bluuebunny/crossref_metadata_2025 huggingface dataset:
External validation and performance analysis of a deep learning-based model for the detection of intracranial hemorrhage
Authors: Nada Ayman , Sayed Alaa A. , Hamouda Mourad , Tantawi Mohamed , Khan Amna , Alt Addison , Hassanein Heidi , Sevim Burak C. , Altes Talissa , Gaballah Ayman
Published: November 2024

Purpose

We aimed to investigate the external validation and performance of an FDA-approved deep learning model in labeling intracranial hemorrhage (ICH) cases on a real-world heterogeneous clinical dataset. Furthermore, we delved deeper into evaluating how patients’ risk factors influenced the model’s performance and gathered feedback on satisfaction from radiologists of varying ranks.

Methods

This prospective IRB approved study included 5600 non-contrast CT scans of the head in various clinical settings, that is, emergency, inpatient, and outpatient units. The patients’ risk factors were collected and tested for impacting the performance of DL model utilizing univariate and multivariate regression analyses. The performance of DL model was contrasted to the radiologists’ interpretation to determine the presence or absence of ICH with subsequent classification into subcategories of ICH. Key metrics, including accuracy, sensitivity, specificity, positive predictive value, and negative predictive value, were calculated. Receiver operating characteristics curve, along with the area under the curve, were determined. Additionally, a questionnaire was conducted with radiologists of varying ranks to assess their experience with the model.

Results

The model exhibited outstanding performance, achieving a high sensitivity of 89% and specificity of 96%. Additional performance metrics, including positive predictive value (82%), negative predictive value (97%), and overall accuracy (94%), underscore its robust capabilities. The area under the ROC curve further demonstrated the model’s efficacy, reaching 0.954. Multivariate logistic regression revealed statistical significance for age, sex, history of trauma, operative intervention, HTN, and smoking.

Conclusion

Our study highlights the satisfactory performance of the DL model on a diverse real-world dataset, garnering positive feedback from radiology trainees.
Evaluation and Influencing Factors of Regional Environmental Efficiency in China Based on Three-Stage DEA Model
Authors: Guanglan Zhou , Zhening Zhang
Published: November 2024

China needs high-quality economic development while environmental problems are intensifying. The deteriorating resource and environmental situation have caused serious hindrances to economic and social development. Therefore, we decided to explore the primary causes of environmental pollution and resource waste and provide efficient solutions for future ecological management and environmental optimization. Our study is based on panel data of inter-provincial regions in China from 2011 to 2020 and uses a three-stage [Formula: see text] model to evaluate the level of environmental efficiency, the trend of change and its variability among regions under the same environment, which accurately and objectively reflects the true level of environmental efficiency of each region in China. The results found that: (1) The adjusted environmental efficiency levels of the inter-provincial regions in China change significantly. (2) Without the influence of external environmental factors and random error factors, the real environmental efficiency among provinces in China is significantly unbalanced. (3) There is a significant influence of external environmental variables on the actual environmental efficiency. Therefore, to further improve the level of environmental efficiency in China, it is imperative to encourage a wider range of market accessibility; optimize the industrial structure; learn from excellent development experiences; reasonably increase capital investment in environmental management; and improve the environmental awareness of enterprises.
Exploring the Lived Experiences of LGBTQIA+ People in Diverse Fields: A Qualitative Study in Urban India
Authors: Mahajan Ritika , Agrawal Monika , Sareen Monica
Published: November 2024

This article is based on a comprehensive investigation of the lived experiences of lesbian, gay, bisexual, transgender, queer, intersexual, and asexual plus (LGBTQIA+) individuals working in diverse fields within the urban Indian context. The study contributes to the mainstream discourse on diversity and inclusion (D&I) from the gender lens. It reveals how organizational policies, societal attitudes, and cultural norms in India influence the identity, family, and peer relationships, educational and workplace environments, support systems, and coping mechanisms of LGBTQIA+ professionals. Utilizing a qualitative research approach, data were obtained from interviews published on the “Feminism in India” website. Thematic analysis revealed seven themes, shedding light on the marginalization and challenges faced by LGBTQIA+ communities, including the exclusion of trans individuals within feminist spaces and inadequate representation in Pride events. This research investigates nascent experiences within social and professional contexts and narrows down the focus to the LGBTQIA+ community in India. In this study, intersectionality theory is integrated to explain how sexual orientation merges with gender, caste, class, and religion to establish workplace inclusion, equity, and belonging. The themes identified in the study reveal that it is the social, personal, and structural relationships that influence the lives of LGBTQIA+ persons in urban India. Organizations and policymakers can only minimize discrimination and support positive development upon understanding these experiences.
Impact of the COL1A1 (RS1107946) gene polymorphism on anterior cruciate ligament rupture in professional soccer players
Authors: Andrade EF , Alcântara DFA , Machado JKS , Cohen-Paes AN , Burbano RMR
Published: November 2024

Objectives

To describe the allelic frequency of rs1107946, belonging to the COL1A1 gene in professional soccer players and compare these findings with data from continental populations described in the 1000 Genomes database, in order to evaluate the frequency of genotypes highly associated with genetic susceptibility to anterior cruciate ligament (ACL) injuries in the literature.

