Orthopedics Commons^™

Understanding Barriers And Facilitators To Implementation Of Psychosocial Care Within Orthopedic Trauma Centers: A Qualitative Study With Multidisciplinary Stakeholders From Geographically Diverse Settings, Ana-Maria Vranceanu, Jafar Bakhshaie, Mira Reichman, James Doorley, Ryan A. Mace, Cale A. Jacobs, Mitchel Harris, Kristin R. Archer, David Ring, A. Rani Elwy

Orthopaedic Surgery and Sports Medicine Faculty Publications

BACKGROUND: Psychosocial factors are pivotal in recovery after acute orthopedic traumatic injuries. Addressing psychosocial factors is an important opportunity for preventing persistent pain and disability. We aim to identify barriers and facilitators to the implementation of psychosocial care within outpatient orthopedic trauma settings using the Consolidated Framework for Implementation Research (CFIR) and Proctor's taxonomy of implementation outcomes, and to provide implementation strategies derived from qualitative data and supplemented by the Expert Recommendations for Implementing Change.

METHODS: We conducted live video qualitative focus groups, exit interviews and individual interviews with stakeholders within 3 geographically diverse level 1 trauma settings (N …

Variations In Management Of A3 And A4 Cervical Spine Fractures As Designated By The Ao Spine Subaxial Injury Classification System, Barry Ting Sheen Kweh, Jin Wee Tee, Sander Muijs, F Cumhur Oner, Klaus John Schnake, Lorin Michael Benneker, Emiliano Neves Vialle, Frank Kanziora, Shanmuganathan Rajasekaran, Gregory D. Schroeder, Alex R. Vaccaro, Ao Spine Subaxial Injury Classification System Validation Group

Rothman Institute Papers

Objective: Optimal management of A3 and A4 cervical spine fractures, as defined by the AO Spine Subaxial Injury Classification System, remains controversial. The objectives of this study were to determine whether significant management variations exist with respect to 1) fracture location across the upper, middle, and lower subaxial cervical spine and 2) geographic region, experience, or specialty.

Methods: A survey was internationally distributed to 272 AO Spine members across six geographic regions (North America, South America, Europe, Africa, Asia, and the Middle East). Participants' management of A3 and A4 subaxial cervical fractures across cervical regions was assessed in four clinical …

Mechanisms Of Reducing Joint Stiffness By Blocking Collagen Fibrillogenesis In A Rabbit Model Of Posttraumatic Arthrofibrosis, Andrzej Steplewski, Jolanta Fertala, Ryan Tomlinson, Mark L. Wang, Allison Donahue, William V Arnold, Michael Rivlin, Pedro K Beredjiklian, Joseph A Abboud, Surena Namdari, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

Posttraumatic fibrotic scarring is a significant medical problem that alters the proper functioning of injured tissues. Current methods to reduce posttraumatic fibrosis rely on antiinflammatory and anti-proliferative agents with broad intracellular targets. As a result, their use is not fully effective and may cause unwanted side effects. Our group previously demonstrated that extracellular collagen fibrillogenesis is a valid and specific target to reduce collagen- rich scar buildup. Our previous studies showed that a rationally designed antibody that binds the C-terminal telopeptide of the α2(I) chain involved in the aggregation of collagen molecules limits fibril assembly in vitro and reduces scar …

Long-Term Treatment With Senolytic Drugs Dasatinib And Quercetin Ameliorates Age-Dependent Intervertebral Disc Degeneration In Mice, Emanuel J Novais, Victoria Tran, Shira N Johnston, Kayla R Darris, Alex J Roupas, Garrett A Sessions, Irving Shapiro, Brian O Diekman, Makarand V Risbud

Department of Orthopaedic Surgery Faculty Papers

Intervertebral disc degeneration is highly prevalent within the elderly population and is a leading cause of chronic back pain and disability. Due to the link between disc degeneration and senescence, we explored the ability of the Dasatinib and Quercetin drug combination (D + Q) to prevent an age-dependent progression of disc degeneration in mice. We treated C57BL/6 mice beginning at 6, 14, and 18 months of age, and analyzed them at 23 months of age. Interestingly, 6- and 14-month D + Q cohorts show lower incidences of degeneration, and the treatment results in a significant decrease in senescence markers p16INK4a, …

