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Objectives: Fractures of anterior glenoid rim, aka "Postage-Stamp" fractures, are potential complications of arthroscopic Bankart repairs that occur when a fracture line propagates through previous anchor sites producing a serrated edge. (Fig.1: A and J) Placing multiple anchors adjacent to glenoid rim in attempt to recreate the labral bumper was suggested to reduce the risk of recurrent dislocation after surgery, [Boileau et al 2006] as well as to create a stress riser that may predispose to fracture if another traumatic event may occur. This controlled laboratory study investigated the effect of increased number holes, and different types and sizes of suture anchors on the load necessary to create Postage-Stamp fractures. Our objective was to establish a safe number of anchors that could be inserted in the anterior glenoid rim without incurring in a substantially high risk of fracture. Hypothesis: Increasing the number of holes and anchors and their size would decrease forces necessary to break the anterior glenoid rim. Methods: We tested 46 synthetic scapulae with similar compressive strength and elastic modulus of human glenoid (4th gen. composite scapulae, Sawbones, Pacific Research Laboratories, USA) in a servohydraulic apparatus (Fig.1: B and H) following a previous published biomechanical model. [Farmer et al2014] A guide ensured holes were drilled and anchors were inserted in the same exact angle, depth and location for every specimen. (Fig.1: C to F) A metallic humeral head applied force to the anterior glenoid rim at 1mm/s until fracture occurred. (Fig. 1: G to K) Load-to-fracture of intact glenoid was compared to groups of drilling anchor holes (# 3,4,5,6 and 7) of different diameters (1.6mm and 3mm), and groups with anchors of different sizes and types (1.6mm all-suture and 3mm core anchors).(Fig.1: I to K) One-way ANOVA followed by Turkey post-hoc test compared groups to determine the number of holes necessary to weaken glenoids below 70% of intact value with a p value <0.005. Results: Intact glenoid mean load-to-fracture was 1,238 ± 74N. Drilling 3 to 7 holes of 1.6mm-diameter linearly reduced load to 93%, 89%, 74%, 56% and 52% of intact value respectively, while 3.0mm drill holes reduced load to 87%, 65%, 51%, and 40% respectively.(Fig.2) Directly comparing drill role sizes there were significant differences on the 4, 5 and 7 holes groups (p=0.045, 0.032 and 0.015, respectively), so that a glenoid could safely sustain up to 5 holes of 1.6mm, but no more than 3 holes of 3.0mm-diameter.(Fig.3) Inserting 1.6mm "all-suture" anchors in the 1.6mm-diameter holes did not change the load-to-fracture on the 4 or 5 holes groups (Fig.4A), indicating that the number of drill holes was the main determinant of anterior glenoid rim strength, so that the all-suture anchors did not act as stress risers. Thus, up to 5 "all-suture" 1.6mm anchor could be safely used on a Bankart repair. The 3.0mm "core" anchors increased the load-to-fracture when compared to the group with the same number of holes of the same diameter size. Despite 4 holes of 3.0mm-diameter decreased the load-to-fracture bellow the safety line of 70% of intact value, the group with 4 anchors of 3.0mm-diameter "core" anchors increased load-to-fracture to 85% of intact value (p=0.033).(Fig.4B) This stress shield effect of the 3.0mm core anchor was not noticed on the 5 anchors group, in which the overall strength of the construction was bellow the 70% of intact safety line. Conclusions: Our data call in that up to four 3.0mm "core" anchors or five 1.6mm-diameter "all-suture" anchors could be safely inserted in the anterior glenoid rim without incurring in increased risk of Postage-Stamp fracture. One should prefer small diameter anchors if more than 4 anchors were intended on a Bankart repair. This study contributed to important data about number, size and type of anchors that the anterior glenoid rim could safely sustain in order to avoid postage-stamp fracture in case a new traumatic dislocation episode occur after a Bankart repair, which is of clinical interest in high risk population preoperative planning and selection of implant size, type and number. [ABSTRACT FROM AUTHOR]

Objectives: It is unclear if concomitant glenohumeral osteoarthritis is protective or detrimental with respect to rotator cuff integrity after arthroscopic repair surgery. We hypothesized that the associated stiffness might protect the repaired tendon. In the alternate, arthritis might reflect a gradual degeneration of the joint including a degenerative tendon and therefore predispose the repair to re-tear. Therefore, the purpose of this study was to investigate whether concomitant osteoarthritic changes found intra-operatively during arthroscopic rotator cuff repairs (RCR) have a beneficial or detrimental effect on post-operative repair integrity. Methods: This study is a post-hoc analysis of prospectively collected data of patients who underwent primary arthroscopic RCR between 2005 and 2019 by a single surgeon. Patients were divided into an osteoarthritic group and a control group based on the presence or absence of intra- operative osteoarthritic changes respectively. The primary outcome measure was cuff integrity detected by post-operative ultrasound at 6-months. The secondary outcomes were patient-reported outcomes including shoulder pain, stiffness, level of activity at work and level of sport, and physician-reported outcomes including shoulder range of motion and strength. Results: A total of 2155 consecutive patients met the inclusion criteria with a mean age of 59 years (SD=0.2) and there were more males as compared to females (56% vs. 44%). 28% of patients undergoing RCR had osteoarthritic changes detected intra- operatively. Intra-operatively, the osteoarthritic group had more full-thickness tears (64% vs. 59%) (p<.001), a larger mean anteroposterior tear length [20mm (SD=0.5) vs. 17mm (SD=0.4)] (p<.001) and a larger mean mediolateral tear length [17mm (SD=0.5) vs. 15mm (SD=0.4)] (p<.001). Ultrasonographic evaluation at 6-months post-surgery demonstrated that the osteoarthritic group had a higher incidence of cuff re-tear rate as compared to the control group (15% vs. 11%) (p=.016) (Figure 1). However, after performing a multiple logistic regression analysis, osteoarthritis was not found to be an independent predictor of re-tear. There were very marginal differences in patient-reported outcomes at 6-months after surgery between the two groups (Table 1). The osteoarthritic group reported lesser post-operative frequency of activity pain [2.0 (SD=1.46) vs. 2.2 (SD=1.43)] (p=.005), frequency of extreme pain [0.8 (SD=1.35) vs. 1.0 (SD=1.41)] (p=.035) and level of pain during overhead activity [1.7 (SD=1.30) vs. 1.9 (SD=1.30)] (p=.021) as compared to controls. As compared to controls, the osteoarthritic group also experienced lesser post-operative stiffness [1.5 (SD=1.32) vs. 1.6 (SD=1.31)] (p=.019) and reported lower intensities of work-related activities [1.1 (SD=0.88) vs. 1.2 (SD=0.85)] (p=.038) and lower level of sport activity [0.4 (SD=0.62) vs. 0.5 (SD=0.70)] (p=.004). In terms of physical examination at 6-months following surgery (Table 2), the osteoarthritic group were found to have lesser range of motion in forward flexion [146° (SD=33.1) vs. 151° (SD=31.2)] (p=.009), abduction [127° (SD=38.8) vs. 131° (SD=38.1)] (p=.034), external rotation [50° (SD=21.4) vs. 52° (SD=21.0)] (p=.024) and internal rotation (L1 vertebrae (SD=4.2) vs. T12 vertebrae (SD=4.2)] (p=.004) as compared to controls. The osteoarthritic group as weaker internal rotation strength [68N (SD=30.5) vs. 73N (SD=32.9)] (p=.004), external rotation strength [57N (SD=25.3) vs. 60N (SD=27.2)] (p=.026), supraspinatus flexion strength [45N (SD=26.8) vs. 50N (SD=27.9)] (p<.001), lift-off [40N (SD=24.3) vs. 44N (SD=25.3)] (p<.001) and adduction strength [76N (SD=36.5) vs. 81N (SD=39.3)] (p=.008) as compared to the control group. Conclusions: Patients with concomitant glenohumeral osteoarthritis who underwent arthroscopic RCR had higher re-tear rates at 6-months after surgery. However, osteoarthritis is not an independent predictor of rotator cuff re-tear at 6-months. Therefore, arthroscopic RCR is a viable surgical option for these patients. Figure 1: Proportion of intract vs. torn rotator cuff repairs between the osteoarthritic group (n=1552) and control group (n=603) at 6-months post-operative follow-up (p=.016). Table 1: 6-month post-operative pain scares and shoulder function in the osteoarthritic group vs. control group. Table 2: 6-month post-operative shoulder range of motion and strength in the osteoarthritic group vs. control group. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study is to identify clinical and radiographic factors that predict return to sport in high-level athletes and to determine thresholds for significant predictors. Methods: Data were reviewed on all patients who underwent primary hip arthroscopy between November 2008 and August 2018. Patients were included if they played professional, college, or high school sports within 1 year before surgery and had preoperative, 3-month, 1-year, and 2-year postoperative patient reported outcome (PRO) scores for modified Harris Hip Score (mHHS), Hip Outcome Score-Sport Specific-Subscale (HOS-SSS), and Non-Arthritic Hip Score (NAHS). Patients were divided into groups based on whether they returned to sport (RTS). Multivariate logistic regression and receiver operator characteristic (ROC) analysis were used to evaluate the correlation between significant variables and RTS. Results: A total of 136 patients with a mean age of 20.8 ± 7.07 years were included. Competition level, postoperative alpha angle, change in alpha angle, and postoperative PROs were significantly different between groups. The multivariate logistic regression model identified postoperative alpha angle as a statistically significant predictor of return to sport [P <.001, S > 9.97 (OR 0.85, CI 0.79-0.91)]. The ROC curve for postoperative alpha angle demonstrated acceptable discrimination between patients returning to sport and patients not returning to sport with an area under the curve of 0.71 and a threshold value of 46˚. Athletes with a postoperative alpha angle ≤ 46˚ returned to sport at a rate of 71.2%, while those with a postoperative alpha angle > 46˚ returned to sport at a rate of 28.1% [(P <.001, S > 9.97 (OR 6.3, CI 2.6-15.2)] Conclusions: Postoperative alpha angle was identified as a predictor of return to sport in high-level athletes. The odds of returning to sport were 6.3 times greater in athletes with postoperative alpha angles ≤ 46˚ compared to athletes with angles > 46˚. [ABSTRACT FROM AUTHOR]

