搜索结果：AANA

Proximal tibiofibular joint (PTFJ) instability is a rare and often underrecognized cause of lateral knee pain and dysfunction, most commonly presenting as anterolateral subluxation of the fibular head after trauma. While conservative management is first-line, persistent instability may require operative intervention. We present the case of a 20-year-old male athlete who sustained a PTFJ injury during sport and noted instability. After a successful PTFJ diagnostic taping trial, he elected for surgical reconstruction after completing his competitive season. Imaging confirmed an isolated PTFJ pathology without intra-articular knee injury. The reconstruction was performed using an ipsilateral semitendinosus tendon autograft. After a standard semitendinosus tendon harvest, a posterolateral approach to the fibular head was performed. A common peroneal nerve neurolysis was performed. The fibular head and proximal lateral tibial tunnels were reamed to reproduce the anatomic attachments of the native ligaments. The graft was passed from anterior to posterior through the fibular tunnel and secured with a bioabsorbable screw. The remaining graft was then passed from posterior to anterior through the tibia and secured using a bioabsorbable interference screw at 70° of knee flexion. Isolated anatomic reconstruction of the PTFJ using a semitendinosus tendon autograft provides excellent restoration of joint stability in cases of chronic anterolateral instability. Postoperative assessment consistently demonstrates elimination of symptomatic subluxation and restoration of fibular head stability under clinical examination. These outcomes align with findings in the limited published literature, which report high rates of return to activity and symptom resolution after anatomic PTFJ reconstruction using autograft techniques. Anatomic reconstruction of the PTFJ using a semitendinosus tendon autograft provides a reproducible, biomechanically sound option for stabilizing the joint, avoiding complications associated with fibular head resection or fixation constructs. This case highlights key technical considerations, such as graft tensioning, tunnel positioning, and peroneal nerve protection, which are all essential for successful outcomes in young athletic patients. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Graduate students, including medical students, use cognitive enhancer (CE) medications with or without legal prescription to aid academic performance despite little evidence that they improve performance in individuals without a medical diagnosis and subsequent prescription. However, there is limited information on CE medication use, with or without legal prescription, by resident registered nurse anesthetists (RRNAs). This cross-sectional survey assessed prevalence of CE medication use with or without legal prescription and its potential predictors (depression, anxiety, Attention Deficit Hyperactivity Disorder [ADHD] symptoms, and demographic variables) in 421 RRNAs. Descriptive and binary logistic regression analyses were conducted. The prevalence of CE use with or without prescription was 27.3%, with 93% obtained by prescription. The prevalence of clinically significant symptoms of ADHD (25.7%), depression (26.9%), and anxiety (23.1%) were assessed among RRNAs. No significant differences in age, gender, or program years were observed between CE medication users with or without legal prescription and CE non-users. However, white respondents were more likely to be CE medication users with or without legal prescription compared with respondents of other racial groups (P = .020). In the full logistic regression model, ADHD (aOR, 1.17; 95% CI, 1.10-1.24) was associated with increased odds of CE use. The Backward stepwise selection model retained ADHD and anxiety as significant predictors.

