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Background: The study investigated the association between varicocele, lower extremity venous insufficiency and hemorrhoidal disease. Methods: The study included 62 patients with varicocele and 60 voluntary subjects with no varicocele. Patients who were diagnosed as having varicocele on physical examination and Doppler ultrasonography were included in the study group. Examination of lower extremity venous insufficiency was performed by physical examination and Doppler ultrasonography. Examination of hemorrhoidal disease was performed by a general surgery specialist. Results: The patients with varicocele had a statistically significant (p < 0.05) higher rates of venous insufficiency of the lower extremities and had a borderline significant difference of higher hemorrhoidal disease rates (p = 0.05). Therewithal incidences of hemorrhoidal disease and lower extremity venous insufficiency were significantly higher in body mass index > 25 and age > 30 years of varicocele patients. Conclusion: There is a statistically significant relation between varicocele, lower extremity venous insufficiency, and hemorrhoidal disease. In particular, varicocele patients who are aged over 30 years and overweight are at higher risk. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the effects of the Pilates method on the reduction of pain, improvement of joint function, and quality of life of patients with chronic Chikungunya fever. Design: This is a randomized, controlled, blind trial for the evaluators. Setting: The study was conducted at the Advanced Laboratory in Physical Education and Health at Federal University of Pernambuco, Brazil. Subjects: A total of 51 patients were allocated randomly and divided into 2 groups: a Pilates group (26 patients) and a control group (25 patients). After 12 weeks, 4 patients in the Pilates group and 5 in the control group were lost to follow-up. Intervention: The Pilates group performed 24 Pilates method intervention sessions; the control group continued to receive standard clinical treatment at the outpatient clinic. Main measures: The main measures were as follows: visual analogue scale (VAS) for pain, functional capacity evaluated by Health Assessment Questionaire (HAQ), quality of life measured by the 12-Item Short-Form Health Survey (SF-12), and range of joint motion by goniometry. Results: After 12 weeks, patients in the Pilates group presented lower VAS (P < 0.001), lower HAQ scores (P < 0.001), and higher quality-of-life scores (P < 0.001) compared with the control group. We found statistically significant results for the Pilates group in the range of movement for shoulder, knee, ankle, and lumbar spine (P < 0.001). In the intragroup analysis, there was a significant improvement in all outcomes evaluated. Conclusion: In this study, patients undertaking Pilates method for 12 weeks had less pain, better function and quality of life, and increased range of joint movement. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility and effects of a 12-week intervention combining aerobic and strength exercises in prison inmates with psychiatric disorders. Design: Two parallel-group, randomized controlled trials. Setting: A psychiatric prison hospital. Subjects: Forty-one men prison inmates (mean age ± SD = 38.2 ± 9.2 years, mean prison duration ± SD = 2.6 ± 2.5 years) with psychiatric disorders (primarily personality disorder, n = 27; mean illness duration ± SD = 12.0 ± 10.5 years). Interventions: Participants were randomly allocated to intervention group consisted of exercise plus usual care (n = 21) or control group which received usual care (n = 20) for 12 weeks. The exercise programme included three weekly sessions of group-based moderate-to-high intensity combined exercises designed and supervised by exercise professionals. Main measures: Fitness and anthropometric measures were assessed using field-based tests (6-minute walk, Incremental Shuttle Walk, Arm-Curl, and Chair-Stand), handgrip dynamometry, bioelectrical impedance, and waist and hip circumferences. Results: There were no adverse events, and 10 intervention participants withdrew. The remaining 11 participants attended a mean of 28 sessions, of which nine met the compliance criteria. Between-group change differences substantially favoured the compliance intervention group for the 6-minute walk (+21.2%), Incremental Shuttle Walk (+33.9%), Arm-Curl (+13.8%), waist (−3.5%), waist/height0.5 (−1.7%) (−2.7%), waist/hip (−3.4%), and Body Shape Index (−3.3%) (−3.5%). Additional analysis showed beneficial effects of exercise participation on handgrip strength. Conclusion: The intervention was safe, had a high dropout rate, and seemed to be effective for improving fitness and anthropometric measures in men prison inmates with psychiatric disorders who attended and participated in the exercise sessions. [ABSTRACT FROM AUTHOR]

Background: Professional athletes are reported to be at greater risk of septic arthritis (SA) after anterior cruciate ligament reconstruction (ACLR) than the nonprofessional population. However, this finding has been controversial, and confusion has arisen in the literature owing to the underpowering of previous studies. Purpose/Hypothesis: The purpose was to report the differences in the rate of SA after ACLR in a large series of patients and to perform pooled data analysis including previously published studies. The hypothesis was that professional athletes have a significantly higher risk of SA than nonprofessional athletes. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was performed. Patients who underwent ACLR between January 2009 and July 2017 (with a minimum follow-up of 12 months) were considered for study eligibility. The rate of SA was determined, and multivariate analysis was used to evaluate potentially important risk factors, including participation in professional sport. Furthermore, a literature search was performed, and data were extracted from all identified relevant studies. A pooled data analysis was performed to determine differences in the risk of SA between professional and nonprofessional populations. Results: The current series comprised 4421 anterior cruciate ligament surgical procedures with 265 professional athletes. There were 15 cases of SA diagnosed over the study period (0.34%; 95% CI, 0.19%-0.56%). Ten cases occurred in professional athletes (3.8%; 95% CI, 1.82%-6.83%). The percentage of SA was 0.12% (95% CI, 0.04%-0.28%) in the nonprofessional population. Being a professional athlete was associated with a significantly increased risk of SA after ACLR (odds ratio, 21.038; 95% CI, 6.585-75.789; P <.0001). This finding was confirmed in the pooled data analysis comprising 11,416 patients including 1118 professional athletes (odds ratio, 5.03; 95% CI, 1.17-21.61). Conclusion: Professional athletes are at greater risk of SA after ACLR than nonprofessional athletes. The results of previous studies may have been conflicting owing to underpowering. The current study confirms the elevated risk by using a large clinical series and pooled data analysis to avoid the limitations of previous studies. [ABSTRACT FROM AUTHOR]

Despite the promise of decision support for improving care, alerts are often overridden or ignored. We evaluated Dutch general practitioners' intention to accept decision support in a proposed implementation based on clinical rules regarding care for elderly patients, and their reasons for wanting or not wanting support. We developed a survey based on literature and structured interviews and distributed it to all doctors who would receive support in the proposed implementation (n = 43), of which 65 percent responded. The survey consisted of six questions for each of 20 clinical rules. Despite concerns about interruption, doctors tended to choose more interruptive forms of support. Doctors wanted support when they felt the rule represented minimal care, perceived a need to improve care, and felt responsible for the action and that they might forget to perform the action; doctors declined support due to feeling that it was unnecessary and due to concerns about interruption. [ABSTRACT FROM AUTHOR]

Objectives: The goal of this study is to describe the 30-day postoperative sequelae of pediatric choanal atresia repair and identify predictive factors for adverse events. Study Design: The American College of Surgeons' National Surgery Quality Improvement Program-Pediatric (NSQIP-P) database was searched between January 2012 and December 2015 to identify pediatric patients status post choanal atresia repair. Postoperative outcomes included surgical site complications, readmissions, and total length of stay. Results: A total of 178 children underwent choanal atresia repair. The overall complication rate was 6.2%, while the 30-day readmission rate was 15%. Patients with CHARGE had a longer mean duration of hospitalization (26.91 days vs 8.05 days, P =.013). Additionally, patients ≤10 days of age had longer duration of hospitalization (17.84 days vs 9.24 days, P ≤.001) and higher readmission rates (33.30% vs 10.1%, P =.001). Among the nonsyndromic cohort, ventilator dependence was a predictor of postoperative complications (odds ratio [OR] = 16.08, P <.001), higher readmission rates (OR = 5.46, P =.002), and a longer hospital stay (OR = 18.69, P <.001). Conclusion: Analysis of the 2012-2015 NSQIP-P data set reveals that patients with a diagnosis of CHARGE and those ≤10 days of age have a longer duration of hospitalization. Increased risk of postoperative complications and longer duration of hospitalization were both influenced by chronic steroid use and ventilator dependence. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic techniques are now considered the gold standard for treatment of most rotator cuff (RC) tears; however, no consensus exists on the maintenance of results over time, and long-term follow-up data have been reported for few cohorts of patients. Purpose: To present the long-term results associated with the arthroscopic treatment of RC tears and to evaluate associations between preoperative factors and RC integrity at final follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 169 patients were contacted at least 10 years after arthroscopic RC surgery and were invited to a clinical evaluation. Information on preoperative conditions, tear size, subjective satisfaction, and functional scores was collected; isometric strength and range of motion were also measured; and each patient underwent an ultrasound examination to evaluate supraspinatus integrity and a shoulder radiograph to evaluate osteoarthritis. Results: A total of 149 patients (88.2% of the eligible patients) were available for a complete telephonic interview, and 102 patients were available for the final evaluation. Ultrasound revealed an intact supraspinatus in 54 patients (53.47%). By adding the 10 patients who underwent revision surgery to the nonintact group, this percentage would drop to 48.65%. Tear size was associated with supraspinatus integrity in univariate analysis (hazard ratio, 3.04; 95% CI, 1.63-5.69; P =.001) and multivariable analysis (hazard ratio, 2.18; 95% CI, 1.03-4.62; P =.04). However, no significant differences were encountered in the subjective and functional scores collected, with the exception of the Constant-Murley Score, which was significantly higher in patients with smaller tears at the index procedure. Strength testing also revealed significantly superior abduction and flexion strength in this group, and radiographs showed a significantly higher acromion-humeral distance and lower grades of osteoarthritis. Patients with an intact supraspinatus at final follow-up showed superior results in all functional scores, greater satisfaction, superior abduction and flexion strength, higher acromion-humeral distance, and lower grades of osteoarthritis. Conclusion: RC tear size at the time of surgery significantly affects supraspinatus integrity at a minimum follow-up of 10 years. However, a larger tear is not associated with an inferior subjective result, although it negatively influences abduction and flexion strength, range of motion, and osteoarthritis progression. Intraoperative efforts to obtain a durable RC repair are encouraged, since supraspinatus integrity at final follow-up influences clinical and functional outcomes, patient satisfaction, and osteoarthritis progression. [ABSTRACT FROM AUTHOR]

Background: There is controversy about the benefit of arthroscopic partial meniscectomy (APM) for degenerative lesions in middle-aged patients. Purpose: To compare satisfaction with APM between middle-aged patients with no or mild knee osteoarthritis (OA) and a degenerative meniscal tear and those with a traumatic tear. Study Design: Cohort study; Level of evidence, 2. Methods: A comparative prospective study at 5 years of middle-aged patients (45-60 years old) with no or mild OA undergoing APM for degenerative (n = 115) or traumatic (n = 143) tears was conducted. Patient satisfaction was measured by a 5-point Likert scale and functional outcomes by the Knee injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Univariate and multivariate regression analyses were used to identify factors correlating with patient-reported satisfaction at 5 years postoperatively. Results: Baseline patient characteristics were not different between groups. At the 5-year evaluation, the satisfaction rate in the traumatic and degenerative groups was 68.5% versus 71.3%, respectively (P =.365). Patient satisfaction was significantly associated with functional outcomes (r = 0.69; P =.024). In the degenerative group, 43 patients (37.4%) had OA progression to Kellgren-Lawrence (K-L) grade 2 or 3, but only 24 patients (20.8%) had a symptomatic knee at final follow-up. Multivariate regression analysis for patient dissatisfaction at 5-year follow-up showed the following significant independent factors: female sex (odds ratio [OR], 1.6 [95% CI, 1.1-2.3]; P =.018), body mass index >30 kg/m2 (OR, 2.6 [95% CI, 1.7-4.9]; P =.035), lateral meniscal tears (OR, 0.6 [95% CI, 0.1-0.9]; P =.039), and OA progression to K-L grade ≥2 at final follow-up (OR, 1.4 [95% CI, 1.2-2.6]; P =.014). At the final evaluation, there were no significant differences between groups in pain scores (P =.648), WOMAC scores (P =.083), or KOOS-4 scores (P =.187). Likewise, there were no significant differences in the KOOS subscores for Pain (P =.144), Symptoms (P =.097), or Sports/Recreation (P =.150). Although the degenerative group had significantly higher subscores for Activities of Daily Living (P =.001) and Quality of Life (P =.004), the differences were considered not clinically meaningful. Conclusion: There were no meaningful differences in patient satisfaction or clinical outcomes between patients with traumatic and degenerative tears and no or mild OA. Predictors of dissatisfaction with APM were female sex, obesity, and lateral meniscal tears. Our findings suggested that APM was an effective medium-term option to relieve pain and recover function in middle-aged patients with degenerative meniscal tears, without obvious OA, and with failed prior physical therapy. [ABSTRACT FROM AUTHOR]

