bluuebunny/crossref_metadata_2025 huggingface dataset:
Progress in the Studies of Triterpene Glycosides From Sea Cucumbers (Holothuroidea, Echinodermata) Between 2017 and 2021
Authors: Kalinin Vladimir I. , Silchenko Alexandra S. , Avilov Sergey A. , Stonik Valentin A.
Published: October 2021

Structural diversity of triterpene glycosides produced by sea cucumbers or holothurians (Holothuroidea, Echinodermata) is extremely high, although all of them are either lanostane derivatives or, rarely, products of their molecular rearrangements. The majority of them are holostane derivatives possessing an 18(20)-lanostane lactone as aglycone. They contain carbohydrate chains consisting of one to six monosaccharide units including sulfated ones. The glycosides demonstrate interesting biological activities, mainly caused by membranolytic action, namely cytotoxic, ichthyotoxic, antifungal, and hemolytic properties, as well as a series of additional effects at sub-toxic doses, including immunomodulatory, and cancer preventive. This review summarizes the literature data concerning structures and biological activities of all the new triterpene glycosides isolated from sea cucumbers during 2017 to 2021.
The clinical implications of sinus tachycardia in mild COVID-19 infection: A retrospective cohort study
Authors: Hsieh Jenny Yi Chen , Kan Juliana Yin Li , Mattar Shaikh Abdul Matin , Qin Yan
Published: October 2021

Objectives:

This study aims to estimate the prevalence of sinus tachycardia in hospitalized patients with mild COVID-19 infection and to identify the clinical, radiological, and biological characteristics associated with sinus tachycardia.

Methods:

A retrospective cohort study was conducted on patients with mild COVID-19 infection and sinus tachycardia during hospitalization. Outcomes measured included incidences of venous thromboembolism, high-dependency/intensive care unit admission, laboratory parameters, and radiological findings.

Results:

A total of 236 COVID-19 positive patients admitted to Singapore General Hospital isolation general wards from 1 June 2020 to 30 June 2020 were included in this study. Ninety-seven (41.1%) patients had sinus tachycardia on or during their admission. All patients were monitored in general wards and discharged to community quarantine facilities. None required oxygen support or high-dependency/intensive care unit admission. Sinus tachycardia was associated with increased C-reactive protein level (odds ratio = 1.033, 95% confidence interval = 1.002–1.066), abnormal chest X-ray findings (odds ratio = 3.142, 95% confidence interval = 1.390–7.104), and longer hospitalization (odds ratio = 1.117, 95% confidence interval = 1.010–1.236). There was no significant statistical association between sinus tachycardia and incidences of venous thromboembolism.

Conclusion:

This study suggests that patients with mild COVID-19 infection and concurrent sinus tachycardia are more likely to have higher inflammatory marker levels, abnormal imaging, and prolonged hospitalization. However, no significant association between sinus tachycardia and thromboembolism is identified in mild COVID-19 infection.
Left atrial appendage thrombosis in a patient with Friedreich Ataxia–related cardiomyopathy, left ventricular systolic dysfunction, and atrial fibrillation
Authors: Russo Michele , Nuzzo Annachiara , Foschi Matteo , Boarin Simona , Lorenzetti Stefano , Tomasi Corrado , Querzani Pietro , Rubboli Andrea
Published: October 2021

Friedreich ataxia is the most common form of hereditary ataxia. Heart involvement in Friedreich ataxia is common and can include increased left ventricular wall thickness, atrial fibrillation, and in the later stages, a reduction of left ventricular ejection fraction. We present the case of a 45-year-old man with a history of paroxysmal atrial fibrillation and a congestive heart failure, hypertension, age ⩾ 75 years, diabetes mellitus, stroke, vascular disease, age 65–74 years, and female sex (CHA2DS2-VASc) score of only 1 (because of reduced left ventricular ejection fraction) who presented with pneumonia and was also found to have atrial fibrillation with a rapid ventricular response. Despite already being on long-term therapy with a non-vitamin K-antagonist oral anticoagulant, a transesophageal echocardiogram showed a mobile floating thrombus in the left atrial appendage. In accordance with previous necropsy evidence of thrombosis and thromboembolism in Friedreich ataxia subjects who likely have had only non-sex-related CHA2DS2-VASc score ⩽1, this case suggests that the risk of thromboembolism in Friedreich ataxia subjects with atrial fibrillation may not be adequately predicted by the sole CHA2DS2-VASc score.
Dashboard design and the ‘datafied’ driving experience
Authors: Hind Sam
Published: October 2021

In this article, I consider how the redesign of vehicle dashboards has restructured car-related data processes. I do so by charting the emergence of two such processes enabled by the redesign of vehicle dashboards: firstly, the transformation of ‘geodata’ into ‘navigational data’ with the integration of voice-activated navigation systems into vehicle dashboards, and secondly, the transformation of ‘vehicle data’ into ‘driving data’ in the convergence, and customization, of dashboard features and functionality. Both transformations are enabled through strategic design decisions, persuading drivers to participate in novel practices they might otherwise not. Firstly, in that voice-activation is depicted as a seamless, unmediated interface between the normal, natural speech of a driver, and the vehicle itself. Secondly, through the strategy of control, the driver is persuaded to believe they have full(er) customizable power within, and of, the vehicle. The systems discussed here – a voice-activated navigation system built on the What3words platform, and a ‘widescreen’ dashboard in a range of Mercedes-Benz vehicles – are representative of broader efforts within the automotive industry to cultivate a newly ‘datafied’ driving experience.
Mainstreaming Genetic Testing for Adult Patients With Autosomal Dominant Polycystic Kidney Disease
Authors: Elliott Mark D. , James Leslie C. , Simms Emily L. , Sharma Priyana , Girard Louis P. , Cheema Kim , Elliott Meghan J. , Lauzon Julie L. , Chun Justin
Published: October 2021

