Ehlers-Danlos Syndrome (EDS) is a hereditary disorder of the connective tissue, which has been classified into numerous subtypes over the years. EDS is generally characterized by hyperextensible skin, hypermobile joints, and tissue fragility. According to the 2017 International Classification of EDS, 13 subtypes of EDS have been recognized. The majority of genes involved in EDS are either collagen-encoding genes or genes encoding collagen-modifying enzymes. Orthopedic surgeons most commonly encounter patients with the hypermobile type EDS (hEDS), who present with signs and symptoms of hypermobility and/or instability in one or more joints. Patients with joint hypermobility syndrome (JHS) might also present with similar symptomatology. This article will focus on the surgical management of patients with knee or shoulder abnormalities related to hEDS/JHS.

Background: Recent literature suggests that three-dimensional magnetic resonance imaging (3D MRI) can replace 3D computed tomography (3D CT) when evaluating glenoid bone loss in patients with shoulder instability. We aimed to examine if 2D MRI in conjunction with a validated predictive formula for assessment of glenoid height is equivalent to the gold standard 3D CT scans for patients with recurrent glenohumeral instability. Methods: Patients with recurrent shoulder instability and available imaging were retrospectively reviewed. Glenoid height on 3D CT and 2D MRI was measured by two blinded raters. Difference and equivalence testing were performed using a paired t-test and two one-sided tests, respectively. The interclass correlation coefficient (ICC) was used to test for interrater reliability, and percent agreement between the measurements of one reviewer was used to assess intrarater reliability. Results: Using an equivalence margin of 1 mm, 3D CT and 2D MRI were found to be different (p = 0.123). The mean glenoid height was significantly different when measured on 2D MRI (39.09 ± 2.93 mm) compared to 3D CT (38.71 ± 2.89 mm) (p = 0.032). The mean glenoid width was significantly different between 3D CT (30.13 ± 2.43 mm) and 2D MRI (27.45 ± 1.72 mm) (p < 0.001). The 3D CT measurements had better interrater agreement (ICC, 0.91) than 2D MRI measurements (ICC, 0.8). intrarater agreement was also higher on CT. Conclusions Measurements of glenoid height using 3D CT and 2D MRI with subsequent calculation of the glenoid width using a validated methodology were not equivalent, and 3D CT was superior. Based on the validated methods for the measurement of glenoid bone loss on advanced imaging studies, 3D CT study must be preferred over 2D MRI in order to estimate the amount of glenoid bone loss in candidates for shoulder stabilization surgery and to assist in surgical decision-making.

Background: Recent literature suggests that three-dimensional magnetic resonance imaging (3D MRI) can replace 3D computed tomography (3D CT) when evaluating glenoid bone loss in patients with shoulder instability. We aimed to examine if 2D MRI in conjunction with a validated predictive formula for assessment of glenoid height is equivalent to the gold standard 3D CT scans for patients with recurrent glenohumeral instability. Methods: Patients with recurrent shoulder instability and available imaging were retrospectively reviewed. Glenoid height on 3D CT and 2D MRI was measured by two blinded raters. Difference and equivalence testing were performed using a paired t-test and two one-sided tests, respectively. The interclass correlation coefficient (ICC) was used to test for interrater reliability, and percent agreement between the measurements of one reviewer was used to assess intrarater reliability. Results: Using an equivalence margin of 1 mm, 3D CT and 2D MRI were found to be different (p = 0.123). The mean glenoid height was significantly different when measured on 2D MRI (39.09 ± 2.93 mm) compared to 3D CT (38.71 ± 2.89 mm) (p = 0.032). The mean glenoid width was significantly different between 3D CT (30.13 ± 2.43 mm) and 2D MRI (27.45 ± 1.72 mm) (p < 0.001). The 3D CT measurements had better interrater agreement (ICC, 0.91) than 2D MRI measurements (ICC, 0.8). intrarater agreement was also higher on CT. Conclusions Measurements of glenoid height using 3D CT and 2D MRI with subsequent calculation of the glenoid width using a validated methodology were not equivalent, and 3D CT was superior. Based on the validated methods for the measurement of glenoid bone loss on advanced imaging studies, 3D CT study must be preferred over 2D MRI in order to estimate the amount of glenoid bone loss in candidates for shoulder stabilization surgery and to assist in surgical decision-making.

