Search

Background: Acute pancreatitis has been documented as a postoperative complication in both, the general surgery and orthopaedic literature. Most of the orthopaedic cases reported involve some type of spinal procedure (laminectomy and scoliosis). The etiology of this type of postoperative pancreatitis is not clear. The purpose of this study was to determine the incidence and possible predisposing factors for acute pancreatitis following scoliosis surgery in immature patients. Methods: Retrospective review of records and radiographs of patients with congenital or idiopathic scoliosis and kyphosis undergoing surgery over a three-year period (1995-1997). Neuromuscular and syndromic cases were excluded. Twenty-one clinical and radiological parameters were assessed in each patient. These included but were not limited to, body mass index, instrumentation type, type of operation, length of surgery, blood loss, intraoperative mean arterial pressure, levels of fusion and percentage of curve correction. Ninety-seven patients were included. Their mean age was 13 years (118 yr.). There were 83 females and 14 males. Results: Nine patients (9.3%) had elevated serum amylase and lipase levels. All of them were adolescent idiopathic cases. The only parameter found to be statistically different was age; 15.6 [+ or -] 1.6 yr. for the pancreatitis group versus 13.2 [+ or -] 2.9 for the asymptomatic group (p = 0.002). No further differences between the two groups were encountered. Estimated blood loss and low mean arterial pressure was nearly identical for both groups. Conclusion: In this retrospective study, 9 out of 97 patients (9.3%) with congenital or adolescent scoliosis developed chemical pancreatitis. The only significant factor was age (symptomatic patients were older). There were no other positive predictive factors associated to post-operative pancreatitis. Despite a delay in reaching a regular diet there was not difference in length of stay or physical therapy regimen between groups., S. Fealy, MD, F.J. Lapraza, MD, K.E. Schneider MD, P.J. Millett MD, R.F. Widmann MD. (Hospital for Special Surgery, New York, NY, [...]

Background: The number of total shoulder arthroplasties has increased exponentially over the last ten years, creating a more prominent role for revision shoulder arthroplasty in the future. The main reasons for failure of shoulder arthroplasty can be classified as soft-tissue deficiencies, osseous deficiencies, component wear, or infection. We hypothesized that, despite appropriate surgical techniques, the outcome of revision total shoulder replacement can be predicted on the basis of the indication for the revision procedure.Methods: We conducted a retrospective review of seventy-eight shoulders that had undergone revision shoulder arthroplasty. The shoulders were divided into two categories: (1) those with osseous or component-related problems and (2) those with soft-tissue deficiency. Category 1 consisted of four cohorts of shoulders: twenty-two treated with revision of the glenoid component, sixteen treated with conversion of a hemiarthroplasty to a total shoulder arthroplasty because of glenoid arthrosis, eight treated with revision of the humeral stem, and four treated for a periprosthetic fracture. Category 2 consisted of five cohorts of shoulders: ten treated with rotator cuff repair following total shoulder replacement, four with a failed tuberosity reconstruction, four with cuff tear arthropathy, five with instability, and five with infection. Patients were evaluated with the UCLA subjective outcome instrument, the L'Insalata shoulder questionnaire, and a subjective satisfaction scale (maximum score of 5 points).Results: The average UCLA score was 21.4 points and the average L'Insalata score was 68.73 points for the seventy-eight shoulders that were analyzed. The average score on the subjective satisfaction questionnaire was 2.91 points. According to the UCLA scores, twenty-four revisions were considered to have had an excellent result; fifteen, a good result; twenty-four, a fair result; and fifteen, a poor result. The average scores for the category-1 shoulders were significantly better than those for the category-2 shoulders (p < 0.05). Of the different types of operations, revision or implantation of a glenoid component and open reduction and internal fixation of a periprosthetic fracture provided the best outcomes. Tuberosity reconstruction, hemiarthroplasty for treatment of cuff tear arthropathy, and revision due to infection had uniformly poor outcomes.Conclusions: In general, these results indicate that the outcome of revision shoulder arthroplasty can be predicted on the basis of the indication for the procedure. Component revisions, excluding humeral head revision for salvage, provide the best results, whereas soft-tissue reconstructions can be expected to yield poorer results overall.Level Of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

BACKGROUND: Treatment of chronic, refractory biceps tendinitis remains controversial. The authors sought to evaluate clinical and functional outcomes of arthroscopic release of the long head of the biceps tendon. HYPOTHESIS: In specific cases of refractory biceps tendinitis, site-specific release of the long head of the biceps tendon may yield relief of pain and symptoms. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Fifty-four patients diagnosed with biceps tendinitis underwent arthroscopic release of the long head of the biceps tendon as an isolated procedure or as part of a concomitant shoulder procedure over a 2-year period. Patients were not excluded for concomitant shoulder abnormality, including degenerative joint disease, rotator cuff tears, Bankart lesions, or instability. Nine of 40 patients had an isolated arthroscopic release of the biceps tendon. At a minimum of 2 years, the American Shoulder and Elbow Surgeons; the University of California, Los Angeles; and the L'Insalata shoulder questionnaires as well as ipsilateral and contralateral metrics were used for evaluation. RESULTS: The L'Insalata; University of California, Los Angeles; and American Shoulder and Elbow Surgeons scores were 77.6, 27.6, and 75.6, respectively. Seventy percent had a Popeye sign at rest or during active elbow flexion; 82.7% of men and 36.5% of women had a positive Popeye sign (P < .05); 68% were rated as good, very good, or excellent. No patient reported arm pain at rest distally or proximally; 38% of patients complained of fatigue discomfort (soreness) isolated to the biceps muscle after resisted elbow flexion. CONCLUSION: Arthroscopic release of the long head of the biceps tendon is an appropriate and reliable intervention for patients with chronic, refractory biceps tendinitis. Cosmetic deformity presenting as a positive Popeye sign and fatigue discomfort were the primary complaints. CLINICAL RELEVANCE: Although tenotomy is not the ideal intervention for patients of all ages with various shoulder abnormalities, data suggest that it may be an acceptable surgical intervention for a specifically selected cohort of individuals. [ABSTRACT FROM AUTHOR]

