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Abstract Background Predicting hamstring graft size preoperatively for anterior cruciate ligament (ACL) reconstruction is important for preempting an insufficient diameter in graft size intraoperatively, possibly leading to graft failure. While there are multiple published methods using magnetic resonance imaging (MRI) picture archiving and communication systems (PACS), most are not feasible and practical. Our study aims to (1) practically predict the ACL hamstring graft size in a numerically continuous manner using the preoperative MRI from any native MRI PACS system, (2) determine the degree of correlation between the predicted and actual graft size, and (3) determine the performance of our prediction method if we define an adequate actual graft size as ≥ 8 mm. Methods A retrospective review of 112 patients who underwent primary ACL reconstruction with quadrupled hamstring semitendinosus-gracilis grafts at a tertiary institution was conducted between January 2018 and December 2018. Graft diameter can be predicted in a numerically continuous manner as √[2*(AB + CD)], where A and B are the semitendinosus cross-sectional length and breath, respectively, and C and D are the gracilis cross-sectional length and breath, respectively. Results A moderately positive correlation exists between the predicted and actual graft diameter (r = 0.661 and p

Abstract Background Chat Generative Pretrained Transformer (ChatGPT), a generative artificial intelligence chatbot, may have broad applications in healthcare delivery and patient education due to its ability to provide human-like responses to a wide range of patient queries. However, there is limited evidence regarding its ability to provide reliable and useful information on orthopaedic procedures. This study seeks to evaluate the accuracy and relevance of responses provided by ChatGPT to frequently asked questions (FAQs) regarding total knee replacement (TKR). Methods A list of 50 clinically-relevant FAQs regarding TKR was collated. Each question was individually entered as a prompt to ChatGPT (version 3.5), and the first response generated was recorded. Responses were then reviewed by two independent orthopaedic surgeons and graded on a Likert scale for their factual accuracy and relevance. These responses were then classified into accurate versus inaccurate and relevant versus irrelevant responses using preset thresholds on the Likert scale. Results Most responses were accurate, while all responses were relevant. Of the 50 FAQs, 44/50 (88%) of ChatGPT responses were classified as accurate, achieving a mean Likert grade of 4.6/5 for factual accuracy. On the other hand, 50/50 (100%) of responses were classified as relevant, achieving a mean Likert grade of 4.9/5 for relevance. Conclusion ChatGPT performed well in providing accurate and relevant responses to FAQs regarding TKR, demonstrating great potential as a tool for patient education. However, it is not infallible and can occasionally provide inaccurate medical information. Patients and clinicians intending to utilize this technology should be mindful of its limitations and ensure adequate supervision and verification of information provided.

Background: Enhanced Recovery After Surgery (ERAS) is a "fast-track", perioperative, multi-disciplinary concept aimed at improving recovery time and reducing length of hospital stay. Objective: This study aims to compare the postoperative outcomes of ERAS versus non-ERAS Total Knee Arthroplasty (TKA), with the primary outcomes being day 0 pain score, days 1-2 range of motion (ROM), days 1-2 distance walked and hospital length of stay (LOS). Methods: A retrospective analysis was performed for 111 consecutive patients who had undergone primary unilateral TKA from November 2019 to October 2020 at a single tertiary hospital by fellowship-trained arthroplasty surgeons. Three independent, blinded observers extracted patient data from our institution's Electronic Medical Records. The ERAS protocol included preoperative smoking and alcohol cessation, preoperative physiotherapy, intraoperative local infiltration analgesia using a drug cocktail, postoperative multimodal analgesia and postoperative day 0 physiotherapy, while any patient who deviated from any step were classified as non-ERAS. Two-sample t-tests, Wilcoxon rank-sum tests and Chi-squared tests were used to compare the outcome variables between ERAS and non-ERAS patients. Results: Patients under the ERAS protocol (n = 67) reported a significantly lower postoperative day 0 pain score (p = .0480) and a shorter hospital LOS (p = .0189) than non-ERAS patients (n = 44). No significant difference (p > .05) was observed for ROM and distance walked on days 1-2. Conclusion: Our study demonstrates that the ERAS protocol improves day 0 postoperative pain and shortens hospital LOS while being non-inferior for ROM and distance walked on days 1-2. [ABSTRACT FROM AUTHOR]

Study Design: We developed a spinal nerve root wrapping rodent model to evaluate the relationship between recombinant human bone morphogenetic protein 2 (rhBMP-2) dosage and the degree of inflammation.Objective: To investigate the direct effects of recombinant human bone morphogenetic protein 2 (rhBMP-2) dosage and the degree of inflammation in rodent spinal nerve roots.Summary Of Background Data: rhBMP-2 is commonly used in clinical practice to augment spinal fusion. However, complications such as postoperative leg pain, and a higher rate of postoperative neurologic deficits have been reported. These may be attributable to the exposure of adjacent nerve roots to high doses of rhBMP-2.Methods: Eighteen rats were randomized into three groups as follows: Group 1: absorbable collagen sponge (ACS) + 10 μg rhBMP-2, Group 2: ACS + 1 μg rhBMP-2, and Group 3 ACS with 20 μL saline. The ACS containing rhBMP-2 or saline were then wrapped around the L5 nerve root and secured loosely with nonabsorbable sutures. At 1-week postoperation, the rats were sacrificed, and the L5 nerve root and dorsal root ganglion harvested for reverse transcription polymerase chain reaction (RT-PCR), histology and immunohistochemical staining.Results: In our study, 10 μg rhBMP-2 induced a 10-fold increase in seroma compared with 1 μg group. Using RT-PCR, macrophage markers MIP3-α, and CD-68 were upregulated by 8- and 2-fold respectively in comparison with the saline group. Haematoxylin and eosin (H&E) images demonstrated disruption of nerve structures in the high dose 10 μg rhBMP-2, but not at 1 μg rhBMP-2 and with saline.Conclusion: High doses of rhBMP-2 induced neuroinflammation in a dose dependent manner, resulting in higher seroma volume, macrophage marker gene expressions, and higher proportions of immunohistochemically stained TNF-alpha and more macrophage infiltration.Level Of Evidence: 2. [ABSTRACT FROM AUTHOR]

The article presents an overview related to Medical Grand Challenge (MGC) 2017, a student-led medical innovation competition hosted by the Yong Loo Lin School of Medicine (YLLSOM). Topics discussed MGC providing more opportunities for inter-faculty collaboration and medical innovation; mentions the workshops conducted regarding design process and systems thinking, and intellectual property; and encourages students to develop future.