bluuebunny/crossref_metadata_2025 huggingface dataset:
Managing cystic fibrosis alongside children’s schooling: Family, nurse and teacher perspectives
Authors: Gathercole Katie
Published: December 2018

The treatment regimen for children with cystic fibrosis (CF) is vast and is usually undertaken in the family home. Managing CF coincides with other important family routines such as children’s participation in education. There is a dearth of research that considers family routines that may influence, and be influenced by how CF is managed. To address this gap, this patient-led study examined how families manage CF alongside children’s education in England. Semi-structured interviews were conducted with 14 participants comprising 5 children and young people with CF, 4 parents, 2 CF nurse specialists and 3 teachers. The results revealed that CF routines were organized to minimize disruption to education, although families experienced challenges in meeting all daily health and education demands. Families chose between children doing their treatments or participating in school activities when doing both were not feasible. Treatments were sometimes a barrier to education participation and children’s learning. Families found treatment routines restrictive upon children’s friendships. Education is a priority for families, which affects how they manage CF. CF clinical teams should consider bidirectional influences between important family routines and families’ management of CF, when planning appropriate treatment regimens.
Reflexive secularization? Concepts, processes and antagonisms of postsecularity
Authors: Beaumont Justin , Eder Klaus , Mendieta Eduardo
Published: December 2018

This article deals with the concepts, processes, and antagonisms that are associated with the notion of postsecularity. In light of this article’s expanded interpretation of José Casanova on the secular and secularization, as well as thoughts on James A. Beckford’s take on public religions, five rubrics on the postsecular derived from critical theory and an understanding of ‘reflexive secularization’ are presented. This term focuses on secularization processes and how these practices unleash complementary as well as antagonistic tendencies, a confrontation of normativities and specific social-empirical challenges. From this basis it is argued that social-empirical analysis should focus on non-naturalistic relations between individuals occupying structurally equivalent positions in narrative networks. A plurality of normativities are seriously considered as ideas circulating through social relations where the critical competence of the participants of such communication processes are provoked to subvert anything – including any normative positionality – as taken for granted. Moves towards the decolonization of the secular/postsecular dyad are emphasized, with ramifications for thinking about the urban, which point to the universal and authentic foundations of the human condition that are brought into play.
(Un)troubling identity politics: A cultural materialist intervention
Authors: Moran Marie
Published: December 2018

This article draws on the cultural materialist paradigm articulated by Raymond Williams to offer a radical historicization of the idea of identity, with a view to clarifying and resolving some of the issues animating the ‘identity politics’ debates currently dividing left academia and activism. First, it offers clarity on the concept ‘identity politics’, demonstrating that we should reserve the term to refer only to politics that mobilize specifically and meaningfully around the concept of identity. Second, and in virtue of this, it provides new insights into five central questions that have driven the identity politics debates: Do identity politics always tend towards essentialism?; Do identity politics inevitably promote a politics of recognition over redistribution?; Do identity politics inevitably create political cleavages rather than solidaristic forms of political action?; What is the relationship between ‘identity politics’ and ‘call-out culture’?; And, are the problems of identity politics resolved by reference to intersectionality?
Intelligent computing for Duffing-Harmonic oscillator equation via the bio-evolutionary optimization algorithm
Authors: Khan Najeeb Alam , Hameed Tooba , Razzaq Oyoon A , Ayaz Muhammad
Published: December 2018

This paper presents a bio-evolutionary metaheuristic approach to study the harmonically oscillating behavior of the Duffing equation. The proposed methodology is an amalgamation of the artificial neural network with the firefly algorithm. A novelty in the activation of neurons of artificial neural network is described using the cosine function with the angular frequency. Chronologically, artificial neural network approximates discretizes the nonlinear functions of the governing problem, which then undergoes an optimization process by the firefly algorithm that then later generates the effective values of the unknown parameters. Generally, the algorithm and implementation of the scheme are assimilated by considering an application of Duffing-harmonic oscillator. Some error measurements, in order to discuss the convergence and accuracy of the scheme, are also visualized through tables and graphs. An effective optimized relationship between the angular frequency and amplitude is derived and its results are depicted in a tabular form. The comparison of the proposed methodology is also deliberated by homotopy perturbation method. Moreover, the geometrical illustration of the trajectories of the dynamic system is also added in the phase plane for different values of amplitude and angular frequency.
New approach based on operational strain modal analysis to identify dynamical properties of the high-speed reciprocating operation mechanism
Authors: Jiang Xuchu , Li Bin , Mao Xinyong , Peng Yili , He Songping
Published: December 2018

