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Article ; Online: Return to Sport After Ulnar Collateral Ligament Tears Treated with Platelet-Rich Plasma Injections is Influenced by Length of Rehabilitation and Leukocyte Content of Injections: A Systematic Review.

Fucaloro, Stephen P / Kang, Alex S / Bragg, Jack T / Krivicich, Laura / Salzler, Matthew J

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association

2024

Abstract: Purpose: To analyze the current literature assessing return to sport (RTS) outcomes after platelet-rich plasma (PRP) injections for the nonoperative treatment of ulnar collateral ligament (UCL) injuries.: Methods: A systematic review of PubMed, ... ...

Abstract	Purpose: To analyze the current literature assessing return to sport (RTS) outcomes after platelet-rich plasma (PRP) injections for the nonoperative treatment of ulnar collateral ligament (UCL) injuries. Methods: A systematic review of PubMed, Embase, and Web of Science databases was conducted in June 2023 to identify studies assessing RTS after PRP injections for UCL injuries. Tear severity, leukocyte content of PRP, rehabilitation protocol, and RTS outcomes were collected. Heterogeneity was assessed through proportional random-effects models for RTS and return to preinjury level of play (RTLP) with subgroup analysis by rehabilitation length, leukocyte content of PRP, and tear severity. Results: Eight studies with 278 partial-thickness and 44 full-thickness tears were identified. The mean age of patients ranged from 17.3 to 26 years. The mean RTS time after injection ranged from 5.2 to 25.4 weeks. High heterogeneity was observed among studies, with RTS rates ranging from 46% to 100% (I Conclusions: Studies assessing RTS after PRP injections are highly heterogeneous; however, current data suggest nonoperative RTS and RTLP rates ranging from 46% to 100% and 34% to 100%, respectively. Studies with at least 12 weeks of rehabilitation and studies using leukocyte-poor PRP demonstrated low heterogeneity and greater RTS rates. Alternatively, high heterogeneity was observed among both partial- and full-thickness tears. Level of evidence: Level IV, systematic review of Level III-IV studies.
Language	English
Publishing date	2024-03-18
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	632528-2
ISSN	1526-3231 ; 0749-8063
ISSN (online)	1526-3231
ISSN	0749-8063
DOI	10.1016/j.arthro.2024.03.017
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Article: Intrasubstance Patellar Tendon Repair with the Addition of a Bio-inductive Implant.

Bragg, Jack T / Shields, Margaret V / Salzler, Matthew J

Arthroscopy techniques

2022 Volume 12, Issue 1, Page(s) e11–e15

Abstract: Intrasubstance patellar tendon ruptures are an uncommon injury that can have devastating long-term effects for patients. Operative intervention to repair the ruptured tendon is the gold standard treatment for these injuries and can be performed using a ... ...

Abstract	Intrasubstance patellar tendon ruptures are an uncommon injury that can have devastating long-term effects for patients. Operative intervention to repair the ruptured tendon is the gold standard treatment for these injuries and can be performed using a variety of techniques. Unlike the more common patellar tendon ruptures at the level of the patella, repairs of intrasubstance ruptures are often challenging because of the poor quality of the remaining tendon fibers. Tendon repair with augmentation via bio-inductive implants has gained popularity in upper extremity literature, as it has demonstrated improved tendon strength and patient outcomes. However, there remains a sparsity of reports regarding tendon augmentation in the lower extremity literature. Here, we describe repair of an intrasubstance patellar tendon rupture using a modified SpeedBridge repair and augmentation with a bio-inductive implant.
Language	English
Publishing date	2022-12-21
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2653101-X
ISSN	2212-6287
ISSN	2212-6287
DOI	10.1016/j.eats.2022.08.051
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Article ; Online: Is Patellar Instability a Contraindication to Semiextended Tibial Nailing?: A Case Report.

Ray, Gabrielle S / Leroy, Taryn E / Ryan, Scott P / Bragg, Jack T / Salzler, Matthew J

JBJS case connector

2023 Volume 13, Issue 2

Abstract: Case: We report a 40-year-old woman with undiagnosed patellofemoral instability that worsened 8 months after intramedullary nailing of a distal left tibia fracture in the semiextended position through a partial medial parapatellar approach. Patella ... ...

