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Various approaches have been explored to study skin biology, including the use of stem cells. Mesenchymal stem cells (MSCs) from the umbilical cord can be safely and easily obtained; however, a simple strategy to monitor their differentiation is essential. Involucrin is a marker of keratinocyte differentiation, and its promoter (pINV) directs stratum-specific expression of this protein. We designed a reporter system containing EGFP under the control of pINV to assess MSC transdifferentiation into keratinocytes. The functional sequence of pINV was inserted into a lentiviral vector, producing LeGO-GpINV. MSCs were transduced with LeGO-GpINV and induced to transdifferentiate into keratinocytes under cultivation with keratinocyte serum-free medium. MSC transdifferentiation was confirmed by morphological changes and by the expression of epidermal markers by flow cytometry, quantitative PCR, Western blot and the activity of epidermal kallikreins 5, 6 and 7. After 14 days of transdifferentiation, MSCs transduced with LeGO-GpINV showed an increase in EGFP fluorescence and expressed CK10, CK14, involucrin and filaggrin. There was also an increase in kallikrein activity. This reporter system allowed us to temporally assess epidermal differentiation, simultaneously with involucrin expression, opening possibilities for the in vivo study of skin biology and in regenerative medicine.

Objectives: This study aimed to evaluate the rate of graft failure, return to sport (RTS), and clinical outcomes in patients undergoing osteochondral allograft (OCA) transplantation in the patellofemoral (PF) joint with concomitant tibial tuberosity osteotomy (TTO) compared to those undergoing an isolated PF OCA transplantation. Methods: This is a retrospective review of patients who underwent PF OCA transplantation with or without TTO at a single institution. Patients with a primary patellar or trochlear lesion were included. Those undergoing revision OCA, medial patellofemoral ligament reconstruction (MPLFR), or who had a prior TTO were excluded. Graft failure was defined as cartilage procedure revision, chondroplasty, or conversion to joint replacement. Knee pain and functional outcomes were assessed with Visual Analog Scale (VAS), Knee Injury and Osteoarthritis Outcome Score Joint Restoration (KOOS JR), and Tegner Activity Scale. Additionally, patients were asked about preoperative and postoperative sports activity to determine rate of RTS. Results: A total of 40 patients met inclusion criteria for the study; 35 were available for follow-up at an average of 31.6 ± 7.8 months. The cohort had 20 female (64%) and 15 male (36%) patients; the average age was 34 ± 8 years. Graft failure rates were 7.7% and 22.7% in the PF OCA + TTO and isolated PF OCA groups, respectively (p= 0.254). There were no significant differences in RTS between groups (p=0.668). Among patients who returned to sport at a lower level, those in the OCA + TTO group unanimously cited pain as the primary reason (100%), while most in the isolated OCA group cited fear of re-injury instead (66.7%). Patients who underwent concomitant OCA + TTO experienced reported lower KOOS scores (p=0.009). However, after adjusting for covariates, there was no significant association between TTO (p=0.86) and KOOS. Conclusions: In this study population, patients undergoing OCA with concomitant TTO were found to have comparable return to sport rates compared to patients who underwent an isolated OCA. Both cohorts showed improvements in pain levels and functional outcomes from baseline. However, patients undergoing combined OCA and TTO exhibited higher pain levels with activity and cited pain as the primary reason for return at a lower level of performance. These findings highlight the need for additional well-powered studies to further investigate clinical and functional outcomes following OCA and concomitant TTO to offload the PF compartment.

Different approaches have been explored to study skin biology, including the use of stem cells. Mesenchymal stem cells (MSC) from umbilical cord can be safely and easily obtained, however a simple strategy to monitor their differentiation is essential. Involucrin is a marker of keratinocyte terminal differentiation, and its promoter (pINV) directs stratum-specific expression of this protein. We designed a reporter system containing EGFP under control of pINV to assess MSC differentiation into keratinocytes. The functional sequence of pINV was inserted into a lentiviral vector, originating LeGO-GpINV. MSC were transduced with the LeGO-GpINV and induced to differentiate into keratinocytes upon cultivation with Keratinocyte Serum Free Medium supplemented. MSC differentiation was confirmed by morphological changes and by the expression of epidermal markers, by flow cytometry, quantitative PCR and western blot. The activity of kallikreins 5, 6 and 7 was detected using fluorogenic substrates. After 14 days of differentiation, MSC transduced with LeGO-GpINV showed an increase in EGFP fluorescence and expressed CK10, CK14, involucrin and filaggrin. There was also an increase in the kallikrein activity. This reporter system allowed to temporally assess the epidermal differentiation, simultaneously with involucrin expression, opening perspectives for the in vivo study of skin biology and in regenerative medicine.

