bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors for Arthrofibrosis in Tibial Spine Fractures: A National 10-Site Multicenter Study
Authors: Aoyama Julien , Mistovich Justin , Yen Yi-Meng , Ellis Henry , Lee Jay , Fabricant Peter , Green Daniel , Cruz Aristides , McKay Scott , Schmale Gregory , Ganley Theodore , Bram Joshua
Published: July 2020

Objectives:

To identify risk factors for developing arthrofibrosis after TSF treatment.

Methods:

This was a retrospective, multi-center study across ten institutions of 448 patients <25 years old who presented to care with a tibial spine fracture between 1/2000 and 2/2019. Patient records were reviewed for a multitude of pre-operative, intra-operative, and post-operative characteristics. Patients were then separated into two cohorts based on if they suffered from post-treatment arthrofibrosis.

Results:

Chart review demonstrated that 43 (9.6%) of the patients suffered from post-treatment arthrofibrosis. There were no demographic differences observed between the two groups. However, based on MRIs at the time of injury, distal femoral and proximal tibial growth plates were more frequently closed in the arthrofibrosis group (17.6% vs 4.4%, p=0.023 for both comparisons). Additionally, there was no difference in Meyers & McKeever (MM) classification (p=0.597). All arthrofibrosis patients received operative treatment (p=0.003), though there was no difference in fixation technique (p=0.734). Intraoperatively, a higher number of screws were used in the arthrofibrosis group (p=0.002) with the placement of hardware more likely to be epiphyseal (p=0.007). Other operative parameters including number of sutures were not different. Post-operatively, arthrofibrosis patients were more likely to have been immobilized in a cast (p<0.001) with no difference observed for weight-bearing status. After multivariate regression, screw number (OR 8.9, CI 1.9-41.7, p=0.005) and immobilization in a cast (OR 7.8, CI 1.0-60.4, p=0.049) remained significant predictors of post-treatment arthrofibrosis.

Conclusion:

This serves as the largest study of tibial spine fractures to analyze risk factors for the development of post-treatment arthrofibrosis. Our study demonstrates that pre-operative factors were largely similar between groups, but that intra-operative decisions, including the number of screws used for fixation and placement of hardware in relation to the physis, were significant predictors of post-treatment arthrofibrosis. These findings may influence operative decision-making in tibial spine fracture patients. Additionally, post-operative immobilization in a cast should be avoided given the high risk of arthrofibrosis. [Table: see text]
Femoral Tunnel Fixation for Medial Patellofemoral Ligament Reconstruction in the Growing Patient is Safe for Future Growth
Authors: Brenner Madison , Wyatt Charles , Zynda Aaron , Wilson Philip , Ellis Henry , Gross Bruno
Published: July 2020

Objectives:

Medial patellofemoral ligament (MPFL) reconstruction has been shown to be a successful treatment for patients with recurrent patellar instability and is increasingly used to treat skeletally immature patients. The purpose of this study is to compare radiographic parameters prior to and following an MPFL reconstruction with femoral tunnel fixation in the skeletally immature patient to investigate potential effects on the physis and future growth.

Methods:

Skeletally immature patients undergoing isolated MPFL reconstruction were retrospectively reviewed. Fixation of proximal MPFL was performed as a femoral socket using Schottle’s point with the entry approximately 5 mm distal to the physis. Patients with open growth plates and 1-year postoperative standing alignments were included. Radiographic measures of patellar tilt, patellar height, patellar subluxation, and trochlear dysplasia were compared pre-operatively and post-operatively on the operative limb. Pre- and post-operative coronal alignment and limb length measurements were compared between the operative and non-operative limbs.

Results:

Nineteen skeletally immature patients with an average age of 11.6 years (range 5-15 years old) underwent isolated MPFL reconstruction. The average follow-up time was 24 months. No significant differences were found between the change in femur (0.49 mm, p=0.526) or total limb length (1.08 mm, p=0.241) when comparing the operative to the non-operative limb, with an average of 47 mm of growth in the operative limb seen during the time period. There was no significant difference in the change in LDFA between operative and non-operative limb as well as symmetric changes noted in the mechanical axis. The change in patellar tilt on the operative limb was found to be significant (12.78°, p=0.030), and the change in patellar height by Caton-Deschamps approached significance (0.08mm, p= 0.077). No significant difference was found with trochlear dysplasia measures.

Conclusion:

The present study suggests MPFL reconstruction with femoral tunnel fixation is safe and does not result in growth disturbance in skeletally immature patients. [Table: see text]
Increased Tibiofemoral Rotation with Increasing Severity of Patellar Instability in the Pediatric Population
Authors: James Evan , Aitchison Alexandra , Schlichte Lindsay , Wang Grace , Green Daniel , Lin Kenneth
Published: July 2020

Objectives:

Tibiofemoral rotation (TFR), specifically external tibial rotation, has been recently identified as a potential contributing factor to patellar instability. However, no previous studies have explored the clinical effects of differing degrees of TFR in relation to patellar instability. The purpose of this study is to investigate the relationship between severity of instability with degree of TFR. Our hypothesis is that fixed or obligatory dislocators (FOD) are more likely to have increased external TFR (tibial external rotation compared to femur) than standard patellar instability (SPI) patients requiring medial patellofemoral ligament (MPFL) reconstruction, who will have similar or slightly increased external TFR compared to normal controls.