Methods

The DNA of the 38 professional soccer players was collected from oral mucosa samples. DNA extraction was performed using the PureLinkTMGenomicDNAMini Kit, according to the manufacturer's protocol. For genotyping and allelic discrimination of the selected SNP (rs1107946), real-time PCR was used with TaqMan® SNP GenotypingAssay specific probes (AppliedBiosystems, Foster City, CA, USA) on the QuantStudio 6 Flex Realtime PCR system. The MMA was consistently identified in all specimens. In 26 of 33 (82%) specimens, the MMA branched directly from the popliteal artery, while in 6, the MMA shared a common trunk with the inferior medial genicular artery (IMGA). The MMA was easily distinguishable from the superior MGA, inferior MGA, and MGA, given its direct course to the medial joint line with terminal branches to the posterior horn of the medial meniscus and deep to the semimembranosus tendon. The MMA exhibited a smaller vessel diameter relative to the genicular arteries.

Results

Our findings demonstrated that the frequency of the wild-type allele C was 65%, while the frequency of the mutant allele A was 45%, highlighting that despite the wild-type allele, which confers protection against the risk of ACL injury, is predominantly distributed in the sample, the mutant allele is significantly present in the individuals investigated. When comparing our findings with data from continental populations described in 1000 Genomes, we found statistically significant allelic and genotypic distributions (Student's T Test p = 0.021), demonstrating that the athletes investigated have a different genetic profile. In our findings, the individuals studied presented a statistically significant allelic frequency of the mutation when compared to the European population, inferring that the frequency of this mutation is higher in European individuals than in mixed-race individuals from Brazil.

Conclusion

The prevalence of the rs1107946 polymorphism of the COL1A1 gene in athletes may have an important role in the development of ACL injuries.
Lateral femoral sliding osteotomy without screw fixation is not associated with pain or varus trust in valgus knee arthroplasty
Authors: Zorzi AR , Iupi RT , Souza PAM , Piedade SR , Miranda JB , Campos GC
Published: November 2024

Objectives

Several ligament balancing techniques for valgus total knee arthroplasty have been described. One of them is the sliding osteotomy of the lateral epicondyle described by Brilhault. This osteotomy releases the origins of the lateral collateral ligament and the popliteal tendon. According to the original description, the bone fragment is fixed with two screws after desired correction. The aim of this study is to determine the safety and feasibility of a simplified and non-fixed lateral epicondyle sliding osteotomy.

Methods

Retrospective case series of patients with valgus deformity who underwent total knee arthroplasty between 2006 and 2018. The main outcome was the incidence of complications and adverse events. Secondary outcomes were visual pain scale, Knee Society scale, varus stress test and varus knee thrust during gait. Limb alignment was also assessed with standing radiographs.

Results

22 participants (26 knees) were included in the study. There was no re-operation or early revision. The average follow-up was 4.5 years. Eighteen participants had no pain. Four participants had lateral knee pain (VAS pain = 4.5 ± 2.9). Last follow-up Knee Society Scale was 84.9 ± 6.7 ranging from 74 to 95. No participant presented varus instability. Radiographic alignment restored the limb's mechanical axis in all cases.

Conclusion

The simplified lateral epicondyle osteotomy procedure without fixation proved to be safe and effective.
Meniscal Radial Tears Repaired with All-Inside and Inside-Out Techniques Result in Improved Clinical Outcome Scores; However, More Complications are Reported After Inside-Out Repair: A Systematic Review
Authors: Mameri ES , Dzidzishvili L , Jackson G , Allende F , Allahabadi S , Chahla J
Published: November 2024

Objectives

To compare patient-reported outcomes (PROs), failure, and healing rates following all-inside (AI) repair versus inside-out (IO) repair for the treatment of meniscal radial tears.

Methods

A literature search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the Scopus, PubMed, and Embase computerized databases. Level of evidence I through IV human clinical studies evaluating PROs and/or the incidence of failure and healing following AI versus IO repairs for meniscal radial tears were included. Study quality was assessed using the MINORS criteria and MCMS score.

Results

Ten studies comprising 205 patients were identified including 142 patients who underwent AI repair and 63 patients who underwent IO radial repair. Postoperative Lysholm and Tegner scores ranged from 90.8 to 95.6 and 5.7 to 8.2, respectively, in the AI repair group, compared to 86.9 to 94.2 and 6 to 7.5, respectively, in the IO repair group. Clinical failure ranged from 0% to 21.4% % and 0% to 62.5% in the AI and IO groups, respectively. Healing assessments on second-look arthroscopy revealed failure rates ranging from 0% to 8% in the AI repair group and 0% to 30% in the IO group. Complete and partial healing ranged from 13% to 69% in the AI group and from 22% to 58.3% in the IO group. Postoperative complications ranged from 0%-2% within the AI group compared to the IO group ranging from 0% to 25%. No implant-related complications were reported in any study group.