Labral tears and acromioclavicular joint abnormalities were differentiated on physical examination using a new diagnostic test. The standing patient forward flexed the arm to 90 degrees with the elbow in full extension and then adducted the arm 10 degrees to 15 degrees medial to the sagittal plane of the body and internally rotated it so that the thumb pointed downward. The examiner, standing behind the patient, applied a uniform downward force to the arm. With the arm in the same position, the palm was then fully supinated and the maneuver was repeated. The test was considered positive if pain was elicited during the first maneuver, and was reduced or eliminated with the second. Pain localized to the acromioclavicular joint or 'on top' was diagnostic of acromioclavicular joint abnormality, whereas pain or painful clicking described as 'inside' the shoulder was considered indicative of labral abnormality. A prospective study was performed on 318 patients to determine the sensitivity, specificity, and positive and negative predictive values of the test. Fifty-three of 56 patients whose preoperative examinations indicated a labral tear had confirmed labral tears that were repaired at surgery. Fifty-five of 62 patients who had pain in the acromioclavicular joint and whose preoperative examinations indicated abnormalities in the joint had positive clinical, operative, or radiographic evidence of acromioclavicular injury. There were no false-negative results in either group. [ABSTRACT FROM AUTHOR]

Sixty patients with the diagnosis of reflex sympathetic dystrophy of the knee were evaluated retrospectively at our institution. The average followup was 2 years. Fifty-five (92%) patients treated with outpatient sympathetic blockade had resolution of the symptoms attributed to reflex sympathetic dystrophy. The time from onset of symptoms to initiation of treatment did not affect the ultimate outcome. The prognosis was most closely related to the presence or absence of an anatomic lesion that would continue to act as a painful stimulus. Eighty-one percent (29 of 36) of patients who had a significant anatomic lesion or surgical correction of a lesion had a complete resolution of their knee symptoms. However only 21% (5 of 24) of patients with a persistent anatomic lesion in the knee had complete resolution. Fourteen patients required preliminary sympathetic blockade therapy before the underlying cause could be identified. This study emphasizes the need for establishing a precise diagnosis before contemplating any surgery of the knee, including arthroscopy. Arthroscopic procedures were the most common event precipitating reflex sympathetic dystrophy in this study. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to identify and evaluate psychological interventions or strategies designed to reduce relocation stress in older people making the permanent transition into residential aged care., Method: A scoping review following the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was conducted. An electronic search of nine databases and the search engine google scholar was completed in December 2022. Article screening and quality appraisal was undertaken independently by at least two reviewers., Results: Eight full-text articles were included for review, from which four psychological interventions were identified: 1) Resident peer support; 2) Life review; 3) Mental Health Service for Older Adults; 4) The Program to Enhance Adjustment to Residential Living. No interventions were implemented before transitioning into care; all were implemented within three months of resident relocation into an aged care facility., Conclusion: The transition to residential aged care is an inherently distressing experience. The absence of interventions implemented during the pre- and mid-transition phases presents a gap in the literature and suggests an opportunity for early intervention. As population ageing continues to increase, there is a pressing need for the development and implementation of interventions aimed at reducing symptoms of depression and anxiety for older people undertaking this major life transition.

Background: During the COVID-19 pandemic, there was a rapid adoption of telehealth care services as a public health strategy to maintain access to essential health care. In Australia, there has been increasing optimism for the expansion of telehealth services. However, little is known about the patterns and determinants of telehealth adoption among older adults, with concerns that an expansion of telehealth services may only be of benefit to those who already have better access to health care., Objective: Leveraging data collected by The Sax Institute's 45 and Up COVID Insights study between November 2020 and April 2022, the objective of this study was to identify and describe the sociodemographic and health-related determinants of telehealth adoption and use among a cohort of older Australians. We hypothesized that health-related factors would be key determinants of telehealth adoption for Australians aged ≥65 years during the COVID-19 pandemic., Methods: A repeated cross-sectional design was used. The relationships between telehealth use (classified as low, moderate, or high) and selected sociodemographic and health-related characteristics were assessed using logistic regression techniques. Variable selection and findings were situated within the Technology Acceptance Model, the Unified Theory of Acceptance, and the Use of Technology theoretical frameworks., Results: Of the 21,830 participants aged ≥65 years, the proportion who indicated adopting telehealth ranged from 50.77% (11,082/21,830) at survey 1 in 2020 to 39.4% (7401/18,782) at survey 5 in 2022. High levels of telehealth use were associated with being female, aged <85 years, living in a major city, cohabiting with others, and being from the most socioeconomically disadvantaged areas (deciles 1-3). Individuals with a disability, chronic disease, multimorbidity, and lower perceived quality of life and those experiencing missed or delayed care were significantly more likely to use telehealth across all levels (P<.001). A temporal association was observed, whereby participants who engaged with telehealth services before or early in the pandemic (as assessed in survey 1) were more likely to continue telehealth use when assessed in survey 5 in 2022 (P<.001)., Conclusions: This research contributes to the broader understanding of telehealth adoption and use among older adults. As telehealth models of care expand, there is an opportunity to tailor these services to the needs of older adults, particularly those living with chronic diseases and multimorbidity, by using targeted strategies that overcome barriers to accessing specialized health care services., (©Shanna Fealy, Suzanne McLaren, Claire Ellen Seaman, Melissa Nott, Donovan Jones, Pauletta Irwin, Patricia Logan, Rachel Rossiter, Simon McDonald. Originally published in JMIR Aging (https://aging.jmir.org), 23.08.2024.)