Objectives: To determine if subgroups of patients exist based on the recovery trajectory of health-related quality of life following hip arthroscopy for femoroacetabular impingement syndrome (FAIS), and to determine clinical data predictors for these subgroups of patients. Methods: A clinical hip data repository was queried for patients who underwent primary hip arthroscopy for the treatment of FAIS between January 2012 and May 2018. Patients who completed pre-operative, 1-year, and 2-year International Hip Outcome Tool-12 (iHOT-12) were included in the study. Latent class growth analysis (LCGA) and growth mixture models (GMM) were used to identify subgroups of patients based on trajectories of recovery for iHOT-12 utilizing 3 clinical time points (pre-operative [within 1 week of surgery], one-year postoperative, and two-year postoperative). LCGA and GMM models using 1 – 6 classes were assessed for best model fit according to AIC, BIC, bootstrapped likelihood ratio test, and log-likelihood ratios. Following the final model selection, a multivariable multinomial logistic regression on the final model was performed with the largest class as the reference group to determine clinical predictors of subgroup membership. Results: A total of 443 patients with an average age of 34.25 ± 12.65 and BMI of 25.02 ± 5.11met inclusion criteria. The 3-class GMM was the best fit model, and the resulting subgroups were named based on trajectories of iHOT-12 scores: early progressors, late regressors, and late progressors (Figure 1A). The early progressors comprised 70.0% of the study group and had substantial early improvement between preoperative and 1-year follow-up with further improved 2-year outcomes (Figure 1B). The late regressors comprised 22.3% of the study sample and demonstrated improvement between preoperative and 1-year follow-up with decreasing function between 1-year and 2-years postoperatively (Figure 1C). The late progressors represented the smallest group at 7.7% and only demonstrated improved outcomes after 1-year postoperatively (Figure 1D). Predictors of the late regressor membership were worker's compensation status, psychiatric history, preoperative chronic pain, and lower preoperative iHOT-12 scores. Patients in the late progressor subgroup were less likely to participate in physical hobbies/exercise. Conclusions: Using growth mixture models, three natural courses of health-related quality of life recovery following hip arthroscopy for the treatment of FAIS were identified: early progressors, late regressors, and late progressors. Worker's compensation status, psychiatric history, preoperative chronic pain, and lower preoperative iHOT-12 scores were predictive of less than favorable trajectories of recovery. Figure 1. [ABSTRACT FROM AUTHOR]

Objectives: Current techniques for ulnar collateral ligament (UCL) do not reproduce the anatomic ulnar footprint of the UCL. The purpose of this study was to describe a novel UCL reconstruction technique that utilizes proximal-to-distal ulnar bone tunnels to better recreate the anatomy of the UCL and compare the biomechanical profile at time zero between this technique, the native UCL, and the traditional docking technique. Our hypothesis was that the biomechanical profile of the anatomic technique is similar to the native UCL and traditional docking technique. Methods: Ten matched cadaveric elbows were potted with the forearm in neutral rotation. The palmaris longus tendon graft was harvested, and bones were sectioned 14 cm proximal and distal to the elbow joint. Specimen testing included: (1) native UCL testing performed at 90° flexion with 0.5 Nm valgus moment preload, (2) cyclic loading from 0.5-to-5 Nm valgus moment for 1000 cycles at 1 Hz, and (3) load to failure at 0.2 mm/s. Elbows then underwent UCL reconstruction with one elbow of each pair receiving the classic docking technique using either anatomic (proximal-to-distal) or traditional (anterior-to-posterior) tunnel locations. Specimen testing was then repeated, as described above. Results: There was no difference between maximum load at failure or valgus angle between the anatomic or traditional tunnel location techniques (34.90 ± 10.65 Nm vs. 37.28 ± 14.26 Nm, P = 0.644) or the native UCL (45.83 ± 17.03 Nm, P = 0.099). Additionally, there was no difference in valgus angle after 1000 cycles across the anatomic (4.58 ± 1.47°), traditional (4.08 ± 1.28°), or native UCL (4.07 ± 1.99°). Anatomic group and the native UCL had similar valgus angles at failure (24.13 ± 5.86° vs. 20.13 ± 5.70°, P = 0.083), while the traditional group had a higher valgus angle at failure compared to the native UCL (24.88 ± 6.18° vs. 19.44 ± 5.86°, P = 0.015). Conclusions: UCL reconstruction with the docking technique utilizing proximal-to-distal ulnar tunnels to restore the anatomic ulnar footprint better recreates the anatomy of the UCL while providing valgus stability comparable to reconstruction with docking technique using traditional anterior-to-posterior ulnar tunnel locations. These results suggest that utilization of the anatomic tunnel location in UCL reconstruction has similar biomechanical properties compared to the traditional method at the time of initial fixation (i.e., not accounting for healing following reconstruction in vivo) while keeping the ulnar tunnels further from the ulnar nerve. Further studies are warranted to determine if an anatomically based UCL reconstruction results in differing outcomes compared to traditional reconstruction techniques. [ABSTRACT FROM AUTHOR]

In the era of visual media, cities, and society are represented, experienced, and interpreted through images. The need for interdisciplinary visual approaches, therefore, is indisputable. By focusing on cinema, this paper aims to develop a conceptual, methodological framework through which theory helps a broad range of researchers in social sciences, humanities, and arts interpret the represented phenomenon. Based on Peirce's model of signs, the framework provides the basis for a dynamic interpretation of the city and society. This paper shows that Peircean cinesemiotics takes advantage of theory in three ways: First, as the basis that provides scholars with clues necessary for identifying eligible "image-signs"; second, as the guiding framework that helps them reach a final interpretation; third, as ideas are being criticized from visual perspectives. As an example of its application, using Jane Jacobs' "The Death and Life of Great American Cities," the final part of the paper applies Peircean cinesemiotics to an image-sign from Death Wish (2018) and interprets it as the representation of safety/crime in a neighborhood. [ABSTRACT FROM AUTHOR]

The structural properties of selected (Ba1−xSrx)PbO3 ceramics were examined at 14–1148 K using X-ray powder diffraction (XRD). These materials are attractive due to their variety of applications, such as, for example, high-temperature thermoelectric energy conversion. Attention was paid to this paper as a continuation of the previous examinations of higher Sr2+ concentrations. The type of perovskite distortion and temperatures of the structural phase transitions (SPTs) were determined from the splitting of certain pseudocubic lines. At this point, for example (Ba0.3Sr0.7)PbO3 showed three temperature-induced SPTs. When the amount of Sr increased in the samples, no phase transition was observed, which is contrary to the data previously demonstrated in the literature. The quality of the ceramics was examined by scanning electron microscopy-energy dispersion X-ray spectroscopy (SEM-EDS), demonstrating their homogeneity and uniform elements dispersion. As a result of profound crystal investigations, confirmed by thermogravimetric analysis and quadrupole mass spectroscopy (TGA-QMS), a phase diagram was prepared for the (Ba1−xSrx)PbO3 system based on our former and recent study. Also, the investigation of a new application for the (Ba1−xSrx)PbO3 family is presented in this paper for the first time. The TGA analysis was conducted on Illinois#6 hard coal to evaluate the capability of perovskites to be used in the chemical looping combustion (CLC) process in a range of temperatures 1073–1173 K. Due to its thermal stability and reactivity, Ba0.9Sr0.1PbO3 is the material with the greatest potential to be applied as an oxygen carrier. The combination of strontium and barium offers encouraging results compared to the pure barium and strontium lead oxide perovskites. [ABSTRACT FROM AUTHOR]

Objectives: Although the risk of tibial tunnel convergence in the setting of multiligament reconstruction has been reported in the literature, the risk of tunnel convergence in the setting of posterior cruciate ligament (PCL), anterior cruciate ligament (ACL), and medial and lateral meniscal root repair has not been defined. The purpose of this study was to examine the risk of tunnel convergence and to determine optimal tunnel placement for ACL and PCL reconstruction performed in conjunction with posterior medial and lateral meniscal root repairs in the proximal tibia. Methods: Three-dimensional tibial models were created using computed tomography scans of twenty cadaveric specimens. After determining optimal tunnel entry and exit points for ACL and PCL reconstructions, and medial and lateral meniscal root repair on the models, Mimics software was used to create root tunnels. The meniscal root repair tunnels were then re-oriented to be parallel to the ACL tunnel. The initial and re-oriented configurations are illustrated in Figure 1. Tunnel convergence risk was analyzed with single and double tunnel techniques in both case scenarios. Results: There were no cases of convergence between the ACL and medial meniscal root tunnels in any of the configurations. The greatest distance between the tunnels was achieved with the single tunnel technique in parallel orientation (12.09 ± 2.78 mm). All specimens demonstrated convergence between the ACL and lateral meniscal root tunnels when the sagittal plane entry was not taken into consideration and only the anatomic root attachment was accounted for, for single and double tunnel techniques, but no convergence was seen between these tunnels with the parallel orientation in the sagittal plane. Figure 2 illustrates the reduction in the convergence risk when the meniscal root tunnels are reoriented as parallel to the ACL tunnel. There were no cases of convergence between the PCL and medial meniscal root tunnels in the original orientation, but 2/20 specimens demonstrated convergence in the parallel orientation with the double tunnel technique and no cases of convergence in the single tunnel technique. The PCL and lateral meniscal root tunnels did not demonstrate convergence in any configuration. Table 1 demonstrates the mean, minimum and maximum distances of each tunnel configuration as well as the number of cases where the distance between tunnels was <2mm. A summary of the preferred tunnel configurations for each setting, ranked by greatest tunnel distance conferred and cases of convergence, is reported in Table 2. Conclusions: There is a high risk of convergence between ACL and posterior meniscus root tunnels. Re-orienting meniscal root tunnels parallel to ACL tunnels may help reduce this risk. When PCL reconstruction is performed with ACL reconstruction and medial and lateral meniscal root repair, the single tunnel root repair technique may pose less risk over the double tunnel technique to prevent tunnel convergence between the meniscal root repair and PCL tunnels in the tibia. Figure 1. Illustration of the reconstruction of the tunnels. (A) Initial orientation where the meniscal root tunnels' entry points on the anteromedial aspect of the tibia were created above the ACL tunnel. (B) The meniscal root tunnels re-orientated and were placed parallel to that of the ACL and aimed to exit at the anatomic attachment of the posterior roots of the meniscus. (Gold guide for the creation of the ACL tunnel and silver guide for the creation of the meniscal root tunnel) [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the affect of blood flow restriction (BFR) therapy conducted both before and after anterior cruciate ligament (ACL) reconstruction on early quadriceps strength and patient reported outcomes. Methods: A total of 43 patients (24 male, 19 female; age 27.6 ± 11.88 years) presenting with an ACL tear were randomized into two groups, BFR (N=22) and Control (N=21) at their initial clinic visit (ICV). Quadriceps strength was measured utilizing a handheld dynamometer in order to calculate peak force, average force and time to peak force during seated leg extension at the ICV. All patients were provided education on preoperative exercises to be performed 4-5 days per week for two weeks between the ICV and date of surgery. The BFR group was instructed to perform these exercises with a pneumatic cuff set to 80% of limb occlusion pressure placed over the proximal thigh. Following surgery, patients underwent physical therapy utilizing standard post-ACL reconstruction therapy protocols, with exercises performed with and without the use of BFR in each respective group. Patient Reported Outcome Measurement System Physical Function (PROMIS-PF), International Knee Documentation Committee (IKDC) scores, knee range of motion and quadriceps circumference were gathered at the ICV, the day of surgery, 2 weeks and 6 weeks after surgery. Quadriceps strength measurements were repeated the day of surgery and six weeks following ACL reconstruction. Results: No significant differences were noted between the BFR and control groups in peak quadriceps force generation (Figure 1), time to peak force or average force at any timepoints (P>0.05). At six weeks post-surgery, the BFR group had significantly higher PROMIS-PF (43.16 ± 5.29 versus 38.39 ± 5.39, p=0.02) and IKDC (58.22 ± 7.64 versus 47.05 ± 13.50, p=0.01, Figure 2) scores compared to the control group. Conclusions: Blood flow restriction therapy before and after ACL reconstruction results in improved patient reported outcomes scores without objective improvements in strength at six week follow up. Long term follow up is needed to determine if differences arise in quadriceps strength between groups. Figure 1. Peak quadriceps force of the injured leg measured in Newtons during the initial clinic visit (ICV), day of surgery (PreOp) and 6 weeks post ACL reconstructions. No statistically significant differences (p>0.05) Figure 2. International Knee Documentation Committee (IKDC) scores collected at initial clinicvisit (ICV), day of surgery (PreOp), 2 weeks and 6 weeks following ACL reconstruction. * Denotes statistically significant difference between groups (p<0.05) [ABSTRACT FROM AUTHOR]