Conclusion

All-inside and inside-out repairs for meniscal radial tears both demonstrate improved PROs; however, current literature suggests that the IO technique may present higher failure and complication rates relative to AI repair techniques.
Migratory articular cartilage-derived cells obtained by arthroscopic cartilage biopsy in non-osteoarthritic individuals
Authors: Giglio PN , Levy D , Varone BB , Favaron PO , Bydlowsky SP , Demange MK
Published: November 2024

Objectives

Migratory cartilage-derived cells have potential autologous use in cartilage repair surgery. However, obtaining cells through arthroscopic biopsy has never been reported in subjects without osteoarthritis. This study aimed to characterize cell lines derived from cartilage obtained by arthroscopic biopsies of non-osteoarthritic volunteers.

Methods

Consent was obtained for eight volunteers undergoing routine knee arthroscopy for ligament or meniscal injury treatment, aged between 18 and 55 years, with no knee osteoarthritis. After arthroscopic inspection, 5-10 mm cartilage fragment was removed from a non-weight-bearing area on the trochlear lateral edge or intercondylar notch, using an arthroscopic gouge.Cell isolation was performed by enzymatic digestion or by explant cell migration. Protein analysis was performed to evaluate the expression of osteogenic, chondrogenic or adipogenic differentiation factors.

Results

Successful cell cultures were obtained using both methods, enzymatic digestion or cell migration from cartilage biopsy fragments, with no significant differences in stem cell markers and plasticity among cell lines. Cells obtained from both procedures have: fibroblast-like morphology, expression of CD29, CD90, and CD105 markers as well Nanog and SOX2, and can differentiate in adipocytes, chondrocytes, and osteoblasts under appropriate conditions. Cells obtained via migration exhibited lower expression of collagen I and II, and a lower collagen II/collagen I ratio, both positively associated with chondral matrix production. RUNX2 expression, an osteogenic differentiation factor, was also lower in this group. No difference was observed in levels of SOX9, key for chondrogenic differentiation, or syndecan and perlecan gene expression.

Conclusion

This study showed for the first time chondral explant migration can effectively derive cells from arthroscopic biopsies from non-osteoarthritic individuals, showing comparable and plasticity profiles. Moreover, these cells exhibit important chondrogenic markers and proteins. Further, in vivo studies are needed to better evaluate the regeneration potential of these cell lines.
Outcomes Following Isolated Medial Meniscus Posterior Root Repair Using An Anatomic Transtibial Pull-Out Technique In Patients Aged > 60 Years: A Matched Cohort Study
Authors: Mameri ES , Jackson G , Khan Z , Chahla J
Published: November 2024

Objectives

To compare patient-reported outcomes following anatomic transtibial pull-out repair for isolated medial meniscus posterior root (MMPR) tears in patients > 60 versus ≤60 years of age, as well as the incidence of repair failures.

Methods

Patients aged ≥18 years undergoing isolated anatomic transtibial pull-out repair for MMPR tears at a single institution between January 2016 and September 2020 were analyzed. Patients with minimum 2-year follow-up were divided based on age: >60 versus ≤60 years. Patients completed IKDC, KOOS JR, and VR12 surveys before surgery and at final follow-up. Differences in outcome scores between age groups, as well as repair failures, defined by the need for repeat arthroscopy, were analyzed.

Results

Twenty patients aged ≥60 with a mean age of 65.7 ± 4.1 years (range, 60.2 – 74.9 years) were compared to 40 patients ≤ 60 years of age with a mean age of 49.3 ± 9.0 years (range, 23.4 – 59.8). Significant improvement in all outcomes scores was observed in both groups at final follow-up relative to pre-operative values. No significant difference in IKDC, KOOS JR, or VR12-Physical scores was observed between groups. Revision repair was required in one patient (2.5%) under age 60, but no patients over age 60.

Conclusion

Anatomic transtibial pull-out repair for MMPR tears resulted in improved outcome scores at minimum 2-year follow-up, with no significant differences among our cohorts of patients >60 or ≤60 years of age. While chronologic age should be accounted for when discussing expectations and management of MMPR tears, a specific age cut-off should not exclude consideration for root repair, as appropriately selected patients >60 years of age exhibit non-inferior outcomes compared to patients aged ≤60 years.
Equal rates of bone healing and reduced surgical time with iliac crest allograft compared to autograft in medial opening wedge high tibial osteotomy: A Randomized Controlled Clinical Trial
Authors: De Paula RE , Cordeiro A , Mozella AP , Sobral RD , Cobra HAAB , Albuquerque RSP
Published: November 2024

Objectives

Iliac crest autograft is frequently used to fill in bone defects after osteotomies. Nonetheless, surgery for bone autograft procurement is associated with morbidity and pain at the donor site. Alternatives to it have been explored, but there is no consensus to guide their application as a routine practice in several orthopedic procedures. Thus, this study was designed to compare the efficacy and safety between iliac crest autograft and allograft in medial opening wedge high tibial osteotomy.

Methods

Forty-seven patients with a symptomatic unilateral genu varum and an indication for high tibial osteotomy. They were randomly assigned to receive either autograft or allograft to fill the osteotomy site. Operative time, bone healing, and complication rates (delayed union, nonunion, superficial and deep infection, loss of correction, and hardware failure) were recorded after a one-year follow-up. Data were expressed as Mean ± Standard Deviation and considered statistically significant when p < 0.05.