Background: Baseball is one of the most popular sports among youth athletes in the United States, and among these players, pitchers are at a particularly high risk of sustaining an injury. Overuse of the arm from repetitive pitching is a common mechanism for injury. Despite the attention that overuse injury has received, little is known regarding the mechanism that leads to elbow injury. This study aims to determine the effect of increasing pitch count on elbow flexion at ball release in a youth pitching cohort. The authors hypothesize that elbow flexion would increase as pitch count increases., Methods: Study subjects included volunteers from youth baseball players from local teams and public advertisements. Retroreflective markers attached to bony landmarks were placed on the players according to International Shoulder Group recommendations. Pitchers threw an indoor simulated game. Three-dimensional marker trajectories were collected using a 12-camera optical motion capture system, and ball velocity was captured using a radar gun. Voluntary maximal isometric strength of the internal and external rotators was evaluated before and after pitching. Paired 2-tailed t tests were performed to determine if a significant change occurred between the fresh and fatigued sets., Results: Twelve adolescent male pitchers were recruited. Eleven of 12 pitchers completed the prescribed 6 sets of 15 pitches, culminating in a 90-pitch simulated game. The ball speed in the second set was found to be the highest in all pitchers and was considered the "peak set" (P = .021), whereas ball speed was the slowest in the sixth set of pitches and was therefore considered the "fatigue set" (P = .001). There was a moderate but statistically significant inverse correlation between elbow flexion at ball release and maximum internal rotation velocity (P = .005). Elbow flexion at ball release was also significantly positively correlated with shoulder abduction at ball release (P = .004). Elbow flexion at ball release was not significantly correlated with ball velocity (P = .108)., Conclusions: In a simulated game laboratory setting, increasing pitch count was associated with increasing elbow flexion angle at ball release in youth baseball pitchers. These findings demonstrate that pitching with fatigue may cause biomechanical changes that have been associated with increased rates of elbow injury in the adult throwing population. Further investigation on the association between elbow flexion angle and elbow injury in the youth baseball population is needed., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Prior to the Major League Baseball (MLB) draft, some pitchers undergo predraft magnetic resonance imaging (MRI). This study aimed to evaluate pre-draft elbow MRI on baseball pitchers who were entering the MLB draft to determine the presence or absence of pathology, the associations between these pathologies and ulnar collateral ligament (UCL) tears, and interobserver reliability regarding common MRI pathology., Methods: Predraft elbow MRI performed on prospective MLB pitchers between 2011 and 2017 were deidentified and then reviewed by two separate authors. The authors graded the MRI on several factors including presence or absence of: UCL ossification, UCL appearance (heterogeneous or not), UCL thickening (and location), UCL tear (partial vs. full thickness and location), muscle strain, flexor tendon tear, posteromedial osteophyte, sublime tubercle enthesophyte, and osseous stress reactions., Results: Overall, 245 predraft elbow MRI were reviewed. MRI abnormalities were found in 70% (171/245) of pitchers. UCL thickening was found in 20% (50/245) of pitchers. Regarding UCL tears, 3% had a full thickness tear and 24% had a partial thickness tear. Of full thickness tears, 86% were distal and 1 was midsubstance. Of partial thickness tears, 41% (24/58) were distal, 12% (7/58) were midsubstance, and 47% (27/58) were proximal. Periligamentous edema was present in 36% of pitchers while 14% had a flexor pronator muscle strain., Conclusion: The majority (70%) of pitchers entering the MLB draft had abnormal findings on their MRI, most commonly involving changes to the UCL. Interobserver reliability was acceptable following the definition of pathology when reading predraft elbow MRI on MLB prospects., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Introduction: Supporting the health and well-being of older Australians necessitates the implementation of effective and sustainable community-based interventions. Rural settings, however, pose unique challenges to intervention implementation and sustainability, with limited research exploring strategies employed to overcome these complexities., Objective: To identify enabling strategies that support the sustainable implementation of community-based health and well-being interventions for older adults in rural Australia., Design: A scoping review, following methods by Arksey and O'Malley and enhanced by elements of the Joanna Briggs Institute methodology for scoping reviews and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), was conducted. An electronic search of seven databases was completed in April 2023. A thematic analysis was applied to provide a comprehensive and contextualised understanding of the phenomenon of interest., Findings: Of 1277 records screened, 15 studies were identified and included for review. Five themes identified key enablers for rural implementation: (1) Co-designing for the local context; (2) Embedding local champions; (3) Leveraging existing local resources; (4) Maintaining impact beyond the end of the funded period and (5) Flexibility in funding models., Discussion: The sustainable implementation of interventions requires active community involvement and consultation through all stages of program design and delivery to effectively meet the health and well-being needs of older rural-dwelling Australians., Conclusion: Our findings advocate for clear implementation guidelines to support the design, delivery and adaptation of community-based programs that appropriately reflect the unique contextual needs and strengths of rural communities., (© 2024 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Introduction: This paper will describe the research protocol for the Deadly Aboriginal and Torres Strait Islander Nursing and Midwifery Mentoring (DANMM) Project, which will determine the feasibility and acceptability of a cultural mentoring programme designed for Aboriginal and Torres Strait Islander nurses and midwives across five diverse local health districts in New South Wales, Australia. Government and health agencies highlight the importance of culturally appropriate and safe environments for Aboriginal people. Specifically, New South Wales Health prioritises workforce strategies that support Aboriginal people to enter and stay in the health workforce. However, retaining Aboriginal nurses and midwives remains challenging. The DANMM Project aligns with these local and state-wide health plans and strategies, addressing critical issues of workforce cultural safety and retention., Methods and Analysis: A mixed-methods study design will be employed to assess feasibility, acceptability and preliminary efficacy of the DANMM Programme across five publicly funded local health districts in New South Wales, Australia. Adhering to cultural safety, a project cultural governance group will be formed. Quantitative outcome measures include the use of questionnaires (Nursing Workplace Satisfaction Questionnaire, Ganngaleh nga Yagaleh Cultural Safety assessment tool). Resource implications will be measured using the Organisational Commitment and Health Professional Program Readiness Assessment Compass. These will be triangulated with individual and group yarning circles to provide a holistic evaluation of the programme., Ethics and Dissemination: The study has ethics approval: Aboriginal Health and Medical Research Council (#2054/23); New South Wales Health Human Research Committees (Greater Western Human Research Committee #2022/ETH01971, Murrumbidgee-site-specific approval, Sydney Local Health District-site-specific approval, Western Sydney Local Health District-site-specific approval and Mid North Coast-site-specific approval); and Charles Sturt University Human Research Committee (#2054/23). Findings will be disseminated through peer-reviewed articles, conferences and through roundtable discussions with key stakeholders., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Idiopathic Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder worldwide. Due to ageing populations, prevalence estimates for PD are set to increase in western countries including Australia., Objective: This study aims to investigate the prevalence of PD in regional, rural and remote areas of Australia, to inform the provision of equitable PD-specific care., Design: A scoping review, following the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), was conducted. An electronic search of four databases and the search engine google scholar was completed in May 2022 and updated in September 2023. Article screening and quality appraisal were undertaken independently by at least two reviewers., Findings: Of 514 records screened, six articles (between 1966 and 2019) were identified and included for review. Wide variations in PD prevalence were evident, ranging from 0.58 to 8.5 per 1000 people. Two studies suggested prevalence may be higher in regional, rural and remote areas of Australia than in urban localities., Discussion: The limited number of studies identified, and wide variation in prevalence rates makes it difficult to draw firm conclusions to inform heath care planning and resource allocation., Conclusion: A paucity of reliable prevalence data indicates the need for well-designed, country-specific epidemiological studies to be conducted to estimate the actual impacts of the disease to inform public health planning, particularly in regional, rural and remote areas where access to PD-specific care is already inequitable., (© 2023 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Glenoid superior biceps-labral pathology diagnosis, treatment, and outcomes are an evolving area of shoulder surgery. Historically, described as superior labrum anterior posterior (SLAP) tears, these lesions were identified as a source of pain in throwing athletes. Diagnosis and treatments applied to these SLAP lesions resulted in less than optimal outcomes in some patients and a prevailing sense of confusion. The purpose of this paper is to perform a reappraisal of the anatomy, examination, imaging, and diagnosis by the American Shoulder and Elbow Surgeons/SLAP biceps study group. We sought to capture emerging concepts and suggest a more unified approach to evaluation and identify specific needs for future research., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Supporting women to achieve healthy gestational weight gain is a global health challenge. Inadequate and excessive gestational weight gains are associated with short and long-term adverse maternal and infant health outcomes. Qualitative studies suggest that symptoms of pregnancy, health professional attitudes, lack of guidance, personal knowledge and beliefs, lack of support, weight stigma, and lack of time and money, are barriers to achieving healthy weight gain. Less is known about women's perceptions and experience of gestational weight gain within normal body mass index categories with even less known about the experience of women motivated to participate in pregnancy weight management intervention trials., Aim: To describe the experience and perspectives of women participating in an Australian weight management pilot randomised controlled trial., Methods: Five women from regional New South Wales enrolled in the Eating 4 Two trial, participated in semi - structured interviews during the post-natal period. A qualitative descriptive methodology and inductive thematic analysis was applied., Findings: Two main themes emerged: 1) Addressing weight gain in pregnancy; and 2) Pregnancy weight the balancing act. Women identified weight gain as an important topic, the need for improvements within maternity services, responsive feedback and realistic support strategies. Women identified pregnancy symptoms, occurring during early and late pregnancy as barriers to achieving healthy weight gain., Conclusion: Further investigation into the effects of pregnancy symptoms on eating and physical activity patterns across pregnancy is warranted. Both qualitative and quantitative research is needed to monitor the translation of guideline recommendations into clinical practice., Competing Interests: Declaration of Competing Interest On behalf of all authors, I declare that there are no conflicts of interest., (Copyright © 2021. Published by Elsevier Ltd.)

