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  • 1
    Online Resource
    Online Resource
    Laparosonic Coagulating Shears: Alternative Method of Hemostatic Control of Unsupported Tissue
    Mary Ann Liebert Inc ; 1996
    In:  Journal of Endourology Vol. 10, No. 5 ( 1996-10), p. 431-433
    Details
    In: Journal of Endourology, Mary Ann Liebert Inc, Vol. 10, No. 5 ( 1996-10), p. 431-433
    Type of Medium: Online Resource
    ISSN: 0892-7790 , 1557-900X
    URL: Article
    DOI: 10.1089/end.1996.10.431
    Language: English
    Publisher: Mary Ann Liebert Inc
    Publication Date: 1996
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  • 2
    Online Resource
    Online Resource
    Effects of Initial Graft Tension and Patient Sex on Knee Osteoarthritis Outcomes After ACL Reconstruction: A Randomized Controlled Clinical Trial With 10- to 12-Year Follow-up
    SAGE Publications ; 2022
    In:  The American Journal of Sports Medicine Vol. 50, No. 13 ( 2022-11), p. 3510-3521
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 50, No. 13 ( 2022-11), p. 3510-3521
    Abstract: The initial graft tension applied during anterior cruciate ligament (ACL) graft fixation may promote posttraumatic osteoarthritis (PTOA). Purpose/Hypothesis: This study sought to assess the effect of initial graft tension and patient sex on PTOA outcomes at 10 to 12 years after ACL reconstruction (ACLR). The hypothesis was that there would be no group- or sex-based differences in outcomes. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients were randomized to receive ACLR with a low or high initial graft tension. Outcomes were evaluated at 10 to 12 years postoperatively and compared with a matched, uninjured control group. Outcomes included clinical assessments (anteroposterior [AP] knee laxity measurement, International Knee Documentation Committee [IKDC] examination score), a functional assessment (single-leg hop for distance), patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score [KOOS], 36-Item Short Form Health Survey, Tegner activity level, patient satisfaction), and PTOA imaging (Osteoarthritis Research Society International [OARSI] radiographic score and Whole-Organ Magnetic Resonance Imaging Score [WORMS]). Two-way mixed-model analyses of variance were used to evaluate differences in outcomes between tension groups and the control group and between female and male patients. Results: Both tension groups scored worse than the control group for the IKDC examination ( P≤ .021), KOOS (Pain, Activities of Daily Living, Sport/Recreation, and Quality of Life subscales) ( P≤ .049), and WORMS difference score ( P≤ .042). The low-tension group scored worse than the control group for KOOS Symptoms ( P = .016) and the OARSI difference score ( P = .015). The index limb had worse scores than the contralateral limb within the high-tension group for AP laxity ( P = .030) and hop deficit ( P = .011). This result was also observed within both tension groups for the WORMS ( P≤ .050) and within the low-tension group for the OARSI score ( P = .001). Male patients had higher Tegner scores (mean ± SE) relative to female patients (male, 5.49 ± 1.88; female, 4.45 ± 1.65) and worse OARSI difference scores (male, 1.89 ± 5.38; female, 0.244 ± 0.668) ( P = .007 and .034, respectively). However, no significant differences were detected between tension groups for any of the outcomes measured. Conclusion: Overall, ACLR failed to prevent PTOA regardless of initial graft tension. However, male patients treated with a low initial graft tension may be at greater risk for PTOA. These results do not support the hypothesis of no sex differences in outcomes at 10 to 12 years after ACLR.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465221124917
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 197482-8
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 3
    Online Resource
    Online Resource
    Preoperative Risk Factors for Subsequent Ipsilateral ACL Revision Surgery After an ACL Restoration Procedure
    SAGE Publications ; 2023
    In:  The American Journal of Sports Medicine Vol. 51, No. 1 ( 2023-01), p. 49-57
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 51, No. 1 ( 2023-01), p. 49-57
