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Purpose: This study explores the feasibility, acceptability, and treatment outcomes of Empower@Home, a digital cognitive behavioral therapy intervention for geriatric depression. Method: Participants with depressive symptoms (PHQ-9 ≥ 5) underwent a nine-session remote intervention supported by a lay coach (N = 103). Results: Most participants (91%) completed all nine sessions (mean = 8.5). According to the Treatment Evaluation Inventory, participant attitudes toward the program were largely positive. A medium effect in depression reduction was observed following the intervention (Cohen's d = 0.75) and at a 10-week follow-up (Cohen's d = 0.60). This reduction was large (Cohen's d = 1.31 at posttest and Cohen's d = 1.18 at 10-week follow-up) among those who presented with moderate depression at baseline (PHQ-9 ≥ 10). Significant improvements were also reported in anxiety, social isolation, loneliness, and behavioral activation. Discussion: Empower@Home is a promising, acceptable digital mental health intervention for treating depression in older adults. [ABSTRACT FROM AUTHOR]

Background: Despite focus on surgical preservation of the chondrolabral junction (CLJ), the transition zone between the acetabular cartilage and labrum, the association between severity of CLJ breakdown and functional outcomes after hip arthroscopy remains unexplored. Purpose: To assess the influence of CLJ breakdown on patient-reported outcome measures (PROMs) at a 24-month follow-up after hip arthroscopy for symptomatic labral tears. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of prospectively collected data was conducted to identify patients ≥18 years of age with a minimum 24-month follow-up who underwent hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears secondary to femoroacetabular impingement. The Beck classification of transition zone cartilage was used to grade CLJ damage; patients with grades 0 to 2 were stratified into the mild CLJ damage cohort, and those with grades 3 and 4 were stratified into the severe CLJ damage cohort. PROMs were collected at baseline and at 3, 6, 12 months, and annually thereafter postoperatively. Linear mixed-effects models were used to compare PROMs. Rates of achieving clinically meaningful thresholds and subsequent surgery rates were also compared. Results: In total, 198 patients met the inclusion criteria, with a mean follow-up of 3.54 ± 1.26 years. A total of 95 patients with severe CLJ damage (mean age, 34.9 ± 10.5 years) were compared with 103 patients with mild CLJ damage (mean age, 38.2 ± 11.9 years). Hip Outcome Score–Activities of Daily Living (HOS-ADL), Non-Arthritic Hip Score (NAHS), and visual analog score for pain were inferior in the severe CLJ group at enrollment and all follow-up time points (P ≤.05). However, patients with severe CLJ breakdown exhibited greater improvements in HOS-ADL and NAHS at the 24-month follow-up and achieved clinically meaningful thresholds at equivalent rates to patients with mild CLJ breakdown. Subsequent surgery rates were 6.8% and 12.6% in patients with mild versus severe CLJ damage, respectively (P =.250). Conclusion: Severe CLJ breakdown is associated with increased pain and decreased functional level preoperatively and up to 24 months after hip arthroscopy. Despite this, patients with severe CLJ breakdown experienced greater improvements in functional outcomes at a 24-month follow-up and achieved clinical thresholds at similar rates to patients with mild CLJ damage. Thus, while worse baseline pain and functional levels may indicate severe CLJ breakdown, these patients still benefit substantially from hip arthroscopy. [ABSTRACT FROM AUTHOR]

