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Background: Direct impacts with the head (linear acceleration or pressure) and inertial loading of the head (rotational acceleration or strain) have been postulated as the 2 major mechanisms of head-related injuries such as concussion. Although data are accumulating for soccer and American football, there are no published data for nonhelmeted collision sports such as rugby union. Purpose: To quantify head impacts via instrumented mouthguard acceleration analyses for rugby union players over a season of matches. Study Design: Descriptive epidemiology study. Methods: Data on impact magnitude and frequency were collected with molded instrumented mouthguards worn by 38 premier amateur senior rugby players participating in the 2013 domestic season of matches. Results: A total of 20,687 impacts >10g (range, 10.0-164.9g) were recorded over the duration of the study. The mean ± SD number of impacts per player over the duration of the season of matches was 564 ± 618, resulting in a mean ± SD of 95 ± 133 impacts to the head per player, per match over the duration of the season of matches. The impact magnitudes for linear accelerations were skewed to the lower values (Sp = 3.7 ± 0.02; P<.001), with a mean linear acceleration of 22.2 ± 16.2g. Rotational accelerations were also skewed to the lower values (Sp = 2.0 ± 0.02; P < .001), with a mean rotational acceleration of 3902.9 ± 3948.8 rad/s2. Conclusion: The acceleration magnitudes and number of head impacts in amateur rugby union players over a season of matches, measured via instrumented mouthguard accelerations, were higher than for most sports previously reported. Mean linear acceleration measured over a season of matches was similar to the mean linear accelerations previously reported for youth, high school, and collegiate American football players but lower than that for female youth soccer players. Mean rotational acceleration measured over a season of matches was similar to mean rotational accelerations for youth, high school, and collegiate American football players but less than those for female youth soccer players, concussed American collegiate players, collegiate American football players, and professional American football players. [ABSTRACT FROM AUTHOR]

Background: In pediatric patients, anterior cruciate ligament (ACL) reconstruction is controversial; however, delaying surgery until skeletal maturity is complete may increase the risk of secondary meniscal and articular cartilage injury.Purpose: To assess the risk of meniscal and chondral injuries with delay of ACL reconstruction.Study Design: Cohort study; Level of evidence, 3.Methods: Records were reviewed in patients younger than 17 years (median age, 14 years) who had ACL reconstruction. Patients were consecutively enrolled and assigned to 1 of 3 surgical groups based on timing of surgery: acute (\6 weeks after surgery), subacute (6-12 weeks), or chronic (.3 months). The type and grade of meniscal injuries was documented according to the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine (ISAKOS) meniscal classification criteria. International Cartilage Repair Society (ICRS) criteria were used to document location and grade of chondral injuries. Associationsbetween patient characteristics and meniscal injury were tested using rank sum and chi-square tests. Regression analyses were conducted to model incidence and severity of lateral and medial meniscal tears. There were 130 patients who had 135ACL reconstructions between the years of 2000 and 2012.Results: Sixty-two ACL injuries were treated acutely, 37 were subacute, and 36 were chronic. Meniscal injuries (n = 112) included 70 lateral and 42 medial tears. Time to surgery had bivariate association with lateral and medial meniscal tears (P = .016 and .007, respectively). Independent risk factors for incidence of lateral meniscal tears were younger age (P = .028) and return to sports activities before surgery (P = .007). Patients with 1 episode of instability had 3-fold higher odds of higher grade lateral meniscal tear (95% CI, 1.30-7.60). Compared with acute reconstruction, subacute and chronic reconstruction patients had 1.45 and 2.82 times higher odds, respectively, of lateral meniscal tear severity (P = .12). Independent risk factors for incidence of medial meniscal tears were female sex (P = .03), older age (P = .01), and any episode of instability (P = .01). Adjusted odds ratio for medial meniscal tear was 4.7 for an instability episode (vs no episode; P = .01). Adjusted odds ratio for increased severity of medial meniscal tears included any instability episode, 5.6 (P \ .01); playing sports before reconstruction, 15.2 (P \ .01); and time to surgery greater than 3 months, 4.3 (P = .046). Seventeen patients had 23 chondral injuries. The risk factors for chondral injury included increased time to surgery (P = .005) and any instability episode (P = .001). For increased grade of chondral injury, risk factors were time to surgery (P = .001) and any instability episode (P = .003).Conclusion: Delayed ACL reconstruction increased the risks of secondary meniscal and chondral injuries in this population of pediatric patients.Keywords: ACL; adolescent; cartilage; children; knee; meniscus; reconstruction; skeletally immature [ABSTRACT FROM AUTHOR]