Methods:

A retrospective study was performed with patients from 3 cohorts from April 2009 to February 2019: FOD, SPI, and controls with normal magnetic resonance imaging (MRI) of the knee. All FOD patients from the study time frame were analyzed, while controls and SPI patients were randomly selected. Patients were included for age under 18 years and diagnosis corresponding to one of the three cohorts, and excluded for outside institution MRI, and previous MPFL reconstruction or tibial tubercle osteotomy. TFR was measured on preoperative axial MRI using the posterior femoral and tibial condylar lines (Figure 1). Tibial tubercle to trochlear groove distance (TT-TG) was measured. Intraclass correlation coefficient (ICC) was calculated among 3 measurers. Statistical analysis using ANOVA and t-test was performed with significance set at α=0.05.

Results:

A total of 57 patients were included, 19 in each cohort. Average age was 13.2 years (range 10-17 years), with 31 females (54%). ICC for TT-TG and TFR were 0.90 and 0.72, respectively. TT-TG differed between the controls and SPI patients (both P<0.001), and controls and FOD patients (P<0.001), but not between SPI and FOD patients (P=0.12). TFR differed among the three groups: 8.4° (SD 16.7°) external TFR in FOD, 1.6° (SD 5.4°) external TFR in SPI, and 2.5° (SD 5.8°) internal TFR in controls (P=0.0089). FOD patients had significantly greater external tibial rotation than the SPI group (P=0.047).

Conclusions:

The degree of TFR is correlated with severity of patellar instability, with greater external tibial rotation seen in FOD than SPI patients, while TT-TG was not different. Further information on the relationship of TFR and patellar instability will not only improve understanding of pathogenesis and prognosis, but may also direct surgical treatment strategies in refractory or severe cases.
Defining MCID in patients following meniscectomy and the role of pre-operative PROMIS scores in predicting clinical improvement
Authors: Franovic Sreten , Kuhlmann Noah , Korn Michael , Pietroski Alex , Schlosser Collin , Makhni Eric , Moutzouros Vasilios
Published: July 2020

Objectives:

The Patient-Reported Outcomes Measurement Information System (PROMIS) is emerging as a valid and efficient means of collecting patient outcomes in patients with meniscal tears. Our purpose was to examine the role of pre-operative PROMIS computer adaptive test (CAT) scores in predicting post-operative PROMIS CAT scores, as well as the minimal clinically important difference (MCID) following meniscectomy. We hypothesize that pre-operative PROMIS CAT scores will directly impact both post-operative PROMIS CAT scores and likelihood of achieving MCID.

Methods:

Patients undergoing arthroscopic meniscectomy that completed PROMIS CAT forms for physical function (PROMIS-PF), pain interference (PROMIS-PI), and depression (PROMIS-D) were utilized. MCID was calculated according to the distribution methodology, and receiver operating characteristics (ROC) were utilized to determine if pre-operative scores were predictive of post-operative outcomes. Preoperative cutoffs were used to predict which patients would likely meet MCID, using 90% specificity.

Results:

A total of 135 patients met our inclusion criteria. PROMIS-PF, PROMIS-PI, and PROMIS-D improved 3 months after surgery (p<0.01). 62% of the entire cohort met MCID for PROMIS-PF, while 68% met MCID for PROMIS-PI, and 41% met MCID for PROMIS-D. Individuals with PROMIS-PF scores below 34.9 yielded an 82% probability of achieving MCID, while PROMIS-PI scores above 67.5 yielded an 86% probability of achieving MCID and a cutoff of 58.9 for PROMIS-D yielded a 60% probability of achieving MCID, with 90% specificity.

Conclusions:

Significant portions of patients undergoing meniscectomy achieve MCID in PROMIS-PF, PROMIS-PI, and PROMIS-D, at the 3-month time point. In particular, patients with PROMIS-PF scores of <34.9 are far more likely to achieve MCID for physical function.
The serial changes of static anterior tibial subluxation on MRI after double-bundle anterior cruciate ligament reconstruction
Authors: Fukuda Hideaki , Ogura Takahiro , Takahashi Kenji , Asai Shigehiro
Published: July 2020

Objectives:

Static anterior tibial subluxation after an anterior cruciate ligament (ACL) injury highlights the abnormal relationship between the tibia and femur in patients with ACL insufficiency. One of the aims of ACL reconstruction is to restore the normal tibiofemoral relationship. However, several studies indicated that an abnormal tibiofemoral relationship remained after single-bundle (SB) ACL reconstruction. The purpose of this study was to determine the serial changes of static relationship between tibia and femur in patient who had double-bundle ACL reconstruction with acute and chronic injuries.

Methods:

Thirty five patients who underwent double-bundle ACL reconstruction between January 1 to July 31, 2017 were included in this prospective study and divided two groups: the acute ACL injury group and the chronic ACL injury group (more than 6 month after injury). All participants underwent preoperative and postoperative magnetic resonance imaging (MRI) at 3 weeks, 3, 6 and 12 months. Anterior tibial subluxation (ATS) of the medial and lateral compartments relative to the femoral condyles were measured on MRI.