PURPOSE: To identify potential differences in interportal capsulotomy size and cross-sectional area (CSA) using the anterolateral portal (ALP) and either the: (i) standard anterior portal (SAP) or (ii) modified anterior portal (MAP). MATERIALS AND METHODS: Ten cadaveric hemi pelvis specimens were included. A standard arthroscopic ALP was created. Hips were randomized to SAP (n=5) or MAP (n=5) groups. The spinal needle was placed at the center of the anterior triangle or directly adjacent to the ALP in the SAP and MAP groups, respectively. A capsulotomy was created by inserting the knife through the SAP or MAP. The length and width of each capsulotomy was measured using digital calipers under direct visualization. The CSA and length of the capsulotomy as a percentage of total iliofemoral ligament (IFL) side-to-side width were calculated. RESULTS: There were no differences in mean cadaveric age, weight or IFL dimensions between the groups. Capsulotomy CSA was significantly larger in the SAP group compared with the MAP group (SAP 2.16±0.64 cm2 vs. MAP 0.65±0.17 cm2, P=0.008). Capsulotomy length as a percentage of total IFL width was significantly longer in the SAP group compared with the MAP group (SAP 74.2±14.1% vs. MAP 32.4±3.7%, P=0.008). CONCLUSION The CSA of the capsulotomy and the percentage of the total IFL width disrupted are significantly smaller when the interportal capsulotomy is performed between the ALP and MAP portals, compared to the one created between the ALP and SAP. Surgeons should be aware of this fact when performing hip arthroscopy.

Purpose: Intracavernosal injections are used to treat erectile dysfunction. Patient compliance with intracavernosal injections is required for success, though factors influencing compliance are unknown. This study aimed to identify factors that influence compliance with intracavernosal injections among men with erectile dysfunction. Materials and Methods: A retrospective analysis was conducted using men who were prescribed intracavernosal injections between 2017 and 2022 at an academic medical center in a cosmopolitan area. Custom Python code was used to capture the first and last prescription refill events, and the duration of intracavernosal injection use was calculated. Additional patient-related data, including demographics and comorbidities, were gathered through chart reviews. Cox Proportional Hazards Regression models were used to evaluate the effects of predictor variables on the duration of intracavernosal injection use. Results: A total of 4,072 patients were included in the analysis. The study revealed that age significantly predicted discontinuation of intracavernosal injection therapy, showing an elevated hazard ratio of 1.007 for each additional year of age (p<0.001). Men who preferred to speak Spanish as their primary language was a significant predictor of discontinuation of injection therapy, showing a hazard ratio of 1.163 compared to those who preferred English (p=0.004). Men with a history of prostate cancer treatment stayed on treatment for 80 days fewer on average than those without (p=0.002). Conclusions Older age, prior history of prostate cancer treatment, and men who preferred to speak Spanish were all identified as factors potentially associated with reduced continuation of intracavernosal injection therapy for erectile dysfunction. Understanding these factors can help healthcare providers in both patient selection and counseling when discussing treatment options for erectile dysfunction.

Purpose: Intracavernosal injections are used to treat erectile dysfunction. Patient compliance with intracavernosal injections is required for success, though factors influencing compliance are unknown. This study aimed to identify factors that influence compliance with intracavernosal injections among men with erectile dysfunction. Materials and Methods: A retrospective analysis was conducted using men who were prescribed intracavernosal injections between 2017 and 2022 at an academic medical center in a cosmopolitan area. Custom Python code was used to capture the first and last prescription refill events, and the duration of intracavernosal injection use was calculated. Additional patient-related data, including demographics and comorbidities, were gathered through chart reviews. Cox Proportional Hazards Regression models were used to evaluate the effects of predictor variables on the duration of intracavernosal injection use. Results: A total of 4,072 patients were included in the analysis. The study revealed that age significantly predicted discontinuation of intracavernosal injection therapy, showing an elevated hazard ratio of 1.007 for each additional year of age (p<0.001). Men who preferred to speak Spanish as their primary language was a significant predictor of discontinuation of injection therapy, showing a hazard ratio of 1.163 compared to those who preferred English (p=0.004). Men with a history of prostate cancer treatment stayed on treatment for 80 days fewer on average than those without (p=0.002). Conclusions Older age, prior history of prostate cancer treatment, and men who preferred to speak Spanish were all identified as factors potentially associated with reduced continuation of intracavernosal injection therapy for erectile dysfunction. Understanding these factors can help healthcare providers in both patient selection and counseling when discussing treatment options for erectile dysfunction.

Purpose: Intracavernosal injections are used to treat erectile dysfunction. Patient compliance with intracavernosal injections is required for success, though factors influencing compliance are unknown. This study aimed to identify factors that influence compliance with intracavernosal injections among men with erectile dysfunction. Materials and Methods: A retrospective analysis was conducted using men who were prescribed intracavernosal injections between 2017 and 2022 at an academic medical center in a cosmopolitan area. Custom Python code was used to capture the first and last prescription refill events, and the duration of intracavernosal injection use was calculated. Additional patient-related data, including demographics and comorbidities, were gathered through chart reviews. Cox Proportional Hazards Regression models were used to evaluate the effects of predictor variables on the duration of intracavernosal injection use. Results: A total of 4,072 patients were included in the analysis. The study revealed that age significantly predicted discontinuation of intracavernosal injection therapy, showing an elevated hazard ratio of 1.007 for each additional year of age (p<0.001). Men who preferred to speak Spanish as their primary language was a significant predictor of discontinuation of injection therapy, showing a hazard ratio of 1.163 compared to those who preferred English (p=0.004). Men with a history of prostate cancer treatment stayed on treatment for 80 days fewer on average than those without (p=0.002). Conclusions Older age, prior history of prostate cancer treatment, and men who preferred to speak Spanish were all identified as factors potentially associated with reduced continuation of intracavernosal injection therapy for erectile dysfunction. Understanding these factors can help healthcare providers in both patient selection and counseling when discussing treatment options for erectile dysfunction.