Lateral extra-articular tenodesis (LET) is used as an adjunct to anterior cruciate ligament reconstruction (ACLR) to enhance stability. However, understanding of the optimal fixation method is limited. The purpose was to compare biomechanical knee stability using 3 femoral LET fixation methods before and after cyclic loading. It was hypothesized that the fixation achieved with a suture anchor or an interference screw would demonstrate greater stability than that achieved with a metallic staple. Controlled laboratory study. Ten matched pairs of cadaveric knees (mean age 64 years) underwent modified Lemaire LET. Each pair received suture anchor fixation on 1 knee and either interference screw (arm A) or metallic staple (arm B) fixation on the contralateral knee. Specimens were tested in 4 states: intact (native), anterolateral knee lesion, modified Lemaire (LET) procedure, and modified Lemaire (LET) procedure after cyclic loading. Cyclic loading consisted of 2000 cycles of 5 N·m internal rotation at 1 Hz. Anterior translation was applied at 90 N of force using visual marker motion capture. Internal rotation was measured using a 5 N·m moment and a digital inclinometer. No significant differences in anterior translation were observed between the different states (anterolateral lesion, LET, and post-cyclic loading) for all constructs. The mean increase in internal rotation among the subgroups after undergoing anterolateral lesion ranged from 2.1° to 4.0°. No significant difference was found in mean internal rotation after samples underwent cyclic loading in both arms of the study (arm A [suture anchor vs screw], P = .262; arm B [suture anchor vs staple], P = .450). Specimen undergoing suture anchor fixation demonstrated significantly greater change in internal rotation from pre- to post-cyclic loading than those using screw fixation (arm A, 7.2% ± 2.3% vs -1.3% ± 2.6%, respectively; P = .011) but not staple fixation (arm B, 14.3% ± 16.7% vs 5.3% ± 3.1%; P = .338). Internal rotatory stability was restored by all LET methods even after undergoing cyclic loading. All fixation methods restored rotational stability to near-native levels even after loading. Suture anchor fixation appeared more vulnerable to cyclic loading than the other 2 methods. Suture anchors appeared most vulnerable to cyclic loading. No significant difference was found in absolute mean internal rotation values between suture anchors and screws or staples. Clinically, all 3 methods remain viable options for LET fixation. Staples and screw may better resist cyclic physiologic stress when compared with suture in controlled settings; however, this may not be clinically significant.

Data on midterm outcomes in patients with borderline hip dysplasia (BHD) based on sex differences after hip arthroscopy are scarce. To report sex-based differences in patient-reported outcome measures (PROMs), clinical benefit, and survivorship in patients with BHD who underwent hip arthroscopy at a minimum 5-year follow-up. Cohort study; Level of evidence, 3. Data were retrospectively reviewed for all patients with BHD who underwent primary hip arthroscopy with a lateral center-edge angle (LCEA) between 18&#xb0; and 25&#xb0; from 2008 to 2018. The exclusion criteria were as follows: LCEA <18&#xba; or >25&#xba;, previous ipsilateral hip surgery or conditions, and T&#xf6;nnis grade >1. The modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale (VAS) for pain and patient satisfaction were reported. Clinical benefit was assessed via minimal clinically important difference (MCID), the patient acceptable symptomatic state (PASS), and the maximum outcome improvement (MOI). Survivorship was defined as nonconversion to total hip arthroplasty. A sex-based propensity-matched comparison was made in a 1-to-1 ratio based on age, body mass index (BMI), and T&#xf6;nnis grade. Propensity-score matching created a cohort of 152 hips, 76 per group. Significant and comparable improvements in all PROMs were observed at a minimum 5-year follow-up, with high achievement rates for the MCID, PASS, and MOI in both groups. However, improvements were significantly higher for women for MCID for the mHHS (86.8% vs 69.7%; P = .0105), MCID for the NAHS (88.2% vs 61.8%; P = .0002), MCID for the VAS for pain (84.2% vs 64.5%; P = .005), PASS for the mHHS (90.8% vs 78.9%; P = .041), and MOI for the NAHS (77.6% vs 55.3%; P = .0057). Survivorship was similar for men (94.74%) and women (89.47%) (P = .229). At a minimum 5-year follow-up, a propensity-matched comparison of female and male patients with BHD who underwent primary hip arthroscopy demonstrated significant improvement and comparable PROMs and survivorship. Clinical benefit was significantly higher in women, as evidenced by higher achievement rates on the MCID, PASS, and MOI.