Purpose:

Genetic testing results are currently obtained approximately 1 year after referral to a medical genetics team for autosomal dominant polycystic kidney disease (ADPKD). We evaluated a mainstream genetic testing (MGT) pathway whereby the nephrology team provided pre-test counseling and selection of patients with suspected ADPKD for genetic testing prior to direct patient interaction by a medical geneticist.

Sources of information:

A multidisciplinary team of nephrologists, genetic counselors, and medical geneticists developed an MGT pathway for ADPKD using current testing criteria for adult patient with suspected ADPKD and literature from MGT in oncology.

Methods:

An MGT pathway was assessed using a prospective cohort and compared to a retrospective cohort of 56 patients with ADPKD who received genetic testing using the standard, traditional pathway prior to implementing the MGT for ADPKD. The mainstream pathway was evaluated using time to diagnosis, diagnostic yield, and a patient survey to assess patient perceptions of the MGT pathway.

Key findings:

We assessed 26 patients with ADPKD using the MGT and 18 underwent genetic testing with return of results. Of them, 52 patients had data available for analysis in the traditional control cohort. The time for return of results using our MGT pathway was significantly shorter with a median time to results of 6 months compared to 12 months for the traditional pathway. We identified causative variants in 61% of patients, variants of uncertain significance in 28%, and 10% had negative testing which is in line with expectations from the literature. The patient surveys showed high satisfaction rates with the MGT pathway.

Limitations:

This report is an evaluation of a new genetic testing pathway restricted to a single, publicly funded health care center. The MGT pathway involved a prospective collection of a limited number of patients with ADPKD with comparison to a retrospective cohort of patients with ADPKD evaluated by standard testing.

Implications:

A MGT pathway using clearly defined criteria and commercially available gene panels for ADPKD can be successfully implemented in a publicly funded health care system to reduce the time required to obtain genetic results.
Reducing respondents’ perceptions of bias in survey research
Authors: Mayer Adam
Published: October 2021

Response rates for surveys have declined steadily over the last few decades. During this period, trust in science has also waned and conspiratorial theorizing around scientific issues has seemingly become more prevalent. In our prior work, we found that a significant portion of respondents will claim that a given survey is “biased.” In this follow-up research, we qualify these perceptions of bias and point to potential causes and ameliorative mechanisms.
The Impact of Covid-19 on Diabetes Care in Muscat Governorate: A Retrospective Cohort Study in Primary Care
Authors: Al Harthi Thuraiya , Anwar Huda , Al Lawati Anwaar , Al Shuriqi Fathyia , Al Rashdi Fakhria , Al Mahrouqi Adil , Al Ismaili Mohammed , Al Syiabi Riyadh , Al Azri Hasna , Meah Umme Habiba , Al Ghafri Thamra
Published: October 2021

Background

COVID-19 pandemic has led to health service modification and temporary disruption of the routine care provided to patients with diabetes mellitus (DM) in primary care. This was done to minimize outpatient visits, permit physical distancing, and ensure patients’ and healthcare providers safety. There is no evidence that explored or measured the impact of COVID-19 pandemic on diabetes services and patients’ glycemic outcome in Oman.

Aim and Objectives

To explore the accessibility of DM services in primary care after COVID-19 pandemic announcement, and measure patients’ glycemic outcome.

Methods

Before and after, retrospective cohort study using Al-Shifa healthcare database in primary care. One thousand adult patients with diabetes who attended DM clinic before pandemic announcement in 2019 were randomly selected and followed up until end of 2020. Patients aged ≥18 years and had at least 2 visits in 2019 were included. Access to DM services was identified by number of patients received care, frequency of consultations, mode of consultation, and type of intervention given to patients. Patients’ glycated hemoglobin (HbA1c), and other glycemic parameters after pandemic announcement in 2020 were determined and compared with the same parameters before pandemic in 2019. Association between patients’ HbA1c and mode of consultation was measured using multivariable regression analysis.

Results

A total of 937 patients continued to follow and received DM care after pandemic announcement. Median number of consultations was 2 with interquartile range (IQR): 3-2. 57.4% had face-to-face alone, 32.4% had combined face to face and telephone consultation, and 10% had telephone consultation alone. Mean difference in HbA1c (%) before and after pandemic announcement was 0.2 ± 1.4 (95% CI: 0.1 to 0.3), P = .002. With multivariable linear regression, the mean difference in HbA1c was −0.3 (−2.3 to 1.5), P = .734 for telephone consultation alone, −0.5 (−2.4 to 1.4), P = .613 for face-to-face alone, and −0.5 (−2.4 to 1.3), P = .636 for combined consultations, compared to those who did not receive any formal consultation.

