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Background: Insertional Achilles tendinopathy is a frequent condition among physically active individuals. Extensive intratendinous pathologies may require partial tendon detachment, debridement and reconstruction of the tendon footprint. Positive functional outcomes are reported after the procedure, but literature on postoperative sport function is limited., Methods: Pre- and postoperative sports capability and ankle function were assessed in 25 patients undergoing Achilles tendon debridement and double-row footprint reconstruction., Results: The mean VAS score for pain during sport decreased significantly from 7.4 (SD, 2.5) to 1.2 (SD, 2.0) postoperatively (p < 0.001). Sports ability and subjective fitness levels increased significantly from 3.6 (SD 3.0) and 3.5 (2.2) to 8.8 (2.4) and 8.8 (2.2), respectively (p < 0.001). A trend from high-impact sports to low-impact sports was observed postoperatively. The subjective surgical outcome was good or excellent in 96 %., Conclusion: Our study shows improvement in postoperative sports ability and high patient satisfaction after insertional Achilles tendon debridement, and double-row tendon footprint reconstruction., Level of Evidence: Level IV - retrospective case series., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest regarding the information presented in this manuscript. They have no financial or personal relationships that could influence the objectivity or integrity of the content provided., (Copyright © 2024 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Background: The long head of the biceps tendon (LHBT) is a well-known source of pain in the shoulder, especially in active patients., Purpose: To evaluate the outcomes and return-to-sports rate after all-arthroscopic suprapectoral tenodesis of the LHBT using a small knotless anchor., Study Design: Case series; Level of evidence, 4., Methods: In this retrospective study, 27 patients-who underwent all-arthroscopic tenodesis of the LHBT using a 2.7-mm knotless polyether ether ketone anchor-were evaluated. Sports activities, the return-to-sports rate, and other sports-related parameters (eg, pain during sports, level of sports) were examined. Sports-related data, the Constant score with isometric force (at 90° of abduction in the scapular plane), the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST) score, the visual analog scale (VAS) score for satisfaction, range of motion, and the presence of a Popeye deformity were assessed at a mean follow-up of 15.3 ± 8.7 months. The data were initially analyzed using descriptive statistics., Results: The postoperative ASES, Constant, and SST scores were 81.61, 85.74 and 8.85, respectively. Of the 27 patients, 4 patients (14.8%) showed a Popeye deformity. Preoperatively, 25 patients (92.6%) participated regularly in some type of sports activity. All 25 patients (100.0%) were able to return to sports activities after surgery. 24 (96.0%) returned to the same level preoperatively, with 88.0% (22/25) within 6 months. Patient satisfaction with the outcome was high (VAS score: 2.15 ± 2.78). Neither bicipital groove pain nor cramping was reported. There were no signs of osteolytic bone around the anchor or a fracture of the humeral bone., Conclusion: Our clinical results after using a 2.7-mm knotless anchor for LHBT tenodesis as well as the return-to-sports rate were satisfying. Using an anchor this size can lower the risk of cortical bone damage and therefore the risk of fractures of the humeral head while still enabling patients to perform at a high level., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: The Department of Orthopedic and Trauma Surgery at Klinik Diakonissen Schladming has received honoraria from Smith+Nephew. 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) 2024.)

Background : Reversed total shoulder arthroplasty (RTSA) is an established surgery for many pathologies of the shoulder and the demand continues to rise with an aging population. Preoperative planning is mandatory to support the surgeon's understanding of the patient's individual anatomy and, therefore, is crucial for the patient's outcome. Methods : In this observational study, we identified 30 patients who underwent RTSA with two- and three-dimensional preoperative planning. Each patient underwent new two-dimensional planning from a medical student and an orthopedic resident as well as through a mid-volume and high-volume shoulder surgeon, which was repeated after a minimum of 4 weeks. The intra- and interobserver reliability was then analyzed and compared to the 3D planning and the implanted prosthesis. The evaluated parameters were the size of the pegged glenoid baseplate, glenosphere, and humeral short stem. Results : The inter-rater reliability showed higher deviations in all four raters compared to the 3D planning of the base plate, glenosphere, and shaft. The intra-rater reliability showed a better correlation in more experienced raters, especially in the planning of the shaft. Conclusions : Our study shows that 3D planning is more accurate than traditional planning on plain X-rays, despite experienced shoulder surgeons showing better results in 2D planning than inexperienced ones.