Objectives: It is not currently understood which subset of patients with recurrent patellofemoral instability require concomitant bony realignment procedures in addition to a soft tissue stabilization. Additionally, the optimal timing of surgical intervention is not well defined by current literature and can be dictated by the skeletal maturity of a patient. If the patient's complete pathology is not addressed at their primary procedure, there can be a high risk of recurrent instability necessitating revision surgery. It is not known if the outcomes of medial patellofemoral reconstruction with concomitant tibial tubercle osteotomy (MPFL+TTO) performed as a revision procedure equate the outcomes of MPFL+TTO performed in the primary setting. This study compares patients who underwent primary MPFL+TTO versus those who underwent the same procedure in the revision setting. Methods: Patients who underwent a MPFL+TTO from March 2014 to December 2018 were identified from an institutional patellofemoral registry. Patients were separated into two groups, those undergoing a primary MPFL+TTO and those undergoing a MPFL+TTO after a previously failed surgical attempt for patellar stabilization. Baseline demographic, radiographic, and knee-specific patient reported outcome measures (PROMs) including KOOS QOL, Pedi-Fabs, IKDC, KOOS-PS, and Kujala were collected prior to surgery and at 1- and 2-years following surgical intervention. Return to sport (RTS) rates and recurrent instability events were also collected. Results: 92 knees (84 patients) were included; 59 in the primary group and 33 in the revision group. No differences were identified between the groups with respect to sex (85% vs. 82%, p=0.715), age (23.7 vs. 22.5, p=0.468), BMI (26.3 vs 24.5, p=0.144), TT-TG (20.3 vs 19.3, p=0.238), or patella alta (33% vs 19%, p=0.354). Previous procedures in the revision cohort included 12 MPFL reconstructions, 3 tibial tubercle transfers, 16 lateral releases, 9 imbrications/reefings/plications, 7 loose body removals and 9 chondroplasties. 53 (90%) patients in the primary group and 29 (88%) patients in the revision group had a minimum of 2-year follow-up. There was no difference between the groups for recurrent dislocation (4% vs 0%, p=0.547), recurrent subluxation (9% vs 0%, p=0.162) and RTS (88% vs 83%, p=0.713). In regard to RTS, 79% of the primary surgery group and 71% of the revision group returned at an equal or higher level (p=0.461). At baseline, the primary group had a higher IKDC (42.0 vs 34.7, p=0.049). At 2-year follow-up both groups had significant improvements from baseline in all PROMs, except Pedi-FABS which had no change. There was no difference between groups at 2-year follow-up in KOOS-QoL (60.8 vs 51.1, p=0.186), Pedi-FABS (8.0 vs 7.3, p=0.796), IKDC (75.2 vs 67.7, p=0.206), KOOS-PS (15.8 vs 20.9, p=0.379), and Kujala (86.5 vs 77.9, p=0.143). Conclusions: Management of patellofemoral instability is complex. The optimal timing of surgical intervention and whether a concomitant bony realignment procedure is indicated has yet to be elucidated. This study demonstrates that primary MPFL+TTO versus revision MPFL+TTO have comparable objective and subjective outcomes at short term follow-up. Ongoing data collection for this patient cohort will determine whether these results are sustained at long term follow-up. [ABSTRACT FROM AUTHOR]

Objectives: Posterior shoulder instability accounts for approximately 2-12% of shoulder instability cases and represents a debilitating if not potentially career-ending injury in athletic populations. Arthroscopic posterior shoulder stabilization through capsulolabral reconstruction has been shown to reduce pain and improve function, facilitating return to sport at short- to medium-term follow-up. However, few long-term follow-up studies (exceeding 10 years) have been performed to assess the persistent benefit in shoulder function achieved by surgical intervention. Therefore, the purpose of this study was to investigate the objective and subjective clinical outcome measures of shoulder function in patients who underwent arthroscopic posterior shoulder stabilization with a minimum follow-up time of 10 years. It was hypothesized that current shoulder function would remain statistically superior to preoperative shoulder function, with diminishing benefit for those who required revision surgery. Methods: A group of 183 patients (200 shoulders) who underwent arthroscopic capsulolabral reconstruction for isolated posterior shoulder instability between January 1998 and December 2009 were recruited via existing contact information within the electronic medical record at a single academic medical institution. Institutional review board approval was obtained prior to study initiation, and all patients signed informed consent. Patient characteristics including age, gender, hand dominance, sports played, level of participation, and length of follow-up, were obtained. Patients completed an online questionnaire containing the American Shoulder and Elbow (ASES) shoulder score and the Kerlan-Jobe Orthopaedic Clinic (KJOC) shoulder and elbow score. Subjective scores of pain, stability, range of motion (ROM), and strength were also obtained. The level of sporting participation after treatment was determined and patients assessed whether the initial surgery was worthwhile. Current shoulder status, as compared to preoperative (but post-injury) shoulder status, was compared according to the above metrics. Subgroup analyses were performed comparing outcomes between athletes whose primary sport did or did not involve overhead throwing. Subgroup analyses were also performed for patients who underwent revision surgery, as compared to those who did not, including additional evaluation of shoulder function after failure but preceding revision surgery. Group means for continuous variables were compared using ANOVA and student's t tests as appropriate, while ordinal or categorical data were compared with Wilcoxon signed rank tests or Fisher's exact test when suitable. Results: 53 patients (55 shoulders) with a mean age of 23 years at surgery were included, with an average follow-up time of 15.4 years. 49 of 53 patients were right-hand dominant, with right shoulder injury in 35 cases. Patient characteristics for subgroup analyses based upon position and need for revision surgery are shown in Table 1. Across all patients (55 shoulders) there was significant improvement in all outcome measures, including scores of ASES, KJOC, pain, stability, ROM, and strength, comparing current to preoperative shoulder status (Table 2). Similar trends were found in subgroup analyses, with throwers and non-throwers demonstrating equivalent improvements. In contrast, patients who underwent revision surgery (n=8) possessed a current shoulder status equivalent to preoperative status, across all outcome measures, although significantly improved when compared to shoulder status after initial failure (Table 2). Across all patients, 60% returned to sport at any level, with 34.5% returning to sport an the same level as prior to injury. 89% of patients felt the initial surgery was worthwhile. Subgroup analysis demonstrated a trend towards compromised return to sport at pre-injury levels in throwing athletes, but statistical significance was not achieved (p =.09). Conclusions: The main finding of this study was that arthroscopic capsulolabral reconstruction produced significant pain relief and improved shoulder function at long-term follow-up, that is, at a mean of 15.4 years following surgery. Of the limited patient population that underwent revision surgery (n=8), current shoulder status did not differ statistically from preoperative status (i.e., no significant improvement compared to preoperative function). Both findings support the hypothesis. No differences in throwing athletes were found in comparison to non-throwing athletes according to the outcome measures explored. The majority of patients were able to return to sport following surgery, but only 64% of non-throwers returned to sport at the same level as prior to injury, with only 21% of throwers returning to pre-injury levels. While some of these findings are attributed to a discontinuation or reduction in sporting activity due to expected life circumstances (e.g. graduation), the results suggest continued opportunity to improve shoulder function following injury entailing a posterior instability event. This study is also limited by the absence of a group that did not undergo operative intervention. While this study is limited by a relatively small sample size, it does represent one of the longest follow-up periods for posterior shoulder stabilization, demonstrating sustained benefit in shoulder pain and function following arthroscopic surgery. [ABSTRACT FROM AUTHOR]

Objectives: Shoulder instability among adolescent athletes remains a complex challenge with high recurrence rates. Knotted suture anchors have provided consistently reliable biomechanical and clinical results. In recent years, the advent of the knotless suture anchor technology has come with proposed advantages of minimizing technical difficulty and knot migration, as well as reducing subsequent intra-articular cartilage irritation and damage. While several studies have analyzed the utility of knotless suture anchors in the adult population, to our knowledge, there has not been a direct comparison within this more at risk for surgical failure adolescent population. The purpose of this study was to compare the effect of knotted versus knotless suture anchor use on postoperative outcomes of arthroscopic shoulder instability surgery in the adolescent athlete. Methods: A multicenter comparative cohort was conducted of patients that underwent primary arthroscopic shoulder labral repair with suture anchor implants for shoulder instability between June 2015 and November 2017. Additional inclusion criteria included patient age <20 years and minimum follow up duration of 3.5 years. Data collected included demographics, number and type of suture anchor (knotted or knotless), number of instability events, type of instability, and presence of bony Bankart lesions. All included patients had <20% glenoid bone loss at the time of surgery. Type of instability was also recorded and was classified as either: anterior, posterior, or multidirectional (MDI). The primary outcome measure was surgical failure, which was defined as any recurrent instability event post-surgery. Incidence of secondary surgery (including revision or need for additional procedure), surgical times, and return to sport (RTS) data were also recorded. Patient-reported outcomes were evaluated using the Pediatric and Adolescent Shoulder Survey (PASS), SANE (Single Assessment Numeric Evaluation) scores, and the Quick version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) survey. Results: Eighty-eight shoulders (54 male, 34 female) from 84 patients met inclusion criteria and were analyzed. 43 received knotless anchors and 45 received knotted anchors. Mean follow-up duration was 4.5 years (range, 3.5-6 years) for the knotless cohort and 4.8 years (range, 3.7-5.8 years) for the knotted cohort. Demographics and type of instability by suture anchor type is shown in Table 1. Surgical failure rate was significantly lower in the knotless cohort (knotless, 16%; knotted, 53%; P <.001). Patients with knotless suture anchors reported significantly higher mean PASS scores (knotless, 90.2; knotted, 81.3; P =.002). There was no difference in both RTS rates (knotless, 86%; knotted, 68%; P =.055) and incidence of repeat surgery between cohorts (knotless, 9%; knotted, 13%; P =.551). Surgical times, SANE scores, and QuickDASH scores were available for approximately three-quarters of shoulders (total, 65; knotless, 36; knotted, 29) in the cohort. Mean surgical time was approximately 18 minutes shorter for knotless anchors (knotless, 84.4 minutes; knotted, 102.7 minutes; P <.001). SANE scores were significantly higher in the knotless group (knotless, 88.8; knotted, 74.3; P =0.004). QuickDASH scores, of which a lower score is considered a better outcome, were not different (knotless, 5.7; knotted, 11.4; P =.063). Conclusions: Our initial intent was to demonstrate that knotless anchors would be just as successful as labral repairs with knotted anchors, but our results indicate several promising advantages, including: better patient reported outcome measures (PASS and SANE scores), reduced surgical times, and lower failure rates at a mean 4.5 years. There were some non-significant differences in the two cohorts regarding the type of instability that likely contributed to the differences in the number of anchors utilized. Future studies with larger sample sizes may serve to confirm our observed benefits associated with knotless anchors. In summary, the utilization of knotless suture anchor constructs for the repair of labral tears in adolescent shoulder instability may be safely considered with potentially improved outcomes over knotted anchors. Table 1. Demographic characteristics of included patients [ABSTRACT FROM AUTHOR]