The purpose of this study is to report outcomes of patients with Diabetes Mellitus (DM) who underwent hip arthroscopy for femoroacetabular impingement (FAI) at short- to mid-term timepoints comparing these results to a control group of non-DM patients. Data were retrospectively analyzed for patients who underwent primary hip arthroscopy for FAI with a history of DM. Patients had completed pre- and postoperative patient-reported outcomes (PROs) at a minimum 2-year follow-up, including clinically important thresholds for hip arthroscopy, revision surgery, and conversion to arthroplasty. Subanalysis was conducted based on glycemic control. Patients were propensity matched to a control group of nondiabetic patients in a 1:3 ratio. A total of 116 patients were included, with 29 DM patients matched to 87 control patients. DM patients displayed significant improvements across all PROs and high patient satisfaction. No significant differences were observed in the sub-analysis. When compared to a control group, DM patients had lower preoperative PROs and reached similar postoperative scores. DM patients had significantly lower patient satisfaction (7.70&#x2009;&#xb1;&#x2009;2.43 compared to 8.63&#x2009;&#xb1;&#x2009;1.57 in the control group P&#x2009;<&#x2009;.05.) at the latest follow-up and had a higher relative risk for revision hip arthroscopy (P&#x2009;<&#x2009;.05). Hip arthroscopy for the treatment of FAI in DM patients resulted in significant short- to mid-term improvements in PROs, comparable to a matched control group. DM patients had an overall 2.63-fold increased relative risk of revision hip arthroscopy compared to non-DM patients, with a trend toward more uncontrolled DM patients undergoing revision hip arthroscopy. Perioperative diabetic control is recommended.

Female athletes sustain anterior cruciate ligament (ACL) ruptures at higher rates than male athletes. There is limited literature focusing on outcomes after ACL reconstruction (ACLR) in this population. The purpose of this study was to conduct a scoping review into female-specific literature for primary ACLR procedure, and to ascertain the variability in reporting outcomes in the literature. 'Female' was defined as sex assigned at birth for the purposes of this study. The systematic review was conducted according to PRISMA, and also used Arksey and O'Malley's established five-stage process for scoping reviews to map the literature for primary ACLR in female-specific literature. After screening, data were extracted and mapped to provide a descriptive and thematic analysis. A total of 1,172 studies were identified from the initial search with 16 studies eligible for final scoping review published from 2004 to 2024. Studies were identified from eight countries, with 9/16 (56.3%) from the USA. The mean age was 23.4 years (16 to 32). Key variables such as graft type (7/16, 43.8%) and graft diameter (2/16, 12.5%) were significantly under-reported. Of the functional outcomes, Tegner Activity Score was reported in seven studies (7/16, 43.8%), the International Knee Documentation Committee Score (IKDC) in six studies (6/16, 37.5%), and the Knee Injury and Osteoarthritis Outcome Score (KOOS) in six studies (6/16, 37.5%). Overall, 25 clinical outcomes were recorded spanning all studies including graft re-rupture (4/16, 25.0%), Lachman's score (3/16, 18.8%), pivot shift (4/16, 25.0%), and return to sport (5/16, 31.3%). This review identified 16 studies which analyzed female-specific literature for primary ACLR over the last 20 years. There is a significant lack of studies in the literature reporting on female-specific outcomes, and in the eligible studies, there was a significant lack of standardization of variable and outcome reporting.

To test new, more stable and long-lasting formulations of liposomal adenosine in the treatment of OA in a preclinical canine model. OA was induced by arthroscopic medial meniscus release (MR) in the right knee (stifle) of purpose-bred hounds. Symptomatic OA developed by 2 months after which knees were injected monthly with 3 mL of saline or 2 different liposomal adenosine preparations, RgnA09M or RgnA09N, for a total of 3 injections. Blinded assessments of knee pain, function, comfortable range of motion (CROM) and effusion were performed before induction of OA, at 2 months, 4 months and at the time of sacrifice (6 months post-Tx). Radiographic assessments and MRI of the knees were also performed. Plasma and synovial fluid were collected and COMP and CTX-II levels assessed by ELISA. Symptomatic OA developed by 2 months with increased pain, loss of function and diminished CROM. Saline treatment did not improve knee pain, CROM or loss of function at any time point but intraarticular injection of RgnA09M and RgnA09N markedly improved pain, CROM and function at all timepoints. Injections of RgnA09M and RgnA09N, but not saline, improved radiographic assessments at 4 months and 6 months. Similarly, MRI scores significantly improved in RgnA09M and RgnA09N treated dogs compared to saline. Histologic analysis showed that RgnA09M and RgnA09N injections reduced synovial inflammation. This is the first evidence that intraarticular injection of liposomal adenosine reduces pain, improves CROM and function and mitigates radiologic progression in a large animal OA model.