Results:

There were no significant differences in the age and KT side to side difference between both groups (Table 1). The ATS measurements are shown in table 2. In lateral compartment, the ATS in the acute ACL injury group was 5.3mm before surgery, while it was -0.31mm, 3.4mm, 3.5mm and 4.9mm at 3 weeks, 3, 6, 12months after surgery, respectively. The ATS in the chronic ACL injury group was 6.7mm before surgery, while it was 0.47mm, 3.9mm, 4.6mm and 5.9mm at 3 weeks, 3, 6, 12months after surgery, respectively. No significant difference was found between 2 groups. In medial compartment, the ATS in the acute ACL injury group was 1.8mm before surgery, while it was -1.6mm, 0.28mm, 0.93mm and 2.1mm at 3 weeks, 3, 6, 12months after surgery, respectively. The ATS in the chronic ACL injury group was 2.5mm before surgery, while it was -1.4mm, 1.6mm, 1.7mm and 3.0mm at 3 weeks, 3, 6, 12months after surgery, respectively. No significant difference was found between 2 groups.

Conclusion:

In both of lateral and medial compartment, the ATS was not significant different between acute and chronic ACL injuries before surgery. In lateral compartment, at 3 weeks, 3months and 6months after surgery, ATS was significantly less than before surgery in both groups. At 12 months, ATS was not significant different from before surgery in both groups. In medial compartment, at 3 weeks, ATS were significantly less than before surgery in both groups. After 3 months, ATS was not significant different from before surgery in both groups. The ATS was not significant different between acute and chronic ACL injuries in the same period after surgery. [Figure: see text][Figure: see text][Figure: see text][Figure: see text]
The Multiligament Knee Injury Classification Stratifies Patients into Risk Categories
Authors: Huang Patrick , Li Don , Petit Logan , Porrino Jack , Medvecky Michael , Kahan Joseph
Published: July 2020

Objectives:

Our goal was to characterize the precise ligamentous injury locations and patterns of acute multi-ligament knee injuries (MLKI) and determine associated rates of dislocations, fractures, peroneal nerve palsies, and vascular injuries.

Methods:

All patients at a single level one trauma center who received operative treatment for MLKI between 2001 and 2019 were retrospectively identified. Demographic, injury mechanism, injury patterns, presence of dislocation, and associated injuries including vascular injury, peroneal nerve palsy, and fracture were assessed for each patient. MLKI both with and without a document knee dislocation were classified into five classes based on pattern of ligamentous tear (Figure 1). Class 1 included unicruciate tear with any combination of collateral tear. Class 2 are a bicruciate tear without collateral involvement. Class 3 are bicruciate tears with either a medial or lateral sided tear. Class 4 are bicruciate tears with both medial and lateral sided tears. Class 5 are periarticular fracture with any of the preceding ligamentous injury patterns. Rates of dislocation, vascular injury and peroneal nerve injury were analyzed among each class. Single variable statistics such as t-tests as well as multivariable techniques such as Chi square and multiple regression analysis was performed to identify patterns of injury and to predict risk of associated injuries.

Results:

100 knees were identified as multiligament knee injuries. 34 of the knees (34%) were dislocated at presentation, and the remaining 66 (66%) did not have a documented knee dislocation. Patients with a documented knee dislocation had higher rates of vascular injury (24% vs. 3%, p = 0.0148), but not higher rates of peroneal nerve injury (32% vs. 20%, p = 0.0863). Patients with PLC injuries had statistically higher rates of peroneal nerve injury compared to acute multiligament knee injuries without a lateral sided injury (30% vs. 3%, p = 0.005). Rates of vascular injury between MLK Class are shown in Table 1. MLK Class was found to be predictive of vascular injury, but not of peroneal nerve injury.

Conclusion:

We present a new classification of multiligament knee injuries with the goal of providing a more precise diagnosis to aid in the surgical planning and decision making as well as to enhance clinical outcomes research of these complicated injury patterns. By classifying these injuries into five separate classes and further subclassified based on presence of dislocation and lateral sided injury, we are better able to predict likelihood of neurovascular injury. We hope that understanding the risks associated with each class will allow physicians to better appreciate the likelihood of potential complications of these injuries.
Incidence of 2nd Surgery after Medial Patellofemoral Ligament Reconstruction and Simultaneous Osteochondral Fracture Fixation in Pediatric Patients Treated for Patellar Dislocation
Authors: Schlichte Lindsay , Aitchison Alexandra , Green Daniel
Published: July 2020

Objectives:

Osteochondral fractures occur in 5-15% of cases of acute or recurrent patellar dislocations. In these settings, early surgical intervention with biodegradable fixation nails is recommended to optimize healing. The aim of this study was to determine the incidence of recurrent instability and second surgery following osteochondral fracture fixation with concomitant medial patellofemoral ligament (MPFL) reconstruction.

Methods:

We conducted a retrospective cohort study of 321 MPFL reconstructions performed by a single surgeon between 2011 and 2019. Thirty-eight knees underwent MPFL reconstruction with osteochondral fixation. Demographic data, surgical details, date of latest radiographic and clinical follow-up, and subsequent surgical procedures were collected.