Background: Chondral and osteochondral lesions in osteoarthritic knees of young patients remain challenging for orthopaedic surgeons, due to a combination of high functional demands and limited indications for joint replacement in this population. The possibility of extending the indication of cartilage regenerative procedures to these patients may allow the delay of metal resurfacing. Purpose: To analyze the potential of a cartilage regenerative approach to provide clinical benefits in young patients with osteoarthritic knees, documenting outcomes in terms of clinical improvement as well as failures, in particular regarding knee replacement, at long-term follow-up. Study Design: Case series; Level of evidence, 4. Methods: A total of 41 patients (mean ± SD age, 43 ± 9 years) who had cartilage lesions (4 ± 2 cm2) in osteoarthritic knees (Kellgren-Lawrence grade 2 or 3) underwent matrix-assisted autologous chondrocyte transplantation (MACT) as a salvage procedure. Patients were evaluated with International Knee Documentation Committee (IKDC), EuroQol visual analog scale (EQ-VAS), and Tegner scores before surgery; at 1, 2, 5, and 9 years after surgery; and at a final follow-up at a mean of 15 years after surgery (range, 14-18 years). Failures were also recorded. Results: An improvement was observed in all scores after surgery, but a progressive worsening over time was noted. The mean ± SD IKDC score improved from 38.6 ± 16.2 to a maximum of 66.0 ± 18.6 at 2 years (P <.0005), with a subsequent deterioration until the final evaluation at 56.2 ± 21.7 (P =.024). A similar trend was confirmed by EQ-VAS scores. Tegner scores improved at all follow-up points but did not reach the preinjury level. Patients who underwent combined surgery obtained significantly lower results. Only 13 patients (32%) had an IKDC score higher than 70. During the follow-up period, 21 patients underwent reoperation (18 with knee replacement) and 3 more patients experienced clinical failure, for a total surgical and clinical failure rate of 59% at 15 years. Conclusion: The use of cartilage regenerative surgical procedures, such as MACT, as salvage procedures for young, active patients affected by chondral and osteochondral lesions in osteoarthritic knees led to a limited improvement, with the majority of patients experiencing failure at long-term follow-up. Although a minor subpopulation experienced favorable and stable improvement, the use of MACT for such a challenging indication remains questionable until responding patients can be profiled. [ABSTRACT FROM AUTHOR]

Background: Subchondral changes, specifically cyst formation, are a known finding after osteochondral allograft (OCA) transplantation. Purpose/Hypothesis: The purpose was to determine potential predictive associations between preoperative patient characteristics or OCA morphology and postoperative OCA appearance as assessed by the osteochondral allograft magnetic resonance imaging scoring system (OCAMRISS) at 6-month follow-up. It was hypothesized that preoperative patient factors or OCA morphology is associated with postoperative OCAMRISS scores. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study evaluated 74 OCAs that were implanted in the femoral condyles of 63 patients for the treatment of symptomatic osteochondral defects in the knee. Postoperative magnetic resonance imaging was obtained at a mean ± SD follow-up of 5.5 ± 1.0 months. A musculoskeletal radiologist scored all grafts according to the OCAMRISS. Point biserial correlation, Mann-Whitney U test, Fisher exact test, and chi-square test were used to distinguish associations between OCAMRISS subscales and age, sex, smoker status, body mass index, previous surgery, concomitant surgery, bone marrow augmentation, graft location, graft size, and bony graft thickness. Results: OCA bony thickness showed significant correlation with cystic changes at the graft-host junction (P =.019). Grafts with cystic formation were significantly thinner than grafts without cystic changes (P =.008). The odds ratio for grafts with <5-mm bony thickness demonstrating cystic changes was 4.9 (95% CI, 1.5-16.1; P =.009). Bony graft thickness was not associated with graft integration, but 40% of grafts with a bony thickness >9 mm presented with a residual osseous cleft, as opposed to 11.3% of thinner grafts (P =.1). The augmentation with bone marrow aspirate did not affect osseous graft integration or subchondral cystic formation (P =.375 and P =.458, respectively). Conclusion: Osteochondral allograft thickness is associated with subchondral cyst formation at short-term follow-up. Thin grafts demonstrate a substantially increased risk of developing subchondral cysts at the graft-host junction after OCA transplantation. Conversely, thicker grafts may negatively affect osseous graft integration. Hence, surgeons should be aware of the potential pitfalls of transplanting thin or thick grafts regarding cystic formation and delay of osseous integration after cartilage resurfacing. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of therapeutic ultrasound combined with transcutaneous electrical nerve stimulation versus therapeutic ultrasound alone for pain relief and functional improvement in patients with symptomatic knee osteoarthritis. Design: Randomized controlled trial (blinded assessor). Setting: Outpatient. Participants: A total of 148 ambulatory knee osteoarthritis patients (pain score ⩾ 5/10) were recruited as study participants. Interventions: Ultrasound combined with transcutaneous electrical nerve stimulation (study group) or ultrasound (control group). Both groups received treatment in the supine position for 10 minutes per session, for 10 sessions within two weeks. Main outcomes: Pain score and gait speed were measured after random allocation and on day 10. Adverse events, global assessment, and patient satisfaction were recorded after treatment. Results: All baseline data were comparable between groups. The mean (SD) pain score at baseline and day 10 was 5.9 (1.3) and 2.7 (1.7) in the control group, and 5.8 (1.3) and 2.9 (1.7) in the study group, respectively. Gait speed at baseline and day 10 was 1.11 (0.30) and 1.23 (0.38) m/s in the control group, and 1.10 (0.36) and 1.17 (0.39) m/s in the study group, respectively. No difference was observed between groups for total pain score (0.28; 95% confidence interval (CI): –0.28, 0.84) or gait speed (–0.03; 95% CI: –0.13, 0.07). The results from intention-to-treat analysis were similar to those from per-protocol analysis. No difference was observed between groups for adverse events. Most participants reported satisfaction and improvement for the global assessment. Conclusion: Adding transcutaneous electrical nerve stimulation to ultrasound demonstrated no additional beneficial effect over ultrasound alone in patients with symptomatic knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Background: Adult patients who succeed in returning to their preinjury levels of sport after anterior cruciate ligament (ACL) reconstruction have been characterized by a more positive psychological response. It is not known whether this relationship is valid for adolescent athletes. Purpose: To investigate psychological readiness to return to sport, knee-related self-efficacy, and motivation among adolescent (15-20 years old) and adult (21-30 years old) athletes after ACL reconstruction. A further aim was to compare athletes (15-30 years old) who had recovered their muscle function and returned to sport with athletes who had not. Study Design: Case-control study; Level of evidence, 3. Methods: Data were extracted from a rehabilitation-specific register 8 and 12 months after ACL reconstruction. Athletes previously involved in knee-strenuous sport who had undergone primary ACL reconstruction were included. Data comprised psychological patient-reported outcomes and results from 5 tests of muscle function. Comparisons were performed between age groups, between athletes who had and had not recovered their muscle function, and between patients who had returned to sport and not. Results: In all, 384 (50% females) and 271 athletes (52% females) were included at the 8- and 12- month follow-ups, respectively. Enhanced self-efficacy was reported at both follow-ups by adolescents and by athletes who had recovered their muscle function. Athletes who had recovered their muscle function reported higher (P =.0007) motivation to achieve their goals. Subgroup analyses on patient sex revealed findings similar to those in the main analyses for females but not for males. Moreover, adolescent and adult athletes who had returned to sport reported significantly higher levels on the Knee Self-Efficacy Scale and the ACL–Return to Sport After Injury scale at both follow-ups. Conclusion: Adolescent athletes, especially females, perceived enhanced self-efficacy, had a higher return-to-sport rate, and were more motivated to reach their goals after ACL reconstruction compared with adults. Regardless of age, athletes who had returned to sport and athletes with more symmetrical muscle function had a stronger psychological profile. [ABSTRACT FROM AUTHOR]

Background: Traumatic anterior shoulder instability is a common condition affecting sports participation among young athletes. Clinical outcomes after surgical management may vary according to patient activity level and sport involvement. Overhead athletes may experience a higher rate of recurrent instability and difficulty returning to sport postoperatively with limited previous literature to guide treatment. Purpose: To report the clinical outcomes of patients undergoing primary arthroscopic anterior shoulder stabilization within the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Consortium and to identify prognostic factors associated with successful return to sport at 2 years postoperatively. Study Design: Case series; Level of evidence, 4. Methods: Overhead athletes undergoing primary arthroscopic anterior shoulder stabilization as part of the MOON Shoulder Instability Consortium were identified for analysis. Primary outcomes included the rate of recurrent instability, defined as any patient reporting recurrent dislocation or reoperation attributed to persistent instability, and return to sport at 2 years postoperatively. Secondary outcomes included the Western Ontario Shoulder Instability Index and Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow questionnaire score. Univariate regression analysis was performed to identify patient and surgical factors predictive of return to sport at short-term follow-up. Results: A total of 49 athletes were identified for inclusion. At 2-year follow-up, 31 (63%) athletes reported returning to sport. Of those returning to sport, 22 athletes (45% of the study population) were able to return to their previous levels of competition (nonrefereed, refereed, or professional) in at least 1 overhead sport. Two patients (4.1%) underwent revision stabilization, although 14 (28.6%) reported subjective apprehension or looseness. Age (P =.87), sex (P =.82), and baseline level of competition (P =.37) were not predictive of return to sport. No difference in range of motion in all planes (P >.05) and Western Ontario Shoulder Instability Index scores (78.0 vs 80.1, P =.73) was noted between those who reported returning to sport and those who did not. Conclusion: Primary arthroscopic anterior shoulder stabilization in overhead athletes is associated with a low rate of recurrent stabilization surgery. Return to overhead athletics at short-term follow-up is lower than that previously reported for the general athletic population. [ABSTRACT FROM AUTHOR]

