Background/Objectives: Tranexamic acid (TXA) is widely used to reduce bleeding in orthopedic surgery, but its safety and impact on outcomes in arthroscopic rotator cuff repair (ARCR) remain unclear. The purpose of this study was to evaluate the safety and effects of injectable TXA on short- and long-term postoperative outcomes and opioid use following ARCR. Methods: The TriNetX Research Network, an insurance claims-based database, was utilized to conduct this retrospective, propensity-matched cohort study. Patients aged ≥18 years undergoing ARCR were identified and divided into TXA (n = 5855) and non-TXA (n = 5855) groups after propensity score matching. Outcomes assessed included 30-day hospital utilization, complications (infection, thromboembolism, hemarthrosis, blood transfusion), one-year revision and shoulder surgery rates, and early, prolonged, and chronic postoperative opioid use. Results: No significant differences were observed between groups in 30-day emergency department visits (2.0% vs. 1.8%, p = 0.502), readmissions, infections, wound dehiscence, blood transfusions, hemarthrosis, or one-year revision and shoulder surgery rates. TXA use was associated with significantly lower rates of early (24.8% vs. 26.8%, p = 0.011), prolonged (9.5% vs. 12.8%, p < 0.001), and chronic opioid use (6.6% vs. 9.6%, p < 0.001). Conclusions: Injectable TXA is safe in ARCR, with no increase in postoperative complications or hospital utilization. Furthermore, TXA use is linked to reduced postoperative opioid consumption, suggesting benefits in pain management and recovery. Prospective studies are warranted to further explore these findings.

Trimalleolar ankle fractures are complex injuries associated with high complication rates and poorer outcomes, particularly in elderly and medically comorbid patients. While open reduction and internal fixation (ORIF) remains the standard treatment, alternative strategies such as tibiotalocalcaneal arthrodesis (TTCA) have been increasingly explored for high-risk populations. A retrospective cohort study was performed using the TriNetX Research Network. Adult patients undergoing operative treatment for trimalleolar fractures were identified and stratified by procedure (TTCA versus ORIF). Propensity score matching (1:1) was performed to balance demographics and comorbidities, including age, sex, obesity, tobacco use, osteoporosis, diabetes, dementia, and peripheral vascular disease. Outcomes were assessed at 90 days, 1 year, and 2 years. Primary outcomes included secondary surgery (revision procedures, irrigation and debridement, hardware removal, and below-knee amputation). Secondary outcomes included 90-day infection and wound dehiscence. Risk ratios with 95% confidence intervals were calculated, with p < 0.05 considered significant. After matching, 210 patients were included in each group. At 90 days, infection and wound complication rates were similar between TTCA and ORIF cohorts. TTCA was associated with significantly higher rates of secondary surgery at 1 year (28.1% vs 17.1%; RR 1.64, p = 0.007) and 2 years (31.4% vs 21.0%; RR 1.50, p = 0.015). Irrigation and debridement was also more frequent in the TTCA cohort at 1 year (RR 2.25, p = 0.012) and 2 years (RR 2.23, p = 0.009). In sensitivity analysis of closed fractures, findings remained consistent, with higher secondary surgery rates in the TTCA group. In this large propensity-matched study, TTCA may be associated with a higher incidence of secondary surgery-particularly irrigation and debridement-compared with ORIF at one and two years postoperatively, while early wound complication rates were similar. These findings may be influenced by residual confounding despite propensity matching.

