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Infections can have a significant impact on morbidity and mortality in multiple sclerosis (MS) patients. Therefore, vaccinations are of immense importance. If vaccination willingness is to be increased, possible influencing factors should be identified. The aim of the present study was to investigate the status of active immunisation in MS patients in association with sociodemographic, clinical-neurological, psychopathological and personality variables using the NEO-Five Factor Inventory, the Temperament and Character Inventory-Revised and the Hospital Anxiety and Depression Scale.Four hundred and four MS patients from two German neurological hospitals were examined for their vaccination attitudes, in detail, the general willingness to vaccinate and the current vaccination status of mumps, measles and rubella (MMR) as well as tetanus and influenza. We also looked at the current level of disability in relation to the current vaccination status, as well as possible associated personality and psychopathological variables.Patients with a complete MMR vaccination status were significantly younger and those with a complete influenza vaccination status were significantly older than those with related incomplete vaccination status. Tetanus vaccination status completeness did not differ depending on age and did not show substantial association with personality scores. However, influenza vaccination completeness was associated with differences in personality and psychopathological variables; extraversion, openness, novelty seeking, harm avoidance and anxiety. A reported general vaccination willingness was significantly correlated with the current completeness of tetanus and influenza vaccinations. Novelty seeking, persistence, extraversion, agreeableness, conscientiousness and neuroticism were found associated with an increased vaccination willingness. Anxiety and depression were not related to general vaccination willingness.No specific personality trait could be defined on its own in relation to general vaccination willingness or complete vaccination status. Younger patients should be made more aware of influenza vaccination. Reasons for rather low vaccination rates need to be further investigated.

Background: Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection represents a serious health risk, especially in chronically ill people. Multiple sclerosis (MS) is the most common chronic immune-mediated neurological disease. Vaccinations play an important role in the therapeutic MS management. This study aimed at determining MS patients’ attitudes toward vaccinations and governmental measures before and during the SARS-CoV-2 pandemic, including associations with sociodemographic and clinical variables. Methods: In a longitudinal, multicenter study, 200 MS patients were investigated regarding their vaccination attitudes before and after the first wave of the SARS-CoV-2 pandemic. Data on vaccination status and burden (physical, psychological, and social) experienced as caused by the pandemic and related governmental safety measures were registered. Results: Patients with progressive MS felt significantly more pandemic-burdened than patients with relapsing-onset MS (p < 0.001). Older patients were more frequently willing to get vaccinated against SARS-CoV-2 than younger patients (p < 0.001). After the first pandemic wave, patients with pre-pandemic willingness to comply with vaccination recommendations were more likely to accept recommended standard vaccinations (60% vs. 36%) and a possible SARS-CoV-2 vaccination than pre-pandemic nonwilling patients (66.7% vs. 42.0%). Conclusions: The vaccination topic was not immediately present in many patients before the pandemic. MS patients need comprehensive and understandable education meeting their concerns using evidence-based and convincing arguments on the subject of vaccination, particularly younger patients. Older patients are already more often willing to become vaccinated. Complete vaccination status is necessary to avoid multiple infections.

Background: Medial patellofemoral ligament reconstruction in skeletally immature patients who experience lateral patellar dislocation has been reported to yield good results. Whether bony abnormalities such as patellar height and trochlear dysplasia should be addressed additionally is a topic of discussion. Purpose: To evaluate patient-reported outcomes and redislocation rates after isolated medial patellofemoral ligament reconstruction as first-line surgical treatment for lateral patellar dislocation in skeletally immature patients. Further, to analyze epidemiological, intraoperative, and radiographical factors influencing redislocation and clinical outcome. Study Design: Case series; Level of evidence, 4. Methods: Prospectively collected data were retrospectively analyzed for adolescent patients younger than 16 years who underwent medial patellofemoral ligament reconstruction between 2014 and 2018. Inclusion criteria were isolated medial patellofemoral ligament reconstruction with gracilis tendon and availability of accurate pre- and postoperative radiographs with the presence of open physes. The patients were questioned regarding further surgery, redislocation, and clinical outcomes using the Tegner Activity Scale, International Knee Documentation Committee (IKDC) Subjective Knee Form, Lysholm score, and Kujala score. The influence of diverse epidemiological, intraoperative, and radiographical parameters on the redislocation rates and clinical outcome was analyzed. Results: A total of 54 medial patellofemoral ligament reconstructions (49 patients) met the inclusion criteria. After 4.3 ± 1.7 years (range, 2.0-7.3 years), 45 reconstructions (83.3%) in 41 patients were available for follow-up. The distribution of trochlear dysplasia was as follows: type A and B, 19 cases (42.2%) each; type C, 6 cases (13.3%); and type D, 1 case (2.2%). Patellar redislocation occurred in 3 patients (6.7%). The mean Tegner, subjective IKDC, Lysholm, and Kujala scores at follow-up were 6.3 ± 1.6 (range, 3-9), 93.6 ± 8.8, 95.9 ± 7.4, and 97.9 ± 7.1, respectively. Patellar height and trochlear dysplasia had no influence on redislocation or clinical scores. The Lysholm score was lower in knees with intraoperative retropatellar chondral lesion grade ≥III versus grade Conclusion: Isolated medial patellofemoral ligament reconstruction as first-line surgical treatment in skeletally immature patients yields excellent midterm results, irrespective of patellar height and trochlear dysplasia. Redislocation still occurs in a certain number of patients, and a higher degree of retropatellar chondral lesion is a predictor for a worse clinical outcome.

