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Chronic lateral ankle instability is a common condition. Split peroneal tendon lateral ankle stabilization, a modification of the Chrisman-Snook procedure, is biomechanically stable and often used for severe and/or recurrent chronic lateral ankle instability. The purpose of the present study was to evaluate the efficacy and safety of this technique. Specifically, the midterm recurrence of instability and postoperative complications, such as stiffness, neurologic pain, and wound healing complications, were evaluated. We evaluated 30 consecutive procedures with a minimal follow-up period of 1 year. The mean follow-up period was 25 ± 13 (median 19, range 13 to 62) months. Five patients (17%) developed recurrent ankle instability, of whom 4 underwent revision surgery. One superficial infection and two wound disruptions developed. Two patients experienced stiffness and eight (27%) surgically induced neurologic complaints, such as sural neuritis. Finally, 2 patients developed complex regional pain syndrome.

Study Design Clinical measurement, cross-sectional. Background Quadriceps deficits are common in individuals with knee joint impairments and impact functional and quality-of-life outcomes. Quadriceps strength symmetry influences clinical decisions after knee injury. Isometric electromechanical dynamometry (ISO-ED) is the gold standard for measuring symmetry, but is not available in all clinical settings. Objectives To compare concurrent validity of handheld dynamometry and 1-repetition-maximum leg press, knee extension from 90° to 0°, and knee extension from 90° to 45° to that of ISO-ED in identifying meaningful quadriceps strength deficits. Methods Fifty-six participants with knee joint impairments completed ISO-ED and 4 alternative measures of quadriceps strength symmetry in a single session. Absolute agreement of alternative measures with ISO-ED was calculated with intraclass correlation coefficients (ICCs). Clinical agreement values at thresholds of 80% and 90% symmetry were compared between the alternatives and ISO-ED. Results Knee extension from 90° to 45° (ICC = 0.67) and handheld dynamometry (ICC = 0.70) had the greatest ICCs. Clinical agreement was also best for these measures for 80% symmetry (κ = 0.56 and 0.55, respectively) and 90% symmetry (κ = 0.19 and 0.33, respectively). Conclusion Handheld dynamometry and 1-repetition-maximum testing of knee extension from 90° to 45° are fair alternatives, although symmetry is typically overestimated. Receiver operating characteristic analysis identified alternative measure thresholds that correlated with the 80% and 90% symmetry thresholds on the ISO-ED. Clinicians should use more stringent symmetry values for these alternative tests to increase the probability that individuals have a minimum ISO-ED symmetry of 80% or 90%. J Orthop Sports Phys Ther 2017;47(2):97-107. doi:10.2519/jospt.2017.6651.

El Capitan is the latest extended reach drilling (ERD) well to be drilled from the Heritage Platform into the Sacate Field, offshore California. The application of learnings from previous wells enabled El Capitan to be drilled to a total depth of 37,165 ft measured depth (MD) / 6,938 ft true vertical depth (TVD) with 33,682 ft of horizontal displacement (HD). The most challenging phases of the well will be described in this paper, concentrating on the main engineering focus areas during planning and execution. El Capitan holds the record for the longest well drilled in North America and is the third longest directional well drilled worldwide by MD (seeFig. 1). El Capitan also holds the record for the deepest (MD) 12-1/4-in. hole section and the deepest (MD) set 9-5/8-in. liner. Application of the company's recently modified Fast Drill Process (FDP) emphasizing the redesign of borehole related performance limiters enabled a 250% improvement in drilling performance from offsets in the 12-1/4-in. and 8-1/2-in. hole sections (Dupriest et al., 2010). Casing floatation techniques used on previous wells in the field were refined to enable a 27,267 ft long 9-5/8-in. liner to be successfully run to the 12-1/4-in. hole section total depth (TD). The well objectives were achieved with no safety or environmental incidents, 92 days ahead of plan, significantly under budget and with only 15% non-productive time (NPT).

During extended reach drilling operations at the Hibernia Platform, operated by Hibernia Management and Development Company Ltd. utilizing ExxonMobil Canada Ltd. resources, bit gauge length and profile have been systematically varied to improve drilling performance while using a standard bottomhole assembly (BHA) and bit design. Prior to developing the standard BHA design and implementing a global performance management process, the ExxonMobil Fast Drill Process, multiple bit runs were required to drill a typical high angle, 10,000-ft interval of 12¼-in. hole. Tool failure and bit damage caused by vibration resulted in multiple bit runs. In order to reduce vibrations and improve drilling performance, bit gauge length has been systematically increased in 1-in. increments while utilizing a standard BHA. Partially tapered gauge was used in conjunction with the increased gauge length to allow directional control. This paper presents the results of progressing from a 4-in. non-tapered gauge bit to a 5-, 6-, and 7-in. partially tapered gauge bit from 2005 to 2009. Mechanical specific energy (MSE), vibration, rotary steerable wear, and directional response data is presented to show the impact of the incremental changes in gauge length over a group of seven wells. The tapered profile and increased gauge length provided comparable directional response with significantly improved drilling performance, resulting in multiple field record rates of penetration (ROPs) and bit run lengths.

Background: With the recent reporting of 191 cases of epoetin induced PRCA (Bennett CL, NEJM 2004), information is needed about the long-term follow-up of individuals with this diagnosis. While 47 cases from France, Germany, and England have been reported recently (Verhelst D, Lancet 2004), these data are limited by short follow-up and absence of information from other regions. Methods: RADAR investigators identified cases of epoetin-associated PRCA from the Food and Drug Administration MEDWatch database and proprietary reports from both the manufacturers epoetin alpha (Epogen from AMGEN, and Eprex from Johnson and Johnson) and epoetin beta (Neorecormon from Roche). Patients exposed to more than one epoetin form were excluded. PRCA recovery was operationally defined as transfusion independence, clearance of anti-erythropoietin antibody, and/or normalization of reticulocyte count. Results: See table. Conclusions: The overall recovery rate of 82% following transplantation versus 40% following immunosuppression suggests that transplantation might be the optimal therapy for epoetin-associated PRCA. Almost half of the patients rechallenged with epoetin developed recurrent PRCA, raising concern over the benefits of rechallenge. Eprex (N=82) Neorecormon (N=11) Epogen (N=5) Origin: US 60% 64% 100% Europe 60% 64% – Pacific Rim/Asia 21% 36% – Canada 19% – – Subcutaneous delivery 99% 100% 60% Recovery with Immunosuppression 37% 73% 0% Recovery with renal Transplant 11% – – No recovery with renal transplant 1% – 20% No Recovery 41% 18% 40% Unknown Recovery 10% 9% 40% Male gender 68% 73% 40% Rechallenged with epoetin N=12 – – Response rate 50% Median age 68 years 47 years 51 years