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Walking performance and cognitive function demonstrate strong associations in older adults, with both declining with advancing age. Walking requires the use of cognitive resources, particularly in complex environments like stepping over obstacles. A commonly implemented approach for measuring the cognitive control of walking is a dual-task walking assessment, in which walking is combined with a second task. However, dual-task assessments have shortcomings, including issues with scaling the task difficulty and controlling for task prioritization. Here we present a new assessment designed to be less susceptible to these shortcomings while still challenging cognitive control of walking: the Obstructed Vision Obstacle (OBVIO) task. During the task, participants hold a lightweight tray at waist level obstructing their view of upcoming foam blocks, which are intermittently spaced along a 10 m walkway. This forces the participants to use cognitive resources (e.g., attention and working memory) to remember the exact placement of upcoming obstacles to facilitate successful crossing. The results demonstrate that adding the obstructed vision board significantly slowed walking speed by an average of 0.26 m/s and increased the number of obstacle strikes by 8-fold in healthy older adults (n = 74). Additionally, OBVIO walking performance (a score based on both speed and number of obstacle strikes) significantly correlated with computer-based assessments of visuospatial working memory, attention, and verbal working memory. These results provide initial support that the OBVIO task is a feasible walking test that demands cognitive resources. This study lays the groundwork for using the OBVIO task in future assessment and intervention studies., Competing Interests: Declaration of competing interest The authors declare no potential conflicts of interest., (Published by Elsevier Inc.)

Purpose: To investigate the effects of combining bone marrow stimulation (BMS) with oral losartan to block transforming growth factor β1 (TGF-β1) on biomechanical repair strength in a rabbit chronic injury model., Methods: Forty rabbits were randomly allocated into 4 groups (10 in each group). The supraspinatus tendon was detached and left alone for 6 weeks to establish a rabbit chronic injury model and was then repaired in a surgical procedure using a transosseous, linked, crossing repair construct. The animals were divided into the following groups: control group (group C), surgical repair only; BMS group (group B), surgical repair with BMS of the tuberosity; losartan group (group L), surgical repair plus oral losartan (TGF-β1 blocker) for 8 weeks; and BMS-plus-losartan group (group BL), surgical repair plus BMS plus oral losartan for 8 weeks. At 8 weeks after repair, biomechanical and histologic evaluations were performed., Results: The biomechanical testing results showed significantly higher ultimate load to failure in group BL than in group B (P = .029) but not compared with group C or group L. A 2 × 2 analysis-of-variance model found that the effect of losartan on ultimate load significantly depended on whether BMS was performed (interaction term F 1,28  = 5.78, P = .018). No difference was found between the other groups. No difference in stiffness was found between any groups. On histologic assessment, groups B, L, and BL showed improved tendon morphology and an organized type I collagen matrix with less type III collagen compared with group C. Group BL showed the most highly organized tendon matrix with more type I collagen and less type III collagen, which indicates less fibrosis. Similar results were found at the bone-tendon interface., Conclusions: Rotator cuff repair combined with oral losartan and BMS of the greater tuberosity showed improved pullout strength and a highly organized tendon matrix in this rabbit chronic injury model., Clinical Relevance: Tendon healing or scarring is accompanied by the formation of fibrosis, which has been shown to result in compromised biomechanical properties, and is therefore a potential limiting factor in healing after rotator cuff repair. TGF-β1 expression has been shown to play an important role in the formation of fibrosis. Recent studies focusing on muscle healing and cartilage repair have found that the downregulation of TGF-β1 by losartan intake can reduce fibrosis and improve tissue regeneration in animal models., (Copyright © 2023. Published by Elsevier Inc.)

Introduction: Screw cut out and varus collapse are the most common complication of locked plate fixation of proximal humerus fractures. The purpose of this study was to compare dual plating and endosteal fibular allograft struts as augmentation strategies to prevent varus collapse., Materials and Methods: A trapezoidal osteotomy was created at the metaphysis to create a 2-part proximal humerus model in 18 paired shoulder specimens. Each specimen was assigned to group A, B, or C and was fixed with either a lateral locking plate, a lateral locking plate and anterior one-third tubular plate in an orthogonal 90/90 configuration, or a lateral locking plate with intramedullary fibular strut, respectively. The specimens were stressed in axial compression to failure. Displacement, elastic limit, ultimate load, and stiffness were recorded and calculated., Results: There was no difference in mean cyclic displacement between the three groups (0.71 mm vs 0.89 mm vs 0.61 mm for Group A, B, C, respectively). Lateral plating demonstrated the greatest absolute and relative displacement at the elastic limit (5.3 mm ± 1.5 and 4.4 mm ± 1.3) without significance. The elastic limit or yield point was greatest for fibular allograft, Group C (1223 N ± 501 vs 1048 N ± 367 for Group B and 951 N ± 249 for Group A) without significance., Conclusions: Dual plating of proximal humerus fractures in a 90-90 configuration demonstrates similar biomechanical properties as endosteal fibular strut allograft. Both strategies demonstrate superior stiffness to isolated lateral locked plating., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Existing biomechanical studies of posterior glenoid bone loss and labral pathology are limited by their use of anterior instability models, which differ in both orientation and morphology and have been performed in only a single, neutral arm position., Purpose: To evaluate the biomechanical effectiveness of a posterior labral repair in the setting of a clinically relevant posterior bone loss model in various at-risk arm positions., Study Design: Controlled laboratory study., Methods: Ten fresh-frozen cadaveric shoulders were tested in 7 consecutive states using a 6 degrees of freedom robotic arm: (1) native, (2) posterior labral tear (6-9 o'clock), (3) posterior labral repair, (4) mean posterior glenoid bone loss (7%) with labral tear, (5) mean posterior glenoid bone loss with labral repair, (6) large posterior glenoid bone loss (28%) with labral tear, and (7) large posterior glenoid bone loss with labral repair. Bone loss was created using 3-dimensional printed computed tomography model templates. Biomechanical testing consisted of 75 N of posterior-inferior force and 75 N of compression at 60° and 90° of flexion and scaption. Posterior-inferior translation, lateral translation, and peak dislocation force were measured for each condition., Results: Labral repair significantly increased dislocation force independent of bone loss state between 10.1 and 14.8 N depending on arm position. Dislocation force significantly decreased between no bone loss and small bone loss (11.9-13.5 N), small bone loss and large bone loss (9.4-14.3 N), and no bone loss and large bone loss (21.2-26.5 N). Labral repair significantly decreased posterior-inferior translation compared with labral tear states by a range of 1.0 to 2.3 mm. In the native state, the shoulder was most unstable in 60° of scaption, with 29.9 ± 6.1-mm posterior-inferior translation., Conclusion: Posterior labral repair improved stability of the glenohumeral joint, and even in smaller to medium amounts of posterior glenoid bone loss the glenohumeral stability was maintained with labral repair in this cadaveric model. However, a labral repair with large bone loss could not improve stability to the native state., Clinical Relevance: This study shows that larger amounts of posterior glenoid bone loss (>25%) may require bony augmentation for adequate stability.