While total hip arthroplasty (THA) is an effective treatment option when indicated, young, active individuals are not ideal candidates. Biologic hip preservation (BHP) using femoral head osteochondral and acetabulum labrum allograft transplantation provides a potential alternative. This study was designed to test the hypothesis that BHP would result in superior hip joint function compared to THA in a 'young adult' preclinical canine model. With Institutional Animal Care and Use Committee Approval, canine femoral heads and acetabular labrums were aseptically recovered for subsequent transplantation. Ten purpose-bred hounds were randomly assigned to undergo either BHP or THA (n&#x2009;=&#x2009;5 each). Postoperatively, dogs were compared for differences in pain, function, and hip range of motion (ROM), and were evaluated for allograft/implant integration, joint architecture and health, and complications using radiographic, gross, and histologic assessments. At 6&#xa0;months postoperatively, BHP had significantly (P&#x2009;=&#x2009;0.039) greater hip ROM recovery (97.8% versus 89.9%) and significantly (P&#x2009;=&#x2009;0.02) less pain (0.3 versus 1.4) compared to THA. Radiographic, gross, and histologic assessments supported the safety of BHP. BHP using femoral head osteochondral and acetabulum labrum allograft transplantation was consistently safe and effective in preserving the architecture of the native hip while restoring hip joint health and function with potential advantages over THA for pain relief and hip ROM. Study results support the use of BHP as an alternative option to THA in patients amenable to this treatment strategy. Future studies are needed to delineate the type and extent of hip joint disorders that are amenable to this treatment strategy.

Rotator cuff tears are common injuries that significantly impair shoulder function and quality of life, particularly for large to massive tears, where maximal repair often results in high retear rates. Bridging reconstruction using acellular dermal allografts such as GraftJacket and AlloPatch offers a promising alternative by providing a scaffold that supports tendon healing and enhances structural stability. Although these grafts have similar biomechanical strengths, they differ in processing and biological properties, and comparative clinical outcomes remain understudied. To compare radiologic and clinical outcomes of patients who underwent arthroscopic rotator cuff reconstruction using GraftJacket or AlloPatch allografts. Cohort study; Level of evidence, 3. Patients who underwent arthroscopic bridging reconstruction for large to massive rotator cuff tears (>3 cm) using GraftJacket or AlloPatch were included. The primary outcome was healing assessed by magnetic resonance imaging. The secondary outcome was the Western Ontario Rotator Cuff (WORC) index. Tertiary outcomes were imaging-based structural metrics, including acromiohumeral interval (AHI), muscle atrophy (Warner grade), fatty infiltration (Goutallier-Fuchs classification), and structural integrity (Sugaya classification). Demographics, intraoperative data, and all outcome measures were compared between graft groups. There were no significant demographic differences between GraftJacket (n = 49) and AlloPatch (n = 37) groups. The AlloPatch group had higher baseline supraspinatus muscle atrophy (P = .006) and fatty infiltration (P = .03) grades, along with more concurrent subscapularis repairs (P < .001). Postoperative imaging occurred at 2.22 &#xb1; 1.14 years for GraftJacket and 1.35 &#xb1; 0.70 years for AlloPatch (P < .001). Graft healing was not significantly different between groups (AlloPatch: 76%, GraftJacket: 69%; P = .52). Postoperative patient-reported outcomes were measured at 2.91 &#xb1; 0.87 years for GraftJacket and 2.64 &#xb1; 0.66 years for AlloPatch (P < .27). Both groups improved WORC scores from preoperative to postoperative assessment (P < .001), with no between-group difference (P = .97). The AlloPatch group had an increased postoperative AHI (P = .045), and the GraftJacket group did not, although the GraftJacket group had higher structural integrity (Sugaya) grades postoperatively (P = .02). No other between-group differences in imaging-based structural metrics were found. GraftJacket and AlloPatch dermal allografts yield comparable healing, patient-reported outcomes, and structural imaging metrics following arthroscopic bridging reconstruction for large to massive rotator cuff tears, demonstrating similar efficacy.

