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Bridged or caged polycyclic hydrocarbons have rigid structures that project substituents into precise regions of 3D space, making them attractive as linking groups in materials science and as building blocks for medicinal chemistry. The efficient synthesis of new or underexplored classes of such compounds is therefore an important objective. Herein, we describe the silver(I)-catalyzed rearrangement of 1,4-disubstituted cubanes to cuneanes, which are strained hydrocarbons that have not received much attention from the synthetic community. The synthesis of 2,6-disubstitued or 1,3-disubstituted cuneanes can be achieved with high regioselectivities, with the regioselectivity being dependent on the electronic character of the cubane substituents. A preliminary assessment of cuneanes as scaffolds for medicinal chemistry was also performed, which suggests cuneanes could serve as isosteric replacements of trans-1,4-disubstituted cyclohexanes and 1,3-disubstituted benzenes.

PURPOSE: The optimal surgical approach for removal of colorectal endometrial deposits is unclear. Shaving and discoid excision of colorectal deposits allow organ preservation but risk recurrence with associated functional issues and re-operation. Formal resection risks potential higher complications but may be associated with lower recurrence rates. This meta-analysis compares peri-operative and long-term outcomes between conservative surgery (shaving and disc excision) versus formal colorectal resection. METHODS: The study was registered with PROSPERO. A systematic search was performed on PubMed and EMBASE databases. All comparative studies examining surgical outcomes in patients that underwent conservative surgery versus colorectal resection for rectal endometrial deposits were included. The two main groups (conservative versus resection) were compared in three main blocks of variables including group comparability, operative outcomes and long-term outcomes. RESULTS: Seventeen studies including 2861 patients were analysed with patients subdivided by procedure: colorectal resection (n=1389), shaving (n=703) and discoid excision (n=742). When formal colorectal resection was compared to conservative surgery there was lower risk of recurrence (p=0.002), comparable functional outcomes (minor LARS, p=0.30, major LARS, p=0.54), similar rates of postoperative leaks (p=0.22), pelvic abscesses (p=0.18) and rectovaginal fistula (p=0.92). On subgroup analysis, shaving had the highest recurrence rate (p=0.0007), however a lower rate of stoma formation (pCONCLUSION: Colorectal resection has a significantly lower recurrence rate compared to shaving. There is no difference in complications or functional outcomes between discoid excision and formal resection and both have similar recurrence rates.

The current study examined the reliability of a novel Gaelic football match simulation protocol (GFSP) that simulates the match-specific activity demands of elite Gaelic football match-play. After familiarisation, 16 male Gaelic footballers performed the GFSP on two occasions, 7–10 days apart to determine the reliability of a range of team sport performance indicators. The total distance (TD), high-speed running distance (HSRD) and sprint distance were 8479 ± 594 m, 2349 ± 308 m and 651 ± 319 m, respectively. In addition, decrements in TD (− 2.4%), HSRD (− 11.2%) and sprint distance (− 32.6%) from first to second half were observed. There was no significant difference between repeated trials of the GFSP for all running performance and physiological measurements. The GFSP demonstrates good test–retest reliability for the majority of performance and physiological responses. Between trial coefficient of variations (CV) and intraclass correlation coefficients (ICC) were: TD 1.9%, 0.93; HSRD 3.0%, 0.93; sprint distance 17.6%, 0.86; peak speed 4.5%, 0.60; mean heart rate (HR) 1.8%; 0.94; peak HR 2.2%, 0.89. The current investigation shows that the GFSP replicates the average movement demands of elite Gaelic football match play. The current simulation is reliable and may be seen by practitioners as a viable monitoring tool within the Gaelic football research and training process to monitor the effectiveness of various training and nutritional interventions on Gaelic football-related performance.

Gold(I)-catalyzed nucleophilic allylations of pyridinium and quinolinium ions with various allyl pinacolboronates are reported. The reactions are completely selective with respect to the site of the azinium ion that is attacked, to give various functionalized 1,4-dihydropyridines and 1,4-dihydroquinolines. Evidence suggests that the reactions proceed through nucleophilic allylgold(I) intermediates formed by transmetalation from allylboronates. Density functional theory (DFT) calculations provided mechanistic insight.