Results

The time to radiologic union was similar between both groups (Allograft: 2.38 ± 0.97 months vs. Autograft: 2.45 ± 0.91 months; p=0.79). Complication rates were also similar in both groups, with one infection in the allograft group and two in the autograft group, two delayed unions in the allograft group, and three in the autograft group. The operative time differed by 11 minutes between the groups, being lower in the allograft group (Allograft: 65.4 ± 15.1 minutes vs. Autograft: 76.3 ± 15.2 minutes; p=0.02).

Conclusion

Iliac crest allografts can be safely and effectively used in medial opening wedge high tibial osteotomy as it promotes the same rates of bone union as those achieved by autologous grafts, with the benefits of a shorter operative time.
Evaluation of fresh homologous osteochondral transplantation in the knee as a salvage therapy: Prospective case series with a minimum follow-up of 10 months
Authors: Gracitelli GC , Carrer RU , Galvão PHSAFG , Franciozi CES , Kubota MS , Rezende FC
Published: November 2024

Objectives

Evaluate the clinical outcome and satisfaction of patients submitted to fresh homologous osteochondral transplantation in the knee as a salvation therapy.

Methods

A total of eight knees from seven patients who were submitted to fresh Homologous Osteochondral Transplantation by a single surgeon were analyzed preoperatively and followed up by a period between ten months and five years and five months. We reported the clinical outcomes through the use of IKDC (International Knee Documentation Committee) and KOOS (Knee and Osteoarthritis Outcome Score) - quality of life item.

Results

This is a sample of complex cases, all of them submitted to previous surgeries with no success on the related operated knees. There was a range of improvement in function, with 7 of the 8 operated knees showing clinical and statistically significant improvement, according to the IKDC score, only one patient was not satisfied with the procedure and all of them showed improvement in the quality of life item on the KOOS score. There was no failure case, any infection or need for a new surgery in the operated patients.

Conclusion

Fresh Homologous Osteochondral Transplantation is a safe salvage therapy method in our country to treat large osteochondral lesions when other previous procedures failed. Despite the small sample size of this case series, there were a great positive clinical outcomes without associated complications.
Immunohistochemical Analysis of the Quadriceps Femoris Muscle Before and After Total Knee Arthroplasty
Authors: Kawatake EH , Pochini AC , Cohen M , Luzo MVM , Martinez CAR , Pereira JA
Published: November 2024

Objectives

The number of total knee arthroplasties (TKA) has increased steadily with the aging of the population. This surgical procedure is recognized for its success in pain relief and restoration of knee function. However, decreased quadriceps femoris (QF) muscle strength after TKA is frequently observed but with unknown etiology. Evidence suggests that the location of the operative incision (i.e., surgical access) can influence QF muscle structure and function. The present study aimed to assess the fiber type composition, structure and assembly of the QF's vastus medialis (VM) and vastus lateralis (VL) muscles before and after TKA.

Methods

Muscle biopsies (VM and VL muscles) were collected from patients previously submitted to TKA via the medial parapatellar route and undergoing TKA revision (main group, n=9) and patients with osteoarthrosis (OA) who will undergo TKA (control group: n=18). The biopsied muscle tissue was prepared, stored, and then sectioned in a cryostat at -25ºC. The tissue sections were evaluated using routine staining techniques in pathological anatomy and histochemistry.

Results

The normal mosaic pattern of the medial and lateral knee muscles was observed in the main and control groups, with no evidence of peripheral nerve damage. Notably, 88.9% of the patients exhibited mild to severe VL atrophy, while only 11.1% of patients in the control group presented this feature (p<0.001).

Conclusion

The medial parapatellar incision for TKA surgical access does not generate definitive morphological changes in the VM and VL muscle fibers but may contribute to VL atrophy.
The Medial Cross And The Anteromedial Region Of The Knee Revisited, A Cadaveric Study
Authors: PB Jorge , DE Oliveira , JMD Malpaga , SMG Canuto , CP Helito , MM Horita
Published: November 2024

Objectives

The medial knee structures have a primary role in valgus and rotational stress stabilizing, making them important in the global assessment of the ligament-injured knee and choosing the most adequate treatment This study aimed to conduct a layer-by-layer dissection of the knee anteromedial side and to describe, qualitatively and quantitatively, the anatomy and histology of the Anterior Oblique Ligament (AOL) and its relationship with what the authors call The Medial Cross, an important ligament complex that stabilizes the Medial Pivot

Methods

35 fresh-frozen knees resulting from transfemoral amputations, which were exclusively performed for vascular reasons, were dissected. Structures were identified after meticulous dissection, respecting the same protocol, measured with a digital caliper rule (Mitutoyo TM)., and histologically studied for data.

Results

The Medial Cross is represented by the superficial Medial Collateral Ligament, the AOL (anterior region), and the Posterior Oblique Ligament (POL). The Anterior Oblique Ligament was found in all dissected knees. It the mean length was 31,47 ± 5.06 mm. This structure presented ligament histology with densely organized collagen fibrils.