We hypothesized that hybrid telerehabilitation, delivered as an adjunct to standard in-person physical therapy (PT), would demonstrate similar improvements in functional scores, pain, and range of motion (ROM) compared with traditional PT, while reducing PT utilization in patients undergoing shoulder arthroplasty and arthroscopic rotator cuff repair (RCR). This retrospective cohort study included 207 adults who underwent shoulder arthroplasty or arthroscopic RCR between 2021 and 2025. Historical controls receiving standard in-person postoperative PT alone (IP-PT; n = 134) were compared with patients receiving hybrid telerehabilitation with the Band Connect platform in addition to in-person postoperative PT (BC+IP-PT; n = 73). Primary outcomes included the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) pain score, and active range of motion (ROM), assessed preoperatively and at 3 and 6 months postoperatively. Analyses were performed separately for arthroplasty and RCR cohorts using stabilized inverse probability of treatment weighting and generalized estimating equations with additional covariate adjustment for residual imbalance. Secondary outcomes included PT utilization, complications, and reoperations. The study included 85 patients in the arthroplasty cohort (33 BC+IP-PT, 52 IP-PT) and 122 patients in the RCR cohort (40 BC+IP-PT, 82 IP-PT). In both cohorts, changes in ASES score, VAS pain, forward flexion, external rotation, and internal rotation over 6 months were similar between groups (all FDR-p > 0.05). In the arthroplasty cohort, the hybrid group completed fewer weeks of PT (16 ± 6 vs 22 ± 9 weeks; FDR-p = 0.023), fewer in-clinic visits (19 ± 7 vs 24 ± 10; FDR-p = 0.026), and fewer missed appointments (0 ± 1 vs 1 ± 3; FDR-p = 0.030). In the RCR cohort, the hybrid group completed fewer weeks of PT (18 ± 6 vs 23 ± 7 weeks; FDR-p = 0.026) and fewer in-clinic visits (21 ± 8 vs 27 ± 10; FDR-p = 0.020), whereas missed appointments were similar between groups (FDR-p = 0.190). Complication and reoperation rates were similar in the arthroplasty (BC+IP-PT 9.1% vs IP-PT 11.5%, FDR-p = 1.000; BC+IP-PT 3.0% vs IP-PT 1.9%, FDR-p = 1.000) and RCR cohorts (BC+IP-PT 0.0% vs IP-PT 11.0%, FDR-p = 0.059; BC+IP-PT 0.0% vs IP-PT 2.4%, FDR-p = 1.000). Hybrid telerehabilitation following shoulder surgery was associated with comparable clinical outcomes, as well as fewer weeks of physical therapy and fewer in-clinic therapy sessions, supporting its use as an efficient adjunct to traditional postoperative rehabilitation. Level III; Retrospective Cohort Comparison; Treatment Study.

Case: A 14-year-old adolescent girl with bilateral chronic patellofemoral instability (CPFI), trochlear dysplasia, elevated tibial tubercle to trochlear groove distances, and generalized ligamentous laxity presented with recurrent dislocations despite prior hemiepiphysiodesis and Roux-Goldthwait procedure. Examination revealed bilateral J-sign, four-quadrant patellar glide, and Beighton score of 9. Imaging confirmed bilateral CPFI with cartilage damage. She underwent staged bilateral medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle osteotomy (TTO), and right patellar cartilage restoration using particulated juvenile allograft cartilage. At 1-year follow-up, she was pain-free, with no recurrent instability and return to sport. Conclusion: Combined MPFLR and TTO can successfully treat bilateral CPFI, even after prior failed surgeries.

To evaluate whether preoperative use of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) is associated with increased risk of reoperation, nonunion, infection, hospital readmission, or emergency department (ED) visits following operative fixation of isolated long bone fractures. This retrospective, multicenter cohort study was conducted using the TriNetX Research Network. Adults (≥18 years) who underwent operative fixation of isolated tibial, femoral, or humeral shaft fractures between 2012 and 2024 were included. Patients prescribed an SSRI or SNRI within 180 days prior to fracture and within 12 months after surgery were compared with controls without antidepressant prescriptions before or within 12 months after fracture. Polytrauma, pathologic fractures, and prior surgery at the same site were excluded. Propensity score matching (1:1) was performed for demographics, fracture location, and relevant medical and psychiatric comorbidities. The primary outcome was reoperation within 12 months. Secondary outcomes included nonunion, infection, hospital readmission, and ED visits. Analyses were stratified by fracture type (open vs closed) and location. A total of 5293 SSRI/SNRI users were matched to 5293 controls. In closed fractures, antidepressant use was associated with higher rates of nonunion (5.2% vs 4.0%; RR 1.29, 95% CI 1.06-1.56). Open fractures demonstrated a trend towards greater rates of nonunion (4.8% vs 3.1%) and reoperation (15.2% vs 13.9%); however, this was not significant. 30-day ED visits, 30-day surgical site infection, and 90-day readmissions were comparable between groups. Preoperative SSRI or SNRI use was associated with increased risk of nonunion following operative fixation of closed long bone fractures. Outcomes following open fractures were largely unaffected, likely due to the dominant biological and mechanical risks inherent to open injuries. These findings suggest the need for increased clinical vigilance in patients with closed fractures receiving serotonergic antidepressants and highlight the importance of prospective studies to further clarify causality and guide management strategies.