bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurofilament light chain in a phase 2 clinical trial of ibudilast in progressive multiple sclerosis
Authors: Fox Robert J , Raska Paola , Barro Christian , Karafa Matthew , Konig Victoria , Bermel Robert A , Chase Marianne , Coffey Christopher S , Goodman Andrew D , Klawiter Eric C , Naismith Robert T , Kuhle Jens
Published: February 2021

Background:

Sensitive and specific biomarkers for use in progressive multiple sclerosis (MS) have not been established. We investigate neurofilament light (NfL) as a treatment response biomarker in progressive MS.

Objective:

To evaluate whether ibudilast 100 mg/day alters serum and cerebrospinal fluid (CSF) levels of NfL in progressive MS.

Methods:

In a protocol-defined exploratory analysis from a 2-year, phase 2 clinical trial of ibudilast in progressive MS (NCT01982942), serum samples were collected from 239 subjects and a subset contributed CSF and assayed using single-molecule assay (SIMOA) immunoassay. A mixed model for repeated measurements yielded log(NfL) as the response variable.

Results:

The geometric mean baseline serum NfL was 31.9 and 28.8 pg/mL in placebo and ibudilast groups, respectively. The geometric mean baseline CSF NfL was 1150.8 and 1290.3 pg/mL in placebo and ibudilast groups, respectively. Serum and CSF NfL correlations were r = 0.52 and r = 0.78 at weeks 48 and 96, respectively. Over 96 weeks, there was no between-group difference in NfL in either serum ( p = 0.76) or CSF ( p = 0.46). After controlling for factors that may affect NfL, no effect of ibudilast on NfL in either serum or CSF was observed.

Conclusion:

Ibudilast treatment was not associated with a change in either serum or CSF NfL.
A unified solution for in-plane vibration analysis of composite laminated sector and annular plate with elastic constraints
Authors: Guan Xianlei , Qin Bin , Zhong Rui , Wang Qingshan
Published: February 2021

A semi-analytical method for in-plane vibration analysis of a composite laminated annular and sector plate with elastic constraints is presented. The theoretical model is on the basis of a variational method and a multi-segment technique. Displacement variables are expanded by the Jacobian orthogonal polynomial. Boundary conditions and continuity conditions between segments are characterized by penalty parameters. On this basis, a series of numerical examples are given. The results show that the method has good convergence speed and accuracy. Finally, the parametric study of geometric and material parameters is carried out to provide important support for solving the in-plane characteristics of this kind of composite structure.
Early Marriage in Perspective: Practicing an Ethics of Dialogue with Syrian Refugees in Jordan
Authors: Raemdonck An Van , Regt Marina de
Published: February 2021

This article discusses rationales for development and humanitarian intervention through the lenses of poststructuralist policy analysis and a postcolonial politics of the womb. It aims to show a variety of perspectives on early marriage and the limitations of dominant policy responses. The article argues that humanitarian logics easily blend with developmentalist models, especially in conditions of protracted displacement. The response to the rise of early marriage among Syrians in Jordan mainly consists of educational activities such as awareness raising that are based on imparting knowledge. The article suggests that responses based on an ethics of dialogue may be more adequate to meet refugees’ needs and, second, may help to shift the balance from developmentalist reproductive governance towards realizing the humanitarian goal of identifying and addressing women refugees’ needs.
Opening Minds through Art: A preliminary study evaluating the effects of a creative-expression program on persons living with dementia and their primary care partners
Authors: Levenberg Kate , George Daniel R , Lokon Elizabeth
Published: February 2021

For people living with dementia and their care partners, a decline in the ability to effectively communicate can cause significant distress. However, in recent decades, the arts have emerged as an effective care modality in fostering communication and expression for those with declining verbal skills and memory loss. Opening Minds through Art (OMA) is a national initiative that empowers people living with dementia by facilitating creative expression and social engagement through art-making in partnership with trained college student volunteers. Research has demonstrated that participation in the program benefits quality of life for those living with dementia and also improves student attitudes toward dementia. To date, however, no research has involved primary care partners. We implemented an OMA program at three residential care homes in State College, Pennsylvania, with residents cocreating artwork alongside primary care partners (i.e., a family member or primary medical personnel) over the course of four art-making sessions. We evaluated the effects of participation on quality of life and care partner burnout through pre–post use of “emotional thermometers” (measuring levels of distress, anxiety, depression, anger, and perceived quality of life), the National Institute of Health NIH emotional support scale, and the NIH caregiver assessment (care partner burnout). For people living with dementia, participation significantly increased perceived quality of life while decreasing distress, anxiety, depression, and anger ( p < .01; n = 12) after each class; however, the intervention did not significantly impact perceived emotional support. For care partners, participation significantly lowered post-intervention measures of burnout and self-rated stress ( p < .01; n = 9). This preliminary study suggests that a structured art-based activity appears to positively impact acute mood for patients and, importantly, decrease care partner burnout. Future research can bring more robust methods to bear in determining how to use OMA and other arts interventions to optimize social support for people living with dementia and their care partners.
Determinants of Psychology Students’ Study Satisfaction
Authors: Bebermeier Sarah , Austerschmidt Kim L. , Nussbeck Fridtjof W.
Published: February 2021