Globally, there has been a renewed focus on addressing gestational weight gain (GWG). In Australia, the Department of Health pregnancy care guidelines recommend women be offered routine weighing and receive brief nutritional and physical activity support during antenatal care visits. Women gaining weight outside the Institute of Medicine (IOM)'s weight gain reference values are further recommended to be referred to a dietitian. However, professional and organizational barriers, including an absence of weight gain referral pathways and limited workforce resources, exist with the translation and scaling of these recommendations into practice. This study aimed to explore patterns of GWG among a cohort of Australian pregnant women and to determine if pregnancy weight gains of above or below 2 kg or 5 kg in the second and third trimester can be used to predict total GWG outside recommendations. Sensitivity, specificity, negative, and positive likelihood ratios were calculated. The most predictive time point was 24 weeks' gestation using the minimum weight change parameter of +/-2 kg, demonstrating reasonable sensitivity (0.81, 95% CI 0.61-0.83) and specificity (0.72, 95% CI 0.61-0.83), resulting in 55% ( n = 72/131) of the cohort qualifying for dietetic referral. Given the current health service constraints, a review of dietetic services within maternity care is warranted.

Background: Understanding specific risk profiles for each patient and their propensity to experience clinically meaningful improvement after anterior cruciate ligament reconstruction (ACLR) is important for preoperative patient counseling and management of expectations., Purpose: To develop machine learning algorithms to predict achievement of the minimal clinically important difference (MCID) on the International Knee Documentation Committee (IKDC) score at a minimum 2-year follow-up after ACLR., Study Design: Case-control study; Level of evidence, 3., Methods: An ACLR registry of patients from 27 fellowship-trained sports medicine surgeons at a large academic institution was retrospectively analyzed. Thirty-six variables were tested for predictive value. The study population was randomly partitioned into training and independent testing sets using a 70:30 split. Six machine learning algorithms (stochastic gradient boosting, random forest, neural network, support vector machine, adaptive gradient boosting, and elastic-net penalized logistic regression [ENPLR]) were trained using 10-fold cross-validation 3 times and internally validated on the independent set of patients. Algorithm performance was assessed using discrimination, calibration, Brier score, and decision-curve analysis., Results: A total of 442 patients, of whom 39 (8.8%) did not achieve the MCID, were included. The 5 most predictive features of achieving the MCID were body mass index ≤27.4, grade 0 medial collateral ligament examination (compared with other grades), intratunnel femoral tunnel fixation (compared with suspensory), no history of previous contralateral knee surgery, and achieving full knee extension preoperatively. The ENPLR algorithm had the best relative performance (C-statistic, 0.82; calibration intercept, 0.10; calibration slope, 1.15; Brier score, 0.068), demonstrating excellent predictive ability in the study's data set., Conclusion: Machine learning, specifically the ENPLR algorithm, demonstrated good performance for predicting a patient's propensity to achieve the MCID for the IKDC score after ACLR based on preoperative and intraoperative factors. The femoral tunnel fixation method was the only significant intraoperative variable. Range of motion and medial collateral ligament integrity were found to be important physical examination parameters. Increased body mass index and prior contralateral surgery were also significantly predictive of outcome., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: A.S.R. has received research support from DePuy and Stryker; consulting fees from Ceramtec, Medtronic, Moximed, Smith & Nephew, and Stryker; speaking fees from Ceramtec, Medtronic, Smith & Nephew, and Stryker Mako; and royalties from DePuy, Saunders/Mosby–Elsevier, Springer, and Stryker Mako and has stock/stock options in ConforMIS and Enhatch. R.J.W. has received research support from Histogenics; consulting fees from Arthrex, JRF Ortho, and Lipogems; royalties from Arthrex; hospitality payments from Stryker and has stock/stock options in BICMD, Cymedica, Engage Surgical, Gramercy Extremity Orthopedics, Pristine Surgical, and RecoverX. A.A.A. has received consulting fees from Arthrex and has stock/stock options in Pristine Surgical and Rom3. B.U.N. has received royalties from Remote Health. D.D. has received consulting fees and royalties from Zimmer Biomet. A.K. has received education payments from Arthrex. B.K. has received consulting and nonconsulting fees and royalties from Arthrex and speaking fees from Synthes GmbH. M.M. has received education payments from Arthrex. S.S. has received consulting fees from DePuy, Flexion Therapeutics, Pfizer, and Vericel and honoraria from JRF Ortho and Vericel. S.C. has received education payments from Pinnacle, consulting fees from Stryker, and nonconsulting fees from Smith & Nephew. J.H. has received hospitality payments from Smith & Nephew. R.W. has received royalties from Zimmer Biomet and nonconsulting fees from Arthrex. S.R. has received consulting fees from Flexion Therapeutics, nonconsulting fees from Smith & Nephew, honoraria from Fidia Pharma, and royalties from Zimmer Biomet and is a paid associate editor for The American Journal of Sports Medicine. S.F. has received royalties from Encore Medical. J.S.D. has received consulting fees from Arthrex, Merck Sharp & Dohme, Trice Medical, and Wright Medical; speaking fees from Arthrex; and royalties from Linvatec. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