Hip Replacement For Femur Neck Fracture In The Elderly, Effects Of Delayed Surgical Intervention On Morbidity And Mortality, A Retrospective Comparative Study, Ahmed Habib, Shah Fahad, Muhammad Atif, Javeria Saeed, Pervaiz Hashmi, Mujahid Jamil Khattak

Section of Orthopaedic Surgery

Hip fracture is one of the most common injuries in the elderly population. Delay in operating on patients with hip fracture is associated with greater mortality and morbidity. A retrospective review of medical charts of patients who underwent primary total hip replacement (THR) for neck of femur fractures at our tertiary care level 1 trauma was carried out. Data was collected from the patients' charts and analysed for 30-day mortality and morbidity. A total of 96 patients were included in the study. Out of the 36 patients in the delayed THR group, mortality within 30 days was observed in 4 …

Caudal Epidural Steroid Injections In The Setting Of Remaining On Antithrombotics: A Retrospective Study., Jeremy I Simon, Jeffrey Gehret, Eric S Larsen, Kyle Hummerston, Do, Philip J. Koehler Iii, Do, Paul Kitei, Md

Rothman Institute Papers

BACKGROUND: The American Society of Regional Anesthesia currently recommends ceasing antithrombotic medications for all spinal epidural steroid injections, however there is a paucity of data on the true risk of spinal epidurals via various approaches versus the risk of cessation of an agent as it relates to the underlying medical condition.

OBJECTIVE: This study evaluated the complication rate of caudal epidural steroid injections in patients who remain on antithrombotic medications.

STUDY DESIGN: Retrospective chart review.

SETTING: Physiatric Spine Clinic in Orthopedic Specialty Office and Surgical Center.

METHODS: A retrospective chart review was performed identifying patients (n = 335) who received …

Multicenter Outcomes After Hip Arthroscopy: Comparative Analysis Of Patients Undergoing Concomitant Labral Repair And Ligamentum Teres Debridement Versus Isolated Labral Repair, Blake Bodendorfer, Thomas Alter, Steven Defroda, Andrew Wolff, Dominic Carreira, John Cristoforetti, Dean Matsuda, John Salvo, Benjamin Kivlan, Shane Nho

Department of Orthopaedic Surgery Faculty Papers

Background: Increased attention has been directed toward the ligamentum teres (LT) and its association with acetabular coverage, labral pathology, and hip microinstability; however, few studies have evaluated whether LT pathology influences the rate of clinically significant outcome improvement after hip arthroscopy. Purpose: To determine if patients with femoroacetabular impingement syndrome (FAIS) undergoing labral repair and concomitant LT debridement achieve outcomes similar to patients without LT pathology undergoing labral repair. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a retrospective review of a prospectively maintained multicenter database for hip arthroscopy. Included were patients with FAIS who underwent primary …

The Surgical Treatment Of Cervical Myelopathy In Patients Who Ambulate Independently, Ambulate With Assistive Devices, Or Are Wheelchair Bound: A Michigan Spine Surgery Improvement Collaborative Study, Rafid Kasir, Lonni Schultz, Richard W. Easton, Victor Chang, Jad Khalil

Conference Presentation Abstracts

We examine whether wheelchair bound patients undergoing cervical spine surgery for cervical myelopathy have improvement in patient-reported outcome measures.

Use Of Ultrasound-Guided Platelet-Rich Plasma In The Treatment Of Carpometacarpal Osteoarthritis, Manuel Britto, Siraaj Dawood, Siyang Lu, Martin Canillas

HCA Healthcare Journal of Medicine

Introduction

Osteoarthritis (OA) is the most common form of arthritis and can severely affect function and quality of life. Platelet-rich plasma (PRP) is derived from a patient’s own blood and has potential as an adjunct to treat OA. However, research has been limited for small joints such as the carpometacarpal (CMC) joint.

Clinical Findings

A 65-year-old Caucasian male complained of bilateral wrist and neck pain after a motor vehicle accident. His initial exam noted swelling, tenderness and pain with movement at the bilateral thumb CMC joints and anatomic snuffboxes. However, there was no strength, range of motion or tactile deficits …

Long-Term Sports Participation And Satisfaction After Ucl Reconstruction In Amateur Baseball Players., Robert A Jack, Somnath Rao, Taylor D'Amore, Donald Willier Iii, Robert Gallivan, Steven B. Cohen, Christopher C Dodson, Michael G. Ciccotti

Rothman Institute Papers

Background: While the incidence of ulnar collateral ligament reconstruction (UCLR) has increased across all levels of play, few studies have investigated the long-term outcomes in nonprofessional athletes.

