bluuebunny/crossref_metadata_2025 huggingface dataset:
Defining Patient Acceptable Symptom State Thresholds for the IKDC Subjective Knee Form and KOOS for Patients Undergoing ACL Reconstruction
Authors: Muller Bart , Yabroudi Mohammad A. , Lai Chung-Liang , Lynch Andrew , Harner Christopher D. , Dijk C. Niek Van , Fu Freddie H. , Irrgang James J.
Published: September 2013

Objectives:

In clinical practice and research, the magnitude of change in patient-reported outcome (PRO) is often used to assess outcome of treatment. However, a clinically meaningful change in PRO may not be associated with an acceptable state that corresponds to “feeling well”, which is also called the Patient Acceptable Symptom State (PASS). Thresholds for common PRO measures for achieving a PASS after ACL reconstruction have not been determined. The purpose of this observational cross section study was to determine thresholds for the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and the Knee Injury and Osteoarthritis Outcome Scale (KOOS) that indicate achievement of the PASS.

Methods:

Patients 1 to 5 years after primary ACL reconstruction completed a survey that included the IKDC-SKF and KOOS. Patients assessed satisfaction with their current state by answering the question “Taking into account all the activity you have during your daily life, your level of pain and also your activity limitations and participation restrictions, do you consider the current state of your knee satisfactory?” The IKDC-SKF and KOOS scores associated with a positive and negative response to this question were determined. Additionally, receiver operator characteristic (ROC) curves and the Youden Index were used to determine the PASS thresholds with the best sensitivity and specificity for each PRO that differentiated patients with an acceptable versus an unacceptable symptom state.

Results:

One hundred and sixty seven patients (mean age, 28.8±10.9 years) completed the survey. One hundred and forty six patients indicated they were in an acceptable symptom state (PASS-Y) and 21 were not (PASS-N) (Table 1). All PROs were significantly different between the PASS-Y and PASS-N groups (p<.001). Based on ROC curve analysis, threshold values that best distinguished an acceptable versus an unacceptable symptom state, with values of sensitivity and specificity, are reported in Table 1.

Conclusion:

Patients who did not achieve a PASS have worse IKDC-SKF and KOOS scores, indicating limitations in function, sports participation, and knee-related quality of life (QoL). The differences between PASS-Y and PASS-N for the KOOS pain, symptoms and activities of daily living (ADL) subscales were smaller than differences for sports & recreation, knee-related QoL, and the IKDC-SKF. This indicates that after ACL reconstruction, achieving an acceptable symptom state is more dependent on the ability to participate in sports than on the absence of symptoms or participation in ADL. The threshold values identified will aid in determining if patients after ACL reconstruction have achieved an acceptable symptom state based on their IKDC-SKF and KOOS scores.
Reliability of the ROCK Osteochondritis Dissecans Knee Arthroscopy Classification System - Multi-center Validation Study
Authors: Carey James L. , Wall Eric J. , Kevin G. Shea, MD  , Nathan L. Grimm, BS  , Allen F. Anderson, MD  , Eric W. Edmonds, MD  , Henry G. Chambers, MD  , Benton E. Heyworth, MD  , Mininder S. Kocher, MD, MPH  , Roger M. Lyon, MD  , Michael Lucas Murnaghan, MD  , Carl W. Nissen, MD  , John Polousky, MD  , Jennifer Weiss, MD  , Rick W. Wright, MD
Published: September 2013

Objectives:

Very few predictors of healing have been identified to help guide OCD treatment decisions for patients, families and physicians. As this condition is not common, multi-center study groups will be necessary to determine optimal diagnostic and treatment strategies. For staging systems to be useful, there must be agreement among observers of each stage, and from different centers. Although arthroscopic staging systems exist for OCD, none have been tested for intra-observer and inter-observer reliability. Using an expert consensus method, the ROCK OCD study group developed an arthroscopy classification system for OCD of the knee. The purpose of this study was to determine the reliability of an OCD classification system in a multicenter study group.

Methods:

We developed a classification system for arthroscopic evaluation of OCD of the knee based on the experience of a 13 centers experienced in the care of OCD. The classification system produced 6 arthroscopic categories (Cue Ball, Shadow, Wrinkle in the Rug, Locked Door, Trap Door, and Crater). A training module including arthroscopic photos, iconic sketches, and representative videos was developed to describe each stage. A total of 30 representative arthroscopic videos were viewed by 10 orthopedic surgeons who had not participated in the video case selection and preparation. After 60 days, the 30 videos were reviewed a second time in a new, randomly selected order and classified. An inter-rater reliability assessment was performed using the intra-class correlation method.

Results:

The intra-class correlation coefficient was 0.92, indicating a very good to excellent reliability of this classification system amongst orthopedic surgeons within the ROCK group.

Conclusion:

The ROCK OCD Knee arthroscopy classification system demonstrated high reliability. Relatively rare conditions will require multi-center study groups to perform high quality outcome studies. This classification system will facilitate multi-center studies for OCD.
The Demographics, Epidemiology, and Incidence of Progression to Surgery of Osteochondritis Dissecans of the Knee in Children and Adolescents
Authors: Kessler Jeffrey I. , Nikizad Hooman , Shea Kevin G. , Jacobs John C. , Ishkhanian Rita M. , Weiss Jennifer
Published: September 2013

Objectives:

To assess the demographics and epidemiology of osteochondritis dissecans (OCD) of the knee in patients age 2-19 and the frequency with which these lesions progress to surgery.