Over 700,000 total knee arthroplasties (TKAs) are performed in the United States annually. Long-term functional recovery following TKA depends heavily on early ambulation and rehabilitation, which requires effective pain management. Adductor canal blocks (ACBs) offer targeted analgesia while preserving quadriceps strength. However, postoperative pain often outlasts single-shot peripheral nerve blocks. This analysis evaluated whether perineural dexmedetomidine added to local anesthetics increased the efficacy and duration of ACBs in patients undergoing TKA. This systematic review and meta-analysis examined adult patients undergoing primary TKA under general or spinal anesthesia and ACB. Five randomized controlled trials examining 445 patients met inclusion criteria. Patient ages ranged from 18 to 85 years and demonstrated similar comorbidities. Pooled analysis showed that patients receiving dexmedetomidine reported lower pain scores at rest (mean difference [MD] -0.35; P = .009) and during activity (MD -0.40; P < .0001). Opioid consumption decreased by an average of 8.91 mg (P = .05). Time to first rescue analgesia increased by 1.54 hours, and ambulation outcomes consistently showed improvement in the dexmedetomidine group. This analysis supports the use of dexmedetomidine as an adjunct for ACB in TKA. However, significant heterogeneity among studies limits applicability of this analysis's findings. Clinicians are advised to consider this when making practice decisions.

While the clinical outcomes of acetabular labral repair and reconstruction have been reported, comparative cellular responses between common allografts to clinically relevant load are less clear. This study aims to compare acetabular labrum (LAB), anterior tibialis tendon (TEN), and knee meniscus (MEN) cellular responses to biaxial tensile strain during in vitro culture. LAB, TEN, and MEN tissues were recovered from skeletally mature research hounds (n&#x2009;=&#x2009;5). Primary LAB, TEN, and MEN fibroblast cell cultures were established. Using a bioreactor, cells were loaded at 0%, 4%, or 10% biaxial tensile strain for 5&#xa0;days. RNA was extracted and reverse transcription-polymerase chain reaction (RT-PCR) was used to determine relative gene expression levels. Cells were then tested for various stress-induced biomarkers. Statistical analysis determined significance between groups for relative gene expression levels and biomarker concentrations. LAB in the 0% strain group had more viable cells compared to the 4% and 10% strain groups, and MEN fibroblasts in the 4% strain group had more viable cells compared to the 10% strain group. LAB and MEN were associated with higher concentrations of MMP-3 in the 10% strain compared to the 0% strain group. The characterization of acetabular labrum cellular responses to clinically relevant loads of force more closely matches those of meniscal allograft tissue than tibialis anterior allograft tissue. This has potential implications for labral reconstruction, as meniscal allograft tissues may be more suited than tibialis anterior tissues to withstand compressive forces necessary for stabilization and chondroprotection within the hip.