Background: Cancer patients are highly prone to infectious diseases. While undergoing antineoplastic treatment, the risk of severe symptoms upon infection increases, necessitating efficient protective measures, such as vaccination. For patients receiving radiotherapy, there is no specific information about humoral immunity. During the COVID-19 pandemic, serial antibody measurements were therefore offered to cancer patients, following SARS-CoV-2 vaccination while obtaining radiotherapy., Methods: Out of 74 enrolled patients, 46 met the inclusion criteria. Two cohorts were allocated, depending on an association with chemotherapy or pure radiotherapy. An additional healthy control cohort of 16 healthcare workers was enrolled. All participants followed a two-fold BNT162b2 vaccine schedule. SARS-CoV-2 binding antibodies were measured serially in a 7-day cycle for 35 days and over the long-term, using the Elecsys ® Anti-SARS-CoV-2 immunoassay., Results: Cancer patients under pure radiotherapy have a comparable humoral vaccination response and long-term persistency of antibodies to healthy controls. Patients receiving additional chemotherapy show a significantly delayed immune response and decreased antibody titers. The vaccine was well tolerated in all cohorts., Conclusions: Pure radiotherapy in cancer patients does not interfere with the vaccine-induced humoral immune response or other immunogenetic aspects, whereas previous or simultaneous chemotherapy does. Findings are of particular relevance for future epidemic or pandemic scenarios.

Downhill-mountain biking (DMB) is a high-risk sport and often leads to several injuries, especially in non-professional athletes. We retrospectively analyzed the most common injuries and profiled the injury mechanism. Until now, there is no such analysis of injuries by non-professional mountain bike athletes. We collected patient data from patients who suffered from an injury during DMB. The inclusion criteria were (1) injury during the summer season of 2020 and 2021, (2) injury during off-road and downhill mountain bike sports activity, and (3) treatment at the Department of Traumatology of the Klinik Diakonissen Schladming. Patient data was analyzed regarding the type of injury, location of the injury, patient age and gender of the patients. Most patients with injury are at the age of 26-35. Second most are between 36 and 71 years old. The type of injury differs between age and gender. Mostly upper-extremity injuries occur with a high probability of shoulder injuries. In the elderly patients, we found additional injuries of the thorax and chest. To conclude, most common types of injuries are soft-tissue injuries, often in combination with fractures. The risk for injuries is higher for recreational athletes with different injury characteristics than professional athletes., (© 2024. The Author(s).)

Background: Total hip arthroplasty (THA) affects the biomechanics of the hip and the patient gait. The stem design influences femoral lever ratios and tissue trauma. Biomechanical changes such as these have the potential to induce knee arthritis. A varus or valgus configuration of knee arthritis is formed by asymmetric loadings. The aim of this study was to evaluate the impact of stem design in THA on knee valgus by comparing a standard implant with an implant with a short stem., Methods: A total of 2953 patients who underwent primary total knee arthroplasty for end-stage osteoarthritis between 2015 and 2021 were included in this retrospective data analysis. Patients were divided into three groups, depending on hip status (straight stem, short stem, and native joint). Leg alignment was distinguished as varus or valgus, and the degree of axial deviation was measured. Descriptive and explorative statistical analyses were performed, with a p value < 0.05 set as significant., Results: Ipsilateral knee valgus occurred significantly more often in patients with straight stems (57.2%) than in those with short stems (29%) and native joints (25.8%) ( p < 0.001). Additionally, mean valgus deviation was significantly increased in patients with straight stems (8.9°) compared to those with short stems (6.4°) or native hip joints (6.7°). Both findings were accentuated in women., Conclusions: Previous ipsilateral straight-stem THA is associated with knee valgus deformity, especially in women. Short-stem THA seems to be better suited to restoring physiological biomechanics and preventing the development of valgus osteoarthritis of the ipsilateral knee.