Results:

Thirty-seven MPFL reconstructions with osteochondral fracture fixation in 36 patients were performed by a single surgeon from 2011 to 2019 (1 bilateral). The average age at surgery was 14.8 years (range 10.6– 19.6 years). The average length of clinical follow-up was 2.1 years (range 0.3– 5.5 years). The average number of biodegradable fixation nails used was 4.4 (range: 2-8). Twenty-seven (72.9%) fractures were fixed to the patella and 10 were fixed to the lateral femoral condyle or trochlea. There was 1 report of recurrent instability. Ten (27%) patients required a second surgery on the ipsilateral knee, and underwent chondroplasty (n=8), removal of biodegradable fixation nails (n=4), removal of hemi-epiphysiodesis or TTO hardware (n=2), revision MPFL with tibial tubercle osteotomy (n=1), lateral meniscus repair (n=1). The one patient who required revision MPFL reconstruction has juvenile idiopathic arthritis and underwent 3 additional surgeries after the initial MPFL procedure. Eight patients (22%) underwent a second surgery to address cartilage damage or removal of nails. The mean time to second surgery was 40.0 weeks (range:11-82.7). Of the four patients who required removal of nails, the average number of nails initially placed was 7 ± 1.7. This was significantly more than the patients who did not require second surgery related to nail removal (4.1 ± 1.6, p < .05).

Conclusion:

Approximately 78% of patients undergoing MPFL reconstruction and osteochondral fracture fixation with biodegradable nails showed good fracture healing and patellar stability while 22% went on to require a second surgery. The second surgery most commonly involved debridement of an unhealed portion of the cartilage.
INCREASED PREVALENCE OF JUVENILE OSTEOCHONDRITIS DISSECANS IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS
Authors: Dickason Celeste Quitiquit , Jinguji Thomas , shenoi susan , Thapa Mahesh , Saper Michael , Bompadre Viviana , Schmale Gregory , Hinkle Andrew
Published: July 2020

Objectives:

To determine the prevalence and severity of OCD in patients with JIA.

Methods:

This was a retrospective review of patients with JIA and OCD treated between January 2008 and March 2019 at one children’s hospital. We queried Department of Rheumatology records for JIA patients treated during this interval as well as Departments of Orthopedics and Radiology records for patients with OCD. Demographic information, classification of the stability of OCD lesions by review of magnetic resonance imaging, and clinical details of treatment were recorded.

Results:

2,021 JIA patients were identified, 20 of whom (19 girls, 1 boy) had OCD of the knee and/or talus for a prevalence of 1/100 or 1000/100,000, or approximately 30-200x that of the general population. These 20 patients had a total of 28 OCD lesions: 43% (9 femur, 3 talus) were radiographically stable over time, 50% (10 femur, 2 patella, and 2 talus) were unstable at initial diagnosis, and 7% (femur) were initially stable but progressed to unstable lesions despite drilling. Eleven patients (55%) underwent surgery: 5 with stable femoral lesions for persistent symptoms despite prolonged non-operative treatment, and 6 for treatment of their unstable lesions (femur and patella). Of these 11 patients, 3 underwent two or more surgeries for OCDs, and 3 were treated with hemiepiphysiodesis for concomitant genu valgum.

Conclusion:

OCD lesions are 30-200x more prevalent in JIA compared to the general population. In JIA, OCD often presents at an advanced stage requiring surgery for stabilization. Patients with JIA may benefit by early screening, to potentially allow for treatment of an OCD lesion prior to the progression to instability.
Osteochondral Allograft Transplantation of the Knee in “Ideal” Candidates: Clinical Outcomes and Graft Survivorship
Authors: Bugbee William
Published: July 2020

Objectives:

Osteochondral allograft (OCA) transplantation of the knee is an effective treatment for chondral and osteochondral lesions, but graft survivorship and clinical outcomes vary by patient-specific factors. Fresh OCA are often used for large or complex lesions or in the revision cartilage repair setting, but recent literature suggests that the most ideal candidates for OCA transplantation may be young patients with a small lesion on the femoral condyle or trochlea due to osteochondritis dissecans or chondral trauma. The purpose of this study was to assess outcomes following OCA transplantation in a cohort of “ideal” candidates.

Methods:

We identified 91 patients (97 knees) who underwent primary OCA transplantation for osteochondritis dissecans (88%) or a traumatic chondral injury (12%), were age 30 years or younger, and had an isolated lesion(s) of the femoral condyle or trochlea less than 8 cm2. Mean age was 20 years and 70% were male. Lesions were located on the femoral condyle (85%) or trochlea (15%). One graft was used in 85% of knees and two grafts were used in 15%. Mean total graft area was 5.2 cm2. Evaluation included pain, function, satisfaction, and reoperations. OCA failure was defined as revision allografting or conversion to arthroplasty. Median follow-up was 5.7 years (range 2-17 years).

Results:

Seventeen knees (18%) underwent reoperations. Two knees (2%) were classified as OCA failures (one revision OCA at 2.7 years and one conversion to unicompartmental arthroplasty at 10.2 years). Survivorship was 99% at 5 and 10 years. Pain and function improved (Table 1.), and 93% of patients were satisfied with the results of the OCA transplantation.