Background: Isolated medial patellofemoral ligament reconstruction (iMPFLR) is increasingly used for the surgical treatment of recurrent patellofemoral instability. Purpose: The purpose of this study was to identify the clinical and radiological predictors that can significantly influence the functional outcomes after an iMPFLR. Study Design: Case series; Level of evidence, 4. Methods: A total of 107 patients (112 ligament reconstructions) who underwent iMPFLR were evaluated with a mean ± SD follow-up of 59 ± 33 months (range, 12-123 months). Functional International Knee Documentation Committee (IKDC) and Kujala scores were assessed preoperatively and every 12 months. Radiological assessment of patellar height and tilt (Laurin angle, Merchant angle, Maldague classification) and computed tomography (CT) scan measurement of patellar tilt (contracted and relaxed quadriceps) and tibial tubercle–trochlear groove distance were performed preoperatively and at 6 months. Femoral tunnel position was assessed following the criteria formulated by Schöttle. The amount of femoral tunnel widening was measured by means of 3-dimensional CT scan at 6 months. Predictors were determined from univariate and multivariate regression analyses integrating clinical and radiological criteria pre- and postoperatively. The dependent variable was defined as the difference between pre- and postoperative scores. Results: Between pre- and postoperative measurement at last follow-up, a significant improvement for IKDC and Kujala functional scores was observed (Kujala: 57 ± 11.3 to 87 ± 12.9, P <.001; IKDC: 47.8 ± 13.1 to 79 ± 15.8, P <.001). Demographics (age, body mass index, sex), dislocation characteristics (number of dislocations, time between first dislocation and surgery, age at first dislocation, mechanism of first dislocation, knee side), clinical data (frontal limb alignment, hyperlaxity, recurvatum, pre- and postoperative range of motion), and complications (quadriceps atrophy, complex regional pain syndrome) did not influence functional scores. The predictors of lower improvement in functional scores included small correction of the patellar tilt reported on the CT scan measurement, malpositioning of the femoral tunnel, and a widening of this tunnel near the medial cortex. Malpositioning of the femoral tunnel was correlated with tunnel widening, and patients with anterior and proximal malpositioning experienced stiffness in flexion. Conclusion: Overall, iMPFLR demonstrated good outcomes. Predictors influencing the functional results were identified. Less improvement in clinical outcome was reported for patients with a high preoperative patellar tilt and only a small correction in tilt and for those who had femoral tunnel malpositioning, which was correlated with tunnel widening. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of acupuncture in patients with vascular cognitive impairment no dementia (VCIND) in comparison with citicoline, an agent for cognitive disturbances associated with chronic cerebral disorders. Design: A randomized controlled multicenter trial. Setting: In three hospitals in Beijing, China. Subjects: A total of 216 patients with VCIND were recruited. Interventions: Patients with VCIND (mean age of 65.4 years) were randomized to receive acupuncture (two sessions per week) or oral citicoline (100 mg three times daily) over three months. Main measures: The primary outcome was the change from baseline to three months in cognitive symptom, measured by Alzheimer's disease Assessment Scale, cognitive subscale (ADAS-cog). Secondary outcomes included changes from baseline to six months in ADAS-cog, executive function measured by the Clock Drawing Test (CDT), and functional disability measured by the Ability of Daily Living (ADL) scale at three and six months. Results: At three months, the acupuncture group had a greater decrease in mean ADAS-cog score (−2.33 ± 0.31) than the citicoline group (−1.38 ± 0.34) with a mean difference of −0.95 (95% CI, −1.84 to −0.07, P = 0.035). The mean change from baseline to six months in ADAS-cog also significantly favored acupuncture treatments (acupuncture change −2.61 vs citicoline −1.25, difference: −1.36 points; 95% CI, −2.20 to −0.51; P = 0.002). There was no difference between the two groups on CDT and ADL scores at either time point. Conclusion: Compared with citicoline, acupuncture has comparable and even superior efficacy with improved cognitive and daily living performance as a complementary and alternative medicine treatment for VCIND. [ABSTRACT FROM AUTHOR]

Background: Meniscal allograft transplantation (MAT) is a widely performed surgical technique used to reconstruct meniscal deficiencies after meniscectomy. However, the long-term effects of extrusion on clinical and radiologic outcomes are unclear. Hypothesis: In long-term follow-up, extrusion after MAT would show poorer outcomes than nonextrusion and would lead to faster progression of arthritic changes. Study Design: Cohort study; Level of evidence, 3. Methods: Forty-five MAT cases (lateral, n = 36; medial meniscal, n = 9) with a minimum 8-year follow-up period were selected. The mean follow-up period was 12.3 years (range, 8.0-19.6 years). Data were collected on patients' sex, age, surgical side, and mechanical axis deviation. Patients were categorized into 2 groups: extrusion (≥3 mm) and nonextrusion (<3 mm). Categories were based on extrusion length measured via magnetic resonance imaging taken 1 year after surgery. Joint space width (JSW) on the affected and contralateral sides was measured on bilateral weightbearing posterior-anterior radiographs at 45° of flexion at 3 time points (preoperative, 4-6 years postoperative, and >8 years postoperative). Differences of the measured and relative JSW values between the groups and differences at different time points were analyzed. The Lysholm score was used to evaluate clinical function. Results: Mean ± SD extrusion was 3.07 ± 0.82 mm. The extrusion and nonextrusion groups were composed of 19 (42.2%) and 26 (57.8%) patients, respectively. Analysis of JSW showed a difference in relative JSW between the groups at >8 years (P = .017). At the point of transition from 4 to 6 years to >8 years, the differences in absolute JSW values were −1.25 ± 0.78 mm (extrusion group) and −0.58 ± 0.66 mm (nonextrusion group; P < .001). Relative JSW values also differed between groups (extrusion group, −0.22 ± 0.13; nonextrusion group, −0.04 ± 0.18; P < .001). No differences were observed in the Lysholm scores between the groups at each time point. Conclusion: Long-term follow-up after MAT revealed a greater decrease in JSW in the extrusion group than in the nonextrusion group. However, no significant differences in clinical outcomes were observed. [ABSTRACT FROM AUTHOR]

Background: Recent studies identified microinstability in the hip as a pathoetiology of painful hip conditions, and it was proposed that generalized ligamentous laxity conditions may predispose patients to such microinstability. Purpose: To study the relationship of generalized ligamentous laxity with patient characteristics, clinical presentation, intraoperative findings, and surgical treatments in a cohort of patients undergoing hip arthroscopy. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Registry data were prospectively collected and retrospectively reviewed between February 2014 and November 2017 for patients who underwent primary hip arthroscopy and had a documented Beighton score to assess generalized ligamentous laxity. Patients with a history of an ipsilateral hip condition or ipsilateral hip surgery, those with Tönnis grade >1, and those who had simultaneous arthroscopic and open procedures were excluded from the study. Two comparisons were made between patients with low and high Beighton scores: Beighton 0 vs ≥1 (B 0 vs B ≥1) and Beighton 0-3 vs ≥4 (B 0-3 vs B ≥4). Patient demographics, symptomatology, physical examination, and intraoperative findings were compared between these low and high Beighton groups. Results: A total of 1381 patients met our inclusion and exclusion criteria. Within this patient population, there were 882 with B 0, 499 with B ≥1, 1120 with B 0-3, and 261 with B ≥4. B 0 was 54.1% female, compared with 84.2% of B ≥1. Similarly, B 0-3 was 58.5% female, while B ≥4 was 92.7% female. The difference in sex makeup was significant between both sets of groups (P < .0001). The relative risk of having B ≥1 for women versus men was 2.869, and the relative risk of having B ≥4 for women versus men was 6.873. The patients with higher Beighton scores in B ≥1 and B ≥4 had a younger mean age at onset of symptoms (P < .0001) and lower mean body mass index (P < .0001) than those in B 0 and B 0-3, respectively. The B ≥1 group had higher preoperative range of motion with internal rotation (P = .05), external rotation (P = .017), and flexion (P < .0001) than B 0 patients, as well as a lower frequency of Trendelenburg gait pattern (P = .0268). Similarly, the B ≥4 group had higher range of motion than the B 0-3 group with internal rotation (P = .030), external rotation (P = .003), flexion (P < .0001), and abduction (P = .002). As compared with the lower-score groups, the higher-score groups also had smaller labral size and tear dimension (P < .0001), and a higher proportion of these patients underwent labral repair, capsular repair, and iliopsoas fractional lengthening. Conclusion: Patients undergoing hip arthroscopy who have generalized ligamentous laxity are overall younger, have a lower body mass index, and are more often female, as compared with patients who have lesser laxity. Patients with higher preoperative Beighton scores had greater hip range of motion and smaller intraoperative labral size and tear dimensions. Additionally, these patients were more likely to undergo labral repair, capsular plication, and iliopsoas fractional lengthening. [ABSTRACT FROM AUTHOR]

Background: Biomechanical studies have shown that double-bundle (DB) posterior cruciate ligament reconstruction (PCLR) is better than single-bundle (SB) PCLR in restoring normal biomechanical function and stability. However, most clinical studies report no differences between the technical methods, and there is yet no long-term clinical comparative study. Hypothesis: DB PCLR would show superior results and survivorship outcomes to those of SB PCLR in long-term follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: The authors retrospectively evaluated 64 patients who underwent primary PCLR between 2000 and 2008 and were followed up for a minimum of 10 years: 28 patients underwent SB PCLR (mean ± SD: age, 29.1 ± 12.2 years), and 36 underwent DB PCLR (age, 27.0 ± 9.2 years). Clinical scores (International Knee Documentation Committee subjective score, Lysholm score, Tegner activity score), side-to-side difference in stress radiographs, osteoarthritis progression, and survival rate were compared between the SB and DB groups at the last follow-up. Results: At the final follow-up, all clinical scores showed no significant differences between the SB and DB groups. The mean side-to-side difference in stress radiographs (SB, 5.3 ± 3.5 mm; DB, 5.0 ± 3.8 mm; P = .828) and osteoarthritis progression (SB, 14.3%; DB, 13.9%; P = .964) were not different between the groups. The 15-year survival rate was 82.1% for SB PCLR and 83.7% for DB PCLR. Conclusion: Both the SB and DB techniques for PCLR showed satisfactory long-term clinical results and survivorship outcomes. There were no significant differences between SB and DB PCLR in clinical, radiologic, and survivorship outcomes at a minimum follow-up of 10 years. Clinical Relevance: DB PCLR did not show superior clinical results to those of SB PCLR in the long-term follow-up. These results should be considered in the surgical planning for PCLR. [ABSTRACT FROM AUTHOR]

Objective: To compare five-year outcomes and changes over time of a client-centred activities of daily living (ADL) intervention versus usual ADL interventions for people with stroke and their significant others. Design: Five-year follow-up of a cluster-randomized controlled trial where a client-centred ADL intervention (n = 129) or usual ADL interventions (n = 151) were delivered to people with stroke. Setting: Multicentre study including 16 inpatient or home-based rehabilitation units. Participants: People with stroke and significant others. Intervention: The client-centred ADL intervention aimed at enabling agency in daily activities and participation in everyday life and at reducing caregiver burden. Main measures: For people with stroke, perceived participation (Stroke Impact Scale), independence in ADL, life satisfaction, and use of formal/informal care were measured. For significant others, caregiver burden, life satisfaction, and mood (Hospital Anxiety and Depression Scale) were assessed. Results: Five years post-intervention, data were collected from 145 people with stroke (intervention group: n = 71/control group: n = 74) and 75 significant others (intervention group: n = 36/control group: n = 39). For those with stroke, the Participation domain of the Stroke Impact Scale showed no group differences at year five (68.9 vs 75.4, P = 0.062) or in changes over time. At year five, the control group had better outcomes regarding Other help/supervision. Significant others in the control group were more likely to show signs of depression at year five (odds ratio = 22.3; P < 0.001). Conclusion: The client-centred ADL intervention appears to render similar long-term effects as usual ADL interventions for people with stroke, but for significant others signs of depression might be reduced. [ABSTRACT FROM AUTHOR]