Rehabilitation after knee injury or surgery can provide challenges to patients and medical teams alike. A criteria-based progression through the acute, endurance, strength, power and return to sport phases is established to guide the process. This model of linear periodisation provides graduated increases in intensity of loading to allow for joint adaptation while addressing physiological deficits. Criteria at the end of each phase serve as markers for the patient and clinician to measure progress. Return-to-sport testing criteria are the final measures and include assessment of strength, power, neuromuscular control and psychological readiness for resuming athletic activity. Through this process of rehabilitation and testing, performance may be optimised and reinjury risk may be reduced.

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The synthesis of functionalized 1-tetralones by the rhodium(i)-catalyzed reaction of alkynyl malonates with arylboronic acids is described. These arylative cyclizations proceed via an alkenyl-to-aryl 1,4-Rh(i) migration as a key step. Preliminary results of an enantioselective variant of these reactions are also presented.

Background: Previous research has reported that elite Gaelic football players’ carbohydrate (CHO) intakes are sub-optimal, especially, in the lead up to competitive matches. Despite clear decrements in running performance across elite Gaelic football matches, there are no studies that have investigated nutrition interventions on match-related Gaelic football performance. The aim of this study was to determine whether a higher-CHO diet in line with sports nutrition guidelines can improve Gaelic football-related performance compared to lower CHO intakes previously observed in Gaelic footballers. Methods: Twelve Gaelic football players completed a Gaelic football simulation protocol (GFSP) on two occasions after consuming a high-CHO diet (7 g·kg−1) (HCHO) or an energy-matched lower-CHO diet (3.5 g·kg−1) (L-CHO) for 48 h. Movement demands and heart rate were measured using portable global positioning systems devices. Countermovement jump height (CMJ) and repeated-sprint ability (RSA) were measured throughout each trial. Expired respiratory gases were collected throughout the trial using a portable gas analyser. Blood samples were taken at rest, half-time, and post-simulation. Results: There was no significant difference in total distance (p = 0.811, η2 = 0.005) or high-speed running distance (HSRD) covered between both trials. However, in the second half of the HCHO trial, HSRD was significantly greater compared to the second half of the LCHO trial (p = 0.015). Sprint distance covered during GFSP was significantly greater in HCHO (8.1 ± 3.5 m·min−1) compared with LCHO (6.4 ± 3.2 m·min−1) (p = 0.011, η2 = 0.445). RSA performance (p &lt, 0.0001, η2 = 0.735) and lower body power (CMJ) (p &lt, η2 = 0.683) were significantly greater during the HCHO trial compared to LCHO. Overall CHO oxidation rates were significantly greater under HCHO conditions compared to LCHO (3.3 ± 0.5 vs. 2.7 ± 0.6 g·min−1) (p &lt, 0.001, η2 = 0.798). Blood lactate concentrations were significantly higher during HCHO trial versus LCHO (p = 0.026, η2 = 0.375). There were no significant differences in plasma glucose, non-esterified fatty acids (NEFAs), and glycerol concentration between trials. In both trials, all blood metabolites were significantly elevated at half-time and post-trial compared to pre-trial. Conclusion: These findings indicate that a higher-CHO diet can reduce declines in physical performance during simulated Gaelic football match play.

Aim Management paradigms for tumours from the sigmoid colon to the lower rectum vary significantly. The upper rectum (UR) represents the transition point both anatomically and in treatment protocols. Above the UR is clearly defined and managed as colon cancer and below is managed as rectal cancer. This study compares outcomes between sigmoid, rectosigmoid and UR tumours to establish if differences exist in operative and oncological outcomes. Methods Electronic databases were searched for published studies with comparative data on peri-operative and oncological outcome for upper rectal and sigmoid/rectosigmoid (SRS) tumours treated without neoadjuvant radiation. The search adhered to PRISMA guidelines (Preferred Reporting Items in Systematic Reviews and Meta-analyses) guidelines. Data was combined using random-effects models. Results Seven comparative series examined outcomes in 4355 patients. There was no difference in ASA grade (OR, 1.28; 95% CI, 0.99–1.67; P = 0.06), T3/T4 tumours (OR, 1.24; 95% CI, 0.95–1.63; P = 0.12), or lymph node positivity (OR, 0.97; 95% CI, 0.70–1.36; P = 0.87). UR cancers had higher rates of operative morbidity (OR, 0.72; 95% CI, 0.55–0.93; P = 0.01) and anastomotic leak (OR, 0.47; 95% CI, 0.31–0.71; P = 0.0004). There was no difference in local recurrence (OR, 0.63; 95% CI, 0.37–1.08; P = 0.10). SRS tumours had lower rates of distant recurrence (OR, 0.83; 95% CI, 0.68–1.0; P = 0.05). Rectosigmoid operative and cancer outcomes were closer to UR than sigmoid. Conclusions Based on existing data, UR and rectosigmoid tumours have higher morbidity, leak rates and distant recurrence than more proximal tumours.