Conclusion:

In this cohort of “ideal” cartilage repair patients undergoing OCA transplantation, graft survivorship and clinical outcomes were excellent, with high satisfaction, pain relief, and functional improvement. Outcomes were equal or superior to other cartilage repair techniques. [Table: see text]
Short Oblique Patellar Tunnels for Patellar Fixation Do Not Increase Fracture Risk in MPFL Reconstruction: A Retrospective Cohort Study
Authors: Lesevic Milos , Deasey Matthew , Burnett Zachary , Diduch David , Moran Thomas
Published: July 2020

Objectives:

The current standard of care for recurrent patellar instability is reconstruction of the medial patellofemoral ligament (MPFL), the primary soft tissue constraint to lateral subluxation of the patella. Historically, transpatellar bone tunnels have been associated with increased rates of patella fracture. To avoid this dreaded outcome, many surgeons now employ suture anchors to affix the MPFL graft to the patella. This study aims to evaluate the costs and outcomes associated with short oblique patella tunnels as compared to suture anchor fixation in MPFL reconstruction.

Methods:

A total of 467 knees in 419 patients undergoing MPFL reconstruction between 2011 and 2018 were included in the study. A single institution electronic medical record queried for all patients undergoing extra-articular ligament reconstruction using Current Procedural Technology codes 27422 and 27427. Chart review of operative reports was utilized to identify those who had undergone MPLF reconstruction. Patients undergoing revision MPFL reconstruction were excluded, as were patients for whom fully transpatellar bone tunnels were employed for patellar fixation. This left two groups: those for whom small, oblique tunnels (n = 277) and suture anchors (n = 190) for patellar fixation were compared. Implant pricing for the 3.2 mm drill bit, suture anchors, and allograft were obtained through publicly available databases and prior published research.

Results:

Short oblique tunnels showed no significant increase in risk of patellar fracture compared to suture anchors for patellar fixation (P = 1.00). Use of suture anchors was associated with an increased risk of subluxation or dislocation compared to small, oblique tunnels (OR = 3.34, P = 0.021). No significant difference in the need for revision MPFL reconstruction surgery was found (OR = 1.964, P = 0.45) [Table 1]. The cost difference between allo- and autograft in ligament reconstruction has been analyzed in multiple prior studies and found to be $1100. The 3.2mm drill bit used to create the tunnels cost $84 but is reusable, while the average cost of two suture anchors was $500, leading to a material cost savings of $1600 per case in which transpatellar tunnels were used for MPFL autograft fixation when compared to a suture anchor and allograft combination. Regardless of the graft choice, material cost savings exceeds $400 per case simply by conversion to short oblique tunnels rather than suture anchors.

Conclusion:

The use of small, oblique tunnels with hamstring autograft is a safe and cost effective method for patellar fixation in MPFL reconstruction. Value in healthcare is defined as quality divided by cost. As surgeons and institutions are increasingly judged not only by the quality of the care they provide, but also in its cost, employment of this high-value technique should be considered by surgeons performing MPFL reconstruction.
A Practical Pre-Operative Predictive Model for Determining Hamstring Autograft Size for Anterior Cruciate Ligament Reconstruction in Children and Adolescents
Authors: Sherman Benjamin , Schlechter John , Kwan Kevin
Published: July 2020

Objectives:

The most commonly used graft for pediatric and adolescent anterior cruciate ligament (ACL) reconstruction is the hamstring autograft. Recent evidence has suggested that graft sizes less than 8 mm and age less than 20 years old are the most significant factors influencing graft failure. Additionally, studies examining the role of augmenting smaller grafts with allograft have demonstrated mixed results and potentially increased failure rates. Efforts to predict hamstring size preoperatively using MRI and ultrasound in the adult population have shown promise. However, there have been no studies in an entirely pediatric population. The purpose of this study was to evaluate the predictive value of MRI in determining hamstring autograft size preoperatively for pediatric ACL reconstructions.

Methods:

Children and adolescents from 10-20 years old that had undergone ACL reconstruction using hamstring autograft were identified from 2017-2018. Semitendinosus and gracilis cross-sectional area and diameter were measured on preoperative knee MRIs using the field of interest (FOI) and distance measurement tools. The slice used for measurement was identified as the largest section by the measuring surgeon. Two surgeons independently measured all MRIs. Preoperative demographic data (height, weight, body mass index (BMI), gender) and operative data (graft size) was collected. Data was analyzed by an independent statistician. Ordinal regression analysis was performed to determine the relationship between demographic data and graft size. A Classification and Regression Tree (CART) was constructed to identify predictors for the pre-determined graft sizes of 8 mm. Receiver operating characteristics (ROC) analysis were then created to assess the performance of the predictive model and determine sensitivity and specificity. All analyses were performed using SPSS v. 24 with alpha set at p<0.05 to declare significance.

Results:

One hundred and ten children (54 boys, 56 girls) were included in this study with an average age of 15.93 years (range 11.81-20.22) and average BMI of 25.98 (range 16.02-40.08). CART analysis determined that if the sum of the cross-sectional areas of the semitendinosus and gracilis tendons were greater than 31.17 mm then 87.5% of children had graft sizes of 8 mm or greater. The ROC analysis determined the model to have an 80% sensitivity and 74% specificity for predicting a graft size of 8 mm or larger.