The purpose of this study was to prospectively evaluate the clinical and radiological results of double level osteotomy (distal femoral lateral closed wedge and proximal tibial medial open wedge) in medial osteoarthritis and varus malalignment due to bifocal deformity of femur and tibia.From 2017 to 2019 all cases of DLO in osteoarthritic varus malaligned knees with bifocal deformity (femoral and tibial deformity) were prospectively enrolled into this observational therapeutic study. Evaluation was performed preoperatively, at six, twelve, 18 and 24 months with regard to survival (not requiring arthroplasty), functional outcome [subjective International Knee Documentation Committee score (IKDC), Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome score (KOOS) and Tegner Activity Scale], pain level (numeric rating scale), subjective satisfaction (rating 1-5), radiographic parameters on a pre-and postoperative full leg x-rays (mechanical axis, mechanical proximal tibial and distal femoral angles) and complications. For statistical evaluation student's t test, Mann-Whitney U test and Wilcoxon-signed-rank test were used.Fifty-two consecutive cases in 48 patients were enrolled in the study. Three cases were excluded, resulting in a follow-up rate of 94%. No arthroplasties were performed within follow-up. All functional outcome scores substantially and significantly increased as early as six months after the index procedure and further increased until final follow-up (p 0.001). Pain level significantly decreased (p 0.001). At final follow-up all patients stated that they would retrospectively undergo the operation again, and rated the result with 4.5 ± 0.6 out of 5 (3-5). Radiographic parameters were within physiological limits postoperatively. No severe complications occurred.Double level osteotomy has excellent short-term results while maintaining physiological radiographic parameters. Therefore, it should be an integral part and standard procedure in realignment surgery for monocompartimental osteoarthritis.IV (prospective observational therapeutic study).

To determine the prevalence of an "increased posterior tibial slope (PTS)" (PTS ≥ 12°) in a population with one, two or ≥ three anterior cruciate ligament (ACL) graft insufficiencies. Furthermore, to investigate whether the prevalence of an increased PTS and the absolute PTS increases with an increasing number of ACL graft insufficiencies, as well as to determine the survival time of the first ACL graft.Patients diagnosed with an ACL graft insufficiency between January 2021 and March 2022 were included. The PTS was measured using the proximal anatomical tibial axis on long lateral knee radiographs. Patients were divided into 3 groups depending on the number of ACL graft insufficiencies: group A (1 graft insufficiency), group B (2 graft insufficiencies) and group C (≥ 3 graft insufficiencies). The prevalence of increased PTS and absolute PTS between groups was compared alongside the survival of the first ACL graft between patients with or without increased PTS.Two-hundred and six patients (147 males/59 females) met the inclusion criteria. 73 patients showed an increased PTS [prevalence 35% [95% confidence interval (CI) (29%; 42%)]. 155 patients were found in category A, 42 patients in B and 9 patients in C. The prevalence of increased PTS for group A, B and C was, 32% [95% CI (25%; 40%)], 38% [95% CI (23%; 53%)] and 78% [95% CI (51%; 100%)], respectively. The prevalence of increased PTS and mean PTS did not increase significantly between group A and B. However, both parameters increased significantly between group A and C, and group B and C (p 0.05). The survival time of the first ACL graft in patients with or without an increased PTS was 3 (interquartile range (IQR) 5) and 6 years (IQR 9), respectively (p 0.05).There is a 35% prevalence of increased PTS in the studied ACL graft insufficient patient cohort. The survival of the first ACL graft is shorter in patients with an increased PTS. Surgeons should be aware of the high prevalence of increased PTS when consulting patients for revision ACL reconstruction as it is an important risk factor for recurrent instability.

Arthroskopische Therapie vollschichtiger Knorpeldefekte des Kniegelenks zur Wiederherstellung der Gelenkflache. Lokalisierte Knorpeldefekte des Kniegelenks (ICRS [International Cartilage Repair Society] ≥ Grad 3) ab einer Grose von ca. 2,5 cm2. Arthrose (Kellgren-Lawrence > Grad 2), knocherne Defektsituation, Knorpelschaden der gegenuberliegenden Gelenkflache (ICRS > Grad 2), Bandinstabilitaten, Achsabweichung zu Ungunsten des betroffenen Gelenkkompartiments (>3–4°), entzundliche Gelenkerkrankungen. Ersteingriff (Zellentnahme): Behandlung von Begleitpathologien, Knorpeldefektpraparation, Entnahme von Knorpel-Knochen-Zylindern fur die Zellkultivierung. Zweiteingriff (Zellimplantation): Trockenarthroskopie, Reinigung und Trocknung des vorpraparierten Defekts, Implantation der in situ polymerisierbaren Knorpelzellsuspension. Ersteingriff (Zellentnahme): fruhfunktionelle Nachbehandlung mit schmerzadaptierter Vollbelastung. Zweiteingriff (Zellimplantation): keine Drainage, Streckorthese fur 4 Tage, dann freie Beweglichkeit, Teilbelastung fur 4 Wochen bei femoropatellarer Transplantation und fur 8 Wochen bei femorotibialer Transplantation, CPM(„continuous passive motion“)-Schiene ab der 2. postoperativen Woche, Fahrrad‑/Ergometerbelastung ab der 9. postoperativen Woche. In der Literatur wird fur die autologe Chondrozytentransplantation (ACT) am Kniegelenk gerade bei groseren Knorpeldefekten von guten Ergebnissen berichtet. Arthroskopische Techniken sollen die Komplikationsraten und die perioperative Morbiditat weiter senken. Im eigenen Kollektiv traten keine technikspezifischen Komplikationen auf. Von 2012 bis 2015 wurden 98 Patienten mit der beschriebenen Technik behandelt. Davon konnten 62 Patienten mit einem Follow-up von 31,0 ± 14,8 (12,5 bis 61,4) Monaten retrospektiv evaluiert werden. Bei 15 Patienten (28 %) wurden Begleiteingriffe (7 vordere Kreuzbandrekonstruktionen, 3 Umstellungsosteotomien und 5 Rekonstruktionen des medialen patellofemoralen Ligaments) durchgefuhrt. Die durchschnittliche Knorpeldefektgrose betrug 4,7 ± 2,8 cm2, und bei 18 Patienten (29 %) wurden multifokale Knorpelschaden behandelt. Der subjektive IKDC(International Knee Documentation Committee)-Score und Gesamt-KOOS (Knee injury and Osteoarthritis Outcome Score) ergaben 66 ± 10 und 73 ± 19 Punkte.