Objectives: The purpose of the current study is to evaluate and compare the effect of three different bone void fillers; autogenous bone (auto), calcium phosphate cement (cement), and demineralized bone matrix (DBM), on anterior knee pain following anterior cruciate (ACL) reconstruction with bone-patellar tendon-bone (BPTB) autograft. Methods: This is a single-center randomized, controlled trial conducted in 150 patients. Patients undergoing ACL reconstruction with BTPB autograft were equally randomized into the three bone void filler cohorts; 1) auto, 2) cement, or 3) DBM. Baseline day of surgery, postoperative 1 week, and postoperative 1.5, 3, and 6 months VAS scores and KOOS and KUJALA scores at 1.5, 3, 6, and 12 months were evaluated. To compare primary and secondary outcomes between the three groups with auto group as control, an analysis of variance (ANOVA) was performed. A p-value of 0.05 was set to determine statistical significance. Results: An interim analysis was conducted on 70 patients with 6 month follow-up outcomes. There were no significant differences in VAS scores between groups at baseline (p =0.919), 1 week postoperatively (p = 0.75), 1.5 months postoperatively (p = 0.708), 3 months postoperatively (p = 0.529), and 6 months postoperatively (p = 0.115). In addition, no significant differences in KOOS scores were seen between the groups at 1.5 months (p = 0.365), 3 months (p = 0.964), or 6 months (p = 0.917). Similarly, no significant differences in KOOS scores were seen between the groups at 1.5 months (p =0.514), 3 months (p =0.763), or 6 months (p =0.815). Conclusions: There is no difference in the level of anterior knee pain or patient-reported functional outcome scores between the auto, cement and DBM for patellar bone void filling following ACLR with BPTB.

Objectives: While a growing body of evidence has demonstrated that tele-rehabilitation is effective, the functional outcomes of patients undergoing tele-rehabilitation as compared to in-person rehabilitation after arthroscopic meniscectomy remains unclear. This is especially salient against the backdrop of COVID-19 and the Delta variant and the subsequent increased demand for remote care of these patients. Methods: A randomized-controlled trial was conducted including patients scheduled to undergo arthroscopic meniscectomy for meniscal injury by one of five fellowship trained sports medicine surgeons between August 2020 and May 2021. Patients were randomized to receive tele-rehabilitation, defined as exercises and stretches provided by trained physical therapists over a synchronous face-to-face video visit, or in-person rehabilitation for their post-operative course. International Knee Documentation Committee Subjective Knee Form (IKDC) score and Visual Analogue Scale (VAS) score were collected at timepoints of baseline, 3 months, 6 months, and 12 months post-operatively. Statistical analysis was conducted using Student T-test to assess for differences across the two groups. Results: An interim analysis was conducted on 60 patients with 6 month follow-up outcomes. There were no significant differences in VAS scores between groups at baseline (p =0.716) and 3 months postoperatively (p = 0.700). and 6 months postoperatively (p = 0.688). In addition, no significant differences in IKDC scores were seen between the groups at baseline (p = 0.146) and 3 months (p = 0.746). At 6 months, 24 patients were available with no significant differences observed across groups at this time point (IKDC; p = 0.633) (VAS; p = 0.688). Conclusions: Tele-rehabilitation is demonstrated to be as efficacious as traditional in-person rehabilitation following arthroscopic meniscectomy at up to 6 months post-op. This serves as a convenient and safe alternative for conventional patients during their post-operative course.