The past decade has seen a rise in the availability of modern information and communication technologies (ICTs) for developing smart societies and communities. However, the smart divide, characterized by inequalities in ICT infrastructures, software access, and individual capabilities, remains a significant barrier for rural communities. Limited empirical studies exist that explore what and how ICT infrastructures can be developed to bridge the smart divide. The paper aimed to address rural broadband access in the context of infrastructural dimensions of smart divide (i.e., smart infrastructural divide) in the United States, focusing on the wireless network infrastructure's role in narrowing the gap. It examined the broadband specifications needed for smart applications like smart education and telehealth, emphasizing the importance of wireless network capabilities. While fixed broadband offers higher speeds, wireless networks can support many smart applications with decent flexibility and ease of access. To further understand the implications of wireless broadband to rural communities, we conducted a case study in Carbondale and Cairo, two rural towns in Southern Illinois, using on-site user-inspired speed testing. An Android application was developed to measure download/upload speeds and Reference Signal Received Power (RSRP) for broadband quality. Results suggest both Carbondale and Cairo experienced below-average speeds with high variability among census blocks, which highlights the need for improved wireless network infrastructure. The paper culminated in the technological and policy recommendations to narrow down the smart infrastructural divide. [ABSTRACT FROM AUTHOR]

Objectives: Recent studies have described an increased risk of osteoarthritis (OA) following ACL reconstruction (ACLR). Systematic reviews have suggested that meniscal pathology, which occurs in up to 60% of patients with ACL injury, increases this risk. The purpose of this study was to determine the influence of lateral meniscus tears and repair versus partial lateral meniscectomy on the risk of OA in patients following ACLR. Methods: All patients who underwent primary autograft or allograft bone-patellar tendon-bone (BPTB) transtibial ACLR by a single surgeon between 1999-2019, were identified. Revision ACLR, multi-ligamentous reconstructions, and patients with less than 2-year imaging follow-up were excluded. Patients with lateral meniscus pathology at the time of ACLR were identified and treatment (e.g. lateral meniscectomy or lateral meniscus tear) was extracted. OA was defined at follow-up as Kellgren-Lawrence (KL) grade III-IV on plain radiographs. Chi-square tests assessed differences in incidence rates (p<0.05). Results: A consecutive series of 113 patients (57 males, 56 females; age 35.7±11.9 years) with BPTB ACLR were included. The mean follow-up was 9±5 years. The prevalence of lateral meniscus tears was 60.2% (68/113) and the prevalence of lateral compartment OA at follow-up was 14% (16/113) Patients with a lateral meniscus tear were 4.7 times more likely to develop OA compared to patients with no lateral meniscus tear. 20.6% of patients (14/68) with lateral meniscus tear developed lateral OA compared to 4.4% of patients (2/45) without lateral meniscus tear (p=0.0158). Patients who underwent lateral meniscal repair (n=16) had significantly lower prevalence of OA (0/16) compared to patients who underwent lateral meniscectomy (14/52) (p=0.0196). Conclusions: At nine-year follow-up, patients with a lateral meniscus tear at time of ACLR were more likely to develop OA compared to patients with no lateral meniscus tear and patients treated with partial meniscectomy had higher prevalence of OA compared to those treated with meniscus repair. In patients who require ACLR, care should be taken in evaluating and treating the lateral meniscus to decrease the likelihood of the development of OA. We believe lateral meniscal repair is essential for lateral meniscus tears at the time ACL reconstruction to help avoid development of OA. Figure 1. [ABSTRACT FROM AUTHOR]

Objectives: High cumulative workloads and spikes in player workloads have been associated with an increased risk of injury in soccer and other sports. These studies, however, have all been conducted with data from male soccer players or male athletes in other sports, with few studies investigating female athletes. Using metrics collected from GPS units to monitor cumulative load and distance may be valuable for injury prevention. The purpose of this study was to examine the relationship between injury risk and workload as collected from wearable GPS units in NCAA Division I women's soccer players. Methods: Lower extremity injury incidence and GPS workload data (player load, total distance, and high-speed distance) of 65 NCAA Division I women's soccer players were collected over 3 seasons. Accumulated 1-, 2-, 3- and 4-weekly loads and acute: chronic workload ratios (ACWR) were classified into discrete ranges by z-scores. ACWR was calculated using rolling averages and exponentially weighted moving averages (EWMA) models. Binary logistic regression models were used to compare the 7:28 rolling average and EWMA ACWRs between injured and non-injured players for all GPS/accelerometer variables. The prior 1-, 2-, 3-, and 4-weekly accumulated loads for all GPS/accelerometer variables were compared between the injured and uninjured cohorts using two-sample t -tests with an alpha level of 0.05 set as significant. Results: There were a total of 53 lower extremity injuries that resulted in lost time recorded (5.76/1000 hours 'on-field' exposure time; 34 non-contact and 19 contact injuries). The prior 2-week (7,242 vs 6,613; p=0.02), 3-week (10,533 vs 9,718; p=0.02), and 4-week (13,819 vs 12,892; p=0.04) accumulated player loads and 2-week (62.40 vs 57.25 km; p=0.04), 3-week (90.97 vs 84.10 km; p=0.03), and 4-week (119.31 vs 111.38 km; p=0.05) accumulated total distances were significantly higher for injured players compared to non-injured players during the same timeframes. There were no significant differences in player load, total distance, or high-speed distance ACWR between injured and non-injured players for both the rolling averages and EWMA calculations. Conclusions: Higher accumulated player load and total distance, but not ACWR, are associated with injury in women's soccer players. [ABSTRACT FROM AUTHOR]

Objectives: Shoulder pain due to labral tears and biceps tendon pathology is commonly found in competitive softball players. Surgical options for treatment of these sources of shoulder pain include labral repair and biceps tenodesis. While past studies comparing these two modalities are limited by mostly heterogeneous study groups from multiple sports, this is the first study to our knowledge that assesses clinical outcomes and return to play rates specifically for softball players. The purpose of this study is to evaluate the clinical outcomes and return to play for softball players treated for a SLAP tear and recalcitrant biceps tendonitis with a biceps tenodesis compared with a traditional SLAP repair. We hypothesized that performing a biceps tenodesis in softball players that have recalcitrant biceps tendonitis or a SLAP tear would have comparable outcomes with a faster return to play compared to SLAP repair. Methods: We performed a retrospective analysis on all patients who were active softball players at the time of injury treated surgically for either a SLAP tear, recalcitrant biceps tendonitis or a combination of both between 2001 and 2019. Inclusion criteria for this study included softball players who underwent biceps tenodesis or a SLAP repair at our institution with greater than 2-year follow-up. Exclusion criteria involved patients with less than 2-year follow-up and patients who had undergone concomitant procedures on the ipsilateral shoulder at the time of SLAP repair or biceps tenodesis. Follow-up was either self-reported through OBERD, a PRO-managing software, or achieved over the phone by three authors using four questionnaires: American Shoulder and Elbow Surgeons (ASES-S), Andrews/Carson KJOC, and our institution-specific VAS visual pain indication and return-to-play questionnaires. Results: After applying the proper inclusion and exclusion criteria, we identified 76 patients who were eligible for this study. From this group of 76 patients, 63 were successfully contacted over the phone or had self-reported outcome scores pulled from our PRO-managing software for a follow-up rate of 83%. The average age for our study group at the time of surgery was 20.6 years and the average post-operative follow-up time was 6.0 years. Of the 76 patients in our study, 34 underwent a biceps tenodesis procedure (45%), 21 underwent a SLAP repair procedure (28%), 6 underwent a combination of both procedures (8%), and 2 underwent a biceps tenotomy (3%). For the 34 patients in our study who underwent biceps tenodesis, the average age at the time of surgery was 20.0 years with a mean follow-up time of 3.7 years. The mean Andrews-Carson score was 82.2 and KJOC score was 73.7 in this group. The mean ASES-S score was 92.0 for the affected shoulder and 97.8 for the unaffected shoulder. The VAS pain indicator score for this group was 1.4 out of 10. The 21 patients in the study who underwent SLAP repair had an average age of 20.9 years at the time of surgery. The average age follow-up time was 8.18 years. This group demonstrated a mean Andrews-Carson score of 86.7 and a KJOC score of 80.7. The mean ASES-S score was 93.3 for the affected shoulder and 96.4 for the unaffected shoulder. The VAS pain indicator score for this group was 1.2 out of 10. Of the 21 SLAP repair patients, 20 (95%) returned to full competition at an average of 7.5 months. Of the 34 patients who underwent biceps tenodesis, 31 (91%) returned to full competition at an average of 7.1 months. Conclusions: In conclusion, this study demonstrated comparable outcomes between SLAP repairs and biceps tenodesis procedures among our study group. Statistical analysis of PRO scores for each group found no significant differences between any of the measures used to evaluate patient outcome post-operatively. There was no significant difference between RTP times between the two groups. Further analysis is needed for additional comparisons, including level of play and position data. [ABSTRACT FROM AUTHOR]

Objectives: To determine predictors of clinically significant outcome achievement at a minimum of 5-year follow-up in patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement syndrome with routine capsular closure. Methods: Data were collected and analyzed from consecutive patients who underwent primary hip arthroscopy with routine capsular closure for the treatment of FAIS from a single fellowship-trained surgeon between January 2012 and December 2018. Baseline data, preoperative patient reported outcome measures (PROMs) and 5- year PROMs including Hip Outcome Score-Activities of Daily Living, HOS-Sports Subscale, international Hip Outcome Tool 12 questions, modified Harris Hip Score and visual analog scale pain were recorded. The minimal clinically important difference (MCID) was calculated using the distribution method while patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) were determined from literature defined values. Bivariate correlations with any MCID achievement, any PASS achievement, and any SCB achievement as well as a principle components analysis for variable reduction were used to create three separate multivariate binary logistic regressions to identify significant predictors of achieving a clinically significant outcome. Results: 453 patients with an average age of 34.3 ± 12.5 and average BMI of 25.5 ± 4.9 and majority female (69.1%) were included in the final analysis. There was a significant improvement in all 5-year functional outcomes when compared to preoperative scores (p<0.001 for all). At a minimum of 5-year follow-up, 82.8% of patients achieved any MCID, 69.8% achieved any PASS, and 58.9% achieved any SCB. A total of 23 patients (5.1%) of the study population underwent revision hip arthroscopy or total hip arthroplasty within the follow-up period. Female sex (Odds Ratio (OR), 2.56 [95% confidence interval (CI), 1.47 to 4.45) was a positive predictor of achieving any MCID while higher Tönnis angle (OR, 0.92 [95% CI, 0.87 to 0.98]), Tönnis grade =1 (OR, 0.34 [95% CI, 0.14 to 0.83]) were negative predictors of achieving any MCID. Higher preoperative HOS-ADL (OR, 1.03 [95% CI, 1.01 to 1.05]) and female sex (OR, 2.01 [95% CI, 1.14 to 3.55]) were positive predictors of PASS. With regards to SCB, running (OR, 2.02 [95% CI, 1.31 to 3.14]) was a positive predictor of achievement while a history of back pain (OR, 0.49 [95% CI, 0.28 to 0.86]) and preoperative chronic pain for greater than 2 years (OR, 0.62 [95% CI, 0.36 to 0.98]), were negative predictors of achievement. Conclusions: At a minimum of 5-year follow-up, 82.8% of patients undergoing primary hip arthroscopy for the treatment of FAIS achieved any MCID, 69.8% achieved any PASS, 58.9% achieved any SCB. Female sex, higher preoperative PROs, and participation in running were positive predictors of achieving a clinically significant outcome while a higher Tönnis angle, Tönnis grade = 1, preoperative chronic pain, and back pain were negative predictors of achieving a clinically significant outcome. [ABSTRACT FROM AUTHOR]

