Orthopaedic Research Foundation

Root fixation for medial meniscal transplantation can be performed with or without bone plugs. Bone plug fixation has generally been shown to have superior time-zero biomechanical characteristics. Little is known about the biomechanics of peripheral stabilization for meniscal allograft transplantation (MAT) and its ability to improve time-zero biomechanics. The purpose was to compare the biomechanical effectiveness of modern soft tissue (ST) root fixation versus bone plug (BP) root fixation as well as peripheral stabilization in MAT. The hypothesis was that, while BP root fixation likely has better time-zero biomechanical characteristics with regard to contact forces and laxity, the addition of peripheral stabilization would mitigate these differences for either type of root fixation in a cadaveric model. Controlled laboratory study. A total of 8 matched-pair cadaveric knees with a mean age of 55 ± 10 years (5 female and 3 male) were used. The knees were tested in the following states: intact, meniscectomy, MAT (with either BP or ST root fixation) with peripheral stabilization, and MAT (with either BP or ST root fixation) without peripheral stabilization. Medial tibiofemoral joint contact area and pressure as well as knee laxity for anterior-posterior tibial translation, external-internal rotation, and varus-valgus were quantified at 0°, 30°, 60°, and 90° of knee flexion. A paired t test with a significance level at .05 was used for statistical analysis. There were small but significant differences between ST and BP MAT with or without peripheral stabilization in contact forces and most laxity measurements. While both groups demonstrated improved stability with peripheral stabilization, the BP MAT group exhibited greater influence from stabilization in laxity with internal-external rotation (P = .010), contact area with internal-external rotation (P = .022), and contact area with varus (P < .005). This study demonstrated the slight superiority of BP versus ST root fixation and that the addition of peripheral stabilization for ST and BP MAT decreased medial tibiofemoral joint contact pressure and increased medial tibiofemoral joint contact area at time zero. While the time-zero biomechanical characteristics of BP MAT were more influenced by peripheral stabilization than the ST technique, this is most likely because of graft size mismatch. With current root fixation devices, both ST and BP MAT had generally similar biomechanical characteristics at time zero, and peripheral stabilization seemed to improve both modes of fixation.

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity among US adults, including recurrent emergency department (ED) visits and unplanned hospital admissions. Despite this, the transition of care (TOC) from the inpatient to outpatient setting remains under-studied. The objectives of the Reduce Respiratory Emergent Visits using Implementation Science Interventions Tailored to Setting (Reduce REVISITS) study are to conduct contextual assessments to inform implementation plans for COPD TOC interventions, conduct a cluster randomized trial evaluating implementation over 1 year of COPD TOC bundles, and monitor sustainment of implementation over a 2-year period across 20 sites. This pragmatic, multisite study uses a hybrid type II effectiveness-implementation design to evaluate clinical and implementation outcomes of COPD TOC programs across 20 sites. Sites are cluster-randomized to 1 of 4 intervention groups, varying by program delivery method (in-person vs virtual) and implementation strategy (mentored implementation with or without co-design). Sites select evidence-based interventions they wish to incorporate into their COPD TOC program and are randomized to in-person or virtual delivery. During the 1-year active implementation period of the study, assigned mentors will meet monthly with sites (for a total of 12 sessions) to enable on-the-ground troubleshooting of site-specific difficulties with TOC interventions. The primary effectiveness outcome for this study will be COPD-specific acute health care use, defined as a composite of all ED visits and hospitalizations within 30 days of index hospitalization for a COPD exacerbation. The primary implementation outcome will be reach, defined as the proportion of patients receiving their assigned TOC interventions (the whole bundle). As of August 2025, 21 sites completed the contextual assessments and developed site-specific implementation plans. Publication of the qualitative data from this pre-implementation phase is anticipated in December 2025. Site randomization is complete; sites randomized to co-design have completed 3 sessions. Baseline data collection on use is complete. Implementation-year data collection on use is nearly complete. Year 1 and 2 post-implementation-phase data collection on use is ongoing. Quantitative data analyses of the baseline and implementation-phase reports are nearly complete. Manuscript submission for the primary implementation-phase manuscript is anticipated for December 2025. Manuscript submission for the implementation-sustainment analyses are anticipated for September 2026. Qualitative data collection for year 1 of the post-implementation phase is complete, and analysis is under way. Qualitative data collection for year 2 began in August 2025. The Reduce REVISITS study will use novel integrated implementation science and human-centered design methodology to investigate bundles of effective COPD TOC interventions with the goal of reducing COPD hospital revisits. The study will evaluate evidence-based programs for effectiveness and implementation across a wide variety of health care sites to ultimately improve outcomes in this high-risk patient population. ClinicalTrials.gov NCT05568043; https://clinicaltrials.gov/study/NCT05568043. DERR1-10.2196/82043.