Methods:

A retrospective EMR chart review of an integrated health system was done on OCD between 2007 and 2011. Inclusion criteria included OCD of the knee and patients aged 2-19, with approximately 1 million patients in this cohort. Lesion location, laterality, and all patient demographics were recorded. OCD incidence was determined for the group as a whole and by age group (divided into age 2-5, group A=6-11, group B=12-19). Differences in progression toward surgery were compared between age groups, gender, and joint location.

Results:

192 patients with a total of 206 OCD lesions fit the inclusion criteria. No OCD lesions were found in 2-5 year olds. 53.4% of lesions were right-sided, 46.6% left-sided. The medial femoral condyle was the most commonly affected location with 63.6% of the knee OCD lesions, followed by the lateral femoral condyle with 32.5%. Lesions of the femoral trochlea, patella, and lateral tibial plateau represented less than 4% of the total combined. No OCD lesions were found in the 2-5 year-olds. The incidence of knee OCD for patients aged 6-19 was 9.6 per 100,000 for all patients, and 15.7 and 3.3 per 100,000 for males and females, respectively. Group B represented the vast majority of OCD, with an incidence of 21.8 per 100,000 in 12-19 year olds versus 8.7 in group A. Females in group A and B had an incidence of 4.6 and 13.3 per 100,00, respectively, while males had an incidence of 12.5 and 30.1 per 100,00 for group A and B, respectively. The overall male/female ratio for knee OCD was 3.7/1. 33.8% of all lesions progressed to surgery. Lesion location did correlate with progression to surgery, with rare trochlear lesions and tibial lesions more likely to undergo surgery (100%, 100%) than lateral and medial femoral condyle lesions (40.3% and 28.7%) and patellar lesions (33.3%).

Conclusion:

In this population-based cohort study of pediatric OCD in nearly 1 million children, males had a much greater incidence of OCD and the majority were right sided lesions. Teenagers had nearly 3 times the incidence of OCD as compared to the 6-11 year old group. Although most OCD lesions were located on the medial femoral condyle, lateral femoral condyle lesions were also common. The incidence of OCD in this study was similar to a smaller Swedish study by Linden et al 40 years previously. The knowledge of likelihood of progression to surgery of OCD by location, sex, and age is useful in counseling patients and in planning treatment. To our knowledge, this is the largest study of the demographics, epidemiology, and incidence of progression to surgery of OCD of the knee in children ever reported.
Knee Dislocation from Minor Trauma in Morbidly Obese Patients
Authors: Vaidya Rahul , Nanavati Dhiren , Prince Matthew , Sethi Anil
Published: September 2013

Objectives:

To present a series of atraumatic knee dislocations in obese and morbidly obese patients.

Methods:

An IRB approved retrospective study was preformed at a level 1 tertiary care trauma center. Eighteen patients who presented with a knee dislocation from a minor injury were included in the study. Charts, Radiographs, MRI’s were reviewed and patients were contacted in to examine them at latest follow up. We include patients in our database from 2001-2011.

Results:

The mean age at presentation was 33 (range of 15-74 years) with 4 males and 14 females. The average BMI was 43 range (34- 64.4) with an average follow up of 29 months (range 9- 72 months) Five patients (27%) had a popliteal artery injury and 8 (44.4%) had a peroneal nerve injury at presentation. All 5 had a vascular repair, and 4/8 patients had return of peroneal nerve. Surgical repair was preformed on 10 individuals. The average operating time for ligament reconstruction was 183% of that with injury matched patients. All patients had external fixation to protect the repair post op which was removed at 6 weeks post op and accompanied with a manipulation intra-op. Two patients failed reconstruction, one at 5 years due to a second injury and another at 4 months from a fall. We were unable to fit custom braces on these individuals so it was abandoned. Opposite knees were determined to have hyper mobility in all 16 patients who had an adequate exam. Eight operative patients who complied with therapy had an average range of 91.4 degrees (60-110). One patient was noncompliant by not taking therapy and ended up with only 40 degrees of flexion..The non operative patients had an avg ROM of 53.6 degrees (range 30-90) and may have been that they had less aggressive rehabilitation. Three of these had gone on to TKA.

Conclusion:

Knee dislocations from minor falls occur in obese patients and often have neurovascular complications. Surgical reconstruction is more time consuming and more difficult then in normal weighted individuals. It may be preferable to non operative treatment
Arthroscopic Transfer of the Long Head of the Biceps Tendon
Authors: Taylor Samuel , Baret Nikolas J. , Newman Ashley , Delos Demetris , Drakos Mark , Copple Zachary M. , DiPietro James R. , O'Brien Stephen J.
Published: September 2013

Objectives:

Evaluation of the mid-term clinical and functional outcome in a cohort of patients who underwent transfer of the long head of the biceps tendon (LHBT).

Methods:

Patients diagnosed with biceps instability or related pathology that underwent arthroscopic assisted or all arthroscopic transfer of the long head of the biceps tendon to the conjoint tendon were considered. The procedure was performed either as an isolated procedure on in conjunction with another procedure by the senior author. Outcome surveys were collected for 157 patients with a subset of 43 patients available for clinical examination at 2-10 years postop time point. Outcome measures were based on American Society of Shoulder and Elbow Surgeons (ASES), University of California at Los Angeles (UCLA), and L’Insalata questionnaires. Ipsilateral and contralateral metrics were also evaluated.