A high-speed reciprocating operating mechanism with fast running and frequent stopping produces a certain vibration due to inertia. The inherent vibration of this mechanism becomes a key factor affecting positioning accuracy and time. However, the existing vibration identification method is suitable only for static or low-speed structure operations. Therefore, a method of identification for operational modal parameters based on strain response is proposed. This method combines the strain mode with the operational modal analysis method, both of which are verified under the static and operational states, respectively. First, the theoretical background of the identification method is derived. Next, the proposed approach is used to identify the displacement mode shapes and the strain mode shapes of the beam structure with modal parameters that are obtained by experimental modal analysis. These results show that the beam structure presents different displacement mode shapes and strain mode shapes under different constraints. Finally, the displacement mode shapes of the sorting arm are obtained by the method under operation. The recognition results are compared with the computational modal analysis, and the two mode shapes are found to be highly consistent, which verifies that the method is equally reliable during operation. This method expands the application scope of the classic experimental modal analysis and reduces the error because of the additional mass of the actual sensor.
The morality of lying to my grandparent with dementia
Authors: Miron Anca M , Ebert Alexandria R , Hodel Amy E
Published: December 2018

We used a morality of care perspective to examine how grandchildren cope with having to deceive or lie to their grandparent with dementia. Data from interviews with 13 young adults were analyzed using interpretative phenomenological analysis. We found that a moral orientation shift toward a person-centered morality of care occurs gradually. Grandchildren struggle with concepts of moral goodness, importance of close others, and questions about self as a moral agent. We uncovered three antecedents of this shift (severity of dementia symptoms, valuing of the grandparent’s welfare, and valuing of the relationship) and three outcomes (transformation of moral self, changed relationship with the grandparent, and changed family relationships). Implications of a morality of care in intergenerational dementia relationships are discussed.
Short- and Midterm Outcomes of Open Repair and Fenestrated Endografting of Pararenal Aortic Aneurysms in a Concurrent Propensity-Adjusted Comparison
Authors: Fiorucci Beatrice , Speziale Francesco , Kölbel Tilo , Tsilimparis Nikolaos , Sirignano Pasqualino , Capoccia Laura , Simonte Gioele , Verzini Fabio
Published: December 2018

Purpose: To compare outcomes of patients treated for pararenal aortic aneurysms using fenestrated endovascular aneurysm repair (fEVAR) vs open surgical repair (OSR) in 3 high-volume centers. Materials and Methods: A multicenter retrospective analysis was conducted of 200 pararenal abdominal aortic aneurysm patients electively treated with OSR (n=108) or fEVAR (n=92) from 1998 to 2015 at 3 tertiary institutions. Endpoints were 30-day morbidity and mortality, late reinterventions, visceral artery occlusion, and mortality. Analysis was conducted on the entire population and on a propensity score–matched population constructed on age, gender, coronary artery disease (CAD), and chronic renal failure. Results: In the total cohort, fEVAR patients were significantly (p<0.001) older and had higher frequencies of CAD (p<0.001) and previous stroke (p=0.003). OSR patients had higher risk of perioperative morbidity (OR 2.5, 95% CI 1.09 to 5.71, p=0.033), specifically respiratory failure (OR 4.06, 95% CI 1.12 to 4.72, p=0.034). These findings were confirmed in the propensity-adjusted analysis, where cardiac complications were also higher after OSR (OR 12.8, 95% CI 0.07 to 0.21, p=0.02). No difference in perioperative mortality (2.2% in fEVAR vs 1.9% in OSR) was identified. Mean follow-up was 50 months (range 0–119). Four-year results showed higher survival (91.2% vs 69.3%, p=0.02) and freedom from reintervention (95.6% vs 77.8%, p=0.01) after OSR in the unmatched population, with a small but significant (p=0.021) difference in the risk of late visceral artery occlusion/stenosis after fEVAR. On propensity analysis, no differences in late survival were found between groups. Conclusion: fEVAR and OSR may afford similar early and midterm survival rates. Higher risks of perioperative systemic complications after OSR are counterbalanced by higher risks of late visceral vessel patency issues and need for reintervention after fEVAR. Both procedures are safe and effective in the long term in experienced centers, where patient evaluation should drive the treatment strategy.
Hybrid Foot Vein Arterialization in No-Option Patients With Critical Limb Ischemia: A Preliminary Report
Authors: Ferraresi Roberto , Casini Andrea , Losurdo Fabrizio , Caminiti Maurizio , Ucci Alessandro , Longhi Matteo , Schreve Michiel , Lichtenberg Michael , Kum Steven , Clerici Giacomo
Published: December 2018