Background: Fear of reinjury and lack of confidence influence return-to-sport outcomes after anterior cruciate ligament (ACL)reconstruction. The physical, psychosocial, and functional recovery of patients reporting fear of reinjury or lack of confidenceas their primary barrier to resuming sports participation is unknown.Purpose: To compare physical impairment, functional, and psychosocial measures between subgroups based on return-to-sportstatus and fear of reinjury/lack of confidence in the return-to-sport stage and to determine the association of physical impairmentand psychosocial measures with function for each subgroup at 6 months and 1 year after surgery.Study Design: Case-control study; Level of evidence, 3.Methods: Physical impairment (quadriceps index [QI], quadriceps strength/body weight [QSBW], hamstring:quadriceps strengthratio [HQ ratio], pain intensity), self-report of function (International Knee Documentation Committee [IKDC]), and psychosocial(Tampa Scale for Kinesiophobia–shortened form [TSK-11]) measures were collected at 6 months and 1 year after surgery in73 patients with ACL reconstruction. At 1 year, subjects were divided into ‘‘return-to-sport'' (YRTS) or ‘‘not return-to-sport''(NRTS) subgroups based on their self-reported return to preinjury sport status. Patients in the NRTS subgroup were subcategorizedas NRTS-Fear/Confidence if fear of reinjury/lack of confidence was the primary reason for not returning to sports, and allothers were categorized as NRTS-Other.Results: A total of 46 subjects were assigned to YRTS, 13 to NRTS-Other, and 14 to NRTS-Fear/Confidence. Compared with theYRTS subgroup, the NRTS-Fear/Confidence subgroup was older and had lower QSBW, lower IKDC score, and higher TSK-11score at 6 months and 1 year; however, they had similar pain levels. In the NRTS-Fear/Confidence subgroup, the IKDC scorewas associated with QSBW and pain at 6 months and QSBW, QI, pain, and TSK-11 scores at 1 year.Conclusion: Elevated pain-related fear of movement/reinjury, quadriceps weakness, and reduced IKDC score distinguishpatients who are unable to return to preinjury sports participation because of fear of reinjury/lack of confidence. Despite low averagepain ratings, fear of pain may influence function in this subgroup. Assessment of fear of reinjury, quadriceps strength, andself-reported function at 6 months may help identify patients at risk for not returning to sports at 1 year and should be consideredfor inclusion in return-to-sport guidelines. [ABSTRACT FROM AUTHOR]