Results:

157 patients (25 female, 132 male; average age 50 years; average postop 4.9 years) were evaluated with L’Insalata, UCLA, and ASES questionnaires, scoring 84.78, 29.77, and 83.4, respectively. In the 33 patients who had an isolated LHBT transfer, the L’Insalata, UCLA, and ASES scores were 79.52, 27.6, and 83.95, respectively. 43 shoulders (7 female, 36 male; average age 50 years; average postop 5.1 years) were available for clinical examination by a physician other than the treating surgeon. There was no statistically significant side-to- side strength difference using a 10-pound weight. All of the patients reported no arm pain at rest with regard to the biceps. 81% of patients reported no biceps tenderness upon palpation of the bicipital groove and 85.8% had a negative throwing test. 95.2% of patients had a negative active compression test. Speed’s and Yergason’s tests were negative in 90.5% and 95.2% of patients respectively. One patient (3%) complained of fatigue discomfort (soreness) isolated to the biceps muscle following resisted elbow flexion. Five patients (12.0%) had a Popeye sign and one patient (3%) exhibited biceps subsidence. 86% of patients were self-rated as good to excellent, with the remaining 14% reporting fair or poor results.

Conclusion:

Arthroscopic subdeltoid transfer of the LHBT to the conjoint tendon is an appropriate and reliable intervention for active patients with chronic, refractory biceps pathology. There was no loss of strength for biceps curls. All patients reported no pain isolated to biceps muscle at rest. Ninety-seven percent of patients had resolution of their preoperative biceps symptoms.
Professional Pitchers with GIRD Display Greater Dominant Humeral Retrotorsion than Pitchers with Normal ROM
Authors: Noonan Thomas J. , Shanley Ellen , Bailey Lane Brooks , Wyland Douglas J. , Kissenberth Michael , Hawkins Richard J. , Thigpen Charles A.
Published: September 2013

Objectives:

Glenohumeral internal rotation deficit (GIRD) in the dominant shoulder of a throwing athlete is a previously recognized phenomenon which has been associated with upper extremity injury. The relationship between GIRD and humeral torsion has not clearly been elucidated. The purpose of this study was to compare humeral torsion between professional pitchers presenting with GIRD and those with normal ROM.

Methods:

Humeral torsion and shoulder range of motion (ROM) was measured in 128 professional pitchers prior to spring training from 2009-2012. Shoulder external (ER) and internal (IR) ROM was assessed in 90º of abduction with the scapula stabilized. Humeral torsion was measured via ultrasound using previously described and validated methods. GIRD was defined as the loss of internal rotation > 15º with a concomitant loss of 10º total arc of motion. The side-to-side difference in HT was calculated by subtracting the dominant arm (D) HT from the non-dominant (ND) HT. A mixed model ANOVA(side X GIRD) were used to compare pitchers dominant and non-dominant HT between pitchers with GIRD to those without GIRD. Independent t-tests were used to compare the side to side difference in HT between pitchers with GIRD and those without (α=0.05).

Results:

Pitchers with GIRD displayed alterations in ROM (ER=131.8±14.3, IR= 29.1±10.1, Total Arc=160.9±15.5 ) compared with those with normal ROM (ER=132.0±14.2 , IR= 40.5±11.3 , Total Arc= 172.5 ±16.2 ). Pitchers with GIRD displayed significantly less humeral torsion (i.e. greater retro torsion) in their dominant arm compared to those without (GIRD=4.4±12.0º, Normal=10.4±11.6º, P=0.002). Pitchers with GIRD also displayed a greater side to side difference in humeral retro torsion (GIRD=19.5±11.9 compared with 12.4±12.4º, P=0.001). There was no difference in non-dominant humeral torsion in pitchers with and without GIRD ( P>0.05).

Conclusion:

Professional pitchers who display deficits in total arc of motion on the internal rotation side greater than 15º tend to also have greater dominant humeral retro torsion and greater side to side differences. An adaptive increase in humeral retro torsion in the dominant arm due to repetitive throwing may limit internal rotation in the follow through phase of the throwing motion. This, in turn, may increases forces on the posterior soft tissues of the glenohumeral joint leading to the development of GIRD. Given that deficits in total arc of motion and internal rotation are associated with increased arm injury risk future studies should examine the amount of humeral torsion that predisposes a shoulder to develop GIRD.
Shoulder and Scapular Kinematics during the Windmill Softball Pitch
Authors: Backus Sherry I. , Kraszewski Andrew , Kontaxis Andreas , Gibbons Mandi , Bido Jennifer , Graziano Jessica , Hafer Jocelyn , Jones Kristofer J. , Hillstrom Howard , Fealy Stephen
Published: September 2013

Objectives:

Pitch count has been studied extensively in the overhand throwing athlete. However, pitch count and fatigue have not been systematically evaluated in the female windmill (underhand) throwing athlete. Direct kinematic measurements of the glenohumeral and scapulo-thoracic joint have not to be correlated and determined. The purpose is to measure scapular kinematics for the high school female windmill softball pitcher and identify kinematic adaptions and changes in pitching performance due to fatigue.

Methods:

Eight female high school softball pitchers without previous shoulder injury were enrolled. Three-dimensional (3D) motion of the humerus, scapula and trunk were recorded with surface markers at 250 Hz. Marker placement and the anatomical calibration of bony landmarks followed recommendations by the ISB (Wu et al. 2005) and Kontaxis et al (2009). A custom marker cluster was used to dynamically track the scapula (Karduna et al. 2001). The pitching mound was at regulation distance (43’) from the strike zone target. All athletes completed 105 pitches in sets of 15 with a rest of 5 minutes between sets. Ball speed recorded with a radar gun, 3D angular rotations of the glenohumeral joint, scapulo-thoracic joint and thorax with respect to the room were calculated for all throws. The last five pitches of every set were averaged for analysis.

