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Category: Ankle; Sports Introduction/Purpose: Peroneal tendon injury is a common sequela of recurrent lateral ankle instability. Surgical repair of the peroneal tendons can be performed in isolation or concomitantly with a retrofibular groove deepening procedure. Although some prior studies with limited follow-up have suggested a potential return-to-sport benefit associated with groove deepening, no previous study has evaluated the impact of retrofibular groove deepening on long-term reoperation rates. The purpose of this investigation was to compare reoperation rates among patients who underwent peroneal tendon repair with groove deepening versus without groove deepening. Methods: A large, nationwide insurance database was retrospectively reviewed to identify all patients who underwent peroneal tendon repair with and without retrofibular groove deepening and from 2010 and 2019. Patients who underwent peroneal tendon repair without groove deepening were matched to patients who underwent repair with groove deepening using a propensity scoring algorithm. The rates of reoperation including revision peroneal tendon repair as well as progression to ankle arthrodesis and total ankle arthroplasty (TAA) were compared between groups. Results: Patients who underwent peroneal tendon repair without groove deepening had a significantly higher risk (OR: 16.20; p < 0.001) of requiring a revision peroneal tendon procedure within two years postoperatively. However, there was no difference between groups with regard to the comparative risk of subsequent TAA and ankle arthrodesis within ten years (p > 0.05). Conclusion: Patients who underwent peroneal tendon repair without retrofibular groove deepening were over 15 times more likely to require revision peroneal tendon surgery compared to their propensity-matched counterparts who underwent groove deepening at the time of the index peroneal tendon repair. Whereas surgeons commonly reserve the groove deepening procedure for patients with a convex retrofibular morphology, the results of this study suggest that the indications for groove deepening may be expanded to reduce the risk of reoperation following peroneal tendon repair.

Category: Ankle; Sports Introduction/Purpose: Lateral ankle ligament stabilization is indicated for patients with chronic ankle instability that persists despite nonoperative management. The purpose of this investigation was to compare reoperation rates in patients who underwent a primary repair versus those who underwent a secondary reconstruction of the lateral ankle ligaments. Methods: A large, nationwide insurance database was retrospectively reviewed to identify all patients who underwent isolated primary repair and/or secondary reconstruction of the lateral ankle ligamentous complex from 2010 and 2019. Patients who underwent primary repair were matched using a propensity-scoring algorithm to patients who underwent secondary lateral ankle reconstruction. Reoperation rates including ankle arthroscopy and revision lateral ankle ligament repair/reconstruction were compared between groups at two years postoperatively. Complication rates within 90 days postoperatively were also evaluated and compared between groups. Results: 41,452 patients who underwent primary lateral ankle ligament repair were matched to 41,452 patients who underwent secondary reconstruction. Patients who underwent primary repair had an increased risk of undergoing a subsequent ankle arthroscopy (OR: 1.15; p < 0.001) or revision stabilization procedure (OR: 1.30; p < 0.001) within two years postoperatively. Moreover, the risks of sustaining complications such as wound dehiscence (OR 1.34; p < 0.001) or surgical site infection (OR 1.43; p = 0.008) within 90 days were higher for the primary ligament repair group compared to the secondary reconstruction group. Conclusion: Patients who underwent primary lateral ankle ligament repair were more likely to require subsequent ankle arthroscopy or revision ankle stabilization within two years postoperatively, compared to those who underwent secondary reconstruction of the lateral ankle ligament complex. Although secondary reconstruction procedures (e.g. Watson-Jones, Colville) are conventionally utilized in the revision setting, surgeons may consider expanding the indications for reconstruction to the primary setting, particularly in surgical candidates who are identified preoperatively as high-risk for recurrent instability.