Background: In spite of the probable advantages of Bankart repair with modified Mason-Allen technique, there has been no study to evaluate the clinical outcomes of the modified Mason-Allen technique for Bankart repair. Purpose: To prospectively compare the anatomic and clinical outcomes between the vertical simple stitch and the modified Mason-Allen stitch with respect to the labral height, retear rate, redislocation/apprehension, and various functional outcome scores. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients who underwent arthroscopic Bankart repair with double-loaded suture anchors were randomly allocated to 1 of 2 groups: the vertical simple stitch method (SS; n = 45) or the Bankart repair using modified Mason-Allen technique (BRUMA; n = 41). All patients underwent computed tomography arthrography at 6 months postoperatively and various functional outcome measurements at least 2 years postoperatively. The labral height and width at the 3-, 4-, and 5-o'clock positions were measured preoperatively and at 6 months after surgery on axial computed tomography arthrography; the redislocation/apprehension rate, the retear rate, and various functional outcome scores were evaluated at each follow-up visit. Results: Postoperative labral height and width were significantly increased at all locations (all P < .001) in both groups, but they were not statistically different between groups (all P > .05). Two patients in the SS group (4.4%) and 2 in the BRUMA group (4.9%) experienced redislocation after surgery, and 4 patients in the SS group (8.9%) and 2 in the BRUMA group (4.9%) group showed apprehension after surgery. Additionally, 5 patients in the SS group (11.1%) and 2 in the BRUMA group (4.9%) showed retear at 6 months (P = .239). There were no differences in any functional outcome scores (all P > .05). Conclusion: There was no difference in the radiologic outcomes at 6 months and the clinical outcomes assessed at least 2 years after surgery between the groups. [ABSTRACT FROM AUTHOR]

Background: Although the cause of rotational instability after revision anterior cruciate ligament reconstruction (ACLR) is multifactorial, the rationale of adding an extra-articular procedure is based on its ability to restrict rotational instability. Purpose: To assess the effect of anterolateral ligament (ALL) reconstruction on revision ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 87 patients who underwent revision ACLR between March 2011 and July 2014 with a follow-up of more than 3 years were included in this retrospective study. Patients were divided into the isolated revision ACLR group (group I, n = 45, from March 2011 to January 2013) or the revision ACLR in combination with ALL reconstruction group (group C, n = 42, from February 2013 to July 2014). Subjective knee assessments including the subjective International Knee Documentation Committee (IKDC) form, Lysholm score, Tegner activity scale, and Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scale were used. Clinical and functional tests were performed before surgery and at ≥6 months after surgery. All tests were usually completed at 36 months of follow-up. Results: The mean follow-up duration for groups I and C were 41.5 ± 8.2 and 38.2 ± 6.9 months, respectively (P = .451). The subjective IKDC score, Tegner score, and ACL-RSI score were significantly better in group C compared with those in group I at the last follow-up (84.3 ± 18.5 vs 75.9 ± 19.2, 7.0 ± 0.8 vs 6.3 ± 0.7, and 69.5 ± 25.4 vs 51.9 ± 23.1, respectively), although they were not significantly different between the 2 groups at 12 months after surgery (79.2 ± 18.8 vs 76.7 ± 17.2, 6.7 ± 0.7 vs 6.5 ± 0.9, and 50.2 ± 24.6 vs 49.9 ± 25.1, respectively). There were no significant differences in KT-2000 arthrometer, isokinetic extensor strength, single-legged hop for distance, co-contraction test, or carioca test results between the 2 groups at the last follow-up (P = .304, .068, .125, .056, and .066, respectively). Preoperatively, 43 (95.6%) patients in group I and 40 (95.2%) patients in group C had a grade 2 or 3 pivot shift (P = .387). Postoperatively, 23 (53.5%) patients in group I and 38 (90.5%) patients in group C had a negative pivot shift (P < .001). Group C showed a higher rate of return to the same level of sports activity than group I (57.1% vs 25.6%, respectively; P = .008), although there was no significant difference in the rate of return to any sports activity at the last follow-up (88.4% in group I vs 88.1% in group C; P = .713). Conclusion: Revision ACLR in combination with ALL reconstruction significantly reduced rotational laxity and showed a higher rate of return to the same level of sports activity than revision ACLR alone, although there were no significant differences in anterior laxity or functional test results between the 2 groups. [ABSTRACT FROM AUTHOR]

Objective: This pre-planned secondary analysis of geriatric interdisciplinary home rehabilitation, which was initially found to shorten the postoperative length of stay in hospital for older individuals following hip fracture, investigated whether such rehabilitation reduced the numbers of complications, readmissions, and total days spent in hospital after discharge during a 12-month follow-up period compared with conventional geriatric care and rehabilitation. Design: Randomized controlled trial. Setting: Geriatric department, participants' residential care facilities, and ordinary housing. Subjects: Individuals aged ⩾70 years with acute hip fracture (n = 205) were included. Intervention: Geriatric interdisciplinary home rehabilitation was individually designed and aimed at early discharge with the intention to prevent, detect, and treat complications after discharge. Main measures: Complications, readmissions, and days spent in hospital were registered from patients' digital records and interviews conducted during hospitalization and at 3- and 12-month follow-up visits. Results: No significant difference in outcomes was observed. Between discharge and the 12-month follow-up, among participants in the geriatric interdisciplinary home rehabilitation group (n = 106) and control group (n = 93), 57 (53.8%) and 44 (47.3%) had complications (P = 0.443), 46 (43.4%) and 38 (40.9%) fell (P = 0.828), and 38 (35.8%) and 27 (29.0%) were readmitted to hospital (P = 0.383); the median total days spent in hospital were 11.5 and 11.0 (P = 0.353), respectively. Conclusion: Geriatric interdisciplinary home rehabilitation for older individuals following hip fracture resulted in similar proportions of complications, readmissions, and total days spent in hospital after discharge compared with conventional geriatric care and rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Scoring systems integrating possible prognostic factors and predicting rotator cuff healing after surgical repair could provide valuable information for clinical practice. Purpose: To determine the prognostic factors predictive of rotator cuff healing after surgical repair and to integrate these factors into a scoring system. Study Design: Case-control study; Level of evidence, 3. Methods: The authors reviewed the records of 603 patients who, at least 12 months after primary rotator cuff repair by a single surgeon, had magnetic resonance imaging or computed tomographic arthrography to assess repair integrity. The mean age at the time of surgery was 60 years (range, 39-81 years), and 378 patients were women (62.7%). Previous known or suggested factors affecting cuff integrity were analyzed through univariate and multivariate analyses. Factors identified in the multivariate analysis were integrated in a scoring system based on odds ratios (ORs). Results: The overall healing failure rate was 24%. The following independent risk factors were identified in the multivariate analysis: age >70 years at the time of surgery (P = .003, OR = 2.71), size of the tear in anteroposterior dimension (P = .033, OR = 1.94) and retraction (P = .000, OR = 4.56), fatty infiltration of infraspinatus exceeding grade 2 (P = .001, OR = 2.91), low bone mineral density (T score ≤ –2.5, P = .04, OR = 1.95), and high level of work activity (P = .036, OR = 2.18). A 15-point scoring system comprised the following: 4 points for retraction; 3 points for fatty infiltration of infraspinatus; and 2 points for anteroposterior tear size, age, bone mineral density, and work activity, weighted according to multivariate analysis ORs. Patients with ≤4 points had a 6.0% healing failure rate, and those with ≥5 and ≥10 points had 55.2% and 86.2% healing failure rates, respectively. Conclusion: A numerical scoring system including significant clinical and radiological factors was designed to predict healing of the rotator cuff after surgical repair. This scoring system helped predict the adequacy of the repair and assist in deciding the appropriate treatment options. [ABSTRACT FROM AUTHOR]

Background: There is a lack of knowledge about the changes in perianchor cysts over time and the factors related to perianchor cysts. Purpose: To evaluate the changes in perianchor cyst formation and anchor absorption over time after arthroscopic rotator cuff repair with a biocomposite suture anchor and to evaluate the factors affecting perianchor cyst persistence and their relationship with patient outcomes. Study Design: Case-control study; Level of evidence, 3. Methods: Forty consecutive patients (mean age, 61.10 ± 5.79 years) who underwent arthroscopic repair for medium- to large-sized rotator cuff tears using a single type of biocomposite (poly-L-lactic acid/polyglycolic acid–beta tricalcium phosphate) medial-row anchor were prospectively enrolled. Postoperative magnetic resonance imaging (MRI) at 2 different time points (6 and 18 months) was performed, and perianchor cyst formation, anchor absorption, and healing failures were evaluated using postoperative MRI. Demographic and clinical data were collected, and functional outcomes at a minimum of 18 months after surgery were assessed. Results: Perianchor cysts were observed in 24 patients (60.0% total; grade 1: 35.0%; grade 2: 10.0%; grade 3: 7.5%; grade 4: 7.5%) at 6 months, and 7 patients (18.4% total; grade 1: 7.9%; grade 2: 5.3%; grade 3: 2.6%; grade 4: 2.6%) had a persistent perianchor cyst at 18 months after surgery. No anchors were absorbed at 6 months, but 73.7% of patients revealed complete or near-full absorption at 18 months. Patients with persistent perianchor cysts showed a significantly larger tear size in the anteroposterior dimension (P = .002) and greater retraction (P < .001). There were no differences in healing failures and functional outcomes between patients with and without persisting perianchor cysts (all P > .05). No differences were found in perianchor cyst formation and anchor absorption between anchors inserted in the greater tuberosity and the lesser tuberosity (all P > .05). Conclusion: The incidence and severity of perianchor cysts decreased with time, and most biocomposite suture anchors were absorbed at 18 months after surgery. Persisting perianchor cysts correlated with a larger tear size in the anteroposterior dimension and greater retraction. [ABSTRACT FROM AUTHOR]

Background: Revision hip arthroscopy is increasingly common and often addresses acetabular labrum pathology. There is a lack of consensus on indications or outcomes of revision labral repair versus reconstruction. Purpose: To report clinical outcomes of labral reconstruction during revision hip arthroscopy at minimum 2-year follow-up as compared with pair-matched labral repair during revision hip arthroscopy (control group) and to suggest a decision-making algorithm for labral treatment in revision hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent revision hip arthroscopy with labral reconstruction were matched 1:2 with patients who underwent revision arthroscopic labral repair. Patients were matched according to age, sex, and body mass index. Outcome scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score, Hip Outcome Score–Sport-Specific Subscale, and a visual analog scale for pain, were collected preoperatively and at minimum 2-year follow-up. At latest follow-up, patient satisfaction on a 0-10 scale and the abbreviated International Hip Outcome Tool (iHOT-12) were collected. Complications, subsequent arthroscopies, and conversion to total hip arthroplasty were collected as well. Results: A total of 15 revision labral reconstructions were pair matched to 30 revision labral repairs. The reconstructions had fewer isolated Seldes type I detachments (P = .008) and lower postoperative lateral center-edge angle, but there were otherwise no significant differences in demographics, radiographics, intraoperative findings, or procedures. Both groups demonstrated significant improvements in all outcomes and visual analog scale at minimum 2-year follow-up. The revision repairs trended toward better preoperative scores: mHHS (mean ± SD: 59.3 ± 16.5 vs 54.2 ± 16.0), Non-Arthritic Hip Score (61.0 ± 16.7 vs 51.2 ± 17.6), Hip Outcome Score–Sport-Specific Subscale (39.6 ± 25.1 vs 30.5 ± 22.1), and visual analog scale (5.8 ± 1.8 vs 6.2 ± 2.2). At follow-up, the revision repair group had significantly higher mHHS (84.1 ± 14.8 vs 72.0 ± 18.3, P = .043) and iHOT-12 (72.2 ± 23.3 vs 49.0 ± 27.6, P = .023) scores than the reconstruction group. The magnitudes of pre- to postoperative improvement between the groups were comparable. The groups also had comparable rates of complications: 1 case of numbness in each group (P > .999), subsequent arthroscopies (repair: n = 2, 6.5%; revision: n = 3, 20%; P = .150), and conversion to total hip arthroplasty (1 patient in each group, P > .999). Conclusion: Labral reconstruction safely and effectively treats irreparable labra in revision hip arthroscopy. However, labral repair is another treatment option for reparable labra, yielding similar magnitude of improvement. A proposed algorithm may assist in surgical decision making to achieve optimal outcomes based on the condition and history of each patient's acetabular labrum. [ABSTRACT FROM AUTHOR]