Vaccination is a key strategy for controlling the SARS-CoV-2 pandemic. Acceptance of SARS-CoV-2 vaccines by chronically ill patients, such as multiple sclerosis (MS) patients, plays an important role in prevention of complicated disease course. This longitudinal, prospective, multi-centre-study of German MS-patients aimed to detect socio-demographic, clinical, or psychological determinants of attitudes towards standard vaccines, SARS-CoV-2 vaccines, and governmental measures before/during the pandemic. Exactly 404 MS-patients were investigated by standardized questionnaires and structured interviews on socio-demographic, clinical-neurological, and psychological characteristics, vaccination status, and vaccination from June 2019. Data on SARS-CoV-2 vaccination willingness were collected in two follow-up assessments (1st: June to July 2020, before SARS-CoV-2 vaccine availability, N = 200; 2nd: March to May 2021, after SARS-CoV-2 vaccine availability, N = 157). Age, sex, MS course type, depression, and personality characteristics (Extraversion, Novelty seeking, Self-directedness, and Cooperativeness) were significantly associated with vaccination willingness. Although the majority of MS-patients showed SARS-CoV-2 vaccination willingness at both follow-ups (1st: 60%, 2nd: 61%), a substantial proportion had concerns and were undecided or opposed to vaccination. Socio-demographic variables like age and sex, psychopathological status, and various personality characteristics might influence vaccination willingness and should be considered when discussing with MS-patients about SARS-CoV-2 vaccination.

To determine and compare the incidence of post-operative septic arthritis following revision anterior cruciate ligament reconstruction (R-ACLR) with autologous quadriceps tendon (with patellar bone block) compared to autologous hamstring tendons (semitendinosus and gracilis). A total of 1638 isolated R-ACLR with either autologous hamstring tendons (n = 1004, 61.3%) or quadriceps tendon (n = 634; 38.7%) were performed between 2004 and 2017 and were retrospectively analysed with regard to the occurrence of post-operative septic arthritis. The technique of R-ACLR did not significantly change during the years of the study. All patients received pre-op i.v.antibiotics, but no presoaking of the grafts in vancomycin was performed in the years of the study. The individual decision of graft choice was based on graft availability, tunnel position and the presence of tunnel widening. Generally, hamstring tendons were preferred. There were no clinically relevant differences between the groups regarding gender or age. Routine follow-up examination was performed 6 weeks after the index operation (follow-up rate 96.5%), and patients unsuspicious for septic arthritis at that time were classified as non-infected. Fourteen patients with septic arthritis were identified, resulting in an overall incidence of 0.85%. There was one patient with septic arthritis in the quadriceps tendon group (incidence: 0.16%) and 13 patients in the hamstring tendons group (incidence: 1.29%), respectively. The difference was significant (p = 0.013). In this series, the incidence of post-operative septic arthritis after R-ACLR was lower when quadriceps tendon graft was used compared to hamstring tendon grafts. III.

To determine and compare the incidence of postoperative septic arthritis following revision anterior cruciate ligament reconstruction (R-ACLR) with and without soaking of the graft in vancomycin solution prior to implantation in a large single-centre series. A total of 2155 isolated R-ACLR with autologous tendons were performed from 2004 to 2019 and were reviewed with regard to the occurrence of postoperative septic arthritis. From February 2017 onwards, all grafts were wrapped in a vancomycin-soaked (5 mg/ml) gauze swab between harvest and implantation (517 patients, treatment group (2), prospectively followed). These were compared to 1638 patients before that date (control group (1), retrospectively evaluated). The technique of R-ACLR did not significantly change during the years of the study. Hamstring tendons were used in 1310 patients (60.8%) and quadriceps tendons with patellar bone block were used in 845 patients (39.2%), respectively, with no difference between the groups (n.s.). Routine follow-up examination was performed 6 weeks postoperatively (follow-up rate 96.5%), and patients with no treatment for septic arthritis until that time were classified as non-infected. There were 14 cases of postoperative septic arthritis in group 1 (incidence 0.9%), and none in group 2 (incidence 0.0%), respectively. The difference was significant (p = 0.029). Soaking of the graft in vancomycin solution prior to implantation dramatically reduces the incidence of postoperative septic arthritis in R-ACLR. III.