Objectives: Recurrent pain, instability and loss of function is a challenging complication that can occur after arthroscopic treatment of posterior shoulder instability and SLAP tears in athletes. Many surgeons allow return to sport after a designated arbitrary postoperative time point. Recent evidence has demonstrated that a majority of athletes have residual strength and functional limitations at 6 months postoperatively – the time at which most time-based protocols allow full return to sport1. Recent data has also been presented that patients undergoing arthroscopic Bankart repair who are required to meet objective return to sport testing criteria have a 4x lower rate of recurrent anterior instability than those who return based on time elapsed since surgery2. Considering these findings, the purpose of this study is to investigate the use of a similar objective return to sport testing protocol on recurrence rates following arthroscopic surgery for posterior shoulder instability and SLAP tears. We hypothesized that patients who meet objective return to sport criteria would have a lower rate of reoperation and recurrence of symptoms compared to those who did not undergo the testing and were cleared to return based on time from surgery. Methods: Consecutive patients (Group 1) who underwent arthroscopic posterior shoulder stabilization surgery with or without SLAP repair by a single surgeon from 2016 to 2019, had a minimum of 1 year follow up, and completed functional and strength testing to evaluate readiness for return to sport were included in this retrospective case-controlled study. These patients were compared to a control group of historical consecutive cases (Group 2) from 2012-2016 who did not undergo return to sports testing and were cleared for sports after a minimum of 6 months following surgery. Failure was defined as recurrent symptoms of pain or instability requiring reoperation. Exclusion criteria were: patients undergoing isolated anterior stabilization procedures with or without concomitant SLAP tears, multidirectional instability, and open procedures. Chi-square, Fisher exact tests and two-tailed Students T-test were performed. Statistical significance was set at p<0.05. Results: There were 33 patients in Group 1 who underwent return to sport testing, and 90 patients in Group 2, the historical control. There were no differences between groups regarding sex (p=0.46), hand dominance (p=0.16), side affected (p= 0.69. The average age of Group 1 (20.8 +/- 4 yrs) was significantly younger than Group 2 (31.6 +/- 9.1 yrs, p< 0.00001). Patients who underwent return to sport criteria-based testing protocol had a rate of recurrent symptoms of pain or instability of 12.1% compared to 18.9% for those who did not (p= 0.43). Similarly, there were no reoperations for in Group 1, while three patients in group 2 (3.3%) underwent revision surgery for recurrent symptoms. This difference, however, did not reach statistical significance (p= 0.5633). Conclusions: In our cohort of young patients undergoing arthroscopic surgery for posterior shoulder instability, we detected no significant difference in reoperation rate and recurrence of symptoms between athletes who underwent objective return to sport testing and those who were released to sport on a time-based protocol. This may be related to an overall lower rate of reoperation in patients undergoing arthroscopic posterior stabilization or SLAP repairs in general compared to those undergoing arthroscopic anterior stabilization and differences in tolerance and presentation of recurrent posterior instability/SLAP tears versus anterior instability. It is possible that criteria-based return to sport testing prior to clearance to return to sport may be less critical for improving failure rates following arthroscopic posterior stabilization and SLAP repair than for anterior stabilization. Alternatively, given low reoperation rates overall, future studies investigating the role of return to sport testing after arthroscopic surgery for posterior shoulder instability and SLAP repairs may need to include more patients in order to detect differences related to the testing protocol. Objective functional testing may be a viable alternative to arbitrary, time-based criteria for returning to sport in patients who have undergone arthroscopic posterior shoulder stabilization and SLAP repairs. [ABSTRACT FROM AUTHOR]

Objectives: Ulnar collateral ligament (UCL) surgery continues to improve since its inception by Dr. Frank Jobe in 1974. There is now ample data on the outcomes of surgery for throwing athletes, such as baseball players, who undergo either UCL reconstruction or UCL repair. In comparison, there is very little available data regarding outcomes of UCL surgery for non-throwing athletes who are seeking similar benefit from the procedure. The primary objective of this study is to provide clinical outcomes of UCL surgery performed in non-throwing athletes at a single institution with a minimum two-year follow-up. Methods: Forty non-throwing athletes who underwent UCL surgery (repair or reconstruction) between 2011 and 2019 were identified. All surgeries were performed by one of three fellowship-trained sports medicine surgeons at our institution utilizing a uniform technique for repair or reconstruction. Demographics were recorded including age, sex, laterality, arm dominance, sport, level of competition, and type of surgery (UCL repair or reconstruction). Outcomes included return to play (rate and average time), American Shoulder and Elbow Surgeons (ASES) scores, and complications. Results: Thirty-seven patients (92.5%) were available for evaluation with a minimum two-year follow-up consisting of 16 males (43%) and 21 females (57%). Mean age at the time of surgery was 18±3.7 years.28 UCL repairs (76%) and 9 UCL reconstructions (24%) were performed.Sports included football (n=11), gymnastics (11), cheerleading (7), wrestling (4), volleyball (2), basketball (1), and acrobatics (1). Quarterbacks were excluded from the football patients as quarterbacks are throwing athletes. Level of competition included youth (1), high school (26), college (8), and professional (2).Return to play rate was 93% (26 of 28) at a mean of 7.4 months for UCL repair, and 100% (9 of 9) at a mean of 10 months for UCL reconstruction.Mean ASES scores were 94.4 and 98.7 for UCL repair and reconstruction, respectively.Two Patients in the UCL repair group required ulnar neurolysis and revision ulnar nerve transposition. Conclusions: Both UCL reconstruction and UCL repair show favorable outcomes at minimum two-year follow-up in non-throwing athletes.93% or greater returned to play with good functional outcomes and minimal complications. Table 1. Patient Characteristics Table 2. Outcomes Comparison [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the safety and efficacy of performing a lateral extra-articular tenodesis (LET) with a modified Lemaire technique (MLT) in conjunction with anterior cruciate ligament reconstruction (ACLR) in children and adolescents at increased risk for failed ACLR. Methods: A consecutive series of patients ≤19 years who underwent simultaneous ACLR and LET with minimum two-year follow-up data were reviewed. Patients were indicated for LET when one or more of the following risk factors were present: participant in high-risk competitive sport such as football, lacrosse, soccer or basketball, grade 3 pivot shift, hyperlaxity (Beighton score > 6), recurvatum, revision ACLR, contralateral ACLR, or chronic ACL insufficiency. ACLR was performed using either full-thickness quadriceps tendon (QUAD) for skeletally immature patients or bone-patellar tendon-bone (BTB) autograft for skeletally mature patients. All-epiphyseal (AE) or complete transphyseal (CT)techniques were used depending on patients' skeletal maturity. At a minimum two-year follow-up, patient-reported outcome measures included Single Assessment Numeric Evaluation (SANE), Pediatric International Knee Documentation Committee (Pedi-IKDC), and the HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores. Return-to-sport (RTS)data and second surgeries were also obtained. Results: Sixty-one consecutive patients (mean age 15.17 ±1.73 years, range 11-19 years, 62% female) were analyzed (Table 1). 59 patients (97%) participated in organized sports including soccer, basketball, football and lacrosse, with soccer being the most popular one. The average grade at the time of surgery was 9th grade. Ten patients (16%) were revision ACLR procedures. Seven (11%) patients underwent AE and 54 (89%) underwent CT ACLR. Forty-two (69%) cases employed a QUAD autograft, while 19 (31%) utilized a BTB autograft. All patients underwent a LET with a MLT and 2 patients underwent simultaneous implant mediated guided growth with a plate for structural genu valgum. At two-year follow-up, mean SANE score was 95, median Pedi-IKDC score was 91, and median HSS-Pedi Fabs score was 27. RTS rate was 91.8%. Ten patients had subsequent surgical procedures, including two hardware removal procedures for hemiepiphysiodesis, three contralateral ACLR, three meniscus surgeries, one lysis of adhesions, and one revision ACLR for BTB graft re-rupture. Two patients were lost to follow-up and excluded from the study. Conclusions: The findings suggest that concomitant LET and ACLR in adolescent patients with risk factors for failed ACLR is associated with favorable patient-reported outcomes, high return to sports participation, and low ACL re-rupture rate at two years follow-up. [ABSTRACT FROM AUTHOR]

Objectives: To define minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) at a minimum of 5-years for patients undergoing endoscopic and open gluteus medius repair. Methods: A retrospective review was performed of prospectively collected data from all patients undergoing primary open or endoscopic repair of gluteus medius tears between January 2012 and December 2015 with a minimum 5-years follow-up. Patient data collected included patient demographics, preoperative clinical function scores, and pre and postoperative patient-reported outcomes (PROs). Patient reported outcome measures included the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports Subscale (HOS-SS), Modified Harris Hip Score (mHHS) and Internation Hip Outcome Tool 12 questions (iHOT-12). The minimal clinically important difference (MCID) values were calculated for each PRO using the distribution method while PASS was determined via the anchor-based method utilizing ROC curves and Youden's index using SPSS Statistics (Version 27, IBM, Armonk, NY). Results: A total of 46 patients were included in the study. A majority of patients were female (91.3%), with an average age and BMI of 61.26 ± 9.74 and 27.42 ± 6.02, respectively. Differences in preoperative and 5-year postoperative PROs were statistically significant for each of the four measures (p<0.001). The MCID threshold values for the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Sport-Specific (HOS-SS) subscale, modified Harris Hip Score (mHHS), and the international Hip Outcome Tool-12 (iHOT) were calculated to be 13.1, 14.5, 12.6 and 11.2 respectively. The PASS scores of HOS-ADL, HOS-SS, mHHS and iHOT were calculated to be 85.6, 79.7, 68.2 and 60.5 respectively. In addition, 86.1% of patients achieved either MCID or PASS postoperatively, with 90.9% and 69.8% reaching at least 1 threshold score for achieving MCID and PASS respectively, and 69.7% achieving both any MCID and any PASS. Conclusions: In patients undergoing open or endoscopic gluteus medius repair, our study defines MCID and PASS at mid-term follow-up. A majority of patients achieved any MCID (90.9%) and any PASS (69.7%) at 5-years postoperatively. [ABSTRACT FROM AUTHOR]