Accuracy and classification of vision systems employed in industry are impacted by illumination. Varying levels of illumination effect a scene, thus changing how the vision system ‘sees’ the object. Depending how a model was trained and under what condition, this may cause a vision system to lose confidence and incorrectly classify objects. This research considers the effect of illuminance on vision systems, taking into account the recommended lumen levels of industrial workspaces and considering how best to train a neural network for a vision system based on the findings. A vision system using convolutional neural networks was trained under standard office lighting conditions to recognise an industrial component. The vision system was tested at incrementing lux intervals for presence and absence of the component. The vision system failed to classify correctly when tested under industrial workshop lighting settings. A statistically significant relationship was found indicating a negative linear relationship between illuminance and model confidence.

The anterior cruciate ligament (ACL) is the most commonly reconstructed ligament of the knee. Most often, the goal of surgical reconstruction is to recreate stability within the knee and prevent joint degeneration. To date, clinical studies have not demonstrated the ability of various reconstruction techniques in establishing complete knee stability when comparing rates of osteoarthritis. Rates of osteoarthritis commonly resemble those of knees which have not be reconstructed and in this light, may not demonstrate a successful outcome. As modern medicine continues to develop and in the understanding of underlying biological processes grows, some surgeons have turned their attention back to an ACL repair technique. The purpose of this clinical commentary is to discuss the parameters associated with a phase progression for an isolated ACL repair. Physiological healing time frames, along with objective clinical assessment, following a criterion-based progression is described in accordance with post-operative healing parameters to serve as a reference for a rehabilitation specialist. Level of evidence 5

Background: Outcomes after sports-related multiple-ligament knee reconstructions are limited. Purpose: To evaluate outcomes after single-stage surgical treatment of sports-related multiple-ligament knee injuries and to compare outcomes after anterior cruciate ligament (ACL)–based and posterior cruciate ligament (PCL)–based multiple-ligament knee reconstructions. Study Design: Case series; Level of evidence, 4. Methods: Skeletally mature patients with at least 2 major knee ligaments torn during a sporting activity that required surgery with a minimum of 2 years’ follow-up were included. The Lysholm score, Tegner activity scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-Item Short Form Health Survey Physical Component Summary were collected preoperatively and at a minimum of 2 years’ follow-up. Clinical data, including range of motion and knee stability, were also recorded at final follow-up. Results: A total of 276 patients with multiple-ligament knee injuries incurred during sport participation from 2010 to 2016 were identified. Of the 276 patients, 194 (70.5%) had complete follow-up at a mean 3.5 years (range, 2-8 years). There was a significant improvement in all outcome scores as compared with the preoperative scores ( P < .001 for all scores). The median (first and third quartiles) Tegner activity score improved from 1 (0, 2) preoperatively to 6 (4, 7) postoperatively. Significant improvements were from 41 (22, 57) to 90 (78, 95) and 44 (24, 60) to 3 (1, 8) for median Lysholm and WOMAC scores, respectively. There was no significant difference in postoperative outcome scores between patients treated in the acute and chronic phases. Furthermore, there was no significant difference between PCL- and ACL-based multiple-ligament knee injuries. Eighteen (9.3%) patients developed arthrofibrosis requiring reintervention surgery. Conclusion: These results demonstrated that single-stage anatomic-based knee ligament reconstructions with immediate postoperative rehabilitation in the setting of sports-related multiligament injuries yielded significantly improved outcomes irrespective of the ligament injury pattern. In addition, there was no difference in outcomes between ACL- and PCL-based injuries in the setting of sports-related multiligament injuries.