Understanding characteristics that contribute to psychology students’ academic success is important to better support them during their studies. Referring to person–environment fit theory, we examined effects of study-relevant characteristics (self-efficacy beliefs, self-assessed level of information about the study program) on subjective criteria of success (persistence with the choice of study subject, later study satisfaction) and controlled for effects of grade point average (GPA) and mathematical skills. We present a longitudinal survey study including five cohorts of first-year students (total N = 854). Mediation models ( N = 254) revealed that self-efficacy and level of information at study entry predicted students’ persistence at the end of the first semester, which predicted satisfaction at the end of the second semester. In the presumed overall model we found total effects of self-efficacy and level of information, with direct and indirect effects (via persistence) on satisfaction, and no total or direct effects of GPA and mathematical skills, but an indirect effect of GPA on satisfaction. Thus, psychology students’ satisfaction substantially depends on study-relevant characteristics and less on skills. An enhancement of students’ self-efficacy beliefs and comprehensive information for those who are interested in the subject might help to increase satisfaction and thus success.
Aortic Remodeling After Custom-Made Candy-Plug for Distal False Lumen Occlusion in Aortic Dissection
Authors: Eleshra Ahmed , Rohlffs Fiona , Spanos Konstantinos , Panuccio Giuseppe , Heidemann Franziska , Tsilimparis Nikolaos , Kölbel Tilo
Published: February 2021

Purpose:

To report a single-center experience with the use of a custom-made Candy-Plug (CP) for distal false-lumen (FL) occlusion in subacute and chronic aortic dissection (AD).

Materials and Methods:

A retrospective single-center analysis was conducted on consecutive patients with subacute and chronic AD who were treated with a custom-made CP for distal FL occlusion using 3 design generations (CP I to CP III) from October 2013 to September 2019.

Results:

A custom-made CP was used in 57 patients. Of these, 34 patients (29 males, mean age 62±10 years) were treated with a CP I vs 23 patients (16 males, mean age 59±17 years) with CP II/III. Technical success was achieved in 57 (100%) patients. Clinical success was achieved in 54 (95%) patients; 33 (97%) in CP I group vs 21 (91%) patients in CP II/III group, p=0.116. The mean hospital stay was 10±8 days (9±5 days in CP I group vs 13±9 days in CP II/III, p=0.102). The 30-day computed tomography angiography (CTA) confirmed successful CP placement at the intended level in all patients within both groups. Early complete FL occlusion was achieved in 50 (88%) patients; 30 (88%) patients in CP I group vs 20 (87%) in CP II/III group, p=0.894. Follow up CTA was available in 44 (77%) patients. Of these; 30/34 (88%) patients in CP I group with mean follow-up 29±17 months) vs. 14/23 (61%) patients with mean follow-up 14±5 months in CP II/III group. Thoracic aortic remodeling was achieved in 34/44 (77%) patients; 25/30 (83%) patients in CP I group vs 9/14 (64%) patients in CP II/III group, p=0.197. The aneurysm size remained stable in 9/44 (20%) patients; 5/30 (17%) patients in CP I group vs 4/14 (29%) patients in CP II/III group, p=0.741. The thoracic aneurysm increased size was seen in 1/44 (2%) patient. This patient was in CPII/III group.

Conclusion:

CP technique using custom-made devices is technically feasible with a low mortality and morbidity, and a high rate of aortic remodeling. Both, the original design (CP I) and newer designs with a self-closing central sleeve (CP II and CP III) showed similar excellent outcomes.
Application of Near-Infrared Fluorescence Imaging Technology in Liver Cancer Surgery
Authors: Liu Ying , Gao Benjian , Fang Cheng , Su Song , Yang Xiaoli , Tian Jie , Tian Bo
Published: February 2021

Background. Hepatocellular carcinoma, among the most common malignant digestive system tumorsworldwide, is most effectively treated with precise surgical resection. Near-infrared fluorescence imaging technology is being increasingly used clinically and has achieved great initial results in the navigation of liver cancer surgery. Methods. This review describes the application of indocyanine green fluorescence (ICG) imaging technology with near-infrared window I in the navigation of liver cancer surgery, explores novel fluorescent probes and near-infrared window II fluorescence imaging technology, and discusses the development status of the 2 emerging tools. Results. ICG fluorescence imaging technology can precisely localize the tumor, reveal the boundary of liver cancer or liver segment, and identify the bile leakage. The novel fluorescent probe is more targeted than ICG, which makes the detection of cancer more accurate. Near-infrared window II fluorescence imaging technology can lead to outstanding gains in deeper detection, higher resolution, and fidelity. But, due to the shortcomings of machine and probe, it is not widely used in clinical. Conclusion. Near-infrared fluorescence imaging has great development potential. With the advent of precision medicine and the progress of various biotechnology studies, fluorescence imaging technology will be better developed and applied in the diagnosis, surgical navigation, and treatment of liver cancer.
The Association of Insurance Status and Complications After Carpal Tunnel Release
Authors: Sun Cao Phoebus , Loewenstein Scott N. , Timsina Lava R. , Adkinson Joshua M.
Published: February 2021

Background:

Carpal tunnel release (CTR) is one of the most commonly performed procedures in hand surgery. Complications from surgery are a rare but significant patient dissatisfier. The purpose of this study was to determine whether insurance status is independently associated with complications after CTR.