Losing the social support from family and friends may affect coping, resilience and increase a risk of mental health problems among pregnant teenagers and teenage mothers. This article aims to describe the importance and availability of social support related to coping, resilience and mental health among unwed pregnant teenagers and teenage mothers in Malaysia during their stay in a shelter home. A purposive sampling was employed to select seventeen respondents from 128 unmarried pregnant and teenage mothers; age 10 to 18 years living in four different shelter homes owing that they were pregnancy out of wedlock. The findings are based on analysis of interviews and questionnaires related to social support, ways of coping, resilience and mental health. The study found strong indication in both, the qualitative and quantitative data, that unwed pregnant teenagers and teenage mothers have poor social support in terms of availability and adequacy. Hence, it reflected in their ways of coping, resilience, and put them at risk to develop mental health problems if untreated. The authorities and the staff in shelter homes are advice to take seriously social support aspects, especially from the family since they play a vital role for well-being and mental health of unwed pregnant teenagers and teenage mothers. Special Issue 10

To determine survivorship and functional results of medial open-wedge high tibial osteotomy (HTO) combined with anterior cruciate ligament reconstruction (ACLR) and a chondral resurfacing (CR) procedure (abrasion/microfracture) in patients with Kellgren-Lawrence grade 3 and 4 osteoarthritis with full thickness-cartilage defects, ACL-insufficiency and varus alignment. A cohort of 23 patients undergoing a combined procedure of HTO (fixation with angular stable internal fixator, Tomofix®), ACLR and CR for the treatment of severe symptomatic medial osteoarthritis, ACL insufficiency and varus alignment (> 4°) between 2005 and 2009 was prospectively surveyed with a minimum follow-up of 10 years with regard to survival (not requiring arthroplasty), functional outcome (subjective IKDC score), pain level (numeric rating scale), Oxford Knee Score (OKS) and subjective satisfaction. The Wilcoxon signed-rank-test was used for statistical evaluation of non-parametric data in these related samples. Twenty-one cases were included, one case with incomplete follow-up data and another case excluded. The follow-up rate was 91% at 12.0 ± 1.0 years (10.0–13.4). Mean age at time of surgery was 47.3 ± 5.9 years (37.8–57.7). At final follow-up, no arthroplasty was performed in any of the cases (survival: 100%). Subjective IKDC score improved from 47 ± 11 to 75 ± 15 at 1, 72 ± 15 at 3, 73 ± 17 at 6 years and 70 ± 16 at final follow-up (p

To clinically evaluate an arthroscopic autologous chondrocyte implantation (ACI) technique with an in situ crosslinking matrix for the treatment of full thickness cartilage defects of the knee and to present histological results of a graft cartilage biopsy obtained after 1.5 years. Fifteen cases of arthroscopic autologous chondrocyte implantation in the knee performed between November 2011 and October 2012 were included in the study. Medical charts and operational reports were screened and the patients were contacted after 0.8 ± 0.3 years (0.4–1.3) and 4.3 ± 0.3 years (4.0–4.8) to asses subjective IKDC and re-operation. The Tegner activity scale was collected at the second follow-up time point. Subjective IKDC response rates were assessed at both follow-up time points. The first and second follow-up was completed by all 15 patients (100%). The subjective IKDC scores showed a significant improvement (pre-operative 44.5 ± 15.9, first follow-up 71.1 ± 15.9, p

The Concise Binary Object Representation (CBOR, RFC 7049) is a data format whose design goals include the possibility of extremely small code size, fairly small message size, and extensibility without the need for version negotiation. In CBOR, one point of extensibility is the definition of CBOR tags. RFC 7049 defines two tags for time: CBOR tag 0 (RFC 3339 date/time string) and tag 1 (Posix "seconds since the epoch"). Since then, additional requirements have become known. This specification defines a CBOR tag for an RFC 3339 date text string, for applications needing a textual date representation within the Gregorian calendar without a time. It also defines a CBOR tag for days since the date 1970-01-01 in the Gregorian calendar for applications needing a numeric date representation without a time. This specification is intended as the reference document for IANA registration of the CBOR tags defined.

Police trainees have to be prepared for future job demands and challenges. Personality plays an important role in stress management. The first assessment of a longitudinal investigation was conducted among 103 Swedish police trainees to study their personality changes and mental health responses in first two weeks after intake. Fifty-two of these trainees, who participated in the second assessment, were included in the analysis. The Temperament and Character Inventory (TCI) was used to measure personality, and the Symptom Checklist-90-Revised (SCL-90-R) was used to measure mental health. A multiple regression analysis was performed with personality scores from the first assessment as independent variables and SCL-90-R scores as dependent variables. Over two years, minor changes were found in the police trainees’ personality characteristics, which seemingly fit the demands of policing and are potentially valuable in the trainees’ future careers. Personality characteristics are predictors of mental health at the end of university training.

Background Young patients with severe medial osteoarthritis, varus malalignment and insufficiency of the anterior cruciate ligament (ACL) are difficult to treat. The tibial slope has gained attention with regard to osteotomies and ligamentous instability. The purpose was to evaluate the outcome of combined high tibial osteotomy (HTO), ACL reconstruction and chondral resurfacing (CR, abrasion plus microfracture), and to analyse graft failure rates with regard to the tibial slope. Methods Fifty cases (48.9 ± 5.4 years) of combined HTO, ACLR and CR were retrospectively analysed with regard to survival, functional outcome (subjective International Knee Documentation Committee (IKDC) examination form) and subjective satisfaction. The tibial slope was determined on lateral radiographs and analysed with regard to its influence on graft functionality at the time of hardware removal. Results Follow-up rate was 100% after 5.6 ± 1.6 years. No arthroplasties were performed. Subjective IKDC score was 70 ± 18, and 94% were satisfied with the result. The graft was intact in 39 cases (78%), and non-functional in 11 cases (22%). No significant changes were present in pre- and postoperative tibial slope (P = 0.811). Graft insufficiency was strongly dependent on tibial slope, with a failure rate of seven percent in cases of postoperative tibial slope 12.5°. Conclusion Combined HTO, ACLR and CR is an effective treatment in these cases. The graft failure rate increases with an increase in tibial slope, in particular when exceeding 12.5°. Level of evidence Case series, Level 4.