There is currently a lack of research into the energy demands and associated nutritional intakes of elite Gaelic football players during the pre-season period, which is a crucial time of year for physical development. The aim of the current study was to investigate the dietary intake and energy expenditure (EE) of elite Gaelic football players during a typical pre-season week. Over a seven-day period, which included four training days and three rest days, dietary intake (validated self-reported estimated food diary) and EE (Sensewear Pro armband) were recorded in 18 male players from a single elite inter-county Gaelic football team. Average energy intake (EI) (3283 &plusmn, 483 kcal) was significantly (p = 0.002) less than average EE (3743 &plusmn, 335 kcal), with a mean daily energy deficit of &minus, 460 &plusmn, 503 kcal. Training days elicited the greatest deficits between intake and expenditure. The mean carbohydrate (CHO) intake was 3.6 &plusmn, 0.7 g/kg/day, protein intake was 2.1 &plusmn, 0.5 g/kg/day, and fat intake was 1.6 &plusmn, 0.2 g/kg/day. These findings indicate that the dietary practices of the sampled players were inadequate to meet EE and CHO recommendations. Training days are of particular concern, with the players not altering energy and CHO intake to encounter increased energy demands. Education on nutritional strategies for elite Gaelic footballers should be considered in relation to training demands to avoid detriments to performance and health.

One of the most challenging components of the UK nuclear legacy is Magnox sludge, arising from the corrosion of Mg alloy-clad irradiated metallic U fuel that has been stored in high pH ponds. The sludges mainly comprise Mg hydroxide and carbonate phases, contaminated with fission products and actinides, including Pu. Cementation and deep geological disposal is one option for the long-term management of this material, but there is a need to understand how Pu may be leached from the waste, if it is exposed to groundwater. Here, we show that cemented Mg(OH)2 powder prepared with Pu(IV)aq is altered on contact with water to produce a visibly altered &lsquo, leached zone&rsquo, which penetrates several hundred microns into the sample. In turn, this zone shows slow leaching of Pu, with long-term leaching rates between 1.8&ndash, 4.4 &times, 10&minus, 5% of total Pu per day. Synchrotron micro-focus X-ray fluorescence mapping identified decreased Pu concentration within the &lsquo, A comparison of micro-focus X-ray absorption spectroscopy (&micro, XAS) spectra collected across both leached and unleached samples showed little variation, and indicated that Pu was present in a similar oxidation state and coordination environment. Fitting of the XANES spectra between single oxidation state standards and EXAFS modeling showed that Pu was present as a mixture of Pu(IV) and Pu(V). The change in Pu oxidation from the stock solution suggests that partial Pu oxidation occurred during sample ageing. Similarity in the XAS spectra from all samples, with different local chemistries, indicated that the Pu oxidation state was not perturbed by macro-scale variations in cement chemistry, surface oxidation, sample aging, or the leaching treatment. These experiments have demonstrated the potential for leaching of Pu from cementitious waste forms, and its underlying significance requires further investigation.

The purpose of this study was to determine the biomechanical effects of simulated immediate motion and weightbearing during rehabilitation on different double-bundle posterior cruciate ligament reconstruction (DB-PCLR) graft options. Nine each of commercially prepared (allograft) Achilles tendon allografts, fresh-frozen (autograft) bone-patellar tendon-bone grafts, and fresh-frozen quadriceps tendon grafts were paired with commercially prepared anterior tibialis allografts, fresh-frozen semitendinosus grafts, and fresh-frozen semitendinosus grafts, respectively. Graft pairs were loaded to simulate early range of motion on a stationary bicycle, partial weightbearing (30 %), and full weightbearing. Acquired laxity (displacement, mm) between graft pairs was not significantly different during simulated early range of motion. However, during simulated partial weightbearing, the median acquired laxity of the patellar tendon/semitendinosus pair (1.06 mm) was significantly less than that of the quadriceps tendon/semitendinosus (1.50 mm, p = 0.01) and Achilles/anterior tibialis (1.44 mm, p = 0.003) graft pairs. During simulated full weightbearing, significantly less acquired laxity was observed for the patellar tendon/semitendinosus graft pair (2.38 mm) compared to the Achilles/anterior tibialis pair (4.85 mm, p = 0.04), but a significant difference was not observed compared to the QT/semitendinosus graft pair (3.91 mm, n.s.). There were no significant differences in the ultimate loads between any of the graft pairs. Simulated early range of motion and early partial weightbearing did not result in clinically significant acquired graft laxity in common graft options utilized for DB-PCLR. However, simulated full weightbearing did result in clinically significant acquired graft laxity, and therefore, early rehabilitation protocols should avoid implementing full weightbearing that could contribute to graft failure.