Objectives: The optimal treatment protocol for proximal hamstring ruptures, particularly when involving less than 3 cm of retraction, is not known. The purpose of this study was to compare patient-reported outcomes (PROs) between patients who underwent operative or non-operative management of proximal hamstring ruptures. Methods: A retrospective review of the electronic medical record identified all patients who were treated operatively or non-operatively for a proximal hamstring rupture from 2013 to 2020. Patients were stratified into two groups which were matched based on demographics including age, gender, BMI, chronicity of the injury, tendon retraction, and injury grade (complete, or three tendons, versus partial, or one or two tendons). All patients completed a battery of PROs including the Perth Hamstring Assessment Tool (PHAT), Modified Harris Hip Score (MHHS), Visual Analogue Scale for pain (VAS), and the Tegner Activity Scale. Patients from the non-surgical group were then case-matched in 2:1 fashion to their surgical counterparts. Results: Overall, 113 patients met inclusion criteria and were available for follow-up. Of the 113, 59 (52.2%) underwent primary hamstring tendon repair and 54 (47.8%) patients underwent non-operative treatment consisting of physical therapy. These 54 patients were case-matched to 28 surgically managed patients. When controlling for patient demographics, there were no differences in patient reported outcomes between non-operative and operative treatment of proximal hamstring in any validated outcome indicator (p > 0.05). Chronicity of the injury and older age correlated significantly to worse outcomes in both groups (p < 0.05). Conclusions: In patients with proximal hamstring ruptures with

Objectives: The purpose of the current study was to investigate whether pain, function, satisfaction, or return to play (RTP) differ between sexes post-operatively in those undergoing MPFL reconstruction for symptomatic patellar instability. Methods: A retrospective review of patients who underwent an MPFL reconstruction for symptomatic patellar instability was performed. Kujala score, Visual Analogue Scale (VAS), patient satisfaction, willingness to undergo surgery again, revisions, return to play (RTP) and MPFL-RSI score were evaluated. Clinical outcomes were compared between male and female patients. A p value of Results: Our study included 141 knees that underwent MPFLR, and the patient population was 69.5% female. Post-operatively, the mean VAS score at rest was 1.0 ± 1.7 in male patients and 1.6 ± 2.1 in female patients (p= 0.0963). The mean Kujala score was 88.8 ± 13.3 and 83.5 ± 16.1 for male and female patients respectively (p=0.1062). Overall, there was a significant difference in RTP, with male patients returning at higher rates (58.1% vs 33.3%, p = 0.0479). The mean VAS score during activity was significantly lower in male patients at 1.8 compared to female patients at 3 (p=0.016). MPFL-RSI-score was also significantly worse in female patients (69.5 vs 55.6, p = 0.0098). While female patients had slightly higher rates of recurrent subjective instability (14.3% vs 11.7%) and re-dislocation (2% vs 0%), the difference was not statistically significant (p = 0.6731 and 0.3490, respectively). Female patients demonstrated higher rates of additional surgery at long term follow up, though this difference was also not statistically significant (12.2% vs 4.6%, p = 0.1674). Conclusions: Female patients had worse clinical outcomes than males undergoing MPFLR for patellar instability, with significantly lower rates of RTP, VAS score during sport and MPFL-RSI scores with a trend towards lower Kujala score and VAS score.

Objectives: The etiology of isolated patellofemoral (PF) cartilage defects without patellar instability is currently incompletely understood. The purpose of the present study was to evaluate the variation in knee sagittal alignment in patients with and without PF cartilage wear. Methods: This was a single-center, retrospective review of patients that underwent a cartilage restoration procedure for isolated PF cartilage wear from 2014-2020. Patients were matched in a 1:2:2 ratio for age, sex, and BMI to anterior knee pain diagnosis and meniscectomy procedure cohorts as controls. Exclusion criteria included knee flexion angle >10°, elevated Caton-Deschamps index (CDI>1.3), increased sulcus angle (>145°), increased patellar tilt (>5°), elevated coronal TT-TG (>15mm), varus/valgus malalignment (>5°), or ICRS patellofemoral cartilage defects of ≥3 in either control group. The sagittal TT-TG (sTT-TG) distance was measured on preoperative axial T2 magnetic resonance imaging (MRI) and was defined as the distance between a point at the nadir of the trochlear cartilage and the most anterior point of the tibial tubercle. Comparisons between the 3 groups were made using ANOVA testing with Bonferroni corrections. Reliability was assessed with the interclass correlation coefficient (ICC). Odds ratios were calculated based on a sTT-TG measurement threshold obtained from a receiver operative characteristic curve graph. Results: Two hundred and thirty-five patients (47 cartilage restoration, 94 anterior knee pain, 94 meniscectomy) were included. Mean age, BMI, and height were 33.8 +/- 8.7 and 26.7 +/- 5.7, 170.6 +/- 24.3 respectively, with 130 males (55%) and 105 females (45%). There were no significant differences between groups for age, BMI or sex(p>0.05). Mean sTT-TG was significantly more posterior in the cartilage restoration group compared to the meniscectomy group (-2.5 mm +/-5.9 vs 1.72 mm +/- 5.3, pConclusions: Cartilage restoration procedure patients had a significantly more posterior tibial tubercle than partial meniscectomy controls. Anterior knee pain patient sagittal TT-TG was between both groups, but was not significantly different from either. Patients with sTT-TG of