Category: Trauma; Sports Introduction/Purpose: Disruption of the distal tibiofibular syndesmosis can occur concomitantly with ankle fracture or as an isolated soft tissue injury. Although syndesmotic fixation is effective in providing stability to the distal tibiofibular joint, biomechanical studies suggest that over-reduction of the syndesmosis may increase ankle contact pressures and potentially accelerate tibiotalar joint degeneration in the longer term. The purpose of this investigation was to evaluate reoperation rates in patients with isolated syndesmotic disruption who underwent fixation versus those who were managed nonoperatively. Methods: A large, nationwide insurance database was retrospectively reviewed to identify all patients who were diagnosed with an isolated distal tibiofibular syndesmotic injury (without concomitant fracture) between 2010 and 2019. Patients who underwent surgical stabilization were matched using a propensity scoring algorithm to patients who were managed nonoperatively. The rates of reoperation including subsequent ankle arthroscopy, ankle arthrodesis, and total ankle arthroplasty (TAA) were compared between groups. Results: 24,758 patients who underwent operative stabilization were matched to 24,758 patients who underwent nonoperative management for syndesmotic injury. Patients who underwent surgical stabilization had an increased risk of ankle arthrodesis (4.04; p< 0.001) and TAA (OR 3.11; p< 0.001) within ten years compared to patients managed nonoperatively. There was no difference between groups with regard to the comparative risk of subsequent ankle arthroscopy within five years. Conclusion: Patients with isolated syndesmotic injury who underwent operative stabilization were more likely to require an ankle arthrodesis or total ankle arthroplasty within 10 years compared to those who were managed nonoperatively. These findings in a large, propensity-matched cohort suggest that surgeons should consider the implications of syndesmotic over-reduction when managing these injuries intraoperatively. Moreover, surgeons may incorporate these data into the decision making process when counseling patients regarding the expected outcomes of operative and nonoperative management for syndesmotic injury.

Background: The split anconeus fascia transfer (SAFT) is an option for reconstruction of the lateral ulnar collateral ligament (LUCL) in chronic posterolateral rotatory instability (PLRI) of the elbow with potential advantages of using only local tissue within the surgical exposure and not requiring ulnar fixation. This study aimed to assess SAFT strength compared to a traditional free graft reconstruction in a PLRI biomechanical model. Methods: To measure biomechanical strength, eight cadaveric upper extremity pairs were utilized. Within each pair, one specimen was randomly assigned to LUCL reconstruction with autograft palmaris longus and the other to SAFT reconstruction. Torque load to failure was assessed on a load frame with the elbow in 30 degrees of flexion, 5 degrees of valgus, and 25 N axial load as the elbow was brought into external rotation. Torque load to failure was compared between the two reconstruction techniques. Results: No difference was found in the torque load to failure between SAFT specimens compared to palmaris longus autograft specimens (mean 14.6 ± 4.4 Nm vs. mean 11.3 ± 3.9 Nm; P = .16). Discussion: In this biomechanical study, the SAFT LUCL reconstruction provided torque load to failure similar to that of the traditional technique. These findings suggest that the SAFT technique warrants continued study as a biomechanically sound option for LUCL reconstruction in the setting of elbow PLRI.

Category: Hindfoot; Basic Sciences/Biologics Introduction/Purpose: Primary repair of mid-substance Achilles tendon rupture may be performed using an open or a percutaneous technique. Previous meta-analyses of clinical data comparing the two techniques have demonstrated mostly equivalent functional outcomes and re-rupture rates. Individual cadaveric studies have also compared the biomechanical properties of the two approaches. However, the results of these studies have been heterogeneous, and there is currently no consensus as to whether one technique may be biomechanically superior. The purpose of this meta-analysis was to evaluate the biomechanical properties of open versus percutaneous Achilles tendon repair. Methods: A systematic review of original research articles was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. To qualify for study inclusion, articles were required to be published in English, utilized a cadaveric laboratory design, and had to directly compare the biomechanical properties of open Achilles repair using a Krackow or Kessler technique versus percutaneous repair using either the PARS (Arthrex) or Achillon (Integra) tendon repair systems. Evaluated outcomes included displacement (mm), load to failure (N), and stiffness (N/m). Results: Nine studies met inclusion criteria, including 190 cadaveric specimens (open: 83, PARS: 56; Achillon: 51) that underwent primary mid-substance Achilles tendon repair. Pooled analysis demonstrated no statistically significant difference in displacement (p = 0.418; Figure 1), load to failure (p = 0.923; Figure 2), or stiffness (p = 0.195; Figure 3) between the open and percutaneous techniques. Among the percutaneous approaches, there was no difference in displacement (p = 0.109; Figure 4) between the PARS and Achillon tendon repair systems. Conclusion: The results of this study suggest that both open and percutaneous techniques are biomechanically viable approaches for primary mid-substance Achilles tendon repair. These biomechanical findings must be interpreted in the context of clinical outcomes data as well as the differing complication profiles of the two techniques to best inform the surgical decision-making process for primary mid-substance Achilles tendon repair.