Conclusion

The 35 dissections reported in this study demonstrate a ligamentous structure, called AOL, in the knee medial region. It originates from the anterior border of the medial epicondyle and inserts more widely, under the articular surface, thus having a fan shape. It is in an extracapsular situation, not directly related to the medial meniscus, and represent the Medial Cross anterior arm. Studying and revisiting the medial compartment can provide important information for understanding joint instability, and promoting better results in ligament reconstructions.
Can We Not Use A Tourniquet In Total Knee Arthroplasty?
Authors: JPF Guerreiro , CW Janeiro , B Zarpelon , PM Calzavara , PR Bignardi , MV Danieli
Published: November 2024

Objectives

To analyze whether there is more bleeding in patients undergoing Total Knee Arthroplasty (TKA) without the use of a tourniquet. Secondary objectives were to analyze surgical and hospitalization time, need for transfusion and complication rate.

Methods

Retrospective study with analysis of medical records. Patients were divided into two groups: one group in which TKA was performed using a tourniquet and the other without. The values of drops in hemoglobin and hematocrit 24 and 48 hours after surgery, surgical time, hospital stay, need for transfusion and the rate of complications up to six months postoperatively were compared.

Results

104 patients were operated on during the period, 94 of which were included in the study. There was no difference between the mean values of hemoglobin and hematocrit between groups, preoperatively (p 0.675 and p 0.265), 24h (p 0.099 and p 0.563) and 48h (p 0.569 and p 0.810) after surgery. Surgical time and length of hospital stay were also not different between groups (p 0.484 and p>0.05). There was no difference regarding the need for transfusions, nor regarding the rate of complications analyzed.

Conclusion

We can don’t use of a tourniquet in TKA surgeries without significant change in the value of hemoglobin and hematocrit levels at 24 and 48 days after surgery when compared to the group using a tourniquet. Likewise, there was no significant difference in the total duration of surgeries, length of stay, need for transfusions or in the rates of complications analyzed.
Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Using the Rectus Femoris Tendon: Surgical Technique
Authors: BG Barroso , SMG Canuto , CP Helito , MCF Rego , FS Martins , MCF Rego
Published: November 2024

Objectives:

Present a combined ACL and anterolateral ligament (ALL) reconstruction technique using a rectus femoris tendon graft harvested in a minimally invasive approach without specialized instruments.

Methods:

The graft is harvested from the lateral portion of the rectus femoris tendon. The distal end is detached from the patella, and dissection is extended proximally by 8 cm, ensuring preservation of the intermediate and deep layers of the quadriceps tendon (QT). A closed tendon stripper is carefully pushed with the knee at 20 degrees of flexion. The graft is folded asymmetrically, with the distal portion forming a double or triple graft for the ACL, and the proximal portion remaining unfolded for the ALL. The femoral tunnel is made using an outside-in technique, replicating both the ACL and ALL footprints.

Results:

The graft length typically ranges from 28 to 35 cm, and the ACL portion diameter ranges from 8 to 10 mm. The technique showed a low rate of complications and provided adequate control of pivot shift. Advantages include predictable graft diameter, use of standard instruments, and preservation of hamstring strength. Disadvantages include potential quadriceps strength reduction, risk of hematoma, an additional incision, and the need for an extra screw for ligament fixation.

Conclusion:

To our knowledge, this is the first report of a combined ACL and ALL reconstruction technique using a QT graft. The minimally invasive rectus femoris graft approach offers a viable alternative for combined ACL and ALL reconstruction in both primary and revision surgeries.
Distal Femur Morphology in a Brazilian Population: Challenging the Universal Use of 3-Degrees of External Rotation
Authors: Mameri ES , Ballarini IK , Leonel MB , Ferreira MC , Kubota MS , Luzo MVM
Published: November 2024

Objectives:

To assess the external rotation angle between the transepicondylar axis (TEA) and the posterior condylar axis (PCA) in a Brazilian population, to determine whether the universal use of 3-degrees external rotation of the femoral component is appropriate during total knee arthroplasty (TKA) in this population.

Methods:

The TEA rotation relative to the PCA was measured in 167 magnetic resonance imaging (MRI) exams using four different methods for the PCA, based on posterior reference points: (A) cartilage references; (B) bony references; (C) lateral posterior reference and medial cartilage reference; and (D) lateral cartilage reference and medial bony reference. The measurements were statistically compared to the traditional 3-degrees external rotation used in TKA instrumentation. An analysis of variance was conducted to assess differences between the measurement methods.

Results:

Mean TEA external rotation for methods A, B, C, and D was 5.44º ± 2.39º, 4.94º ± 2.10º, 8.56º ± 2º, and 2.33º ± 2º, respectively. All measurement methods showed significant differences compared to the traditional 3-degrees external rotation (p<.0001). Significant differences were also found between all measurement methods (p<.0001), except between methods A and B (p=0.1614).

Conclusion:

Using cartilage or bony reference points for the PCA, the TEA in the Brazilian population is approximately 5-degrees externally rotated. The traditional 3-degrees femoral component rotation may be insufficient for this population, particularly in valgus knees. This highlights the importance of an individualized approach to achieve optimal component rotational alignment during TKA.
Patelloplasty Versus Traditional Patellar Retention in TKA
Authors: DE PADUA VITOR BARION CASTRO , ZANETTI JULIANO , DE FARIA JOSE LEONARDO ROCHA , DE PAULA MOZELLA ALAN
Published: November 2024

Objectives

Resurfacing the patella in total knee arthroplasty(TKA) is a controversial procedure. Although there are some advantages to replace the patella, there is a conservative trend among surgeons who prefer to retain it, leading to a faster procedure, preserving bone stock, with fewer complications and similar outcomes. Traditional procedure consists in removing the osteophytes and performing a denervation around the patella. A different approach is to perform patelloplasty, defined as reshaping the patella for optimal tracking in the trochlea. Objective:to compare traditional preservation and patelloplasty in primary TKA.