Purpose: To determine the rate of progression to higher levels of play, long-term patient-reported outcomes (PROs), and long-term patient satisfaction in nonprofessional baseball players after UCLR.

Study Design: Case series; Level of evidence, 4.

Methods: We evaluated UCLR patients who were nonprofessional baseball athletes aged(KJOC), the Timmerman-Andrews (T-A) Elbow score, the Mayo Elbow Performance Score (MEPS), and a custom return-to-play questionnaire.

Results: A total of 91 baseball players met the inclusion criteria, and …

A Pilot Study Of Knee And Hip Osteoarthritis Patient Experience With Telemedicine During The Covid-19 Pandemic, Rondy M. Lazaro, Kyle J. Smith, Mohammad H. Bawany, Nathan Barford, Jennifer H. Paul

Advances in Clinical Medical Research and Healthcare Delivery

Objective: The purpose of this pilot study is to examine patients' experience and satisfaction using telemedicine for knee and hip osteoarthritis care during the COVID-19 pandemic.

Methods: Adult patients seen via telemedicine for knee and/or hip osteoarthritis pain completed surveys through the REDCap online platform or pen/paper evaluating their experiences and satisfaction with telemedicine, assessed using yes/no and Likert scale questions. Demographic information was collected from the electronic medical record (EMR).

Results: 32 subjects (9 males, 23 females, mean age 63.2 years [SD = 12.2 years]) completed surveys. 90.6% of subjects stated that they were satisfied with the audio/video quality …

Platelet-Rich Plasma Vs. Traditional Surgical And Nonsurgical Interventions For Rotator Cuff Tendinopathies, Nick Slingerland

Theses and Graduate Projects

Background: Rotator cuff tendinopathies present as one of the most common musculoskeletal injuries of the upper extremity. The rotator cuff consists of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis with the supraspinatus the most injured of the group. Over time, variations regarding treatment through surgical or nonsurgical interventions have remained constant. In recent years, the use of platelet-rich plasma (PRP) as an additional alternative has become popular to promote healing and improve functionality of the shoulder. The purpose of this clinical review using various study designs is to assess if the platelet-rich plasma injections are more effective when …

What Treatment And Prevention Options Are The Most Effective For Elbow, Knee, And Plantar Tendinopathies?, Cody Lawson

Theses and Graduate Projects

Objective: Tendinopathies of the upper and lower extremity are one of the most common injuries in athletes and non-athletes in the United States. This literature review aimed to determine the most effective preventions and treatments for patients with tendinopathies.

Methods: A literature search was conducted primarily through Google Scholar and PubMed, for articles related to effective preventions and treatments for tendinopathies.

Discussion: Based on the literature review, there were multiple effective treatments and preventative measures for tendinopathies in the upper and lower extremity. The most effective preventative measures consisted of risk factors, dynamic warmups, and prevention programs. Treatments were broken …

Pain Reduction In Chronic Lumbar Patients Using Spinal Cord Stimulation, David Botros

Theses and Graduate Projects

Background: Spinal cord stimulation (SCS) is commonly used to treat chronic neuropathic pain. A common indication for the SCS is failed back surgery syndrome (FBSS). There are many interventional approaches to treating lumbar pain; however, the SCS may provide the greatest benefit in terms of health care utilization and overall pain relief to the patient.

Objective: The goal of this paper is to assess the effectiveness of SCS compared to conventional therapies such as physical therapy, oral medications, radiofrequency ablations (RFA), epidural steroid injections (ESI), and intrathecal pain pumps (IT pain pump) in patients with chronic lumbar pain due to …

Novel Cemented Technique For Trochanteric Fixation And Reconstruction Of The Abductor Mechanism In Proximal And Total Femoral Arthroplasty: An Observational Study, Brian T. Muffly, Kyle T. Boden, Cale A. Jacobs, Patrick W. O’Donnell, Stephen T. Duncan

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: Little evidence exists regarding the clinical outcomes of cemented trochanteric fixation for abductor mechanism reconstruction in proximal or total femoral replacements. Clinical outcomes were assessed for a novel cemented technique for trochanteric fixation in femoral megaprostheses.