Conclusion

Despite service modification and disruption of comprehensive care in primary care after COVID-19 pandemic announcement, DM services were accessible as majority of patients maintained follow up. There was an overall increase in mean glycated hemoglobin, however, it was a less than 1 unit increase. After adjusting for multivariable, glycated hemoglobin was reduced among those who received consultation including telephone consultation compared to those who did not, however evidence was unconvincing.
On Assessing the Scope of Missing Native Americans in Nebraska: Results From a State-Wide Study and Recommendations for Future Research
Authors: Richards Tara N. , Wright Emily M. , Nystrom Alyssa , Gilbert Sheena L. , Branscum Caralin
Published: October 2021

Recent legislation in multiple states has called for studies on the scope of missing Native American persons. Here we report on one such study from Nebraska by first describing the practical and methodological issues for researchers to consider when examining data on missing Native persons. Then, using data from four point-in-time-counts in 2020, rates of Native American missing persons as well as case contexts over the study period are reported. Findings show that Native Americans are disproportionately represented among Nebraska's missing persons, that reports often involve minor boys, and that cases are dynamic and most are resolved quickly. Relatedly, most Native missing persons cases are only listed on the state clearinghouse, not the national missing persons lists. The paper is concluded with a discussion of specific directions for future research and policy regarding missing Native Americans.
Family-Focused Early Learning Programing: Access, Opportunities, and Issues in one Canadian Context
Authors: Doyle Antoinette , Li Ling
Published: October 2021

Family-focused early learning programs aim to assist parents in supporting their young children language and literacy development. This study examined program access and learning opportunities for diverse families across a wide range of community-based settings in one eastern Canadian province. As well, the study examined practitioners’ perspectives on issues related to program development and implementation. Primarily through surveys, practitioners provided data on more half of all community-based programs in the province. The findings of the study showed that most programs offered a form of parent and child focused drop-in play as the core of their programing. Few programs offered a more formalized parent-facilitator learning component as is sometimes found in other jurisdictions. The issues and challenges in programing identified by practitioners included attracting participants, maintaining funding and expanding program activities, and staff training to expand and enhance programing to meet the needs of families. These issues are discussed in light of current public policy and practice.
The changing political trends in erstwhile FATA: a study of the last three elections
Authors: Ahmed Raja Qaiser , Ishaq Mohammad , Shoaib Muhammad
Published: October 2021

This study investigates the changing political trends in erstwhile Federally Administered Tribal Areas of Pakistan. Analysis of the last three elections (2008, 2013, 2018) shows a substantial change in the region. The tribal structure, local traditions, power arrangement and electoral practices have changed significantly over a decade. The extension of the Political Parties Order to the region and its merger with Khyber Pakhtunkhwa stimulated political activities in the area that increased the political awareness of tribal people. The results of the 2013 and 2018 elections highlight the changes. Electoral activities, women participation and voter turnout increased with every election. Tribal youth joined existing political forums to demand their democratic rights. A significant percentage of the young, educated Pashtuns joined the Pashtun Tahafuz Movement in its demand for improved governance.
Pre-Draft Elbow Magnetic Resonance Imaging in Major League Baseball Pitchers (127)
Authors: Erickson Brandon , Chalmers Peter , Dangelo John , Ma Kevin , Alexander Frank , Ahmad Christopher
Published: October 2021

Objectives:

Evaluate pre-draft elbow MRI on baseball pitchers who were entering the MLB draft to determine the presence or absence of pathology, and the associations between these pathologies and UCL tears, and inter-observer reliability regarding common MRI pathology.

Methods:

Pre-draft elbow MRI and X-Rays on prospective MLB pitchers between 2011-2017 were deidentified and reviewed by two separate authors. The authors graded the X-Rays MRI on several factors including presence or absence of ulnar collateral ligament (UCL) ossification, UCL appearance (heterogeneous or not), UCL thickening (and location), UCL tear (partial vs. full thickness and location), muscle strain, flexor tendon tear, posteromedial osteophyte, sublime tubercle enthesophyte, and osseous stress reactions.

Results:

Overall, 245 pre-draft elbow X-Rays and MRI were reviewed. On X-Ray: 12 (4.9%) had ossification within the UCL; 34 (13.9%) had an olecranon osteophyte; 14 (5.7%) had a sublime tubercle enthesophyte. MRI abnormalities were found in 70% (171/245) of pitchers. UCL thickening was found in 20% of pitchers. Regarding UCL tears, 3% had a full thickness tear and 24% had a partial thickness tear. Of full thickness tears, 86% were distal and one was midsubstance. Of partial thickness tears, 41% (24/58) were distal, 12% (7/58) were midsubstance, and 47% (27/58) were proximal. Periligamentous edema was present in 36% of pitchers while 14% had a flexor pronator muscle strain. Stress reactions were seen in 27% and most commonly involved the sublime tubercle. Based upon the presence of periligamentous edema, distal UCL pathology was more likely to be chronic than acute while proximal UCL pathology was more likely to be acute.

Conclusions:

The majority (70%) of pitchers entering the MLB draft had abnormal findings on their MRI, most commonly involving changes to the UCL. Interobserver reliability was acceptable following definition of pathology when reading pre-draft elbow MRI on MLB prospects.
Identification of Factors Associated with Disease Progression in the Contralateral Hip of Patients with Symptomatic Femoroacetabular Impingement. (139)
Authors: Khan Adam , Louer Craig , Abu-Amer Wahid , Pashos Gail , Garrido Cecilia Pascual , Clohisy John , Nepple Jeffrey
Published: October 2021

Objectives:

Femoroacetabular Impingement (FAI) is one of the most common causes of hip osteoarthritis. Nevertheless, the factors contributing to symptom development and FAI disease progression are poorly understood. The purpose of this study was to (1) investigate rates of symptom development in the contralateral hip of patients with FAI at mid-term follow-up, and (2) identify predictors of disease progression (symptom development) in the contralateral hip.