Methods:

We retrospectively identified all patients undergoing CTR between 2008 and 2018 using the Indiana Network for Patient Care, a state-wide health information exchange, and built a database that included patient demographics and comorbidities. Patients were followed for 90 days to determine whether a postoperative complication occurred. To minimize dropout, only patients with 1 year of encounters after surgery were included.

Results:

Of the 26 151 patients who met inclusion criteria, 2662 (10.2%) had Medicare, 7027 (26.9%) had Medicaid, and 16 462 (62.9%) had commercial insurance. Compared with Medicare, Medicaid status ( P < .001) and commercial insurance status ( P < .001) were independently associated with postoperative CTR complications. The overall complication rate was 2.23%, with infection, wound breakdown, and complex regional pain syndrome being the most common complications. Younger age, alcohol use, diabetes mellitus, hypertension, and depression were also independently associated with complications.

Conclusions:

The incidence of complications after CTR is low. Insurance status, patient demographics, and medical comorbidities, however, should be evaluated preoperatively to appropriately risk stratify patients. Furthermore, surgeons can use these data to initiate preventive measures such as working to manage current comorbidities and lifestyle choices, and to optimize insurance coverage.
Local Anesthesia Alone for Postaxial Polydactyly Surgery in Infants
Authors: Bjorklund Kim A. , O’Brien Meghan
Published: February 2021

Background:

Surgical excision for postaxial polydactyly type B is advocated to avoid long-term complications. Excision with local anesthesia (LA) in infancy represents a safe and effective treatment for this condition, although general anesthesia (GA) is employed by many surgeons. We present a comparison of surgical outcomes, cost, and time between LA and GA to support widespread change in management.

Methods:

A retrospective review of patients under 12 months of age undergoing surgical polydactyly excision by a single surgeon was performed. Anesthesia type, patient demographics, and complications were recorded. Comparisons were made between LA and GA groups on procedure cost, operating time, length of stay (LOS), and time from procedure end to discharge. Stepwise forward regression was used to identify the best model for predicting total costs.

Results:

Ninety-one infants with a mean age of 3 months (±1.9) were examined; 51 (56%) underwent LA alone, 40 (44%) underwent GA. Mean operating time was 11.53 ± 4.36 minutes, with no difference observed between anesthesia groups ( P = .39). LA infants had a significantly shorter LOS (2.5 vs 3.5 hours; P < .05), quicker postoperative discharge (32 vs 65 minutes, P < .05), and fewer overall expenses, 2803 vs 6067 U.S. dollars (USD), P < .05. Two minor surgical complications (1 in each group) were reported.

Conclusions:

This study demonstrates significantly decreased cost, LOS, and time to discharge using LA alone for surgical excision of postaxial polydactyly type B. Results suggest the approach is quick, economical, and avoids the risks of GA in early infancy.
Parallel importation as a policy option to reduce price of patented health technologies
Authors: Abbas Muhammad Zaheer
Published: February 2021

The COVID-19 pandemic has burdened most of the health systems around the world. Governments, especially in resource-constrained low- and middle-income countries, are finding it hard to meet the health needs of their nationals. Patent exclusive rights further add to the cost of healthcare by allowing supra-competitive prices of protected technologies. Parallel importation of patented health technologies is a legitimate policy option to obtain patented health technologies at a reduced price. This paper examines the legality and practical significance of parallel trade of patented medicines as a price-reducing policy option and evaluates some of the practical hurdles in the actual use of this important public health flexibility. This study supports the adoption of international exhaustion of patent rights as a mandatory rule for the international trading system.
Identifying the challenges to implementing a neuromuscular warm-up in pre-elite netball
Authors: Smyth Erin , Appaneal Renee , Drew Michael , Antcliff Alanna , Waddington Gordon , Newman Phil , Weissensteiner Juanita , Donaldson Alex
Published: February 2021

Objective

To identify challenges for implementing Netball Australia’s ‘Knee injury prevention for Netballers and Enhance performance and Extend play’ (KNEE) program for 17/U & 19/U State (i.e. regional/provincial representative) teams.

Design

Concept mapping, a mixed-methods approach incorporating qualitative and quantitative data collection and analyses.

Setting

Pre-elite netball.

Participants

Thirty-nine netball coaches, strength & conditioning coaches and physiotherapists working with State 17/U & 19/U teams.

Methods

Participants brainstormed challenges to implementing the KNEE program, sorted the challenges into groups based on similar meaning and rated the importance and difficulty of overcoming each challenge on a scale from 0 (least important/easiest to overcome) to 5 (most important/hardest to overcome).

Results

Forty-six statements (i.e. challenges) were identified and organised into the following eight clusters (mean importance rating out of 5, mean difficulty rating out of 5): ‘athlete engagement’ (3.31, 2.48); ‘supervision and correction of technique’ (3.03, 2.67); ‘time constraints’ (2.79, 2.59); ‘athlete technique’ (2.70, 2.64); ‘education’ (2.56, 2.16); ‘support staff resourcing’ (2.51, 2.67); ‘program flexibility and adaptability’ (2.02, 1.85); and ‘coach and support staff prioritisation’ (1.95, 1.81). Nineteen statements/challenges had above average ratings for importance (2.63) and difficulty (2.41).