Background: Identifying predictors of contralateral anterior cruciate ligament (ACL) reconstruction is important to focus preventivestrategies and related research on high-risk groups.Purpose: To investigate predictors of contralateral ACL reconstruction in patients who have already undergone a primary ipsilateralreconstruction.Study Design: Cohort study; Level of evidence, 2.Methods: This study was based on data from the Swedish National Knee Ligament Register from January 1, 2005, to December31, 2013. Patients aged 13 to 59 years who underwent primary ipsilateral (index) ACL reconstruction with hamstring tendon orbone–patellar tendon–bone autografts were included. Follow-up started on date of index ACL reconstruction and ended eitherwith primary contralateral ACL reconstruction, after 5 years of follow-up, or on December 31, 2013, whichever occurred first.The investigated variables were patient sex, age at index reconstruction, activity at the time of index injury, timing of surgery, graftselection, graft harvest site, and meniscal and chondral injury. The study end point was primary contralateral ACL reconstruction.Relative risks (RRs) and 95% CIs were calculated and adjusted for confounding factors using multivariate statistics.Results: A total of 9061 participants were included (n = 5196 males [57.3%] and 3865 females [42.7%]), of which 270 participants(3.0%) underwent primary contralateral ACL reconstruction during the 5-year follow-up. There was no difference in contralateralreconstruction rates between males and females (3.0% vs 2.9%, P = .695). Age \20 years significantly increased the risk of contralateralreconstruction (males: RR = 2.4 [95% CI, 1.7-3.4] and females: RR = 2.9 [95% CI, 1.9-4.5]; P \ .001). Among femalepatients undergoing reconstruction using autograft hamstring, harvest of a contralateral hamstring tendon significantly increasedthis risk (RR = 3.4 [95% CI, 1.4-7.9]; P = .006).Conclusion: In both male and female participants, age \20 years predicted an almost 3 times higher 5-year risk of contralateralACL reconstruction. Among female participants undergoing reconstruction with autograft hamstring, a contralateral harvest predicteda more than 3 times higher 5-year risk of contralateral ACL reconstruction. Patient sex, activity at the time of index injury,graft selection, meniscal injury, and chondral injury were not predictors of contralateral ACL reconstruction. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic exertional compartment syndrome (CECS) have pain during exercise that subsides with rest.Diagnosis is usually confirmed by intramuscular compartment pressure (IMCP) measurement. Controversy exists regarding theaccuracy of existing diagnostic criteria.Purpose: (1) To compare dynamic IMCP measurement and anthropometric factors between patients with CECS and asymptomaticcontrols and (2) to establish the diagnostic utility of dynamic IMCP measurement.Study Design: Cohort study (diagnosis); Level of evidence, 2.Methods: A total of 40 men aged 21 to 40 years were included in the study: 20 with symptoms of CECS of the anterior compartmentand 20 asymptomatic controls. Diagnoses other than CECS were excluded with rigorous inclusion criteria and magneticresonance imaging. The IMCP was measured continuously before, during, and after participants exercised on a treadmill, wearingidentical footwear and carrying a 15-kg load.Results: Pain experienced by study subjects increased incrementally as the study progressed (P\.001). Pain levels experiencedby the case group during each phase of the exercise were significantly different (P = .021). Subjects had higher IMCP immediatelyupon standing at rest compared with controls (23.8 mm Hg [controls] vs 35.5 mm Hg [subjects]; P = .006). This relationship persistedthroughout the exercise protocol, with the greatest difference corresponding to the period of maximal tolerable pain(68.7 mm Hg [controls] vs 114 mm Hg [subjects]; P \ .001). Sensitivity and specificity were consistently higher than the existingcriteria with improved diagnostic value (sensitivity = 63%, specificity = 95%; likelihood ratio = 12.5 [95% CI, 3.2-49]).Conclusion: Anterior compartment IMCP is elevated immediately upon standing at rest in subjects with CECS. In patients withsymptoms consistent with CECS, diagnostic utility of IMCP measurement is improved when measured continuously during exercise.A cutoff of 105 mm Hg in phase 2 provides better diagnostic accuracy than do the Pedowitz criteria of 30 mm Hg and20 mm Hg at 1 and 5 minutes after exercise, respectively. [ABSTRACT FROM AUTHOR]

Background: Polyethylene wear has been a major cause of revision of cementless total hip replacements. Highly cross-linked polyethylene has been developed to increase mechanical resistance to wear. However, cross-linking from irradiation of the polyethylene generates free radicals and these can oxidise in vivo and might over time alter the initial mechanical properties. Vitamin-E infused highly cross-linked polyethylene has been developed to reduce the amount of free radicals without compromising the mechanical properties. Purpose: To measure wear of vitamin E infused highly cross-linked polyethylene and compare wear between 2 different head sizes. Methods: In a prospective randomised study between 32 mm and 36 mm Biolox® delta heads in 50 hips we analysed the in vivo wear of the E-poly™ with markerless radiostereometry. Results: Mean (95% CI) wear for the total material was 0.041 mm (0.015-0.066) in the vertical direction and 0.177 mm (0.155-0.200) in the total 3D direction. After the anticipated period of bedding-in we found no statistically significant differences in wear from three months to 2 years in vertical and total 3D directions. Although statistical significant differences between 32 mm and 36 mm heads were found in the total 3D direction we cannot conclude that there are significant clinical important differences in wear comparing these head sizes. Conclusions: This study shows promising early results with very low wear, even for 36 mm heads, but long term follow-up is necessary to evaluate if this polyethylene will provide low wear and good mechanical properties in the long-term. [ABSTRACT FROM AUTHOR]

The article presents a study on posterior meniscal root injuries due to the tunnel reaming for single-bundle posterior cruciate ligament (PCL) reconstruction. Topics include medial meniscus, meniscal roots, and the quantification of area reduction following tibial reaming. Also mentioned is the biomechanical testing of the menisci using a dynamic tensile testing machine.

The article presents a study on the injuries to the anteromedial (AM) and anterolateral (AL) meniscal root attachments because of reaming a tibial reconstruction tunnel in the anatomic center of the anterior cruciate ligament (ACL). Topics include medial meniscus, lateral meniscus, and meniscal roots. Also mentioned is tibial tunnel reaming during anatomic single-bundle ACL reconstruction.