Methods: A descriptive series of 13 patients who underwent proximal or total femoral arthroplasty from 2016 to 2019 were reviewed. Radiographic trochanteric displacement > 1 cm defined construct failure. A Kaplan-Meier survival analysis was performed to determine survival rates for these cemented constructs. Demographic information was obtained to better characterize the patient population in whom this technique was used.

Results: Eleven patients were …

Gum Chewing, Added To Conventional Feeding, Reduces Risk Of Post-Operative Ileus After Elective Hip And Knee Arthroplasty Procedures In Elderly Population: A Protocol For A Parallel Design, Open-Label, Randomized Controlled Trial, Obada Hussein Hasan, Laraib Mazhar, Ahsun Jiwani, Dilshad Begum, Riaz Hussain Lakdawala, Shahryar Noordin

Department of Medicine

Introduction: Postoperative ileus (poi) is defined as a temporary cessation of bowel movement after a surgical procedure. Cessation of bowel movement not only leads to disturbing constipation but also may lead to nausea, loss of appetite, and food intolerance. Literature reports "sham feeding" (gum-chewing) effect as an increase in chewing and saliva which enhances the gastric emptying and overall motility of gut as a cephalic phase of digestion. Therefore, we aim to assess the effect of adding gum-chewing to the conventional postoperative feeding regimen on restoring postoperative bowel function and length of stay in hospital of patients undergoing elective hip …

Primary Leiomyosarcoma Of The Distal Tibia: A Case Report., Sachin Dheer, Pamela Gekas, Faith Schick, Homyar Karanjia, Nicholas Taweel

Department of Radiology Faculty Papers

The authors present an unusual case of a leiomyosarcoma of the distal tibia. Leiomyosarcoma tumors typically originate from smooth muscle tissue. It is rare for it to derive from bone and even rarer to be found in a bone of the lower limb. Given this extreme rarity in addition to nonspecific findings on plain film radiographs and magnetic resonance imaging (MRI), biopsy was needed in this case. It was only through immunochemistry staining that a definitive diagnosis was made. As such, this case is an illustrative example of an aggressive, though rare, primary lesion of the bone which should be …

Comparison Of Surgical Site Infection After Skin Closure By Prolene Or Staples In Bilateral Simultaneous Knee Arthroplasty Patients: A Parallel Design Randomized Controlled Trial Protocol, Obada Hussein Hasan, Ahsun Jiwani, Laraib Mazhar, Dilshad Begum, Riaz Hussain Lakdawala, Shahryar Noordin

Department of Medicine

Introduction: Knee arthroplasty also known as the total knee replacement is an orthopedic surgical procedure done to resurface the knee that has been severely damaged by arthritis. After the completion of the surgical procedure, the skin closure is done. The optimal goal of skin closure after the procedure is to promote rapid healing and an acceptable cosmetic result while minimizing the risk of infection. Skin closure after knee arthroplasty is done by using either of the two widely used sutures i.e., polypropylene (Prolene) sutures or the skin staple sutures. There are no standard guidelines as which type of the suture …

Functional Outcomes And Complications Of Total Hip Arthroplasty With Dual Mobility Cup : An Audit, Muhammad Younus Khan Durrani, Javeria Saeed, Masood Umer, Pervaiz Hashmi

Section of Orthopaedic Surgery

Objective: To determine the functional outcomes in total hip arthroplasty with a dual mobility cup, performed in our hospital.
Methods: After receiving an exemption from the Ethics review committee of the hospital, data collection for audit was started in January 2019. Records from July 2016 to June 2018 were included. All patients who underwent total hip arthroplasty with dual mobility prosthesis without any age limit were included. A proforma was prepared to collect the required information. Data was entered and analyzed on SPSS v. 21.
Results: Two hundred and ten patients were included, 114 females and 96 males. Of the …

Frequency Of Angular Malalignment After Intramedullary Nailing For Femur Shaft Fractures - A Cross-Sectional Study, Hammad Naqi Khan, Moiz Ali, Rizwan Haroon Rashid, Yasir Mohib, Pervaiz Hashmi