Abstract	Case: We report a 40-year-old woman with undiagnosed patellofemoral instability that worsened 8 months after intramedullary nailing of a distal left tibia fracture in the semiextended position through a partial medial parapatellar approach. Patella stability and asymptomatic knee function were restored after IM nail removal, medial patellofemoral ligament repair, and left tibial tubercle transposition. Conclusion: The optimal surgical approach for tibial IM nailing in patients with chronic patellar instability has not been described. Clinicians should be cognizant of the potential for worsening patellofemoral instability in these patients when using the medial parapatellar approach in the semiextended position.
MeSH term(s)	Female ; Humans ; Adult ; Tibia/surgery ; Fracture Fixation, Intramedullary ; Joint Instability/surgery ; Patellofemoral Joint/diagnostic imaging ; Patellofemoral Joint/surgery ; Bone Nails ; Tibial Fractures/complications ; Tibial Fractures/diagnostic imaging ; Tibial Fractures/surgery ; Ankle Fractures ; Contraindications
Language	English
Publishing date	2023-04-18
Publishing country	United States
Document type	Case Reports ; Journal Article
ISSN	2160-3251
ISSN (online)	2160-3251
DOI	e20.00261
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Article ; Online: Heterotopic Ossification After Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft: A Case Report.

Bragg, Jack T / Hayes-Lattin, Madison / Shields, Margaret V / Salzler, Matthew J

JBJS case connector

2022 Volume 12, Issue 4

Abstract: Case: A 32-year-old healthy woman tore her right anterior cruciate ligament (ACL) and underwent reconstruction with quadriceps tendon autograft. Twelve weeks postoperatively, she had anterior thigh pain limiting knee flexion and a palpable mass in the ... ...

Abstract	Case: A 32-year-old healthy woman tore her right anterior cruciate ligament (ACL) and underwent reconstruction with quadriceps tendon autograft. Twelve weeks postoperatively, she had anterior thigh pain limiting knee flexion and a palpable mass in the anterior thigh. Imaging revealed a calcified mass near the graft site, concerning for heterotopic ossification (HO). After maturation of the heterotopic bone, she underwent debridement and HO removal. Conclusion: This is a case of HO at the quadriceps tendon autograft site after ACL reconstruction. When counseling patients, clinicians should be mindful of this possible complication and its treatment.
MeSH term(s)	Female ; Humans ; Adult ; Autografts ; Anterior Cruciate Ligament Injuries/surgery ; Tendons/transplantation ; Anterior Cruciate Ligament Reconstruction/adverse effects ; Ossification, Heterotopic/surgery
Language	English
Publishing date	2022-11-23
Publishing country	United States
Document type	Case Reports ; Journal Article
ISSN	2160-3251
ISSN (online)	2160-3251
DOI	e22.00445
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Article ; Online: Subjective Outcomes After Allograft Reconstruction and Nonoperative Treatment of Anterior Cruciate Ligament Ruptures Are Similar in Patients Aged 40 Years and Older: A 2:1 Propensity Score-Matched Analysis.

Hayes-Lattin, Madison / Sylvia, Stephen M / Bragg, Jack T / Puzzitiello, Richard N / Richmond, John C / Salzler, Matthew J

Arthroscopy, sports medicine, and rehabilitation

2023 Volume 5, Issue 3, Page(s) e657–e662

Abstract: Purpose: To compare subjective outcomes and rates of subsequent operations for patients aged 40 years and older with anterior cruciate ligament (ACL) ruptures who elected nonoperative management or allograft ACL reconstruction (ACLR).: Methods: This ... ...

Abstract	Purpose: To compare subjective outcomes and rates of subsequent operations for patients aged 40 years and older with anterior cruciate ligament (ACL) ruptures who elected nonoperative management or allograft ACL reconstruction (ACLR). Methods: This was a retrospective study comparing 2-year minimum results of nonoperative treatment and primary allograft ACLR among patients aged 40 years and older presenting to a single institution between the years 2005 and 2016. Patients who elected nonoperative management were 2:1 propensity score (PS)-matched to patients who elected ACLR based on age, sex, body mass index, sports-related mechanism of injury, Outerbridge grade III or IV chondral lesions, and medial or lateral meniscus tears. Univariate analysis was performed to compare subjective outcome measures of International Knee Documentation Committee and Marx activity level scores, subsequent operations, and satisfaction rates. Results: After 2:1 PS matching, 40 ACLR and 20 nonoperative patients with mean ages of 52.2 years and 54.5 years, respectively, were included with a mean follow-up of 5.7 years (SD 2.1 years, range 2.3-10.6 years). There were no significant differences between the groups in any of the matching variables. There were no significant differences in International Knee Documentation Committee scores (81.9 ± 14.1, CI 77.4-86.5 vs 84.3 ± 12.8, CI 78.3-90.3, Conclusions: In this PS-matched analysis of patients aged 40 years and older with ACL ruptures, patients who elected nonoperative management had similar subjective outcomes compared with those who elected allograft ACLR. Patients who elected allograft ACLR did not have fewer subsequent operations than those who elected nonoperative treatment. Level of evidence: Level III, retrospective cohort study.
Language	English
Publishing date	2023-04-19
Publishing country	United States
Document type	Journal Article
ISSN	2666-061X
ISSN (online)	2666-061X
DOI	10.1016/j.asmr.2023.03.005
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Article ; Online: Predictors of Hardware Removal in Orthopaedic Trauma Patients Undergoing Syndesmotic Ankle Fixation With Screws.

