Background: The gold standard for patellar tendon repair is a transosseous technique. Suture anchor repair has gained popularity, with recent biomechanical studies demonstrating significantly less gap formation during cyclic loading and significantly higher ultimate failure loads as compared with transosseous repair. These findings have not been substantiated in a large clinical cohort. Purpose: To report demographic and epidemiologic data, clinical and surgical findings, and outcomes and complications of anchor and transosseous suture repairs of acute patellar tendon ruptures. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who underwent a primary repair of a traumatic patellar tendon rupture within 45 days of injury between 2006 and 2016 were retrospectively reviewed. Surgery was performed at a multisurgeon (120 surgeons) multicenter (14 centers) community-based integrated health care system. Patient demographic information, repair type, complications, and time from surgery to release from medical care were recorded. Results: A total of 361 patients (374 knees) met our inclusion criteria. The mean age was 39.8 years (range, 9-86 years), and 91.7% were male. There were 321 transosseous and 53 anchor repairs. There was no significant difference in the mean age ( P = .27), sex ( P = .79), tourniquet time ( P = .93), or body mass index ( P = .78) between the groups. There was a significant difference in rerupture rate between transosseous and anchor repairs (7.5% vs 0%, respectively; P = .034). Based on logistic regression, transosseous repair had 3.24 times the odds of reoperation verseus anchor repair (95% CI, 0.757-13.895; P = .1129). The infection rate was 1.6% for transosseous repair and 7.5% for anchor repair ( P = .160). There was no difference in time to release from medical care: 18.4 weeks for anchor and 17.1 weeks for transosseous repairs ( P = .92). Conclusion: Anchor repair demonstrated a significant decrease in rerupture rate when compared with transosseous repair. There was no difference in reoperation rate, infection rate, or time to release from medical care.

Background:Providing high-quality care while also containing cost is a paramount goal in orthopaedic surgery. Increasingly, insurance providers in the United States, including government payers, are requiring financial and performance accountability for episodes of care, including a push toward bundled payments.Hypothesis:The direct cost of outpatient arthroscopic rotator cuff repair was assessed to determine whether, due to an older population, rotator cuff surgery was more costly in Medicare-insured patients than in patients covered by other insurers. We hypothesized that operative time, implant cost, and overall higher cost would be observed in Medicare patients.Study Design:Cohort study; Level of evidence, 3.Methods:Billing and operative reports from 184 outpatient arthroscopic rotator cuff repairs performed by 5 fellowship-trained arthroscopic surgeons were reviewed. Operative time, number and cost of implants, hospital reimbursement, surgeon reimbursement, and insurance type were determined from billing records and operative reports. Patients were stratified by payer (Medicare vs non-Medicare), and these variables were compared.Results:There were no statistically significant differences in the number of suture anchors used, implant cost, surgical duration, or overall cost of arthroscopic rotator cuff repair between Medicare and other insurers. Reimbursement was significantly higher for other payers when compared with Medicare, resulting in a mean per case deficit of $263.54 between billing and reimbursement for Medicare patients.Conclusion:Operating room time, implant cost, and total procedural cost was the same for Medicare patients as for patients with private payers. Further research needs to be conducted to understand the patient-specific factors that affect the cost of an episode of care for rotator cuff surgery.