Background: Lateral meniscal deficiency with valgus malalignment increases the rate of lateral compartment osteoarthritis. Lateral meniscal allograft transplantation (LMAT) with a concomitant varus-producing opening-wedge distal femoral osteotomy (DFO) is an option yet to be evaluated biomechanically., Purpose/hypothesis: The purpose of this study was to clarify the biomechanical effects of the realignment procedure in the setting of LMAT. We hypothesized that (1) given the dependence of the lateral compartment on the lateral meniscus, a DFO and increasing degrees of varus would be insufficient to restore lateral compartment pressures to normal from a lateral meniscus-deficient state, and that (2) LMAT would restore lateral compartment pressures to the intact state while DFO would decrease lateral compartment pressures for any given state of the meniscus., Study Design: Controlled laboratory study., Methods: Ten cadaveric knees underwent opening-wedge varus-producing DFO secured by an external fixator. Anatomic alignment was standardized to 6° of mechanical valgus, and each joint was tested in full extension. Submeniscal placement of thin film pressure sensors allowed for the recording of contact pressure, peak contact pressure, and contact area. The specimens were loaded on a biaxial dynamic testing machine with loading angles between 9° valgus and 6° varus of mechanical alignment. Conditions tested included intact meniscus, meniscal deficiency, and meniscal transplantation., Results: Isolated varus-producing DFO to 6° in the meniscus-deficient state failed to restore joint pressures and contact areas to the intact state, with significant changes in mean contact pressure (175%), mean peak contact pressure (135%), and contact area (-41%) (all P < .05 vs intact), while LMAT restored all outcome measures (all P > .05 compared with intact). After LMAT, every additional 1° of DFO correction contributed to a decrease in the mean contact pressure, peak pressure, and contact area of 5.6% (-0.0479 N/mm 2 ), 5.9% (-0.154 N/mm 2 ), and 1.4% (-6.99 mm 2 ) for the lateral compartment and 7.3% (+0.034 N/mm 2 ), 12.6% (+0.160 N/mm 2 ), and 4.3% (+20.53 mm 2 ) for the medial compartment, respectively., Conclusion: Isolated DFO was inadequate to restore load distribution in meniscus-deficient knees, while concomitant LMAT restored near normal forces and improved the lateral compartment biomechanical profile., Clinical Relevance: Our findings support the concomitant use of LMAT and varus-producing DFO in the setting of lateral meniscal deficiency with valgus malalignment. This study provides tools for the orthopaedic surgeon to individualize the correction for each patient., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: S.L. has received grant support from Arthrex; education payments from Arthrex and Smith & Nephew; and hospitality payments from Medical Device Business Services. R.M.F. has received education payments from Arthrex and Smith & Nephew; consulting fees and nonconsulting fees from Arthrex; and hospitality payments from JRF Ortho. A.F.V. has received consulting fees from Arthrex and Stryker; speaking fees from Arthrex and Smith & Nephew; and honoraria from Vericel. 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) 2023.)

Purpose: The purpose of this study was to compare, using a cadaveric model, the biomechanical properties of headless compression screws (HCSs) and HCSs augmented with a buttress plate (BP) in capitellar fractures., Methods: Twenty pairs of fresh-frozen humeri (mean age, 46.3 years; range, 33-58 years) were used. The soft tissue was removed, and a Dubberley type IA capitellar fracture was created. One specimen in each pair was randomly assigned to receive either two 2.5-mm HCSs (HCS group) or two 2.5-mm HCSs augmented with an anterior 2.4-mm BP (HCS + BP group). This resulted in a similar distribution of the left and right humeri between the groups. Cyclic loading was performed, and displacement of the capitellum at 50, 100, 250, 500, 1,000, and 2,000 cycles was assessed using a motion capture system. This was followed by load-to-failure testing, wherein the load at a displacement of 1 and 2 mm was recorded. Failure was defined as 2-mm displacement., Results: During cyclic loading, there were no significant differences in the displacement between the HCS and HCS + BP groups at any of the assessed cycles. During load-to-failure testing, no significant strength differences were observed in the load at 1-mm displacement between the HCS (mean: 449.8 N, 95% CI: 283.6-616.0) and HCS + BP groups (mean: 606.2 N, 95% CI: 476.4-736.0). However, a significantly smaller load resulted in a 2-mm displacement of the fragment in the HCS group (mean: 668.8 N, 95% CI: 414.3-923.2) compared with the HCS + BP group (mean: 977.5 N, 95% CI: 794.1-1,161.0)., Conclusions: Anterior, low-profile buttress plating in addition to HCSs results in a significantly higher load to failure compared with HCSs alone in a biomechanical Dubberley type IA capitellar fracture model., Clinical Relevance: The addition of an anterior BP may be considered to improve initial stability in select cases such as osteoporotic patients or when the posterolateral column is frail., (Copyright © 2023 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: Transsyndesmotic fixation with suture buttons (SBs), posterior malleolar fixation with screws, and anterior inferior tibiofibular ligament (AITFL) augmentation using suture tape (ST) have all been suggested as potential treatments in the setting of a posterior malleolar fracture (PMF). However, there is no consensus on the optimal treatment for PMFs., Purpose: To determine which combination of (1) transsyndesmotic SBs, (2) posterior malleolar screws, and (3) AITFL augmentation using ST best restored native tibiofibular and ankle joint kinematics after 25% and 50% PMF., Study Design: Controlled laboratory study., Methods: Twenty cadaveric lower-leg specimens were divided into 2 groups (25% or 50% PMF) and underwent biomechanical testing using a 6 degrees of freedom robotic arm in 7 states: intact, syndesmosis injury with PMF, transsyndesmotic SBs, transsyndesmotic SBs + AITFL augmentation, transsyndesmotic SBs + AITFL augmentation + posterior malleolar screws, posterior malleolar screws + AITFL augmentation, and posterior malleolar screws. Four biomechanical tests were performed at neutral and 30° of plantarflexion: external rotation, internal rotation, posterior drawer, and lateral drawer. The position of the tibia, fibula, and talus were recorded using a 5-camera motion capture system., Results: With external rotation, posterior malleolar screws with AITFL augmentation resulted in best stability of the fibula and ankle joint. With internal rotation, all repairs that included posterior malleolar screws stabilized the fibula and ankle joint. Posterior and lateral drawer resulted in only small differences between the intact and injured states. No differences were found in the efficacy of treatments between 25% and 50% PMFs., Conclusion: Posterior malleolar screws resulted in higher syndesmotic stability when compared with transsyndesmotic SBs. AITFL augmentation provided additional external rotational stability when combined with posterior malleolar screws. Transsyndesmotic SBs did not provide any additional stability and tended to translate the fibula medially., Clinical Relevance: Posterior malleolar fixation with AITFL augmentation using ST may be the preferred surgical method when treating patients with acute ankle injury involving an unstable syndesmosis and a PMF ≥25%.