The identification and measurement of psychosocial factors that are specific to pregnancy and relevant to gestational weight gain is a challenging task. Given the general lack of availability of pregnancy-specific psychosocial assessment instruments, the aim of this study was to develop a short-form psychosocial assessment tool for the detection of women at risk of excessive gestational weight gain with research and clinical practice applications. A staged scale reduction analysis of the weight-related behaviours questionnaire was conducted amongst a sample of 159 Australian pregnant women participating in the Women and Their Children's Health (WATCH) pregnancy cohort study. Exploratory factor analysis, univariate logistic regression, and item response theory techniques were used to derive the minimum and most predictive questions for inclusion in the short-form assessment tool. Of the total 49 questionnaire items, 11 items, all 4 body image items, n = 4 attitudes towards weight gain, and n = 3 self-efficacy items, were retained as the strongest predictors of excessive gestational weight gain. These within-scale items were highly correlated, exhibiting high item information function value statistics, and were observed to have high probability ( p < 0.05) for excessive gestational weight gain, in the univariate analysis. The short-form questionnaire may assist with the development of tailored health promotion interventions to support women psychologically and physiologically to optimise their pregnancy weight gain. Confirmatory factor analysis is now required.

Background: Anterior cruciate ligament (ACL) injuries are occurring with increasing frequency in the adolescent population. Outcomes after ACL reconstruction (ACLR) are inconsistently reported in homogeneous patient populations., Purpose/hypothesis: To evaluate outcomes after bone-patellar tendon-bone (BTB) autograft ACLR in competitive high school-aged athletes by examining return to sport (RTS), patient satisfaction, and reinjury rates. Our hypothesis was that RTS rates and satisfaction will be high and reinjury rates will be low., Study Design: Case series; Level of evidence, 4., Methods: An institutional ACL registry was utilized to identify competitive high school-aged athletes (14-18 years old) who underwent primary ACLR using BTB autograft with a minimum 2-year follow-up. A postoperative questionnaire was administered to determine rates and types of RTS, quality of sports performance, reinjury, and satisfaction. Uni- and multivariable analyses were used to identify demographic, sport-specific, and clinical factors related to RTS., Results: A total of 53 patients were included (mean ± SD age at the time of surgery, 16.6 ± 1.34 years). Mean follow-up was 3.78 ± 0.70 years (range, 2.60-4.94 years). The overall ipsilateral ACL retear rate was 7.5% (n = 4). There were 10 subsequent ACL tears to the contralateral knee (19%). Forty-four (83%) patients successfully returned to at least their prior level of sport at a mean 10.5 ± 8.7 months (range, 3-48 months). Overall satisfaction was high, with 91% of patients very satisfied with the outcome. Higher confidence levels regarding performance of the reconstructed knee were associated with increased probability of RTS on multivariate analysis., Conclusion: BTB autograft ACLR results in high rates of RTS and satisfaction and low rates of subsequent ipsilateral ACL injuries in competitive high school-aged athletes. Patients with higher confidence in performance of the reconstructed knee are more likely to return to at least their prior level of sport., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: B.U.N. has received grants and education payments from Arthrex; education payments from Smith & Nephew; hospitality payments from Stryker, Wright Medical, and Zimmer Biomet Holdings; and royalties from Remote Health. R.J.W. has received research support from Histogenics; consulting fees from Arthrex, JRF Ortho, and Lipogems; royalties from Arthrex; and hospitality payments from Stryker. R.J.W. also has stock or stock options in BICMD, Cymedica, Engage Surgical, Gramercy Extremity Orthopedics, Pristine Surgical, and RecoverX. J.S.D. has received research support and nonconsulting fees from Arthrex; consulting fees from Arthrex, Linvatec, Merck Sharp & Dohme, Trice Medical, and Wright Medical; and royalties from Linvatec, Thieme, and Wolters Kluwer Health–Lippincott Williams & Wilkins. D.W.A. has received consulting fees from Stryker Corp and hospitality payments from Arthrex. A.P. has received education payments from Arthrex; consulting fees from Exactech, Zimmer Biomet, and Stryker; nonconsulting fees from Smith & Nephew; and royalties Zimmer Biomet. A.A. has received consulting fees from Arthrex. D.D. has received consulting fees and royalties from Zimmer Biomet. A.R. has received nonconsulting fees from Arthrex and Smith & Nephew; education payments from Arthrex; consulting fees from Arthrex, Smith & Nephew, Stryker, and Flexion; and royalties from ConforMIS. A.K. has received education payments from Arthrex. B.K. has received consulting fees, nonconsulting fees, and royalties from Arthrex and faculty/speaker fees from Synthes GmbH. M.M. has received education payments from Arthrex. S.S. has received consulting fees from Flexion Therapeutics, Vericel, DePuy, and Pfizer and honoraria from Vericel and JRF Ortho. J.H. has received hospitality payments from Smith & Nephew. S.C. has received consulting fees and royalties from Stryker Corp, nonconsulting fees from Smith & Nephew, and education payments from Pinnacle. R.W. has received royalties from Arthrex and Zimmer Biomet and nonconsulting fees from Arthrex. S.R. has received consulting fees from Flexion Therapeutics, nonconsulting fees from Smith & Nephew, honoraria from Fidia Pharma, and royalties from Zimmer Biomet and is a paid associate editor for The American Journal of Sports Medicine. S.F. has received royalty payments from Encore. T.W. has royalty payments from Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