Mud Hills clinoptilolite has been used in an effluent treatment plant (SIXEP) at the Sellafield nuclear reprocessing site. This material has been used to remove 134/137Cs and 90Sr successfully from effluents for 3 decades. Samples of the zeolite have been tested in column experiments to determine their ability to remove radioactive Cs+ and Sr2+ ions under increasing concentrations of competing ions, Ca2+, Mg2+, Na+ and K+. These ions caused increased elution of Cs+ and Sr2+. Ca2+, Mg2+ and K+ were more effective competitors than Na+. For Na+, it was found that if concentration was reduced, then column performance recovered rapidly. Electronic supplementary material The online version of this article (10.1007/s10967-018-6329-8) contains supplementary material, which is available to authorized users.

Blood flow restriction (BFR) training involves occluding venous outflow while maintaining arterial inflow by the application of an extremity tourniquet after surgery. BFR ultimately reduces oxygen delivery to muscle cells, similar to an anaerobic environment, and allows patients to exercise with low resistance and stimulates muscle hypertrophy and strength using heavy resistance. Thus orthopaedic surgeons and physical therapists are incorporating this type of training into their postoperative rehabilitation protocols, particularly after injuries or surgical procedures about the knee joint. The purpose of this Technical Note is to describe a BFR clinical application technique and to report on the indications, safety considerations, and postoperative knee surgery rehabilitation protocols for BFR.

The anterior cruciate ligament (ACL) is the most commonly reconstructed ligament of the knee. Most often, the goal of surgical reconstruction is to recreate stability within the knee and prevent joint degeneration. To date, clinical studies have not demonstrated the ability of various reconstruction techniques in establishing complete knee stability when comparing rates of osteoarthritis. Rates of osteoarthritis commonly resemble those of knees which have not be reconstructed and in this light, may not demonstrate a successful outcome. As modern medicine continues to develop and in the understanding of underlying biological processes grows, some surgeons have turned their attention back to an ACL repair technique. The purpose of this clinical commentary is to discuss the parameters associated with a phase progression for an isolated ACL repair. Physiological healing time frames, along with objective clinical assessment, following a criterion-based progression is described in accordance with post-operative healing parameters to serve as a reference for a rehabilitation specialist.5.