Methods:

This prospective study included 179 patients undergoing ipsilateral FAI surgery with no history of previous contralateral hip surgery. In the current study, the contralateral hip was assessed at minimum 5 year follow-up. Symptoms (defined as moderate pain) and the need for surgery were monitored over the study course. Statistical analysis compared patient and FAI imaging characteristics of patients developing symptoms to those who remained asymptomatic.

Results:

A total of 146 hips (81.5%) were included at a mean 6.7 years of follow-up. Thirty-nine (26.7%) presented with symptoms in the contralateral hip, while an additional 35 (23.9%) developed symptoms during the follow-up period. Twenty-Six (17.8%) progressed to surgery for their contralateral hip. Head-neck offset ratio (HNOR) on AP pelvis radiographs was significantly lower among hips that developed symptoms (0.16 vs. 0.15 p=0.03). Maximum alpha angle (p=0.41), lateral center edge angle (p=0.70), and crossover sign (p=0.12) were not predictive of symptoms. Patients with a UCLA activity score greater than 9 were less likely to develop symptoms (14% vs. 46%, p=0.081), but this was not statistically significant. The total arc of rotation in 90° of flexion (40.0° vs 50.8°, p=0.01) as well as external rotation at 900 of flexion (28.9° vs 36.6°, p=0.02) were decreased in hips developing symptoms. Internal rotation in flexion was not significantly decreased in symptomatic patients (11.1° vs 14.2°, p=0.11). Kaplan Meier survival analysis demonstrated 53% and 45% of patients remaining asymptomatic at 5 and 8 year time points (Figure).

Conclusions:

At a mean follow-up of 6.7 years, significant symptoms in the contralateral hip of patients with FAI are present in 50.7% of patients, while 49.3% remain asymptomatic or minimally symptomatic. We identified unique radiographic and physical exam findings that are associated with symptom development in patients with FAI. Specifically, decreased hip rotation arc and decreased HNOR were strongly associated with disease progression and may represent important factors for future risk modeling in FAI patients.
Cost-Effectiveness of Particulated Juvenile Articular Cartilage Versus Matrix-Induced Autologous Chondrocyte Implantation for Patellar Chondral Lesions (176)
Authors: LeBrun Drake , Feingold Jake , Swenson-Buza Stephanie , Gruber Simone , Dennis Elizabeth , Stein Beth Shubin
Published: October 2021

Objectives:

Treatment options for articular cartilage lesions of the patella have evolved over the past several years due to the development of novel cell-based cartilage restoration techniques, including particulated juvenile allograft cartilage (PJAC) and matrix-induced autologous chondrocyte implantation (MACI). The objective of this study was to evaluate the cost -effectiveness of these modalities in the management of patellar cartilage defects.

Methods:

A Markov state-transition model was utilized to evaluate the cost-effectiveness of three strategies for patients with patellar chondral lesions: (1) nonoperative management, (2) PJAC, and (3) MACI. Probabilities, health utilities, and costs of surgical procedures and rehabilitation protocols were derived from institutional data and literature review. Effectiveness was assessed using quality-adjusted life-year (QALY). Cost-effectiveness was evaluated from societal and payer perspectives over a 15-year time horizon. The principal outcome measure was the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed on pertinent model parameters to assess their effect on base case conclusions.

Results:

From a societal perspective, nonoperative management, PJAC, and MACI cost $4,140, $52,683, and $83,073 respectively. Nonoperative management, PJAC, and MACI were associated with 4.91, 7.07, and 7.79 QALYs gained, respectively. Therefore, PJAC and MACI were cost-effective relative to nonoperative management (ICERs $22,527/QALY and $27,456/QALY, respectively; Figure 1). Although MACI was more cost-effective than PJAC in the base case, this was strongly sensitive to the estimated probabilities of full versus intermediate benefit following PJAC and MACI (Table 1). If the probabilities of full and intermediate benefit following PJAC were assumed to be the same as those following MACI (i.e., PJAC and MACI were equally effective), then PJAC dominated MACI by being cheaper and more effective. At a $100,000/QALY willingness-to-pay threshold, MACI, PJAC, and nonoperative management were the preferred strategies in 63%, 33%, and 4% of the Monte Carlo probabilistic sensitivity analyses, respectively (Figures 2 and 3). Similar results were seen from a payer perspective.

Conclusions:

In the management of symptomatic patellar cartilage defects, PJAC and MACI were both cost-effective compared to nonoperative treatment in the management of symptomatic patellar cartilage defects; however, MACI was the preferred strategy in our base-case analysis. The cost-effectiveness of PJAC compared to MACI depended heavily on the probability of achieving full versus intermediate benefit after PJAC and MACI.
Prevalence and Role of Psychiatric Conditions in Patients Diagnosed with Anterior Knee Pain (192)
Authors: Swinehart Steven , Bowman Eric , Freeman Thomas , Rees Andrew , Harper Holly , Coronado Rogelio
Published: October 2021

Objectives:

Anterior knee pain is a common musculoskeletal complaint with a multifactorial etiology. Psychiatric conditions may play a significant role in both the evolution of anterior knee pain and recovery from it. This retrospective, matched case-control study evaluates the prevalence of psychologic conditions in patients with anterior knee pain to assess their role as a potential contributor.