Problem: Studies investigating the direct and indirect relationships between psychosocial factors (i.e. attitudes, beliefs and values), health related behaviour (diet and physical activity) and gestational weight gain are increasing. To date heterogeneity of psychosocial measurement tools has limited research progress in this area, preventing measurement of effects by meta-analysis techniques., Aim: To conduct a revalidation analysis of a Weight Related Behaviours Questionnaire, originally developed by Kendall, Olson and Frangelico within the United States of America and assess its performance for use within the Australian context., Methods: A revalidation study using Exploratory Factor Analysis was undertaken to assess the factor structure and internal consistency of the six psychosocial scales of the Weight Related Behaviours Questionnaire, within the Woman and Their Children's Health (WATCH), pregnancy cohort. The questionnaire was self-completed between 18 - 20 weeks gestation. Psychosocial factors included; Weight locus of control; Self-efficacy; Attitudes towards weight gain; Body image, Feelings about the motherhood role; and Career orientation., Findings: Weight locus of control, Self-efficacy and Body image, retained the same factor structure as the original analysis. The remaining psychosocial factors observed a different factor structure in terms of loadings or number of factors. Deleted items modelling suggests the questionnaire could be strengthened and shortened., Conclusion: Weight Locus of control, Self-efficacy and Body image were observed as consistent, valid and reliable psychosocial measures for use within the Australian context. Further research is needed to confirm the model and investigate the potential for combining these scales into a shorter psychosocial measurement tool., Competing Interests: Declaration of Competing Interest On behalf of all authors I declare that there are no conflicts of interest., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Aim: To identify and describe the demographic and social-cognitive factors associated with excessive gestational weight gain using the Weight-Related Behaviours Questionnaire, within an Australian pregnancy cohort., Background: Supporting women to achieve optimal weight gain in pregnancy is complex. Social-cognitive factors are recognised antecedents to, and mediators of, weight related behaviour change. Less is known about their role during pregnancy., Methods: 159 women enrolled in a pregnancy cohort study completed the Weight-Related Behaviours Questionnaire (WRBQ) at approximately 19 weeks gestation, and total gestational weight gain was later measured at 36 weeks. Summary scores were reported descriptively. Multivariable logistic regression was used to test demographic (maternal age, pre pregnancy body mass index, parity, smoking status, marital status, education) and social-cognitive factors (weight locus of control, self- efficacy, attitudes towards weight gain, body image, feelings about motherhood, career orientation) as predictors of excessive gestational weight gain., Findings: Maternal age was the sole demographic factor predictive of excessive gestational weight gain. Older participants (34-41 yrs) were less likely to gain excessive weight when compare to younger participants (18-24 yrs): Odds Ratio 0.20, 95% Confidence Interval 0.05, 0.82. Body image (measured as personal satisfaction and perception of own weight) was the sole social-cognitive factor associated with excessive gestational weight gain. For every one unit improvement in body image score, there was a 33% decreased odds of excessive gestational weight gain (OR 0.67, 95% CI 0.53, 0.85)., Conclusion: This study suggests that younger maternal age and lower perceived body image are predictive of excessive gestational weight gain., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: During the perinatal period, 10-20% of women experience anxiety and/or depression. Untreated perinatal depression has the potential for adverse effects on the family and infant resulting in long-term deleterious consequences. This study measured the association between self-reported depression using the Edinburgh Postnatal Depression Scale scores, self-reported anxiety and neonatal birth outcomes., Methods: A retrospective design was used with ObstetriX™ data retrieved from 16 metropolitan and rural hospitals in NSW, Australia during 2009-2014. Data were available for 53,646 singleton births. The Edinburgh Postnatal Depression Scale was used to identify self-reported depression while women self-reported pregnancy related anxiety. Regression modelling measured the effects of self-reported depression and self-reported pregnancy related anxiety on neonatal birth outcomes. Linear regression and logistic regression were used to model the effect on birth weight, gestational age, admission to NICU or the SCN, outcome (stillborn vs livebirth), and Apgar scores. Cox proportional hazards regression was used to estimate the effect on neonatal length of stay., Results: Babies born to women self-reporting anxiety were more likely to have birth complications, be admitted to the nursery, had lower Apgar scores and longer hospital stays. Babies born to women self-identifying as experiencing a level of depression were more likely to have a lower birth weight, shorter gestational age, and, lower Apgar score. These babies were more likely to be admitted to the nursery with an increased length of stay., Conclusions: Perinatal anxiety and depression contribute to poor birth outcomes. Early detection of maternal perinatal anxiety and depression is an important step towards treatment interventions. More research is needed to identify models of care that are effective in identifying and managing perinatal depression and anxiety to improve birth outcomes for women and their babies.

Background: Inadequate or excessive gestational weight gain is associated with both short and long-term adverse maternal and infant health outcomes. The practice of routine maternal weight monitoring has been suggested as an effective health promotion intervention, both as a screening tool for adverse maternal and infant outcomes and as a weight management strategy for addressing gestational weight gain., Discussion: The effectiveness of routine maternal weighing as part of maternity care has been debated for more than 30 years. The National Health and Medical Research Council of Australia have recently revised their pregnancy care clinical practice guidelines recommending maternal weight monitoring (clinician and/or self-weighing) be reintroduced into clinical practice. This paper presents a timely discussion of the topic that will contribute new insights to the debate., Conclusion: Weight gain in pregnancy is complex. Evaluation of the translation, implementation, acceptability and uptake of the newly revised guidelines is warranted, given that evidence on the practice remains inconclusive. Future research exploring social ecological interventions to assist pregnant women achieve optimal gestational weight gains are suggested to expand the evidence base., (Copyright © 2019 Australian College of Midwives. All rights reserved.)