Purpose: To report the clinical outcomes of quadriceps tendon repair using adjustable cortical fixation devices at a minimum 2-year follow-up. Methods: A retrospective chart review identified patients who underwent quadriceps tendon repair using adjustable cortical fixation devices between January 2017 and March 2020. Patients with a partial tendon rupture were excluded. Demographic and injury-specific variables were gathered preoperatively and postoperatively from the electronic medical record and patient-reported outcomes (Lysholm Knee Questionnaire, Lower Extremity Functional Scale, and SF-12) were collected via telephone at a minimum of 2 years postoperatively. Results: Fourteen quadriceps tendon repairs were included in a total of 13 patients. The average time to follow-up was 3.5 ± 1.2 years with a range of 1.9 to 5.7 years. The mean age of this cohort was 55.7 ± 11.6 years, and the mean body mass index was 32.9 ± 6.0. Ten injuries (71.4%) were sustained by mechanical fall, 2 patients (14.3%) suffered a direct blow to the knee, and 2 patients (14.3%) reported a noncontact injury mechanism. Thirteen quadriceps ruptures (13/14, 92.9%) underwent surgery within 10 days of their injury. One knee (7.1%) had a postoperative extensor lag of 5°, whereas another knee (7.1%) required a reoperation for manipulation under anesthesia and arthroscopic lysis of adhesions at 3 months’ postoperatively. None of the included patients (0.0%) developed a tendon re-rupture, venous thromboembolism, delayed wound healing, surgical-site infection, neuropraxia or nerve injury, hardware irritation, patella fracture, or heterotopic ossification. Conclusions: In this study, adjustable cortical fixation was a safe and effective surgical technique for quadriceps tendon repair, with adequate restoration of quadriceps function and a low rate of adverse events at 2 years postoperatively. Level of Evidence: Level IV, therapeutic case series.

The purpose of this study was to use the Altmetric Attention Score to determine the 50 most impactful medial ulnar collateral ligament articles in online media and compare their characteristics to the most-cited medial ulnar collateral ligament articles in the scientific literature. The Altmetric database was queried to identify all published articles about the medial ulnar collateral ligament, and this list was stratified by the Altmetric Attention Score to identify the 50 highest scoring articles. Several data elements were extracted, including article topic, article type, journal name, and the number of online mentions on Facebook, Twitter, news, and other platforms. Each article’s geographic origin was determined based on the institutional affiliation of the first author. Our index search yielded 1283 articles published between 1987 and 2020, from which the 50 articles with the highest Altmetric Attention Scores were included for analysis. Altmetric Attention Scores of the top 50 medial ulnar collateral ligament articles ranged from 20 to 482 (median: 32, interquartile range: 20–62). The most common article type was original research (72%), and the most common topic was epidemiology/risk factors (26%). A majority of studies were Level 3 (36%) or Level 4 evidence (36%). Of the top 50 medial ulnar collateral ligament articles, 94% originated from the United States. A few articles had a high Altmetric Attention Score, suggesting that medial ulnar collateral ligament research does not generate consistently high online attention. The lack of Level 1 studies suggests the need for high-level studies on the medial ulnar collateral ligament. Most studies originated in the United States and were published in the American Orthopaedic Society for Sports Medicine–affiliated journals. The medial ulnar collateral ligament articles included in this study differed substantially from a previous report of the most-cited medial ulnar collateral ligament articles in the literature, suggesting that alternative metrics add a unique dimension to understanding the overall impact of published research on the medial ulnar collateral ligament.

Objectives: To identify the top 100 most impactful anterior cruciate ligament articles in online media as measured by the Altmetric Attention Score and compare their characteristics to the most-cited anterior cruciate ligament articles in the scientific literature. Methods: The Altmetric database was queried to identify all published articles pertaining to the anterior cruciate ligament. The search yielded 9445 articles, which were stratified by highest to lowest Altmetric Attention Score. The top 100 articles were included. Collected data included article type, article topic, journal name, and online mentions in news, blogs, Twitter, Facebook, Wikipedia, and other sources. The geographic origin of each article was also determined based on the institutional affiliation of the first author. Results: Altmetric Attention Score of the top 100 anterior cruciate ligament articles ranged from 109 to 2193 (median 172.0, interquartile range 137.5–271.5). Of the 100 articles, 65 were published in three journals: American Journal of Sports Medicine, British Journal of Sports Medicine, and Journal of Orthopaedic & Sports Physical Therapy. The most prevalent article type was original research (60%), followed by systematic review/meta-analysis (18%). The most prevalent article topic was rehabilitation and return to play after anterior cruciate ligament reconstruction (22%), followed by epidemiology/risk factors (16%), injury prevention (14%), and biomechanics of anterior cruciate ligament injuries (14%). Of the top 100 articles, 54% were American, 31% were European, and 15% were published in other countries outside of the United States and Europe. Conclusion: This study used Altmetric Attention Score to identify the 100 most engaged anterior cruciate ligament articles in online media. The characteristics of these articles differed substantially from the most-cited anterior cruciate ligament articles in the literature with regard to article type, article topic, geographic origin, and publication journal. These findings suggest that alternative metrics measure distinct components of anterior cruciate ligament article engagement and add an important dimension to understanding the overall impact of published research on the anterior cruciate ligament.