We conducted a review to summarize the settings, configurations, and capture data for an array of fisheries gear types used to capture invasive bigheaded carps (Hypophthalmichthys spp.) in North America. The goal of this paper was to synthesize patterns of bigheaded carp catch data across various gear types and capture methods. Data consisted of bigheaded carps captured among a variety of riverine habitats where their populations are well-established (e.g., lower pools of the Illinois River), as well as near the leading edge of their invasion front (e.g., Upper Mississippi, Upper Illinois, Upper Missouri, Red River). Our synthesis provides a summary of (1) capture gears and their settings/configurations, (2) catches (fish size, number captured, precision of estimates), and (3) assessment of gears that were robust (i.e., high precision, low cost, high catch, sample many habitat types) in riverine environments and impoundments. Across the 26 gear types used to target bigheaded carps, catch rates of silver carp were consistently higher than bighead carp, which may result from a combination of sampling inefficiencies, sampling biases, and spatial dynamics of their invasions. Gear performance matrices combining catch rate, precision, and labor cost indicated that DC electrofishing and herding fish into gill nets and/or trammel nets were the top-ranked capture methods. This review provides guidance for the development of detection, monitoring, and control programs that target bigheaded carp species, as well as identifies future research to fill critical data gaps. [ABSTRACT FROM AUTHOR]

Objectives: While minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) have been defined for hip-specific legacy patient reported outcome measures, they have not been defined for the Patient-Reported Outcomes Measurement Information System (PROMIS) instruments for patients undergoing hip arthroscopy. The purpose of the study was to define the MCID, PASS, and SCB thresholds for the PROMIS Physical Function (PF) computerized adaptive test (CAT) and PROMIS Pain Interference (PI) instruments in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Methods: Patients undergoing primary hip arthroscopy between August 2018 and January 2019 for the treatment of FAIS were retrospectively analyzed. Patients received PROMIS-PF, PROMIS-PI, Hip Outcome Score Activities of Daily Living, Hip Outcome Score Sport Subscale, modified Harris Hip Score, and international Hip Outcome Tool-12 preoperatively and at 1 year postoperatively. MCID was calculated using the distribution method, while PASS and SCB were calculated using an anchor-based method. Patients achieving clinically significant outcomes (CSOs) were compared to those who failed to achieve via chi-square and independent sample t-tests, and a multivariate logistic regression was conducted to determine predictors of CSO achievement. Results: 124 patients with an average age of 32.7±12.3 were included in the analysis. The threshold scores required to achieve MCID, PASS, and SCB, respectively, were as follows: PROMIS-PI (-3.1, 53.7, 51.9) and PROMIS-PF (3.3, 47.0, 49.9). Patients achieved any MCID, PASS, and SCB for PROMIS scores at a rate of 89.0%, 71.8%, and 62.1%, respectively compared to 87.1%, 76.6%, and 71.8% for legacy PROMs. For PROMIS-PF, higher preoperative PROMIS-PF score was a positive predictor of CSO achievement, and patients achieving SCB were significantly younger (30.3±12 vs 35.6±12, p=0.017) with significantly lower BMIs (24.7±6.4 vs. 27.9±7, p=0.009). Preoperative chronic pain and past history of orthopaedic surgery were negative predictors of PROMIS-PI CSO achievement while higher (worse) preoperative PROMIS-PI scores were a positive predictor. Conclusions: Our study defined the MCID, PASS, and SCB for the PROMIS PF and PI CAT at 1-year postoperatively. CSO is achieved via PROMIS at a rate comparable, but slightly less than legacy hip PROMs. In addition, patients with higher preoperative PROMIS scores, younger age, and lower BMIs were more likely to achieve a CSO while preoperative chronic pain and past history of orthopaedic surgery were negative predictors of CSO achievement. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of the current study was to evaluate the clinical outcomes and rates of return to play in patients who underwent an osteochondral allograft (OCA) procedure for a symptomatic osteochondral defect in the knee. Methods: A retrospective review of patients who underwent an OCA for an osteochondral defect of the knee, between June 2011 and March 2019 was performed. Return to play, the level of return and the timing of return were assessed. Additionally, the reasons for being unable to return were evaluated. A p-value of < 0.05 was considered to be statistically significant. Results: Overall, there were 103 patients who underwent OCA at our institution and met our inclusion and exclusion criteria. The mean age was 31.8 ± 11 years, and 63.9% were male, with a mean of 44.2 ± 23.3 month follow-up. The overall rate of return to play was found to be 63.1% (N=65), while the rate of RTP at the same or higher level was 32.0% (N = 33). With respect to the patients who were unable to return to their desired sport, reasons cited included pain in the operative knee (N = 18, 47.3%), physical inability to perform in the desired sport (N = 8, 21.1%), and fear of re-injury (N = 6, 15.8%). Conclusions: Overall, there was a poor rate of return to play following OCA. Additionally, the majority of patients were unable to return to play at their pre-injury level. [ABSTRACT FROM AUTHOR]

Objectives: While it is well-known that a glenoid osseous defect of >25% glenoid width or 20% of the glenoid length critically destabilizes the shoulder, it is unclear whether glenoid cartilage defects contribute to the shoulder stability, and if so at what size defect the shoulder is critically destabilized. The purpose of this study was to determine the effect of incremental cartilage defect sizes on the anterior shoulder stability. We hypothesized that cartilage defects of equal to or greater than 25% of the glenoid width or 20% of the glenoid length will significantly the decrease the anterior shoulder stability ratio. Methods: This was a controlled laboratory study testing 12 fresh-frozen shoulders. Specimens were attached to a custom testing device in abduction and neutral rotation with 50N compression applied to the glenoid. The humeral head was translated 10 mm anteriorly, anteroinferiorly, and anterosuperiorly with conditions of intact cartilage and labrum and anterior cartilage defects of 3, 6, and 9 mm width. Translation force was measured continuously. Peak translation force divided by 50 N compression force was defined as the stability ratio. Data were analyzed using ANOVA tests. Results: In the anterior direction, the stability ratio decreased between intact cartilage (36±7%) and all defects 3-mm or larger (32±8%, p=0.023.) In the anteroinferior direction, the stability ratio decreased between intact cartilage (52±7%) and all defects 3-mm or larger (47±7%, P=0.006). In the anterosuperior direction, the stability ratio decreased between intact cartilage (36±4%) and all defects larger than 6-mm (32.6±4%, P = 0.006.) A 3-mm cartilage defect was equivalent to 10% of the glenoid width and 7% of the glenoid length. There were strong negative correlations between the glenoid cartilage defect size and the stability ratio in the anterior direction, the anteroinferior direction and the anterosuperior direction (r= -0.79, -0.63, and -0.58, respectively, P≤0.001). There were strong negative correlations between the ratio of glenoid cartilage defect size to the glenoid width and the stability ratio in all directions (r= -0.81, -0.63, and -0.61, respectively, P≤0.001.) Conclusions: An anterior cartilage defect of >3 mm or >10% of the glenoid width or 7% of the glenoid length significantly decreases anterior and anteroinferior stability and may require further treatment to restore stability. Cartilage defect size negatively correlates with stability. [ABSTRACT FROM AUTHOR]

Objectives: Pain is a common presentation following glenohumeral labral injuries. However, the source of that pain is undetermined. We aimed to determine if there is a differential expression of nerve fibres around the glenoid labrum and if torn labra have increased neuronal expression compared to untorn labra. Methods: Labral tissue was collected at 3, 5, 9 and 12 o clock during total shoulder arthroplasty (n = 7). Samples were also collected at 3, 5 and 12 o clock during rotator cuff repair (n = 16), anterior labral repair (n = 6), type II superior labral anterior to posterior (SLAP) repair (n = 4) and capsular release for idiopathic capsulitis (n = 5). Sections were immunostained with antibodies to neurofilament, a specific neuronal marker which is used to identify central and peripheral nerve fibres, and the concentration and intensity of immunostained-positive cells assessed. Results: The concentration of neurofilament staining was similar in the superior, anterior, posterior and inferior glenoid labrum in untorn labra (8 neurofilament expressing cells/mm2, p > 0.05). Torn labra exhibited a 3-4-fold increase in neuronal expression which was isolated to the location of the tear in SLAP (p = 0.09) and anterior labral tears (p = 0.02). The concentration of neurofilament expressing cells in torn glenoid labrum samples were comparable to the glenoid labrum of adhesive capsulitis samples (p > 0.05). Figure 3. Mean (SD) neurofilament expressing cells per mm2 at 12 o'clock (A), 3 o'clock (B) and 5 o'clock (C) using labral tissue from patients with either a; RCT (n = 16), anterior labral tear (n = 6), SLAP tear (n = 4) or a frozen shoulder (n = 5). *p <0.05 compared using a one-way ANOVA with post-hoc analysis. Conclusions: This study supports the hypothesis that following a traumatic tear of the anterior or superior labrum, the labrum in that region becomes populated with new nerves fibres and that these fibres are likely to be responsible for many of the symptoms noted by patients with superior (SLAP) and/or anterior labral (Bankart) tears. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the efficacy of a multimodal non-opioid analgesic protocol in controlling postoperative pain compared to opioids following a primary arthroscopic rotator cuff repair. Methods: Seventy consecutive patients undergoing a primary rotator cuff repair were assessed eligibility. A prospective randomized controlled trial was designed in accordance with the Consolidated Standards of Reporting Trials 2010 (CONSORT) statement. The two arms of the study included a multimodal non-opioid pain regimen for the experimental group, and a standard of care narcotics for the control group. The primary outcome was visual analog scale (VAS) pain scores for the first ten postoperative days. Secondary outcomes included PROMIS-PI, patient satisfaction, and adverse drug events. Patients were randomized using a random number generator. Whiles patients were not blinded to their treatment group, all reported outcomes were collected by blinded observers. Results: Twenty-six patients either declined to participate or were excluded from the study. Forty-four patients were included in the final analysis. A total of 27 patients were in the traditional group and 17 patients were in the nonopioid group. Patients in the traditional pain control group reported a significantly lower VAS pain score on post-operative day 1 (opioid: 5.7 ± 2, nonopioid: 3.7 ± 2.2, p=0.011) and post-operative day 4 (opioid: 4.4 ± 2.7, nonopioid: 2.4 ± 2.2, p=0.023). No significant difference was seen on any other postoperative day. When mixed measured models were used to control for confounding factors the non-opioid group demonstrated significantly lower VAS and PROMIS-PI scores (p<0.01) at every time point. The most commonly reported side effects for patients in both groups were drowsiness (opioid: 2.7 ± 3.3 days, nonopioid: 1.9 ± 3.3 days) and constipation (opioid: 2.2 ± 2.9 days, nonopioid: 0.2 ± 0.6 days). Patients in the traditional analgesia group reported significantly greater average number of days with constipation (opioid: 2.2 ± 2.9, nonopioid: 0.2 ± 0.6, p=0.003) and days with upset stomach (opioid: 1.3 ± 2.5, nonopioid: 0.0 ± 0.0, p=0.020) than those in the nonopioid group. Conclusions: This study found that a multimodal nonopioid pain protocol provided at least equivalent pain control compared to traditional opioid analgesics in patients undergoing primary arthroscopic rotator cuff repair. Minimal side effects were noted with some improvement in the multimodal nonopioid pain cohort, and all patients reported satisfaction with their pain management. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to assess and compare the effect of 1) arthroscopic osteochondroplasty with or without labral repair versus 2) arthroscopic lavage with or without labral repair on the time to reoperation in adults aged 18 to 50 with femoroacetabular impingement (FAI) over the 27-months post-operative using a time-to-event analysis. Methods: Using the comprehensive dataset from the multinational Femoroacetabular Impingement Randomized Controlled Trial (FIRST), all reoperations were identified until 27-months post-operative. Subjects were randomized to a treatment of arthroscopic osteochondroplasty or arthroscopic lavage with or without labral repair. The analysis was conducted using a Cox proportional-hazards model, with the percentage of patients with a reoperation analyzed in a time-to-event analysis as the outcome. The independent variable was the procedure, with age and impingement subtype explored as potential covariates. The effects from the Cox model were expressed as the hazard ratio (HR), corresponding 95% confidence interval (CI) and the associated p-value. All tests were two-sided with an alpha level of 0.05. Results: A total of 108 patients in the osteochondroplasty group and 106 in the lavage group were included. The mean age of the patients included in the study was 36.0 (SD=8.5) years. Overall, a total of 27 incident reoperations were identified within 27 months of follow-up for an incidence rate of 6.0 per 100 person years. Within the osteochondroplasty group a total of 8 incident reoperations were identified for incidence rate of 3.4 per 100 person years while within the lavage group, a total of 19 incident reoperations were identified for an incidence rate of 8.7 per 100 person years. The hazard of reoperation for patients undergoing osteochondroplasty is 40% that of patients undergoing lavage (HR=0.40,95% CI=0.17-0.91,p=0.029). Conclusions: This, time-to-event analysis with 27-months follow-up demonstrates that for adults between the ages of 18 and 50 with FAI, arthroscopic osteochondroplasty is associated with a 2.5-fold decrease in the hazard of reoperation at any point in time compared to arthroscopic lavage. [ABSTRACT FROM AUTHOR]