Background: Immersive virtual reality is an advancing technology that has the potential to change the traditional pedagogical approaches to teaching tertiary nursing and midwifery students. The application of immersive virtual reality in nursing and midwifery education may be a novel, accessible method for information provision and skill acquisition, however little is known of the extent of immersive virtual reality technology integration into tertiary nursing and midwifery programs., Objectives: The purpose of this review is to identify the application and integration of immersive virtual reality within nursing and midwifery tertiary education programs., Design: A scoping review based on the Joanna Briggs Institute methodology for scoping reviews was undertaken. An a priori review protocol and eligibility criterion was developed with the protocol subject to review a posteriori following first round screening. An electronic search of ten databases was conducted in January 2018., Results: A total of n = 506 non-duplicate records were identified and subjected to level one and level two screening. The search strategy and screening process identified n = 2 articles that were quality checked and included for review., Conclusions: There is currently a paucity of quality published literature on the application and/or integration of immersive virtual reality into nursing and midwifery tertiary education. Immersive virtual reality has the potential to increase competence and confidence for students providing accessible and repeatable learning opportunities in a fail-safe environment. There is a need for educators to be involved in the conceptualisation, design, integration and research of immersive virtual reality technology into undergraduate nursing and midwifery programs., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Aim: The aim of this study is to summarise the qualitative findings from systematic reviews to identify what pregnant women perceive as barriers and enablers to smoking cessation during pregnancy., Background: Smoking during pregnancy is a predictor of adverse maternal and infant outcomes. Despite known health risks, less than half of pregnant smokers quit during pregnancy., Methods: An umbrella review using the Johanna Briggs Institute methodology was conducted. A comprehensive literature review was completed in July 2017. All included papers were subject to an eligibility criterion and checked for quality by at least two reviewers., Findings: A total of n=529 papers were identified and screened. Of these, only two met all inclusion and quality criteria and were included for review. More barriers than facilitators were identified from the available literature., Conclusion: An enabler or barrier to smoking cessation for pregnant women is not a fixed entity but dependent on the context of an individual's life. What is an enabler for one woman may be considered a barrier for another, and these are dependent on support provided by family and friends. Further research is needed to optimise ways of addressing these barriers., (Copyright © 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Aim: To report a pilot trial protocol for testing the effectiveness of the Support for New Mums smartphone application in a cohort of first-time mothers., Design: A pilot/feasibility randomized controlled trial using a two-group pre-test and repeated post-test design., Method: This protocol follows the Standard Protocol Items: Recommendations for Intervention Trials (SPIRIT) guidelines. The Intervention group will receive access to the smartphone application for 6 weeks post birth. Both Intervention and control groups will receive standardized institutional postnatal care services. Trial funding was gained from respective grant sponsors in May and November 2016., Discussion: The Support for New Mums smartphone application could be a novel method for addressing the gap in provision of postpartum care services providing psychoeducation and improving maternal parental self-efficacy for Australian childbearing women., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001580268., (© 2019 John Wiley & Sons Ltd.)

Background: Although batters are frequently hit by pitch (HBP) in baseball, the effect of HBP injuries remains undefined in the literature., Purpose: To determine the effect of HBP injuries in terms of time out of play, injury patterns resulting in the greatest time out of play, and the value of protective gear such as helmets and elbow pads., Study Design: Descriptive laboratory study., Methods: Based on the Major League Baseball (MLB) Health and Injury Tracking System, all injuries to batters HBP during the 2011-2015 MLB and Minor League Baseball (MiLB) seasons were identified and analyzed. Video analysis was performed on all HBP events from the 2015 MLB season. Multivariate stepwise regression analysis was utilized to determine the predictive capacity of multiple variables (velocity, pitch type, location, etc) on injury status and severity., Results: A total of 2920 HBP injuries resulted in 24,624 days missed (DM) over the 5 seasons. MLB HBP injuries occurred at a rate of 1 per 2554 plate appearances (1 per 9780 pitches thrown). Mean DM per injury were 8.4 (11.7 for MLB vs 8.0 for MiLB, P < .001). Surgery was required for 3.1% of MLB injuries and 1.2% of MiLB injuries ( P = .005). The most common body regions injured were the hand/fingers (n = 638, 21.8%), head/face (n = 497, 17.0%), and elbow (n = 440, 15.7%), and there were 146 (5.0%) concussions. Injury rates and mean DM correlated with velocity in a near linear fashion. Players hit in the head/face (odds ratio, 28.7) or distal upper extremity (odds ratio, 6.4) were more likely to be injured than players HBP in other locations. Players with an unprotected elbow missed 1.7 more days (95% CI, -4.1 to 7.6) than those with an elbow protector ( P = .554) when injured after being HBP., Conclusion/clinical Relevance: Although HBP injuries occur infrequently in the course of normal play, they collectively represent a significant source of time out of play. The most common body regions injured include the hands/fingers and head/face, and batters hit in these locations are significantly more likely to be injured. After contusions, concussions were the most common injury diagnosis.

Background: Few studies have investigated detailed 3-dimensional lower extremity kinematics during baseball pitching in adolescent athletes during extended play. Changes in these parameters may affect performance outcomes., Purpose: To investigate whether adolescent baseball pitchers experience changes in lower extremity kinematics and event timing during a simulated game-length pitching bout., Study Design: Descriptive laboratory study., Methods: Twelve male adolescent pitchers (aged 14-16 years) threw 6 sets of 15 fastball pitches from an artificial pitching mound to a target at regulation distance. Joint angles and angular velocities at the hip, knee, and ankle of both legs were collected throughout the phases of the pitching cycle as well as stride length, pelvis orientation, pitch duration, timing of foot contact and ball release, ball speed, and pitching accuracy. Paired t tests ( P < .05) were used to compare the dependent variables between the last 5 pitches of the second (baseline) and sixth (final) sets., Results: During the stride phase, decreased maximum angular excursions for hip extension (baseline: 14.7° ± 9.8°; final: 11.6° ± 10.3°; P < .05) and ankle plantar flexion (baseline: 30.2° ± 14.5°; final: 24.2° ± 15.3°; P < .05) as well as maximum angular velocity for knee extension (baseline: 144.9 ± 63.3 deg·s -1 ; final: 121.7 ± 62.0 deg·s -1 ; P < .05) were observed between sets in the trailing leg. At foot contact, pitchers had decreased hip flexion (baseline: 69.5° ± 10.1°; final: 66.5° ± 11.8°; P < .05) and increased hip abduction (baseline: 20.7° ± 8.9°; final: 25.4° ± 6.0°; P < .05) in the leading leg in the final set. Compared with the baseline set, ball speed significantly decreased in the final set (29.5 ± 2.5 m·s -1 vs 28.3 ± 2.5 m·s -1 , respectively; P < .05)., Conclusion: Kinematic changes and decreased ball speeds observed in the final set suggest that adolescent pitchers are unable to maintain lower extremity kinematics and performance as a result of extended play., Clinical Relevance: The results from this study may warrant further investigation into how altered lower extremity kinematics may affect trunk and upper extremity function, performance, and risk of injuries during pitching in adolescent athletes, particularly during actual game play.