Purpose: To describe a preliminary experience in treating no-option critical limb ischemia (CLI) patients with a hybrid foot vein arterialization (HFVA) technique combining open plus endovascular approaches. Materials and Methods: Between May 2016 and January 2018, 35 consecutive patients (mean age 68±12 years; 28 men) with 36 no-option CLI limbs underwent HFVA in our center. All limbs had grade 3 WIfI (Wound, Ischemia, and foot Infection) ischemia, and the wound classification was grade 1 in 4 (11%) limbs, grade 2 in 4 (11%), and grade 3 in 28 (78%). Surgical bypass was done on the medial marginal vein or a posterior tibial vein, followed by endovascular removal of foot vein valves and embolization of foot vein collaterals. A “tension-free” surgical approach was used to treat foot lesions. Results: At a mean follow-up of 10.8±2 months, limb salvage was achieved in 25 (69%) limbs and wound healing in 16 (44%); 9 patients presented an unhealed wound. Eleven (31%) patients underwent a major amputation (2 below the knee and 9 thigh). One patient with an unhealed wound and open bypass died of myocardial infarction. Conclusion: HFVA is a promising technique able to achieve acceptable rates of limb salvage and wound healing in no-option patients generally considered candidates for an impending major amputation. Further studies are needed to standardize the technique and better identify patients who can benefit from this approach.
Universal Screening Methods and Models: Diagnostic Accuracy of Reading Assessments
Authors: VanMeveren Kalie , Hulac David , Wollersheim-Shervey Sarah
Published: December 2018

Reading screening assessments help educators identify students who are at risk of reading and determine the need for intervention and supports. However, some schools screen and assess students more often than needed, and the additional information does not improve the accuracy of decisions. This may be especially true for students at the upper elementary grades who have already taken high-stakes tests. This exploratory study evaluated how accurately a variety of screening measures predicted performance on a high-stakes end of year test for fourth- and fifth-grade students. Results of this study indicated that previous scores on the statewide assessment and computer-adaptive assessment best predicted student performance on a high-stakes reading test (Minnesota Comprehensive Assessment—Third Edition). When comparing screening models, a two-gate approach appeared to be the best method for identifying student risk.
Immediate Lower Extremity Reconstruction Using an Anterolateral Thigh Free Flap With Simultaneous Interposition Graft of Descending Branches of Lateral Circumflex Femoral Vessels
Authors: Lim Joonho , Kwon Heeyeon , Lee Kyoung Min , Pak Changsik
Published: December 2018