Background: While early weightbearing protocols have been advocated after anterior cruciate ligament (ACL) reconstruction, early weightbearing after fibular (lateral) collateral ligament reconstruction has not been well defined. Purpose: (1) To determine if early partial controlled weightbearing after fibular collateral ligament (FCL) reconstruction resulted in an objective difference in laxity on varus stress radiographs at postoperative 6 months as compared with nonweightbearing, and (2) to determine if there was a difference in pain, edema, range of motion, and subjective patient-reported outcomes between these groups at 3 time points. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients were prospectively enrolled from January 2014 to April 2017. Patients who underwent isolated FCL reconstruction or combined ACL and FCL reconstructions were included in this study. Patients were randomly assigned to either a control group (nonweightbearing for 6 weeks) or a treatment group (partial controlled weightbearing at 40% body weight with crutches for 6 weeks). Patient-related data, including knee pain, edema, and range of motion, were collected for all patients at postoperative day 1, 6 weeks, and 6 months. Subjective outcomes were collected preoperatively and at 6 months postoperatively. The primary objective endpoint was varus stability, evaluated by bilateral varus stress radiographs obtained preoperatively and at 6 months postoperatively. Results: Thirty-nine patients were enrolled in the study, with 6-month follow-up obtained for 36 (92%). There was a significant improvement between the preoperative side-to-side difference (SSD) (2.4 ± 1.0) and postoperative SSD (0.2 ± 1.0) for lateral compartment laxity on varus stress radiographs among all patients ( P < .001). Clinical and statistical equivalence was found between groups in terms of SSD on varus stress radiographs ( P < .001). The SSD in knee edema was significantly lower in the partial early weightbearing group (beta = −0.6 cm, P = .001), but there were no significant group differences in knee pain, flexion, or extension. All patients demonstrated significant improvements in subjective outcome scores between the preoperative and 6-month postoperative conditions ( P < .001 for every score measured). Conclusion: Clinical and statistical equivalence was found at postoperative 6 months between the early partial weightbearing and nonweightbearing groups among patients undergoing either an isolated FCL reconstruction or a combined ACL and FCL reconstruction. There were no significant differences observed between the groups regarding knee stability, pain, swelling, range of motion, or subjective outcomes. Given these findings, the authors recommend early partial weightbearing after isolated FCL reconstruction or combined ACL and FCL reconstruction.

Blood flow restriction (BFR) therapy is becoming increasingly popular in musculoskeletal injury rehabilitation. In particular, this form of therapy is being utilized more often in the postoperative setting following knee surgery, including anterior cruciate ligament reconstruction. BFR therapy provides patients and clinicians an alternative treatment option to standard muscle strengthening and hypertrophy guidelines in the setting of postoperative pain, weakness, and postoperative activity restrictions that contribute to muscle atrophy. The ability to complete exercise in a low load environment and achieve similar physiological adaptations as high-intensity strength training makes this modality appealing. With poor patient-related outcomes associated with continued muscle atrophy, pain, and muscle weakness, some researchers have investigated BFR training postoperatively following arthroscopic knee surgery with promising results. However, owing to the current paucity of research studies, inconsistency among reported protocols, and mixed results, it may be some time before a mass adoption of BFR therapy is made into the world of orthopaedic rehabilitation. Although the current data is inconclusive, we choose to utilize BFR in postoperative knee patients, regardless of weight-bearing status, for whom maintenance of existing muscle mass or improvement of decreased postoperative strength levels is important. Therefore, the purpose of this expert opinion is to review the background of BFR, describe the clinical evidence of BFR following knee surgery, and report the authors' current recommendations for application of BFR postoperatively.

Multiple ligament knee injuries are complex and challenging pathologies that often result from traumatic knee dislocations. An appropriate diagnosis and treatment of all the damaged structures is vital for a successful outcome. Reconstruction of all injured ligaments is recommended in order to aid in early mobilization and to avoid joint stiffness or graft failure. Postoperative recovery after a multiligament knee reconstruction procedure typically requires 9–12 months of rehabilitation prior to returning to full activities. This allows proper time for the grafts to incorporate and to heal in order to prevent graft failure. A well-crafted rehabilitation plan after a multiligament knee reconstruction should focus on graft protection and functional outcomes including regaining motion, strength, and function. Once a muscular strength foundation with good dynamic neuromuscular control has been established, patients can progress to their functional sport-specific exercises. The purpose of this chapter is to give a thorough overview of key rehabilitation concepts after a multiligament knee reconstruction.

Outcomes of primary anterior cruciate ligament (ACL) reconstruction have been reported to be far superior to those of revision reconstruction. However, as the incidence of ACL reconstruction is rapidly increasing, so is the number of failures. The subsequent need for revision ACL reconstruction is estimated to occur in up to 13,000 patients each year in the United States. Revision ACL reconstruction can be performed in one or two stages. A two-stage approach is recommended in cases of improper placement of the original tunnels or in cases of unacceptable tunnel enlargement. The aim of this study was to describe the technique for allograft ACL tunnel bone grafting in patients requiring a two-stage revision ACL reconstruction.