Conclusion:

A preoperative summation of the cross-sectional areas of the semitendinosus and gracilis tendons greater than 31.17 mm predicts an intraoperative graft size of 8 mm or larger in 87.5% of children. [Figure: see text][Table: see text]
Color-Blind Racism in Pandemic Times
Authors: Bonilla-Silva Eduardo
Published: July 2020

In this article the author examines how the frameworks of color-blind racism have influenced many topics during the pandemic. Using readily available material from popular culture (TV shows, newspaper and magazine articles, and advertisements) and from statements by government officials, the author examines how color blindness has shaped our national discussion on essential workers and heroes, charity, and differential mortality. The main argument is that color-blind racism is limiting our understanding of the structural nature of the various racial problems coronavirus disease 2019 has revealed, making it difficult to envision the kinds of policies needed to address them. the author concludes by summarizing what these ideological perspectives block from view as well as addressing the nascent discursive cracks that might be used to produce alternative frames for interpreting matters and organizing collective action.
Racialized Organizations and Color-Blind Racial Ideology in Brazil
Authors: Carrillo Ian
Published: July 2020

Although the relationship between organizations and structural racism is well established, less is known about how racialization occurs within organizations. Overlooking how racial ideology is imbued in organizational logic obscures the role organizations play in reproducing structural racism. The prevalence of color-blind racial ideology further complicates the study of racialization, as most societies deny the existence of racism targeting people of color. In this article the author asks, How does color-blind racial ideology guide management decisions and the rationalization of racially unequal organizational practices? Using an extended case study method, the author examines sugar-ethanol mills in Brazil, where nonwhite workers are disproportionately exposed to hazardous risks. The author argues that the racialization of organizational practices occurs through a twofold process in which white elites use nonracial discourse to rationalize unequal outcomes and to reproduce the social conditions that steer nonwhite peoples into hazardous worksites. This article makes two contributions to the literature. First, through the discursive frames of cultural racism, naturalization, victimization, and politicized markets, the author shows how the allocation of resources and opportunities at the organizational level shapes and is shaped by racialized social systems. Second, by studying unequal relations in Brazil, the author elucidates the long-standing presence of color blindness in Iberian America while also tracing similarities and differences with color-blind racism in the United States.
A strong and united Europe in the common foreign and security policy
Authors: Annen Niels
Published: July 2020

We live in a changing and increasingly challenging world. The arc of insecurity around our borders to the south, the ongoing conflict in Syria, Iran’s nuclear ambitions, the Ukraine conflict and also a more assertive Russia to the east pose huge foreign and security policy challenges for the European Union. To address these challenges, we need a united EU foreign and security policy that is fit for purpose. The Common Foreign and Security Policy (CFSP) has vast untapped potential – I will address some of the changes we need to make to unlock it.
Building an Innovative and Entrepreneurial Dimension in an Institution of Higher Education
Authors: Corso Ron
Published: July 2020

Institutions of higher education in the twenty-first century are undergoing a transformation locally and globally from traditional pillars of learning to being more entrepreneurial in their core business. There is increasing pressure on universities to becoming more flexible and adaptable as organizations and in the graduate attributes, they imbed in their students. There is a need to build deeper links with business, to both maximize innovation and promote growth, to ensure students are equipped to excel in the workforce. This change is having a disruptive effect on the role of universities, from classical research institutions to entrepreneurial universities mimicking more of the modern workplace working environment, requiring autonomy in their decision-making and in the way new research is developed, implemented and transferred in the relationships formed within their respective regions.

This article outlines work in progress on the University of South Australia’s attempts to rebrand itself as a University of Innovation and Enterprise (Australia’s University of Enterprise) in both its end-user inspired research outcomes and industry-informed teaching and learning.
Authentic Leadership, Power and Social Identities: A Call for Justice in Indian Higher Education System
Authors: Sinha Chetan
Published: July 2020

The current socio-political situation in India has gradually shifted the meaning of leader, power and identity in the Indian higher education system. Normalizing the diverse voices, oppression, concretizing the social categories and policing of education created a crisis of ethics. The majoritarian and populist leadership took the shape of an authentic leader, representing the identities of the groups who prejudice towards the minorities. The higher education systems such as universities have become a seat of monitoring and limiting dissenting voices and a neoliberal wave has taken over the whole system in the name of morality, nationalism and religious dominance. This article presents a critical analysis of leadership in the university settings and the way leadership processes are considered to be authentic and ethical in a cultural context.
Perceptions of Cultural Competency Among Premedical Undergraduate Students
Authors: Goyal Reeti , Martin Skky , Garbarski Dana
Published: July 2020

Background:

Cultural competence is a difficult skill to teach, as it has several operational definitions as well as limited and unstandardized training procedures. Currently, there is no formal cultural competency training at the undergraduate level for students who seek to become a medical doctor. The purpose of this study is to explore perceptions of cultural competence among premedical undergraduates by assessing how they define and understand cultural competency and their knowledge (and sources thereof) of sociocultural realities in health and medicine.

Methods:

Structured in-depth interviews took place in 2016 and 2017 at a medium-sized private college in the Midwestern United States. Twenty premedical students were interviewed. The interviews were transcribed and thematically coded following an inductive, iterative, and systematic process.