Results:

Ball speed (Figure 1, n=8 subjects) and peak glenohumeral, scapulo-thoracic and thoracic angular rotations (n=4 subjects) were consistent across all sets. Examples of kinematics at two of these joints are presented across all sets (Figure 2, n=4). Data across all planes demonstrated similar consistency.

Conclusion:

This study presents a systematic protocol for the study of fatigue during windmill softball pitching. To our knowledge, this is one of the first studies to analyze glenohumeral as well as scapulo-thoracic kinematics during this task. The consistency in the glenohumeral, scapulo-thoracic and torso kinematics during the throwing protocol demonstrates that despite completing 105 pitches, these athletes are able to maintain shoulder kinematics and ball speed during the underhand pitch. This contrasts to the common observation that male overhand pitchers fatigue around 90 pitches.
Arthroscopic Shoulder Surgery in Female Professional Tennis Players
Authors: Young Simon W. , Safran Marc R. , Dakic Jodie , Nguyen Michael L. , Stroia Kathleen
Published: September 2013

Objectives:

Recent publications have highlighted the relatively poor outcome of other overhead athletes, particularly baseball players, with regard to return to sports at the same or higher level after shoulder surgery. However, true assessment of their ability when returning to sport is not as clear. Further, ability to return to other overhead sports has not been reported. Our objective was to assess outcome and time to return to previous level of function following shoulder surgery in professional tennis players.

Methods:

The records of all female tennis players on the Women’s Tennis Association (WTA) professional circuit between January 2008 and June 2010 were reviewed to identify players who underwent shoulder surgery on their dominant (serving) shoulder. Details of the surgery including date, procedures performed, and complications were recorded. The primary outcomes were ability and time to return to professional play, and if they were able to return to their previous level of function, as determined by singles ranking. Pre and post-operative singles rankings were used to determine rate and completeness of return to preoperative function. Their highest ranking pre-injury, post operatively, and the time to return to pre-injury ranking were evaluated.

Results:

During the study period eight professional women tennis players from the WTA underwent shoulder surgery on their dominant arm. All surgery was performed arthroscopically, 7 out of 8 players had more than one procedure performed during the surgery. In total, 3 players underwent debridement of a partial rotator cuff tear and 2 players underwent repair of a complete supraspinatus tear. Three players had an anterior labral repair or reconstruction for anterior instability, and one player underwent repair of a SLAP lesion. Two players underwent neurolysis of a suprascapular nerve, and three players in total underwent a subacromial decompression. All players (100%) returned to professional play. The mean time to return to play was 6.7 months after surgery. However, only 25% (2 out of 8) players had achieved their pre-injury singles rank or better by 18 months post operatively. In total, three players returned to their pre-injury singles ranking, with their peak singles ranking being attained at a mean of 2.5 years post operatively.

Conclusion:

This study demonstrates that in professional female tennis players, a high return to play rate following arthroscopic shoulder surgery is also associated with a prolonged and often incomplete return to previous level of performance. Thus, counselling the patient to this fact is important to manage their expectations.
A Prospective Randomized Trial of Functional Outcomes Following Rotator Cuff Repair With and Without Acromioplasty
Authors: Tetteh Elizabeth , Hussey Kristen Elizabeth , Abrams Geoffrey D. , Gupta Anil K. , Dhawan Aman , Karas Vasili , Cole Brian J. , Romeo Anthony A. , Verma Nikhil N.
Published: September 2013

Objectives:

The purpose of this study is to report the clinical outcomes of patients undergoing an arthroscopic rotator cuff repair with and without acromioplasty at a minumul of two year follow-up.

Methods:

Patients undergoing arthroscopic repair of full thickness rotator cuff tears were randomized into acromioplasty or non-acromioplasty groups. Pre-operatively, validated outcome scores including the Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons score (ASES), UCLA score, and SF-12 health assessment were collected along with physical examination including range of motion and dynamometer strength testing. Pre-operative imaging was also reviewed to classify the acromial morphology, acromial angle, and lateral acromial angulation. Intra-operative data including tear size, repair configuration, and concomitant procedures were recorded. Postoperatively, data was collected at 6 weeks, 6 months, one year and at two years. Results are reported as mean ± standard deviation. Student’s t-test was utilized for statistical analysis with an alpha value of 0.05 set as significant.

Results:

Sixty-one patients completed surveys pre- and post-operatively at a mean 2.6 years. All patients had at least two year follow-up. Thirty-five patients with an average age of 58.4 years (range 44.4 - 74.7) were randomized to the acromioplasty group (22 male, 13 female) and 26 patients with a mean age of 58.2 years (range 42.9-77.0) to the non-acromioplasty group (17 male, 9 female). All outcome scores improved significantly (p < 0.05) in both groups from pre- to post-operatively at two year follow-up. In the acromioplasty group, improvements were observed for SST (5.6 ± 2.7 to 10.7 ± 1.7), ASES (53.5 ± 16.8 to 91.0 ± 13.5) and UCLA (10.7 ± 3.1 to 17.9 ± 30.0) scores. In the non-acromioplasty group, SST increased from 5.6 ± 3.1 to 10.5 ± 2.2; ASES from 58.9 ± 19.1 to 93.5 ± 10.8, and UCLA from 12.0 ± 2.8 to 17.4 ± 3.7. There was no statistical difference in clinical outcome when comparing the groups.