Purpose: The purpose of our study is to identify the location of the posterior femoral cutaneous nerve (PFCN) and its branches in relation to the proximal hamstring tendon. Methods: Fifteen lower torso human cadaveric specimens were dissected in prone position. Skin and subcutaneous tissues were reflected to expose the gluteal and hamstring musculature. The distance between the ischial tuberosity and lateral border of the hamstring, PFCN, perineal branch of the PFCN, and descending femoral branch of the PFCN was measured with digital calipers. Measurements were repeated three times and averaged. Results: The PFCN was 30.5 ± 11.4 mm lateral to the central tip of the ischial tuberosity (range: 15.7 to 52.0 mm). The average longitudinal distance from the tip of the ischial tuberosity to the point where the perineal branch crossed the hamstrings was 24.1 ± 15.0 mm (range: 9.9 to 52.2 mm). The average longitudinal distance to the point where the descending cutaneous branch crossed the hamstrings was 83.3 ± 21.3 mm (range: 41.3 to 110.3 mm). The PFCN was nearest to the inferior border of the gluteus maximus 45.8 ± 13.6 mm lateral to the ischial tuberosity (range: 13.6 to 62.1 mm). Eleven specimens (73%) had one identifiable perineal branch; four (27%) had two distinct perineal branches. Conclusions: The PFCN was in close proximity to the surgical approach used during proximal hamstring repair, with the perineal branch consistently crossing the surgical field transversely. The location of these nerves varied substantially among the specimens tested, with some nerves less than 1 cm from the ischial tuberosity and 27% of specimens with two perineal branches.

This article draws on the researcher’s training and experience as a certified intimacy coordinator to examine how labour from professional sex work to intimacy coordination necessitates nuanced approaches to consent. What I call consent work – practices of communication, negotiation, and boundary setting – supports bodily autonomy while guiding portrayals of intimacy and nudity in film, television, theatre, and erotic media. I begin by discussing intimacy coordinators’ communication and consent frameworks to create context for my ensuing investigation. Next, utilizing data from interviews with online sex workers, I explore their sophisticated personal and community-oriented harm reduction techniques that, without formal training, dovetail with those in the intimacy coordination industry. Continuing my qualitative analysis, I describe the ways in which my interlocutors’ use of knowledge from consensual BDSM reflects the breadth of practices that inform consent work while illuminating the links between kink and intimacy coordination. Finally, I unpack how consent models remain entangled within systems of inequality and exclusion while owing much to marginalized communities’ contributions to contemporary understandings of bodily autonomy. Overall, consent work and its capacious lineage contribute to the expanding literature on intimacy coordination and highlight the field’s under-researched intersections with adult content creation.