The article presents a study on the commonly known patient factors that can predict revision surgery following anterior cruciate ligament (ACL) reconstruction. Topics covered include sports medicine, autografts, and anthropometry. Also mentioned are graft failure and subsequent revision surgery as key concerns for patients and orthopaedic surgeons.

The article explores the time-zero displacement of the posterior meniscal root in response to cyclic loading after transtibial pull-out repair, as well as factors that contributed to displacements like suture elongation, button-bone interface and meniscus-suture interface. Topics discussed include treatment for posterior meniscal root tears, as well as controversial results from the surgical intervention and the role of meniscus-suture interface in the transtibial pull-out construct.

The article presents research which discussed the rate and risk factors for patients who underwent revision anterior cruciate ligament reconstruction in Ontario. Topics covered include the number of participants who have been readmitted after the surgery as well as survival rate among those who had re-revision of the approach. Also mentioned is the rarity of patients who had total knee arthroplasty.

Do children who go on to develop dyslexia show normal verbal and nonverbal development before reading onset? According to the aptitude–achievement discrepancy model, dyslexia is defined as a discrepancy between intelligence and reading achievement. One of the underlying assumptions is that the general cognitive development of children who fail to learn to read has been normal. The current study tests this assumption. In addition, we investigated whether possible IQ deficits are uniquely related to later reading or are also related to arithmetic. Four-year-olds (N = 212) with and without familial risk for dyslexia were assessed on 10 IQ subtests. Reading and arithmetic skills were measured 4 years later, at the end of Grade 2. Relative to the controls, the at-risk group without dyslexia had subtle impairments only in the verbal domain, whereas the at-risk group with dyslexia lagged behind across IQ tasks. Nonverbal IQ was associated with both reading and arithmetic, whereas verbal IQ was uniquely related to later reading. The children who went on to develop dyslexia performed relatively poorly in both verbal and nonverbal abilities at age 4, which challenges the discrepancy model. Furthermore, we discuss possible causal and epiphenomenal models explaining the links between early IQ and later reading. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to measure the prevalence of social isolation in community-dwelling elderly and related factors based on household composition differences. Method: We used the six-item Lubben Social Network Scale to measure social isolation in 2,000 individuals. Multiple logistic regression analysis was performed to examine factors related to social isolation with household composition after adjusting for gender and age. Results: The prevalence of social isolation was 31.0% for elderly living alone and 24.1% for those living with family. For both, poor mental health and lack of social support from nonfamily members were associated with social isolation risk. For elderly living with family, low intellectual activities and poor health practice were associated with social isolation risk. Discussion: This study showed high prevalence of social isolation. For prevention, promoting mental health and encouraging them to make friends may be important. For elderly living with family, promoting intellectual activities and good health practice is recommended. [ABSTRACT FROM PUBLISHER]

Objective: To estimate the short-term (14 months) impact of anemia on mortality among Mexican older adults (OAs). Method: Longitudinal analyses using data from a quasi-experimental study in a non-contributory pension program in Mexico with a sample of 3,621 OAs aged 65 to 74 years. Data on health, nutrition, life conditions, and mortality were gathered at both baseline and follow-up. Logistic regression model was used to estimate the impact of anemia and hemoglobin quintiles on mortality. Results: Overall mortality rate was 2.1%. Both mild anemia and moderate/severe anemia increased mortality risk at 14 months (odds ratio [OR] = 2.04, 95% confidence interval [CI] = [1.1, 4.1]; and OR = 6, 95% CI = [2.1, 16.9], respectively). Discussion: In the short term, degree of severity of anemia is an independent predictor of mortality risk. Because anemia is a modifiable factor, further research is required to better understand this condition in terms of main causes, prevention, treatment, and impact on OAs’ survival. [ABSTRACT FROM PUBLISHER]

The article presents research which discussed the impact of earthquake sequence in New Zealand on the adverse mental health conditions of people in the area. Topics covered include information on an earthquake that hit Christchurch, New Zealand in September 2010 as well as participation of 295 people in the study. Also mentioned are the damages caused by the disaster.

The article discusses a study which examined the failure strengths, stiffness, and attachment areas of the native posterior medial, posterior lateral, anterior medial, and anterior lateral meniscal roots compared with the meniscal root attachment after sectioning of supplemental fibers. Topics covered include the failure of surgical techniques for meniscal root tears to reestablish biomechanical properties of the repaired tissue, the collection of tissue specimen, and results of the study.