In 2010, Major League Baseball and the Major League Baseball Players Association reached an agreement regarding the development and implementation of an electronic medical record system and a new league-wide injury surveillance system. The systems were developed to create a more efficient method to track medical histories of players longitudinally as they move across Major and Minor league affiliates, as well as to identify and monitor injury trends in the sport, identify areas of specific concern, and conduct epidemiologic research to better optimize player health and safety. The resulting injury surveillance system, the Health and Injury Tracking System (HITS), is a robust system that includes all players from the both the Major and Minor Leagues. HITS also allows for data linkage with other player- and game-level data to inform the development of injury prevention policies and programs. In the present article, we document the development and implementation of HITS; describe its utility for epidemiologic research; illustrate the potential analytic strength of the surveillance system and its ability to inform policy change; and note the potential for this new surveillance system to advance the field of sports injury epidemiology., (© The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Problem: Obesity in pregnancy is associated with an increased incidence of maternal and foetal morbidity and mortality, from conditions like preeclampsia, gestational diabetes, preterm birth and stillbirth. Between 20% and 25% of pregnant women in Australia are presenting to their first antenatal appointment with a body mass index (BMI) ≥ 30 kg/m(2), defined as obesity in pregnancy. These figures are concerning for midwifery and obstetric staff directly involved in the clinical care of these women and their families. In the absence of national or state clinical practice guidelines for managing the risks for obese pregnant women, a local quality improvement project was conducted., Aim: To plan, implement, and evaluate the impact of an alternative clinical care pathway for pregnant women with a BMI ≥ 35 kg/m(2) at their first antenatal visit., Project Setting: The project was undertaken in the antenatal clinic of a rural referral hospital in NSW, Australia., Subjects: Eighty-two women with a BMI ≥ 35 kg/m(2) were eligible for the alternative care pathway, offered between January and December 2010., Intervention: The alternative care pathway included the following options, in addition to usual care: written information on obesity in pregnancy, referral to a dietitian, early plus repeat screening for gestational diabetes, liver and renal function pathology tests, serial self-weighing, serial foetal growth ultrasounds, and a pre-labour anaesthetic consultation., Findings: Despite being educated on the risk associated with obesity in pregnancy, women did not take up the offers of dietetic support or self-weighing at each antenatal visit. Ultrasounds were well received and most women underwent gestational diabetes screening., (Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.)

Objective: To investigate the efficacy of using contrast-enhanced ultrasound to assess the relationship of altered vascularity and tendon morphology following injection of platelet-rich plasma (PRP) for lateral epicondylitis., Materials and Methods: This study prospectively evaluated six patients who had a baseline ultrasound confirming tendinosis of the common extensor tendon. Patients received a single 3-ml PRP injection under ultrasound guidance. Grayscale images of the injected elbow were obtained at baseline and were repeated at 1 and 6 months after injection. DEFINITY® contrast was also injected after by 2 sets of wrist-extension exercises in order to obtain contrast-enhanced images of the elbow. Qualitative and quantitative analyses of the level of enhancement to the regions of interest were performed using off-line quantitative analysis software., Results: All patients had either moderate or severe common extensor tendinosis as determined on clinical examination and baseline imaging. Five patients demonstrated improved tendon morphology using ultrasound imaging 6 months after PRP injection (one patient was lost to follow-up). At baseline, there was evidence of increased vascularity at the myotendinous junction (MT) of the common extensor tendon when compared to its footprint (FP). There was a trend towards no change in FP vascularity between baseline and 6 months (p = 0.062) and between 1 and 6 months (p = 0.288). There was a trend for increased vascularity to the MT region from baseline to 6 months (p = 0.433) and from 1 to 6 months (p = 0.783)., Conclusions: Contrast-enhanced ultrasound provides a sensitive method the display alterations in vascularity in the common extensor tendon of the elbow. PRP therapy for lateral epicondylitis can improve extensor tendon morphology. Corresponding increased extensor tendon FP vascularity, however, was not seen. There is a trend for increased vascularity at the MT up to 6 months following PRP injection, based on limited pilot data.

Background: The objectives of this study were to characterize and compare the vascularity of arthroscopically repaired rotator cuff tendons at short-term and intermediate-term follow-up., Materials and Methods: Nineteen patients who underwent arthroscopic rotator cuff repair were prospectively monitored for an average of 21.2 months. Initial baseline, grayscale ultrasound images of the operated-on shoulder were obtained on all patients at 3 months and at a minimum of 10 months postoperatively. Perflutren-lipid microsphere contrast (DEFINITY, Lantheus Medical Imaging, North Billerica, MA, USA) was injected after baseline grayscale images and after exercise to obtain contrast-enhanced images of the repair. Three regions of interest--supraspinatus tendon, peribursal tissue, and bone anchor site--were evaluated before and after rotator cuff-specific exercises., Results: The peribursal tissue demonstrated the greatest blood flow, followed by the bone anchor site and tendon, in pre-exercise and postexercise states. Significantly less blood flow was observed in all regions of interest before exercise (P < .05) and only at the bone anchor site after exercise (P < .001) at latest follow-up compared with the 3-month values. Intratendinous blood flow remained relatively low at both evaluation points after surgical repair., Conclusion: Preliminary findings suggest that the peribursal tissue and bone anchor site are the main conduits of blood flow for the rotator cuff tendon after arthroscopic repair, with the supraspinatus tendon being relatively avascular. Blood flow of the repaired rotator cuff tendon decreases with time. Furthermore, exercise significantly enhances blood flow to the repaired rotator cuff., (Copyright © 2012. Published by Mosby, Inc.)

Objectives: To characterize the distribution of vascularity of the postoperative rotator cuff tendon using a maximum intensity projection technique after contrast-enhanced sonography., Methods: We retrospectively evaluated image data on 23 patients (11 male and 12 female) with intact rotator cuff repairs who had previously undergone contrast-enhanced sonography of their shoulders using lipid microspheres before and after a standardized exercise protocol. The patients were on average 3 months out from their surgery. Using offline image analysis software, a maximum intensity projection image was obtained for each patient, reflecting the regional vascular distribution within the repair and adjacent soft tissue. Subjective analysis was performed in 4 regions of interest: peribursal, articular medial, articular lateral, and suture anchor, independently by 2 musculoskeletal radiologists using a semiquantitative scale ranging from 0 to 4 for each region (0, no enhancement; 1, 1%-25% enhancement; 2, 26%-50%; 3, 51%-75%; and 4, 76%-100%). A combined vascularity score (0-8) was produced for each region and formed the basis for the subjective analysis., Results: Using a Mann-Whitney nonparametric test, the data showed significantly higher regional enhancement in the peribursal and suture anchor regions compared to the tendon (P < .001). Exercise resulted in a statistically significant increase in the extent of enhancement in all regions (P < .002). Inter-rater reliability analysis using a weighted κ statistic showed strong agreement (0.63-0.64) for the suture anchor site and moderate agreement for the others (peribursal, 0.35-0.39; articular medial, 0.45-0.55; and articular lateral 0.32-0.33)., Conclusions: The maximum intensity projection technique after contrast-enhanced sonography provides a topographic map of rotator cuff vascularity; the latter has been implicated as an important factor in promoting bone-tendon healing. Approximately 3 months after rotator cuff repair, the suture anchor and peribursal regions showed the most robust vascularity. Maximum intensity projection imaging further establishes that there is a global increase in vascular response at the repair site after exercise.