may help surgeons guide patient expectations during recovery.

Aliakbar Daemi, Mike Miller Eismeier, Tye Lidman

The cosmetic surgery conjecture predicts that for a non-trivial knot in the three-sphere, performing two different Dehn surgeries results in distinct oriented three-manifolds. Hanselman reduced the problem to $\pm 2$ or $\pm 1/n$ surgeries being the only possible cosmetic surgeries. We remove the case of $\pm 1/n$-surgeries using the Chern-Simons filtration on Floer's original irreducible-only instanton homology, reducing the conjecture to the case of $\pm 2$ surgery on genus $2$ knots with trivial Alexander polynomial. We also prove some similar results for surgeries on knots in $S^2 \times S^1$. As key steps in establishing these results, we define invariants of the oriented homeomorphism type of three-manifolds derived from filtered instanton Floer homology and introduce a new surgery relationship for Floer's instanton homology.

Anjana Wijekoon, Adrito Das, Roxana R. Herrera et al.

Accurate intra-operative Remaining Surgery Duration (RSD) predictions allow for anaesthetists to more accurately decide when to administer anaesthetic agents and drugs, as well as to notify hospital staff to send in the next patient. Therefore RSD plays an important role in improving patient care and minimising surgical theatre costs via efficient scheduling. In endoscopic pituitary surgery, it is uniquely challenging due to variable workflow sequences with a selection of optional steps contributing to high variability in surgery duration. This paper presents PitRSDNet for predicting RSD during pituitary surgery, a spatio-temporal neural network model that learns from historical data focusing on workflow sequences. PitRSDNet integrates workflow knowledge into RSD prediction in two forms: 1) multi-task learning for concurrently predicting step and RSD; and 2) incorporating prior steps as context in temporal learning and inference. PitRSDNet is trained and evaluated on a new endoscopic pituitary surgery dataset with 88 videos to show competitive performance improvements over previous statistical and machine learning methods. The findings also highlight how PitRSDNet improve RSD precision on outlier cases utilising the knowledge of prior steps.

Gonzalo de Cabo, M.D., Nuria Álvarez-Benito, M.D., Pablo Ramos-Murillo, M.D. et al.

Several arthroscopic techniques to treat anterior shoulder instability have been described. Bankart repair may be insufficient in cases with some degree of bone loss, and arthroscopic Latarjet is technically challenging. It is not rare to find at the time of surgery a more extensive labral tear (SLAP lesion) or an insufficient anterior capsulolabral tissue. We describe for those cases a dynamic anterior stabilization where using the long head of the biceps we are treating the SLAP lesion and at the same time it provides the “sling effect” of a Latarjet procedure for the anterior instability.

Harshini Suresh Kumar, Edwina N. Barnett, John L. Fowlkes et al.

ABSTRACT Diabetes is a chronic metabolic disorder that can lead to diabetic myopathy and bone diseases. The etiology of musculoskeletal complications in such metabolic disorders and the interplay between the muscular and osseous systems are not well understood. Exercise training promises to prevent diabetic myopathy and bone disease and offer protection. Although the muscle‐bone interaction is largely biomechanical, the muscle secretome has significant implications for bone biology. Uncoupling effects of biophysical and biochemical stimuli on the adaptive response of bone during exercise training may offer therapeutic targets for diabetic bone disease. Here, we have developed an in vitro model to elucidate the effects of mechanical strain on myokine secretion and its impact on bone metabolism decoupled from physical stimuli. We developed bone constructs using cross‐linked gelatin, which facilitated osteogenic differentiation of osteoprogenitor cells. Then muscle constructs were made from fibrin, which enabled myoblast differentiation and myotube formation. We investigated the myokine expression by muscle constructs under strain regimens replicating endurance (END) and high‐intensity interval training (HIIT) in hyperglycemic conditions. In monocultures, both regimens induced higher expression of Il15 and Igf1, whereas END supported more myoblast differentiation and myotube maturation than HIIT. When co‐cultured with bone constructs, HIIT regimen increased Glut4 expression in muscle constructs more than END, supporting higher glucose uptake. Likewise, the muscle constructs under the HIIT regimen promoted a healthier and more matured bone phenotype than END. Under static conditions, myostatin (Mstn) expression was significantly downregulated in muscle constructs co‐cultured with bone constructs compared with monocultures. Together, our in vitro co‐culture system allowed orthogonal manipulation of mechanical strain on muscle constructs while facilitating bone‐muscle biochemical cross‐talk. Such systems can provide an individualized microenvironment that allows decoupled biomechanical manipulation, help identify molecular targets, and develop engineered therapies for metabolic bone disease. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.