The purpose of this study was to determine the incidence of septic arthritis following arthroscopic posterior cruciate ligament (PCL) and multi-ligament reconstructions, and to evaluate a treatment regime with sequential arthroscopic irrigation and debridement procedures combined with antibiotic therapy that is focused on retention of the graft. Between 2004 and 2016 a total of 866 PCL reconstructions and multi-ligament reconstructions were performed at our institution (408 isolated PCL reconstructions, 458 combined reconstructions). Medical charts of all cases were retrospectively reviewed with regard to the occurrence of septic complications. These cases were analysed with special focus on clinical management, number of reoperations and if the grafts were retained. Further, microbiological findings, postoperative clinical course and available clinical outcome data were evaluated. Four cases of septic arthritis (0.5%) were identified (follow-up rate 96.5%): two following isolated PCL reconstruction (0.5%), and two following multi-ligament reconstruction (0.4%), respectively. Septic arthritis was successfully treated in all cases with a mean of 2.5 ± 2.4 irrigation and debridement procedures (1–6). In one case of isolated PCL reconstruction, the graft was resected within the fifth irrigation and debridement due to septic loosing of the femoral fixation. All other grafts were retained. With regard to the outcome, all patients were subjectively satisfied with good stability (stress radiographs) in cases of retained grafts. Postoperative septic arthritis after arthroscopic PCL and complex knee ligament reconstructions is a rare but serious complication. Arthroscopic graft-retaining treatment is recommended, as it is established in ACL surgery. Graft retention can be expected in the majority of the cases. Case series, Level 4.

To analyse 1000 consecutive patients, treated with isolated or combined posterior cruciate ligament (PCL) reconstruction in a single centre according to the epidemiological factors and differences in injury patterns depending on the activity during trauma. Between 2004 and 2019, one thousand isolated and combined PCL reconstructions were performed. The medical charts and surgical reports of all patients were analysed regarding epidemiological factors. The PCL lesions were divided into isolated and combined lesions with at least one additional ligamentous injury. The influence of activity during accident and additional injury on the presence of isolated or combined lesions and injury patterns was calculated. In 388 patients (38.8%), sporting activity was the main activity in PCL lesions, followed by traffic accidents in 350 patients (35.0%). Combined injuries were present in 227 patients (58.5%) with sports injuries and 251 patients (71.7%) with traffic accidents. Only during handball, an isolated PCL lesion (69.1%) was more common than a combined lesion. Highest rate of combined lesions was present in car accidents (91.7%). In all activities except skiing and biking, the most common additional peripheral injury was a tear of the posterolateral corner. In skiing and biking accidents, the most common additional peripheral lesion was a lesion of the medial collateral ligament. In patients with PCL lesion and additional fracture of the same lower extremity, a combined lesion was more common than an isolated lesion (p = 0.001). Combined PCL lesions are more common than isolated lesions, even in sports injuries (except handball). Incidence and injury pattern vary depending on activity during trauma. Main additional peripheral lesion is a lesion of the posterolateral corner, except biking and skiing accidents where a medial lesion is more common. Level III.

To determine and compare the incidence of postoperative septic arthritis following anterior cruciate ligament reconstruction (ACLR) with and without soaking of the graft in vancomycin solution prior to implantation in a large single-centre case series. From 2004 to 2019, a total of 10,516 primary ACLR were performed and reviewed with regard to the occurrence of postoperative septic arthritis. From February 2017 onwards, all grafts were wrapped in a vancomycin-soaked (5 mg/ml) gauze swab between harvest and implantation (2294 patients, treatment group (2), prospectively followed). These were compared to 8222 patients before that date (control group (1), retrospectively evaluated). The technique of ACLR did not significantly change during the years of the study. There was no difference between the groups with regard to graft choice: Hamstring tendons were used in 99% and quadriceps tendons were used in 1% in both groups, respectively (n.s.). Routine follow-up examination was performed at 6 weeks (follow-up rate 97.1%) postoperatively. Patients with no treatment for septic arthritis at that time were classified as non-infected. There were 35 cases of postoperative septic arthritis in group 1 (incidence: 0.4%), and none in group 2 (incidence 0.0%), respectively. The difference was significant (p

Problems and complications concerning the patellar fixation in medial patellofemoral ligament reconstruction (MPFLR) have been reported. The purpose of this retrospective study was to systematically analyze the surgical technique for MPFLR with a V-shaped patellar bonetunnel for implant-free fixation of an autologous gracilis tendon, allowing early functional rehabilitation, regarding restoration of the patellofemoral stability, patient satisfaction, return to sports, and technique-specific complications. In 2010, 128 cases of consecutive isolated MPFLR were performed. All these cases were included. After a minimum follow-up of 3 years, 104 cases were retrospectively analyzed (follow-up: 81.3%) with regard to redislocation, subjective functional outcome (Tegner's score and sports level compared with preoperative level), patient satisfaction, revision surgery, and technique-specific complications. After a follow-up of 45.7 ± 3.2 months, 101 of 104 cases (97.1%) showed no redislocation. Mean Tegner's score was 5.1 ± 1.8 (range, 2–9). A total of 61.5% patients reported about a higher sports level compared with their preoperative level. The patient satisfaction was high with 94.2%. In two cases (1.9%), technique-specific problems occurred as the bone bridge of the V-shaped tunnel was insufficient due to a malpositioning of the aiming device. No further technique-specific problems occurred and no revision surgery was necessary during the observational period. The presented surgical technique is safe and it reliably restores the patellofemoral stability, with a low rate of redislocations, an excellent subjective functional outcome, and a high-patient-reported satisfaction. No major technique-specific complications occurred.