Conclusions

This study identified ‘athlete engagement’, ‘supervision and correction of technique’, ‘time constraints’, ‘athlete technique’, ‘education’ and ‘support staff resourcing’ as the most important and difficult challenges to implementing the KNEE program in pre-elite netball. These multi-factorial challenges are the main barriers to implementing the KNEE program. They can be addressed using the implementation driver’s framework.
Performance, perceptual and physiological comparison of traditional and small-sided games in youth hockey
Authors: Henley-Martin Sarah R , Hiscock Daniel J , Ducker Kagan J , Jacques Angela , Brade Carly J
Published: February 2021

This study aimed to determine if children playing field hockey small-sided games (SSG) have different levels of physiological, performance and perceptual responses, compared to traditional hockey. Fifteen school hockey players (10–12 y) played eight matches over four months. Traditional games (n = 4) were played on a full-sized pitch with 11 players per team, and SSG were played as two-separate games (n = 8), with 7 players per team on a half-field pitch. Heart rate, movement data and match involvement were collected during the game. Participants were asked their session rating of perceived exertion (sRPE) and completed an enjoyment questionnaire. There were more possessions per player in the SSG format compared to traditional (53.9 ± 2.5 vs. 36.8 ± 6.5, [ d = 3.83]). Number of shots on goal, total goals, penalty corners and circle penetrations were increased in SSG compared to traditional games ( d = 1.11–1.83). Mean and maximum heart rate, sRPE, enjoyment, total distance run, meters per minute, distance run at low velocity and high velocity were similar for both formats, with no significant difference between them. SSG increased match involvements, allowing more participation than the traditional format, without compromising the physiological (e.g. heart rate), performance (e.g. total distance) and perceptual (e.g. sRPE) workload.
Content analysis of living historical memory around the world: Terrorization of the Anglosphere, and national foundations of hope in developing societies
Authors: Choi Sarah Y , Liu James H , Mari Silvia , Garber Ilya E
Published: February 2021

Recently, researchers have endeavored to extend cultural perspectives of collective remembering by examining communicative or living historical memory (collective memories that emerge from informal communication between ordinary people). The current study examined the content and subjective evaluation of living historical memory from open-ended nominations of historical events provided by samples from 39 societies. Results showed that Western societies were dominated by living memories of terrorism, reflecting a distinctly negative climate. By contrast, many developing societies displayed a more positive climate in living memory that was rooted in events related to their nation’s foundation. The current study opens up avenues for conceptualizing the role of collective remembering in shaping emotional climates that influence (or may be part of) national political culture.
Clinical sequencing to assess tumor mutational burden as a useful biomarker to immunotherapy in various solid tumors
Authors: Kim Hana , Hong Jung Yong , Lee Jeeyun , Park Se Hoon , Park Joon Oh , Park Young Suk , Lim Ho Yeong , Kang Won Ki , Kim Kyoung-Mee , Kim Seung Tae
Published: February 2021

Background:

Immune checkpoint inhibitors (ICIs) have become established as a new therapeutic paradigm in various solid cancers. Predictive biomarkers to ICIs have not yet been fully established. Tumor mutational burden (TMB) has been considered as a useful marker to indicate patients who benefit from ICIs.

Methods:

We performed next-generation sequencing, including TMB analysis, as a routine clinical practice in 501 patients with advanced gastrointestinal (GI), genitourinary (GU), or rare cancers. The TruSight™ Oncology 500 assay from Illumina was used as a cancer panel.

Results:

In total, 11.6% (58/501) were identified with tumors with high TMB and MSI-high status was confirmed in seven out of 501 cases (1.4%). High TMB was observed in 11.6% of patients with various solid tumors, including: GU cancers (36.0%, 9/25), colorectal cancer (15.2%, 23/151), biliary tract cancer (14.6%, 7/48), melanoma (14.3%, 3/21), gastric cancer (11.2%, 13/116), hepatocellular carcinoma (8.3%, 1/12), other GI tract cancers (4.5%, 1/22), and sarcoma (1.7%, 1/60). The objective response rate (ORR) to ICIs was 75% (nine out of 12) in solid tumor patients with high TMB and 25% (30 out of 40) in those with non-high TMB. Patients with high TMB had better ORR to ICIs than those with non-high TMB ( p = 0.004). Univariate analysis revealed that the status of PD-L1 expression and of TMB (high versus non-high) had significant association in response to ICIs. However, in multivariate analysis, the status of TMB (high versus non-high) was only significantly related to the response to ICIs ( p = 0.036).