Introduction: The COVID-19 pandemic with its containment measures such as closures of schools and daycare facilities led to numerous restrictions in daily life, putting developmental opportunities and health-related quality of life in children at risk. However, studies show that not every family was impacted equally by the pandemic and that this exceptional health and societal situation reinforced pre-existing health inequalities among the vulnerable. Our study aimed at analyzing changes in behavior and health-related quality of life of children attending elementary schools and daycare facilities in Bavaria, Germany in spring 2021. We also sought to identify associated factors contributing to inequalities in quality of life., Methods: Data from a multi-center, open cohort study ("COVID Kids Bavaria") conducted in 101 childcare facilities and 69 elementary schools across all electoral districts of Bavaria were analyzed. Children attending these educational settings (aged 3-10 years) were eligible for participation in a survey on changes in behavior and health-related quality of life. The KINDL R questionnaire (based on children's self-report and parental report) was administered about one year after the onset of the pandemic (spring 2021). Descriptive and logistic regression analyses and comparisons to pre-pandemic KiGGS (German Health Interview and Examination Survey for Children and Adolescents) data were undertaken., Results: Among respondents, a high percentage of parents reported changes in their children's eating and sleeping behavior, sports and outdoor activities as well as altered screen time. Health-related quality of life in KINDL R analyses compared to pre-pandemic population averages were lower in all age groups (for 3-6-year-old KINDL R -total score: COVID Kids Bavaria MD 74.78 ± 10.57 vs KiGGS data 80.0 ± 8.1; 7-10 years-old KINDL R -total score: COVID Kids Bavaria MD 73.88 ± 12.03 vs KiGGS data 79.30 ± 9.0). No significant differences were detected with regard to associated factors, namely type of institution, sex of the child, migration background, household size and parental education., Conclusion: These findings suggest a relevant impact of the COVID-19 pandemic on children's behavior and health-related quality of life one year after the onset of the pandemic. Further analyses in large-scale longitudinal studies are needed to determine the effects of specific pandemic or crisis associated factors contributing to health inequalities., Competing Interests: The study COVID Kids Bavaria was financed by the Bavarian Ministry of Research and Art. CK reports support from the Care-for-Rare Foundation. CJS reports involvement with other COVID-19 related studies such as the COSMO study, COVerCHILD (NUM) and others. ER reports involvement with other COVID-19 related studies, notably COVerCHILD, and having co-coordinated the German evidence- and consensus-based S3 guideline on schooling during COVID-19 as well as being a member of the WHO Technical Advisory Group on Schooling during COVID-19. HS is a doctoral candidate in the Research Training Group “PrediktOren und Klinische Ergebnisse bei depressiven ErkrAnkungen in der hausärztLichen Versorgung (POKAL, DFG-GRK 2621)” (Predictors and Clinical Outcomes of Depressive Disorders in Primary Care) POKAL, a member of the German Research Foundation (DFG). UB is employed by the Department of Pediatrics, Kinderklinik München Schwabing, StKM GmbH und Klinikum Rechts der Isar, Technische Universität München, Germany. NM is employed by the Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Center Munich, German Research Center for Environmental Health (GmbH), Munich, Germany. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Schillok, Coenen, Rehfuess, Kuhlmann, Matl, Kindermann, Maison, Eckert, von Both, Behrends, Früehwald, Neubert, Woelfle, Melter, Liese, Hübner, Klein, Kern and Jung-Sievers.)

Background and Objectives : Short-stem total hip arthroplasty has become increasingly popular in recent years. While many studies have shown excellent clinical and radiological results, very little is known about the learning curve for short-stem total hip arthroplasty through an anterolateral approach. Therefore, the aim of this study was to determine the learning curve for short-stem total hip arthroplasty among five residents in training. Materials and Methods : We performed retrospective data analysis of the first 30 cases of five randomly selected residents ( n = 150 cases) with no experience before the index surgery. All patients were comparable, and several surgical parameters and radiological outcomes were analyzed. Results : The only surgical parameter with a significant improvement was the surgical time ( p = 0.025). The changes in other surgical parameters and radiological outcomes showed no significant changes; only trends can be derived. As a result, the correlation between surgical time, blood loss, length of stay, and incision/suture time can also be seen. Only two of the five residents showed significant improvements in all examined surgical parameters. Conclusions : There are individual differences among the first 30 cases of the five residents. Some improved their surgical skills faster than others. It could be assumed that they assimilated their surgical skills after more surgeries. A further study with more than 30 cases of the five surgeons could provide more information on that assumption., Competing Interests: The authors declare no conflicts of interest.