BACKGROUND: Clinical trials are increasingly using Bayesian methods for their design and analysis. Inference in Bayesian trials typically uses simulation-based approaches such as Markov Chain Monte Carlo methods. Markov Chain Monte Carlo has high computational cost and can be complex to implement. The Integrated Nested Laplace Approximations algorithm provides approximate Bayesian inference without the need for computationally complex simulations, making it more efficient than Markov Chain Monte Carlo. The practical properties of Integrated Nested Laplace Approximations compared to Markov Chain Monte Carlo have not been considered for clinical trials. Using data from a published clinical trial, we aim to investigate whether Integrated Nested Laplace Approximations is a feasible and accurate alternative to Markov Chain Monte Carlo and provide practical guidance for trialists interested in Bayesian trial design. METHODS: Data from an international Bayesian multi-platform adaptive trial that compared therapeutic-dose anticoagulation with heparin to usual care in non-critically ill patients hospitalized for COVID-19 were used to fit Bayesian hierarchical generalized mixed models. Integrated Nested Laplace Approximations was compared to two Markov Chain Monte Carlo algorithms, implemented in the software JAGS and stan, using packages available in the statistical software R. Seven outcomes were analysed: organ-support free days (an ordinal outcome), five binary outcomes related to survival and length of hospital stay, and a time-to-event outcome. The posterior distributions for the treatment and sex effects and the variances for the hierarchical effects of age, site and time period were obtained. We summarized these posteriors by calculating the mean, standard deviations and the 95% equitailed credible intervals and presenting the results graphically. The computation time for each algorithm was recorded. RESULTS: The average overlap of the 95% credible interval for the treatment and sex effects estimated using Integrated Nested Laplace Approximations was 96% and 97.6% compared with stan, respectively. The graphical posterior densities for these effects overlapped for all three algorithms. The posterior mean for the variance of the hierarchical effects of age, site and time estimated using Integrated Nested Laplace Approximations are within the 95% credible interval estimated using Markov Chain Monte Carlo but the average overlap of the credible interval is lower, 77%, 85.6% and 91.3%, respectively, for Integrated Nested Laplace Approximations compared to stan. Integrated Nested Laplace Approximations and stan were easily implemented in clear, well-established packages in R, while JAGS required the direct specification of the model. Integrated Nested Laplace Approximations was between 85 and 269 times faster than stan and 26 and 1852 times faster than JAGS. CONCLUSION: Integrated Nested Laplace Approximations could reduce the computational complexity of Bayesian analysis in clinical trials as it is easy to implement in R, substantially faster than Markov Chain Monte Carlo methods implemented in JAGS and stan, and provides near identical approximations to the posterior distributions for the treatment effect. Integrated Nested Laplace Approximations was less accurate when estimating the posterior distribution for the variance of hierarchical effects, particularly for the proportional odds model, and future work should determine if the Integrated Nested Laplace Approximations algorithm can be adjusted to improve this estimation.

Previous studies have reported alterations in cortical thickness in autism. However, few have included enough autistic females to determine if there are sex specific differences in cortical structure in autism. This longitudinal study aimed to investigate autistic sex differences in cortical thickness and trajectory of cortical thinning across childhood. Participants included 290 autistic (88 females) and 139 nonautistic (60 females) individuals assessed at up to 4 timepoints spanning ~2-13 years of age (918 total MRI timepoints). Estimates of cortical thickness in early and late childhood as well as the trajectory of cortical thinning were modeled using spatiotemporal linear mixed effects models of age-by-sex-by-diagnosis. Additionally, the spatial correspondence between cortical maps of sex-by-diagnosis differences and neurotypical sex differences were evaluated. Relative to their nonautistic peers, autistic females had more extensive cortical differences than autistic males. These differences involved multiple functional networks, and were mainly characterized by thicker cortex at ~3 years of age and faster cortical thinning in autistic females. Cortical regions in which autistic alterations were different between the sexes significantly overlapped with regions that differed by sex in neurotypical development. Autistic females and males demonstrated some shared differences in cortical thickness and rate of cortical thinning across childhood relative to their nonautistic peers, however these areas were relatively small compared to the widespread differences observed across the sexes. These results support evidence of sex-specific neurobiology in autism and suggest that processes that regulate sex differentiation in the neurotypical brain contribute to sex differences in the etiology of autism.

We examined academic advisors' clinically significant symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD), including whether there are statistically significant relationships between advisors' demographic characteristics, work-related variables, institutional variables, burnout, resilience, and risk of clinically significant MDD/GAD symptoms. We analyzed survey data of academic advisors collected from February to March 2023 (n = 777) and found that 16.9% of advisors met the criteria for MDD while 29.6% met the criteria for GAD, rates higher than national averages. While there were some demographic differences, advisors who experienced higher rates of burnout had increased odds of experiencing MDD and GAD symptoms. In addition, advisors' resilience was associated with decreased odds of experiencing MDD and GAD symptoms.

Self-regulated learning (SRL) is associated with university student academic success outcomes, however students often need support to develop these skills. Technology-mediated feedback is one strategy that may aid educators in supporting students' SRL development. This study aims to explore whether a technology-mediated feedback strategy targeting tutorial preparation for flipped classrooms enhances first-year students' self-report SRL and observed implementation of the strategy. Self-report SRL was measured using the Motivated Strategies for Learning Questionnaire (MSLQ); strategy implementation profiles were based on lecture video access patterns. First-year psychology students (n = 99) were sent technology-mediated feedback emails aimed at developing their SRL. Paired-samples t-tests revealed significant increases in post-intervention self-reported motivational SRL subscales; self-reported and observed learning strategies implementation did not improve. Future research could build upon this exploratory work to form a multi-pronged strategy to increase understanding of the role of technology-mediated feedback in first-year students' SRL development for flipped classroom learning.