The knuckleball is perhaps the most enigmatic pitch in baseball. Relying on the presence of raised seams on the surface of the ball to create asymmetric flow, a knuckleball's trajectory has proven very challenging to predict compared to other baseball pitches, such as fastballs or curveballs. Previous experimental tracking of large numbers of knuckleballs has shown that they can move in essentially any direction relative to what would be expected from a drag-only trajectory. This has led to speculation that knuckleballs exhibit chaotic motion. Here we develop a relatively simple model of a knuckleball that includes quadratic drag and lift from asymmetric flow which is taken from experimental measurements of slowly rotating baseballs. Our models can indeed exhibit dynamical chaos as long In contrast, models that omit torques on the ball in flight do not show chaotic behavior. Uncertainties in the phase space position of the knuckleball are shown to grow by factors as large as $10^6$ over the flight of the ball from the pitcher to home plate. We quantify the impact of our model parameters on the chaos realized in our models, specifically showing that maximum Lyapunov exponent is roughly proportional to the square root of the effective lever arm of the torque, and also roughly proportional to the initial velocity of the pitch. We demonstrate the existence of bifurcations that can produce changes in the location of the ball when it reaches the plate of as much as 1.2 m for specific initial conditions similar to those used by professional knuckleball pitchers. As we introduce additional complexity in the form of more faithful representations of the empirical asymmetry force measurements, we find that a larger fraction of the possible initial conditions result in dynamical chaos., 21 pages, 13 figures, accepted for publication in "Applied Mathematics and Computation"

Traumatic anterior shoulder instability is a common clinical problem among athletic populations, with several surgical treatment options available. The optimal treatment remains undetermined. Currently the main current treatment options are the Latarjet procedure or open or arthroscopic Bankart repair. The purpose of this study was to network meta-analyze the recent evidence to ascertain if the open Latarjet procedure and open or arthroscopic Bankart repair result in lower recurrence rates and subsequent revision procedures. The results were ranked with the P-score.A literature search was performed based on the PRISMA guidelines. Cohort studies comparing any of the open Latarjet procedure and open or arthrosopic Bankart repair for anterior shoulder instability were included. Clinical outcomes were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R.Twenty-nine studies with 2,474 patients were included. The open Latarjet procedure resulted in lower rates of recurrent instability and revisions due to recurrence compared to both open and arthroscopic Bankart repairs. The open Latarjet procedure resulted in the highest rate of return to play. However, the open Latarjet procedure also resulted in the highest complication rate.Our network meta-analysis found the open Latarjet procedure had the lowest recurrence rates, lowest revisions rates, and highest rates of return to play in the surgical treatment of anterior shoulder instability. However, the Latarjet procedure has been shown to result in a higher complication rate, which needs to be considered when deciding which stabilization procedure to perform.

Patients with anterior cruciate ligament (ACL) injuries and reconstruction are at an increased risk of developing osteoarthritis requiring total knee arthroplasty (TKA). There have been few studies analyzing the impact of prior ACL reconstruction (ACLR) on surgical time and perioperative complications following TKA.The purpose of the current study was to compare surgical time and the rate of select early postoperative complications following TKA in patients with a history of ACLR to patients without prior ligament reconstruction.We identified 116 patients who underwent TKA at our institution with a history of ACL reconstruction on the operative knee. These patients were propensity score matched to a control cohort of 348 patients undergoing TKA without a prior ACLR based on age, body mass index, sex, race, smoking status, surgeon, and year of surgery. Outcomes of interest for the current analysis were surgical time, incidence of postoperative wound complications, length of stay, discharge disposition, and 30-day readmission rate.There was no statistically significant difference between the ACLR and non-ACLR groups with respect to surgical time (108.23 ± 45.57 minutes vs. 102.72 ± 38.73 minutes, p = 0.205). There was also no significant difference in length of hospital stay, discharge disposition, incidence of postoperative wound complications, 30-day readmission rate, or reoperation rate.In this matched cohort analysis, we found no difference between patients undergoing TKA after ACLR and patients undergoing TKA for primary osteoarthritis with respect to perioperative complications and select postoperative outcomes, including the rate of reoperations. The current data demonstrates no significant impact of prior ACLR on the surgical time required to perform the arthroplasty.