Purpose: Despite increasing interest in utilizing quadriceps tendon (QT) grafts in anterior cruciate ligament reconstruction (ACLR), data on the optimal quadriceps graft thickness are limited. The purpose of this study was to characterize the mechanical properties for the quadriceps tendon, comparing full-thickness (FT) QT grafts with and without bone to a partial-thickness (PT) QT graft, and comparing the three QT grafts to four-stranded semitendinosus (4-SST) and bone-patellar tendon-bone (BTB) grafts and one experimental graft, the two-stranded rectus femoris (RF)., Methods: Forty-eight (n = 48) young cadaveric grafts (mean age 32 ± 6 years) were utilized for testing with N = 8 specimens in each of the following groups; (1) FT QT with bone, (2) FT QT without bone, (3) PT QT without bone, (4) BTB, (5) RF, and (6) 4-SST. Each specimen was harvested and rigidly fixed in custom clamps to a dynamic tensile testing machine for biomechanical evaluation. Graft ultimate load and stiffness were recorded. Independent groups one-factor ANOVAs and Tukey's pairwise comparisons were performed for statistical analyses., Results: FT QT with bone and 4-SST grafts demonstrated similar ultimate loads to BTB grafts (both n.s), whereas PT QT demonstrate statistically significantly lower ultimate loads to BTB grafts (n.s) and 4-SST grafts (n.s). Furthermore, no statistically significant differences were observed between the ultimate loads of FT QT vs. PT QT grafts without bone (n.s) or between FT QT with vs. without bone (n.s). FT QT grafts with bone did not demonstrate statistically significantly greater ultimate loads than PT QT grafts without bone (n.s). The RF graft demonstrated statistically significantly lower ultimate loads to BTB grafts (p < 0.005) and 4-SST grafts (p < 0.014)., Conclusions: Full thickness QT grafts with bone had similar material properties to BTB and a 4-SST grafts, while Partial thickness QT graft without bone had significantly lower material properties than BTB and 4-SST, in a biomechanical setting., (© 2021. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)

This study investigated locomotor learning of a complex terrain walking task in older adults, when combined with two adjuvant interventions: transcutaneous spinal direct current stimulation (tsDCS) to increase lumbar spinal cord excitability, and textured shoe insoles to increase somatosensory feedback to the spinal cord. The spinal cord has a crucial contribution to control of walking, and is a novel therapeutic target for rehabilitation of older adults. The complex terrain task involved walking a 10-meter course consisting of nine obstacles and three sections of compliant (soft) walking surface. Twenty-three participants were randomly assigned to one of the following groups: sham tsDCS and smooth insoles ( sham/smooth ; control group), sham tsDCS and textured insoles ( sham/textured ), active tsDCS and smooth insoles ( active/smooth ), and active tsDCS and textured insoles ( active/textured ). The first objective was to assess the feasibility, tolerability, and safety of the interventions. The second objective was to assess preliminary efficacy for increasing locomotor learning, as defined by retention of gains in walking speed between a baseline visit of task practice, and a subsequent follow-up visit. Variability of the center of mass while walking over the course was also evaluated. The change in executive control of walking (prefrontal cortical activity) between the baseline and follow-up visits was measured with functional near infrared spectroscopy. The study results demonstrated feasibility based on enrollment and retention of participants, tolerability based on self-report, and safety based on absence of adverse events. Preliminary efficacy was supported based on trends showing larger gains in walking speed and more pronounced reductions in mediolateral center of mass variability at the follow-up visit in the groups randomized to active tsDCS or textured insoles. These data justify future larger studies to further assess dosing and efficacy of these intervention approaches. In conclusion, rehabilitation interventions that target spinal control of walking present a potential opportunity for enhancing walking function in older adults., Competing Interests: The 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., (Copyright © 2022 Clark, Hawkins, Winesett, Cox, Pesquera, Miles, Fuller and Fox.)

Background: The percutaneous knotless repair technique for Achilles tendon ruptures utilizes a Percutaneous Achilles Repair System (PARS) device for suturing the proximal tendon and 2 suture anchors for fixing the sutures into the calcaneus. Determining the best position of the suture anchors may optimize the strength of this repair., Methods: Twelve pairs of human ankle cadaveric specimens were randomly assigned to receive suture anchors placed at 45°, 90°, or 135° from the sagittal plane. The anchors were tensioned according to a protocol representing progressive, postoperative rehabilitation. Load, number of loading cycles, displacement, and mode of failure were recorded., Results: With the anchors placed at 45°, 90°, and 135°, the ultimate failure loads were mean 265 ± 64 N, 264 ± 75 N, and 279 ± 40 N, and the total number of loading cycles were mean 459 ± 166, 466 ± 158, and 469 ± 110, respectively. The effect of anchor angle on failure load, number of loading cycles, and displacement was not statistically significant. Visually, the anchors at 45° and 90° demonstrated sutures cutting through the bone., Conclusion: We found no statistically significant difference in pullout strength between the 3 different anchor angles. Sutures cutting through the bone may be a concern with acute anchor angles. This suggests that a 135° anchor angle may result in a lower risk of tendon elongation with the percutaneous knotless repair technique., Levels of Evidence: Cadaveric laboratory study.

Background: Meniscal deficiency has been reported to increase contact pressures in the affected tibiofemoral joint, possibly leading to degenerative changes. Current surgical options include meniscal allograft transplantation and insertion of segmental meniscal scaffolds. Little is known about segmental meniscal allograft transplantation., Purpose: To evaluate the effectiveness of segmental medial meniscal allograft transplantation in the setting of partial medial meniscectomy in restoring native knee loading characteristics., Study Design: Controlled laboratory study., Methods: Ten fresh-frozen human cadaveric knees underwent central midbody medial meniscectomy and subsequent segmental medial meniscal allograft transplantation. Knees were loaded in a dynamic tensile testing machine to 1000 N for 20 seconds at 0°, 30°, 60°, and 90° of flexion. Four conditions were tested: (1) intact medial meniscus, (2) deficient medial meniscus, (3) segmental medial meniscal transplant fixed with 7 meniscocapsular sutures, and (4) segmental medial meniscal transplant fixed with 7 meniscocapsular sutures and 1 suture fixed through 2 bone tunnels. Submeniscal medial and lateral pressure-mapping sensors assessed mean contact pressure, peak contact pressure, mean contact area, and pressure mapping. Two-factor random-intercepts linear mixed effects models compared pressure and contact area measurements among experimental conditions., Results: The meniscal-deficient state demonstrated a significantly higher mean contact pressure than all other testing conditions (mean difference, ≥0.35 MPa; P < .001 for all comparisons) and a significantly smaller total contact area as compared with all other testing conditions (mean difference, ≤140 mm 2 ; P < .001 for all comparisons). There were no significant differences in mean contact pressure or total contact area among the intact, transplant, or transplant-with-tunnel groups or in any outcome measure across all comparisons in the lateral compartment. No significant differences existed in center of pressure and relative pressure distribution across testing conditions., Conclusion: Segmental medial meniscal allograft transplantation restored the medial compartment mean contact pressure and mean contact area to values measured in the intact medial compartment., Clinical Relevance: Segmental medial meniscal transplantation may provide an alternative to full meniscal transplantation by addressing only the deficient portion of the meniscus with transplanted tissue. Additional work is required to validate long-term fixation strength and biologic integration.