Background: Recent biomechanical investigations of distal biceps tendon repair (DBTR) constructs have typically evaluated time-zero fixation security, while tendon-bone repair footprint characterization has been limited. Consequently, interactions between repair construct design, fixation security, and repair footprint parameters remain minimally assessed. Purpose/Hypothesis: The purpose was to compare time-zero fixation security and repair footprint parameters between a new DBTR construct with 2 interlinked knotless all-suture anchors and an established DBTR construct with an intramedullary cortical button. It was hypothesized that the new interlinked twin-anchor repair technique would demonstrate greater time-zero fixation security and footprint optimization. Study Design: Controlled laboratory study. Methods: A total of 20 cadaveric elbows in 2 matched groups underwent DBTR with either (1) twin interlinked knotless all-suture anchors or (2) a single intramedullary cortical button. Anatomic and repair footprints were digitally captured with a 3-dimensional coordinate-measuring machine. The repair constructs underwent cyclic loading and then were loaded to failure. Anatomic and repair footprint areas and their overlap, tendon-bone interface and total construct displacement, ultimate failure load, and failure mode were recorded. Anatomic footprint restoration and repair footprint accuracy were calculated. Results: The interlinked knotless twin-anchor repair construct demonstrated a larger repair footprint area (55.1 ± 14.9 vs 35.2 ± 19.8 mm2, respectively; P = .032), greater anatomic footprint restoration (42.7% ± 12.9% vs 20.2% ± 9.4%, respectively; P = .003), lower tendon-bone interface displacement (3.2 ± 1.2 vs 12.4 ± 6.6 mm, respectively; P = .003), lower total construct displacement (5.5 ± 1.7 vs 13.9 ± 8.1 mm, respectively; P = .015), and higher ultimate failure load (468.3 ± 124.2 vs 313.2 ± 103.4 N, respectively; P = .001) compared with the single-button repair construct. The most common failure mode was knot slippage/suture breakage (60%) in the single-button group and suture-tendon interface failure (50%) in the twin-anchor group. Conclusion: While this cadaveric study did not account for the effects of tendon-bone healing, the novel interlinked twin-anchor DBTR construct demonstrated greater time-zero fixation security, a larger repair footprint, and greater anatomic footprint restoration over the established single-button repair construct. Clinical Relevance: A DBTR construct with twin interlinked knotless all-suture anchors offers multiple features, including time-zero fixation security and footprint optimization, that may potentially improve clinical outcomes.

Hereditary ataxias are progressive neurodegenerative disorders primarily affecting the cerebellum. Since 2009, the Clinical Research Consortium for the Study of Cerebellar Ataxias (CRC-SCA) has studied the natural history of common types of spinocerebellar ataxias (SCAs). The CRC-SCA is a 17-site academic collaboration supported by the National Ataxia Foundation. In 2024, the CRC-SCA expanded its scope by incorporating newly identified late-onset ataxias, including repeat expansion mutations in RFC1 and FGF14 causing Cerebellar Ataxia with Neuropathy and Vestibular Areflexia Syndrome (CANVAS) and SCA27B, respectively. These ongoing efforts have enriched the understanding of disease progression and facilitated access to biofluid and neuroimaging data for biomarker discovery, setting the stage for therapeutic development in hereditary ataxias. The CRC-SCA's natural history study and biomarker collection have validated several clinical outcome assessments (COAs) to capture important aspects of hereditary ataxias. We have also developed new COAs for cognitive and patient-reported outcome measures. A key component of the study includes biofluid collection-cerebrospinal fluid, plasma, and serum-to identify molecular biomarkers for disease progression and therapeutic response. Additionally, an incorporated magnetic resonance imaging (MRI) substudy provides critical imaging biomarkers, enhancing our ability to track macro- and microstructural, chemical and functional changes in the cerebellum and relate these to clinical presentations. The comprehensive, longitudinal dataset comprising COAs, biofluid biomarkers, and neuroimaging enhances clinical trial readiness in the field and accelerates therapeutic advancements for hereditary ataxias. This review highlights the collective efforts of CRC-SCA, details the study protocol, and emphasizes the integrity and specificity of the collected data elements.

Molecular structures can be determinedin vitroandin situwith cryo-electron microscopy (cryo-EM). Specimen preparation is a major obstacle in cryo-EM. Typical sample preparation is orders of magnitude slower than biological processes. Time-resolved cryo-EM (TR-cryo-EM) can capture short-lived states. Here, we present Cryo-EM Sample Preparation with light-Activated Molecules (C-SPAM), an open-source, photochemistry-coupled device for TR-cryo-EM with single millisecond resolution, tunable timescales, and broad biological applications.