Study Design: Multicenter retrospective analysis of routinely collected data., Objective: The underlying aim of this study was to identify potential treatment-related risk factors for odontoid fracture nonunion while accounting for known patient- and injury-related risk factors., Summary of Background Data: Type II and III odontoid fractures represent the most common cervical spine fracture in elderly patients and are associated with a relatively high nonunion rate. The management of odontoid fractures is controversial and treatment strategies range from conservative treatment to extensive surgical stabilization and fusion., Methods: A total of 415 individuals who sustained odontoid fracture and were treated in either of four tertiary referral centers in Austria and Germany were included in the study. We included the following potential contributing factors for fracture nonunion in cross-validated extreme gradient boosted (XGBoost) and binary logistic regression models: age, gender, fracture displacement, mechanism of injury (high vs. low energy), fracture classification (Anderson II vs. III), presence of comorbidities (Charlson comorbidity index), and treatment (conservative, anterior screw fixation with one or two screws, posterior C1/C2 spondylodesis, cervico-occipital C0-C4 fusion)., Results: In our cohort, 187 (45%) had radiologically confirmed odontoid nonunion six months postinjury. The odds for nonunion increase significantly with age, and are lower in type III compared to type II fractures. Also, odds for nonunion are significantly lower in posterior C1/C2 spondylodesis, and C0-C4 fusion compared to conservative treatment. Importantly, odds are not statistically significantly lower in the group treated with anterior screw fixation compared to conservative treatment. The factors gender, fracture displacement, mechanism of injury, and the presence of comorbidities did not produce significant odds., Conclusion: Higher age, type II fractures, and conservative treatment are the main risk factors for odontoid nonunion. Anterior screw fixation did not differ significantly from conservative treatment in terms of fracture union., Level of Evidence: 3., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Glenoid wear is a common complication of anatomical total shoulder arthroplasty (aTSA) with a metal-backed glenoid (MBG), and the clinical and radiological results of historical implants are poor. The aim of this work was to evaluate the clinical and radiological results of 25 participants as well as the longevity after implantation of an anatomic shoulder prosthesis with a recent, modular cementless flat metal-backed glenoid component after a mean follow-up of 5.7 years. Methods: Clinically, the Simple Shoulder Test (SST), UCLA Activity Score (UCLA), and Constant Murley Score (CMS) were evaluated. Radiographically, the radiolucent lines (RLs), humeral head migration (HHM), and lateral glenohumeral offset (LGHO) were assessed. Survival was calculated with Kaplan−Meier curves and life-table analysis. Results: The mean CMS at follow-up was 46.2 points (range: 14−77; SD: 19.5). In terms of the SST score, the average value was 6.5 points (range: 1−10; SD: 3.5). The UCLA activity score showed a mean value of 5.9 points (range: 1−9; SD: 2.1). There were 17 revisions after a mean follow-up of 68.2 months (range: 1.8−119.6; SD: 27.9). HHM occurred in every patient, with a mean measurement of 6.4 mm (range: 0.5−13.4; SD: 3.9; p < 0.0001). The mean LGHO between the initial postoperative and follow-up images was 2.6 mm (range: 0−4.0; SD: 1.5; p < 0.0001). RLs were found in 22 patients (88%) around the glenoid and in 21 patients (84%) around the humeral head prosthesis. Conclusion: The clinical and radiographic outcomes after metal-backed glenoids were poor at 2.2 to 8.4 years of follow-up. We determined devastating survival in the majority of cases (68%), with mostly inlay wear (71%) as the main reason that led to revision surgery. The use of metalback genoids cannot be recommended based on the data of this study.