Bragg, Jack T / Masood, Raisa M / Spence, Samara S / Citron, Julia E / Moon, Andrew S / Salzler, Matthew J / Ryan, Scott P

Foot & ankle orthopaedics

2023 Volume 8, Issue 3, Page(s) 24730114231198841

Abstract: Background: Indications for removal of syndesmotic screws are not fully elucidated. This study aimed to determine factors related to elective syndesmotic screw removal.: Methods: Patients who underwent fixation of ankle syndesmotic injuries were ... ...

Abstract	Background: Indications for removal of syndesmotic screws are not fully elucidated. This study aimed to determine factors related to elective syndesmotic screw removal. Methods: Patients who underwent fixation of ankle syndesmotic injuries were included. Screw removal was offered after a minimum of 12 weeks after surgery for pain, stiffness or patient desire to remove painful or broken hardware. Patient demographics, surgical data, distance of the syndesmotic screw from the joint, location of the screw at the physeal scar, and number of syndesmotic screws placed were collected for all patients. Bivariate and multivariate analyses were performed to determine the relationship between patient characteristics and screw removal and independent predictors of hardware removal. Results: Of 160 patients, 60 patients (38%) with an average age of 36.1 (range: 18-84) years underwent elective syndesmotic screw removal at a mean of 7 (range, 3-47) months after initial fixation. The most common reason for screw removal (50/60 patients) was ankle stiffness and pain (83%). Patients who underwent screw removal were more likely to be younger (36.1 years ± 13.0 vs 46.6 years ± 18.2, Conclusion: Younger and healthier patients were more likely to undergo elective removal of syndesmotic hardware. Screw distance from joint and screw placement at the physeal scar were not significantly associated with hardware removal. Level of evidence: Level III, retrospective cohort study.
Language	English
Publishing date	2023-09-16
Publishing country	United States
Document type	Journal Article
ISSN	2473-0114
ISSN (online)	2473-0114
DOI	10.1177/24730114231198841
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Article ; Online: Preoperative factors associated with failure to reach the patient acceptable symptom state after anterior cruciate ligament reconstruction in patients aged 40 and older.

Puzzitiello, Richard N / Sylvia, Stephen M / Perrone, Gabriel S / Bragg, Jack T / Richmond, John C / Salzler, Matthew J

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA

2023 Volume 31, Issue 8, Page(s) 3204–3211

Abstract: Purpose: To perform a predictive analysis to identify preoperative patient factors associated with failure to achieve a newly defined patient acceptable symptom state (PASS) for the International Knee Documentation Committee (IKDC) Score after anterior ... ...

Abstract	Purpose: To perform a predictive analysis to identify preoperative patient factors associated with failure to achieve a newly defined patient acceptable symptom state (PASS) for the International Knee Documentation Committee (IKDC) Score after anterior cruciate ligament reconstruction (ACLR) in patients aged ≥ 40 years with a minimum of 2-year follow-up. Methods: This was a secondary analysis of a retrospective review of all patients aged 40 years or older receiving a primary allograft ACLR at a single institution between the years of 2005 and 2016, with 2-year minimum follow-up. Using an updated PASS threshold of 66.7 for the International Knee Documentation Committee (IKDC) score previously established for this patient cohort, a univariate and multivariate analysis was performed to identify preoperative patient characteristics predictive of failure to achieve PASS. Results: A total of 197 patients with a mean follow-up of 6.2 ± 2.1 years (range 2.7 - 11.2) were included in the analysis (48.5 ± 5.6 years, 51.8% female, Body Mass Index (BMI) 25.9 ± 4.4). PASS was achieved by 162 patients (82.2%). Patients who failed to achieve PASS more often had lateral compartment cartilage defects (P = 0.001) and lateral meniscus tears (P = 0.004), higher BMIs (P = 0.004), and Workers' Compensation status (P = 0.043) on univariable analysis. Factors predictive of failure to achieve PASS on multivariable analysis included BMI and lateral compartment cartilage defect (OR 1.12 [1.03-1.23], P = 0.013; OR 5.1 [1.87-13.9], P = 0.001). Conclusion: Among patients ≥ 40 years who receive a primary allograft ACLR, patients who fail to achieve PASS more often had lateral compartment cartilage defects and higher BMIs. Level of evidence: Level IV.
MeSH term(s)	Humans ; Female ; Adult ; Middle Aged ; Male ; Anterior Cruciate Ligament Injuries/surgery ; Knee Joint/surgery ; Menisci, Tibial/surgery ; Retrospective Studies ; Cartilage Diseases/surgery ; Anterior Cruciate Ligament Reconstruction
Language	English
Publishing date	2023-02-22
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1159064-6
ISSN	1433-7347 ; 0942-2056
ISSN (online)	1433-7347
ISSN	0942-2056
DOI	10.1007/s00167-023-07334-x
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Article: Incidence of Deep Venous Thrombosis Associated With Proximal Hamstring Rupture.