This study systematically reviewed the literature for outcomes following revision surgery for a failed prior Latarjet procedure.Two independent reviewers performed the literature search based on PRISMA guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Studies in which the Latarjet procedure was performed as a revision procedure following failed prior shoulder instability surgery were included. Clinical outcomes analyzed were: 1. functional outcomes, 2. recurrent instability, 3. range of motion, and 4.Statistical analysis was performed using IBM SPSS.There were seven studies with 161 patients (162 shoulders) included. Four studies used a bone-block procedure, three used arthroscopic soft-tissue stabilization, and the mean follow-up was 49.8 months. The most commonly reported functional outcome measure was the Rowe score, with a weighted mean average of 79.7, with 82.9% of patients having good to excellent outcomes. Return to play was possible for 73.8% of patients, with 64.2% of those returning to at least the same level of competition. The overall recurrence rate was 9.5%, with 3.6% and 5.9% experiencing recurrent dislocations and subluxations, respectively. The overall revision rate was 4.2%, with all patients undergoing revisions due to recurrence. There were no reported neurovascular complications. Instability arthropathy was reported in 43.3% of patients.Surgical management following a failed Latarjet procedure results in moderate rates of recurrent instability and has a low intraoperative and postoperative complication rate. Additionally, the results across all techniques appear similar, with no procedure being identified as the gold-standard in the literature. However, there was a concerning rate of instability arthropathy, which may be related to the failure of a bony procedure.

Given the relatively low incidence of infection, the role of prophylactic antibiotics for infection prevention in arthroscopic surgery is unclear. Without established evidence-based guidelines, it becomes important to understand the trends and common practices in the field.We hypothesized that a majority of surgeons would use preoperative intravenous antibiotics and that postoperative antibiotics would be rarely used.A web-based link containing a questionnaire on perioperative antibiotic use for arthroscopic surgery of the knee and shoulder was sent to sports medicine surgeons at several institutions in the New York tri-state region. The questionnaire addressed antibiotic use both preoperatively and postoperatively and the type of medication used.During the study period, 86 surgeons responded to the knee portion of the survey and 139 surgeons responded to the shoulder portion of the survey. A significant majority (94.24% for knee and 93.02% for shoulder) of the respondents routinely preferred to use preoperative intravenous antibiotics for both shoulder and knee surgery. The antibiotic of choice for a majority of the respondents was cefazolin (98.1% respondents). In patients with penicillin allergies, most preferred to use clindamycin. Most respondents (84.5%) did not routinely use postoperative oral antibiotics.There is significant consensus among orthopedic surgeons performing knee and shoulder arthroscopic surgery regarding use of preoperative antibiotics, with the majority routinely prescribing preoperative intravenous antibiotics for prophylaxis and cefazolin being the most commonly used antibiotic. The majority of surgeons prefer not to use postoperative oral antibiotics.This study describes the current trends in the use of perioperative antibiotics among orthopedic surgeons for routine arthroscopic procedures in the shoulder and knee.

Meniscus surgery has dramatically changed over the last 20 years. This article reviews the advances and current evidence in meniscus repair.