Conclusion:

The results of this study demonstrate no difference in clinical outcomes following rotator cuff repair with or without acromioplasty at two years postoperatively. These data suggest that acromioplasty may not need to be performed following rotator cuff repair, particularly in the setting of normal acromial architecture.
Kinesiology Tape Compared to NSAIDS in the Treatment of Rotator Cuff Impingement
Authors: Devereaux Moira , Velanoski Kinny Quan , Pennings Amanda , ElMaraghy Amr
Published: September 2013

Objectives:

To determine if kinesiology tape is as effective as nonsteroidal anti-inflammatory drugs (NSAIDS) when used as an adjunctive therapy to exercise at reducing pain and improving function in patients with rotator cuff impingement.

Methods:

A prospective, single-blind, randomized control trial was conducted. One hundred patients (average age: 48 ± 12.3, 61 males, 39 females) with a diagnosis of subacromial impingement syndrome were recruited and randomly assigned to one of three treatment groups: taping and exercise (n=33), NSAIDs and exercise (n=29), or exercise only (n=38). All patients completed a two-week (four sessions) exercise program guided by a registered physiotherapist. The physiotherapist applied the kinesiology tape to the patients in the taping and exercise group who wore the tape full time for an average of 3.5 days. Patients were assessed pre and post treatment by a research assistant who was blinded to each patient’s assigned treatment group. Patients were provided with a usage diary to record their compliance with the treatment protocol. Shoulder pain and function were assessed using a Numeric Pain Rating Scale, the Simple Shoulder Test (SST), and the Constant Score.

Results:

A significant improvement in pain with arm elevation, SST, and Constant Scores was observed in all the groups: taping and exercise group (1.2±2.5, 1.6±2.2, 7.8±8.1, respectively; p<0.05), NSAIDs and exercise group (2.1±2.4, 1.5±2.7, 11.0±11.7; respectively; p<0.05), and the exercise only group (1.3±2.6, 1.4±2.2, 6.3±10.9, respectively; p<0.05). A significant improvement in activities of daily living and functional arm level was observed in the taping and exercise group (0.8±1.2, 1.6±2.2 respectively; p<0.05) and the NSAIDS and exercise group (1.0±1.6, 0.8±2.0 respectively; p<0.05). Between-group differences were not statistically significant. Although all treatment groups showed a slight trend toward increased strength, the results were not significant. Patients were more compliant with the kinesiology tape (100%) than the NSAIDS treatment regime (84%). 88.5% of participants reported on average less than 2/10 discomfort with the tape.

Conclusion:

Kinesiology tape is as effective as NSAIDs as an adjuvant therapy to exercise at reducing shoulder pain and improving function in patients with subacromial impingement. Patients demonstrated increased compliance with the addition of kinesiology tape to an exercise program as compared to NSAIDS. Kinesiology tape appears to be well-tolerated and may prove to be a safer alternative to NSAIDs in the conservative treatment of shoulder impingement pain and dysfunction.
Obstructive Sleep Apnea as a Risk Factor for Postoperative Complications after Shoulder Arthroplasty
Authors: Griffin Justin W. , Browne James A. , Brockmeier Stephen F.
Published: September 2013

Objectives:

Obstructive sleep apnea has been identified as an important risk factor in perioperative orthopaedic surgery outcomes despite limited evidence in specific domains. Our objective was to determine if patients with obstructive sleep apnea have a higher likelihood of postoperative in-hospital complications, length of stay or increased costs after shoulder arthroplasty.

Methods:

We utilized the Nationwide Inpatient Sample database to analyze 22,988 patients undergoing TSA or hemiarthroplasty between 2006-2008. Of these patients 1,983 (5.9%) had a concomitant diagnosis of OSA. Multivariate analysis with logistic regression modeling was used to compare patients with and without OSA for various outcomes and in hospital complications (pneumonia, DVT, PE, wound complications, hematoma, seroma, anemia).

Results:

Patients with obstructive sleep apnea did not have overall increased in-hospital mortality and complications including Pulmonary Embolism (odds radio 1.083; p<0.01; and 1.038 respectively) compared to those without OSA. OSA was not associated with increased postoperative charges (odds ratio 1.01) but did increase length of stay (odds ratio 1.07; p<0.0001).

Conclusion:

OSA does not appear to be associated with increased in-hospital mortality or morbidity. It may however be associated with increased length of stay. Our study is the first to demonstrate that the association of OSA with surgical morbidity and mortality may not be applicable in shoulder arthroplasty. Further research is warranted to attempt to allocate resources and keep patient screening costs down, while optimizing patient outcomes.
The Accuracy of the Physical Exam versus Arthroscopy in the Detection of Subscapularis Tendon Injury
Authors: Faruqui Sami , Wijdicks Coen A. , Foad Abdullah
Published: September 2013

Objectives:

The main purpose of this study was to obtain the accuracy of the physical exam in the detection of subscapularis tendon tears and compare it to the gold standard of arthroscopy to determine whether clinical examination can reliably predict the presence of subscapularis tendon tears.

Methods:

This was a retrospective analysis of 52 patients (52 shoulders) who underwent arthroscopic subscapularis tendon repairs between September 2008 and April 2012. The inclusion criteria for this study were that all patients must have had at least 1 of the 3 screening tests performed prior to arthroscopy, arthroscopic evidence of a subscapularis tear, and subsequent repair of this tear. Exclusion criteria in this study included lack of documentation of screening tests. Positive findings on any combination of the belly press, lift-off, and bear hug tests constituted a positive physical exam result

Results:

There was a positive finding on physical exam in 42/52 patients. The sensitivity of the physical exam in the detection of subscapularis tendon injury was found to be 81%. Ten of the 52 patients with subscapularis tendon tears had negative physical exam results (false negatives). The median number of days between the physical exam and arthroscopic confirmation of a subscapularis tendon tear was 16 days.