Category: Ankle; Hindfoot; Sports Introduction/Purpose: Achilles tendon injuries affect a wide range of individuals, including both recreational and competitive athletes. In the elite athlete population, Achilles tendon ruptures are typically season-ending injuries and can be career-threatening. Due to these impacts on individual players' careers as well as team success, Achilles tendon injuries often generate substantial discussion in the mainstream media and among the general public. However, traditional citation-based metrics fail to capture the dissemination of Achilles research that occurs outside the realm of scientific journal publications. Thus, the purpose of this study was to use the Altmetric Attention Score (AAS) to identify the 100 most impactful articles in online media pertaining to the Achilles tendon and assess their characteristics. Methods: The Altmetric database (Digital Science, Holtzbrinck Publishing) was queried to identify all published articles pertaining to the Achilles Tendon. The articles were stratified by highest to lowest AAS and the top 100 articles with the highest scores were included for analysis. Several data elements were extracted for each article: title, article type, article topic, year of publication, journal name, authors, institutional affiliations, and online mentions (i.e., the number of times the article was mentioned in news, blog, Twitter, Facebook and Wikipedia sources). The geographic origin of each article was also determined by the institutional affiliation of the first author, which was categorized as American (originating in the United States), European (originating in Europe), or Other. Linear regression was used to determine the relationship between online mentions and AAS. Results: The initial search yielded 3,810 articles published between 1957 and 2021. AAS of the top 100 articles ranged from 37 to 476 with a median of 65 (interquartile range: 42-110). The selected articles were published in 39 journals. The most prevalent article type was randomized controlled trial (21.8%), followed by systematic review / meta-analysis (13.9%). The most prevalent article topics were treatment (39.6%), rehabilitation and return to play (11.9%), epidemiology (11.9%), and biomechanics (11.9%). Of the top 100 articles, 25.0% were American, 45.0% were European, and 30.0% were published outside of the United States or Europe. AAS had a strong correlation to Twitter mentions (r = 0.81), a moderate correlation to Google Scholar mentions (r = 0.52), and a weak correlation to Facebook mentions (r = 0.49). Conclusion: This study used AAS to characterize the 100 most impactful Achilles articles in online media. As access to research continues to move away from the conventional printed format, it is critically important to understand how orthopaedic information is disseminated online. Our findings suggest that alternative metrics broaden the definition of article impact beyond what is provided by traditional citation-based metrics and should be considered as a supplemental means of assessing the overall impact of published scientific literature.

Category: Sports Introduction/Purpose: Artificial turf (AT) playing surfaces have emerged as a common alternative to natural grass (NG) at all levels of athletic competition from youth to professional. While several prior articles have compared the lower extremity injury rates on AT and NG, the heterogeneity of these studies in terms of design and methodology has led to widely variable results. The purpose of this systematic review was to determine whether any definitive conclusions can be drawn with regard to the risk of lower extremity injury on AT and NG playing surfaces. Methods: A systematic review of the English-language literature was performed according to the PRISMA guidelines. All included studies presented a direct comparison of injury rates on AT versus NG playing surfaces. No restrictions were made with regard to sport, level of competition, level of evidence, or year of publication. Studies that examined only head injury rates (e.g. concussions) without any comparison of overall injury rates or lower extremity injury rates were excluded. Systematic reviews and meta-analyses were also excluded. The following data elements were extracted from each article: publication year, study design, level of evidence, industry funding, cohort selection process (ad-hoc vs. systematic), sport, level of competition, number of athletic seasons, injury setting, AT type, overall injury rate, knee rate, and foot & ankle injury rate. AT types were classified into Old Generation (1st or 2nd generation) or New Generation (3rd generation or higher). Results: 53 articles met inclusion criteria. 31 articles compared overall injury rates on AT versus NG. Roughly one-half of these studies (51.6%) found no significant difference between NG and AT, while roughly one-third (35.5%) found a higher overall injury rate on AT and just 4 studies (12.9%) found a higher overall injury rate on NG. Similarly, of the 26 articles comparing knee injury rates, 14 studies (53.8%) reported no difference between AT and NG, 8 studies (30.8%) reported a higher injury rate on AT, and 4 studies (15.4%) reported a higher injury rate on NG. With regard to foot & ankle injuries, however, a majority of articles (14/24, 58.3%) reported a higher injury rate on AT. Comparatively few articles (3/24, 12.5%) reported a higher foot & ankle injury rate on NG, while the remaining articles (7/24, 29.2%) reported no difference in foot & ankle injury rate between AT and NG. Conclusion: The present study is a systematic review of 53 articles in the English-language literature that compared injury rates on AT and NG. Our findings suggest that the rates of overall injury and knee injury are similar between these two playing surfaces, though AT may be associated with a higher rate of foot & ankle injuries compared to NG.