Methods:

126 patients with anterior knee pain were retrospectively identified using ICD-10 codes and were individually matched to controls based on gender, age, and BMI. Patient demographics, surgical history, medications, and prior or current diagnoses related to musculoskeletal or psychiatric health were recorded. Demographic data between the anterior knee pain group and controls were evaluated using independent t-tests. Differences between the matched pairs related to psychiatric conditions and medication usage were evaluated using a McNemar Test. A subgroup analysis was also performed and defined by gender, age greater than or less than 35, and BMI greater than or less than 25.

Results:

Evaluation of demographic data between the anterior knee pain group and controls showed no difference with regards to age, gender, and BMI (p>0.05). Analysis of the 126 matched pairs demonstrated similar rates of psychiatric conditions and medication usage between the anterior knee pain group (23 patients, 18.3%) and the control group (18 patients, 14.3%). Statistically, there was no difference between the two groups (p = 0.472). A subgroup analysis also demonstrated no difference between the anterior knee pain group and controls when stratified by gender (Male [p = 0.80]; Female [p = 0.12]), age (< 35 [p = 1.00]; > 35 [p = 0.50]), and BMI (< 25 [p = 0.10]; > 25 [p = 0.82]).

Conclusions:

There was no difference in the prevalence of psychiatric conditions between patients with anterior knee pain and their controls. This suggests a low likelihood that the psychologic condition of patients with anterior knee pain differ from that of the general population and implies that psychologic conditions alone are unlikely to play an isolated role in the etiology of anterior knee pain.
Outcomes of Meniscal Repair versus Meniscectomy in Patients with Concomitant ACL and Bucket Handle Meniscus Tears (200)
Authors: Keeling Laura , Galel Alexandra , Ehlers Cooper , Wang David , Chang Edward
Published: October 2021

Objectives:

Bucket handle meniscus tears often present concurrently with tears of the anterior cruciate ligament (ACL). However, little is known regarding the influence of demographic factors on surgical decision-making, or on outcomes following treatment of bucket handle meniscus tears in ACL-deficient patients. Furthermore, no study has compared outcomes in this population between patients undergoing meniscectomy versus repair. The purpose of this study was therefore to determine if there is a difference in outcomes between patients presenting with concomitant ACL and bucket handle meniscus tears treated with meniscal repair versus meniscectomy. A secondary aim of this study was to discover if there is an association between the decision to perform a meniscus repair or meniscectomy based on demographic factors.

Methods:

In this institutional review board-approved retrospective study, we evaluated 62 patients presenting with ACL tear who were found to have a bucket handle meniscus tear preoperatively or at the time of ACL reconstruction. Of those, 30 patients underwent partial meniscectomy, while 32 underwent meniscal repair. Primary outcome measures included ACL and meniscal retear rates, as well as patient-reported outcome measures (PROMs). Documented PROMs included the International Knee Documentation Committee (IKDC), Single Assessment Numeric Evaluation (SANE), and ACL-Return to Sport after Injury (ACL-RSI) scores. Demographic and patient-specific factors evaluated included age, body mass index (BMI), smoking status, and location of meniscus tear.

Results:

Of 62 patients presenting for ACL reconstruction with concomitant bucket handle meniscus tear, a total of 34 patients with greater than one year (mean 22.4 month) follow-up were included. 14 patients underwent repair, and 20 underwent meniscectomy. No significant differences were noted in IKDC (p = 0.36), delta IKDC (p = 0.18), SANE (p = 0.61), or ACL-RSI (p = 0.67) scores between the repair and meniscectomy groups at final follow-up. No significant differences were found in ACL (p = 1.00) or meniscus (p = 0.49) retear rates between the two groups. Younger age, lower BMI, and tear location (red-red zone) were significantly associated with the decision to perform meniscal repair over meniscectomy (p < 0.05).

Conclusions:

Among patients presenting with concomitant ACL and bucket handle meniscus tears, we found no difference in patient-reported outcomes or retear rates in patients undergoing meniscal repair versus meniscectomy. Demographic and patient-specific factors including age, BMI, and tear location may influence surgical decision-making when determining the optimal treatment of bucket handle meniscus tears in this population.
MANAGEMENT OF FIRST-TIME PATELLAR DISLOCATION: A SURVEY OF PRISM MEMBERS (201)
Authors: Parikh Shital , Veerkamp Matthew ,   PF RIG group
Published: October 2021

Objectives:

There are no current guidelines for optimal management of first-time patellar dislocation in children and adolescents. The objective of this study was to develop consensus-based guidelines for management of first-time dislocation in adolescents.

Methods:

A 29-question, case-based, multiple-choice survey was developed after 2-rounds of iterations by 20 members of the Patellofemoral RIG. The survey contained two case scenarios of first-time patellar dislocation in adolescents - one with and one without an osteochondral fracture. The survey was administered to primary sports medicine and orthopedic surgeons of the PRISM Society in April 2020 and the responses were analyzed. Consensus-based guidelines were generated when at least 66% of the respondents agreed.

Results:

81/276 (29%) members responded to the survey and 6 consensus-based guidelines were generated from those responses (Table 1).There was no consensus between conservative (60%) and operative (40%) treatment of contralateral patellar dislocation. Free-text analysis revealed several variables that influence the decision-making process.