Conclusion:

In the present study, we analyzed the TMB using a cancer panel for various solid tumor patients in routine clinical practice and also demonstrated the usefulness of TMB to predict the efficacy for ICIs.
An arts-based approach with youth born of genocidal rape in Rwanda: The river of life as an autobiographical mapping tool
Authors: Denov Myriam , Shevell Meaghan C
Published: February 2021

Given the tragedy of war and genocide, words often cannot adequately capture the complexity of war-related experiences. Researchers are increasingly utilizing the arts to enable multiple forms of expression, as well as for its therapeutic and empowering qualities. This paper outlines the use of the “river of life,” an arts-based autobiographical mapping tool, conducted with 60 youth born of rape during the genocide against Tutsi in Rwanda who continue to live with this intergenerational legacy of sexual violence. The article begins with a review of current arts-based methods and their relevance for war-affected populations and an overview of the genocide, sexual violence, and the lived realities of children born of rape. We then outline the “river of life” mapping tool, where participants drew their life histories using the metaphor of a river, addressing the ebbs and flows of their lives and the obstacles and opportunities they encountered. Developed in collaboration with local researchers, participants were invited to share the meaning of their drawing with researchers, explaining key events throughout their life course, utilizing metaphors, and symbolism to convey their experiences. The article highlights how the “the river of life” facilitated key insights into the post-genocide experiences of children born of rape, and the long-term impacts at the family, community and societal levels, and proved to be especially helpful in enabling youth participants to process and communicate their histories of genocide and experiences of stigma and discrimination. The “river of life” was also reported by participants as having unintended positive effects, including closure and clarity in navigating their past and their futures. While not without limitations, we argue that this mapping tool represents an important addition to arts-based methods that can be used with populations who have experienced profound forms of violence and marginalization.
Accuracy of Rod Contouring to Desired Angles With and Without a Template: Implications for Achieving Desired Spinal Alignment and Outcomes
Authors: Sardi Juan Pablo , Ames Christopher P. , Coffey Skye , Good Christopher , Dahl Benny , Kraemer Paul , Gum Jeffrey , Devito Dennis , Brayda-Bruno Marco , Lee Robert , Bell Christopher P. , Bess Shay , Smith Justin S.
Published: February 2021

Study Design:

Biomechanical Study.

Objective:

The search for optimal spinal alignment has led to the development of sophisticated formulas and software for preoperative planning. However, preoperative plans are not always appropriately executed since rod contouring during surgery is often subjective and estimated by the surgeon. We aimed to assess whether rods contoured to specific angles with a French rod bender using a template guide will be more accurate than rods contoured without a template.

Methods:

Ten experienced spine surgeons were requested to contour two 125 × 5.5 mm Ti64 rods to 40°, 60° and 80° without templates and then 2 more rods using 2D metallic templates with the same angles. Rod angles were then measured for accuracy and compared.

Results:

Average angles for rods bent without a template to 40°, 60° and 80° were 60.2°, 78.9° and 97.5°, respectively. Without a template, rods were overbent by a mean of 18.9°. When using templates of 40°, 60° and 80°, mean bend angles were 41.5°, 59.1° and 78.7°, respectively, with an average underbend of 0.2°. Differences between the template and non-template groups for each target angle were all significant (p < 0.001).

Conclusions:

Without the template, surgeons tend to overbend rods compared to the desired angle, while surgeons improved markedly with a template guide. This tendency to overbend could have significant impact on patient outcomes and risk of proximal junctional failure and warrants further research to better enable surgeons to more accurately execute preoperative alignment plans.
Outcomes and Tendon Integrity After Arthroscopic Treatment for Articular-Sided Partial-Thickness Tears of the Supraspinatus Tendon: Results at Minimum 2-Year Follow-Up
Authors: Brockmeyer Matthias , Haupert Alexander , Lausch Anna-Lena , Wagenpfeil Gudrun , Stroeder Jonas , Schneider Guenther , Kohn Dieter , Lorbach Olaf
Published: February 2021

Background:

The best surgical treatment option for symptomatic moderate- to high-grade articular-sided partial-thickness rotator cuff tears (PTRCTs) is still controversial.

Purpose/Hypothesis:

The purpose of this study was to evaluate patient-reported and clinical outcomes and tendon integrity after arthroscopic debridement or repair for PTRCTs at a minimum of 2 years postoperatively. We hypothesized that the overall outcomes would be positive, showing pain relief, good shoulder function, and high tendon integrity.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

We evaluated 30 patients (16 men, 14 women; mean age, 51 years) who underwent arthroscopic treatment for symptomatic PTRCTs (Ellman grades 2 and 3). Debridement was performed in 15 patients, and arthroscopic tendon repair was performed in the remaining 15 patients. Patients completed the Constant score; American Shoulder and Elbow Surgeons (ASES) shoulder score; Western Ontario Rotator Cuff Index; Simple Shoulder Test; and visual analog scale (VAS) for pain, function, and satisfaction. In addition, patients were examined clinically (range of motion, impingement tests, rotator cuff tests, and tests for the long head of the biceps tendon), and morphologic assessment of rotator cuff integrity was performed using direct magnetic resonance arthrography and was classified according to Sugaya.

Results:

The mean follow-up period was 55 months. The patient-reported outcome measures showed high patient satisfaction, reduction in persistent pain, and good shoulder function. Linear regression analysis showed that the debridement group had significantly better results on the Constant (bias-corrected and accelerated [BCa] 95% CI, 4.20-26.30), ASES (BCa 95% CI, 5.24-39.26), and VAS (pain: BCa 95% CI, 0.13-3.62; function: BCa 95% CI, 1.04-4.84; satisfaction: BCa 95% CI, 0.14-6.28) scores than did the repair group. At follow-up, there was no significant difference between the groups in clinical testing results. Good supraspinatus tendon integrity was seen in most patients: Sugaya classification grade 1 in 13 patients, grade 2 in 11 patients, and grade 3 in 6 patients.