Purpose: Intracavernosal injections are used to treat erectile dysfunction. Patient compliance with intracavernosal injections is required for success, though factors influencing compliance are unknown. This study aimed to identify factors that influence compliance with intracavernosal injections among men with erectile dysfunction. Materials and Methods: A retrospective analysis was conducted using men who were prescribed intracavernosal injections between 2017 and 2022 at an academic medical center in a cosmopolitan area. Custom Python code was used to capture the first and last prescription refill events, and the duration of intracavernosal injection use was calculated. Additional patient-related data, including demographics and comorbidities, were gathered through chart reviews. Cox Proportional Hazards Regression models were used to evaluate the effects of predictor variables on the duration of intracavernosal injection use. Results: A total of 4,072 patients were included in the analysis. The study revealed that age significantly predicted discontinuation of intracavernosal injection therapy, showing an elevated hazard ratio of 1.007 for each additional year of age (p<0.001). Men who preferred to speak Spanish as their primary language was a significant predictor of discontinuation of injection therapy, showing a hazard ratio of 1.163 compared to those who preferred English (p=0.004). Men with a history of prostate cancer treatment stayed on treatment for 80 days fewer on average than those without (p=0.002). Conclusions Older age, prior history of prostate cancer treatment, and men who preferred to speak Spanish were all identified as factors potentially associated with reduced continuation of intracavernosal injection therapy for erectile dysfunction. Understanding these factors can help healthcare providers in both patient selection and counseling when discussing treatment options for erectile dysfunction.

Purpose: Intracavernosal injections are used to treat erectile dysfunction. Patient compliance with intracavernosal injections is required for success, though factors influencing compliance are unknown. This study aimed to identify factors that influence compliance with intracavernosal injections among men with erectile dysfunction. Materials and Methods: A retrospective analysis was conducted using men who were prescribed intracavernosal injections between 2017 and 2022 at an academic medical center in a cosmopolitan area. Custom Python code was used to capture the first and last prescription refill events, and the duration of intracavernosal injection use was calculated. Additional patient-related data, including demographics and comorbidities, were gathered through chart reviews. Cox Proportional Hazards Regression models were used to evaluate the effects of predictor variables on the duration of intracavernosal injection use. Results: A total of 4,072 patients were included in the analysis. The study revealed that age significantly predicted discontinuation of intracavernosal injection therapy, showing an elevated hazard ratio of 1.007 for each additional year of age (p<0.001). Men who preferred to speak Spanish as their primary language was a significant predictor of discontinuation of injection therapy, showing a hazard ratio of 1.163 compared to those who preferred English (p=0.004). Men with a history of prostate cancer treatment stayed on treatment for 80 days fewer on average than those without (p=0.002). Conclusions Older age, prior history of prostate cancer treatment, and men who preferred to speak Spanish were all identified as factors potentially associated with reduced continuation of intracavernosal injection therapy for erectile dysfunction. Understanding these factors can help healthcare providers in both patient selection and counseling when discussing treatment options for erectile dysfunction.

Methods: We assessed baseline neutral upright, standing flexion, seated lateral radiographs, and magnetic resonance imaging (MRI) for patients identified with spondylolisthesis from January 2021 to May 2022 by a single spine surgeon. DS was classified by Meyerding and Clinical and Radiographic Degenerative Spondylolisthesis classifications. A difference of >10° or >8% between views, respectively, was used to characterize angular and translational instability. Analysis of variance and paired chi-square tests were utilized to compare modalities. Results: A total of 136 patients were included. Seated lateral and standing flexion radiographs showed the greatest slip percentage (16.0% and 16.7%), while MRI revealed the lowest (12.2%, p <0.001). Standing flexion and lateral radiographs when seated produced more kyphosis (4.66° and 4.97°, respectively) than neutral upright and MRI (7.19° and 7.20°, p <0.001). Seated lateral performed similarly to standing flexion in detecting all measurement parameters and categorizing DS (all p >0.05). Translational instability was shown to be more prevalent when associated with seated lateral or standing flexion than when combined with neutral upright (31.5% vs. 20.2%, p =0.041; and 28.1% vs. 14.6%, p =0.014, respectively). There were no differences between seated lateral or standing flexion in the detection of instability (all p >0.20). Conclusions Seated lateral radiographs are appropriate alternatives for standing flexion radiographs. Films taken when standing up straight do not offer any more information for DS detection. Rather than standing flexion-extension radiographs, instability can be detected using an MRI, which is often performed preoperatively, paired with a single seated lateral radiograph.