Background: Evaluation of different factors in patient quality of life after minimally invasive stabilization of intra-articular calcaneal fractures, including the return-to-sports rate., Patients and Methods: Patients with minimally invasive stabilization of intra-articular calcaneal fractures were collected from the database of a Level I trauma center and evaluated in a retrospective and explorative way. The clinical and radiological examination have been done immediately after the operation, after 2 and 6 weeks postoperative and after a minimum follow-up of 2 years. Clinical and radiological examination was performed by applying the American Orthopedic Foot and Ankle Society hindfoot scale score (AOFAS), 36-item Short Form Health Survey (SF-36), the Tegner Activity Scale, the Foot and Ankle Outcome Score (FAOS) and with a questionnaire about pre- and postoperative engagement in sport and recreational activities., Results: Fourty-nine patients with an isolated uni-lateral fracture of the calcaneus who fulfilled all inclusion criteria were assessed. Fourty-two of them were male and 24 were under the age of 50 years. No statistically significant differences were noted between Sanders I/II and Sanders III/IV in terms of SF-36, AOFAS, FAOS or Tegner-scale. A less satisfying result was noticed in Sanders III/IV patients. General health, pain in FAOS, physical functioning and pain in SF-36 were strongly dependent on Tegner score values. Twenty-nine percent of our study population changed sport activities after injury, whereas 22 percent stopped all kinds of sports. Consequently, our overall return-to-sport rate was 78 percent., Conclusion: Clinical results including different scores and quality of life parameters in our study population were satisfying. About 80 percent of patients could return to sports, but there are still many patients that were not able to perform sports and physical activities on the same level as before., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: The pathological mechanism in acute spinal cord injury (SCI) is dual sequential: the primary mechanical lesion and the secondary injury due to a cascade of biochemical and pathological changes initiated by the primary lesion. Therapeutic approaches have focused on modulating the mechanisms of secondary injury. Despite extensive efforts in the treatment of SCI, there is yet no causal, curative treatment approach available. Extracorporeal shock wave therapy (ESWT) has been successfully implemented in clinical use. Biological responses to therapeutic shock waves include altered metabolic activity of various cell types due to direct and indirect mechanotransduction leading to improved migration, proliferation, chemotaxis, modulation of the inflammatory response, angiogenesis, and neovascularization, thus inducing rather a regeneration than repair. The aim of this clinical study is to investigate the effect of ESWT in humans within the first 48 h after an acute traumatic SCI, with the objective to intervene in the secondary injury phase in order to reduce the extent of neuronal loss., Methods: This two-arm three-stage adaptive, prospective, multi-center, randomized, blinded, placebo-controlled study has been initiated in July 2020, and a total of 82 patients with acute traumatic SCI will be recruited for the first stage in 15 participating hospitals as part of a two-armed three-stage adaptive trial design. The focused ESWT (energy flux density: 0.1-0.19 mJ/mm 2 , frequency: 2-5 Hz) is applied once at the level of the lesion, five segments above/below, and on the plantar surface of both feet within the first 48 h after trauma. The degree of improvement in motor and sensory function after 6 months post-injury is the primary endpoint of the study. Secondary endpoints include routine blood chemistry parameters, the degree of spasticity, the ability to walk, urological function, quality of life, and the independence in everyday life., Discussion: The application of ESWT activates the nervous tissue regeneration involving a multitude of various biochemical and cellular events and leads to a decreased neuronal loss. ESWT might contribute to an improvement in the treatment of acute traumatic SCI in future clinical use., Trial Registration: ClinicalTrials.gov NCT04474106., (© 2022. The Author(s).)

Background:  Anterior cruciate ligament (ACL) injury can lead to reduced function, meniscal lesions, and early joint degeneration. Preservation of a torn ACL using the Internal Brace technique might re-establish normal knee kinematics, avoid donor-site morbidity due to tendon harvesting, and potentially maintain proprioception of the knee., Methods:  Fifty subjects were recruited for this study between December 2015 and October 2016. Two groups of individuals who sustained a unilateral ACL rupture were included: those who underwent surgery with preservation of the injured ACL (Internal Brace technique; IB) and those who underwent ACL reconstruction using a hamstring tendon graft (all-inside technique; AI). Subjective self-administered scores were used: the German version of the IKDC Subjective Knee Form (International Knee Documentation Committee), the German version of the WOMAC (Western Ontario and McMaster Universities Arthritis Index), SF-36 (short form), the German version of the KOOS (Knee Osteoarthritis Outcome Score), and the German version of themodified Lysholm Score by Lysholm and Gillquist. Anterior tibial translation was assessed using the KT-1000 Arthrometer (KT-1000 Knee Ligament Arthrometer, MEDmetric Corp., San Diego, CA, USA). Magnetic resonance evaluation was performed in all cases., Results:  Twenty-three subjects (46 %) were men, and the mean age was 34.7 years. The objective IKDC scores were "normal" in 15 and 14 patients, "nearly