Objectives: The purpose of the current study was to evaluate the clinical outcomes and rates of return to play in patients who underwent an osteochondral allograft (OCA) procedure for a symptomatic osteochondral defect in the knee. Methods: A retrospective review of patients who underwent an OCA for an osteochondral defect of the knee, between June 2011 and March 2019 was performed. Return to play, the level of return and the timing of return were assessed. Additionally, the reasons for being unable to return were evaluated. A p-value of < 0.05 was considered to be statistically significant. Results: Overall, there were 103 patients who underwent OCA at our institution and met our inclusion and exclusion criteria. The mean age was 31.8 ± 11 years, and 63.9% were male, with a mean of 44.2 ± 23.3 month follow-up. The overall rate of return to play was found to be 63.1% (N=65), while the rate of RTP at the same or higher level was 32.0% (N = 33). With respect to the patients who were unable to return to their desired sport, reasons cited included pain in the operative knee (N = 18, 47.3%), physical inability to perform in the desired sport (N = 8, 21.1%), and fear of re-injury (N = 6, 15.8%). Conclusions: Overall, there was a poor rate of return to play following OCA. Additionally, the majority of patients were unable to return to play at their pre-injury level.

Objectives: The purpose of the current study was to investigate clinical outcomes in overhead athletes undergoing biceps tenodesis for the treatment of symptomatic, isolated SLAP tears involving the biceps-labral complex. Methods: A retrospective review of overhead athletes who underwent biceps tenodesis for a SLAP tear was performed. The American Shoulder & Elbow Surgeons (ASES) score, Visual Analogue Scale (VAS), Subjective Shoulder Value (SSV), patient satisfaction, willingness to undergo surgery again, revisions, and return to play (RTP) were evaluated. Psychological readiness to return to sport was evaluated using the SLAP-Return to Sport after Injury (SLAP-RSI) score. A p value of Results: The current study included 44 overhead athletes. The mean age was 34.9 (16-46), 79.5% were males, and the mean follow-up was 49 months (18-107). Overall, we found that 81.8% of patients returned to play their overhead sport following biceps tenodesis, and 59.1% of patients returned to the same or higher level of play. It took patients on average 8.7 months to return to play following biceps tenodesis. The mean SLAP-RSI score was 69.3, and 70.5 % of patients passed the SLAP-RSI threshold of 56. The mean scores for ASES, VAS, SSV, and satisfaction were 92, 0.8, 80.5, and 87.9%, respectively. No patients in our cohort required a revision surgery. Conclusions: This study found that athletes undergoing biceps tenodesis as the treatment for a symptomatic, isolated SLAP tear had a high rate of return to play, good functional outcomes, and a low rate of revision surgery.

An important part of clinical training is learning how to identify and prevent hospital-acquired conditions or injuries. Despite this, there are few standardized methods in graduate medical education (GME) for teaching and assessing resident patient safety skills. Residents often do not report safety events, and increasing resident engagement can positively impact patient safety. In the current study, we sought to apply such a tool in gauging the capacity of orthopedic surgery interns at a large academic medical center to identify patient safety hazards and begin a discussion regarding the management of potential patient safety issues.A total of 27 orthopedic surgery interns at a single large academic medical center participated in the current observational study divided into two distinct groups in the summers of 2016 and 2017. A patient room was simulated with a training mannequin lying supine in a hospital bed. A mock patient chart and handoff were created in the electronic medical record (EMR) on the bedside computer. Patient safety hazards and errors of care were placed around the room and in the EMR, including several derived from the Joint Commission's National Patient Safety Goals. Each intern was given a maximum of 20 minutes to identify as many of the simulated patient safety hazards as possible. A debrief was conducted at the end of the exercise to discuss their responsibility to speak up when hazards are identified in a non-simulated patient room. For analysis, the hazards were distributed into four categories: room organization, EMR, patient care, and white board. Each intern's individual score (number of complete identifications/total number of hazards) and the group's performance as a whole in each category were calculated.The mean individual score was 51.54% (26.67% to 70.00%) in group A and 40.41% (25.71% to 54.29%) in group B. In group A, room organization hazards were identified more than any other category (74.62%), followed by patient care errors (40.38%), EMR hazards (40.17%), and white board errors (38.46%). In group B, room organization was identified the most (57.74%), followed by EMR (50%), and patient care and white board hazards (28.57% each). Certain critical safety hazards were identified by a small number of interns. For example, the inadequate handoff was only identified by four interns in each group.Hazards related to room cleanliness were easier to identify than hazards related to specific errors in patient care. A wide variation in the identification of critical safety issues was observed among the trainees assessed. This type of simulated educational experience provides important opportunities for resident-specific education in the realm of patient safety and health care quality.