Synopsis There is a growing body of evidence surrounding the pathology and treatment of meniscal root tears. As surgical techniques are being developed and refined, rehabilitation protocols for meniscal root repairs must be defined and tested. Little information has been published regarding specific rehabilitation parameters for meniscal root repairs through all phases of rehabilitation. The goal of this commentary is to describe a rehabilitation program for meniscal root repairs that is founded on anatomical, physiological, and biomechanical principles with criteria-based progressions. J Orthop Sports Phys Ther 2016;46(2):104–113. Epub 11 Jan 2016. doi:10.2519/jospt.2016.6219

Purpose Historically, the results of posterior cruciate ligament (PCL) reconstructions are not as favourable as anterior cruciate ligament (ACL) reconstructions, and it is well recognized that nonoperative treatment and postoperative rehabilitation for PCL injuries must be altered compared to those for ACL injuries. The purpose of this article was to review current peer-reviewed PCL rehabilitation programmes and to recommend a nonoperative and postoperative programme based on basic science and published outcomes studies. Methods To discover the current practices being used to rehabilitate PCL injuries, we conducted a search of PubMed with the terms ‘‘posterior cruciate ligament’’ and ‘‘rehabilitation’’ from 1983 to 2011. All articles within the reference lists of these articles were also examined to determine their rehabilitation programmes. Results A review of peer-reviewed PCL rehabilitation protocols revealed that the treatment of PCL injuries depends on the timing and degree of the injury. Rehabilitation should focus on progressive weight bearing, preventing posterior tibial subluxation and strengthening of the quadriceps muscles. General principles of proper PCL rehabilitation, whether nonoperative or postoperative, should include early immobilization (when necessary), prone passive range of motion to prevent placing undue stress on grafts or healing tissue, and progression of rehabilitation based on biomechanical, clinical, and basic science research. Conclusions An optimal set of guidelines for the nonoperative or postoperative management of PCL injuries has not yet been defined or agreed upon. Based on the current review study, suggested guidelines are proposed. Level of evidence IV.

Full-thickness chondral defects in the knee are common, and these articular cartilage lesions may present in various clinical settings and at different ages. Articular cartilage defects that extend full thickness to subchondral bone rarely - by providing a suitable environment for new tissue formation and takes advantage of the body's own healing potential. Proper surgical technique and rehabilitation improve the success rate of the microfracture procedure. The goals are to alleviate the pain and disability that can result from chondral lesions and restore joint conformity, thereby preventing late degenerative changes in the joint.

A commercially available synthetic silicotitanate (IONSIV® IE-911), with a sitinakite-like structure, is a candidate material for the remediation of aqueous nuclear waste streams. These streams often vary in both cation composition and cation concentration. Commonly Na, K, Mg, Ca and Ba are present, and sodium is the most prevalent with barium present at much lower concentrations. Batch experiments to measure distribution coefficients (Kd) have been carried out to monitor the effect of these cations on the removal of the fission products Cs and Sr from simulated aqueous waste streams relevant to their remediation prior to release to the environment.

A commercially available synthetic silicotitanate (IONSIV® IE-911), with a sitinakite-like structure, is a candidate material for the remediation of aqueous nuclear waste streams. These streams are often complex in their cation composition. This work investigates the effect of the presence of Na, K, Mg, Ca and Ba on the rates of removal of Cs and Sr radioisotopes as cations of importance in aqueous nuclear waste streams. Results are compiled as isotopic diffusion coefficients, and by analysis of changes in pH with time, observed as the systems reach equilibrium. This kinetic treatment provides necessary data for use in the modelling of plant performance and for the accurate determination of distribution coefficients which will be the subject of the second part in this series.

Biliverdin reductase (BVR) isozymes, BVRA and BVRB, are cell surface membrane receptors with pleiotropic functions. This review compares, for the first time, the structural and functional differences of the isozymes. They reduce biliverdin, a byproduct of heme catabolism, to bilirubin, display kinase activity and BVRA, but not BVRB, can act as a transcription factor. The binding motifs present in the BVR isozymes allow for a wide range of interactions with components of metabolically important signaling pathways, such as with the insulin receptor kinase cascades, protein kinase, and inflammatory mediators. In addition, serum bilirubin levels have been negatively associated with abdominal obesity and hypertriglyceridemia. We will discuss the roles of the BVR isozymes in metabolism, and their potential as therapeutic targets.