Background: Dual orthogonal plating of midshaft clavicle fractures is increasingly used for osteosynthesis. The risk of refracture after hardware removal remains unknown. The purpose of this study was to compare the torsional and 3-point bending loads to failure of the clavicle following removal of single-plane, superior 3.5-mm plate fixation vs. dual orthogonal plating 2.7-mm constructs., Methods: This study used 12 pairs of clavicles (N = 24) harvested from cadaveric specimens with a mean age at death of 56.5 years (range, 46-65 years). One clavicle from each pair was randomly assigned to either superior plating (SP, n = 12) or double plating (DP, n = 12). For SP, a superior 3.5-mm plate was used as a template to drill 3 bicortical 2.8-mm holes medial and lateral to the center of the clavicle. For DP, two 2.7-mm plates were used as a template to drill 4 bicortical 2.0-mm holes medial and lateral to the center of the clavicle. Clavicle pairs were randomly and evenly distributed to undergo either 3-point bending (n = 12) or posterior torsional loading (n = 12). Cyclic loading was performed, followed by load-to-failure testing. Stiffness, displacement at failure, load to failure, and failure mode were assessed and compared between SP and DP constructs., Results: No significant differences between the SP and DP groups were observed for stiffness (768.2 ± 281.3 N/mm vs. 785.5 ± 315.0 N/mm, P = .872), displacement at failure (8.1 ± 2.8 mm vs. 5.4 ± 1.2 mm, P = .150), and ultimate load at failure (1831.0 ± 229.6 N vs. 1842.0 ± 662.4 N, P = .964) under the condition of 3-point bending. Similarly, no significant differences between the SP and DP groups were observed for torsional stiffness (1.3 ± 0.8 N · m/° vs. 1.1 ± 0.4 N · m/°, P = .844), rotation at failure (17.3° ± 4.4° vs. 14.4° ± 1.2°, P = .205), and ultimate torque at failure (14.8 ± 6.5 N · m vs. 14.7 ± 6.9 N · m, P = .103) under the condition of posterior torsional loading. The most common mode of failure for 3-point bending testing was an oblique fracture (7 of 12 clavicles, 58.3%), with no significant difference between groups (3 of 6 in SP group [50%] vs. 4 of 6 in DP group [66.7%], P > .999). The most common mode of failure with posterior torsional loading was a spiral fracture (10 of 12 clavicles, 83.3%), with no significant difference between groups (4 of 6 in SP group [66.7%] vs. 6 of 6 in DP group [100%], P = .455)., Conclusion: Following clavicle plate removal of either DP or SP, there is no statistically significant difference in the amount of force, under the condition of 3-point bending or torsional loading, required to fracture the diaphyseal clavicle in vitro., (Copyright © 2021 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the biomechanical properties of metallic anchor (MA) and all-suture anchor (ASA) constructs in the anatomic reattachment of the lateral ulnar collateral ligament complex to its humeral insertion., Methods: Twenty paired male human cadaveric elbows with a mean age of 46.3 years (range: 33-58 years) were used in this study. Each pair was randomly allocated across 2 groups of either MA or ASA. A single 3.5-mm MA or 2.6-mm ASA was then inserted flush into the lateral epicondyle. A dynamic tensile testing machine was used to perform cyclic loading followed by a load to failure test. During the cyclic loading phase, the anchors were sinusoidally tensioned from 10 N to 100 N for 1,000 cycles at a frequency of 0.5 Hz. In the load to failure test, the anchors were pulled at a rate of 3 mm/s. Load at 1-mm and 2-mm displacement, as well as load to ultimate failure were assessed. Clinical failure was defined as displacement of more than 2 mm. Normality of data was assessed with the Shapiro-Wilk test. Continuous data are presented as medians and compared with the Mann-Whitney U test and categorical data was compared with the χ 2 test or Fisher exact test., Results: Displacement was significantly greater for the ASA group during cyclic loading starting from the tenth cycle (P < .05). Displacement of more than 5 mm within the first 100 cycles was observed in 2 anchors in the ASA group. No difference was observed in loads required to displace 1 mm (MA: 146 N [6-169] vs ASA: 144 N [2-153]; P = .53) and 2 mm (MA: 171 N [13-202] vs ASA: 161 N [9-191]; P = .97), but there was a statistically significant difference between ultimate loads in favor of ASA in the load to failure test (MA: 297 N [84-343] vs 463 N [176-620]; P < .01)., Conclusions: In the cyclic test, no difference in clinical failure defined as pull-out of more than 2 mm was observed between 3.5 mm MAs and 2.6 mm ASAs. In the ultimate load to failure analysis, no difference was observed between groups in force causing 1 and 2 mm of displacement, but there was a significant difference in favor of ASA in the pull to ultimate failure test., Clinical Relevance: Potential benefits of all-suture anchors include preservation of bone stock, reduced radiographic artifacts, and easier revisions. Although their use has been investigated thoroughly in the shoulder, there remains a paucity of literature regarding displacement and pull-out strength in the elbow., (Copyright © 2021. Published by Elsevier Inc.)