Robert Haslhofer

In this paper, we prove the existence of mean curvature flow with surgery for mean-convex surfaces with free boundary. To do so, we implement our recent new approach for constructing flows with surgery without a prior estimates in the free boundary setting. The flow either becomes extinct in finite time or for $t\to\infty$ converges smoothly in the one or two sheeted sense to a finite collection of stable connected minimal surfaces with empty or free boundary (in particular, there are no surgeries for $t$ sufficiently large). Our free boundary flow with surgery will be applied in forthcoming work with Ketover, where we will address the existence problem for $3$ free boundary minimal disks in convex balls.

Robert Haslhofer

In this paper, we introduce a new method to establish existence of geometric flows with surgery. In contrast to all prior constructions of flows with surgery in the literature our new approach does not require any a priori estimates in the smooth setting. Instead, our approach is based on a hybrid compactness theorem, which takes smooth limits near the surgery regions but weak limits in all other regions. For concreteness, here we develop our new method in the classical setting of mean-convex surfaces in $\mathbb{R}^3$, thus giving a new proof of the existence results due to Brendle-Huisken and Haslhofer-Kleiner. Other settings, including in particular free boundary surfaces, will be addressed in subsequent work.

Amanda N. Fletcher MD, MS, Lindsey G. Johnson MBA, Mark E. Easley MD et al.

Category: Ankle Arthritis; Ankle; Hindfoot Introduction/Purpose: The utilization of total ankle arthroplasty (TAA) has increased over the past decade to include bilateral TAAs. The risk-benefit profiles of simultaneous versus staged joint arthroplasty continues to be debated in the literature. There are limited case series reporting outcomes after bilateral TAA with no previous comparison of simultaneous versus staged TAA. It is important to study patients with bilateral pathology as they represent a unique population often with a differing arthritis etiology and an overall more debilitating condition. Thus, we aim to compare bilateral simultaneous versus staged TAAs including perioperative complications and patient reported outcome measures (PROMs). Methods: We performed a comparative cohort study of patients who underwent primary TAA from 2007 to 2019 at a single academic center. Inclusion criteria were primary bilateral TAA performed in simultaneous or staged fashion in patients over 18 years of age. Exclusion criteria were patients with less than two-years follow-up and those with previous tibiotalar arthrodesis or infection. Patient demographics, comorbidities, perioperative complications, and PROMs were collected. PROMs included preoperative and postoperative visual analog scale (VAS) for pain, the Short Form-36 (SF-36) Health Survey, the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Short Musculoskeletal Function Assessment (SMFA) bother and function sub-scores. Bivariate tests of significance were used to compare variables between the two cohorts. Results: Fifty patients were included with an average clinical follow-up was 52.2 (+-27.3; range 24-109) months. The mean time between staged TAA surgeries was 17.5 months (+-20.1, range 3-74). The mean age was 64.3 (+-10.6, range 21-76) years with 32 (64.0%) men. Many patients had primary osteoarthritis (n=28, 56.0%). Both cohorts experienced improvement in all PROMs at one year, which were maintained at final follow-up with no significant between-group differences (p >0.05). There were no differences in perioperative complication rates with similar overall complications (22.0% vs. 24.0%; p=0.7788) and reoperations (6.0% vs 5.0%; p=0.7354) between the simultaneous and staged cohorts, respectively. The two-year and five-year reoperation-free survival were 96.0% and 90.0% for the staged cohort and 94.0% and 88.0% for the simultaneous cohort, respectively (p=0.4612) Both cohorts had 100% failure-free survival up to eight-years postoperative. One patient in the simultaneous cohort required metal component revision at eight years postoperative. Conclusion: The results of bilateral simultaneous TAA, including patient reported outcomes, perioperative complications, and component survival are comparable to patients undergoing staged TAA. When performed under surgeon expertise in appropriately selected patients, we advocate that simultaneous bilateral TAA is a safe and effective method for the treatment of bilateral end-stage ankle osteoarthritis. Potential benefits of simultaneous TAA warranting further investigation include decreased anesthesia events, surgery time, tourniquet time, length of hospitalization, recovery and rehabilitation time, and overall cost. Future investigations will include dedicated analyses of radiographic outcomes and cost comparisons between these two cohorts.