CASE Numerous outcome studies regarding anterior cruciate ligament (ACL) reconstruction demonstrate the ability of athletes to return to a high level of play. However, to our knowledge, there is limited literature regarding return to play following injury to both the ACL and the fibular collateral ligament (FCL). We describe the case of a National Basketball Association (NBA) player who sustained a combined ACL and FCL knee injury and subsequently underwent surgical reconstruction of both affected ligaments. He was able to return to a preinjury level of competition at 9 months postoperatively. CONCLUSION It is possible for athletes to return to competitive basketball and maintain a high production level following a single-staged reconstruction of both the ACL and the FCL.

Injuries to the posterolateral corner (PLC) of the knee have gained increased attention over the last two decades. The PLC is described functionally by three major static stabilizers: the fibular collateral ligament (FCL), the popliteus tendon, and the popliteofibular ligament. Injuries to these structures account for up to 16 % of all ligamentous injuries to the knee. When injured, the PLC structures are more often part of combined ligament injuries. Moreover, chronic complete (Grade III) PLC injuries can lead to pain, instability, meniscal tears, osteoarthritis, and failure of anterior and posterior cruciate ligament reconstruction grafts if left untreated. Therefore, proper diagnosis and treatment is essential in order to maximize patient outcomes and expedite return to activity. An anatomic-based surgical reconstruction is favored over repair due to better reported long-term outcomes. However, in spite of recent advances, there remains a paucity of literature on the treatment of PLC injuries in comparison to other ligamentous injuries of the knee. In this chapter, the general principles of the diagnosis and treatment of chronic PLC injuries will be discussed, with a focus on the essentials of preoperative planning, an anatomic-based reconstruction, and postoperative rehabilitation that are required for a successful surgical outcome.

Ice hockey goaltenders, especially those who employ the butterfly technique, are a specialized population of athletes because of the unique physical demands that the position places on their lower extremities, specifically at the hip. It is no surprise that hip injuries are a common occurrence among goalies. A review of the biomechanical literature has demonstrated that stresses on the hip while in flexion and end-range internal rotation, the position goaltenders commonly use, put the hip at risk for injury and are likely a major contributing factor to overuse hip injuries. The stress on a goaltender's hip can potentially be further intensified by the presence of bony deformities, such as cam- or pincer-type femoroacetabular impingement, which can lead to chondrolabral junction and articular cartilage injuries. There have been few published reports of goaltenders' functional outcomes following femoroacetabular impingement surgery, and, to our knowledge, no studies have yet identified the specific challenges presented in the rehabilitation of goaltenders following femoroacetabular impingement surgery. The present clinical commentary describes a 6-phase return-to-skating program developed as part of a rehabilitation protocol to aid hockey goaltenders recovering from surgery.

Currently there are many functional knee braces but very few designed to treat the posterior cruciate ligament (PCL). No PCL braces have been biomechanically validated to demonstrate that they provide stability with proper force distribution to the PCL-deficient knee. The purpose of this review was to evaluate the history and current state of PCL bracing and to identify areas where further progress is required to improve patient outcomes and treatment options.A PubMed search was conducted with the terms "posterior cruciate ligament", "rehabilitation", "history", "knee", and "brace", and the relevant articles from 1967 to 2011 were analysed. A review of the current available PCL knee bracing options was performed.Little evidence exists from the eight relevant articles to support the biomechanical efficacy of nonoperative and postoperative PCL bracing protocols. Clinical outcomes reported improvements in reducing PCL laxity with anterior directed forces to the tibia during healing following PCL tears. Biomechanics research demonstrates that during knee flexion, the PCL experiences variable tensile forces. One knee brace has been specifically designed and clinically validated to improve stability in PCL-deficient knees during rehabilitation. While available PCL braces demonstrate beneficial patient outcomes, they lack evidence validating their biomechanical effectiveness.There is limited information evaluating the specific effectiveness of PCL knee braces. A properly designed PCL brace should apply correct anatomic joint forces that vary with the knee flexion angle and also provide adjustability to satisfy the demands of various activities. No braces are currently available with biomechanical evidence that satisfies these requirements.IV.