These data suggest that decreases in plasma free-VEGF levels are greater after treatment with aflibercept or bevacizumab compared with ranibizumab at 4 weeks. At 52 and 104 weeks, a greater decrease was observed in bevacizumab versus ranibizumab. Results from 2 subgroups of participants who did not receive injections within at least 1 month and 2 months before collection suggest similar changes in VEGF levels after stopping injections. It is unknown whether VEGF levels return to normal as the drug is cleared from the system or whether the presence of the drug affects the assay's ability to accurately measure free VEGF. No significant associations between VEGF concentration and systemic factors were noted.

Background: Previous research has shown that meniscal and articular cartilage lesions increase with time in the anterior cruciate ligament (ACL)–deficient knee. Purpose: To analyze the association between increased time from ACL injury to reconstruction and the presence of intra-articular lesions. Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective chart review was performed for patients who sustained an ACL injury and underwent reconstruction from January 1, 2009, to May 14, 2015. Factors analyzed included age, sex, and body mass index, as well as time from injury to surgery, the presence of meniscal tears, and the presence of cartilage lesions. The data were evaluated to quantify the association between time from ACL injury to reconstruction and presence of intra-articular lesions. Results: Overall, 405 patients were included in this study. Regarding time from injury, 27.3% patients were treated at <3 months, 23.6% at 3 to <6 months, 18% at 6 to <12 months, 13.6% at 12 to <24 months, 10.6% at 24 to <60 months, and 6.9% at ≥60 months. When compared with the group treated <3 months from injury, a significant increase in the rate of medial meniscal tears was seen in the groups treated at 6 to <12 months (odds ratio [OR], 2.2), 12 to <24 months (OR, 3.5), 24 to <60 months (OR, 7.0), and ≥60 months (OR, 6.3). A similar trend was seen with medial femoral condyle lesions in the groups treated at 6 to <12 months (OR, 2.5), 12 to <24 months (OR, 2.6), 24 to <60 months (OR, 2.6), and ≥60 months (OR, 6.9). The prevalence of lateral tibial plateau and lateral femoral condyle lesions also significantly increased with increased time between ACL injury and reconstruction, but this association was not seen until 24 to <60 months (ORs, 5.1 and 11.5, respectively). Conclusion: For patients undergoing ACL reconstruction, an interval >6 months between injury and surgery was associated with an increased prevalence of medial meniscal tears and medial compartment chondral lesions at the time of surgery. An interval >24 months between injury and surgery was associated with an increased prevalence of lateral compartment chondral lesions at the time of surgery.

Background: Femoral head osteonecrosis (FHON) is a well-recognised complication in patients with human immunodeficiency virus (HIV) infection. Total hip arthroplasty (THA) is a reliable solution to FHON and has provided functional improvement and pain relief in these patients. Higher complication rates, in particular infections, have been reported in the series of THAs done in the HIV-positive patients. The purpose of this study was to evaluate the complication rate of THA for FHON in HIV-positive patients managed with the highly active antiretroviral therapy (HAART) protocols. Methods: A retrospective review was performed of HIV-positive patients with FHON who underwent THAs over a 10-year period at a single institution. Results: A total of 56 THAs (44 patients) met the inclusion criteria. The mean age at the time of THAs was 47 (range 34–60) years. Of the 44 patients, 39 (88.6%) were males. The mean follow-up was 6.6 (range 2.0–11.3) years. The overall complication rate was 12.5%, with 2 (3.6%) cases of deep periprosthetic infections. Conclusions: HIV-positive patients with FHON undergoing THAs do have a considerable complication rate (12.5%). The deep periprosthetic infection rate (3.6%) in these patients, however, has decreased with contemporary disease modification protocols.

Background: Delays from the time of an anterior cruciate ligament (ACL) tear to surgical reconstruction are associated with an increased incidence of meniscal and chondral injuries. Purpose: To evaluate the association between delays in ACL reconstruction (ACLR) and risk factors for intra-articular injuries across 8 patient demographic subsets. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We performed a retrospective chart review of all patients who underwent ACLR from January 2009 to May 2015 at a single institution. Variables collected were age, sex, body mass index, time from injury to surgery, and presence of meniscal tears and chondral injuries. Demographic subsets were created according to sex, age (<27 vs ≥27 years), body mass index (<25 vs ≥25 kg/m2), and injury setting (sports vs non–sports related). Subsets were divided by time from injury to ACLR: 0 to <6 months (control group), 6 to <12 months, and ≥12 months. Multivariate logistic regression–generated odds ratios (ORs) were calculated. Results: Overall, 410 patients were included. ORs were significant for an increased incidence of medial meniscal tears (MMTs) (OR, 1.12-3.72; P = .02), medial femoral condyle (MFC) injuries (OR, 1.18-4.81; P = .02), and medial tibial plateau (MTP) injuries (OR, 1.33-31.07; P = .02) with surgical delays of 6 to <12 months. With ≥12-month delays, significance was found for MMTs (OR, 2.92-8.64; P < .001), MFC injuries (OR, 1.86-5.88; P < .001), MTP injuries (OR, 1.37-21.22; P = .02), lateral femoral condyle injuries (OR, 2.41-14.94; P < .001), and lateral tibial plateau injuries (OR, 1.15-5.27; P = .02). In the subset analysis, differences in the timing, location, rate, and pattern of chondral and meniscal injuries became evident. Female patients and patients with non–sports-related ACL tears had less risk of associated injuries with delayed surgery, while other demographic groups showed an increased injury risk. Conclusion: When analyzing patients who were symptomatic enough to eventually require surgery, an increased incidence of MMTs and medial chondral injuries was associated with ≥6-month delays in ACLR, and an increased incidence of lateral chondral injuries was associated with ≥12-month delays. Female patients and patients with non–sports-related ACL tears had less risk of injuries with delayed ACLR.

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: Below knee amputation (BKA) and Foot amputation (AA) are two commonly performed procedures for diabetic foot conditions. Aim of this study was to analyze the characteristics of the complications and reoperations at 30 days and 1 year in a matched sample of BKA and FA in diabetic patients in a large database population. Methods: Commercially available patient database record (PearlDiver) was used for this study. Diabetic Patient undergoing BKA and FA were identified using CPT code. After matching two groups for smoking, obesity and comorbidities scores, the differences in the risk of complications at 30 days, 90 days and 1 year and the risk of reoperation at 1 year were noted in both groups. Results: There were 8555 patients in each matched group. Most patients were male (71.6%) and 6891 patients were smokers and 5292 patients were obese. More than 50% of general and systemic complications happened after 30 days. Incidence of 30 days, 90 days and 1 year general complications including Acute kidney injury, cardiac arrest, Cerebrovascular event, myocardial infarction, Pulmonary embolism, Pneumonia, sepsis and transfusion were higher in the BKA group. AKI was the most common general complication and PE was the least common general complication observed at 30 days, 90 days and 1 year. The risk of wound dehiscence, surgical site infection and overall wound complications were higher in FA group. One year reoperation for infection and dehiscence were higher in the FA group and reoperation for hematoma formation was higher in BKA group. The risk of revision to a BKA in the FA group at 1 year was 16.4% (1410 patients). Conclusion: FA is associated with higher risk of local complications at 30 days, 90 days and 1 years and higher reoperation rate at 1 year for local complications. However, BKA is associated with higher systemic major complications and higher risk of reoperation for hematoma formation. Most complications in the FA and BKA group happened after 30 days which highlights the fact that studies reporting 30 days complications after FA and BKA may underestimate the complications.