Objective: Compare the long-term effects of two different individualised physical activity interventions in hip or knee osteoarthritis patients. Design: Randomised, assessor-blinded, controlled trial. Setting: Primary care. Subjects: Patients with clinically verified hip or knee osteoarthritis, <150 min/week with moderate or vigorous physical activity, aged 40–74. Intervention: The advice group (n = 69) received a 1-h information and goalsetting session for individualised physical activity. The prescription group (n = 72) received information, goalsetting, individualised written prescription, self-monitoring, and four follow-ups. Main measures: Physical activity, physical function, pain and quality of life at baseline, 6, 12 and 24 months. Results: There were only minor differences in outcomes between the two groups. For self-reported physical activity, the advice group had improved from a mean of 102 (95% CI 74–130) minutes/week at baseline to 214 (95% CI 183–245) minutes/week at 24 months, while the prescription group had improved from 130 (95% CI 103–157) to 176 (95% CI 145–207) minutes/week (p = 0.01 between groups). Number of steps/day decreased by −514 (95% CI −567–462) steps from baseline to 24 months in the advice group, and the decrease in the prescription group was −852 (95% CI −900–804) steps (p = 0.415 between groups). Pain (HOOS/KOOS) in the advice group had improved by 7.9 points (95% CI 7.5–8.2) and in the prescription group by 14.7 points (95% CI 14.3–15.1) from baseline to 24 months (p = 0.024 between groups). Conclusions: There is no evidence that individualised physical activity on prescription differs from individualised advice in improving long-term effects in patients with hip or knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Introduction: Patella fracture fixations were traditionally done using metal tension band wiring techniques. However, complications associated with metallic implants causing soft tissue irritation are not infrequent. Since 1998, there have been emerging case reports and series reporting the use of non-metallic implants, such as braided sutures, in the fixation of patella fractures 3. However, there is a limited clinical study on a direct comparison between metal and suture fixation in patella fractures. The aim of this study is to evaluate the outcome of all-suture fixation in patella fractures and to compare all-suture and metal fixation in mid-pole fractures. Materials and method: A total number of 50 patients with operated fracture patella were retrospectively reviewed in a 2.5-year period. Primary outcomes included operation time, time for fracture union and postoperative knee function. Secondary outcomes include complications, need for secondary operations due to prominent implants, infection or loss of fixation. Results: There was no statistically significant difference concerning time for fracture union, operation time and postoperative functional knee score between the three fixation methods. The rate of secondary operations was higher in the hybrid group (7 out of 11, 63.6%) and metal group (7 out of 13, 53.8%), and was lowest in an all-suture group (0 out of 28, 0%). Metal implant breakage and soft tissue irritation were the main reasons for secondary operations, which was significantly lower in the all-suture group (p < 0.0003). Subgroup analysis for mid-pole patella fractures showed similar results in which all primary outcomes showed no statistically significant difference, while the need for secondary operations was higher in the metal group (p < 0.003). Conclusion: All-suture fixation for patella fractures is a feasible option not limited to distal pole fractures. In our series, this technique achieved similar outcomes when compared with traditional metal implants, with lower rates of secondary operations, and could be safely employed in mid-pole fractures as well. [ABSTRACT FROM AUTHOR]

Background: Static anterior tibial translation (SATT) is radiographically measured to show the amount of tibial translation during the single-leg stance, and thus it is representative of the physiological axial load subjected to the anterior cruciate ligament (ACL) during the stance. Increased SATT has been associated with increased posterior tibial slope (PTS) and is also associated with increased graft failure. Purpose: To compare the SATT value in a control population with that in a population with an isolated ACL injury, as well as to compare the effect of tibial slope on SATT between the 2 groups. Study Design: Cohort study; Level of evidence, 3. Methods: A consecutive series of patients without ligamentous or meniscal injuries between 2019 and 2022 was reviewed. A matched consecutive cohort of patients with nonacute ACL injuries (surgery between 6 and 12 weeks after injury) without concomitant pathology was reviewed. Preoperative SATT and PTS were measured with a previously validated technique on lateral weightbearing knee radiographs. The SATT value was determined, and regression analysis was performed to investigate the relationship between SATT and PTS. Results: In total, 101 controls and 115 patients with an ACL injury were included in this study. The mean SATT was 1.31 mm (SD, 2.44 mm) and the mean PTS was 10.61° (SD, 3.28°) in the control cohort. The SATT was larger (mean, 2.27 mm; SD, 3.36 mm) in the ACL-injured cohort despite the tibial slope measurement being less in the ACL-injured cohort (mean, 9.46°; SD, 2.85°; P =.016). Linear regression analysis showed that for every 1° of increase in PTS, there was a 0.34-mm increase in SATT in the control cohort; however, there was a greater increase of 0.5 mm for every 1° of increase in PTS in the ACL-injured cohort. We found no significant differences in SATT when the cohorts were compared by age (P =.26) or sex (P =.10). Conclusion: The present study reports a reference SATT value of 1.31 mm (SD, 2.44 mm) in a non–ACL-injured cohort, which was lower than in the ACL-injured cohort (mean, 2.27 mm; SD, 3.36 mm). The effect of slope on weightbearing anterior tibial translation was greater in the ACL-injured population than in the control cohort. [ABSTRACT FROM AUTHOR]