Abstract Purpose The purpose of our study was to use the Altmetric Attention Score (AAS) to evaluate the 100 most impactful articles in online media pertaining to the rotator cuff and compare their characteristics to the most‐cited rotator cuff articles in the scientific literature. Methods We performed an article extraction using Altmetric Explorer to identify all published articles pertaining to the rotator cuff. The top 100 articles with the highest AAS were included for analysis. Several data elements were extracted for each included article: title, article type, article topic, year of publication, journal name, authors, institutional affiliations, and online mentions (i.e. the number of times the article was mentioned in news, blog, Twitter, Facebook, and Wikipedia sources). The geographic origin of each article was also determined by the institutional affiliation of the first author, which was categorized as American (originating in the United States), European (originating in Europe), or other. Results The 100 articles with the highest AAS were published between 2009 and 2020, with AAS ranging from 47 to 676 (median: 74.5, 25th percentile: 59.5, 75th percentile: 114.5). Of all online media sources, Twitter correlated most strongly with AAS (r = 0.9007, r2 = 0.8112). The selected articles were most frequently published in the American Journal of Sports Medicine (13), the Journal of Shoulder and Elbow Surgery (11), and the Journal of Bone and Joint Surgery (7). The most common article type was Systematic Review/Meta‐Analysis (29%), followed by Randomized Controlled Trial (15%). The top 3 AAS articles were all published by authors based in Europe. Conclusion The most impactful rotator cuff articles in online media generated substantial online attention. These studies were often performed in Europe and tended to be high level of evidence, focusing on treatment of rotator cuff pathology. The rotator cuff articles that produced the most online attention differed from a previous report of the most‐cited rotator cuff articles, suggesting that alternative metrics may be used in concert with conventional bibliometrics to obtain a more complete representation of scientific impact.

Case. A 74-year-old female developed left shoulder pain after receiving an influenza vaccine. Her initial physical exam was suggestive of subacromial bursitis, and a corticosteroid injection into the subacromial space resulted in a 50% improvement in her pain. Subsequent MRI demonstrated myositis isolated to the infraspinatus muscle. She was successfully treated with anti-inflammatory medication and physical therapy. Conclusion. Shoulder injury related to vaccine administration (SIRVA) is a rare clinical complication, and myositis in the rotator cuff musculature has not been previously reported. Proper administration of intramuscular vaccinations should be emphasized to prevent injury to structures surrounding the shoulder joint.

Whole genome sequences (WGS) enable discovery of rare variants which may contribute to missing heritability of coronary artery disease (CAD). To measure their contribution, we apply the GREML-LDMS-I approach to WGS of 4949 cases and 17,494 controls of European ancestry from the NHLBI TOPMed program. We estimate CAD heritability at 34.3% assuming a prevalence of 8.2%. Ultra-rare (minor allele frequency ≤ 0.1%) variants with low linkage disequilibrium (LD) score contribute ~50% of the heritability. We also investigate CAD heritability enrichment using a diverse set of functional annotations: i) constraint; ii) predicted protein-altering impact; iii) cis-regulatory elements from a cell-specific chromatin atlas of the human coronary; and iv) annotation principal components representing a wide range of functional processes. We observe marked enrichment of CAD heritability for most functional annotations. These results reveal the predominant role of ultra-rare variants in low LD on the heritability of CAD. Moreover, they highlight several functional processes including cell type-specific regulatory mechanisms as key drivers of CAD genetic risk.

Can increasing women’s use of digital financial services raise their empowerment? We test this hypothesis using a randomized control trial with 152 female microfinance groups in Tanzania, where treated groups were randomly switched to repay their loan using mobile money instead of cash. This exogenous shift in women’s use of mobile money for loan repayment substantially increases their use for other types of transactions. Women’s control over their finances increases, they have higher levels of empowerment in the household and expenditures shift towards goods plausibly aligned with their preferences. These findings highlight the benefits of greater use of digital technologies for women.