Engler, Ian D / Bragg, Jack T / Miller, Suzanne L

Orthopaedic journal of sports medicine

2019 Volume 7, Issue 12, Page(s) 2325967119888486

Abstract: Background: Rates of deep venous thrombosis (DVT) have been studied for most common orthopaedic injuries. However, rates and risk factors have not been published for proximal hamstring injuries.: Purpose: To determine the incidence of symptomatic DVT ...

Abstract	Background: Rates of deep venous thrombosis (DVT) have been studied for most common orthopaedic injuries. However, rates and risk factors have not been published for proximal hamstring injuries. Purpose: To determine the incidence of symptomatic DVT associated with proximal hamstring rupture and associations with prophylactic anticoagulation. Study design: Case series; Level of evidence, 4. Methods: Inclusion criteria included all complete and, in a separate cohort, partial proximal hamstring ruptures treated by the senior author from 2007 through 2018 with at least 8 weeks of follow-up. Tendinopathy without tear was excluded. No DVT screening was performed. Charts of patients with symptomatic DVT were reviewed for the treatment method, the presence of imaging-confirmed DVT or pulmonary embolism, and risk factors for DVT. No patients received postinjury DVT prophylaxis. Surgical patients were routinely instructed to take aspirin (325 mg bid) or apixaban (2.5 mg bid) for 4 weeks. Patients with risk factors for DVT received enoxaparin (40 mg daily) for 2 weeks followed by aspirin (325 mg bid) for 2 weeks. Results: A total of 144 complete proximal hamstring ruptures were included: 132 treated operatively and 12 treated nonoperatively. There were 10 DVTs associated with the injury, for an overall rate of 6.9%. Five of the DVTs were diagnosed preoperatively in patients who had not received DVT prophylaxis; the other 5 were diagnosed postoperatively in patients on DVT prophylaxis. Six of the 10 DVTs had identifiable risk factors. All patients with postoperatively diagnosed DVTs were on prophylactic aspirin or enoxaparin. In the partial proximal hamstring rupture cohort of 114 ruptures, there were no DVTs. Conclusion: There is a high incidence of DVT associated with complete proximal hamstring ruptures (6.9%) despite many patients receiving DVT prophylaxis. This is substantially higher than that in other lower extremity injuries. Clinicians should have a high index of suspicion for DVT after these injuries, and postinjury DVT prophylaxis may be warranted.
Language	English
Publishing date	2019-12-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2706251-X
ISSN	2325-9671
ISSN	2325-9671
DOI	10.1177/2325967119888486
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Article ; Online: Preoperative allergy testing for patients reporting penicillin and cephalosporin allergies is economically justified in preventing infection after total shoulder arthroplasty.

Bragg, Jack T / Sudah, Suleiman Y / Moverman, Michael A / Puzzitiello, Richard N / Pagani, Nicholas R / Menendez, Mariano E

Journal of shoulder and elbow surgery

2022 Volume 32, Issue 1, Page(s) 186–191

Abstract: Background: The use of alternative antibiotics to cefazolin has been associated with increased risk of infection after shoulder arthroplasty. Routine preoperative allergy testing in patients reporting penicillin and cephalosporin allergies increases the ...