Methods

25patients underwent bilateral non-simultaneous TKA with the preservation of the native patella, and the same implant in both knees. On one side, patellar denervation and osteophytes resection was performed, and on the other one, patelloplasty. All implants were patellar "friendly" throclea design. 19 patients were evaluated with the average age of 74 years(61 to 89), BMI of 29.7, and the follow up of 4.3 years(2.9 to 7.8) in the traditional patella preservation group and 1.7 years(0.6 to 2.8) in the patelloplasty. The patients were asked which side had the most satisfactory result, in their opinion. Range of motion(ROM), VAS, and KSS, Forgotten knee, KOOS and LEE scores were also evaluated.

Results

8(42%) of the patients didn't have a preference side, 7(37%) preferred traditional preservation knee, and 4(21%) the patelloplasty. Regarding pain, VAS was 1.2 in the traditional and 2 in the patellopalsty. The ROM was similar, showing 126.4 degrees in the traditional side and 126 in the patelloplasty. The differences in KSS(score and function), Forgotten, KOOS and LEE scores between both groups, were not statistically significant.

Conclusion

Patelloplasty is a safe procedure, with few complications, relieving pain, with functional outcomes similar to those of the traditional procedure.
Fast Track protocol in total knee arthroplasty: results with 38 months follow-up
Authors: DE CAMPOS GUSTAVO CONSTANTINO , ALVES PEDRO BEZZAN RODRIGUES , CARDILLO IGOR CANO PAVESI , GRACITELLI GUILHERME CONFORTO , DE MELLO ALVES JUNIOR WILSON
Published: November 2024

Objectives

To define an enhanced recovery after surgery (ERAS) protocol, or “Fast-track” protocol, for primary total knee arthroplasty (TKA) and present the results of patients submitted to this protocol.

Methods

This was a retrospective review of 70 patients (86 knees) submitted to TKA following an ERAS protocol between 2013 and 2018. Range of motion, quadriceps strengh, 6-minute walk test, VAS, WOMAC and SF-36 questionnaires were completed at baseline and at last follow-up. Lenght of stay (LOS), blood count, complications and readmission rates were also analysed.

Results

86 TKAs were analysed. All parameters evaluated (extension deficit, quadriceps deficit, walking test, EVA, WOMAC, SF-36) were significantly improved at one year follow-up, with the exception of knee flexion deficit. Mean LOS was 2,4 days. There were no readmissions. One patient needed blood transfusion.

Conclusion

We present a feasible ERAS protocol that provided a safe short LOS with excelent results.
Surgical Technique for Revision of Anterior Cruciate Ligament Reconstruction, Combined with Postero-Lateral Corner and Anterolateral Ligament Reconstruction Using the Same Femoral Tunnel for Reconstruction of These Structures
Authors: MELO VINICIOS BARRETO , DE GUSMÃO CANUTO SÉRGIO MARINHO , FONSECA LORRAN COQUE , BLUNCK SAULO SANTOS
Published: November 2024

Objectives

The reconstruction of the anterior cruciate ligament (ACL) is the most performed knee surgery in Brazil; consequently, the number of failures in this reconstruction has increased. Each year, the exponential rise in ACL revision surgeries is linked to undiagnosed and untreated injuries. Possible causes of failures should be assessed, including the size and positioning of femoral and tibial tunnels, neglected ligament and meniscal injuries, rotational instabilities, and axis deviations. This article aims to describe a surgical technique for revising ACL reconstruction, associated with the posterolateral corner and anterolateral ligament, using the same femoral tunnel with autograft. Therefore, the article emphasizes the importance of preoperative diagnosis and the treatment of meniscal and ligament injuries associated with ACL injury. This new technique proves to be reliable, easily reproducible, providing adequate stability, reducing the number of femoral tunnels, and minimizing the chance of tunnel convergence, utilizing autologous grafts.

Methods

description of Surgical Technique for Revision of Anterior Cruciate Ligament Reconstruction, Combined with Posterolateral Corner and Anterolateral Ligament Reconstruction Using the Same Femoral Tunnel for Reconstruction of These Structures.

Results

Patients who underwent ACL revision with the technique described presented adequate anterolateral and rotational stability, compared to other reconstruction techniques of the posterolateral corner and anterolateral ligament.

Conclusion

The surgical technique described above generated stability in the revision of the ACL, as it was associated with simple peripheral ligament reconstruction using autologous tendons. This new technique appears to be reliable, easy to reproduce, generating adequate stability, thus reducing the number of femoral tunnels and the chance of confluence of these tunnels.
MENISCAL RECONSTRUCTION WITH SEMITENDINOSUS TENDON AUTOGRAFT COMBINED TO COLLAGEN MEMBRANE: TECHNIQUE NOTE AND LITERATURE REVIEW
Authors: F Kupczik , MEG Schiavon , B Sbrissia , MD Brunet
Published: November 2024

Objectives

The authors describe a technique for meniscal reconstruction using an autologous semitendinosus graft combined to collagen membrane to treat a 39 yrs-old male patient with post-medial meniscectomy syndrome and show its results.