    Abstract: Anterior cruciate ligament (ACL) revision surgery is challenging for both patients and surgeons. Understanding the risk factors for failure after bridge-enhanced ACL restoration (BEAR) may help with patient selection for ACL restoration versus ACL reconstruction. Purpose: To identify the preoperative risk factors for ACL revision surgery within the first 2 years after BEAR. Study Design: Case-control study; Level of evidence, 3. Methods: Data from the prospective BEAR I, II, and III trials were used to determine the preoperative risk factors for ACL revision surgery. All patients with a complete ACL tear (aged 13-47 years, depending on the trial), who met all other inclusion/exclusion criteria and underwent a primary BEAR procedure within 30 to 50 days from the injury (dependent on the trial), were included. Demographic data (age, sex, body mass index), baseline patient-reported outcomes (International Knee Documentation Committee [IKDC] subjective score, Marx activity score), preoperative imaging results (ACL stump length, notch size, tibial slope), and intraoperative findings (knee hyperextension, meniscal status) were evaluated to determine their contribution to the risk of ipsilateral ACL revision surgery. Results: A total of 123 patients, with a median age of 17.6 years (interquartile range, 16-23 years), including 67 (54%) female patients, met study criteria. Overall, 18 (15%) patients required ACL revision surgery in the first 2 years after the BEAR procedure. On bivariate analyses, younger age ( P = .011), having a contact injury at the time of the initial tear ( P = .048), and increased medial tibial slope (MTS; P = .029) were associated with a higher risk of ipsilateral revision surgery. Multivariable logistic regression analyses identified 2 independent predictors of revision: patient age and MTS. The odds of ipsilateral revision surgery were decreased by 32% for each 1-year increase in age (odds ratio, 0.684 [95% CI, 0.517-0.905]; P = .008) and increased by 28% for each 1° increase in MTS (odds ratio, 1.280 [95% CI, 1.024-1.601] ; P = .030). Sex, baseline IKDC or Marx score, knee hyperextension, and meniscal status were not significant predictors of revision. Conclusion: Younger age and higher MTS were predictors of ipsilateral ACL revision surgery after the BEAR procedure. Younger patients with higher tibial slopes should be aware of the increased risk for revision surgery when deciding to undergo ACL restoration.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465221137873
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
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    SSG: 31
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  • 4
    Online Resource
    Online Resource
    Reproducibility and postacquisition correction methods for quantitative magnetic resonance imaging of the anterior cruciate ligament (ACL)
    Wiley ; 2022
    In:  Journal of Orthopaedic Research Vol. 40, No. 12 ( 2022-12), p. 2908-2913
    Details
    In: Journal of Orthopaedic Research, Wiley, Vol. 40, No. 12 ( 2022-12), p. 2908-2913
    Abstract: Quantitative magnetic resonance imaging has been used to evaluate the structural integrity of knee joint structures. However, variations in acquisition parameters between scanners pose significant challenges. Understanding the effect of small differences in acquisition parameters for quantitative sequences is vital to the validity of cross‐institutional studies, and for the harmonization of large, heterogeneous datasets to train machine learning models. The study objective was to assess the reproducibility of T 2 * relaxometry and the constructive interference in steady‐state sequence (CISS) across scanners, with minimal hardware‐necessitated changes to acquisition parameters. It was hypothesized that there would be no significant differences between scanners in anterior cruciate ligament T 2 * relaxation times and CISS signal intensities (SI). Secondarily, it was hypothesized that differences could be corrected by rescaling the SI distribution to harmonize between scanners. Seven volunteers were scanned on 3T Prisma and Tim Trio scanners (Siemens). Three correction methods were evaluated for T 2 *: inverse echo time scaling, z ‐scoring, and Nyúl histogram matching. For CISS, scans were normalized to cortical bone, scaled by the background noise ratio, and log‐transformed. Before correction, significant mean differences of 6.0 ± 3.2 ms (71.8%;  p  = 0.02) and 0.49 ± 0.15 units (40.7%; p  = 0.02) for T 2 * and CISS across scanners were observed, respectively. After rescaling, T 2 * differences decreased to 2.6 ± 2.7 ms (23.9%;  p  = 0.03), 1.3 ± 2.5 ms (10.9%;  p  = 0.13), and 1.27 ± 3.0 ms (19.6%;  p  = 0.40) for inverse echo time, z ‐scoring, and Nyúl, respectively, while CISS decreased to 0.01 ± 0.11 units (4.0%; p  = 0.87). These findings suggest that small acquisition parameter differences may lead to large changes in T 2 * and SI values that must be reconciled to compare data across magnets.