Pak-Cheong Ho, Josephine M-W Wong, Wai-Wang Chau et al.

Introduction: Children with physical disabilities are less likely to access music and arts due to their extremity anomalies. “Budding Well” is a non-conventional rehabilitation program providing music and arts courses for the targeted participants. The program has run through the third year and a review of the service outcomes has been sorted. Materials and methods: Aged 6–18 years with different kinds and degrees of limb dysfunctions were invited to join the program. The course consisted of 10 learning classes on playing harmonica (music) or painting (arts). Functional assessments [Bruininks-Oseretsky-Test-of-Motor- Proficiency second edition (BOT-2) and Grip-and-pinch strength] and psychosocial centric questionnaires [Lyubomirsky and Lepper’s Subjective Happiness Scale (SHS), Well-being Index (WHO-5), and Culture-free Self-esteem Inventory-2 (CFESI-2) Form A] were performed and completed at the first and last (10th) class. Program evaluation questionnaire was filled at the last class. Results: Thirty-five participants (male = 20, female = 15) of mean age 8.65 joined the program. Functional assessments and psychosocial centric questionnaire outcomes except CFESI-2 did not show any statistical difference. Age sensitivity testing in CFESI-2 Social domain score showed the best result when cut-off age was at 10.5 (<italic>p</italic> = 0.04) and this cut-off value was further proved by receiver operating characteristic (ROC) analysis (<italic>p</italic> < 0.01). On subjective evaluation, parents noticed a significant improvement in the hand function of their children (<italic>p</italic>= 0.01). Conclusion: Hand functions and psychosocial skills of children and teenagers with different levels of physical disabilities or disfigurement proved to benefit from our program through music and arts. Participants of age at 10.5 best responded to the program, particularly on the significant improvement in self-esteem.

Tyler J. Gregory, P.T., D.P.T., Samuel A. Rauchwarter, P.T., D.P.T., S.C.S., Michael D. Feldman, M.D.

Dry needling is most commonly used in the subacute and chronic phases of an injury; therefore, it is imperative to understand the use of dry needling in the acute phases of an injury. There are four main reasons to use dry needling during the acute phase of injury: to relieve pain, decrease edema, increase range of motion and flexibility, and increase strength and power. Dry needling can be used pregame, postgame, during half time or an intermission, or following an injury. Although further research is needed, acute dry needling can be used to bolster athletes’ health and possibly improve sports performance.

Derrick M. Knapik, Varun Gopinatth, Garrett R. Jackson et al.