Verletzungen der posterolateralen Strukturen treten haufig in Kombination mit Verletzungen des hinteren Kreuzbands (HKB), seltener bei Rupturen des vorderen Kreuzbands (VKB) und sehr selten isoliert auf. Verschiedene Rekonstruktionstechniken sind beschrieben. Aufgrund der guten klinischen Ergebnisse sowie der verhaltnismasig einfachen und reproduzierbaren Technik hat sich die posterolaterale Stabilisierung nach Larson als haufig angewendetes Verfahren bei solchen Verletzungen etabliert. Dabei werden das laterale Kollateralband und das popliteofibulare Ligament mit einem freien Sehnentransplantat annahernd anatomisch rekonstruiert. In der Regel kommt dieses Verfahren in Kombination mit der Rekonstruktion eines oder beider Kreuzbander zum Einsatz. Der folgende Beitrag schildert detailliert die von den Autoren modifizierte und angewendete Technik der posterolateralen Rekonstruktion.

PurposeThere is a dearth of research on unwed young pregnant Malaysian women and mothers’ coping strategy and resilience in the context of limited social support they received. Hence, the purpose of this paper is to investigate the prediction of mental health by coping, social support, and resilience among unwed young Malaysian pregnant women and mothers.Design/methodology/approachQuantitative data of two assessments from respondents aged 11 to 32 years during their stay in shelter homes have been analyzed.FindingsThe result from the longitudinal study found that the variability in mental health scores could be explained between 14 percent for depressive-behavioral symptoms and 36 percent for general health. The mental health scores from the first assessment were part of the regression equation with the highest standardizedβscores. Cross-sectional, the variance in the three independent variable sets explained between 6 percent (general health) and 23 percent (cognitive depressive symptoms) of the variance in the various mental health scores with different variables of significant standardizedβscores in the regression equation. The study also found there were no significant changes in social support, resilience and coping between the first and second assessments even if the respondents had been in the shelter homes for a period of time.Originality/valueThe study highlighted the issue of mental health among Malaysian unwed mothers during residential periods in shelter homes. As the subject of unwed mothers is considered taboo, their rights are often deprived or overlooked.

[EN] In order to compensate the power quality issues that arise in distribution grids with high penetration of renewable energy sources, an active power filter device controlled by a novel model-based predictive controller, i.e. the linear state signal shaping model predictive controller, is implemented. This paper proposes the use of a Multiobjective Optimization evolutionary algorithm, i.e. the Multiobjective Differential Evolution with Spherical Pruning X, for the tuning of this novel controller. An application example for power quality compensation of a grid modeled as a switched system with four modes is given. The model includes nonlinear loads that introduce harmonic distortion and multiple consumer loads that enable the existence of conflicting objectives, typical of multiobjective optimization problems. A decision making strategy is developed in order to find the best controller parameters in a reasonable amount of time that enable the provision of optimal power quality services by balancing multiple objectives that can conflict with each other., This contribution was partly developed within the project NEW 4.0 (North German Energy Transition 4.0) which is funded by the German Federal Ministry for Economic Affairs and Energy (BMWI). This paper was also partly funded by the Free and Hanseatic City of Hamburg (Hamburg City Parliament publication 20/11568).

Neben der Konzeption von verfugbarkeitsorientierten Geschaftsmodellen und der fur die technische Umsetzung essenziellen Entwicklung von kommunikationsfahigen Komponenten bildet ein intelligentes Informationsmanagement die dritte Saule fur das Anbieten von Verfugbarkeit. Im Rahmen des Forschungsprojektes wurde eine Cloud-basierte Gesamtlosung entwickelt, in der alle beteiligten Softwaresysteme daran arbeiten, dem richtigen Benutzer alle relevanten Informationen zur richtigen Zeit zur Verfugung zu stellen. Im vorliegenden Kapitel wird der Prozess zur Entwicklung einer solchen Plattform beschrieben, ausgehend von der Aufnahme von Anforderungen, die sich in eine modellbasierte Beschreibungssystematik eingliedern und somit die Basis fur die weiteren Prozessschritte liefern. Das durchgangige Systemmodell wird auch wahrend der Konzeption und Implementierung der Cloudplattform sowie der beteiligten Systeme weiter gepflegt. Die eigentliche Implementierung wird anhand der konkreten Einzelsysteme beschrieben: So wurden im Projekt eine Business-Analytics-Plattform, ein Back-End sowie Front-Ends an der Maschine und anderen Endgeraten entwickelt. Am Schluss des Prozesses steht eine entsprechende Verifikation der Teilsysteme sowie der Gesamtplattform.

All arthroscopic treatment of deep cartilage defects in the knee for reconstruction of the articular surface.Focal cartilage defects of the knee (ICRS ≥ grade 3) from a size of 2.5 cmOsteoarthritis (Kellgren-Lawrence grade 2), osseus defect situation, cartilage lesion of the opposing articular surfaces (ICRS grade 2), instability, malalignment (3-4°), inflammatory joint diseases.First procedure (cell harvesting): Treatment of additional pathologies, preparation of the cartilage defect, harvesting of osteochondral cylinders for cell culture. Second procedure (cell implantation): Dry arthroscopy, cleaning and drying of the already prepared defect, implantation of the in situ crosslinking cartilage cell suspension.First procedure (cell harvesting): Early functional treatment with weight bearing as tolerated. Second procedure (cell implantation): No drains, extension brace for 4 days, then free range of motion, partial weight bearing for 4 weeks in patellofemoral implantation and for 8 weeks in tibiofemoral implantation, continuous passive motion beginning in postoperative week 2, cycling from postoperative week 9.In the literature, results for ACI in the knee are reported to be good, especially for larger cartilage defects. Arthroscopic techniques should lead to a decrease of complications and perioperative morbidity. No technique-specific complications occurred in our cohort. From 2012-2015, 98 patients were treated using the above mentioned technique, whereby 62 patients were retrospectively evaluated after 31.0 ± 14.8 (12.5-61.4) months. In 15 patients (28%) additional procedures were performed (7 anterior cruciate ligament reconstructions, 3 correction osteotomies and 5 medial patellofemoral ligament reconstructions). Average cartilage defect size was 4.7 ± 2.8 cm