Abstract	Background: The use of alternative antibiotics to cefazolin has been associated with increased risk of infection after shoulder arthroplasty. Routine preoperative allergy testing in patients reporting penicillin and cephalosporin allergies increases the number able to receive cefazolin and may reduce the occurrence of infection after shoulder arthroplasty, but the financial viability of this practice is unclear. We used break-even modeling to determine the economic viability of routine preoperative allergy testing for infection prevention in total shoulder arthroplasty patients reporting penicillin and cephalosporin allergies. Methods: Allergy testing cost ($248.24), infection rates after shoulder arthroplasty following use of noncefazolin antibiotics (3.09%), and infection-related care costs ($55,243) were derived from the literature. A break-even equation using these variables was developed to determine the absolute risk reduction (ARR) in the infection rate that would economically justify the routine implementation of preoperative allergy testing. The number needed to treat was calculated from the ARR. Results: Preoperative allergy testing is considered economically justified if it prevents at least 1 infection out of 223 shoulder arthroplasties (ARR = 0.45%). These protocols remained economically viable at varying allergy testing costs, initial infection rates, and infection-related care costs. Conclusions: Routine preoperative penicillin allergy testing is an economically justified infection prevention strategy among patients reporting penicillin and cephalosporin allergies in the setting of elective shoulder arthroplasty. Widespread implementation of this practice may considerably reduce the economic and societal burden associated with prosthetic infections.
Language	English
Publishing date	2022-09-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	1170782-3
ISSN	1532-6500 ; 1058-2746
ISSN (online)	1532-6500
ISSN	1058-2746
DOI	10.1016/j.jse.2022.07.022
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Zs.A 3973: Show issues

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Article ; Online: Reverse Fragility Index Comparing Rates of Rerupture After Open Achilles Tendon Repair Versus Early Functional Rehabilitation: A Systematic Review of Randomized Controlled Trials.

Bragg, Jack T / Ruelos, Verdinand C B / McIntyre, J Alex / Puzzitiello, Richard N / Pagani, Nicholas R / Menendez, Mariano E / Moverman, Michael A / Salzler, Matthew J

The American journal of sports medicine

2023 Volume 52, Issue 4, Page(s) 1116–1121

Abstract: Background: Despite similar published rates of rerupture among patients treated with early functional rehabilitation and open repair for acute Achilles tendon rupture, uncertainty still exists regarding the optimal treatment modality. The reverse ... ...

Abstract	Background: Despite similar published rates of rerupture among patients treated with early functional rehabilitation and open repair for acute Achilles tendon rupture, uncertainty still exists regarding the optimal treatment modality. The reverse fragility index (RFI) is a statistical tool that provides an objective measure of the study's neutrality by determining the number of events that need to change for a nonsignificant result to be significant. Purpose: The purpose was to utilize the RFI to appraise the strength of neutrality of randomized controlled trials (RCTs) comparing the rerupture rates of acute Achilles tendon ruptures treated with open repair versus early functional rehabilitation. Study design: Systematic review; Level of evidence, 1. Methods: A systematic review was performed including all RCTs comparing the rerupture rates after operative repair and early functional rehabilitation for acute Achilles tendon ruptures. Studies were included that explicitly used early functional rehabilitation, defined as weightbearing and exercise-based interventions initiated within 2 weeks, as compared with open repair and reported a nonsignificant difference in rerupture rates. The RFI, with rerupture as the primary outcome, was calculated for each study (significance threshold, Results: Nine RCTs were included, with 713 patients and 46 reruptures. The median (interquartile range) rerupture rate was 7.69% (6.38%-9.64%) overall, 4.00% (2.33%-7.14%) in the operative group, and 10.00% (5.26%-12.20%) in the nonoperative group. The median RFI was 3, indicating that an outcome reversal of 3 patients was necessary to change the results from nonsignificant to statistically significant. The median number of patients lost to follow-up was 6 (3-7). Of 9 studies, 7 (77.8%) had a loss to follow-up greater than or equal to its RFI. Conclusion: The statistical nonsignificance of studies reporting equivalent rerupture rates in the management of acute Achilles tendon ruptures with open repair versus nonoperative management with early functional rehabilitation can be reversed by changing the outcome status of only a few patients.
MeSH term(s)	Humans ; Achilles Tendon/surgery ; Rupture/therapy ; Randomized Controlled Trials as Topic ; Physical Therapy Modalities ; Tendon Injuries/therapy ; Acute Disease ; Treatment Outcome
Language	English
Publishing date	2023-06-12
Publishing country	United States
Document type	Systematic Review ; Journal Article
ZDB-ID	197482-8
ISSN	1552-3365 ; 0363-5465
ISSN (online)	1552-3365
ISSN	0363-5465
DOI	10.1177/03635465231178831
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