Background: Hip arthroscopy for the treatment of instability in the setting of borderline dysplasia is controversial. Capsular management in such cases is an important consideration, and plication has been described as a reliable technique, with good midterm outcomes reported when indications are appropriate. Hypothesis: Patients with borderline dysplasia who have a lower lateral center-edge angle (LCEA) and greater age will be at a higher risk of failure after arthroscopic capsular plication. Study Design: Case-control study; Level of evidence, 3. Methods: Data were retrospectively reviewed for all patients between 15 and 40 years of age who underwent hip arthroscopy from November 2008 to January 2015. Inclusion criteria were an LCEA between 18° and 25°, Tönnis grade ≤1, primary case with capsular plication, and minimum 2-year follow-up. Patients were excluded if they had any history of ipsilateral hip procedure or conditions such as Legg-Calve-Perthes disease, slipped capital femoral epiphysis, rheumatologic disease, and Tönnis grade ≥2. Age, sex, and body mass index data were retrieved for each patient. Patient-reported outcomes (PROs)—including modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale, and a visual analog scale (VAS) for pain (0-10)—were obtained preoperatively and at a minimum of 2 years postoperatively, in addition to the postoperative International Hip Outcome Tool–12. The "success" group consisted of all patients who achieved the patient acceptable symptomatic state of mHHS ≥74 and had no ipsilateral hip surgery subsequent to their index arthroscopy. The "failure" group was composed of patients who were below the patient acceptable symptomatic state at latest follow-up or required secondary arthroscopy or conversion to total hip arthroplasty. Patient satisfaction and minimal clinically important difference were also calculated. Mean age for the failure group was applied as a cutoff age for subanalysis, and relative risk for failure was determined. Results: Ninety patients (97 hips; 79.5%) met criteria for the success group, and 25 patients (25 hips) met criteria for the failure group. No significant differences in preoperative baseline scores or VAS were found. However, there did appear to be a trend that the failure group had lower mean preoperative scores for all PRO measures and a higher VAS score. The differences in preoperative mHHS and NAHS closely approached significance (P = .053). Postoperative PRO, VAS, and patient satisfaction scores of the success group were significantly higher than the failure group. The failure group was significantly older than the success group (28.5 ± 7.8 vs 23.5 ± 7.5 years, P = .005). Patients >35 years old were 2.25 times more likely to fail according to relative risk (95% CI, 1.10-4.60; P = .0266). LCEA did not differ between the groups, and no other risk factors for failure were identified. Conclusion: Stringent criteria for patient selection and meticulous repair or augmentation of the static stabilizers of the hip yielded favorable clinical outcomes in this study cohort with borderline dysplasia. Within this carefully selected group, the analysis revealed that increased age was the main risk factor for failure in the management of borderline hip dysplasia via isolated primary arthroscopic hip surgery with capsular plication. [ABSTRACT FROM AUTHOR]

Background: The literature has given little attention to the nonoperative management of femoroacetabular impingement (FAI) syndrome despite a rapidly expanding body of research on the topic. Purpose: To perform a prospective study utilizing a nonoperative protocol on a consecutive series of patients presenting to our clinic with FAI syndrome. Study Design: Cohort study; Level of evidence, 2. Methods: Between 2013 and 2016, patients meeting the following criteria were prospectively recruited in a nonoperative FAI study: no prior hip surgery, groin-based pain, a positive impingement test, and radiographic FAI syndrome. The protocol consisted of an initial trial of rest, physical therapy, and activity modification. Patients who remained symptomatic were then offered an image-guided intra-articular steroid injection. Patients with recurrent symptoms were then offered arthroscopic treatment. Outcome scores were collected at 12 and 24 months. Statistical analysis was performed to identify risk factors for the need for operative treatment and to determine patient outcomes based on FAI type and treatment. Results: Ninety-three hips (n = 76 patients: mean age, 15.3 years; range, 10.4-21.4 years) were included in this study and followed for a mean ± SD 26.8 ± 8.3 months. Sixty-five hips (70%) were managed with physical therapy, rest, and activity modification alone. Eleven hips (12%) required a steroid injection but did not progress to surgery. Seventeen hips (18%) required arthroscopic management. All 3 groups saw similar improvements in modified Harris Hip Score (P = .961) and nonarthritic hip score (P = .975) with mean improvements of 20.3 ± 16.8 and 13.2 ± 15.5, respectively. Hips with cam impingement and combined cam-pincer impingement were 4.0 times more likely to meet the minimal clinically important difference in modified Harris Hip Score (P = .004) and 4.4 times more likely to receive surgical intervention (P = .05) than patients with pincer deformities alone. Participants in team sports were 3.0 times more likely than individual sport athletes to return to competitive activities (P = .045). Conclusion: A majority (82%) of adolescent patients presenting with FAI syndrome can be managed nonoperatively, with significant improvements in outcome scores at a mean follow-up of 2 years. Clinical Relevance: A nonoperative approach should be the first-line treatment for young active patients with symptomatic FAI syndrome. [ABSTRACT FROM AUTHOR]

Background: Factors relating to the patient and anterior cruciate ligament (ACL) reconstruction may help to identify prognostic factors of long-term outcome after reconstruction. Purpose: To determine 10-year risk factors for inferior knee function after ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Prospectively collected data from the Swedish National Knee Ligament Register were extracted for patients who underwent ACL reconstruction between January 2005 and December 2006. Patients who had no data at the 10-year follow-up for the Knee injury and Osteoarthritis Outcome Score (KOOS) were excluded. Multivariable proportional odds regression modeling was used to assess 10-year patient- and surgery-related risk factors across all the KOOS subscales and the KOOS4 (mean score of 4 subscales: pain, knee-related symptoms, function in sport and recreation, and knee-related quality of life). Results: A total of 874 (41%) patients were included (male, 51.5%; median age at the time of ACL reconstruction, 27.5 years [range, 11.2-61.5 years]). An increase in the severity of concomitant articular cartilage injuries resulted in a reduced KOOS on 4 subscales (odds ratio, 0.64-0.80; P < .05). A higher preoperative KOOS pain score increased the odds of a higher score on the pain, symptoms, and sport subscales and the KOOS4. In addition, a higher preoperative body mass index was a significant risk factor for lower scores on 3 KOOS subscales and the KOOS4. No patient- or surgery-related predictor was significant across all KOOS subscales. Conclusion: This 10-year risk factor analysis identified several factors that can affect long-term knee function after ACL reconstruction. Most risk factors were related to preoperative patient-reported outcome and potentially modifiable. On the other hand, most of the surgery-related risk factors were nonmodifiable. Nevertheless, this information may be helpful to physicians and physical therapists counseling patients on their expectations of outcome after ACL reconstruction. [ABSTRACT FROM AUTHOR]

Epidural analgesia (EA) is one of the methods of choice for labor pain relief, but its adverse effects on the mother and child remain controversial. The objective of this study was to determine whether there is an association between the use of EA and different aspects of labor. The author(s) analyzed the effect of EA on different aspects of labor in a retrospective cohort observational study of deliveries in a public Spanish hospital during a 3-year period. Women with EA administration were found to increase the risk of stimulated labor, reduce the percentage of spontaneous deliveries, increase the risk of instrumental labor due to stalled labor or loss of fetal well-being, and increase the percentage of episiotomies. However, women with EA were not and increased risk for perineal laceration or the condition of the membranes at the delivery or with the type of placental expulsion. Thus, the administration of EA should be assessed in each case by the health care professional. [ABSTRACT FROM AUTHOR]

Background: Previous studies have reported various healing rates (0%-100%) as evaluated by second-look arthroscopy after repair of medial meniscal root tears (MMRTs). Such variable results might provoke suspicion of the necessity for repair. Furthermore, the effect of meniscal healing on the clinical outcomes has not been reported. Purpose: To more precisely determine the healing rate of MMRTs repaired through the transseptal portal, which could provide objective visualization of the healed meniscus, and to identify the effect of meniscal healing on the clinical and radiological outcomes. Study Design: Case series; Level of evidence, 4. Methods: Between June 2010 and April 2015, 56 patients underwent pullout suture for MMRT. Lysholm score, Hospital for Special Surgery score, International Knee Documentation Committee subjective score, medial joint space height, and Kellgren-Lawrence (K-L) grade were evaluated. Thirty-three patients underwent second-look arthroscopy and were divided into a “stable healed group” and “unhealed group” according to their healing status, as evaluated through the transseptal portal. The intraoperative, clinical, and radiological outcomes of the 2 groups were compared. Results: All other clinical outcomes improved. However, medial joint space became significantly narrower (P < .001), and 23 patients (41%) showed K-L grade progression. On the basis of second-look arthroscopy, 23 patients (69.7%) were classified into a stable healed group and 10 (30.3%) into a unhealed group. The stable healed group showed a higher Hospital for Special Surgery score (P = .023), International Knee Documentation Committee subjective score (P = .031), and successful microfracture rate (P = .023), with less progression of medial joint space narrowing (P < .001) and K-L grade (P < .001). Conclusion: Despite degenerative change progression, clinical outcomes were improved. The successful healing rate was 69.7% after repair of MMRTs. Compared with the unhealed group, the stable healed group showed better clinical outcomes and less degenerative change progression. [ABSTRACT FROM AUTHOR]

To examine if the application of Orem’s self-care model could improve self-care knowledge, attitudes, practices, and respiratory conditions of trauma patients with chest tubes, a quasi-experimental study was conducted. The participants were assigned to two groups—namely, Orem’s model and routine care. Although the patients’ self-care knowledge, attitudes, and practices were improved in both groups over the course of 3 days since the initial assessments, there was a greater degree of improvement in the experimental group than that in the control group. However, there were no differences in the improvement of the chest parameters between the two groups. Orem’s model was effective in improving self-care in patients with chest tube. [ABSTRACT FROM AUTHOR]

Background: Historically, outcomes of posterior cruciate ligament (PCL) reconstructions have been less predictable and reported to yield inferior results when compared with those for anterior cruciate ligament (ACL) reconstructions. Purpose: To report on the outcomes of double-bundle PCL reconstructions (DB PCLRs) in isolated versus combined injuries and acute versus chronic PCL reconstructions. To compare the outcomes of isolated DB PCLR with isolated ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who underwent a primary endoscopic DB PCLR for complete PCL tears (grade III) between May 2010 and March 2015 were reviewed. Patient-reported outcome scores (Tegner, Lysholm, WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index], SF-12 [12-item Short Form Health Survey]) and objective posterior stress radiographs were collected preoperatively and at a minimum 2 years postoperatively. A cohort subanalysis was additionally performed between isolated and combined PCL reconstruction and acute versus chronic PCL reconstruction. Patients who underwent isolated ACL reconstructions over the same inclusion period (2010-2015) were selected as a comparison group. Results: One hundred patients who underwent DB PCLR were included in this study. There were 31 isolated PCL injuries, and 69 patients had concurrent combined PCL injuries requiring surgery. The mean follow-up for the PCL cohort was 2.9 years (range, 2-6 years). The median Tegner activity score improved from 2 to 5, Lysholm from 48 to 86, WOMAC from 35.5 to 5, and SF-12 Physical Component Summary from 34 to 54.8 (all P values <.001). The mean side-to-side difference in posterior tibial translation on kneeling stress radiographs improved from 11.0 ± 3.5 mm preoperatively to 1.6 ± 2.0 mm postoperatively (P < .001). There were no differences in postoperative functional scores between isolated PCL reconstructions and PCL-based multiligament reconstructions (all P values >.229). There was no significant difference in the reported outcome scores between acute and chronic reconstructions (all P values >.087) except for Tegner scores (P < .001) and patient satisfaction (P = .011) favoring acutely treated PCL injuries. There were no significant differences between patients who had an isolated DB PCLR and patients who underwent an isolated ACL reconstruction (n = 141) in postoperative outcome scores (all P values >.064). Conclusion: Significantly improved functional and objective outcomes were observed after anatomic DB PCLR at a mean 3 years’ follow-up, with low complication rates, regardless of concomitant ligamentous injury or timing to surgery. Additionally, contrary to previous reports, comparable subjective and functional clinical outcomes were achieved compared with an isolated ACL reconstruction control cohort. [ABSTRACT FROM AUTHOR]