Results:

Most students can provide a definition of cultural competence that includes at least one component of how it is conceptualized by the Association of American Medical Colleges. However, students focus largely on defining cultural competence as individual attitudes and interaction rather than systemic or structural realities that produce inequalities in health care. When explicitly asked, students varied in the level of detail provided in explaining the social determinants of health (such as race or ethnicity, sex, gender, and socioeconomic status) and varied in the accuracy of their definitions of traditional health practices. Each student noted the importance of training on cultural competence and many placed patients’ health at the center of their reason for doing so rather than focusing on their own training as a motivation. Students discussed various aspects of sociocultural differences and the need for physicians to understand patients’ outlooks on health care and be able to communicate to patients the purpose of suggested medical treatment, as well as the inherent tension in balancing patients as individuals and members of sociocultural groups. Premedical undergraduate students see their own cultural competence as an informal skill that is gained through social interactions across various areas of life, such as work, family, friends, and school.

Conclusion:

This study traces the sources of sociocultural information that premedical students will bring to their medical training as well as places where cultural competence can be further explored, practiced, and formally integrated in premedical education.
Developing a Workplace-Based Learning Culture in the NHS: Aspirations and Challenges
Authors: Gawne Suzanne , Fish Rebecca , Machin Laura
Published: July 2020

Background:

The delivery of patient care in the United Kingdom is under increasing financial pressure. The need to continuously improve service delivery while making financial savings is challenging. Alongside this, National Health Service (NHS) Trusts must provide a suitable educational environment that meets the needs of all learners while meeting performance standards and targets set by external regulating authorities. This research addresses the gap in literature concerning educational culture in the NHS.

Methods:

This case study examines the delivery of postgraduate medical education in the workplace. Semi-structured interviews were conducted with 6 lead educators in the Medical Division of a North West NHS Trust to glean their insights into what works and what needs to change.

Results:

A thematic analysis of the transcripts revealed a number of factors that facilitated and hindered educational opportunities for doctors in training, including the role of leadership, the demands of external regulatory authorities, and the pressures on frontline staff to deliver safe, personal, and effective care.

Conclusion:

Opportunities for developing a collaborative approach between educational and clinical leaders and the individuals delivering education in the workplace to enhance the educational environment are discussed. Finally, an evaluatory toolkit based on the themes emerging from the data is proposed, as a resource for other health care organisations to help improve the delivery of workplace-based medical education.
Mindfulness Education for Otolaryngology Residents: A Pilot Study
Authors: Kashat Lawrence , Carter Bridgette , Mosha Maua , Kavanagh Katherine R.
Published: July 2020

This pilot project was designed to (1) implement a mindfulness‐based wellness curriculum for otolaryngology residents, (2) determine the impact of a mindfulness‐based curriculum on resident mood, and (3) examine the use of mindfulness among otolaryngology residents. Otolaryngology residents participated in a 6‐week course guided by the Headspace mindfulness mobile application. Resident use of mindfulness was measured by the validated Mindful Attention Awareness Scale (MAAS). Changes in mood before and after each session were assessed using the validated Positive and Negative Affect Schedule (PNAS). Residents reported a statistically significant decrease in postsession negative affect scores (P <. 001). A moderate positive correlation was noted between mindfulness scores and presession positive mood (Pearson r = 0.597, P <. 001). This pilot study supports the feasibility and impact of including mindfulness training as part of a resident wellness curriculum.
Update on the management of poor ovarian response in IVF: the shift from Bologna criteria to the Poseidon concept
Authors: Drakopoulos Panagiotis , Bardhi Erlisa , Boudry Liese , Vaiarelli Alberto , Makrigiannakis Antonis , Esteves Sandro C. , Tournaye Herman , Blockeel Christophe
Published: July 2020

Despite the considerate progress to which assisted reproduction technology (ART) has been subject since 1978, some issues remain unresolved. Notably, the clinical management of patients with a poor ovarian response is still a challenge in everyday practice, frustrating to both the patient and the fertility expert. Poor ovarian responders (PORs) embody 9–24% of patients undergoing ovarian stimulation, meaning that up to one in four patients conceals a poor reproductive prognosis. The last decade has witnessed the attempts of the medical community to standardize diagnosis of POR with the developing of the Bologna Criteria and the subsequent evolution of the low prognosis patient elaborated in the POSEIDON classification. The aim of this article is to summarize all evidence concerning etiology and management of poor ovarian response, including the most recent advances and future prospects in this regard.
What To Tell Your Patient With Clonal Hematopoiesis And Why: Insights From Two Specialized Clinics
Authors: Steensma David P. , Bolton Kelly L
Published: July 2020