Objectives:Patellar tendon ruptures are relatively uncommon injuries. They require prompt diagnosis and surgical repair to restore the extensor mechanism of the knee. The gold standard procedure is a suture repair of the tendon, passed through trans-osseous tunnels, and tying of the sutures on the superior pole of the patella. Suture anchors have gained popularity with a recent cadaveric study demonstrating significantly less gap formation during cyclic loading and significantly higher ultimate failure loads. We present the largest series of patellar tendon repairs and compare the clinical outcomes and complications of trans-osseous (TO) and anchor (A) repair types.Methods:All patients who underwent a primary repair of a traumatic patellar tendon rupture within 45 days of injury, between 2007 and 2016, were retrospectively reviewed. Surgeries were performed at a multi-surgeon (114 surgeons), multi-center (13 centers) community-based integrated health care system. Patients with prior knee surgery, use of graft, patellar debridement for tendonitis, inferior pole avulsion fracture, concurrent knee surgery with other procedures were excluded. Patient demographic information, repair type, complications, and time from surgery to release from medical care were recorded.Results:361 patients (374 knees) met our inclusion criteria. 13 had bilateral repairs during our study period and an additional 8 had a contralateral repair prior to our study period, for a bilateral incidence at 5.8%. The average age was 39.8 years (9 to 86 years). There were 341 males (94.5%). The most common mechanism of injury was basketball (47%), fall (19.5%), football (5.0%), and soccer (4.8%). Average time from injury to surgery was 6.3 days (range: 1- 45 days). There were 321 TO and 53 A repairs. There was no significant difference in the mean age (P=0.27), gender (P=0.79), tourniquet time (P=0.93), or BMI (P=0.78) between the two groups. There was a significant difference in re-rupture between (24 of 321) TO (7.5%) and (0 of 53) A (0%) (P=0.034). Using logistic regression, we found that TO had 3.244 times the odds of re-operation as those with A (95% CI: 0.757, 13.895. p-value: 0.1129) but did not reach signficance. The infection rate was 7.5% for A and 1.6% for TO (P= 0.160). There was no difference in time to release from medical care, 18.4 weeks for and 17.1 weeks (P=0.92).Conclusion:Compared to Anchors, primary repair of patellar tendon ruptures with trans-osseous repair had a significantly higher re-rupture rate, but there was no difference in re-operation rate, infection, or release from medical care.

Figure 1. (A) KPC pancreas sample placed on Novascan's electrode array for a series of spectral bioimpedance measurements. A zoom in of the electrode with a pancreas sample is also shown. White rectangles indicate multiple locations measured across the sample. Spectral impedance scans for a control mouse (B) and a KPC mouse (C). The examination of CRF peak properties was used for cancer identification in pancreas samples. For the control mouse the CRF peaks fall below the threshold of 1 MHz, determining no cancer. For the KPC mouse several scans have CRF peaks above the threshold of 1 MHz, determining cancer presence.

abdomen and pelvis showed a necrotic mass in the left aspect of the pelvis that appeared to erode the sigmoid colon (Figure A). A sigmoidoscopy revealed a 2 cm area in the sigmoid colon with direct communication to a mass that was biopsied (Figure B). The pathology findings were consistent with RCC (Figure C). A transverse colostomy with mucous fistula was successful. She completed 14 days of antibiotic therapy and the fever resolved. Five months later she has had no complications and continued treatment with immunotherapy and radiation. Discussion: GI involvement by RCC is very rare and mostly occurs by metastatic spread to the small bowel. Approximately 5-15% of RCCs spread to nearby structures and 20-30% of patients have metastasis at the time of diagnosis. Formation of a TBF might occur spontaneously from tumor eroding to the bowel or as a consequence of chemotherapy and/or radiotherapy. Due to the retroperitoneal location of the kidney, the colon is almost never affected. From rare reported cases, patients mainly present with lower GI bleeding. In our patient, migration of colonic contents to the tumor mass via TBF may have led to superinfection of the mass. In the presence of intra-abdominal tumors, especially several metastatic masses, the presence of fever can be a sign of TBF and appropriate imaging with CT scan and careful endoscopic examination are necessary to establish a diagnosis and guide the surgical management.[2158] Figure 1. (A) CT scan of the abdomen and pelvis shows a necrotic mass in the left aspect of the pelvis that appears to erode the wall of the sigmoid colon; (B) Flexible sigmoidoscopy revealing a 2 cm erosion of the sigmoid colon with direct communication to the mass; (C) H&E image of the colon biopsy. The large cells with variably sized nuclei, sometimes prominent nucleoli and abundant eosinophilic cytoplasm form a sheet of neoplastic cells. On the right-hand side of the image the smaller cells are plasma cells and lymphocytes with a few neutrophils.