Conclusion:

The belly press, lift-off, and bear hug tests can reliably predict subscapularis tendon tears. Consistent implementation of these three components of the physical exam can potentially lead to fewer undetected subscapularis tears, resulting in fewer failed rotator cuff repairs and improved overall post-operative outcomes.
Operative Management of Elbow UCL Insufficiency in Adolescent Athletes Age 18 Years and Younger
Authors: Jones Kristofer J. , Rebolledo Brian J. , Weeks Kenneth , Dines David M. , Dines Joshua S. , Altchek David W.
Published: September 2013

Objectives:

The incidence of ulnar collateral ligament (UCL) insufficiency of the elbow has drastically increased in the adolescent population over the last decade due to widespread participation in overhead athletics. Previous reports suggest clinical outcomes in teenage athletes are inferior to results in higher-level adult athletes. We hypothesized that UCL reconstruction using the docking technique would result in improved outcomes in this age group.

Methods:

46 adolescent athletes (mean age 17 years, range 12-18 years) underwent UCL reconstruction using the docking technique. The majority of patients were baseball players; there were three gymnasts and three javelin throwers. Retrospective review revealed each patient had a history and physical exam consistent with UCL injury along with advanced imaging demonstrating corresponding UCL pathology (24 distal tears, 22 proximal tears). Patients were evaluated at a minimum of 2 years postoperatively based on their ability to return to athletic activity. Clinical outcomes were classified using the Conway Scale, the Andrews-Timmerman Score, and the Kerlan-Jobe Orthopaedic Clinic (KJOC) Score.

Results:

At most recent follow-up, 89% (41/46) of patients had excellent results using the Conway Scale. There was one good, two fair and two poor results. One fair result was noted in a revision case and the two poor results occurred in patients who had concomitant capitellar OCD lesions. UCL tear location did not affect clinical outcome. There were four postoperative complications in four patients (two gymnasts and two javelin throwers) who developed ulnar neuritis following reconstruction. The average Andrews-Timmerman Score was 86.7 and the mean KJOC score was 88.

Conclusion:

The docking technique results in favorable clinical outcomes in adolescent athletes with UCL insufficiency at a minimum of 2 years postoperatively. Overall, results were better than previously published reports in this age group and this may be attributed to technique specific factors. Patients with concomitant intraarticular pathology should be counseled preopreratively that they may experience inferior clinical outcomes. Additionally, gymnasts and javelin throwers may be at increased risk for postoperative complications due to increased stress on the medial elbow.
Origin of the Medial Ulnar Collateral Ligament on the Pediatric Elbow
Authors: Zell Michael Alan , Dwek Jerry R. , Edmonds Eric W.
Published: September 2013

Objectives:

Surgical reconstruction of the torn anterior bundle of the medial ulnar collateral elbow ligament (UCL) is an established treatment that yields satisfactory results in adults. Children sustain these injuries less frequently and surgical intervention is complicated by the juxtaposed medial epicondyle apophysis. The purpose of this study was to identify the anatomical origin of the pediatric UCL and determine if this location changes with elbow maturity.

Methods:

A retrospective analysis of children with elbow MRI between 2009 and 2012 was performed. Grouped by age (<11, 11-13, and >13) and gender, the exclusion criteria included: poor imaging quality due to motion artifact, elbow flexion beyond 45 degrees, and prior elbow injury obscuring anatomic structures. Measurements of UCL width and UCL midpoint distance from medial epicondyle apophysis were recorded on coronal T1 images utilizing digital PACS software.

Results:

Ninety children (68 boys, 22 girls), mean age 12.8 years (range 6-18), met criteria. Across all groups, boys had a wider UCL than girls (4.05 ± 0.16 mm vs 3.72 ± 0.20 mm, p = 0.03); however, there was no difference in the anatomical origin of the UCL relative to the medial epicondyle apophysis between gender (p = 0.52), between gender age-matched groups, or within gender age-matched groups (Table 1). However, the anatomic origin of the UCL always remained medial to the distal periphery of the apophysis. There was, however, a statistical trend in girls between the <11 and >13 groups for the UCL origin to move closer to the medial epicondyle apophysis with maturity (p=0.053).

Conclusion:

Although surgical reconstruction of the UCL in children is infrequent, it may be the best treatment for a given skeletally immature patient with elbow instability. The procedure requires a choice regarding ligament placement on the humerus versus preservation of the medial epicondyle apophysis. This study elucidates the anatomical origin of the UCL across gender and age for the at risk pediatric group and demonstrates no differences in the UCL center of attachment based on skeletal maturity or gender. Therefore, surgical intervention of the pediatric torn elbow UCL does not require specific consideration of age and gender regarding placement of the reconstructed ligament; however, an anatomic reconstruction of the UCL does place the medial epicondyle apophysis at risk for injury.
On certain subclasses of multivalent functions defined by multiplier transformations
Authors: Patel Jagannath , Cho Nak Eun , Palit Ashis Kumar
Published: September 2013

The purpose of the present paper is to introduce and investigate various properties of a certain class of multivalent functions in the open unit disk defined by a multiplier transformation. In particular, we obtain some inclusion relationships and integral preserving properties of this class of functions. Relevant connections of the results presented in this paper with various known results are also pointed out.