normal" in 11 and 7 patients, and "abnormal" in 1 and 2 patients, in the IB and AI groups, respectively. KT-1000 assessment showed a sideto-side difference of more than 3 mm on maximum manual testing in 11 (44 %) and 6 subjects (28.6 %) in the IB and AI groups, respectively. In the postoperative MRI, 20 (74 %) and 22 subjects (96 %) in the IB and AI groups had an intact ACL. Anterior tibial translation was significantly higher in the IB group compared with the AI group in the manual maximum test., Conclusions:  Preservation of the native ACL with the Internal Brace primary repair technique can achieve comparable results to ACL reconstruction using Hamstring autografts over a short term. Clinically relevant limitations such as a higher incidence of pathologic laxity, with patients more prone to pivot-shift phenomenon were observed during the study period., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Recent advances in artificial intelligence, particularly in the field of deep learning, have enabled researchers to create compelling algorithms for medical image analysis. Histological slides of basal cell carcinomas (BCCs), the most frequent skin tumor, are accessed by pathologists on a daily basis and are therefore well suited for automated prescreening by neural networks for the identification of cancerous regions and swift tumor classification.In this proof-of-concept study, we implemented an accurate and intuitively interpretable artificial neural network (ANN) for the detection of BCCs in histological whole-slide images (WSIs). Furthermore, we identified and compared differences in the diagnostic histological features and recognition patterns relevant for machine learning algorithms vs. expert pathologists.An attention-ANN was trained with WSIs of BCCs to identify tumor regions (n = 820). The diagnosis-relevant regions used by the ANN were compared to regions of interest for pathologists, detected by eye-tracking techniques.This ANN accurately identified BCC tumor regions on images of histologic slides (area under the ROC curve: 0.993, 95% CI: 0.990-0.995; sensitivity: 0.965, 95% CI: 0.951-0.979; specificity: 0.910, 95% CI: 0.859-0.960). The ANN implicitly calculated a weight matrix, indicating the regions of a histological image that are important for the prediction of the network. Interestingly, compared to pathologists' eye-tracking results, machine learning algorithms rely on significantly different recognition patterns for tumor identification (p < 10 -4 ).To conclude, we found on the example of BCC WSIs, that histopathological images can be efficiently and interpretably analyzed by state-of-the-art machine learning techniques. Neural networks and machine learning algorithms can potentially enhance diagnostic precision in digital pathology and uncover hitherto unused classification patterns.

Purpose:  The purpose of this study was to evaluate sports activity before anterior cruciate ligament (ACL) injury and after surgical treatment of ACL rupture comparing ACL repair with an Internal Brace to ACL reconstruction using either a hamstring (HT) or quadriceps tendon (QT) autograft., Methods:  Between 12/2015 and 10/2016, we recruited 69 patients with a mean age of 33.4 years for a matched-pair analysis. Twenty-four patients who underwent Internal Brace reconstruction were matched according to age (± 5 years), gender, Tegner activity scale (± 1), BMI (± 1) and concomitant injuries with 25 patients who had undergone HT reconstruction and 20 patients who had undergone QT reconstruction. The minimum follow-up was 12 months., Results:  Overall, the return-to-sports rate was 91.3 %. There were no significant differences (p ≥ 0.05) in the number of sports disciplines and the time before return to sports within or among the groups. Overall and within the groups, the level of sports participation did not change significantly (p ≥ 0.05) postoperatively. The patients' sense of well-being was excellent after either ACL repair with an Internal Brace or ACL reconstruction with autologous HT or QT., Conclusion:  At short-term follow-up, ACL repair using an Internal Brace enables sports activity and provides a sense of well-being similar to that of classic ACL reconstruction using hamstring or quadriceps tendon autografts in a selected patient population., Level of Evidence: Level III Retrospective comparative study., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Purpose: The purpose of this study was to evaluate sleep disturbance prospectively before and after short-stem hip arthroplasty., Methods: A prospective study on 25 patients undergoing a primary unilateral total short-stem hip replacement was conducted. Patients were observed for six months. To evaluate the sleep quality and daytime sleepiness, the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were used. To assess the general physical health status, we used the Short Form 36 Health Survey (SF-36). Pain was recorded on a visual analog scale., Results: The physical health status of the patients improved significantly (p < 0.05) during the six month follow-up period in seven out of nine categories. During the first post-operative week, the sleep quality stayed on an equal level to the pre-operative state, following a steady improvement over the next months (6 months p = 0.00). The daytime sleepiness showed a significant improvement during all the follow-ups (6 months p = 0.00). Pain decreased significantly from baseline to six months post-operatively (p = 0.00). There was no correlation between pain and sleep quality or pain and daytime sleepiness., Conclusion: According to our results, patients undergoing short-stem total hip arthroplasty can expect a 50% improvement of sleep quality and physical function six months after surgery.