Section of Orthopaedic Surgery

Objective: To determine the frequency of angular malalignment of femur in patients undergoing Intra Medullary nailing for femur shaft fracture by measuring axis on immediate postoperative plain radiographs.
Methods: A cross-sectional study was conducted at the Section of Orthopaedics, Department of Surgery, Aga Khan University Hospital, Karachi from 1st January 2019 till 30th June 2019. All patients between the ages of 15 to 80 years who underwent IM nailing for femur shaft fractures were included. Angulation was measured on immediate post-operative X-ray films and an angle of ≥5° on AP and/or lateral views was defined as malalignment.
Results: A total …

Aging Gracefully - Orthocon 2021, Masood Umer, Haroon Ur Rashid, Rizwan Haroon Rashid

Section of Orthopaedic Surgery

No abstract provided.

Outcome Of Percutaneous Screw Fixation Of Posterior Pelvic Ring Injuries, Hussain Wahab, Pervaiz Hashmi, Haroon Kasi, Naveed Baloch, Tashfeen Ahmad, Haroon Rashid, Masood Umer

Section of Orthopaedic Surgery

Objective: To evaluate the clinical outcome of percutaneous fixation for unstable pelvic ring injury.
Methods: This retrospective study was conducted at orthopaedics section of Aga Khan University Hospital Karachi, Pakistan from July 2015 to December 2018. Data was retrieved from trauma registry from July 2015 till December 2018, including all patients who underwent percutaneous fixation for pelvic ring injury. Majeed pelvic score was used to determine the functional outcome.
Results: A total number of 30 patients were included, 27(90.0%) adults, and 3(10.0%) paediatrics patients. There were 21(70.0%) males and 9(30.0%)females. . Mean age of patients was 37.1±16.1 years. Post op …

Our Experience Of Treating Adult Bone Lymphoma, A Retrospective Cross-Sectional Study In A Tertiary Care Center, Aga Khan University Hospital, Karachi, Masood Umer, Muhammad Younus Khan Durrani, Javeria Saeed, Nasir Ud Din

Section of Orthopaedic Surgery

Objective: To determine the experience at the Aga Khan University Hospital in diagnosing and treating adult patients with primary lymphoma of bone.
Methodology: All patients with Primary lymphoma of bone (PLB) that were diagnosed and/or treated at Aga Khan University Hospital, Karachi from 2005 to 2019 were included as part of this study.
Results: There were 17 patients with PLB including 13 (76.5%) males and 4 (23.5%) females with a mean age of 44 ± 16.5 years. Nine patients were between 30-59 years of age at diagnosis. The mean follow-up time of patients was 80±46.7 months. Six patients had tumours …

Our Experience Of Mega-Prosthesis In Bone Tumours: A Retrospective Cross-Sectional Study In A Tertiary Care Hospital, Masood Umer, Eraj Khurshid Khan, Javeria Saeed

Section of Orthopaedic Surgery

Objective: To evaluate the oncological and functional outcomes of bone tumour patients who underwent reconstruction with mega prosthesis.
Methodology: A retrospective study was conducted in the department of Orthopaedics Aga Khan University Hospital, Karachi. All the paediatric and adult age group patients diagnosed with malignant, benign and metastatic bone tumours and meeting the inclusion criteria were selected and analysed. Retrospective data was collected from January 2008-January 2018.
Results: Sixty-two patients, 30 (48.4%) females and 32 (51.6%) males. were included in the study. Of these 57 (92%) cases had involvement of the lower limb. The mean age was 36.95±19.1 years with …

Functional And Radiological Outcomes Of Atypical Femur Fractures Among Elderly In Karachi, Pakistan, Rizwan Haroon Rashid, Marij Zahid, Usama Khan, Yasir Mohib, Pervaiz Hashmi

Section of Orthopaedic Surgery

Objective: To assess the functional and radiological outcomes in a unique class of fractures i.e. atypical femur fractures and to assess the effects of osteoblastic agents in healing.
Methods: It is a retrospective observational study conducted at Aga Khan University Hospital, Karachi, Pakistan. All patients with atypical femur fractures who were surgically managed with intramedullary nailing from January, 2013 to June, 2017 and with a follow-up till December 2019, were included in the study. Radiological outcomes were expressed as mean healing time and functional outcomes were recorded as mean Short Musculoskeletal Functional Assessment (SMFA) score.
Results: A total of twenty-four …

