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Purpose The purpose of this study was to evaluate the clinical outcomes of patients who were treated with an arthroscopic popliteus bypass (PB) technique, in cases of a posterolateral rotational instability (PLRI) and a concomitant posterior cruciate ligament (PCL) injury of the knee. Methods This was a retrospective case series in which 23 patients were clinically evaluated after a minimum of 2 years following arthroscopic PB and combined PCL reconstruction. Lysholm, Tegner and Knee Injury and Osteoarthritis Outcome scores as well as visual analog scales (VAS) for joint function and pain were evaluated. Posterior laxity was objectiied with stress radiography and a Rolimeter examination. Rotational instability was graded with the dial test. Results 23 patients were available for follow-up, 46.0 ± 13.6 months after surgery. The median time interval from the initial injury to the surgery was 6.0 (3.5;10.5) months. The postoperative Lysholm Score was 95.0 (49-100); the Tegner Score changed from 6.0 (3-10) before the injury to 5.0 (0-10) at the follow-up examination (p = 0.013). The side-to-side diference on stress radiography (SSD) of posterior translation changed from 10.4 (6.6-14.8) mm before the injury to 4.0 (0.2-5.7) mm postoperatively (p < 0.01). Rotational instability was reduced to grade A (82.6%) or B (17.4%) (IKDC). The Rolimeter SSD was 2.0 (0-3) mm at the follow-up examination. VAS Function 0 (0-5), VAS pain 0 (0-6). Conclusions The arthroscopic PB graft technique provided good-to-excellent clinical results in the mid-term follow-up in patients with type A PLRI and concomitant PCL injury. However, an exact diferentiation of lateral, rotational and dorsal instabilities of posterolateral corner (PLC) injuries is crucial, for the correct choice of therapy, as cases with lateral instabilities require more complex reconstruction techniques. Arthroscopic posterolateral corner reconstruction is a safe procedure with a high success rate in the mid-term follow-up. Level of evidence IV.

Study design: A retrospective observational study.Objective. The objective of this study was to investigate the factors associated with the conversion of patient status from ambulatory surgery (AMS) to observation service (OS) (< 48 h) or inpatient ( > 48 h). Summary of Background Data. AMS is becoming increasingly common in the United States because it is associated with a similar quality of care compared with inpatient surgery, significant costs reduction, and patients' desire to recuperate at home. However, there are instances when AMS patients may be subjected to extended hospital stays. Unanticipated extension of hospitalization stays can be a great burden not only to patients but to medical providers and insurance companies alike.Materials and Methods. Data from 1096 patients who underwent one-level or two-level lumbar decompression AMS at an inhospital, outpatient surgical facility between January 1, 2019, and March 16, 2020, were collected. Patients were categorized into three groups based on length of stay: (1) AMS, (2) OS, or (3) inpatient. Demographics, comorbidities, surgical information, and administrative information were collected. Simple and multivariable logistic regression analyses were conducted comparing AMS patients and OS/inpatient as well as OS and inpatients. Results. Of the 1096 patients, 641 (58%) patients were converted to either OS (n = 486) or inpatient (n = 155). The multivariable analysis demonstrated that age (more than 80 yr old), high American Society of Anesthesiologists Physical Status (ASA) grade,

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Bone quality is increasingly being recognized in the assessment of fracture risk.Nonenzymatic collagen cross-linking with the accumulation of advanced glycation end products stiffens and embrittles collagen fibers thus increasing bone fragility.Echogenicity is an ultrasound (US) parameter that provides information regarding the skin collagen structure. We hypothesized that both skin and bone collagen degrade in parallel fashion. Prospectively collected data of 110 patients undergoing posterior lumbar fusion was analyzed. Preoperative skin US measurements were performed in the lumbar region to assess dermal thickness and echogenicity. Intraoperative bone biopsies from the posterior superior iliac spine were obtained and analyzed with confocal fluorescence microscopy for fluorescent advanced glycation endproducts (fAGEs). Pearson's correlation was calculated to examine relationships between (1) US and fAGEs, and (2) age and fAGEs stratified by sex. Multivariable linear regression analysis with adjustments for age, sex, body mass index (BMI), diabetes mellitus, and hemoglobin A1c (HbA1c) was used to investigate associations between US and fAGEs. One hundred and ten patients (51.9% female, 61.6 years, BMI 29.8 kg/m 2 ) were included in the analysis. In the univariate analysis cortical and trabecular fAGEs decreased with age, but only in women (cortical: r = −0.32, p = 0.031; trabecular: r = −0.32; p = 0.031). After adjusting for age, sex, BMI, diabetes mellitus, and HbA1c, lower dermal (β = 1.01; p = 0.012) and subcutaneous (β = 1.01; p = 0.021) echogenicity increased with increasing cortical fAGEs and lower dermal echogenicity increased with increasing trabecular fAGEs (β = 1.01; p = 0.021). This is the first study demonstrating significant associations