Diffuse idiopathic skeletal hyperostosis (DISH) is common spinal condition characterized by increased calcification and ossification of ligaments and entheses, typically in the anterior aspect of the spine. However, extraspinal manifestations of the disease can occur and depending on the degree and location of involvement, may become symptomatic. We present the case of a 63-year-old male with a history of DISH, who failed initial open distal clavicle excision due to the postoperative development of heterotopic bone bridging across the acromioclavicular joint. Revision open distal clavicle excision coupled with postoperative heterotopic ossification prophylaxis led to a successful clinical and functional outcome without heterotopic bone recurrence. The case description is followed by a review of the extraspinal manifestations of DISH and the recommended prophylactic management in patients with DISH and similar risk factors for the development of heterotopic ossification.

Congenital short femur syndrome is a rare condition affecting about 0.017 of every 1,000 births. Patients frequently have ligamentous abnormalities, most frequently aplastic or hypoplastic cruciate ligaments. Advances in limb lengthening procedures have increased movement expectations for these patients, thus necessitating surgical treatment for their ligamentous abnormalities. An individual case is presented, including history, physical exam, and imaging demonstrating both the short femur and absent cruciate ligaments. A surgical reconstruction technique of the anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner is described. At 1-year follow-up, the patient had 0° to 135° of ROM. He reported no pain but mild swelling experienced during squatting. His knee continues to be stable in all planes with a grade 1A Lachman exam and a grade 1 posterior drawer with no posterolateral corner laxity.

Traditionally, biceps tenotomy has been recommended for obese, older, and less active patient populations, while tenodesis is preferred in younger, thinner, and more active individuals. In an effort to better understand the impact obesity has on the surgical management of long head of the biceps tendinopathy, the current study analyzed the effect body mass index had on surgical outcomes following open subpectoralis major biceps tenodesis.Patients who underwent biceps tenodesis between June 2006 and December 2013 were identified from our institution's surgical database. They were then contacted to assess their functional outcomes using validated outcome measures. Comparisons were made between the outcomes seen in obese patients (BMI ≥ 30) and non-obese patients (BMI30) with subgroup analyses looking at gender, age, and length of follow-up.One hundred and twenty-two patients completed a follow-up assessment with a mean follow-up of 29.3 months. The non-obese cohort was composed of 84 patients with a mean BMI of 25.8. The obese cohort was composed of 38 patients with a mean BMI of 33.4. No significant difference was noted to be present with respect to postoperative outcome measures. Regression analysis with BMI as an independent variable demonstrated poor correlation with outcome measures.The results of the current study support open subpectoralis biceps tenodesis as an acceptable option for the treatment of LHB pathology irrespective of the treated patient's body mass index. Both obese and non-obese patients demonstrated low postoperative DASH scores and high Oxford Shoulder scores.

Coronal plane deformity in the adult patient is a complex clinical problem. Once the hip, knee, and ankle joint centers lose collinerarity, the knee is exposed to abnormal loads across its tibiofemoral compartments, leading to early degenerative changes. Malalignment can coexist with arthrosis and ligamentous instability. High tibial osteotomy and distal femoral osteotomy have been useful tools to realign the adult knee. They can be performed along with ligament reconstruction and cartilage restoration procedures with high success rates. Despite novel techniques and fixation methods, principles of deformity correction should be followed to maximize clinical outcomes.

Articular cartilage is a specialized tissue that lines the surface of joints. Injuries to articular cartilage pose challenges due to poor healing potential. Focal cartilage defects are typically the result of high impact or repetitive loads to the articular surface. They tend to occur in the younger, active population and have been shown to cause swelling, pain, and joint dysfunction. Although the natural history of these lesions has never been definitively elucidated in the literature, clinical experience suggests that if left untreated, these lesions will demonstrate an inability to heal and may lead to prolonged increased articular peak stresses, which in turn may lead to pain and significant limitations in the future. The purpose of the present review is to provide the most current treatment options for these injuries and review the literature supporting their use.

The identification of biomarkers has become increasingly important in our fundamental understanding of the molecular basis for disease and subsequently in the advancement of modern medicine. Biomarkers have been identified in a plethora of normal and pathologic conditions and are most often found in blood, tissue, or synovial fluid. Orthopaedic research has more recently focused on biomarkers of cartilage and joint diseases, with an emphasis on understanding the molecular underpinnings of their pathophysiology. This article focuses on the biomarkers identified to date in several select knee pathologies and how further research can contribute to new diagnostic tools and targeted therapeutics.