MSC:30C45.
A molecular model of the full-length human NOD-like receptor family CARD domain containing 5 (NLRC5) protein
Authors: Mótyán János András , Bagossi Péter , Benkő Szilvia , Tőzsér József
Published: September 2013

Background

Pattern recognition receptors of the immune system have key roles in the regulation of pathways after the recognition of microbial- and danger-associated molecular patterns in vertebrates. Members of NOD-like receptor (NLR) family typically function intracellularly. The NOD-like receptor family CARD domain containing 5 (NLRC5) is the largest member of this family that also contains the largest number of leucine-rich repeats (LRRs).

Due to the lack of crystal structures of full-length NLRs, projects have been initiated with the aim to model certain or all members of the family, but systematic studies did not model the full-length NLRC5 due to its unique domain architecture.

Our aim was to analyze the LRR sequences of NLRC5 and some NLRC5-related proteins and to build a model for the full-length human NLRC5 by homology modeling.

Results

LRR sequences of NLRC5 were aligned and were compared with the consensus pattern of ribonuclease inhibitor protein (RI)-like LRR subfamily. Two types of alternating consensus patterns previously identified for RI repeats were also found in NLRC5. A homology model for full-length human NLRC5 was prepared and, besides the closed conformation of monomeric NLRC5, a heptameric platform was also modeled for the opened conformational NLRC5 monomers.

Conclusions

Identification of consensus patterns of leucine-rich repeat sequences helped to identify LRRs in NLRC5 and to predict their number and position within the protein. In spite of the lack of fully adequate template structures, the presence of an untypical CARD domain and unusually high number of LRRs in NLRC5, we were able to construct a homology model for both the monomeric and homo-heptameric full-length human NLRC5 protein.
Suppression of protein kinase C theta contributes to enhanced myogenesis In vitro via IRS1 and ERK1/2 phosphorylation
Authors: Marino Joseph S , Hinds Terry D , Potter Rachael A , Ondrus Eric , Onion Jeremy L , Dowling Abigail , McLoughlin Thomas J , Sanchez Edwin R , Hill Jennifer W
Published: September 2013

Background

Differentiation and fusion of skeletal muscle myoblasts into multi-nucleated myotubes is required for neonatal development and regeneration in adult skeletal muscle. Herein, we report novel findings that protein kinase C theta (PKCθ) regulates myoblast differentiation via phosphorylation of insulin receptor substrate-1 and ERK1/2.

Results

In this study, PKCθ knockdown (PKCθshRNA) myotubes had reduced inhibitory insulin receptor substrate-1 ser1095 phosphorylation, enhanced myoblast differentiation and cell fusion, and increased rates of protein synthesis as determined by [3H] phenylalanine incorporation. Phosphorylation of insulin receptor substrate-1 ser632/635 and extracellular signal-regulated kinase1/2 (ERK1/2) was increased in PKCθshRNA cells, with no change in ERK5 phosphorylation, highlighting a PKCθ-regulated myogenic pathway. Inhibition of PI3-kinase prevented cell differentiation and fusion in control cells, which was attenuated in PKCθshRNA cells. Thus, with reduced PKCθ, differentiation and fusion occur in the absence of PI3-kinase activity. Inhibition of the ERK kinase, MEK1/2, impaired differentiation and cell fusion in control cells. Differentiation was preserved in PKCθshRNA cells treated with a MEK1/2 inhibitor, although cell fusion was blunted, indicating PKCθ regulates differentiation via IRS1 and ERK1/2, and this occurs independently of MEK1/2 activation.

Conclusion

Cellular signaling regulating the myogenic program and protein synthesis are complex and intertwined. These studies suggest that PKCθ regulates myogenic and protein synthetic signaling via the modulation of IRS1and ERK1/2 phosphorylation. Myotubes lacking PKCθ had increased rates of protein synthesis and enhanced myotube development despite reduced activation of the canonical anabolic-signaling pathway. Further investigation of PKCθ regulated signaling may reveal important interactions regulating skeletal muscle health in an insulin resistant state.
Gene expression modifications in Wharton’s Jelly mesenchymal stem cells promoted by prolonged in vitro culturing
Authors: Gatta Valentina , D’Aurora Marco , Lanuti Paola , Pierdomenico Laura , Sperduti Samantha , Palka Giandomenico , Gesi Marco , Marchisio Marco , Miscia Sebastiano , Stuppia Liborio
Published: September 2013

Background

It has been demonstrated that the umbilical cord matrix, represented by the Wharton’s Jelly (WJ), contains a great number of mesenchymal stem cells (MSCs), characterized by the expression of specific MSCs markers, shared by both human and animal models. The easy access to massive WJ amount makes it an attractive source of MSCs for cell-based therapies. However, as in other stem cell models, a deeper investigation of WJ-derived MSCs (WJ-MSCs) biological properties, probably modulated by their prolonged expansion and fast growth abilities, is required before their use in clinical settings. In this context, in order to analyze specific gene expression modifications occurring in WJ-MSCs, along with their culture prolongation, we investigated the transcriptomic profiles of WJ-MSCs after 4 and 12 passages ofin vitroexpansion by microarray analysis.

Results

Hierarchical clustering analysis of the data set originated from a total of 6 experiments revealed that in vitro expansion of WJ-MSCs up to 12 passages promote selective over-expression of 157 genes and down-regulation of 440 genes compared to the 4th passage. IPA software analysis of the biological functions related to the identified sets of genes disclosed several transcripts related to inflammatory and cell stress response, cell proliferation and maturation, and apoptosis.