Conclusion:

Midterm results after arthroscopic debridement and repair for PTRCTs showed high patient satisfaction, good shoulder function, and high tendon integrity for both procedures. Patients who underwent arthroscopic debridement had higher Constant, ASES, and VAS scores compared with patients who underwent tendon repair.
Second ACL Injury Rates in Younger Athletes Who Were Advised to Delay Return to Sport Until 12 Months After ACL Reconstruction
Authors: Webster Kate E. , Feller Julian A. , Klemm Haydn J.
Published: February 2021

Background:

Younger patients are at increased risk for anterior cruciate ligament (ACL) graft rupture and contralateral injury after ACL reconstruction (ACLR). Increasing the amount of time between surgery and the resumption of competitive sport may reduce this risk.

Purpose:

To determine the rates of graft rupture and injury to the contralateral native ACL at 3- to 5-year follow-up in younger patients who were advised to delay a return to competitive sport until 12 months after surgery and compare this with a nondelayed cohort.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The primary study cohort consisted of 142 eligible patients aged <20 years when they underwent their first primary ACLR. All were informed about the risk of further injury and advised not to return to competitive sport before 12 months postoperatively. Return-to-sport status and the number of subsequent ACL injuries (graft rupture or a contralateral injury to the native ACL) were determined at 3- to 5-year follow-up and compared with a historic cohort of 299 patients with ACLR who were not advised to delay their return to sport for a set period. The cohorts were then combined, and injury rates were compared between those who returned to sport before and after 12 months postoperatively.

Results:

The follow-up rate was 91% (129/142). In the delayed cohort, 63% returned to competitive sport after 12 months (mean, 14 months). Few patients (n = 10) returned before 9 months. In the delayed group, 33% had a subsequent ACL injury; this was not significantly different when compared with the nondelayed group (31% rate), in which a majority (58%) returned to competitive sport before 12 months. Subsequent ACL injury rates were also similar when compared between patients who returned before and after 12 months postoperatively (33% vs 32%, respectively).

Conclusion:

At midterm follow-up, the overall rates of subsequent ACL injury were high, even for patients who delayed their return until 12 months after surgery. More research is required to identify strategies to reduce the high reinjury rate in younger athletes.
Open or arthroscopic Latarjet? Prospective analysis of the clinical results
Authors: Girard Mathieu , Dalmas Yoann , Azoulay Vadim , Martel Marie , Rattier Simon , Arboucalot Marine , Mansat Pierre , Bonnevialle Nicolas
Published: February 2021

Objectives:

The arthroscopic bone block procedure in the treatment of anterior shoulder instabilities is now a validated technique. Nevertheless, few studies have compared the clinical results of this technique to the conventional Latarjet procedure. Therefore the objective of this study was to compare the short-term clinical results of the 2 surgical techniques.

Methods:

We conducted a monocentric prospective comparative study, including patients who had undergone a bone block procedure for anterior instability with a minimum follow-up of 12 months. Patients with a surgical history concerning the affected shoulder were excluded. Evaluation was based on the measurement of mobility, the Walch-Duplay score, the Rowe score, the Subjective Shoulder Value (SSV), return to sports, the Net Promoter satisfaction Score, and recurrence (subluxation/luxation). Scarring was assessed by the POSAS score.

Results:

It was possible to follow 45 patients: arthroscopy (A) n=22, open (O) n=25. With an average follow-up of 20 months (12-30), no recurrence of instability was recorded. No significant difference was noted between groups A and O in terms of the Walch-Duplay score (85±19 vs 91±11 points; p=0.3), the Rowe score (93±14 vs 95±9 points; p=0.9), the SSV (72% vs 88%; p=0.2) and the Net Promoter Score (9.3 vs 9.7; p=0.5). At 3 months, return to sports was 11% for group A vs 48% for group O (p=0.01). This difference was no longer significant at 6 months. Loss of external rotation in group A was significantly greater at 1.5 months -58°±18° vs -41°±17° (p=0.01) and 3 months -35°±20° vs -19°±18° (p=0.01). There was no difference in the POSAS score between the 2 groups. (p= 0.9).

Conclusion:

With a longer recovery time for joint amplitudes and a delayed return to sports, the arthroscopic double-button fixation procedure does not seem to provide any short-term clinical benefit. Longer follow-up is required to confirm these results.
Evaluation of 3 different rehabilitation protocols after rotator cuff repair, and the effectiveness of pool therapy: a randomized control study
Authors: Laedermann Alex , Kadri Fayssal , Cikes Alec
Published: February 2021

Objectives:

Exercises performed in water have shown to improve strength and range of motion in various joint pathologies. This study aims to identify the best rehabilitation protocol for patients who undergo arthroscopic rotator cuff repair, and the effectiveness of a pool therapy protocol.

Methods:

Patients who underwent arthroscopic rotator cuff repair for small to medium sized rotator cuff tears, with small to moderate retraction of the affected tendon and who underwent surgery between 2013 and 2016, were randomized in 3 different groups at the time of surgical indication. Groups: 1. Patients who had rehabilitation with physical therapy and no aquatic protocol; The "Dry group", 2. Patients who had rehabilitation with physical therapy, including an aquatic protocol; The "Pool Group", 3. Patients who had self-rehabilitation alone, with no physical therapist. The "Self Group" follow-up: all patients were assessed by an independent observer. The mean outcome measures consisted of pre and postoperative SSV, Constant score, and patient satisfaction. Patients were followed-up at 4, 8 and 12 weeks postoperatively, as well as in 1 and 2 years.