Background: Acellular dermal matrix (ADM) allografts are commonly used in the surgical treatment of complex and irreparable rotator cuff tears. Multiple studies report that superior capsule reconstruction (SCR) using ADM has resulted in short-term clinical success as assessed via radiographic and patient-reported outcomes. However, limited information is available regarding the biologic fate of these grafts in human subjects. This case series describes histologic results from 8 patients who had reoperations, during which the previously implanted ADMs were removed. These explanted ADMs were subjected to histologic analysis with the hypothesis that they would have evidence of recellularization, revascularization, and active remodeling., Methods: Eight patients, 38-82 years old, underwent reoperation 6-38 months after undergoing SCR. ADM explants were voluntarily shipped to the manufacturer for histologic analysis. Each graft's structure and composition were qualitatively evaluated by 1 or more of the following histologic stains: hematoxylin and eosin, safranin O, and Russell-Movat pentachrome. Pan-muscle actin staining also assessed the level of neovascularization, potential myoblast or myocyte infiltration, and muscle tissue development in the graft, and was analyzed to determine the proportion of graft that had been recellularized in situ., Results: Grafts showed varying levels of gross and microscopic incorporation with the host. An uneven, but high, overall degree of recellularization, revascularization, and active remodeling was observed. The degree of remodeling correlated with implant duration. These results are consistent with successful biologic reconstruction of the superior shoulder capsule., Conclusions: The present histologic analysis suggests that ADMs used in SCR undergo active recellularization, revascularization, and remodeling as early as 6 months after implantation, and that graft recellularization positively correlates with duration of implantation. These results represent a significant advancement in our knowledge regarding biologic incorporation of ADMs used in SCR., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: A medialized center of rotation (COR) in reverse total shoulder arthroplasty (RTSA) comes with limitations such as scapular notching and reduced range of motion. To mitigate these effects, lateralization and inferiorization of the COR are performed, but may adversely affect deltoid muscle force. The study purposes were to measure the effect of RTSA with varying glenosphere configurations on (1) the COR and (2) deltoid force compared with intact shoulders and shoulders with massive posterosuperior rotator cuff tears (PS-RCT). We hypothesized that the highest deltoid forces would occur in shoulders with PS-RCT, and that RTSA would lead to a decrease in required forces that is further minimized with lateralization and inferiorization of the COR but still higher compared with native shoulders with an intact rotator cuff., Methods: In this study, 8 cadaveric shoulders were dissected leaving only the rotator cuff muscles and capsule intact. A custom apparatus incorporating motion capture and a dynamic tensile testing machine to measure the changes in COR and deltoid forces while simultaneously recording glenohumeral abduction was designed. Five consecutive testing states were tested: (1) intact shoulder, (2) PS-RCT, (3) RTSA with standard glenosphere, (4) RTSA with 4 mm lateralized glenosphere, and (5) RTSA with 2.5 mm inferiorized glenosphere. Statistical Parametric Mapping was used to analyze the deltoid force as a function of the abduction angle. One-way repeated-measures within-specimens analysis of variance was conducted, followed by post hoc t-tests for pairwise comparisons between the states., Results: All RTSA configurations shifted the COR medially and inferiorly with respect to native (standard: 4.2 ± 2.1 mm, 19.7 ± 3.6 mm; 4 mm lateralized: 3.9 ± 1.2 mm, 16.0 ± 1.8; 2.5 mm inferiorized: 6.9 ± 0.9 mm, 18.9 ± 1.7 mm). Analysis of variance showed a significant effect of specimen state on deltoid force across all abduction angles. Of the 10 paired t-test comparisons made between states, only 3 showed significant differences: (1) intact shoulders necessitated significantly lower deltoid force than specimens with PS-RCT below 42° abduction, (2) RTSAs with standard glenospheres required significantly lower deltoid force than RTSA with 4 mm lateralized glenospheres above 34° abduction, and (3) RTSAs with 2.5 mm inferiorized glenospheres had significantly lower deltoid force than RTSA with 4 mm of glenosphere lateralization at higher abduction angles., Conclusions: RTSA with a 2.5 mm inferiorized glenosphere and no additional lateralization resulted in less deltoid force to abduct the arm compared with 4 mm lateralized glenospheres. Therefore, when aiming to mitigate downsides of a medialized COR, an inferiorized glenosphere may be preferable in terms of its effect on deltoid force., (Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: It is widely accepted that transolecranon fracture-dislocations are not associated with collateral ligament disruption. The aim of the present study was to investigate the significance of the collateral ligaments in transolecranon fractures., Methods: Twenty cadaveric elbows with a mean age of 46.3 years were used. All soft tissue was dissected to the level of the capsule, leaving the anterior band of the medial collateral ligament (MCL) and lateral collateral ligament (LCL) intact. A standardized, oblique osteotomy starting from the distal margin of the cartilage bare area of the ulna was made. The elbows were loaded with an inferiorly directed force of 5 and 10 N in the intact, MCL cut, LCL cut, and both ligaments cut states. All measurements were recorded on lateral calibrated radiographs., Results: The mean inferior translation with intact ligaments (n = 20) when the humerus was loaded with 5 and 10 N was 1.52 mm (95% confidence interval [CI], 1.02-2.02) and 2.23 mm (95% CI, 1.61-2.85), respectively. When the LCL was cut first (n = 10), the inferior translation with 5 and 10 N load was 4.11 mm (95% CI, 0.95-7.26) and 4.82 mm (95% CI, 1.91-7.72), respectively. When the MCL was cut first (n = 10), the inferior translation when loaded with 5 and 10 N was 3.94 mm (95% CI, 0.796-7.08) and 5.68 mm (95% CI, 3.03-8.33), respectively. The inferior translation when loaded with 5 and 10 N and both ligaments cut was 15.65 mm (95% CI, 12.59-18.79) and 17.50 mm (95% CI, 14.86-20.13), respectively. There was a statistical difference between the intact and MCL cut first at 10 N and when both ligaments were cut at 5 and 10 N., Conclusions: The findings suggest that collateral ligament disruption is a prerequisite for a transolecranon fracture-dislocation. An inferior translation of more than 3 mm suggests that at least one of the collateral ligaments is disrupted, and more than 7.5 mm indicates that both collateral ligaments are disrupted., (Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the biomechanical performance of knotless versus knotted all-suture anchors for the repair of type II SLAP lesions with a simulated peel-back mechanism., Methods: Twenty paired cadaveric shoulders were used. A standardized type II SLAP repair was performed using knotless (group A) or knotted (group B) all-suture anchors. The long head of the biceps (LHB) tendon was loaded in a posterior direction to simulate the peel-back mechanism. Cyclic loading was performed followed by load-to-failure testing. Stiffness, load at 1 and 2 mm of displacement, load to repair failure, load to ultimate failure, and failure modes were assessed., Results: The mean load to repair failure was similar in groups A (179.99 ± 58.42 N) and B (167.83 ± 44.27 N, P = .530). The mean load to ultimate failure was 230 ± 95.93 N in group A and 229.48 ± 78.45 N in group B and did not differ significantly (P = .958). Stiffness (P = .980), as well as load at 1 mm (P = .721) and 2 mm (P = .849) of displacement, did not differ significantly between groups. In 16 of the 20 specimens (7 in group A and 9 in group B), ultimate failure occurred at the proximal LHB tendon. Failed occurred through slippage of the labrum in 1 specimen in each group and through anchor pullout in 2 specimens in group A., Conclusions: Knotless and knotted all-suture anchors displayed high initial fixation strength with no significant differences between groups in type II SLAP lesions. Ultimate failure occurred predominantly as tears of the proximal LHB tendon., Clinical Relevance: All-suture anchors have a smaller diameter than solid anchors, can be inserted through curved guides, preserve bone stock, and facilitate postoperative imaging. There is a paucity of literature investigating the biomechanical capacities of knotless versus knotted all-suture anchors in type II SLAP repair., (Copyright © 2020 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Rhizoctonia foliar blight, caused by Rhizoctonia solani, is an important disease of Brachiaria spp. in tropical America. Host-plant resistance is an attractive option for disease management. In this study, we evaluated three inoculum types (mycelium-infected agar disc, microdiscs suspensions, and microencapsulated-mycelium suspensions) in order to identify a rapid and accurate method for mass screening of Brachiaria genotypes for resistance to Rhizoctonia spp. in greenhouse trials. Visual damage score, area under the disease progress curve, and percent chlorophyll loss were estimated to determine the most accurate and precise method for evaluating Rhizoctonia resistance. The microencapsulated-mycelium solution (0.75 g/ml in potato dextrose broth sprayed on plants 30 days after planting) caused greater foliar damage than the other inoculum types and allowed effective discrimination between resistant and susceptible genotypes. The effectiveness of spray-applied, microencapsulated-mycelium was further corroborated by the evaluation of 350 genotypes not previously selected for resistance to Rhizoctonia spp., which varied significantly in their reaction to R. solani. The microencapsulated-mycelium methodology has several advantages over existing methods, including its high-throughput capacity, efficient use of time and space, ease of quantification of inoculum, and consistent results over replicate trials. This methodology could be applied to assess resistance to Rhizoctonia spp. in other crops.

