orthocast
The latest topics, news and trends in orthopedics and sports medicine. From injury treatment/prevention to the latest in orthopedic technology. Get YOUR orthopedic questions answered at OrthoIQ and help train a future custom AI model.
@kj
OR Tuesdays ➡️ Adrenaline rush
Adrenaline - Latin Ad (on) Ren (kidney) , Renalis (of the kidney)
In shoulder arthroscopy, adrenaline (aka epinephrine) is frequently added to irrigation fluids for its vasoconstriction effects. It helps constricts small vessels in the synovium and soft tissues to aid in visualization by preventing blood from obscuring the surgeon's camera view.
In Jōkichi Takamine isolates pure, crystalline adrenaline from animal adrenal glands and in 1901 Parke Davis & Co begins marketing “Adrenalin” and secures the trademark. By 1903 the U.S. patent is gained by Takamine with Parke Davis.
Adrenaline rush… OR Tuesdays.
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@kj
ChatGPT Health is here, and it’s a massive win for data access.
But as an orthopedic surgeon, I see a potential hidden danger of “The Authority Trap.”
AI models don’t just give answers; they give "well-cited, measured, and authoritative" answers that can be confidently wrong.
https://farcaster.xyz/kj/0xa505c08e
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@kj
Small tear. Big impact.
For select partial cuff tears, a “speed-fix” rotator cuff repair uses minimal anchors to restore tendon-to-bone contact while preserving healthy tissue.
Less disruption. Smart fixation. 👌
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@kj
Anterior Cruciate Ligament (ACL) reconstruction is widely considered the most common sports-specific surgery. In athletes an ACL tear often requires surgery to successfully return to sports. The surgery has a high success rate with ~85% of elite athletes returning to play.
Timelapse video of an ACL reconstruction with allograft.
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@kj
What does an ACL tear and reconstruction look like?
ACL tears in the media this week most notably to Patrick Mahomes (which was actually a combined ACL and LCL tear).
The ACL, or anterior cruciate ligament, runs diagonally through the middle of the knee joint with attachments to the intercondylar area of the tibia and to the medial surface of the lateral femoral condyle within the intercondylar notch.
Tears are most commonly through the substance of the tendon or towards lateral wall attachment of the femur as shown in pic 1. Also known as the lateral wall sign.
Pic 2 is after reconstruction… in this case with allograft(donor tendon).
Think Mahomes will be ready for week 1 next season?? 🤔
I’ll share an ACL reconstruction video later. If there’s interest, I can share more videos of this type in channel. Comment below.👇
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@kj
Your femur bone is stronger pound-for-pound than concrete and the longest bone in the body.
But bone density peaks around age 30 👉 after that the decline begins…
Weight bearing exercise + good nutrition are your best defense.
“Did you get your fitness in today?”
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@kj
Today’s case!
Treated with a double row “speedbridge” repair which involves two rows of suture anchors and a crisscross part of suture fixation. The construct increases surface area of tendon to bone contact for healing.
Think this will heal?
RoHI 4 says ~94% chance
RoHI 6 fails to ~68% chance
🤔
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@kj
Today case intraop!
Complete, retracted rotator cuff tear and after cleaning off the footprint area of the greater tuberosity the tear length is ~3cm and retraction ~2cm for a RoHI score of 4.
Patient is 69yo which is right at the age score cutoff of 70 so…. Could easily add 2 for a RoHI score of 6…
What want to do next… 👉 repair!
With RoHI score of 4-6 good opportunities for successful repair but at 6 falling to ~70%
Stay tuned…
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@kj
Today’s case!
69 yo with retracted rotator cuff tear of both supra and infraspinatus rotator cuff tendons, and evidence of moderate atrophic changes in the supraspinatus muscle. Not sounding great…
RoHI classification (Rotator Cuff Healing Index) 👉 the RoHI is a 15-point scoring system used in medicine to predict the likelihood of failure after a surgical rotator cuff repair. It is based on six factors, each assigned points: retraction, fatty infiltration of the infraspinatus muscle, AP tear size, patient age, bone mineral density (BMD), and level of work activity. A higher score indicates a higher risk of repair failure.
So…. for today’s case with a two tendon tear, likely 2.5 cm or greater, and retraction we are likely dealing with at least a ROHI 3 or high of a ROHI 6.
Why does the RoHI matter? A score of 4 or under is associated with high healing rate of ~94% and a score 10 or greater falling to ~14% healing rate…. Or a 86% failure rate!
So… today’s case has pretty good opportunity for healing. Stay tuned for intraop!
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@kj
Evolution in rotator cuff repair and use of the biceps tendon.
“The long head of the biceps has traditionally been ignored, tenodesed, or tenotomized during shoulder arthroscopy. However, more recently, it has been recognized as robust autograft tissue that may be mobilized or harvested to aid in a range of augmentation and reconstructive procedures.”
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