Searchable abstracts may be found at http://www.ors.org/abstract-search/.

Bone marrow edema of the knee occurs secondary to a myriad of causes. The hallmark of a bone marrow lesion (BML) is an area of decreased signal intensity on T1 weighted MRI with a corresponding area of increased signal intensity on a T2 weighted MRI. Recently, chronic bone marrow lesions have been correlated with knee pain and progression of osteoarthritis. These lesions have also been associated with other degenerative conditions such as meniscal tears, cartilage deterioration, subchondral cyst formation, mechanical malalignment, and ultimately progression to arthroplasty. Medical treatments, such as prostacyclin and bisphosphonate therapy, have shown promise. Alignment procedures, as well as core decompression and subchondroplasty, have been used as surgical treatments for chronic BMLs.

Injuries to the pectoralis major muscle are relatively rare but result in pain, weakness, cosmetic deformity and in many cases, inability to return to previous levels of function. The most common cause of this injury is bench-pressing, as it places the muscle fibers in a position of mechanical disadvantage while under heavy load. The ability to detect and appropriately treat each patient with this injury is essential to restoring not only strength and function but also cosmesis. This article reviews the diagnostic workup of this injury and examines both the outcomes and techniques of non-operative and operative management.

Recent science education reform proponents explicitly put forward the idea that all students, regardless of culture, gender, race, or socioeconomic status, are capable of understanding and doing science. To address this need, the authors have developed and implemented a field-based urban ecology science program to engage traditionally underrepresented groups, such as minorities and women in real-world science. The authors describe the components of the program and discuss why the program has been successful in providing opportunities for all students to engage in and learn science. Using mixed methods to evaluate the program, they found that it improves student interest in science, supports students in developing a better understanding of scientific methodologies, and improves students' sense of environmental stewardship when compared with students experiencing traditional science instruction over the course of an academic year.

Recent publications, including Vision and Change in Undergraduate Biology Education (American Association for the Advancement of Science, 2009) and A New Biology for the 21st Century (National Research Council, 2009), highlight needed changes for undergraduate science education. These include a shift away from traditionally structured lab courses toward more authentic scientific inquiry experiences in undergraduate science laboratories. The aim of these reform initiatives is for students to develop not only conceptual understanding of the big ideas of science but also the skills required to conduct an investigation and an understanding of science as a human process of constructing scientific knowledge (National Research Council, 2011). The work that we describe here examines the challenges and successes of engaging nonscience majors in a large introductory university-level science course in conducting scientific inquiry. To understand the course structure and the nature of the laboratory experiences, we describe two different lab experiences. In both cases, students engaged in guided inquiry and then were asked to engage in a more open-ended inquiry experience. Our findings suggest that students need significant scaffolding to make the transition from more guided inquiry to more open-ended inquiry.

AC (acromioclavicular) joint dislocations are a common injury seen by physicians. Symptoms range from minor discomfort with activity to complete disability of the extremity. Although most orthopaedic surgeons agree on how to treat either mild (type 1-2) or severe (type 4-6) injuries, there is no consensus for treatment of type 3 injuries. This article reviews the relevant literature pertaining to the anatomy of the injury, evaluation of the patient, pertinent imaging as well as the controversial management of type 3 AC joint dislocations. With improvement in surgical techniques over the past 30 years, there have been many published studies evaluating both operative and non-operative care. Surgery has shown dramatic improvement in patient-rated outcomes; however, it is not always without complications. These risks in some patients may not be worth the potential surgical benefits. In type 3 AC joint injuries each patient and pathology must be carefully analyzed to ensure that the correct treatment option is chosen.

Bohr’s often quoted phrase “reduce experience to order” highlights that studying science is about collecting data through experiences, inferring patterns or relationships in those experiences, and then developing explanations that provide understanding into why certain patterns emerge and others do not. Geospatial technologies offer educators powerful learning resources to engage students in this scientific process. For 3 years, we have been using a range of geospatial technologies including online applications such as Google Earth to powerful desktop applications such as geographic information systems (GIS) to assist teachers who are introducing their students to the rapidly emerging field of urban ecology. Geospatial technologies along with computational modeling tools have proven to be a powerful way to support teachers and students as they critically examine their own neighborhoods.