Results:

Group 1 (Dry group) and Group 2 (Pool group) showed better Constant scores 2 months postoperatively, although this was not statistically significant. However, patients in group 2 (Pool group) showed statistically better Constant scores and overall satisfaction 3 months postoperatively. All the groups had similar results 6 months, 1 year and 2 years postoperatively, with slightly better outcomes for the Dry and Pool groups compared to the Self group.

Conclusion:

Water therapy after rotator cuff repair provides better early results compared to traditional "dry" rehabilitation or self-exercise therapy. The results remain better for patients who had pool or dry rehabilitation 1 and 2 years postoperatively, although the difference is not statistically significant in the long term.
The mechanical effect of the common fibers of the anterior talofibular and calcaneofibular ligaments
Authors: Cordier Guillaume , Nunes Gustavo Araujo , Dalmau-Pastor Miki
Published: February 2021

Objectives:

The subject of the lateral ankle ligament complex is a familiar one. Common fibers between the inferior bundle of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) have been described. The purpose of this study is to investigate the possibility of transmitting a force to the CFL through the inf. ATFL.

Methods:

An anatomical study was carried out on 12 ankles. Each specimen was dissected according to a protocol to expose the lateral ligaments. A proximal section was made in the superior and inferior bands of the anterior talofibular ligament. A device capable of measuring shifting from one point in relation to another fixed point was used. The fixed point was implanted on the calcaneus and the other part of the sensor on the CFL. Traction of 1-kilogram was applied to the inferior band of the ATFL while the device measured the shifting of the CFL in millimeters. Two measurements were taken on each specimen by two observers. Sample data and distance measurements were recorded and analyzed.

Results:

It was possible to analyze 12 specimens. The specimens were from 7 women and 5 men and included 6 right and 6 left ankles. The anterior talofibular ligament was identified as a two-band ligament in all cases. One ankle had a lesion on the superior band of the ATFL. Common fibers that connect the inferior ATFL and the CFL were observed in all samples of this study. The measuring device showed shifting of the CFL in each case. The first series of measurements indicated average shifting of 0.74 mm (0.46; 1.35; +/- 0.34) and a median of 0.59 mm. The second series indicated a mean of 0.60 mm (0.23 - 1.13; +/- 0.32) and a median of 0.46 mm.

Conclusion:

There is an anatomical connection between the inferior ATFL and the CFL that is capable of transmitting a mechanical force to the CFL when the inferior ATFL is placed in traction. Improvement in the knowledge of the mechanical properties of the lateral ligament plane helps to clarify the possibilities for surgical repairs.
A prospective comparative study of arthroscopic Brostrom procedure alone vs. Brostrom-Gould procedure in the repair of isolated ATFL injury at follow-up in one year
Authors: Tomes Sébastien
Published: February 2021

Objectives:

Arthroscopic Brostrom-Gould procedure is the reference technique in the treatment of isolated anterior talofibular ligament injury. Extensor retinaculum reinforcement uses the proximal part, without any mechanical function. The objective is to compare the isolated ATFL reinsertion technique with reinsertion + biological augmentation.

Methods:

This is a prospective study that compares the isolated ATFL reinsertion technique (Brostrom) vs. reinsertion + retinaculum reinforcement (Brostrom-Gould) at one year follow-up. 2 groups of 25 patients were selected. The two groups matched in terms of age, weight, and gender. All patients presented with isolated ATFL with stage 1 or 2 lesions according to the French arthroscopy society (SFA) classification. Patients were clinically evaluated preoperative and in one year with the FAAM and FAOS scores and the recurrence rate was assessed as well as passive joint amplitudes pre- and postoperatively. There was a single operator for the series and the surgical technique was chosen before surgery. Patients had the same postoperative rehabilitation protocol (ankle splint to be worn for 30 days with weight-bearing, no work in varus before 30 days, rehabilitation at D2).

Results:

Regarding clinical scores, in both groups there was a significant improvement in the sports FAAM and FAOS scores in the postoperative period. In the isolated Brostrom group, the FAAM score increased from 20 to 29 and the FAOS score from 75% to 95%. In the Brostrom-Gould group, the FAAM score increased from 19 to 30 and the FAOS score from 77% to 96%. There was no significant difference between the 2 groups. We identified no postoperative complications in either group. A sprain recurred in 2 patients in the Brostrom-Gould group and in 3 patients in the isolated Brostrom group. The sprain was mild in all cases and was controlled by ultrasound. The joint amplitudes in active plantar flexion were 36° in the isolated Brostrom group and 34° in the Brostrom-Gould group. There was no significant difference between the 2 groups.

Conclusion:

Our study shows that there is no difference between the isolated arthroscopic Brostrom technique and the Brostrom-Gould technique in the management of isolated ATFL grade 1 and 2 lesions in terms of recurrence and clinical scores and that the isolated Brostrom technique can be used to treat these lesions.
Arthroscopic anatomical reconstruction of the lateral collateral ankle ligament: an examination of the learning curve and the influence of laterality and body mass index
Authors: Courtine Matthieu , Tomes Sébastien , Molinier François , Cellier Nicolas , Bauer Thomas
Published: February 2021

Objectives:

Anatomical reconstruction under arthroscopy by gracilis tendon autograft is an innovative technique in full development and requires a learning curve. Our objective was to evaluate this curve and determine the influence of the surgical side and the patient’s body mass index (BMI) on the performance of the procedure.