Objectives: Outcomes following isolated hip arthroscopy for patients with dysplasia have been unfavorable, results have included iatrogenic instability and conversion to total hip arthroplasty (THA) at a young age. However, patients with borderline dysplasia have portended more favorable results at short and medium term follow-up. The purpose of this study was to assess long term outcomes after hip arthroscopy for femoroacetabular impingement (FAI) in borderline dysplasia (BD) patients (LCEA, 18°-25°) compared to a control cohort of nondysplastic patients (LCEA, 25°-40°). Methods: Between March 2009 and July 2012, a BD group of 33 patients (38 hips) was identified. An age- and sex-matched control group of 83 patients (96 hips) was also identified. Patient-reported outcome scores, including the modified Harris Hip Score (mHHS), the Hip Outcome Score–Activities of Daily Living (HOS-ADL) and Sport-Specific Subscale (HOS-SSS), and the International Hip Outcome Tool (iHOT-33), were collected preoperatively and subsequently at an average of 9.6 years post-operatively. Results: The mean LCEA and Tönnis angle was 22.4° ± 2.02° and 6.2° ± 3.23° in the BD group and 31.7° ± 3.52° and 2.42° ± 3.02° in the control group, respectively (P <0.001). A labral repair was performed in 78.9% and 76% of the BD and control groups, respectively, all patients underwent capsular closure as part of routine hip arthroscopy. A cam decompression was performed in 97.4% of the BD patients and 99.0% of the control patients. At mean follow-up of 9.6 years (range, 8.2-11.6 years) on average there was significant improvement in all patient-reported outcomes scores in both groups (P<0.001). There were no significant differences between pre and post-operative scores between BD and control groups. Two hips (5.2%) underwent revision surgery in the BD group and 10 hips (10.4%) in the control group, of these one patient in the BD group underwent THA and one patient who underwent bilateral hip arthroscopies in the control group underwent bilateral hip resurfacing. Conclusions: Durable outcomes (>9 years) with low revision rates can be expected after isolated hip arthroscopy that includes cam resection, labral refixation and capsular closure in BD patients with equivalent outcomes to a nondysplastic cohort. [ABSTRACT FROM AUTHOR]

Objectives: Basic science evidence suggests that quadriceps tendon (QT) autograft is a viable alternative to bone-patellar-tendon-bone (PT) autograft for anterior cruciate ligament (ACL) reconstruction due to promising anatomic, histologic, and biomechanical factors. Little evidence exists, however, comparing short and long-term functional outcomes between these two graft sources in a primary setting. The purpose of this study was to compare graft re-injury rates, return to cutting/pivoting sports rates, complications, and self-reported knee function at two years in individuals receiving primary ACL reconstruction with QT versus PT autograft. Methods: A matched case-control study was conducted in accordance with the Strengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines using a single-surgeon ACL database of 1,324 patients to identify 108 (54 PT and 54 QT) patients undergoing primary ACL reconstruction between 2015-2018 (Figure 1). Patients were age and gender matched and between groups comparisons were examined at the time of return to sport and 24 months postoperatively. Data gathered at return to sport included knee range of motion (ROM), single leg squat and single leg hop symmetry, self-reported knee function (IKDC-2000, International Knee Disability Committee), and psychological readiness (ACL-RSI, ACL-Sport After Injury (ACL-RSI). Injury surveillance was conducted for 2-years to determine graft re-injury rates, and at 24-monts level of sports participation, the prevalence of anterior knee pain (Kujala Scale), and self-reported knee function via the Single Assessment Numeric Evaluation (SANE) scores were obtained. Univariate models were utilized to compare groups differences and an alpha of.05 was used to determine statistical significance using SPSS (version 25, IBM Inc., New York, USA). Results: No baseline patient or surgical demographic differences were observed between groups (Table 1). Patients receiving QT autograft had higher single leg squat symmetry (98.2 ±2.8% v 96.1 ±3.0%, P =.001) at time of return to sport. No significant differences existed at time of return to sport (Table 2) regarding knee ROM, single-leg hop test symmetry, self-reported knee function, psychological readiness, or time to return to sport (8.4 + 2.5 mo vs 8.1 ±3.5 mo; P =.486). At two years, there were no significant differences in re-injury rates (0.0% vs 1.2%, P=.383), the prevalence of anterior knee pain, or SANE scores (Table 3). The PT group were significantly more likely to be participating in level I/II (cutting) sports (84.9% vs 69.2%, P =.001) at two years. Conclusions: Patients receiving QT autografts demonstrated comparable self-reported and functional outcomes at time of return to sport and two-year follow-up to those receiving PT autografts. Surgeons should consider utilizing similar rehabilitation timelines and functional performance goals for patients following ACL reconstruction with QT and PT graft options. [ABSTRACT FROM AUTHOR]

Background: Barriers exist for the provision of surgery for permanent contraception in the postpartum period. Prenatal counseling has been associated with increased rates of fulfillment of desired postpartum contraception in general, although it is unclear if there is impact on permanent contraception specifically. Thus, we aimed to investigate the association between initial timing for prenatal documentation of a contraceptive plan for permanent contraception and fulfillment of postpartum contraception for those receiving counseling. Methods: This is a planned secondary analysis of a multi-site cohort study of patients with documented desire for permanent contraception at the time of delivery at four hospitals located in Alabama, California, Illinois, and Ohio over a two-year study period. Our primary exposure was initial timing of documented plan for contraception (first, second, or third trimester, or during delivery hospitalization). We used univariate and multivariable logistic regression to analyze fulfillment of permanent contraception before hospital discharge, within 42 days of delivery, and within 365 days of delivery between patients with a documented plan for permanent contraception in the first or second trimester compared to the third trimester. Covariates included insurance status, age, parity, gestational age, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index. Results: Of the 3103 patients with a documented expressed desire for permanent contraception at the time of delivery, 2083 (69.1%) had a documented plan for postpartum permanent contraception prenatally. After adjusting for covariates, patients with initial documented plan for permanent contraception in the first or second trimester had a higher odds of fulfillment by discharge (aOR 1.57, 95% C.I 1.24–2.00), 42 days (aOR 1.51, 95% C.I 1.20–1.91), and 365 days (aOR 1.40, 95% C.I 1.11–1.75), compared to patients who had their first documented plan in the third trimester. Conclusions: Patients who had a documented prenatal plan for permanent contraception in trimester one and two experienced higher likelihood of permanent contraception fulfillment compared to those with documentation in trimester three. Given the barriers to accessing permanent contraception, it is imperative that comprehensive, patient-centered counseling and documentation regarding future reproductive goals begin early prenatally. Plain language summary: Permanent contraception is a highly desired form of postpartum contraception in the United States, however there are several barriers to accessing it. In this paper, we investigate whether the timing of when a patient has a documented plan for postpartum contraception has an impact on if they achieve postpartum contraception. This is a cohort study from four hospitals in Illinois, Ohio, California, and Alabama for patients with a desire for postpartum permanent contraception documented in their medical record. We specifically investigated the trimester (first, second, or third) where a patient had a plan for permanent contraception first documented. We then used univariate and multivariate models to determine the relationship between the timing of a plan for permanent contraception and if a patient achieved the procedure at three time-points: hospital discharge, 42-days, and 365-days. Our findings showed that of the 3103 patients in our cohort, only 69.1% of them had a documented plan for postpartum contraception at any point before going to the hospital for their delivery admission. We additionally found that patients who had a documented plan for permanent contraception in the first or second trimester had a higher odds of receiving their postpartum contraception procedure compared to people who had their first documented plan in the third trimester. This showed us the importance of earlier counseling regarding contraception for pregnant patients. There are many barriers to accessing postpartum contraception, so having patient focused counseling about future goals around reproductive health early on in pregnancy is critical. [ABSTRACT FROM AUTHOR]

Background: Hidden Markov Models (HMMs) are often used to model multi-state capture-recapture data in ecology. However, a variety of HMM modeling approaches and software exist, including both maximum likelihood and Bayesian methods. The diversity of these methods obscures the underlying HMM and can exaggerate minor differences in parameterization. Methods: In this paper, we describe a general framework for modelling multi-state capture-recapture data via HMMs using both maximum likelihood and Bayesian methods. We then apply an HMM to invasive silver carp telemetry data from the Illinois River and compare the results estimated by both methods. Results: Our analysis demonstrates disadvantages of relying on a single approach and highlights insights obtained from implementing both methods together. While both methods often struggled to converge, our results show biologically informative priors for Bayesian methods and initial values for maximum likelihood methods can guide convergence toward realistic solutions. Incorporating prior knowledge of the system can successfully constrain estimation to biologically realistic movement and detection probabilities when dealing with sparse data. Conclusions: Biologically unrealistic estimates may be a sign of poor model convergence. In contrast, consistent convergence behavior across approaches can increase the credibility of a model. Estimates of movement probabilities can strongly influence the predicted population dynamics of a system. Therefore, thoroughly assessing results from HMMs is important when evaluating potential management strategies, particularly for invasive species. [ABSTRACT FROM AUTHOR]