Study Design: This was a prospective observational study. Objective: This investigation aimed (1) to determine the impact of sagittal spinal alignment with C7–sagittal vertical axis (SVA), pelvic incidence−lumbar lordosis (PI−LL) mismatch and Roussouly classification on individual segments of spinopelvic mobility represented by lumbar flexibility [∆lumbar lordosis (LL)], pelvic mobility [∆pelvic tilt (PT)], and hip motion [∆pelvic femoral angle (PFA)] and (2) to assess the influence of coronal spinal balance on the spinopelvic complex in patients undergoing total hip arthroplasty (THA) preoperatively and postoperatively. Summary of Background Data: Restricted spinopelvic mobility gained attention as a contributing factor for THA instability. However, it remains unclear what influence the coronal and sagittal spinal alignment has on spinopelvic mobility. Materials and Methods: A total of 197 THA patients were included in the investigation conducting biplanar stereoradiography in standing and sitting position preoperatively and postoperatively. Two independent investigators assessed C7–SVA (≤50 mm balanced, >50 mm imbalanced), PI−LL (≤10 degrees balanced, >10 degrees imbalanced), refounded Roussouly classification, coronal spinal balance with C7–central sacral vertical line, LL, pelvic incidence (PI), PT, PFA. Individual segments of spinopelvic mobility based on the change from standing to sitting were defined as ∆LL, ∆PT, and ∆PFA. Unpaired t test or Welch t test for comparison between groups of 2 was applied. Analysis of variance and post hoc analysis according to Bonferroni or Games-Howell was used to determine differences between groups of >2. The Spearman rank correlation coefficient was used to determine the interrater reliability of the radiographic measurements. Results: Significant differences were demonstrated for ∆LL (SVA balanced/imbalanced: 24.7 degrees/19.1 degrees, P=0.001; PI−LL balanced/imbalanced: 24.4 degrees/16.4 degrees, P<0.000), PT (SVA balanced/imbalanced: 12.5 degrees/15.2 degrees, P=0.029; PI−LL balanced/imbalanced: 10.8 degrees/20.5 degrees, P<0.000), PI (SVA balanced/imbalanced: 52.9 degrees/56.9 degrees, P=0.001; PI−LL balanced/imbalanced: 52.1 degrees/61.0 degrees, P<0.000), LL (SVA balanced/imbalanced: 54.8 degrees/47.8 degrees, P=0.029; PI−LL balanced/imbalanced: 55.3 degrees/42.6 degrees, P<0.000). The coronal spinal balance (central sacral vertical line) indicated no significant differences regarding spinopelvic mobility between positive, neutral, or negative balanced groups. Significant differences with decreased pelvic mobility (∆PT) and lumbar flexibility (∆LL) in low-grade PI types 1 and 2 compared with high-grade PI type 4 according to the Roussouly classification were observed. Conclusions: This is the first study to investigate spinal sagittal alignment using 3 different classifications in association to the spinopelvic complex in THA patients preoperatively and postoperatively. The significantly altered spinopelvic mechanics with decreased lumbar flexibility and ...

Introduction Lumbo-sacral transitional vertebrae (LSTV) are accompanied by changes in soft tissue anatomy. The aim of our retrospective study was to evaluate the effects of LSTV as well as the number of free lumbar vertebrae on surgical approaches of ALIF, OLIF and LLIF at level L4/5. Material and methods We assessed the CTs of 819 patients. Of these, 53 had LSTV from which 11 had six (6LV) and 9 four free lumbar vertebrae (4LV). We matched them for sex and age to a control group. Results Patients with LSTV had a higher iliac crest and vena cava bifurcation, a greater distance between the common iliac veins and an anterior translation of the psoas muscle at level L4/5. In contrast, patients with 6LV had a lower iliac crest and aortic bifurcation, no differences in vena cava bifurcation and distance between the iliac veins compared to the control group. Conclusions For patients with LSTV and five or four free lumbar vertebrae, the LLIF approach at L4/5 may be hindered due to a high riding iliac crest as well as anterior shift of the psoas muscle. Whereas less mobilization and retraction of the iliac veins may reduce the risk of vascular injury at this segment by ALIF and OLIF. For patients with 6LV, a lower relative height of the iliac crest facilitates lateral approach during LLIF. For ALIF and OLIF, a stronger vessel retraction due to the deeper-seated vascular bifurcation is necessary during ALIF and is therefore potentially at higher risk for vascular injury.

Purpose Lumbar fusion surgery has become a standard procedure in spine surgery and commonly includes the posterior placement of pedicle screws. Bone quality is a crucial factor that affects pedicle screw purchase. However, the relationship between paraspinal muscles and the bone quality of the pedicle is unknown. The aim of the study was to determine the relationship between paraspinal muscles and the ex vivo bony microstructure of the lumbar pedicle. Methods Prospectively, collected data of patients undergoing posterior lumbar fusion for degenerative spinal conditions was analyzed. Pre-operative lumbar magnetic resonance imaging (MRI) scans were evaluated for a quantitative assessment of the cross-sectional area (CSA), functional cross-sectional area (fCSA), and the proportion of intramuscular fat (FI) for the psoas muscle and the posterior paraspinal muscles (PPM) at L4. Intra-operative bone biopsies of the lumbar pedicle were obtained and analyzed with microcomputed tomography (μCT) scans. The following cortical (Cort) and trabecular (Trab) bone parameters were assessed: bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb. Th), connectivity density (CD), bone-specific surface (BS/BV), apparent density (AD), and tissue mineral density (TMD). Results A total of 26 patients with a mean age of 59.1 years and a mean BMI of 29.8 kg/m 2 were analyzed. fCSA PPM showed significant positive correlations with BV/TV Trab ( ρ = 0.610; p < 0.001), CD Trab ( ρ = 0.679; p < 0.001), Tb.N Trab ( ρ = 0.522; p = 0.006), Tb.Th Trab ( ρ = 0.415; p = 0.035), and AD Trab ( ρ = 0.514; p = 0.007). Cortical bone parameters also demonstrated a significant positive correlation with fCSA PPM (BV/TV Cort : ρ = 0.584; p = 0.002; AD Cort : ρ = 0.519; p = 0.007). FI Psoas was negatively correlated with TMD Cort ( ρ = − 0.622; p < 0.001). Conclusion This study highlights the close interactions between the bone microstructure of the lumbar pedicle and the paraspinal muscle morphology. These findings give us further insights into the interaction between the lumbar pedicle microstructure and paraspinal muscles.