暂无摘要（点击查看详情）

Female athletes are at a significantly greater risk of anterior cruciate ligament injury when compared to males. The cause of this is multifactorial, due to interactions of extrinsic, anatomic, genetic, hormonal, and neuromuscular factors. Careful preoperative consideration of the patient's anatomy, biomechanics, and goals is crucial when discussing graft type and adjunct procedures. Female athletes are also significantly less likely to return to sport than males, often due to fear of re-injury and/or distrust of their knee. To optimize success in female athletes, it is important to take a multidisciplinary approach, address modifiable risk factors, and provide holistic support.

Multiligament injuries can severely impair knee stability and function, leading to long-term complications if not managed. Injuries involving the posterolateral corner (PLC), especially when combined with anterior cruciate ligament (ACL) tears, require prompt anatomic reconstruction to restore normal knee function. Unrecognized or inadequately treated PLC injuries can lead to persistent varus and rotational instability, increasing stress on cruciate ligament grafts and compromising reconstruction outcomes. Thus, timely surgical reconstruction of all 3 primary PLC stabilizers (the fibular collateral ligament [FCL], popliteus tendon, and popliteofibular ligament [PFL]) is critical to restoring native biomechanics and maintaining long-term knee function. This technique describes an anatomic reconstruction of the posterolateral (PL) bundle of the ACL, along with repairs of the lateral capsule, biceps femoris tendon, and lateral meniscus, in a patient presenting with complete foot drop. After careful neurolysis of the surrounding common peroneal nerve scar tissue, anatomic tunnels were drilled for reconstruction of the PLC-including the FCL, popliteus tendon, and PFL. Sutures were placed in the lateral capsule for a repair later in the case. Next, arthroscopy was performed to evaluate the ACL bundles, during which a PL bundle tear was identified. A semitendinosus tendon autograft was then harvested. The ACL PL bundle femoral tunnel was drilled, followed by an inside-out repair of the lateral meniscus. The ACL PL bundle tibial tunnel was then created. Grafts were passed and fixed sequentially, with the PLC grafts secured first, followed by fixation of the ACL graft in full extension. The procedure concluded with open repairs of the avulsed biceps femoris tendon and lateral capsule. Geeslin et al reported that acute PLC injuries treated surgically within 3 weeks had more favorable outcomes with reconstruction or hybrid techniques, while primary repair followed by staged cruciate reconstruction was associated with higher failure rates. Timely anatomic reconstruction of the main PLC static stabilizers with a concurrent repair of the tendon and capsular structures effectively and reliably restores native knee stability in acute settings. Compared with delayed or staged procedures, early reconstruction often leads to improved outcomes and reduces the risk of graft failure. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Anterior cruciate ligament (ACL) graft failure is a relatively common occurrence and is even more likely in the presence of medial meniscal deficiency. ACL tears cause significant knee instability, particularly anterolaterally, and are commonly treated with a surgical reconstruction. During a revision ACL reconstruction (ACLR), clinical studies have demonstrated that correcting medial meniscus pathologies and reconstructing the anterolateral ligament (ALL) improve outcomes. This is the patient's fourth ACLR, complicated by a concomitant extruded medial meniscal root tear, and confirmed on clinical examination and imaging. An ALL reconstruction (ALLR) and medial meniscal root repair with a centralization suture were therefore indicated during the revision ACLR. The technique described was used for a revision ACLR after 3 failed reconstructions with a concomitant ALLR and lateral meniscal peripheral and medial meniscal root repair as part of the second stage of a 2-stage surgery. The first stage of surgery included ACL tunnel debridement and bone grafting. The second stage procedure described here included a revision ACLR with bone-patellar tendon-bone autograft and an ALLR using the inferior portion of the iliotibial band, fixated with suture anchors to recreate the anatomic proximal and distal attachment sites. For the menisci, a lateral meniscal posterolateral peripheral tear was repaired using an inside-out technique, and the medial meniscal root tear was repaired with a double transtibial tunnel root repair with a centralization suture to reduce extrusion. Recent literature has demonstrated that rerevision ACLR improved functional outcomes and overall knee stability. Despite these improvements, the overall rate of return to preinjury activity levels was poor, with high inter-study variability. A complex revision ACLR with an ALLR and multiple meniscal repairs is described, along with technical considerations to improve long-term outcomes and minimize complication risks. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