Conclusions:

There are changes in trends related to management of first-time dislocation in adolescents. MRI, though not recommended for all patients with first-time dislocation, was obtained by 51% of respondents. The survey provides details of conservative treatment, including the role and duration of bracing and physical therapy. For first-time dislocation with an osteochondral fracture, concomitant patellar stabilization is preferred over isolated fixation. Simultaneous guided-growth for genu valgum correction is recommended. There were several variables that influenced the decision-making process and there were several areas of discordance. Further research studies on these parameters could potentially improve outcomes. *PF RIG members: Matthew Ellington, MD, Craig J Finlayson, MD, Joseph Molony, Jr., PT, MS, SCS, CSCS, Nicole Friel, MD MS, Daniel W Green, MD, Jeffery L Mikutis, DO, Todd A Milbrandt, MD, James L Pace, MD, Albert M Pendleton, MD, Lauren H Redler, MD, Jason Rhodes, MD, Shannon D Safier, MD, John A Schlechter, MD, Beth E Shubin Stein, MD, Curtis Vandenberg, MD, Jeffrey M Vaughn, DO, Eric J Wall, MD, Drew E Warnick, MD, Moshe Yaniv, MD, Shital N Parikh, MD.
Can Opioids be Eliminated After Arthroscopic Meniscus Surgery? A Prospective Randomized Controlled Trial (202)
Authors: Jildeh Toufic , Okoroha Kelechi , Kuhlmann Noah , Cross Austin , Abbas Muhammad , Moutzouros Vasilios
Published: October 2021

Objectives:

To compare a multimodal nonopioid pain protocol to traditional opioid medication in controlling postoperative pain following meniscal surgery. We hypothesized that our nonopioid protocol would show no significant difference in pain and reduced side effects when compared to the standard opioid regimen.

Methods:

Ninety-nine patients undergoing primary meniscectomy or meniscal repair were assessed for participation. A prospective randomized control trial was performed in accordance with the CONSORT (Consolidated Standards of Reporting Trials) 2010 statement. The two arms of the study included a multimodal non-opioid analgesic protocol and a standard opioid regimen with a primary outcome of postoperative pain level (visual analog scale) for 10 days. Secondary outcomes included patient reported outcomes, complications and patient satisfaction. Randomization was achieve using a random number generator. Patients were not blinded. Data collection was done by a blinded observer.

Results:

Eleven patients did not meet the inclusion criteria, and 27 declined participation. A total of 61 patients were analyzed with 30 randomized to the opioid regimen, and 31 randomized to the non-opioid regimen. Patients receiving the nonopioid regimen demonstrated non-inferior VAS scores compared to patients who received opioid pain medication (p>0.05) No significant differences were found in preoperative (opioid: 58.9 ± 7.0; nonopioid: 58.2 ± 5.5, p = 0.724) nor postoperative (opioid: 59.8 ± 6.5; nonopioid: 54.9 ± 7.1, p = 0.064) PROMIS-PI SF scores. No difference was found in recorded side effects between both groups: constipation (p = 0.124), nausea (p = 0.979), diarrhea (p = 0.464), upset stomach (p = 0.174), and drowsiness (p = 0.572).

Conclusions:

This study found that multimodal nonopioid pain protocol provided equivalent pain control and patient outcomes following primary meniscus surgery while having an equivalent side effect profile. All patients reported satisfaction with their pain management without requiring emergency opioid analgesia.
Creation and Validation of a Shorthand Knee MRI Bone Age Assessment Tool as an Alternative for Skeletal Maturity Assessment (203)
Authors: Politzer Cary , Bomar James , Pehlivan Hakan , Gurusamy Pradyumna , Edmonds Eric , Pennock Andrew
Published: October 2021

Objectives:

In managing pediatric knee conditions, an accurate bone age assessment is often critical for diagnostic, prognostic, and treatment purposes. Historically, the Greulich and Pyle Atlas (hand atlas) has been the gold standard bone age assessment tool. In 2013, a shorthand bone age assessment tool based on this atlas (hand shorthand) was established as a simpler and more efficient alternative. Recently, a knee MRI bone age atlas (MRI atlas) was created potentially to circumvent the need for a left hand radiograph. Our objective is to create a shorthand version of the magnetic resonance imaging atlas.

Methods:

A shorthand bone age method (Figure 1) was created utilizing the previously published MRI atlas, which utilizes several criteria that are visualized across a series of images. The MRI shorthand draws on the most characteristic criteria for each age that is best observed on a single MR image. For validation, we performed a retrospective assessment of skeletally immature patients that had a knee MRI and left hand radiograph within four weeks. Four readers who were familiar with the hand atlas, hand shorthand, MRI atlas, and MRI shorthand read each of the images in a blinded fashion. Inter- and intra-observer reliability was evaluated using intraclass correlation coefficient (ICC), variability among observers was evaluated using percent agreement.

Results:

26 patients with a mean age of 13.6 years (range 9.0-16.9) met the inclusion criteria. The intra- and inter-observer reliability of all four assessment tools was excellent (ICC ≥ 0.8, p<0.001) (Table 1). When comparing the MRI shorthand to the MRI atlas, there was excellent agreement (ICC = 0.974), whereas the hand shorthand compared to the hand atlas had good agreement (ICC = 0.765). The MRI shorthand also had perfect agreement in 58% of reads among all four readers and 96% of reads had agreement within 1 year, whereas the hand shorthand had perfect agreement in 32% of reads and 77% agreement within 1 year (Table 2).