Background: The critical shoulder angle (CSA) is the angle created between the superior and inferior bone margins of the glenoid and the most lateral border of the acromion. A few studies recently investigated the relation between CSA and functional outcomes after rotator cuff repair. However, there is a lack of research investigating the effect of CSA on postoperative tendon integrity after rotator cuff repair. Purpose: To assess the effects of the CSA on postoperative tendon integrity after rotator cuff repair. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who underwent rotator cuff repair for full-thickness supraspinatus tears by 1 senior surgeon between January 2010 and January 2014 were included in this study. All patients had standardized anteroposterior shoulder radiographs the day before surgery. CSA and acromial index (AI) were measured. AI was derived by measuring the distance from the glenoid plane to the lateral border of the acromion and dividing it by the distance from the glenoid plane to the lateral aspect of the humeral head. Functional scores—including American Shoulder and Elbow Surgeons shoulder evaluation form, modified University of California at Los Angeles score, Constant-Murley score, and visual analog scale for pain—were used to evaluate shoulder function at a minimum follow-up of 2 years. Meanwhile, magnetic resonance imaging examinations were performed to evaluate rotator cuff integrity according to the Sugaya method and the signal/noise quotient (SNQ) of the rotator cuff tendon. Results: A total of 90 patients were included in this study: 42 patients with a single-row repair and 48 with a double-row repair. There was a significant positive correlation between CSA or AI and tendon SNQ. On the basis of CSA, the patients were divided into 2 groups: large CSA (>38°) and control (CSA ≤38°). At final follow-up, the large CSA group and the control CSA group demonstrated no significant differences in American Shoulder and Elbow Surgeons, University of California at Los Angeles, Constant, and visual analog scale scores. Postoperative magnetic resonance imaging revealed that the large CSA group had 9 cases of retear, with a significantly higher retear rate than the control group (15% vs 0%, P = .03). Furthermore, the tendon SNQ of the large CSA group was significantly greater than that of the control group. Conclusion: CSA did not appear to influence postoperative functional outcomes, while those in the large CSA group had poor tendon integrity after rotator cuff repair. These findings indicate that a large CSA is associated with an increased risk of rotator cuff tendon retear after repair. [ABSTRACT FROM AUTHOR]

The study aims to explore the effect of positive psychological intervention (fun activities combined with positive mental health education) on the well-being, 2-week illness prevalence, and salivary immunoglobulin A of empty nesters. Ninety-two empty nesters were divided into intervention (n = 49) and control (n = 43) groups. The empty nesters in the intervention group performed the intervention in addition to routine community activities. The intervention group scored significantly higher on well-being (p< .05) compared with the control group after intervention. A week after intervention, salivary immunoglobulin A of the intervention group (p< .05) was higher than that before intervention. Meanwhile, the difference in salivary immunoglobulin A in the control group before and after intervention was not statistically significant. 2-week illness prevalence in both groups did not exhibit a significant difference (p> .05). Results indicate that positive psychological intervention can effectively increase the well-being and salivary immunoglobulin A of empty nesters and improve their physical and mental health. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effects of self-management educational intervention on the symptoms of patients with functional constipation. From January 2014 to April 2015, 66 patients with functional constipation were randomly assigned into intervention group receiving intensive educational interventions and control group receiving routine nursing care. The constipation score of all clinical symptoms (Bristol stool form scale, defecation interval, incomplete evacuation, evacuatory difficulty) at 1 month postdischarge were all significantly lower in the intervention group than in the control group (all, p < .05). At 1 month postdischarge, the intervention group had a significantly higher proportion of patients with good health habits (reasonable diet, regular exercise, good defecation habits, proper use of laxatives) as compared with the control group (all, p < .05). These data suggest educational intervention can effectively improve constipation symptoms and compliance with treatment of patients, and lead to the development of good health habits. [ABSTRACT FROM AUTHOR]

Sexual coercion, especially forced sexual debut, is associated with lifelong adverse health consequences. This is compounded in regions, such as Uganda, where the dual impact of HIV and violence critically shapes women’s sexual health risks. Among a sample of women in HIV serodiscordant relationships, we investigated the prevalence and consequences of forced sexual debut. Data for this analysis come from the Highly Active Antiretroviral Treatment as Prevention (HAARP) Study, a cohort of HIV serodiscordant couples in Jinja, Eastern Uganda, and investigates the role of forced sexual debut on two outcomes: age of sexual debut and having more than three lifetime sexual partners. Bivariate and multivariate linear regressions were used to model age at sexual debut using β and adjusted (A) β and 95% confidence intervals (CIs). Bivariate and multivariate logistic regressions were used to model having more than three lifetime sexual partners and used odds ratios (ORs) and adjusted OR (AOR) and 95% CI. A total of 574 women were included in this analysis, median age 35 years, and 241 (41.99%) were living with HIV. A quarter (24.21%) of women experienced forced sexual debut at the median age of 16 years. Forced sexual debut was significantly associated with earlier age of sexual debut (β = –1.17, 95% CI: [–1.64, –0.68]). Forced sexual debut was significantly associated with having more than three sexual partners (AOR: 1.99, 95% CI: [1.33, 2.99]), in addition to older age (AOR: 1.02, 95% CI: [1.01, 1.05]). Speaking Lusoga, the primary language in Jinja (the study site) was associated with lower odds of having more than three sexual partners (AOR: 0.63, 95% CI: [0.43, 0.92]). Forced sexual debut was a common experience significantly associated with younger age of sexual debut and higher number of lifetime sexual partners. Safe and consensual first sexual experiences for young women play an important role in reducing HIV risk and lay the foundation for healthy and safe sexual health. [ABSTRACT FROM AUTHOR]

Background: The authors have sometimes encountered postoperative new-onset pseudoparalysis (PONP) after arthroscopic repair for large to massive rotator cuff tear (ARCR). As there are insufficient data regarding PONP, the authors aimed to determine whether such a condition is characterized by obvious risk factors, as well as to assess the conditions under which it can be reversed. Purpose: To evaluate the predictors of PONP development after ARCR and its reversal and to integrate these predictors into a scoring system that can be applied in clinical practice. Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively analyzed 430 consecutive ARCRs performed between March 2010 and May 2016. Patients were stratified according to the occurrence of PONP. To determine the risk factors of PONP, the authors compared the PONP and control groups (patients who did not experience PONP) in terms of demographic, clinical, and operative characteristics. Results were expressed in terms of odds ratios (ORs). Results: The incidence of PONP was 6.0% (26 of 430). Predictors of PONP included torn subscapularis (OR, 7.875; 95% CI, 1.780-34.956; P = .007), ≥30-mm retraction of the torn supraspinatus (OR, 4.657; 95% CI, 1.537-14.203; P = .007), age ≥65 years (OR, 3.865; 95% CI, 1.465-10.040; P = .006), and preoperative stiffness (OR, 2.954; 95% CI, 1.212-7.159; P = .017). The reversal rate of PONP was 65.4% (17 of 26), and the mean time to PONP reversal was 10 months. The occurrence and reversal of PONP were not related to retear. Fatty infiltration of the supraspinatus lower than Goutallier grade 3 was the sole predictor of reversal (OR, 22.000; 95% CI, 1.857-260.648; P = .014). Conclusion: Although the incidence of PONP after ARCR was low (6.0%), the risk of PONP was higher in patients with a torn subscapularis, larger supraspinatus tear size, older age, and preoperative stiffness. The mean time from PONP onset to reversal was 10 months, and PONP reversal was affected solely by fatty infiltration of the supraspinatus. Therefore, surgeons should consider the risk for PONP and attempt to identify high-risk patients before rotator cuff repair. [ABSTRACT FROM AUTHOR]

Background: Due to the highly organized tissue and avascular nature of the rotator cuff, rotator cuff tears have limited ability to heal after the tendon is reinserted directly on the greater tubercle of the humerus. Consequently, retears are among the most common complications after rotator cuff repair. Augmentation of rotator cuff repairs with patches has been an active area of research in recent years to reduce retear rate. Hypothesis: Graft augmentation with 3D collagen could prevent retears of the repaired tendon and improve tendon-bone healing in moderate to large rotator cuff tears. Study Design: Randomized controlled study; Level of evidence, 2. Methods: A prospective, randomized controlled study was performed in a consecutive series of 112 patients age 50 to 85 years who underwent rotator cuff repair with the suture-bridge technique (58 patients, control group) or the suture-bridge technique augmented with 3-dimensional (3D) collagen (54 patients, study group). All patients were followed for 28.2 months (range, 24- 36 months). Visual analog scale score for pain, University of California Los Angeles (UCLA) shoulder score, and Constant score were determined. Magnetic resonance imaging was performed pre- and postoperatively (at a minimum of 24 months) to evaluate the integrity of the rotator cuff and the retear rate of the repaired tendon. Three patients in each group had biopsies at nearly 24 months after surgery with histological assessment and transmission electron microscopy. Results: A total of 104 patients completed the final follow-up. At the 12-month follow-up, the UCLA shoulder score was 28.1 6 1.9 in the study group, which was significantly better than that in the control group (26.9 6 2.1, P = .002). The Constant score was also significantly better in the study group (87.1 ± 3.2) than in the control group (84.9 6 4.2, P = .003). However, at the final followup, no significant differences were found in the UCLA shoulder scores (29.4 ± 1.9 in the control group and 30.0 ± 1.6 in the study group, P = .052) or Constant scores (89.9 ± 3.2 in the control group and 90.8 ± 3.5 in the study group, P = .18). In terms of structural integrity, more patients in the study group had a favorable type I retear grade (18/51) than in the control group (10/53) (P = .06). The postoperative retear rate was 34.0% in the control group and 13.7% in the study group, thus indicating a significantly lower retear rate in the study group (P = .02). Biopsy specimens of the tendon-bone interface in 6 patients revealed more bone formation and more aligned fibers with larger diameters in the study group than in the control group. No intraoperative or postoperative complications were noted in either group. Conclusion: 3D collagen augmentation could provide effective treatment of moderate to large rotator cuff tears, providing substantial functional improvement, and could reduce the retear rate. This technique could also promote new tendon-bone formation, thus exerting a prominent effect on tendon-bone healing. [ABSTRACT FROM AUTHOR]