    Type of Medium: Online Resource
    ISSN: 0736-0266 , 1554-527X
    URL: Issue
    URL: Article
    DOI: 10.1002/jor.v40.12
    DOI: 10.1002/jor.25319
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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    detail.hit.zdb_id: 2050452-4
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  • 5
    Online Resource
    Online Resource
    Direct Retroperitoneoscopic Adrenalectomy in the Porcine Model
    Mary Ann Liebert Inc ; 1995
    In:  Journal of Laparoendoscopic Surgery Vol. 5, No. 6 ( 1995-12), p. 385-388
    Details
    In: Journal of Laparoendoscopic Surgery, Mary Ann Liebert Inc, Vol. 5, No. 6 ( 1995-12), p. 385-388
    Type of Medium: Online Resource
    ISSN: 1052-3901
    URL: Article
    DOI: 10.1089/lps.1995.5.385
    Language: English
    Publisher: Mary Ann Liebert Inc
    Publication Date: 1995
    detail.hit.zdb_id: 1077427-0
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  • 6
    Online Resource
    Online Resource
    Quantitative MRI Biomarkers to Predict Risk of Reinjury Within 2 Years After Bridge-Enhanced ACL Restoration
    SAGE Publications ; 2023
    In:  The American Journal of Sports Medicine Vol. 51, No. 2 ( 2023-02), p. 413-421
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 51, No. 2 ( 2023-02), p. 413-421
    Abstract: Quantitative magnetic resonance imaging (qMRI) methods were developed to establish the integrity of healing anterior cruciate ligaments (ACLs) and grafts. Whether qMRI variables predict risk of reinjury is unknown. Purpose: To determine if qMRI measures at 6 to 9 months after bridge-enhanced ACL restoration (BEAR) can predict the risk of revision surgery within 2 years of the index procedure. Study Design: Cohort study; Level of evidence, 2. Methods: Originally, 124 patients underwent ACL restoration as part of the BEAR I, BEAR II, and BEAR III prospective trials and had consented to undergo an MRI of the surgical knee 6 to 9 months after surgery. Only 1 participant was lost to follow-up, and 4 did not undergo MRI, leaving a total of 119 patients for this study. qMRI techniques were used to determine the mean cross-sectional area; normalized signal intensity; and a qMRI-based predicted failure load, which was calculated using a prespecified equation based on cross-sectional area and normalized signal intensity. Patient-reported outcomes (International Knee Documentation Committee subjective score), clinical measures (hamstring strength, quadriceps strength, and side-to-side knee laxity), and functional outcomes (single-leg hop) were also measured at 6 to 9 months after surgery. Univariate and multivariable analyses were performed to determine the odds ratios (ORs) for revision surgery based on the qMRI and non-imaging variables. Patient age and medial posterior tibial slope values were included as covariates. Results: In total, 119 patients (97%), with a median age of 17.6 years, underwent MRI between 6 and 9 months postoperatively. Sixteen of 119 patients (13%) required revision ACL surgery. In univariate analyses, higher International Knee Documentation Committee subjective score at 6 to 9 months postoperatively (OR = 1.66 per 10-point increase; P = .035) and lower qMRI-based predicted failure load (OR = 0.66 per 100-N increase; P = .014) were associated with increased risk of revision surgery. In the multivariable model, when adjusted for age and posterior tibial slope, the qMRI-based predicted failure load was the only significant predictor of revision surgery (OR = 0.71 per 100 N; P = .044). Conclusion: Quantitative MRI-based predicted failure load of the healing ACL was a significant predictor of the risk of revision within 2 years after BEAR surgery. The current findings highlight the potential utility of early qMRI in the postoperative management of patients undergoing the BEAR procedure.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465221142323
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
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    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 7
    Online Resource
    Online Resource
    Predicting anterior cruciate ligament failure load with T2* relaxometry and machine learning as a prospective imaging biomarker for revision surgery
    Springer Science and Business Media LLC ; 2023
    In:  Scientific Reports Vol. 13, No. 1 ( 2023-03-02)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2023-03-02)
    Abstract: Non-invasive methods to document healing anterior cruciate ligament (ACL) structural properties could potentially identify patients at risk for revision surgery. The objective was to evaluate machine learning models to predict ACL failure load from magnetic resonance images (MRI) and to determine if those predictions were related to revision surgery incidence. It was hypothesized that the optimal model would demonstrate a lower mean absolute error (MAE) than the benchmark linear regression model, and that patients with a lower estimated failure load would have higher revision incidence 2 years post-surgery. Support vector machine, random forest, AdaBoost, XGBoost, and linear regression models were trained using MRI T 2 * relaxometry and ACL tensile testing data from minipigs (n = 65). The lowest MAE model was used to estimate ACL failure load for surgical patients at 9 months post-surgery (n = 46) and dichotomized into low and high score groups via Youden’s J statistic to compare revision incidence. Significance was set at alpha = 0.05. The random forest model decreased the failure load MAE by 55% (Wilcoxon signed-rank test: p = 0.01) versus the benchmark. The low score group had a higher revision incidence (21% vs. 5%; Chi-square test: p = 0.09). ACL structural property estimates via MRI may provide a biomarker for clinical decision making.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-023-30637-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2615211-3
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