Brachiaria grasses are sown in tropical regions around the world, especially in the Neotropics, to improve livestock production. Waterlogging is a major constraint to the productivity and persistence of Brachiaria grasses during the rainy season. While some Brachiaria cultivars are moderately tolerant to seasonal waterlogging, none of the commercial cultivars combines superior yield potential and nutritional quality with a high level of waterlogging tolerance. The Brachiaria breeding program at the International Center for Tropical Agriculture, has been using recurrent selection for the past two decades to combine forage yield with resistance to biotic and abiotic stress factors. The main objective of this study was to test the suitability of normalized difference vegetation index (NDVI) and image-based phenotyping as non-destructive approaches to identify Brachiaria hybrids tolerant to waterlogging stress under field conditions. Nineteen promising hybrid selections from the breeding program and three commercial checks were evaluated for their tolerance to waterlogging under field conditions. The waterlogging treatment was imposed by applying and maintaining water to 3 cm above soil surface. Plant performance was determined non-destructively using proximal sensing and image-based phenotyping and also destructively via harvesting for comparison. Image analysis of projected green and dead areas, NDVI and shoot biomass were positively correlated ( r ≥ 0.8). Our results indicate that image analysis and NDVI can serve as non-destructive screening approaches for the identification of Brachiaria hybrids tolerant to waterlogging stress.

Background Plants depend on their root systems to acquire the water and nutrients necessary for their survival in nature, and for their yield and nutritional quality in agriculture. Root systems are complex and a variety of root phenes have been identified as contributors to adaptation to soils with low fertility and aluminium (Al) toxicity. Phenotypic characterization of root adaptations to infertile soils is enabling plant breeders to develop improved cultivars that not only yield more, but also contribute to yield stability and nutritional security in the face of climate variability. Scope In this review the adaptive responses of root systems to soils with low fertility and Al toxicity are described. After a brief introduction, the purpose and focus of the review are outlined. This is followed by a description of the adaptive responses of roots to low supply of mineral nutrients [with an emphasis on low availability of nitrogen (N) and phosphorus (P) and on toxic levels of Al]. We describe progress in developing germplasm adapted to soils with low fertility or Al toxicity using selected examples from ongoing breeding programmes on food (maize, common bean) and forage/feed (Brachiaria spp.) crops. A number of root architectural, morphological, anatomical and metabolic phenes contribute to the superior performance and yield on soils with low fertility and Al toxicity. Major advances have been made in identifying root phenes in improving adaptation to low N (maize), low P (common bean) or high Al [maize, common bean, species and hybrids of brachiariagrass, bulbous canarygrass (Phalaris aquatica) and lucerne (Medicago sativa)]. Conclusions Advanced root phenotyping tools will allow dissection of root responses into specific root phenes that will aid both conventional and molecular breeders to develop superior cultivars. These new cultivars will play a key role in sustainable intensification of crop-livestock systems, particularly in smallholder systems of the tropics. Development of these new cultivars adapted to soils with low fertility and Al toxicity is needed to improve global food and nutritional security and environmental sustainability., (© The Author 2016. Published by Oxford University Press on behalf of the Annals of Botany Company.)

Rhizoctonia foliar blight, caused by Rhizoctonia solani anastomosis group 1, is an economically important fungal disease found throughout the world. The fungus attacks numerous crops, including cereals, roots and tubers, legumes, and cruciferous, horticultural, and ornamental plants. In tropical America, this invasive and destructive disease also attacks most Brachiaria spp. used as forages in the ranching industry, especially in the production of cattle. Research to solve this constraint has been ongoing at the International Center for Tropical Agriculture and has generated new Brachiaria hybrids with excellent agronomic performance, tolerance to poor soils, and, particularly, high resistance to biotic factors such as Rhizoctonia foliar blight. These hybrids belong to lines obtained from Brachiaria humidicola, B. brizantha, and B. decumbens. To identify resistance among Brachiaria hybrid genotypes, the hybrid clones were evaluated for their variability in resistance, and their disease reaction was also determined and characterized. Results led to the identification of hybrids that not only were highly resistant to the blight but also had excellent agronomic characteristics.

Nymphs and adults of several spittlebug (Hemiptera: Cercopidae) species are key pests of forage brachiariagrasses (Brachiaria spp.) in tropical America. To support current breeding programs, a series of experiments aimed at characterizing the mechanisms of resistance to adult feeding damage were carried out. Five genotypes were used: two susceptible checks (CIAT 0606 and CIAT 0654) and three nymph-resistant genotypes (CIAT 36087, CIAT 6294, and SX01NO/0102). Test insects were Aeneolamia varia (F.), A. reducta (Lallemand), and Zulia carbonaria (Lallemand). The nymph-resistant genotypes showed tolerance to all spittlebug species tested. Tolerance in these genotypes can be classified as only moderate given the extent of losses (60-80%) caused by both female and male adults. None of the nymph-resistant genotypes had antibiotic effects on adults feeding on foliage. The results also indicated that antixenosis for feeding is not a plausible explanation for lower damage scores and less biomass losses in resistant genotypes. The fact that adult longevity (usually 8 d) was not affected when the adults were forced to feed on roots of a genotype with strong antibiotic resistance to nymphs is regarded as additional evidence that resistances to nymphs and to adults in Brachiaria are largely independent.

Up to 50% of Brachiaria production in the tropics is affected by foliar blight caused by Rhizoctonia spp. Monothallic isolates of Rhizoctonia (n = 147) were cultured from different Brachiaria genotypes in Colombia and morphologically characterized and evaluated in pathogenicity trials in the greenhouse. Based on restriction fragment length polymorphism of the internal transcribed spacer region, 101 of the isolates were identified as Rhizoctonia solani anastomosis group (AG)-1 IA and were multinucleated, with high growth rate, brown mycelium, and high virulence; and 46 isolates were identified as Rhizoctonia sp. AG-D and were binucleated, with low growth rate, white mycelium, and lower virulence on the Brachiaria genotypes tested. The Rhizoctonia isolates also showed variation according to geographic origin, with R. solani AG-1 IA prevalent in warm lowland areas and Rhizoctonia sp. AG-D occurring in cooler areas. Ten Brachiaria genotypes were challenged with different Rhizoctonia isolates and resistant reactions were seen in three of these genotypes, including Brachiaria hybrid (International Center for Tropical Agriculture [CIAT] 36062), Brachiaria brizantha 'Marandú' (CIAT 6294), and Brachiaria hybrid 'Mulato II' (CIAT 36087). These results will contribute to a greater understanding of the interaction of diverse Rhizoctonia isolates on different Brachiaria genotypes, supporting improvement of Brachiaria spp. for disease resistance.

Both nymphal and adult spittlebugs (Hemiptera: Cercopidae) cause serious economic damage to susceptible brachiariagrass [genus Brachiaria (Trin.) Griseb], pastures in tropical America. Both life stages are xylem feeders: nymphs feed primarily on roots and stems, whereas the adults feed mainly on foliage. Numerous interspecific brachiariagrass hybrids with high levels of antibiosis resistance to nymphs of several important spittlebug species have been obtained. Recent studies revealed major inconsistencies between reaction to nymphs and reaction to adults on the same host genotype. Because both insect life stages can cause severe economic damage on susceptible brachiariagrass pastures, a cultivar development strategy must take into account resistance to both life stages. To assess the degree of association between resistance to spittlebug nymphs and to adult feeding, we tested 164 hybrids and six check genotypes for resistance to both life stages of three spittlebug species: Aeneolamia varia (F.), Aeneolamia reducta (Lallemand), and Zulia carbonaria (Lallemand). Most hybrids tested were classified as resistant to nymphs. On the contrary, for all three species, the overall mean damage score of the 164 hybrids did not differ from the mean score of the susceptible checks. None of the hybrids was classified as resistant to adult feeding damage. Correlations between percentage nymph survival and adult damage scores were consistently low (r = 0.0104-0.0191). Correlations between nymphal and adult damage scores were also low (0.109-0.271), suggesting that resistances to the different life stages are largely independent. Chi-square analyses comparing frequency distributions of responses of the 164 breeding hybrids to nymphs or adults confirmed essential genetic independence of these two traits. We conclude that attention to improving genetic resistance specifically to adult feeding damage is warranted.