Background: Inaccurate disclosures of physician and industry relationships in scientific reporting may create an asymmetry of information by hiding potential biases. The accuracy of conflict of interest disclosure in sports medicine research is unknown. Purpose: To compare author financial disclosures in published articles in 2016 in the American Journal of Sports Medicine (AJSM) with the Centers for Medicare and Medicaid Services’ Open Payments Database (OPD) to determine the percentage of payments values and percentage of eligible authors with discrepancies. Study Design: Cross-sectional study; no level of evidence (nonclinical). Methods: All articles published in 2016 in AJSM were screened to identify eligible authors. On the basis of OPD reporting, physician authors affiliated with a US institution were included. Stated disclosures in AJSM publications for these authors were identified and compared with industry-reported payments on OPD. Results: A total of 434 authors were included in this study. Mean and median total payments per author per year were $76,941 and $1692, respectively. The most commonly received payment was for food and beverage (81.3% of authors), followed by travel and lodging (45.4%) and consulting (31.8%). Authors with higher total payments were less likely to be discrepant in their reporting—notably, authors earning >$500,000 had 16.1% of payment values with discrepancy, as opposed to 85.3% for those earning <$10,000 (P < .001). First authors had a lower percentage of payment values with discrepancy (13.8%) versus middle authors (31.9%, P = .001). Finally, men had a lower percentage of payment values with discrepancy (418 authors, 22.3% of payment values with discrepancy) as compared with women (16 authors, 95.3%; P < .001). Regarding industry payments specifically requested on the AJSM disclosure form for authors (royalties, consulting, research payments, and ownership and investments), only 25.3% of authors had a discrepancy in these payment categories in aggregate. Conclusion: Discrepancies exist between disclosures reported by authors publishing in AJSM and what is reported in the OPD. Authors receiving lower total payments, middle authors, and women are more likely to have disclosure discrepancies. Additionally, industry research funding support and ownership interest are most likely to go unreported. However, this study did not assess whether authors with industry payments preferentially published studies pertaining to products from companies from which they received funding. As national registries such as the OPD are increasingly utilized, physicians may benefit from referencing such databases before submitting conflict of interest disclosures. [ABSTRACT FROM AUTHOR]

Background: Cartilage repair algorithms use lesion size to choose surgical techniques when selecting a cartilage repair procedure. The association of fresh osteochondral allograft (OCA) size with graft survivorship and subjective patient outcomes is still unknown. Purpose: To determine if lesion size (absolute or relative) affects outcomes after OCA transplantation. Study Design: Cohort study; Level of evidence, 3. Methods: The study included 156 knees in 143 patients who underwent OCA transplantation from 1998 to 2014 for isolated femoral condyle lesions. The mean age was 29.6 ± 11.4 years, and 62.9% were male. The majority of patients (62.2%) presented for cartilage repair because of osteochondritis dissecans. The mean graft area, used as a surrogate for absolute size of the lesion, was 6.4 cm2 (range, 2.3-11.5 cm2). The relative size of the lesion was calculated as the tibial width ratio (TWR; ratio of graft area to tibial width) and affected femoral condyle ratio (AFCR; ratio of graft area to affected femoral condyle width) using preoperative radiographs. All patients had a minimum follow-up of 2 years. Further surgical procedures were documented, and graft failure was defined as revision OCA transplantation or conversion to arthroplasty. International Knee Documentation Committee (IKDC) pain, function, and total scores were obtained. Satisfaction with OCA transplantation was assessed. Results: The mean follow-up among patients with grafts remaining in situ was 6.0 years (range, 1.9-16.5 years). The OCA failure rate was 5.8%. Overall survivorship of the graft was 97.2% at 5 years and 93.5% at 10 years. No difference in postoperative outcomes between groups was found in absolute or relative size. Change in IKDC scores (from preoperative to latest follow-up) was greater for knees with large lesions compared to knees with small lesions, among all measurement methods. Overall satisfaction with the results of OCA transplantation was 89.8%. Conclusion: The size of the lesion, either absolute or relative, does not influence outcomes after OCA transplantation for isolated femoral condyle lesions of the knee. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the use of active controlled motion (ACM) after unstable ankle fractures needing initial partial weight-bearing. Design: Prospective randomized controlled trial. Setting: Inpatient and outpatient clinic. Subjects: A total of 50 patients with unstable ankle fractures and the need for partial weight-bearing for six weeks. Interventions: Randomization in two groups: physiotherapy alone or physiotherapy with an additional ACM device. Main measures: Follow-up after 6 and 12 weeks. Range of motion, visual analogue scale for foot and ankle (VAS FA), Philip score, Mazur score, American Orthopaedic Foot & Ankle Society (AOFAS) score and dynamic pedobarography. Results: Range of motion was better in the ACM group at six weeks (mean 49° ± 11.1° vs. 41.3° ± 8.1°). Questionnaires revealed better outcome after six weeks in the VAS FA (56 ± 13.7 vs. 40.6 ± 10.5), Mazur score (64.4 ± 12.3 vs. 56.7 ± 11) and AOFAS score (71.2 ± 12 vs. 63.6 ± 8.7) (P > 0.02 for all). Better outcome after 12 weeks in all questionnaires (VAS FA, 77.7 ± 13.8 vs. 61.4 ± 16.3; Philip score, 79.1 ± 10.9 vs. 60.1 ± 21.7; Mazur score, 83.9 ± 10.7 vs. 73.1 ± 14.1; AOFAS score, 87.5 ± 7.9 vs. 75.2 ± 11.7) (P < 0.01 for all). Pressure balance was better under the midfoot region after 12 weeks in the ACM group (P 4.4 N vs. 34.0 N; P = 0.01). The ACM group had an earlier return to work after 10.5 (range, 3-17) versus 14.7 (range, 9-26) weeks (P = 0.02). Conclusion: The use of ACM for patients needing initial partial weight-bearing after operatively treated unstable ankle fractures in the first six postoperative weeks leads to better clinical and functional results and an earlier return to work. [ABSTRACT FROM AUTHOR]

Background: Although image analysis has shown that the outside-in (OI) technique is associated with different femoral tunnel geometry than the transportal (TP) technique in anatomic anterior cruciate ligament (ACL) reconstruction, it is not known whether clinical results differ between the 2 techniques. Purpose: To compare clinical results, second-look arthroscopic findings, and magnetic resonance imaging (MRI) findings between the TP and OI techniques in anatomic double-bundle (DB) ACL reconstruction. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: From November 2010 to March 2013, 128 patients were enrolled in this study and were randomly assigned to either the TP group (64 patients) or the OI group (64 patients), and DB ACL reconstructions were performed. At the minimum 2-year follow-up (34.9 ± 10.9 months), 111 patients (86.7%) were evaluated with multiple clinical scores and stability tests (KT-2000 arthrometer, Lachman test, and pivot-shift test). Ninety-three knees were evaluated for graft continuity, graft tension, and synovialization by use of second-look arthroscopy. Seventy-eight knees were evaluated on MRI for graft continuity, femoral graft tunnel healing, and graft signal/noise quotient (SNQ). The primary outcome was KT-2000 arthrometer results. Results were compared between the TP and OI groups. Results: No significant differences were found between the 2 groups in terms of KT-2000 arthrometer results, which was the primary outcome, and other clinical results, with the exception of the postoperative functional test of International Knee Documentation Committee (IKDC) objective score. The ratio of grade A and B on the postoperative functional test of IKDC objective score was significantly larger for the OI group (51/58) than the TP group (36/53) (P = .005). The second-look arthroscopic findings were not significantly different between the 2 groups in either bundle (P > .05). In addition, MRI findings did not differ significantly between the 2 groups (P > .05). Conclusion: With the exception of the functional test of IKDC objective score, we found that clinical results, second-look arthroscopic findings, and MRI findings did not differ significantly between the OI and TP techniques for anatomic ACL reconstruction, although femoral tunnel geometries differed significantly between the 2 techniques. [ABSTRACT FROM AUTHOR]

Background: Osteochondral allograft transplantation (OCA) is often performed with concomitant meniscus allograft transplantation (MAT) as a strategy for knee joint preservation, although to date, the effect of concomitant MAT on outcomes and failure rates after OCA has not been assessed. Purpose: To determine clinical outcomes for patients undergoing OCA with MAT as compared with a matched cohort of patients undergoing isolated OCA. Study Design: Control study; Level of evidence, 3. Methods: Patients who underwent OCA of the medial or lateral femoral condyle without concomitant MAT by a single surgeon were compared with a matched group of patients who underwent OCA with concomitant MAT (ipsilateral compartment). The patients were matched per age, sex, body mass index, and number of previous ipsilateral knee operations ±1. Patient-reported outcomes, complications, reoperations, and survival rates were compared between groups. Results: One hundred patients undergoing OCA (50 isolated, 50 with MAT) with a mean ± SD follow-up of 4.9 ± 2.7 years (minimum, 2 years) were included (age, 31.7 ± 9.8 years; 52% male). Significantly more patients underwent OCA to the medial femoral condyle (n = 59) than the lateral femoral condyle (n = 41, P < .0001). Patients underwent 2.7 ± 1.7 operations on the ipsilateral knee before OCA. There were no significant differences between the groups regarding reoperation rate (n = 18 for OCA with MAT, n = 17 for OCA without MAT, P = .834), time to reoperation (2.2 ± 2.4 years for OCA with MAT, 3.4 ± 2.7 years for OCA without MAT, P = .149), or failure rates (n = 7 [14%] for OCA with MAT, n = 7 [14%] for OCA without MAT, P > .999). There were no significant differences in patient-reported clinical outcome scores between the groups at final follow-up. There was no significant difference in failure rates between patients undergoing medial femoral condyle OCA (n = 12, 15.3%) and lateral femoral condyle OCA (n = 5, 12.2%, P = .665). Conclusion: These results imply that with appropriate surgical indications to address meniscus deficiency in patients otherwise indicated for OCA and despite the added surgical time and complexity of concomitant MAT, outcomes are favorable, with an 86% OCA graft survivorship at 5 years. This information can be used to counsel patients undergoing OCA with concomitant MAT as part of a knee joint preservation strategy. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is a significant problem for patients with lower extremity injuries. While pain hypersensitivity has been identified in many chronic pain conditions, it is not known whether patients with chronic pain following lower extremity fracture report pain hypersensitivity in the injured leg. Purpose: To quantify and compare peripheral somatosensory function and sensory nerve activation thresholds in persons with chronic pain following lower extremity fractures with a cohort of persons with no history of lower extremity fractures. Method: This was a cross-sectional study where quantitative sensory testing and current perception threshold testing were conducted on the injured and noninjured legs of cases and both legs of controls. Results: A total of 14 cases and 28 controls participated in the study. Mean time since injury at the time of testing for cases was 22.3 (standard deviation = 12.1) months. The warmth detection threshold (p = .024) and nerve activation thresholds at 2,000 Hz (p < .001) and 250 Hz (p = .002), respectively, were significantly higher in cases compared to controls. Conclusion: This study suggests that patients with chronic pain following lower extremity fractures may experience hypoesthesia in the injured leg, which contrasts with the finding of hyperesthesia previously observed in other chronic pain conditions but is in accord with patients with nerve injuries and surgeries. This is the first study to examine peripheral sensory nerve function at the site of injury in patients with chronic pain following lower extremity fractures using quantitative sensory testing and current perception threshold testing. [ABSTRACT FROM AUTHOR]