Highly-skewed steel I-girder bridges are commonly used across the US, especially in congested areas, despite complications in their analysis and design. The American Association of State Highway and Transportation Officials (AASHTO) LRFD Bridge Design Specification provides suggestions for design values of flange lateral bending stress in addition to line girder analysis when bridge skew exceeds 20° for certain cross-frame layouts. For bridges with skew exceeding 60°, a higher level of analysis is often required, with cross-frames considered primary members in design. Neither the magnitude of additional lateral stress nor the associated skew limits are particularly well understood, so more study is needed to refine and support this analysis and design approach. In addition to short-term response and load distribution, long-term bridge behavior for thermally induced stresses and deformations also needs to be more thoroughly studied. In support of an ongoing research initiative in Illinois, an agency survey was formulated and distributed across the US to understand practices used and challenges faced by state transportation agencies when designing and constructing skewed steel I-girder bridges. Findings from the responses of 23 state agencies illuminate issues, concerns, and current practice related to design, construction, and service life of those bridges. The agency survey informed selection of two bridges in Champaign, Illinois, for field monitoring, in order to provide new understanding of skew effects on bridge superstructure behavior. Three-dimensional finite-element analysis was conducted to guide field instrumentation planning, and initial measurements from the monitored bridges under traffic load confirmed good predictions compared to the planning-stage numerical study. This paper presents the initial stages of a long-term project that employs field monitoring and three-dimensional finite-element analysis of skewed steel I-girder bridges. Findings from a survey of state transportation agencies describe issues, concerns, and current practice related to design, construction, and service life of these bridges, which can be of interest to practicing engineers and contractors. This paper illustrates the integration of data from current practice and targeted numerical simulations to establish a rigorous basis for planning a bridge superstructure field monitoring campaign. The information and experiences summarized can be helpful to both practicing engineers and researchers. [ABSTRACT FROM AUTHOR]

Research shows that gentrification influences crime. However, there are no quantitative studies on gentrification's impact on juvenile offending. This paper begins to fill this gap by examining the impact of gentrification on homicides by juveniles. To do this, we use Block, Block, and Illinois Criminal Justice Information Authority's data on Chicago Homicides from 1965 through 1995. We couple these data with historical census data to create a dataset of victims killed by juveniles within gentrified and non-gentrified census tracts. We employ a pooled, longitudinal Poisson regression model. Our findings indicate that gentrification is moderately and negatively associated with people killed by juveniles. [ABSTRACT FROM AUTHOR]

Engaging Youth for Positive Change is a local civic engagement program focused on youth and young adults in the U.S. state of Illinois, and guides them through the process of adopting a local ordinance by working with their local city councils or other governing bodies. Researchers collected two waves of data from EYPC participants to quantitatively assess associations between program participation and changes in a variety of key factors relating to civic engagement. Initial findings indicate participants reported significant increases in variables associated with civic participation, including teamwork, leadership, and internal political efficacy. Furthermore, participants at more rigorous implementation sites reported significantly higher levels of critical civic engagement indicators compared to their peers at less rigorous implementation sites. This paper discusses EYPC in detail, findings from analyses and program evaluation, and concludes with a discussion on next steps regarding how EYPC and similar programs may enhance civic engagement among youth and young adult populations. [ABSTRACT FROM AUTHOR]

Using a staggered difference-in-differences design, this paper analyses the effects of tax increment financing (TIF) in Cook County, Illinois. TIF is negatively correlated with the number of establishments in Chicago, likely due to unintended tax burdens and competition between TIF districts. In non-Chicago areas, TIF shows positive effects on employment for 6–20 years. Lastly, this study provides evidence of the persistent effects of TIF and its potential to move localities from low- to high-density economic activity, calling for a re-evaluation of the argument against subsidising economically lagging areas. [ABSTRACT FROM AUTHOR]

In this paper, a new methodology is developed for urban runoff management based on global sensitivity analysis of the storm water management model (SWMM) considering uncertainties. The variogram analysis of response surface (VARS) model is utilized for sensitivity analysis of the SWMM parameters by combining the runoff simulation model of the SWMM with VARS. Three model efficiency metrics, namely Nash–Sutcliffe efficiency metric for the runoff, NSE metric for the logarithm of the runoff, and percent bias in simulating runoff are used to evaluate SWMM outputs and rank its parameters. The reliability of the obtained rankings of parameters is evaluated by developing a bootstrapping-based strategy to estimate confidence intervals for the calculated sensitivity values. A multi-objective optimization model is integrated with the calibrated SWMM, to select optimum scenarios of low impact development-best management practice (LID-BMP). To take into account the rainfall uncertainty, design storm hyetograph is stochastically derived using Monte Carlo analysis and Huff curves (Huff in Water Resour Res 3(4):1007–1019, 1967; Time distributions of heavy rainstorms in Illinois, State of Illinois Department of Energy and Natural Resources, Illinois, 1990). Finally, a socially acceptable LID-BMP scenario out of a set of non-dominated solutions is obtained using the Nash bargaining theory. The proposed method is applied to an urban watershed Iran. The resulted LID-BMPs could decrease runoff volume and pollution load by 24% and about 74%, respectively. [ABSTRACT FROM AUTHOR]

In this paper, we examine how surface runoff affects public safety and urban infrastructure worldwide and how human activity has significantly altered the frequency and magnitude of these events. We investigate this issue in Ferson Creek, IL, USA. Our study focuses on three specific areas of impact: (1) the primary reasons for a considerable increase in average runoff peaks, using annual maximum runoff discharge and annual maximum precipitation and temperature to evaluate the role of climate variability; (2) the effect of land use change on runoff peaks by coupling dominant land use categories with annual maximum runoff discharge; and (3) the use of return level plots as a reference to explore the watershed's sensitivity to land use change. Our findings indicate that land use change has a greater effect on runoff peak values than climate variability in our region of interest. The agricultural areas of Ferson Creek have been most affected by the rapid transformation of about 20% of their land into developed areas. Although agricultural areas can sometimes intensify runoff peaks, their reduction has led to excessive runoff discharges in Ferson Creek, as they have higher relative infiltration capacity than developed areas. We conclude that each watershed has its own fingerprint in terms of the connection between its land use types and hydrological patterns and that the region is most sensitive to the percentage of forests. These results are essential for improving infrastructure design and risk estimation methods in the region of interest. [ABSTRACT FROM AUTHOR]

Storm frequency estimates and their temporal distributions are important in determining estimates of runoff or peak flow rates in many engineering and hydrological problems. Illinois State Water Survey Bulletin 70 has been serving as the design rainfall standard in Illinois since its publication in 1989. Although Bulletin 70 represented the best available data at the time of its publication, the standards needed to be reevaluated and updated after more than three decades and with the growing evidence of the nonstationary nature of heavy precipitation. The trends in heavy precipitation in Illinois prompted the creation of a new frequency study named Bulletin 75, providing precipitation frequencies for event durations ranging from 5 min to 10 days and for recurrence intervals ranging from 2 months to 500 years. The results are presented for the same 10 geographic sections in Illinois as in Bulletin 70 to maintain the continuity of hydrologic studies and compatibility with regulations. The primary goal of this paper is to outline some of the key methodological issues and challenges, to compare the results with the previous sources, and to highlight the effects of the changing precipitation standards on the development of amendments to existing ordinances. Lake County in Illinois, as one of the most affected urban areas with the highest change in heavy precipitation, was selected to illustrate issues related to the application of modified precipitation standards. [ABSTRACT FROM AUTHOR]

Drawing on literatures on mobility and memory, I present a theoretical and interpretive reframing of skeletal taphonomy and mortuary process previously reported for a precontact Oneota cemetery in the North American midcontinent. Most burials here were single inhumations, with individuals apparently interred promptly after death. Others were placed in graves containing multiple individuals who died violently and whose bones bore taphonomic signatures of extended exposure, suggesting they were killed away from home and not recovered or interred until significant time had passed after their deaths. These burials were previously interpreted as haphazard and carelessly executed, possibly owing to circumstances of death. In this paper, I seek to better understand acts of encountering, collecting, transporting, and interring these decomposed remains as discursive practices, conditioned by localized mobility and charged with social memory. Rather than representing an aberrant burial treatment employed solely for expedient disposal, I suggest that their taphonomy and presence in the cemetery offer insights into intentional and repeated engagement with the landscape, invoking/perpetuating traditional Oneota practices involving skeletonized remains. This interpretation provides a case study on how osteologists can contribute to social perspectives on the power of mobile dead bodies in the deployment of memory and construction of place in the ancient past. [ABSTRACT FROM AUTHOR]

Schools and districts nationwide have heavily emphasized supporting students' health and wellbeing by engaging families and caregivers to truly support the "whole child," as outlined in the Whole School, Whole Community, Whole Child (WSCC) model. The COVID-19 pandemic only heightened the important role of school and family partnerships in supporting children's health. The Chicago Public Schools (CPS) Healthy CPS initiative is designed to support schools in their compliance with existing health and wellness policies to support child health. This study aimed to explore parents' primary health concerns for their children, characterize these views, explore any alignment with WSCC, and identify recommendations for family engagement in school health promotion. Eleven semi-structured focus groups (seven English, four Spanish) were conducted with CPS parents/caregivers. Groups were conducted in spring 2021 on Chicago's West Side, one of the more historically disinvested communities in the city. Focus groups were recorded, transcribed, and analyzed using constant comparison, incorporating both inductive and deductive approaches. Key themes emerged related to parents' perceptions of schools' role in promoting health including: (1) parents see child health as a shared responsibility between families and schools; and (2) parents identify significant structural barriers and inequities that impede child health, such as racism, community violence, and a lack of community resources in their neighborhoods, and believe schools can do more to address them. Parents' viewed child health and wellbeing as multidimensional and stated that these dimensions must be considered holistically. Their views aligned with WSCC family engagement-related components. Parents recommended that schools employ a variety of strategies to engage families. Findings from this paper have implications for engaging families in school health policy and program development as well as implementation, particularly those in lower income, urban communities that have faced a history of structural inequities. Highlights: Chicago Public Schools parents in in this sample see child health as a shared responsibility between families and schools. Consistent with the long-standing evidence documenting historic disinvestment on the West Side of Chicago, participating parents identify significant structural barriers and inequities, such as racism, community violence, and a lack of community resources in their neighborhoods, and believe schools can do more to address them. Parents recommend schools take a variety of strategies to engage families and recommend more leadership opportunities for parents. [ABSTRACT FROM AUTHOR]

A quasiconformal tree is a doubling metric tree in which the diameter of each arc is bounded above by a fixed multiple of the distance between its endpoints. In this paper we show that every quasiconformal tree bi-Lipschitz embeds in some Euclidean space, with the ambient dimension and the bi-Lipschitz constant depending only on the doubling and bounded turning constants of the tree. This answers Question 1.6 of David and Vellis [Illinois J. Math. 66 (2022), pp. 189–244]. [ABSTRACT FROM AUTHOR]