Acquired genetic mutations in hematopoietic stem or progenitor cells can lead to clonal expansion and imbalanced blood cell production. Clonal hematopoiesis is exceptionally common with human aging, confers a risk of evolution to overt hematologic malignancy, and also increases all-cause mortality and the risk of cardiovascular disease. The degree of risk depends on the specific mutation, number of mutations, mutant allele burden, and concomitant non-genetic risk factors (e.g., hypertension or cigarette smoking). People with clonal hematopoiesis may come to clinical attention in a variety of ways, including during the evaluation of a possible hematologic malignancy, as an incidental discovery during molecular analysis of a non-hematological neoplasm, after hematopoietic cell transplant, or as a result of germline testing for inherited variants. Even though the risk of clonal progression or a cardiovascular event in an individual patient may be low, the possibility of future clinical consequences may contribute to uncertainty and worry, since it is not yet known how to modify these risks. This review summarizes clinical considerations for patients with clonal hematopoiesis, including important points for hematologists to consider discussing with affected persons - individuals who may understandably be anxious about having a mutation in their blood that predisposes them to develop malignancy, but which is statistically more likely to result in a myocardial infarction or stroke. The increasing frequency with which people with clonal hematopoiesis are discovered and the need for counseling these patients is driving many institutions to create specialized clinics; we describe our own experience with forming such clinics.
A phase 1b study of AFM13 in combination with pembrolizumab in patients with relapsed or refractory Hodgkin lymphoma
Authors: Bartlett Nancy L. , Herrera Alex F. , Domingo-Domenech Eva , Mehta Amitkumar , Forero-Torres Andres , Garcia-Sanz Ramon , Armand Philippe , Devata Sumana , Izquierdo Antonia Rodriguez , Lossos Izidore S. , Reeder Craig , Sher Taimur , Chen Robert , Schwarz Sylvia E. , Alland Leila , Strassz Andras , Prier Kim , Choe-Juliak Cassandra , Ansell Stephen M.
Published: July 2020

In relapsed/refractory Hodgkin lymphoma (R/R HL), immunotherapies such as the anti-programmed death-1 inhibitor pembrolizumab have demonstrated efficacy as monotherapy and are playing an increasingly prominent role in treatment. The CD30/CD16A-bispecific antibody AFM13 is an innate immune cell engager, a first-in-class, tetravalent antibody, designed to create a bridge between CD30 on HL cells and the CD16A receptor on natural killer cells and macrophages, to induce tumor cell killing. Early studies of AFM13 have demonstrated signs of efficacy as monotherapy for patients with R/R HL and the combination of AFM13 with pembrolizumab represents a rational new treatment modality. Here, we describe a phase 1b, dose-escalation study to assess the safety and preliminary efficacy of AFM13 in combination with pembrolizumab in patients with R/R HL. The primary objective was estimating the maximum tolerated dose; the secondary objectives were to assess safety, tolerability, antitumor efficacy, pharmacokinetics, and pharmacodynamics. In this heavily pretreated patient population, treatment with the combination of AFM13 and pembrolizumab was generally well tolerated, with similar safety profiles compared to the known profiles of each agent alone. The combination of AFM13 with pembrolizumab demonstrated an objective response rate of 88% at the highest treatment dose, with an 83% overall response rate for the overall population. Pharmacokinetic assessment of AFM13 in the combination setting revealed a half-life of up to 20.6 hours. This proof-of-concept study holds promise as a novel immunotherapy combination worthy of further investigation. This phase 1b study was registered at www.clinicaltrials.gov as NCT02665650.
Carfilzomib, lenalidomide, and dexamethasone plus transplant in newly diagnosed multiple myeloma
Authors: Jasielec Jagoda K. , Kubicki Tadeusz , Raje Noopur , Vij Ravi , Reece Donna , Berdeja Jesus , Derman Benjamin A. , Rosenbaum Cara A. , Richardson Paul , Gurbuxani Sandeep , Major Sarah , Wolfe Brittany , Stefka Andrew T. , Stephens Leonor , Tinari Kathryn M. , Hycner Tyler , Rojek Alexandra E. , Dytfeld Dominik , Griffith Kent A. , Zimmerman Todd M. , Jakubowiak Andrzej J.
Published: July 2020

In this phase 2 multicenter study, we evaluated the incorporation of autologous stem cell transplantation (ASCT) into a carfilzomib-lenalidomide-dexamethasone (KRd) regimen for patients with newly diagnosed multiple myeloma (NDMM). Transplant-eligible patients with NDMM received 4 cycles of KRd induction, ASCT, 4 cycles of KRd consolidation, and 10 cycles of KRd maintenance. The primary end point was rate of stringent complete response (sCR) after 8 cycles of KRd with a predefined threshold of ≥50% to support further study. Seventy-six patients were enrolled with a median age of 59 years (range, 40-76 years), and 35.5% had high-risk cytogenetics. The primary end point was met, with an sCR rate of 60% after 8 cycles. Depth of response improved over time. On intent-to-treat (ITT), the sCR rate reached 76%. The rate of minimal residual disease (MRD) negativity using modified ITT was 70% according to next-generation sequencing (<10−5 sensitivity). After median follow-up of 56 months, 5-year progression-free survival (PFS) and overall survival (OS) rates were 72% and 84% for ITT, 85% and 91% for MRD-negative patients, and 57% and 72% for patients with high-risk cytogenetics. For high-risk patients who were MRD negative, 5-year rates were 77% and 81%. Grade 3 to 4 adverse events included neutropenia (34%), lymphopenia (32%), infection (22%), and cardiac events (3%). There was no grade 3 to 4 peripheral neuropathy. Patients with NDMM treated with KRd with ASCT achieved high rates of sCR and MRD-negative disease at the end of KRd consolidation. Extended KRd maintenance after consolidation contributed to deepening of responses and likely to prolonged PFS and OS. Safety and tolerability were manageable. This trial was registered at www.clinicaltrials.gov as #NCT01816971.