Conclusions:

The MRI shorthand is a simple and efficient means of assessing skeletal maturity of adolescent patients with a knee MRI. This bone age assessment technique has inter-observer and intra-observer reliability equivalent or better than the standard means utilizing a left hand radiograph.
Higher Incidence of Post-traumatic Radiographic Osteoarthritis with Transtibial Femoral Tunnel Positioning Compared to Anteromedial Femoral Tunnel Positioning During Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis (208)
Authors: Cinque Mark , Kunze Kyle , Williams Brady , Moatshe Gilbert , LaPrade Robert , Chahla Jorge
Published: October 2021

Objectives:

Anteromedial (AM) femoral tunnel positioning in anterior cruciate ligament reconstruction (ACLR) has been reported by some authors to yield superior clinical and functional outcomes compared to the transtibial (TT) approach; however, differences in the subsequent rates of post-traumatic osteoarthritis (PTOA) incidence are not clear. To perform a systematic review and meta-analysis of the literature to evaluate the influence of femoral tunnel positioning during primary ACLR on the development of radiographic PTOA.

Methods:

The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2019), and MEDLINE (1980-2019) were queried for all studies describing the development of PTOA following TT or AM ACLR. Data pertaining to patient demographics, ACLR technique, and radiographic PTOA were extracted. Meta-analysis utilizing the DerSimonian Laird method for random effects was used to compare the weighted proportion of PTOA after ACLR between the TT and AM approaches.

Results:

Sixteen studies were identified for inclusion with a total of 1,546 patients. The mean follow-up across all studies was 10.9 years (range 5-17.8 years). The mean follow-up specifically in the AM and TT groups were 10.8 years (range, 5.4-17 years) and 11.4 years (range, 6-17.8 years), respectively. A total of 783 (50.6%) patients underwent TT ACLR. Of these patients, 401 (49.3%) developed radiographic PTOA. A total of 763 (49.4%) patients underwent AM ACLR. Of these patients, 324 (mean: 21.8%) went on to develop radiographic PTOA. Meta-analysis demonstrated a significantly greater rate of PTOA following ACLR using a TT technique compared to an AM reconstruction technique overall (49.3% vs.25.4%, p<0.001) and when studies were stratified by 5-10 (53.7% vs. 14.2%, p<0.001) and at greater than 10 year (45.6 % vs. 31.2%, p<0.001) follow-up.

Conclusions:

Transtibial ACLR is associated with higher overall rates of radiographic PTOA compared to the AM ACLR approach. The rates of radiographic PTOA following ACLR with a TT approach are also significantly higher than using an AM approach when stratified by length of follow-up (5-10 and greater than 10-year follow-up).
The Impact of Socioeconomic Factors on Outcomes Following Anterior Cruciate Ligament Reconstruction (209)
Authors: Kingery Matthew , Baron Samuel , Kaplan Daniel , Resad Sehar , Markus Danielle , Strauss Eric , Gonzalez-Lomas Guillem , Campbell Kirk
Published: October 2021

Objectives:

Socioeconomic factors have been shown to impact patient care in many surgical fields; however, their effects have not been thoroughly evaluated in the context of anterior cruciate ligament reconstruction (ACLR) outcomes. The purpose of this study is to investigate the effects of socioeconomic factors on time to surgery, knee function, and subjective outcomes measures following ACLR.

Methods:

A retrospective query of primary ACLR surgeries at a single institution performed from 2011 to 2015 with minimum two-year follow-up was conducted. Patient demographics, insurance type, worker’s compensation status, surgical variables, IKDC score, and failure were recorded from chart review. Education level and income were obtained via phone interview. Differences between functional outcome were compared between Medicaid and non-Medicaid groups.

Results:

268 patients were included in the analysis (43 patients in the Medicaid group and 225 patients in the non-Medicaid group). The Medicaid group demonstrated lower annual income (p<0.01) and a lower level of completed education compared to the non-Medicaid group (p<0.01). Medicaid patients had a greater duration between time of initial knee injury and surgery compared to the non-Medicaid group (11.8 +/- 16.3 months versus 6.1 +/- 16.5 months, p = 0.04). At the time of follow-up, patients in the non-Medicaid group had a significantly greater IKDC score compared to Medicaid patients (82.5 +/- 13.8 versus 75.3 +/- 20.8, p = 0.03).

Conclusions:

Socioeconomic factors impacted care in the setting of ACL injury. Medicaid insurance patients were seen significantly later after initial injury when compared to non-Medicaid carriers, and had worse outcomes compared to their non-Medicaid peers. Higher annual income brackets had significantly higher clinical outcomes scores at a minimum of two years postoperatively. Education level did not affect outcomes.
The Direct Effect of Nanofiber-based Vitamin D Sheet Engineered with 3D Printing for Tendon-to-bone Healing and Muscle Regeneration after Repair in a Chronic Rotator Cuff Tear Model of Rabbit (217)
Authors: Rhee Sung-Min , Nam GunWoo , Park Joo Hyun , Jeong Hyeon Jang , RHIE TAE-YON , Park Suk-Hee , Oh Joo Han
Published: October 2021

Objectives:

To compare the efficacy between the direct effect of nanofiber-based vitamin D sheet engineered with 3D printing (VTD sheet) and vitamin D supplementation (VTDS) as diet on tendon-to-bone healing and muscle regeneration after repair in a chronic rotator cuff tear model of rabbit.