Unicompartmental Knee Arthroplasty Is Associated With A Lower Rate Of Periprosthetic Joint Infection Compared To Total Knee Arthroplasty, Cody S. Lee, Edwin P. Su, Michael B. Cross, Alberto V. Carli, David C. Landy, Brian P. Chalmers

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: Several studies have reported lower perioperative complications with unicompartmental knee arthroplasty (UKA) than with total knee arthroplasty (TKA). However, there is a paucity of data analyzing the incidence of periprosthetic joint infection (PJI) in similar patients undergoing UKA and TKA. As such, we sought to analyze the incidence of UKA and TKA PJI in a large matched population.

Material and Methods: The Mariner data set of the PearlDiver database was queried for all patients undergoing UKA or TKA during 2010-2017. Included patients were required to have at least 2 years of database inclusion after surgery. Patients were then matched …

Surgeon Decision-Making For Individuals With Obesity When Indicating Total Joint Arthroplasty, William F. Sherman, Akshar H. Patel, Nisha N. Kale, Christina M. Freiberger, C. Lowry Barnes, Olivia C. Lee

School of Medicine Faculty Publications

Background: Obesity is a risk factor for complications after total joint arthroplasty (TJA). This study analyzed the impact of individual surgeon demographics, financial concerns, and other factors in determining patient candidacy for TJA based on body mass index (BMI). Methods: A 21-question survey was approved by the American Association of Hip and Knee Surgeons Research Committee for distribution to its membership. Objective questions asked about surgeon or hospital BMI thresholds for offering TJA. Subjective questions asked about physician comfort discussing topics including obesity, bariatric surgery, and weight loss before TJA, as well as insurance and age considerations. Results: For TJA …

Treatment And Outcomes Of Soft Tissue Sarcoma Of Groin, Hip And Thigh: A Retrospective Review From A Tertiary Care Hospital, Masood Umer, Javeria Saeed, Zaid Ahmed Shamsi, Muhammad Usman Tariq

Section of Orthopaedic Surgery

Objective: To study the frequency of the thigh, hip and groin soft tissue sarcomas and retrospectively analyse the management, treatment results, and outcomes of these uncommon malignant tumours, in a tertiary care hospital of the city of Karachi.
Methodology: Data of soft tissue tumours registered from 2017-2018 was retrieved during January 2019 to March 2019 from Aga Khan University Hospital, Karachi bone and soft tissue tumour registry. A retrospective review was performed and all soft tissue tumour cases treated with surgical intervention (with adjuvant /neoadjuvant therapy) or palliative intention were included.
Results: Total 119 cases of soft tissue tumours (STS) …

Prevention Of Falls In Hospital: Audit Report From A Tertiary Care Hospital Of Pakistan, Anum Sadruddin Pidani, Tashfeen Ahmad, Nasreen Panjwani, Shahryar Noordin

Department of Surgery Docs

Objective: The study aims to assess the fall incidents in past 5 years and fall assessment practices at the Aga Khan University Hospital, Karachi.
Methods: We performed a single-center retrospective audit at Aga Khan University Hospital from October 2019 to December 2019. A list of all patients admitted to Aga Khan University Hospital under the Musculoskeletal and Sports Medicine Service Line was obtained using the Hospital Information Management System (HIMS) from Jan 2017 to June 2018. Data including fall assessment scores was collected retrospectively from medical record files.
Results: A total of 1499 patients were admitted during this time period, …

Modulation Of The Acute Post-Anterior Cruciate Ligament Rupture Intra-Articular Environment Via Recruitment Of Marrow-Derived Stem Cells To Promote Bone Tunnel Healing In Acl Reconstruction, Kevin C. Baker, Samantha Hartner, Mackenzie M. Fleischer, Michael D. Newton, William B. Acker, Perry Altman, Christopher Bush, Tristan Maerz, Asheesh Bedi

Conference Presentation Abstracts

Acute, post-injury peripheral blood mobilization therapy with a CXCR4 antagonist improved bone tunnel healing and graft integration following ACL reconstruction surgery in a rat model.