The rate of total ankle arthroplasty (TAA) is projected to continue increasing. Implant malalignment is a significant predictor of complications; however intraoperative evaluation of alignment can be challenging. Patient-specific instrumentation (PSI) was designed to improve implant positioning in TAA. This study compares radiographic alignment and postoperative function in patients who underwent TAA with PSI with an Infinity implant vs standard instrumentation (SI) with a Salto Talaris implant. We retrospectively reviewed 114 TAA cases using PSI compared with 80 TAA surgeries using SI. Demographics, radiographic alignment, range of motion (ROM), complications, and postoperative American Orthopaedic Foot & Ankle Society (AOFAS) pain, function, and alignment scores were compared at a minimum 1-year follow-up. The PSI cohort demonstrated significantly better radiographic alignment, particularly in tibial component positioning, and reduced frequency of lucencies compared with the SI cohort. However, operative time was significantly longer in the PSI group (mean 119.0&#x2009;&#xb1;&#x2009;34.5 vs 96.3&#x2009;&#xb1;&#x2009;26.0&#x2009;minutes; P&#x2009;<&#x2009;.001). For the coronal alignment of the tibial component, PSI alignment was 1.7&#xb0; (0.0&#xb0;-10.2&#xb0;) and 2.5&#xb0; (0.0&#xb0;-9.8&#xb0;) for SI (P&#x2009;=&#x2009;.002). For the sagittal alignment of the tibial component, alignment was observed to be 2.9&#xb0; (0.0&#xb0;-9.9&#xb0;) for PSI and 6.1&#xb0; (1.0&#xb0;-13.0&#xb0;) for SI (P&#x2009;<&#x2009;.001). The PSI cohort had increased AOFAS alignment scores (mean&#x2009;=&#x2009;9.7 vs 8.9, P&#x2009;=&#x2009;.002), but AOFAS total scores were similar (mean&#x2009;=&#x2009;77.7 vs 79.2, P&#x2009;=&#x2009;.539) between cohorts. Similar numbers of patients required revision (1.75% for PSI, 1.25% for SI, P&#x2009;=&#x2009;1.00) or irrigation and debridement (3.51% for PSI, 3.75% for SI, P&#x2009;=&#x2009;1.00). In this study, PSI was associated with modest differences in tibial alignment and early radiographic lucencies compared with SI, without clear significant differences in short-term clinical outcomes. Both cohorts had similar postoperative range of motion and AOFAS scores. Given the retrospective design and short follow-up, further investigation is needed to assess long-term clinical impact and implant survivorship. Level III, retrospective comparative study.

This study aimed to develop an evidence-based perioperative assessment tool for anesthesiology professionals to supplement standard preoperative assessments, targeting the unique health needs of transgender and gender-diverse (TGD) patients to enhance the perioperative experience. Many TGD patients express dissatisfaction with their care, while numerous healthcare professionals report feeling inadequately prepared to care for this population effectively. Using a modified Delphi design, a consensus-based Perioperative Gender-Diverse Assessment Tool (PGDAT) was developed to assist anesthesiology professionals in sensitively engaging with TGD patients and creating evidence-informed, patient-focused anesthetic plans. Fourteen expert panelists from the United States appraised the quality and clinical readiness of the PGDAT through iterative online surveys. Consensus was defined as 0.8 agreement among raters, and a thematic analysis was conducted following Braun and Clarke, with three core themes emerging. The interrater reliability was 0.75707 and 0.83977 using Gwet's AC2. The 0.8 consensus threshold was achieved after two survey rounds, which content-validated the PGDAT and established an evidence-based resource that future research opportunities can use to bring about systemic changes that promote safe and inclusive healthcare environments for all.