Background:High tibial osteotomy (HTO) is a widely used treatment option for medial osteoarthritis and varus malalignment, especially in young patients with early osteoarthritis. Limited outcome data are available for this procedure in severe osteoarthritis, and no long-term data are available using newer implants.Purpose:To determine survivorship and functional results of medial open-wedge HTO combined with a chondral resurfacing (CR) procedure (abrasion plus microfracture) in severe medial osteoarthritis (Kellgren-Lawrence grade 3 and 4) and varus malalignment. Furthermore, factors that potentially influence the outcome were analyzed.Study Design:Case series; Level of evidence, 4.Methods:From September 2005 to December 2008, all cases of HTO (fixation with an angular-stable internal fixator) combined with CR were prospectively surveyed with regard to survival (Kaplan-Meier-method, not requiring arthroplasty) and functional outcome (subjective International Knee Documentation Committee [IKDC] score). Cartilage regeneration at the time of hardware removal, tibial bone varus angle (TBVA), pre- and postoperative mechanical medial proximal tibial angle (MPTA), and postoperative alignment were analyzed with regard to the result.Results:Seventy-nine knees were included (73 patients; mean age 50.9 ± 7.6 years). The follow-up rate was 90% at 10.0 ± 1.2 years (range, 8.3-12.1 years). Pre- and postoperative mechanical tibiofemoral axis were 9.6° ± 3.0° of varus and 0.6° ± 2.7° of valgus, respectively. Survival rate was 81.7% (95% CI, 72.5%-90.9%) at 10 years. Subjective IKDC score significantly improved from 44 ± 11 preoperatively to 70 ± 13 at one, 66 ± 15 at three, 66 ± 15 at five, and 65 ± 17 at ten years ( P < .001 at any point of follow-up). Poor cartilage regeneration and low preoperative IKDC score (95°) with inferior functional outcome at final follow-up, respectively.Conclusion:Even in cases of severe medial osteoarthritis and varus malalignment, HTO in combination with a CR procedure is a good to excellent treatment option. The role of the CR procedure remains unclear. Although good results are obtained with overcorrected MPTA, long-term functional outcome is inferior.

To determine incidence and risk factors for traumatic graft rupture following primary and revision anterior cruciate ligament (ACL) reconstruction. All cases of isolated ACL reconstructions (primary or revision) performed at our institution between January 2007 and December 2010 were included. From this group of 2467 primary reconstructions (32.4 ± 12.2 years) and 448 revision reconstructions (33.0 ± 10.4 years), we identified all patients who underwent revision ACL reconstruction following traumatic graft rupture in further course and all patients who underwent contralateral primary ACL reconstruction until January 2014. Age, gender, time from index procedure and graft diameter (for hamstring autografts) were analysed in terms of being a potential risk factor for graft rupture. Within a follow-up period of 5.0 ± 1.1 years (3.0–7.0), a total of 82 traumatic graft ruptures were identified, resulting in an incidence of 2.8 %. Seventy-three cases were seen following primary reconstructions (3.0 %), and nine cases following revision reconstructions (2.0 %), respectively (n.s.). Age younger than 25 years was identified as a risk factor for both groups (p = 0.001 and p = 0.008; odds ratio 6.0 and 6.4, respectively). In primary reconstruction, male patients had a higher risk of graft rupture compared with females (3.7 vs. 1.6 %; p = 0.005), and the first year after index procedure was associated with a higher risk of graft rupture compared with the following (p

Anatomische Rekonstruktion des medialen patellofemoralen Ligaments in patellarseitig implantatfreier Technik mit autologer Grazilissehne zur Wiederherstellung der patellofemoralen Stabilitat. Rezidivluxationen, Erstluxationen mit hohem Rezidivrisiko und Luxationen mit (osteo-)chondralen Flake-Frakturen. Als Kombinationseingriff mit anderen Verfahren (Trochleaplastik, Tuberositasosteotomie) sowie bei Revisionen. Als isoliertes Verfahren bei hochgradiger Trochleadysplasie, bei chronischer Patellaluxation und patellofemoralem Maltracking ohne Instabilitat. Entnahme der Grazilissehne. Anlage eines V-formigen Bohrkanals mit einem speziellen Zielgerat in anatomischer Position an der medialen Patella. Bildwandlergestutzte Anlage eines femoralen Bohrkanals an der anatomischen Insertion. Durchzug des Transplantats, arthroskopisch kontrollierte Spannung und femorale Fixation mittels bioresorbierbarer Interferenzschraube. Teilbelastung (20 kg) uber 1–2 Wochen. Keine Bewegungslimitierung. Keine Orthese. Sportartspezifische Belastung nach etwa 3 Monaten. Technikspezifische perioperative Komplikationen traten in 1,0 % (7 von 729 Fallen) auf. In einer reprasentativen Gruppe von 72 konsekutiven Fallen von Mai 2010 bis Oktober 2010 fand sich nach 4,0 ± 0,1 Jahren eine Reluxationsrate von 3,2 %, ein Tegner-Aktivitatsscore von 5,1 ± 1,8 und eine subjektive Zufriedenheit von 92 % (Follow-up-Rate 87,5 %). Im gesamten von uns uberblickten Patientengut zeigte sich keine Patellafraktur.