Both nymphal and adult stages of several species of spittlebugs (Hemiptera: Cercopidae) are key economic pests of brachiariagrasses (Brachiaria spp.) in tropical America. Progress has been made in the characterization and development of antibiosis resistance to nymphs in brachiariagrasses. Essentially no attention has been given to screening germplasm for resistance to adults. To support current breeding programs, a series of experiments was conducted to develop a methodology to screen for adult damage and to study categories of resistance to adult feeding damage. Six host brachiariagrass genotypes were used: two susceptible checks (CIAT 0606 and CIAT 0654) and four nymph-resistant genotypes (CIAT 6294, CIAT 36062, CIAT 36087, and SX01NO/0102). Test insects were Aeneolamia varia (F.) and Zulia carbonaria (Lallemand). None of the nymph-resistant genotypes was antibiotic to adults. All four nymph-resistant genotypes showed tolerance to A. varia and Z. carbonaria feeding damage. The levels of tolerance to adults of Z. carbonaria, a larger, more aggressive species, were lower. Of the four nymph-resistant genotypes, only CIAT 6294 and CIAT 36087 showed some tolerance to Z. carbonaria expressed as lower leaf damage scores, less chlorophyll loss, and lower functional plant loss indices. The fact that a genotype like SX01NO/0102, which is highly antibiotic to nymphs, is susceptible to adult damage suggests that mechanisms of resistance to the two spittlebug life stages may be independent. Results of these studies suggest a need to incorporate routine screening for tolerance to adult feeding damage as an additional selection criterion in the breeding scheme.

Several greenhouse experiments were used to measure how high levels of antibiosis resistance to nymphs in two interspecific Brachiaria (brachiariagrass) hybrids affect life history parameters of the spittlebugs Aeneolamia varia (F.) and Zulia carbonaria (Lallemand), two of the most important spittlebug (Hemiptera: Cercopidae) species affecting Brachiaria production in Colombia. The A. varia-resistant hybrid CIAT 36062, the Z. carbonaria-resistant hybrid SX01NO/0102, and the susceptible accession CIAT 0654 were used to compare the effect of all possible combinations of food sources for nymphs and adults. Calculation of growth indexes showed a significant impact of antibiosis resistance on the biology of immature stages of both species. Median survival times of adults feeding on resistant genotypes did not differ from those recorded on the susceptible genotype, suggesting that factors responsible for high mortality of nymphs in the resistant hybrids did not affect adult survival. Rearing nymphs of A. varia on CIAT 36062 and of Z. carbonaria on SX01NO/0102 had deleterious sublethal effects on the reproductive biology of resulting adult females. It is concluded that high nymphal mortality and subsequent sublethal effects of nymphal antibiosis on adults should have a major impact on the demography of the two spittlebug species studied.

The response of one susceptible and three resistant Brachiaria spp. (Hemiptera: Cercopidae) genotypes to individual or combined attacks by nymphs of Aeneolamia varia (F.), Aeneolamia reducta (Lallemand), Zulia carbonaria (Lallemand), and Zulia pubescens (F.) was studied. We assessed the effect of infesting plants of the susceptible check BRX 44-02 and of the A. varia-resistant genotypes CIAT 6294 and CIAT 36062 with A. varia, Z. carbonaria, or Z. pubescens either alone or in two-species combinations. In a second trial, we studied the performance of BRX 44-02, CIAT 6294, and the multiple resistant clone SX01NO/0102 exposed to individual or combined attack by A. reducta and Z. carbonaria. In a third trial, we compared the response of BRX 44-02, CIAT 6294, and CIAT 36062 to individual A. varia, Z. carbonaria, or Z. pubescens attack as opposed to a combined three-species attack. Plant damage scores and percentage of nymphal survival were recorded in all three trials. Data on percentage of survival indicated that competition between and among spittlebug species occurs. However, we found no evidence of interaction between species competition and different levels of resistance to spittlebug. Rather, host genotype reactions conformed to previously known categories of resistance regardless of the presence of more than one spittlebug species. Resistance rather than competition seems to have been the overriding factor determining nymph survival and resistance expression (damage scores) in these experiments. Our results corroborate the need to develop brachiariagrass genotypes with multiple resistance to spittlebugs.

Several genera and species of spittlebugs (Homoptera: Cercopidae) are economic pests of Brachiaria spp. grasses in tropical America. To support current breeding programs aimed at obtaining multiple spittlebug resistance, we undertook a series of studies on antibiosis and tolerance as possible mechanisms of resistance to five major spittlebug species affecting Brachiaria spp. in Colombia: Aeneolamia varia (F.), Aeneolamia reducta (Lallemand), Zulia carbonaria (Lallemand), Zulia pubescens (F.), and Mahanarva trifissa (Jacobi). Four host genotypes, well known for their reaction to A. varia attack, were used to compare their resistance to other spittlebug species: CIAT 0654 and CIAT 0606 (susceptible) and CIAT 6294 and CIAT 36062 (resistant). CIAT 0654 and CIAT 36062 were used in antibiosis studies. Tolerance studies were conducted with CIAT 0654, CIAT 6294, and CIAT 36062. Sixty-five hybrid-derived clones were used to identify levels of multiple resistance to three spittlebug species. The levels of antibiosis resistance in CIAT 36062 clearly differed by spittlebug species and were classified as follows: very high for M. trifissa, high for A. varia and A. reducta, moderate for Z. pubescens, and absent for Z. carbonaria. Our results suggest the presence of true tolerance to Z. carbonaria in CIAT 6294 and CIAT 36062, true tolerance to Z. pubescens in CIAT 6294 and a combination of tolerance and antibiosis as mechanisms of resistance to Z. pubescens in CIAT 36062. Of the 65 hybrid clones tested with A. varia, A. reducta, and Z. carbonaria, 15 combined resistance to two species and three showed antibiosis resistance to all three spittlebug species.

Summary: Advances in arthroscopic technology allow rotator cuff repair through a minimally invasive approach. However, fixation of the rotator cuff tendon to suture anchors can be tedious and time consuming. The supraclavicular fossa portal allows improved access to the tear for passing suture. The authors describe the relevant anatomy, positioning, and surgical technique for use of the supraclavicular fossa portal to simplify arthroscopic rotator cuff repair.

Twenty-four male rats were divided into four groups, with anabolic steroids and exercise as variables. Biomechanical tests and histological evaluations were performed. The results of the biomechanical tests suggested that anabolic steroids produce a stiffer tendon, which fails with less elongation. The energy at the time when the tendon failed, the toe-limit elongation, and the elongation at the time of the first failure were all affected significantly. Changes in the force at failure were not statistically significant. No alterations of structure were noted when the specimens were viewed with light microscopy. Alterations of the sizes of the collagen fibrils were noted on electron microscopy.