Abstract Purpose In the setting of persistent instability or failed non‐operative management, surgical reconstruction is commonly recommended for isolated posterior cruciate ligament (PCL) tears. The purpose of this study was to systematically review published studies to evaluate regional variation in the epidemiology of and surgical approaches to primary, isolated PCL reconstruction. Methods A systematic review was performed in June 2022 to identify studies examining operative techniques during primary, isolated PCL reconstruction. Collected variables consisted of reconstruction technique, graft type, graft source, tibial reconstruction technique, femoral and tibial drilling and fixation methods, and whether the remnant PCL was preserved or debrided. Studies were classified into four global regions: Asia, Europe, North America, and South America. Results Forty‐five studies, consisting of 1461 total patients, were identified. Most of the included studies were from Asia (69%, n = 31/45). Single bundle reconstruction was more commonly reported in studies out of Asia, Europe, and North America. Hamstring autografts were utilized in 51.7% (n = 611/1181) of patients from Asia and 60.8% (n = 124/204) of patients from Europe. Trans‐tibial drilling and outside‐in femoral drilling were commonly reported in all global regions. The PCL remnant was generally debrided, while remnant preservation was commonly reported in studies from Asia. Conclusion Surgical treatment of isolated PCL injuries varies by region, with the majority of published studies coming from Asia. Single‐bundle reconstruction with hamstring autograft through a trans‐tibial approach is the most commonly reported technique in the literature, with males reported to undergo isolated reconstruction more often than females. Level of Evidence Systematic review, Level IV.

Federico Salmoiraghi

We introduce a generalization of Goodman surgery to the category of projectively Anosov flows. This construction is performed along a knot that is simultaneously Legendrian and transverse for a supporting bi-contact structure. If the flow is Anosov there is a particular class of supporting bi-contact structures that induce Lorentzian metrics satisfying Barbot's criterion of hyperbolicity. Foulon and Hasselblatt construct new contact Anosov flows by surgery from a geodesic flow. We generalize their result showing that in any contact Anosov flow there is a family of Legendrian knots that can be used to produce new contact Anosov flows by surgery. Outside of the realm of Anosov flows we generate new examples of projectively Anosov flows on hyperbolic 3-manifolds. These flows contain an invariant submanifold of genus g>0. We also give some application to contact geometry: we interpret the bi-contact surgery in terms of classic contact-Legendrian surgery and admissible-inadmissible transverse surgery and we deduce some (hyper)tightness result for contact and transverse surgeries.

Balázs Kovács

A numerical algorithm for mean curvature flow of closed mean convex surfaces with surgery is proposed. The method uses a finite element based mean curvature flow algorithm based on a coupled partial differential equation system which directly provides an approximation for mean curvature and outward unit normal. The proposed numerical surgery process closely follows the analytical surgery of Huisken \& Sinestrari, and Brendle \& Huisken. The numerical surgery approach is described in detail, along with extensions to other geometric flows and methods. Numerical experiments report on the performance of the numerical surgery process.

Lucas Beckers, Thiago Vivacqua, Andrew D. Firth et al.

Abstract Purpose The purpose of this investigation was to systematically review the contemporary literature to determine if a lateral augmentation (LA) added to an Anterior Cruciate Ligament Reconstruction (ACLR) provides better clinical and patient reported outcomes compared to an isolated ACLR. Methods A systematic review and meta‐analysis was performed according to the Preferred Reporting Items for Systematic reviews and Meta‐analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE® and Embase® on February 6th, 2021 for level I‐III randomized controlled trials (RCT) and prospective cohort studies without randomization, published after 2012 and with a minimum of two year follow‐up. Publications were included when they reported on the objective knee stability examination, patient reported outcome scores, return to sports or graft rupture rate of any type of primary, isolated ACLR compared to ACLR combined with any type of LA. Results A total of 11 studies that reported on a combined total of 1892 unique patients were eligible for data extraction, including five RCTs and six prospective cohort studies. In 6 studies, an Anterolateral Ligament reconstruction (ALLR) was the LA of choice, while the 5 other publications used different types of Lateral Extra‐articular Tenodesis (LET). A significant reduction in graft ruptures was found in patients treated with ACLR + LA (3%) compared to isolated ACLR (12%). Rotational laxity was significantly higher in isolated ACLR (14%) compared to ACLR + LA (6%). Addition of a LA reduced anterior translation when assessed via instrumented laxity testing. No significant difference was found in the patient reported outcome scores (IKDC and Tegner) between both patient groups, except for the Lysholm Score which was significant in favour of the ACLR + LA group. Conclusion Combination of a primary ACLR with a LA can significantly reduce the risk of graft rupture and provide better rotatory stability, without jeopardizing patient reported outcomes. Level of evidence Level III, Systematic Review of Level I, II and III studies.