Die stoffliche und energetische Nutzung von Brenngasen aus der Vergasung von Biomasse steht seit vielen Jahren im Mittelpunkt umfangreicher Forschungen. Ein groses, bislang nicht vollstandig gelostes Problem ist dabei der hohe Anteil an hohersiedenden Kohlenwasserstoffen in den Brenngasen. Durch unvollstandig ablaufende Vergasungsreaktionen und Nebenreaktionen werden diese Kohlenwasserstoffe, Phenole und Kohlenstoff gebildet, die fur eine Weiternutzung des Gases gravierende Storkomponenten darstellen. Im Fokus dieses Beitrages steht die partielle Oxidation zur Teerreduzierung unter Einsatz von Katalysatoren. Im untersuchten Konzept wird die Bereitstellung des Sauerstoffs fur die partielle Oxidation mit der katalytischen Wirkung in einem Festbett kombiniert. The material and energetic utilization of fuel gas from biomass gasification is a focus of extensive research activities since many years. A big problem, which is not completely solved until now, is the high level of higher molecular weight hydrocarbons in the fuel gas. Partial gasification reactions and secondary reactions will form these hydrocarbons, phenols and carbon. These components are important impurities for the further gas utilization. The focus of this paper is the partial oxidation for tar reduction by using catalysts. In the investigated concept the oxygen supply for the partial oxidation will be combined with the catalytic effect in a solid bed.

No systematic studies on optimal treatment of postoperative septic arthritis following arthroscopic meniscus repair are available. The purpose of this study was to retrospectively evaluate the fate of repaired menisci in cases of postoperative septic arthritis, with treatment for infection focused on arthroscopic irrigation and debridement (I&D) and intention to maintain the meniscus. Data of two sports orthopedics centers of the last 10 years were pooled (approximately 25,000 arthroscopic procedures of the knee). All cases of septic arthritis following arthroscopic meniscus repair were identified. These cases were retrospectively evaluated with regard to clinical course and management, especially the number of necessary I&Ds, if eradication was achieved, and if the repaired meniscus was retained or a partial resection was necessary (‘early failure’). Patients with initially maintained meniscus repairs were contacted if further meniscus surgery was performed in further follow-up (‘late failure’). 20 patients with 23 repaired menisci were included. In 65% (13 cases), a concomitant anterior cruciate ligament reconstruction was performed. A mean of 2.0 ± 1.0 (1–4) arthroscopic I&Ds were performed in the treatment of septic arthritis. In two cases, additional open surgery was performed (after outside-in sutures). Eradication was achieved in all cases. Four repaired menisci (17.4%) showed loosened fixation or substantial degradation and were consequently partially resected within treatment for septic arthritis (early failures). The follow-up rate for the 19 initially maintained menisci was 94.7% after 3.0 ± 2.2 years (median 2.8, 0.4–7.8). Three of these underwent further partial resection (13.0%). Cumulative 3-year survival rate (Kaplan–Meier method) of all repairs was 70.7% (95% CI 50.3–91.1%), and for the subgroup of initially maintained menisci 85.6% (95% CI 67.0–100.0%), respectively. Septic arthritis following meniscus repair can be successfully treated with (sequential) arthroscopic I&Ds. There is a considerable rate of early failures, however, in a mid-term follow-up the failure rate of initially retained menisci is low and comparable to what we know from the literature for cases without infection. Therefore, it is generally recommended to try to save the repaired menisci in these cases. IV, therapeutic case series.

The family is a fundamental component of society, and marital satisfaction is the main characteristic of a healthy family. The aim of this cross-sectional research was to assess marital satisfaction in medical staff in Tehran, with a special focus on gender differences. Data were collected from 653 medical staff using sociodemographic questions and the ENRICH marital satisfaction questionnaire. The results indicated that marital satisfaction was significantly higher in men than in women. There was a negative correlation between age and marital satisfaction in women. Educational level was associated with marital satisfaction in both genders. Number of children was correlated with marital satisfaction in both men and women. Gender differences in marital satisfaction were revealed, and all sociodemographic factors showed significant relationships, with at least one subscale of marital satisfaction. This study provides a general view of marital satisfaction in Iranian medical professionals as a group with a stressful job.

Stress significantly influences marital satisfaction. Women tend to be more emotionally involved in problems than men. Furthermore, employed women encounter more stressors especially when their job is stressful which it is often the case in medical professionals. In the present cross-sectional study, relationships were analyzed between marital satisfaction (ENRICH Marital Satisfaction Inventory), ways of coping (Ways of Coping questionnaire) with marital stress and social support (Social Support Questionnaire) in 100 female medical staff members in Tehran university hospitals. The results revealed a significant negative relationship between subscales of marital satisfaction and using “seeking social support”, “confrontive coping”, “escape avoidance”, “distancing”, and “self-controlling” as ways of coping related to marriage related problems. Furthermore, the analyses showed that job satisfaction, social support, and ways of coping explain between 24% and 38% of the variance in subscales of marital satisfaction. Therefore focusing on these factors could be an effective approach to promote marital satisfaction in female medical staff members. Originally published in manuscript form with the title: Marital satisfaction, ways of coping and social support in female medical staff in Tehran- Iran