Conclusions

Taken together, these modifications may lead to an impairment of both cell expansion ability and resistance to apoptosis, two hallmarks of aging cells. In conclusion, results provided by the present study suggest the need to develop novel culture protocols able to preserve stem cell plasticity.
Hypereosinophilic syndrome masquerading as a myocardial infarction causing decompensated heart failure
Authors: Lim Joanna , Sternberg Alexander , Manghat Nathan , Ramcharitar Steve
Published: September 2013

Background

An 81 year old female patient diagnosed with a chronic low grade hypereosinophilic syndrome presented with angina and dyspnoea.

Case presentation

She was managed for a non-ST elevated myocardial infarction since her troponin levels were elevated. On day 5, she suffered an acute clinical deterioration with type I respiratory failure and cardiogenic shock, accompanied by deterioration in left ventricular systolic function demonstrated on echocardiography, and this coincided with a marked rise in eosinophil count. Secondary causes of eosinophilia were excluded permitting a diagnosis of Hypereosinophilic Syndrome (HES) to be made. Coronary angiography revealed unobstructed arteries. Supportive treatment for heart failure included diuretic and inotropes but she dramatically improved both clinically and echocardiographically upon commencement of high dose steroids and hydroxycarbamide. Cardiac magnetic resonance imaging (CMR) demonstrated diffuse, shallow endomyocardial enhancement with late gadolinium, consistent with a diagnosis of eosinophilic myocarditis.

Conclusion

Hypereosinophilic Syndrome can masquerade as a myocardial infarction causing decompensated heart failure. Early recognition and treatment with steroids can improve outcome.
Preparation of lactose-free pasteurized milk with a recombinant thermostable β-glucosidase from Pyrococcus furiosus
Authors: Li Bin , Wang Zemin , Li Shiwu , Donelan William , Wang Xingli , Cui Taixing , Tang Dongqi
Published: September 2013

Background

Lactose intolerance is a common health concern causing gastrointestinal symptoms and avoidance of dairy products by afflicted individuals. Since milk is a primary source of calcium and vitamin D, lactose intolerant individuals often obtain insufficient amounts of these nutrients which may lead to adverse health outcomes. Production of lactose-free milk can provide a solution to this problem, although it requires use of lactase from microbial sources and increases potential for contamination. Use of thermostable lactase enzymes can overcome this issue by functioning under pasteurization conditions.

Results

A thermostable β-glucosidase gene from Pyrococcus furiosus was cloned in frame with the Saccharomyces cerecisiae a-factor secretory signal and expressed in Pichia pastoris strain X-33. The recombinant enzyme was purified by a one-step method of weak anion exchange chromatography. The optimum temperature and pH for this β-glucosidase activity was 100°C and pH 6.0, respectively. The enzyme activity was not significantly inhibited by Ca2+. We tested the additive amount, hydrolysis time, and the influence of glucose on the enzyme during pasteurization and found that the enzyme possessed a high level of lactose hydrolysis in milk that was not obviously influenced by glucose.

Conclusions

The thermostablity of this recombinant β-glucosidase, combined with its neutral pH activity and favorable temperature activity optima, suggest that this enzyme is an ideal candidate for the hydrolysis of lactose in milk, and it would be suitable for application in low-lactose milk production during pasteurization.
Variants in toll-like receptor 9 gene influence susceptibility to tuberculosis in a Mexican population
Authors: Torres-García Diana , Cruz-Lagunas Alfredo , García-Sancho Figueroa Ma Cecilia , Fernández-Plata Rosario , Baez-Saldaña Renata , Mendoza-Milla Criselda , Barquera Rodrigo , Carrera-Eusebio Aida , Ramírez-Bravo Salomón , Campos Lizeth , Angeles Javier , Vargas-Alarcón Gilberto , Granados Julio , Gopal Radha , Khader Shabaana A , Yunis Edmond J , Zuñiga Joaquin
Published: September 2013

Background

The control of Mycobacterium tuberculosis (Mtb) infection begins with the recognition of mycobacterial structural components by toll like receptors (TLRs) and other pattern recognition receptors. Our objective was to determine the influence of TLRs polymorphisms in the susceptibility to develop tuberculosis (TB) in Amerindian individuals from a rural area of Oaxaca, Mexico with high TB incidence.

Methods

We carried out a case–control association community based study, genotyping 12 polymorphisms of TLR2, TLR4, TLR6 and TLR9 genes in 90 patients with confirmed pulmonary TB and 90 unrelated exposed but asymptomatic household contacts.

Results

We found a significant increase in the frequency of the allele A of the TLR9 gene polymorphism rs352139 (A>G) in the group of TB patients (g.f. = 0.522) when compared with controls (g.f. = 0.383), (Pcorr = 0.01, OR = 1.75). Under the recessive model (A/G + A/A vs G/G) this polymorphism was also significantly associated with TB (Pcorr = 0.01, OR= 2.37). The association of the SNP rs352139 was statistically significant after adjustment by age, gender and comorbidities by regression logistic analysis (Dominant model: p value = 0.016, OR = 2.31; Additive model: p value = 0.023, OR = 1.68). The haplotype GAA of TLR9 SNPs was also associated with TB susceptibility (Pcorr = 0.02). Differences in the genotype or allele frequencies of TLR2, TLR4 and TLR6 polymorphisms between TB patients and healthy contacts were not detected.

Conclusions

Our study suggests that the allele A of the intronic polymorphism rs352139 on TLR9 gene might contribute to the risk of developing TB in Mexican Amerindians.