Human cell line models, including the neuronal precursor line LUHMES, are important for investigating developmental transcriptional dynamics within imprinted regions, particularly the 15q11-q13 Angelman (AS) and Prader-Willi (PWS) syndrome locus. AS results from loss of maternal UBE3A in neurons, where the paternal allele is silenced by a convergent antisense transcript UBE3A-ATS, a lncRNA that terminates at PWAR1 in non-neurons. qRT-PCR analysis confirmed the exclusive and progressive increase in UBE3A-ATS in differentiating LUHMES neurons, validating their use for studying UBE3A silencing. Genome-wide transcriptome analyses revealed changes to 11 834 genes during neuronal differentiation, including the upregulation of most genes within the 15q11-q13 locus. To identify dynamic changes in chromatin loops linked to transcriptional activity, we performed a HiChIP validated by 4C, which identified two neuron-specific CTCF loops between MAGEL2-SNRPN and PWAR1-UBE3A. To determine if allele-specific differentially methylated regions (DMR) may be associated with CTCF loop anchors, whole genome long-read nanopore sequencing was performed. We identified a paternally hypomethylated DMR near the SNRPN upstream loop anchor exclusive to neurons and a paternally hypermethylated DMR near the PWAR1 CTCF anchor exclusive to undifferentiated cells, consistent with increases in neuronal transcription. Additionally, DMRs near CTCF loop anchors were observed in both cell types, indicative of allele-specific differences in chromatin loops regulating imprinted transcription. These results provide an integrated view of the 15q11-q13 epigenetic landscape during LUHMES neuronal differentiation, underscoring the complex interplay of transcription, chromatin looping, and DNA methylation. They also provide insights for future therapeutic approaches for AS and PWS.

Effective transport of biological systems as cargo during space travel is a critical requirement to use synthetic biology and biomanufacturing in outer space. Bioproduction using microbes will drive the extent to which many human needs can be met in environments with limited resources. Vast repositories of biological parts and strains are available to meet this need, but their on-site availability requires effective transport. Here, we explore an approach that allows DNA plasmids, ubiquitous synthetic biology parts, to be safely transported to the International Space Station and back to the Kennedy Space Center without low-temperature or cryogenic stowage. Our approach relied on the cyanobacterium Nostoc punctiforme PC73102, which is naturally tolerant to prolonged desiccation. Desiccated N. punctiforme was able to carry the non-native pSCR119 plasmid as intracellular cargo safely to space and back. Upon return to the laboratory, the extracted plasmid showed no DNA damage or additional mutations and could be used as intended to transform the model synbio host Escherichia coli to bestow kanamycin resistance. This proof-of-concept study provides the foundation for a ruggedized transport host for DNA to environments where there is a need to reduce equipment and infrastructure for biological parts stowage and storage.

Understanding the normal function of the Huntingtin (HTT) protein is of significance in the design and implementation of therapeutic strategies for Huntington's disease (HD). Expansion of the CAG repeat in the HTT gene, encoding an expanded polyglutamine (polyQ) repeat within the HTT protein, causes HD and may compromise HTT's normal activity contributing to HD pathology. Here, we investigated the previously defined role of HTT in autophagy specifically through studying HTT's association with ubiquitin. We find that HTT interacts directly with ubiquitin in vitro. Tandem affinity purification was used to identify ubiquitinated and ubiquitin-associated proteins that copurify with a HTT N-terminal fragment under basal conditions. Copurification is enhanced by HTT polyQ expansion and reduced by mimicking HTT serine 421 phosphorylation. The identified HTT-interacting proteins include RNA-binding proteins (RBPs) involved in mRNA translation, proteins enriched in stress granules, the nuclear proteome, the defective ribosomal products (DRiPs) proteome and the brain-derived autophagosomal proteome. To determine whether the proteins interacting with HTT are autophagic targets, HTT knockout (KO) cells and immunoprecipitation of lysosomes were used to investigate autophagy in the absence of HTT. HTT KO was associated with reduced abundance of mitochondrial proteins in the lysosome, indicating a potential compromise in basal mitophagy, and increased lysosomal abundance of RBPs which may result from compensatory up-regulation of starvation-induced macroautophagy. We suggest HTT is critical for appropriate basal clearance of mitochondrial proteins and RBPs, hence reduced HTT proteostatic function with mutation may contribute to the neuropathology of HD.