Rib fractures are the most common serious injury of the chest. They occur most commonly in the middle and lower ribs with blunt trauma, and also with direct force to a small area of the chest wall and violent muscle contractions. Diagnosis is generally not difficult. The athlete should have a chest x-ray to confirm the diagnosis. Differential diagnosis includes severe rib contusion, costochondral separations, muscle strains and pneumothorax. If no internal problems exist, treatment consists of ice, NSAIDs, analgesics and a rib belt or tape. Healing should be well on its way before a return to sports. Fractures of the first 4 ribs or the last 2 ribs, multiple fractures and flail segments are less benign than other fractures, and may result in injury to surrounding structures. First rib and floating rib fractures are uniquely athletic fractures; they are avulsion fractures caused by a sudden vigorous contraction in different directions of pull.

Air-fluid levels in the sphenoid sinus have been described in association with skull fracture, cerebrospinal fluid rhinorrhea, and sinusitis. The authors have observed this sign in the absence of significant trauma in patients with epistaxis and nasal packing. The fluid is probably normal sinus secretion retained due to prolonged recumbency, although other explanations for its accumulation are discussed.

The effects of aerial ultralow volume (ULV) malathion on selected species of nontarget animals in Haiti are reported. Mortality of certain groups of insects such as bees, flies, beetles, and butterflies was observed immediately following spray application. Minor fish mortality occurred only in shallow water exposed to direct spray. The brain acetylcholine esterase levels of living fish, tree lizards, birds and bats collected from treated areas were not significantly reduced. No ill or dead animals, besides the few fish, were seen even when maximum exposure occurred. Only minor changes in the feeding behavior of some insectivorous birds were observed. The relative bird density decreased substantially for only one species during the study, and other factors besides treatment were considered to be the reasons for the decline. Aerial applications of ULV malathion at dosages sufficient to dramatically reduce anopheline populations did not significantly affect nontarget vertebrates in this tropical environment.

Synovial chondromatosis is a rare metaplastic disorder of synovium in which cartilaginous nodules are produced within joint spaces. An unusual case involving the temporomandibular joint, with extension of the lesion beyond the joint capsule into the parotid gland, is described. The patient had a history of previous superficial parotidectomy for a "benign mixed tumor." Review of the histologic features revealed both lesions to be identical. The reason for confusion between the two diagnoses is discussed.

Although the gas chromatographic separation of the isomers of BHC was demonstrated two decades ago, the present AOAC method of analysis of BHC for gamma-isomer (lindane) content is based on a separation carried out on a liquid chromatographic partition column. A method of analysis has been developed that uses an OV-210 column for separation of the gamma-isomer from the other isomers and impurities in technical BHC. Di-n-propyl phthalate was chosen as an internal standard. The same system allows quantitation of lindane in lotion and shampoo after these products are extracted with ethyl acetate-isooctane (1 + 4). The analytical methods were subjected to a collaborative trial with 10 laboratories. The coefficient of variation for technical BHC was 2.83%. For the water-dispersible powder and emulsifiable concentrate, the coefficients of variation were 2.89% and 4.62%, respectively. Coefficients of variation for 1% lindane lotion and shampoo were 4.36% and 11.92%, respectively. The method has been adopted official first action.

A gas-liquid chromatographic method has been developed for the analysis of residues of chlorphoxim, 2-chloro-alpha ((diethoxyphosphinothioyl)oxy)imino)-benzeneacetonitrile, in water and fish. The method is based on the in-block methylation of chlorphoxim with 0.01M trimethylanilinium hydroxide in methanol. The derivative, O,O-diethyl O-methyl phosphorothioate, was determined quantitatively by using a flame photometric detector specific for phosphorus. The in-block reaction is 70% efficient. Water samples were extracted with hexane; fish were extracted with methylene chloride and cleaned up on an acetonitrile-hexane partition column. Recoveries from water and fish samples spiked with chlorphoxim averaged 86.3 and 80.4%, respectively. Limits of detection were 10.0 ppb for 5 g samples of fish and 0.10 ppb for 300 ml water samples.

In 1976, epidemic organophosphate insecticide poisoning due to malathion occurred among 7500 field workers in the Pakistan malaria control programme. In July, the peak month of the epidemic, it is estimated that there were about 2800 cases. In field studies low red-cell cholinesterase activities were associated with the signs and symptoms of organophosphate insecticide intoxication. Toxicity was seen with 3 different formulations of the insecticide and was greatest with the products containing increased amounts of isomalathion, a toxic malathion degradation product. Poor work practices, which had developed when D.D.T. was the primary insecticide for malaria control, resulted in excessive skin contact with and percutaneous absorption of the pesticide. Airborne malathion concentrations were very low. Implementation of good work practices and proscription of use of the 2 pesticide formulations most contaminated with isomalathion halted the epidemic in September. An extensive training programme and surveillance system for pesticide toxicity preceded 1977 spraying operations.

During a malaria eradication programme in Pakistan in 1976, out of 7,500 spraymen, 2,800 became poisoned and 5 died. The major determinant of this poisoning has been identified as isomalathion present as an impurity in the malathion. It seems almost certain that the isomalathion was produced during storage of the formulated malathion. The quantitative correlation found between isomalathion content and toxicity of many field samples of malathion has been confirmed by an examination of mixtures of pure compounds. Addition of known amounts of isomalathion to technical malathion indicates that other active substances are present. These impurities have been identified (trimethyl phosphorothioates) and have been shown to behave like isomalathion in potentiating the toxicity of malathion. Some preliminary work on their toxicological properties is reported. The mechanisms involved in the potentiation of the toxicity of malathion are discussed.

Liquid chromatographic (LC) methods for determination of active ingredient in chlorphoxim formulations have been developed independently by Bayer AG and the Centers for Disease Control (CDC). Both methods specify separation on a silica gel column. The Bayer method uses a 5% solution of tetrahydrofuran in hexane as the eluting solvent and quantitates results on the basis of an external standard. The CDC method uses a 5% solution of ethyl acetate in hexane as the eluting solvent and uses 4-fluorophenyl sulfone as an internal standard. The 2 methods were compared by replicate analyses of samples of chlorphoxim technical and water-dispersible powder and emulsifiable concentrate formulations. The precision of both methods was acceptable.

A variety of column packings and internal standards were evaluated to determine the most satisfactory system to use in a gas chromatographic (GC) method for analysis of fenitrothion, technical and formulations. Fenitrothion and the most closely related isomer, O,O-dimethyl O-(4-methyl-3-nitrophenyl) phosphorothioate, were resolved on columns packed with OV-210 and with polyphenyl ether, 6-ring (PPE-6R). A method based on the separation of fenitrothion on a PPE-6R column with fluoranthene as internal standard was selected for use in a limited collaborative trial and later for use in a full-scale collaborative trial with 21 collaborators participating. Each collaborator was furnished matched pairs of samples of technical fenitrothion, emulsifiable concentrate, and water-dispersible powder. The coefficients of variation (CV) for the paired samples were 1.02, 1.11, and 1.01, respectively, for technical fenitrothion, emulsifiable concentrates, and water-dispersible powders. Data are also presented for an alternative method in which compounds are separated on an OV-210 column with dibutyl sebacate as the internal standard. The method has been adopted official first action.