Methods:

A total of 64 rabbits were randomly allocated into two groups (n=32), then each groups was allocated into four small groups (Group A, A’: VTDS only, Group B, B’: Normal diet + sheet without vitamin D, Group C, C’: Normal diet + VTD sheet, Group D, D’: VTDS + VTD sheet, n=8 each). The supraspinatus tendons which were detached and left for 6 weeks were repaired in a transosseous manner with the sheet only for groups B and B’, and VTD sheet for groups C, C’, D and D’ (Figure 1). Groups A, B, C, and D were extracted at 4weeks after repair, while groups A’, B’, C’, and D’ were extracted at 12 weeks after repair. Serum 25-OH vitamin D level was checked at the time of making tear, repair, and extraction. Regarding tendon-to-bone healing, the expression (relative ratio to control) of genes including type 1 collagen (COL1), type 3 collagen (COL3), bone morphogenic protein-2 (BMP-2), scleraxis (SCX), SOX9, and aggrecan (ACAN) was assessed at 4 weeks (Groups A, B, C, and D), and at 12 weeks (Groups A’, B’, C’, and D’) after repair. The histological and biomechanical evaluations of tendon-to-bone healing were done at 12 weeks after repair. Regarding muscle regeneration, rotator cuff muscle cross-sectional areas were measured at 4 and 12 weeks after repair. Enzyme-linked immunosorbent assay (ELISA) was done to calculate vitamin D level in muscle at 12 weeks after repair.

Results:

Serum vitamin D level of group D and D’ was highest among groups at the time of repair and extraction (p < 0.001). At 4 weeks after repair, mRNA expression of COL1 in group D was highest among groups (A, B, C, D; 0.86 ± 0.25, 0.90 ± 0.27, 0.93 ± 0.19, and 1.06 ± 0.25, respectively, p = 0.046). At 12 weeks after repair, group D’ showed most dense collagen density (p = 0.037) and had highest load to failure among groups (A’, B’, C’, D’; 102.3 ± 12.6 N, 99.5 ± 8.3 N, 102.3 ± 18.5 N, and 139.6 ± 25.3, respectively, p = 0.024). Regarding muscle regeneration, the cross-sectional area of muscle fiber was largest in group D and D’ at 4 and 12 weeks after repair (p < 0.05, figure 4) with highest vitamin D level of muscle by ELISA at 12 weeks after repair (p = 0.003).

Conclusions:

The use of nanofiber-based vitamin D sheet engineered with 3D printing may promote tendon-to-bone healing and regenerate rotator cuff muscle after repair in a chronic rabbit rotator cuff tear model.
Massive Rotator Cuff Tear Bridging Reconstruction Using Acellular Dermal Matrix: Mid-term Results (219)
Authors: Awad Moayd , Sparavalo Sara , Ma Jie , Wong Ivan
Published: October 2021

Objectives:

Management of massive rotator cuff tears remains a challenge despite development of different surgical techniques. Bridging reconstruction was developed to improve clinical outcomes and to avoid the morbidity associated with tendon transfers and arthroplasty. To date, there have been no studies assessing the mid-term clinical outcome for patients undergoing this procedure. The objective of this study was to evaluate the mid-term clinical outcomes of patients who underwent bridging reconstruction using acellular dermal matrix for large/massive rotator cuff tears (> 3 cm).

Methods:

A retrospective chart review was conducted for patients who underwent bridging reconstruction between 2010 and 2018 by one surgeon (IW). Patients with a minimum follow-up of two years were included. All patients completed self-reported questionnaires (Western Ontario Rotator Cuff (WORC) Index and the Disabilities of the Shoulder, Arm and Hand (DASH) score) pre-operatively and post-operatively at six months, one year and annually thereafter.

Results:

One hundred charts were reviewed, and 20 patients were excluded due to lack of pre- or post-operative outcome scores. This cohort of patients consisted of 80 patients mean age of 58.6 ± 9.1 years and an average follow-up of 5.1 ± 1.6 years. The mean pre- and post-operative WORC scores (± SD) were 61.4 ± 20.6 and 28.1 ± 25.5 (p < 0.001), respectively. The mean pre- and post-operative DASH scores were 52.2 ± 19.7 and 23.1 ± 22.4 (p < 0.001), respectively. There was an improvement in WORC and DASH over time with the most significant improvement during the first year post-operatively (Figure 1). Seventy-eight percent of patients met the minimal clinically important difference (MCID) for WORC while 77% of patients met the MCID for DASH. Our results show significant mid-term clinical improvement in WORC and DASH scores that is similar to previously published data that showed significant improvements in other patient-reported outcome scores. We believe these positive outcomes to be a result of better force coupling within the shoulder as compared to other surgical treatments such as maximal repair, superior capsular reconstruction, and reverse total shoulder arthroplasty.

Conclusions:

Arthroscopic bridging reconstruction for the treatment of massive rotator cuff tears results in significant improvement of patient reported outcomes (as measured using the WORC and DASH scores) at a mean follow up of five years. This may suggest that bridging reconstruction is a good treatment alternative as compared to superior capsular reconstruction or reverse total shoulder arthroplasty. Longer follow-up with a prospective study design is necessary to determine the longevity of these outcomes.