Purpose: The purpose of this study was to evaluate sports ability and the rate of return to sports after implant-free iliac bone graft for recurrent, anterior shoulder instability and anterior glenoid bone loss. Subgroups of younger and older patients and patients who had previous arthroscopic Bankart surgery and those who did not have such surgery before implant-free iliac bone graft were formed and compared., Methods: We retrospectively analyzed 34 patients; 14 patients had previous arthroscopic Bankart surgery, and 20 patients did not have the surgery; The median age at the time of iliac bone graft was 35.3 years (range, 23 to 75), 17 patients were over the age of 35, and 17 patients were under the age of 35. The mean follow-up was 40 months (range: 25 to 56)., Results: All the 34 patients were engaged in pre- and post-operative sport, which represents a return to sport rate of 100%. Although the number of sport disciplines decreased significantly from 6 before the operation to 4.8 after the operation (p=0.002), the number of sports sessions per week did not change significantly, and the duration per session did not change significantly. More than two-thirds of all patients returned to sports within 6 months. Overall, 41% of patients changed sport disciplines, 15% of whom cited shoulder-related causes; however, all patients returned to the same sport level., Conclusions: Overall and within the subgroups, the return to sport rate after implant-free iliac bone grafting was high, with a high sense of well-being. The number of sport disciplines decreased significantly and more than one-third of the patients changed disciplines, of which 15% percent changed due to shoulder-related causes. The sport level remained equal, and no other parameters changed significantly compared with the time before the onset of restrictive shoulder symptoms., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objectives: Objective return to sport (RTS) criteria after anterior cruciate ligament (ACL) injury are lacking. Study purposes were (1) to report Limb Symmetry Index (LSI) values achieved in a test battery, (2) to detect how many subjects meet RTS criteria 12-18 months post-operative and (3) to identify whether patient-administered scores predict RTS criteria., Design: Observer-blinded, cross-sectional observational study., Setting: Traumacenter Linz, Austria., Participants: Eighty-eight subjects (48 females; mean (SD) age: 34.73 (10.8) years); Twenty-five had undergone ACL repair (IB), 21 ACL reconstruction (AI). Forty-two healthy subjects served as control., Main Outcome Measures: Participants were evaluated using a single-leg hop test battery. The variable of interest was meeting the RTS criteria by reaching defined cut-off values. Logistic regression was used to investigate the relationship between subjective scores (IKDC, WOMAC, KOOS, Lysholm) and fulfillment of RTS criteria. Additionally, subjective physical activity and anterior knee translation were assessed., Results: Thirty-six percent of IB patients and 28.6% of AI patients met RTS criteria. None of the included scores produced significant odds to predict RTS., Conclusions: Subjective scores, clinical examinations and fulfillment of RTS criteria did not differ significantly between groups. Maximum anterior translation revealed a significant difference (p = 0.009) in favor of the AI group., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

When we buy a product of a brand, we trust the brand to provide good quality and reliability. Therefore, trust plays a major role in consumer behavior. It is unclear, however, how trust in brands is processed in the brain and whether it is processed differently from interpersonal trust. In this study, we used fMRI to investigate the neural correlates of interpersonal and brand trust by comparing the brain activation patterns during explicit trustworthiness judgments of faces and brands. Our results showed that while there were several brain areas known to be linked to trustworthiness evaluations, such as the amygdalae, more active in trustworthiness judgments when compared to a control task (familiarity judgment) for faces, no such difference was found for brands. Complementary ROI analysis revealed that the activation of both amygdalae was strongest for faces in the trustworthiness judgments. The direct comparison of the brain activation patterns during the trustworthiness evaluations between faces and brands in this analysis showed that trustworthiness judgments of faces activated the orbitofrontal cortex, another region that was previously linked to interpersonal trust, more strongly than trustworthiness judgments of brands. Further, trustworthiness ratings of faces, but not brands, correlated with activation in the orbitofrontal cortex. Our results indicate that the amygdalae, as well as the orbitofrontal cortex, play a prominent role in interpersonal trust (faces), but not in trust for brands. It is possible that this difference is due to brands being processed as cultural objects rather than as having human-like personality characteristics., (© 2018 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Purpose: There is sparse evidence for return to sport criteria after knee injury. Functional performance deficits, particularly in fatigued muscular condition, should be verified prior to the attempt to return to high-risk pivoting sports. The purpose of this study was to generate reference values for the limb symmetry