Methods

The tendon was duplicated and its ends were sutured with high-strength sutures and attached to an adjustable button on each side. The collagen membrane was sutured circumferentially to the graft and bone marrow aspirated was injected under the membrane. By arthroscopy, bone tunnels were drilled at the insertion of the meniscal roots with a retrograde drill. The graft was inserted in the meniscal position, fixed into root tunnels by the adjustable buttons and sutured to the joint capsule using inside-out and outside-in sutures.

Results

The patient was evaluated at 3, 6 and 12 months postoperatively and showed good clinical and radiological evolution, being asymptomatic at final evaluation. At MRI, there were a meniscal integration of the graft and no degenerative changes.

Conclusion

The described technique showed to be reproducible and an alternative to treat symptomatic patients undergoing previous meniscectomy. Besides, it may be performed along concomitant procedures like osteotomy, ligament reconstruction and chondral repair.
FIXATION OF OSTEOCHONDRAL PATELLAR FRACTURE BY TRANSOSSEOUS SUTURE: REPORT OF TWO CASES
Authors: Brunet MD , Kupczik F , Schiavon MEG , Sbrissia B , Nakamura EK , Medeiros MP
Published: November 2024

Objectives

The article aims to explore two cases of osteochondral patellar fracture after acute dislocation, emphasizing the importance of appropriate treatment to prevent early progression to patellofemoral osteoarthritis. The study describes a surgical approach involving transosseous suture fixation and fibrin glue adjuvant, presenting it as a potential alternative over existing techniques.

Methods

Two patients (a 38 years-old male, and a 12 years-old female) with patellar osteochondral fracture due acute patellar dislocation were underwent surgical intervention. The procedure was performed by medial parapatellar arthrotomy and a transosseous suture fixation by high-strength sutures in the male and absorbable sutures in the female, plus use of fibrin glue as an adjuvant in both. Additionally, reconstruction of the medial patellofemoral ligament (MPFL) with the medial third of the patellar tendon was performed in the male and MPFL and medial patellar tibial ligament using hamstrings in the female.

Results

Postoperative follow-up revealed good clinical and radiographic outcomes. The patients exhibited complete symptom resolution, full ROM, patellar stability and completely cartilage healing on MRI at 3 and 9 months, respectively. The technique showed potential advantages, including simple reproducibility, low cost, and minimal postoperative complications.

Conclusion

Fixation of osteochondral patellar fracture by transosseous sutures combined with fibrin glue emerges as a reproducible, cost-effective technique with excellent clinical and radiological outcomes. The method displayed advantages over traditional implants, offering a potential alternative for surgeons. Despite the positive results in these cases, the limited literature calls for further research to confirm the technique superiority compared to isolated sutures and other available methods.
Effectiveness of Treatment with Stem Cells in Injuries of the Anterior Cruciate Ligament: A Systematic Review
Authors: Buscariolo FF , Gholmia C , Milani A
Published: November 2024

Objectives

Due to the lack of consensus, the objective of this systematic review was to describe the results in the literature with greater evidence on the effectiveness of stem cell (SC) treatment in ACL injuries, understanding their indications and updates on recommendation level.

Methods

A systematic review was conducted in accordance with PRISMA guidelines. Two reviewers independently carried out a search with the same descriptors in the MEDLINE, EMBASE and Web of Science databases, for studies published up to 2023. The following descriptors were used: Stem cell; knee injuries; Anterior Cruciate Ligament; Treatment. The following filters were used to reach the expected final result: “Randomized Controlled Trial; “Randomized Clinical Trial”; “Meta-Analysis”; “Systematic Reviews”; “Pragmatic Clinical Trial”.

Results

A total of 11 studies met all inclusion/exclusion criteria and were included in this review. There was a very strong correlation between the searches of the two researchers (k=0.841). In the included clinical trials, patients were evaluated primarily based on patient-reported outcome scores, and validated instruments. Clinical trials demonstrated results, but not significantly, post-injection in patients who received SC compared to patients who received hyaluronic acid (HA). There were no significant differences in post-injection outcome scores when comparing patients with and without SC use.

Conclusion

The clinical application of stem cells for the treatment of ACL injuries may be a good adjunctive treatment option. However, published clinical studies to date have not identified a significant difference, even with apparent clinical improvement.
Epidemiological Analysis of Meniscal Repair in the Brazilian Unified Health System
Authors: Faria JLR , Mello CL , Vaqueiro ACV , Mozella AP , Salim R , Guimaraes JAM
Published: November 2024

Objectives

Analyze data related to the surgical treatment of meniscal lesions in Brazil's public system, observing changes and trends during the studied period (2008 – 2021), and to make future projections.

Methods

The study was conducted using the DATASUS database (Unified Health System – Ministry of Health, Brazil) to gather national data on the number of meniscectomies and meniscal sutures performed between 2008 and 2021, and the results obtained were stratified by region of the country. Future projections until 2050 were made using least squares regression.