Background: Borderline developmental dysplasia of the hip (BDDH) is frequently diagnosed concurrently with cam impingement. While hip arthroscopy has advanced the treatment of hip joint pathology, including femoroacetabular impingement (FAI), arthroscopic treatment for FAI in the setting of BDDH remains a challenge amid a subset of patients. The risk factors of poor clinical results after hip arthroscopic labral preservation and FAI corrections in the setting of BDDH patients have not been well established. Hypothesis: Pre- and intraoperative findings can predict the poor clinical outcomes after hip arthroscopic surgery for FAI in the setting of BDDH. Study Design: Case control study; Level of evidence, 3. Methods: Of patients with BDDH (defined as lateral center edge [LCE] angle between 20° and 25°) who underwent arthroscopic procedures for FAI between 2009 and 2014, 45 met inclusion criteria (45 hips: 15 males and 30 females). Their mean age was 31.4 years (range, 12-65 years), and the mean LCE angle was 23.2°. Clinical and radiographic follow-up evaluations up to a minimum of 2 years after surgery were performed for all patients. Failure of the procedure was defined as conversion to subsequent surgery or having a Tönnis osteoarthritis grade of 2, and success was defined as patients who did not need subsequent surgery. Univariate analysis and Cox hazard proportional analysis were performed for both cohorts. Results: Of 45 patients, 11 (24%) had revision surgery (endoscopic shelf acetabuloplasty for 5 patients, total hip arthroplasty for 2, and revision hip arthroscopy for 2) or advanced to Tönnis grade ≥2 osteoarthritis and thus constituted the failure group. In the success group, modified Harris Hip Score (median, pre- vs postoperative: 72.1 vs 100, P< .001, Wilcoxon signed-rank test) and nonarthritic hip score (58.8 vs 98.8, P< .001) were significantly improved at the minimum 2-year follow-up. The median age of the failure group was significantly higher than that of the success group (47.0 vs 20.0, P< .001, Mann-Whitney Utest). Risk factors of poor clinical outcomes were identified as follows: age ≥42 years (hazard ratio [HR], 11.6; 95% CI, 2.5-53.9; P= .002, Cox hazard model), broken Shenton line (HR, 6.4; 95% CI, 1.9-22.3; P= .003), Tönnis angle ≥15° (HR, 3.9; 95% CI, 1.2-12.9; P= .03), vertical center anterior (VCA) angle ≤17° (HR, 5.0; 95% CI, 1.5-17.1; P= .01), Tönnis grade 1 at preoperative radiograph (HR, 3.6; 95% CI, 1.1-11.7; P= .04), severe cartilage delamination at acetabulum (HR, 11.8; 95% CI, 3.0-46.1; P< .001), and mild cartilage damage at femoral head (HR, 8.1; 95% CI, 2.1-30.8; P= .002). Conclusion: Preoperative predictors of poorer outcomes from hip arthroscopic labral preservation, capsular plication, and cam osteoplasty in the setting of BDDH are age ≥42 years old, broken Shenton line, osteoarthritis, Tönnis angle ≥15°, and VCA angle ≤17° on preoperative radiographs. Intraoperative predictors of poorer outcomes are severe acetabular chondral damage and even mild femoral chondral damage. Although the patients in the setting of BDDH may have good outcomes from isolated hip arthroscopy, caution is suggested for those with the aforementioned risk factors. [ABSTRACT FROM AUTHOR]

Background: The effect of patient age or sex on outcomes after osteochondral allograft transplantation (OCA) has not been assessed. Purpose: To determine clinical outcomes for male and female patients aged ≥40 years undergoing OCA compared with a group of patients aged <40 years. Study Design: Cohort study; Level of evidence, 3. Methods: A review of prospectively collected data of consecutive patients who underwent OCA by a single surgeon with a minimum follow-up of 2 years was conducted. The reoperation rate, failure rate, and patient-reported outcome scores were reviewed. All outcomes were compared between patients aged <40 or ≥40 years, with subgroup analyses conducted based on patient sex. Failure was defined as revision OCA, conversion to knee arthroplasty, or gross appearance of graft failure at second-look arthroscopic surgery. Descriptive statistics, Fisher exact or chi-square testing, and Mann-Whitney U testing were performed, with P < .05 set as significant. Results: A total of 170 patients (of 212 eligible patients; 80.2% follow-up) who underwent OCA with a mean follow-up of 5.0 ± 2.7 years (range, 2.0-15.1 years) were included, with 115 patients aged <40 years (mean age, 27.6 ± 7.3 years; 58 male, 57 female) and 55 patients aged ≥40 years (mean age, 44.9 ± 4.0 years; 33 male, 22 female). There were no differences in the number of pre-OCA procedures between the groups (P = .085). There were no differences in the reoperation rate (<40 years: 38%; ≥40 years: 36%; P = .867), time to reoperation (<40 years: 2.12 ± 1.90 years; ≥40 years: 3.43 ± 3.43 years; P = .126), or failure rate (<40 years: 13%; ≥40 years: 16%; P = .639) between the older and younger groups. Patients in both groups demonstrated significant improvement in Lysholm (both: P < .001), International Knee Documentation Committee (IKDC) (both: P < .001), Knee Injury and Osteoarthritis Outcome Score (KOOS) (both: P < .001), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (both: P < .001), and Short Form–12 (SF-12) physical (both: P < .001) scores compared with preoperative values. Patients aged ≥40 years demonstrated significantly higher KOOS symptom (P = .015) subscores compared with patients aged <40 years. There were no significant differences in the number of complications, outcome scores, or time to failure between the sexes. In patients aged <40 years, female patients experienced failure significantly more quickly than male patients (P = .039). In contrast, in patients aged ≥40 years, male patients experienced failure significantly more quickly than female patients (P = .046). Conclusion: This study provides evidence that OCA is a safe and reliable treatment option for osteochondral defects in patients aged ≥40 years. Male and female patients had similar outcomes. Patients aged <40 years demonstrated lower KOOS symptom subscores postoperatively compared with older patients, potentially attributable to higher expectations of return to function postoperatively as compared with older patients. [ABSTRACT FROM AUTHOR]

The psychosocial effects of web-based information have yet to be tested for patients joining a fast-track total hip arthroplasty programme. This study compared and evaluated the psychosocial impact of standard total hip arthroplasty programme, with and without supplementation with a web-based information platform (E-total hip arthroplasty programme). Totally, 299 patients were enrolled in an un-controlled, before-and-after study, 117 in the S-total hip arthroplasty programme group and 182 in the E-total hip arthroplasty programme group. Psychosocial outcomes before and during admission and then 3 months post-surgery were evaluated, with analyses conducted between and within groups. All outcomes improved significantly from pre-admission to 3 months post-surgery, with no between-group differences. In all, 112 of the 182 E-total hip arthroplasty programme patients accessed the learning platform. A subgroup analysis showed no significant differences between users and non-users, either at baseline or in terms of outcome. This study found no positive psychosocial effect between groups, but a significant effect within groups. [ABSTRACT FROM AUTHOR]

Objective: To study the six-month clinical effects of providing ankle-foot orthoses at different moments (early or delayed) in (sub)acute stroke; this is a follow-up to a published trial. Design: Randomized controlled trial. Setting: Rehabilitation centre. Subjects: Unilateral hemiparetic stroke subjects maximal six weeks post-stroke with indication for ankle-foot orthosis use. Interventions: Subjects were randomly assigned to early (at inclusion; week 1) or delayed provision (eight weeks later; week 9). Outcome measures: Functional tests assessing balance and mobility were performed bi-weekly for 17 weeks and at week 26. Results: In all, 33 subjects were randomized. No differences at week 26 were found between both groups for any of the outcome measures. However, results suggest that early provision leads to better outcomes in the first 11–13 weeks. Berg Balance Scale (P = 0.006), Functional Ambulation Categories (P = 0.033) and 6-minute walk test (P < 0.001) showed significantly different patterns over time. Clinically relevant but statistically non-significant differences of 4–10 weeks in reaching independent walking with higher balance levels were found, favouring early provision. Conclusion: No six-month differences in functional outcomes of providing ankle-foot orthoses at different moments in the early rehabilitation after stroke were found. Results suggest that there is a period of 11–13 weeks in which early provision may be beneficial, possibly resulting in early independent and safe walking. However, our study was underpowered. Further research including larger numbers of subjects is warranted. [ABSTRACT FROM AUTHOR]

Background: Femoroacetabular impingement (FAI) can lead to hip pain and early joint degeneration. There have been few reports to date on the outcomes of hip arthroscopy for the treatment of FAI in the military population. Purpose/Hypothesis: The purpose of this study was to compare patient demographics with postoperative outcomes after hip arthroscopy for symptomatic FAI and to identify preoperative risk factors for poor outcomes. The hypothesis was that certain preoperative patient characteristics will be predictive of poorer outcomes and that lower outcomes scores will be associated with a higher likelihood of medical separation from the military. Study Design: Case series; Level of evidence, 4. Methods: Retrospective chart review of active-duty and dependent patients older than 18 years who underwent hip arthroscopy for symptomatic FAI from 2009 to 2014 at a single institution. Results: A total of 469 (309 males and 160 females) surgeries were performed on 456 active-duty personnel and 13 dependent civilians, with a mean 2.5-year follow-up. Overall, 39% (n = 179) were able to return to duty (RTD), 18% (n = 82) were medically cleared to return to normal daily activities but did not remain on active duty, and 43% (n = 195) required referral to the Disability Evaluation System (DES). Increasing rank and male sex were positive predictors and Axis 1 psychiatric diagnosis, revision surgery, concomitant psoas tenotomy, multiple medical comorbidities, and complaints of generalized pelvic pain were negative predictors for returning to duty. US Marine Infantry and Special Forces showed improved RTD rates (50%-86%) compared with administrative, more sedentary, occupations (22%). On average, Single Alpha Numeric Evaluation (SANE) and visual analog scale (VAS) scores improved after surgery, with SANE scores improving 37 ± 28 points and VAS scores improving 2.6 ± 2.5 points. The mean postoperative SANE and VAS scores differed significantly between the RTD group and those not returning to duty; 87 and 1.2 points compared with 69 and 3.6 points, respectively (P < .0001). Conclusion: Hip arthroscopy for the treatment of symptomatic FAI effectively improves pain symptoms and self-reported overall function but shows a much lower than expected return to full, unrestricted active duty in the general active-duty military population. Underlying psychiatric diagnoses, female sex, and more sedentary occupations are associated with lower RTD rates. Furthermore, lower postoperative SANE and VAS scores are associated with lower RTD rates. Only the more active and elite components of the military study population showed RTD rates consistent with previously reported outcomes of return to competitive sports after hip arthroscopy for FAI. [ABSTRACT FROM AUTHOR]

Background: Distal biceps brachii tendon ruptures lead to substantial deficits in elbow flexion and supination; surgical repair restores muscle strength and endurance. Purpose: To examine clinical and surgical outcomes for distal biceps tendon repairs in a large, multispecialty, integrated health care system. Study Design: Cohort study; Level of evidence, 3. Methods: Retrospective cohort study of distal biceps tendon repairs performed between January 1, 2008, and December 31, 2015. The repair methods were classified as double-incision approach using bone tunnel–suture fixation or anterior single-incision approach. Anterior single incisions were further classified according to the fixation method: cortical button alone, cortical button and interference screw, or suture anchors alone. Patient demographics, surgeon characteristics, range of motion, and complications were analyzed for all repair types. Results: Of the 784 repairs that met the inclusion criteria, 639 (81.5%) were single-incision approaches. When comparing double-incision and single-incision repairs, there was a significantly higher rate of posterior interosseous nerve palsy (3.4% vs 0.8%, P = .010), heterotopic bone formation (7.6% vs 2.7%, P = .004), and reoperation (8.3% vs 2.3%, P < .001). The most common nerve complication encountered was a lateral antebrachial cutaneous nerve palsy (n = 162), which was significantly more common in the single-incision repairs than in the double-incision repairs (24.4% vs 4.1%, P < .001). When excluding lateral antebrachial cutaneous nerve palsies, there was no significant difference in the overall nerve palsies between single-incision and double-incision (5.8% vs 6.9%, P = .612). The overall rate of tendon rerupture was 1.9% (single incision, 1.6%; double incision, 2.8%; P = .327). The overall rate of postoperative wound infection was 1.5% (single incision, 1.3%; double incision, 2.8%; P = .182). The average time from surgery to release from medical care was 14.4 weeks (single incision, 14 weeks; double incision, 16 weeks; P = .286). Patients treated with cortical button plus interference screw were released significantly sooner than were patients with other single-incision repair types (13.1 ± 8.01 weeks, P = .011). There were no significant differences in rates of motor neurapraxia, infection, rerupture, and reoperation with regard to surgeon’s years of practice, fellowship training, or case volume. Conclusion: The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, the double-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and reoperation rate. Surgeon’s years of practice, fellowship training, and case volume do not affect the rate of major complications. [ABSTRACT FROM AUTHOR]