index (LSI) of healthy subjects in fatigued and non-fatigued muscular condition in a newly designed test battery., Methods: Forty-two healthy subjects [22 females, 20 males; mean (SD) age 30.4 (6.6) years] were evaluated using a test battery consisting of an isometric strength test, a series of five single-leg hop tests and an integrated fatigue protocol. Subjective physical activity was assessed with the Tegner Activity Scale (TAS). The cut-off values for healthy subjects were calculated considering the fifth percentile as the minimum reference value for the LSI and single-leg hop distance., Results: The mean (SD) overall LSI was 98.8% (4.6). No significant gender or age specific differences in limb symmetry were observed. The comparison of the non-fatigued LSI with the overall LSI revealed no clinically relevant change due to muscular fatigue. Repeated measures ANOVA revealed a significant within effect on fatigue/non-fatigue condition ( F (1,38)  = 18.000; p  < 0.001, η 2  = 0.321) on absolute single-leg hop distance. Moreover, a significant between effect on the TAS-parameter ( F (1,38)  = 5.928; p  = 0.020, η 2  = 0.135 between: TAS ≤ 5/TAS > 5) and on gender ( F (1,38)  = 23.956; p  < 0.001, η 2  = 0.387) could be detected., Conclusions: The absolute jumping distance in the single-leg hop for distance was significantly reduced due to fatigue. No clinically relevant effect of muscular fatigue was observed on limb symmetry in our study sample. Gender and physical activity are important factors to be considered when interpreting reference values., Competing Interests: Compliance with ethical standardsThe project was supported by a research grant from the Austrian Social Insurance for Occupational Risks (AUVA).The authors declare that they have no competing interests.All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.All participants provided written, informed consent after being informed about the protocol and purpose of the study. It was approved by the ethics Committee of the Austrian social insurance for occupational risks (AUVA) that personal rights were respected in this study.

Research has shown that physical activity is essential in the prevention and treatment of chronic diseases like cardiovascular disease (CVD). Smart wearables (e.g., smartwatches) are increasingly used to foster and monitor human behaviour, including physical activity. However, despite this increased usage, little evidence is available on the effects of smart wearables in behaviour change. The little research which is available typically focuses on the behaviour of healthy individuals rather than patients. In this study, we investigate the effects of using smart wearables by patients undergoing cardiac rehabilitation. A field experiment involving 29 patients was designed and participants were either assigned to the study group (N = 13 patients who finished the study and used a self-tracking device) or the control group (N = 16 patients who finished the study and did not use a device). For both groups data about physiological performance during cardiac stress test was collected at the beginning (baseline), in the middle (in week 6, at the end of the rehabilitation in the organized rehabilitation setting), and at the end of the study (after 12 weeks, at the end of the rehabilitation, including the organized rehabilitation plus another 6 weeks of self-organized rehabilitation). Comparing the physiological performance of both groups, the data showed significant differences. The participants in the study group not only maintained the same performance level as during the midterm examination in week 6, they improved performance even further during the six weeks that followed. The results presented in this paper provide evidence for positive effects of digital self-tracking by patients undergoing cardiac rehabilitation on performance of the cardiovascular system. In this way, our study provides novel insight about the effects of the use of smart wearables by CVD patients. Our findings have implications for the design of self-management approaches in a patient rehabilitation setting. In essence, the use of smart wearables can prolong the success of the rehabilitation outside of the organized rehabilitation setting.

Objectives: The neuroactive hormone oxytocin (OT) has significant influence on human behavior, and it has been measured peripherally in venous blood and in saliva in many behavioral neuroscience studies. Assessment of salivary hormone levels is popular due to non-invasiveness, but there is a controversy as to whether OT can be reliably measured in saliva and how possible time lags between plasma and salivary OT levels influence correlation., Design and Methods: In order to shed light on the question whether salivary and plasma OT levels correlate, we designed an experiment where healthy young men had to look at a presentation of trustworthy faces on a computer screen (faces were taken from an established database in trust research). During three points in time, plasma and saliva samples were collected and analyzed using ELISA., Results: Plasma and salivary OT levels did not correlate even when considering a time lag of 15 or 30 minutes., Conclusions: Our results suggest that plasma and salivary OT levels do not correlate in healthy young men, and hence comparison of results across plasma and salivary studies is neither informative nor warranted. However, we recommend replicating this study based on mixed-gender samples.