Results

In Brazil, a total of 91,067 meniscal procedures were performed in the Unified Health System (SUS) from 2008 to 2021, of which 72,452 (80%) were partial or total meniscectomies and 18,615 (20%) were meniscal repairs. In 2019, there was an increase in both the total number of procedures and the number of meniscal repairs. However, the proportion remained the same as in 2008 (77% Meniscectomy / 23% Repair). There was a decrease in the number of procedures performed in 2020 and 2021, the period related to the COVID-19 pandemic, but with a higher proportion of meniscectomies performed (82% and 79%, respectively). The national trend indicates a linear increase in the number of procedures, maintaining a higher proportion of meniscectomies over meniscal repair.

Conclusion

Meniscal repairs show a trend towards an increase in their incidence in the Brazilian Unified Health System, which is compatible with similar studies conducted in other regions of the world. However, their percentage proportion compared to meniscectomy did not show a significant increase within the public health system.
Timely Vaccination and Its Associated Factors Among Parents With Children Aged From 0 to 23 Months in Wolaita Zone Public Hospitals, Southern Ethiopia, 2024: A Facility-Based Cross-Sectional Study
Authors: Geta Hardido Temesgen , Atinafu Ataro Bizuayehu , Elifios Eshetu
Published: November 2024

Background. This study assessed determinants of timely vaccination among children aged from 0 to 23 months in Wolaita Zone Public hospitals, southern Ethiopia: A facility-based cross-sectional study in the study area. Methods and material. An institution-based cross-sectional study was undertaken in Wolaita Zone Public hospitals from December 12 2023 to January 12 2024, G.C. Study subjects were randomly selected through systematic sampling method. Data were gathered by structured questionnaire, entered into Epidata 4.6 and transferred to SPSS 23 for analysis. An adjusted odds ratio (AOR) along with a 95% confidence interval at a P < .05 was used to declare significance level. Results. This study found that 71.5% of children were vaccinated timely. Time to reach the health facility, place of delivery, ANC follow-up, attitude, and knowledge of women, significantly attributed to timely vaccination. Conclusion. About 71.5% of study participants vaccinated their children on the national recommended vaccination schedule. Highly strategic interventions should be taken in improving timely vaccination and identified factors.
Institutional experience, formal institutional quality, and firm performance: An analysis of firms from the European Union
Authors: Oliveira Alexandre , Carvalho Fernando , Reis Nuno Rosa
Published: November 2024

Firms’ success depends on their ability to deal with formal institutional quality. Specifically, firms exposed to a diversified set of institutional profiles can achieve institutional competitive advantage that provides firms with diverse knowledge and broader learning opportunities. While prior studies argued that being exposed to a diversified set of institutional profiles negatively influences firms because institutional knowledge can only be replicated in similar institutional profiles, they missed the point of learning from diversity. The purpose of this study is to further understand how firms’ institutional experience moderates the relationship between formal institutional quality and firms’ performance. We argue that firms with higher and more diverse institutional experience will adapt more efficiently to formal institutional quality, thus improving firms’ performance. We test the hypotheses on 4,011 publicly traded firms from the European Union between 2010 and 2021, and our results show that firms that develop higher institutional experience are better able to efficiently adapt to and leverage formal institutional quality and achieve higher firm performance. We contribute to the ongoing discussion on how formal institutions influence firms’ performance by acknowledging the importance of developing a diversified institutional experience.

JEL CLASSIFICATION: F23
Futility of dialysis in patients with tumor lysis syndrome in advanced hematological malignancy: A case series
Authors: Golbus Ashley L , Teruel Benjamin , McMahon Blaithin A
Published: November 2024

Introduction:

Type-B lactic acidosis and tumor lysis syndrome (TLS) can occur in patients with advanced hematological malignancies. In these patients, TLS can lead to an acute kidney injury (AKI) as hyperuricemia and hyperphosphatemia cause crystal nephropathy. Patients with this presentation are frequently started on dialysis. However, it is rare for patients to present with the constellation of hematological malignancy, type-B lactic acidosis, TLS, and AKI, and there is a lack of data on dialysis outcomes in these complex patients.

Methods:

We performed a single-center retrospective study at the Medical University of South Carolina, using the TriNetX search to identify adult patients presenting with hematological malignancy, type-B lactic acidosis, TLS, and AKI. After applying exclusion criteria, we identified 10 patients.

Results:

Nine patients had a stage 3 AKI and one patient had a stage 2 AKI. Dialysis was initiated in 70% of patients. The median time from TLS diagnosis to initiation of dialysis was 1 day and the median duration of dialysis was 2 days. Death occurred in 100% of patients within 12 months. The median time from onset of TLS to death was 4.5 days. There was no statistically significant difference in time to death between the dialysis and no dialysis groups ( p = 0.373).

Discussion:

The mortality rate and short time to death despite treatment optimization suggest that in patients with an underlying hematological malignancy, presentation with the constellation of type-B lactic acidosis, TLS, and AKI is an indicator of poor prognosis. Larger, well-designed studies are needed to determine the utility of dialysis in these patients.