Methods:

In this retrospective study, conducted from January 2015 to March 2020, data was collected from 7 centers through 11 operators, and included the surgical side, body mass index and total procedure time. The ankle ligament reconstruction had to be performed entirely under arthroscopy, without any associated procedure, at the expense of the gracilis tendon. The learning curve was calculated over the total operating time.

Results:

The learning curve showed a logarithmic pattern with an average decrease of 20% in operating time for the 4th patient. In the largest cohort, there was a significant difference in operating time between the right and left sides (35.39 minutes vs. 32.29 minutes, p < 0.002, [CI95] = 1.23; 4.98). In the two largest cohorts, there was a correlation between operating time and BMI (ρ= 0.7022, p < 7.29E-20, [CI95] = 0.6006; 0.7814 and ρ= 0.2749, p < 0.025, [CI95] = 0.0371; 0.4832) for all the patients (ρ= 0.1753, p < 0.0001, [CI95] = 0.0867; 0.2612).

Conclusion:

Arthroscopic anatomical ligament reconstruction of the ATFL and CFL is a technical intervention with a fast learning curve, with good control of the procedure in less than ten procedures. The surgical side and the patient’s BMI were noted to have an influence on the duration of the procedure.
Posteromedial tendinous and neurovascular structures of the ankle: the correlation between arthroscopic and open dissection in a cadaveric study
Authors: Bauer Thomas , Morvan Antoine , Baudrier Nicolas , Villain Benoit
Published: February 2021

Objectives:

Posterior ankle arthroscopy has advanced considerably in recent years. A large number of posteromedial pathologies can now be treated by arthroscopy on an outpatient basis. The purpose of this study was to evaluate the feasibility and safety of a posteromedial ankle arthroscopy with an open control procedure.

Methods:

Twenty cadavers were dissected (twenty-four ankles). We first performed a posterior ankle arthroscopy using the classical ankle approaches: posteromedial and posterolateral. A third approach was created at the base of the posterior tibial tendon, posterior to the colliculus of the medial malleolus. Through this opening a hook was introduced to protect the posteromedial neurovascular bundle. A posteromedial arthroscopy was then performed, from the flexor hallucis longus tendon to the medial malleolus, as far as possible. The second part consisted of performing an open posteromedial dissection of the ankle to determine whether there were lesions of the posteromedial neurovascular bundle.

Results:

Tenolysis of the flexor hallucis longus, flexor digitorum longus and posterior tibial tendons was successfully performed. Exposure of the posteromedial ankle junction was satisfactory enough to enable the performance of various surgical procedures in this zone: such as tenolysis, a posteromedial intra-articular procedure. During the open procedure, no lesions were noted in the neurovascular bundle as all the structures were intact.

Conclusion:

We arthroscopically dissected the posteromedial ankle junction. A safe reproducible technique to explore the posteromedial ankle that enables arthrolysis, posterior tibial nerve exploration, tendon surgery, and treatment of talar dome lesions was described.
Using a self-rehabilitation application alone can effectively combat post-ACL ligament reconstruction flexion contracture during the COVID-19 lockdown
Authors: Fayard Jean Marie , Tatar Maxime , Thaunat Mathieu , Sonnery-Cottet Bertrand , Freychet Benjamin , Bauwens Paul-Henri
Published: February 2021

Objectives:

The lockdown during the COVID-19 crisis deprived the majority of patients who had undergone ACL surgery of access to their physical therapist. The objective of the study was to analyze the benefit of using a self-rehabilitation application to combat post-ligament reconstruction flexion contracture in the absence of rehabilitation during the lockdown.

Methods:

We conducted a retrospective study that compared 2 groups of patients who had undergone ACL reconstruction: the "App" group that underwent surgery between 10 February and 15 March 2020 were partially or totally deprived of access to a physiotherapist due to the COVID-19 lockdown and had completed rehabilitation using a self-rehabilitation application, and the "Physio" group that underwent surgery between 16 May and 23 December 2019 and had completed rehabilitation with a physiotherapist.

Results:

148 patients were included in the study: 47 in the "App" group and 101 in the "Physio" group. Mean flexion contracture 3 weeks postoperatively was 1.3° +/- 3.8 in the "App" group versus 3.3° +/- 4 in the "Physio" group (p=0.002). The rate of flexion contractures was 45% in the “App” group and 65% in the “Physio” group (p=0.025). 71.4% of the patients acquired knee locking on weight-bearing with crutches in the "App" group, compared to 40.6% in the "Physio" group (p<0.01). No significant difference was noted between the two groups concerning the degree and rate of flexion contractures 6 weeks postoperatively and quadriceps recovery at 3 and 6 weeks postoperatively.

Conclusion:

Our study showed that the use of a self-rehabilitation application that targets flexion contracture control and quadriceps recovery in the first 6 weeks after ACL reconstruction provides similar results to a rehabilitation protocol by an independent physiotherapist.