In a severely injured leg with acute limb ischemia, both immediate revascularization of an endangered part and coverage of soft tissue defect are crucial to limb salvage. In this article, we report a case of an anterolateral thigh free flap with interposition graft of descending branches of the lateral circumflex femoral vessels. A 18-cm-long graft was harvested and used to replace the injured anterior tibial vessels. One month later, a duplex sonogram revealed intact circulation to both the interposition graft and the flap. Despite anatomic inconstancy, the anterolateral thigh free flap is commonly utilized in reconstructive surgeries. When descending branches of the lateral femoral circumflex vessels were included sufficiently, its pedicle can be used to bridge a vascular defect in the extremity while covering soft tissue defect.
The Jonas Hypertension Program: An Academic–Community Partnership to Address Hypertension in Four Dominican Bateyes
Authors: Conley Tammie , Enriquez Maithe , Cheng An-Lin , Jorge Dorcas , Meristal Sandy Yan , Coe Benjamin , Logan Pamela R. , Stiles Steven , Beall Ginny , Biggs Alfred , McKinsey David S.
Published: December 2018

Introduction:

Adults living in bateyes (i.e., sugarcane plantation villages) in the Dominican Republic have minimal access to health care services. Hypertension (HTN) is a serious and often unrecognized health problem among batey residents. The Jonas Batey Hypertension Program was built on existing social networks to address the detection and treatment of HTN.

Methods:

An ongoing community-based participatory research endeavor involves a partnership among three organizations and collaboration with promotoras who engage their batey communities in a mobile HTN screening and treatment program. Adults are screened and, if indicated, are treated with antihypertensive medications. Data collection includes project documentation, participant observation, demographic data, blood pressure (BP) measurements, and pill counts.

Results:

To date, 243 adults have received HTN treatment in four batey communities. A within-group, as-treated, repeated-measures, pre-/postanalysis showed that among participants who had been receiving antihypertensive treatment for 12 months ( n = 70), there was a significant decrease in BP ( p < .005).

Conclusion:

Results of an interim data analysis indicate that the program model has been implemented successfully and is making a positive impact on BP control. Evaluation is ongoing with regard to the long-term HTN-related health outcomes of batey residents. Ensuring program sustainability is an important consideration for the future.
Effects of Game Characteristics and Player Positions on Concussion Incidence and Severity in Professional Football
Authors: Dai Jennifer B. , Li Adam Y. , Haider Syed F. , Tomaselli Raechel , Gometz Alex , Sobotka Stanislaw , Post Alexander F. , Adams Ryan , Maniya Akbar Y. , Lau George K. , Kaye-Kauderer Halley P. , Lovell Mark R. , Choudhri Tanvir F.
Published: December 2018

Background:

Increasing efforts have been made to reduce the incidence and severity of concussion in high-contact sports. Despite these efforts, a relative lack of knowledge is available regarding modulating factors affecting concussion injury.

Purpose:

To analyze the potential influence of game characteristics and outcomes on concussion incidence and severity in professional football.

Study Design:

Descriptive epidemiology study.

Methods:

PBS Frontline Concussion Watch was used to collect concussion injury data from regular-season games of 32 National Football League (NFL) teams from 2012 to 2015. Game characteristic variables such as rushing and passing attempts, turnovers, and margin of victory were collected from ESPN. Analysis included descriptive statistics, analysis of variance, t tests, and correlation tests.

Results:

Away teams demonstrated a significantly greater concussion incidence per game than home teams. Losing teams had a significantly greater concussion incidence per game than winning teams. Being both the away team and the losing team appeared to have an additive effect. The home-versus-away and win-versus-loss effects were significant for offensive but not defensive positions. Within individual positions, significantly greater concussion incidence was associated with tight ends, running backs, wide receivers, and cornerbacks. When running versus passing positions were compared, passing positions (wide receiver, tight end, cornerback, safety) had significantly greater concussion incidence. A total of 626 games were missed as a result of reported concussions. Away teams had significantly more games missed due to concussion when they lost. Play time did not significantly differ before or after concussion injury. Other game characteristic variables did not significantly affect concussion frequency or intensity.

Conclusion:

Position, game location, and game outcome affect concussion incidence for professional football players. In a subset of analyses, the number of games missed aligned with concussion incidence, but this appeared to be an imperfect measure. These findings highlight new factors that may modulate concussion incidence and merit further study on how they may influence concussion evaluation.
Reconstruction of the Middle Patelofemoral Ligament with Quadricipital Autoinjerto and Use of the 3D Preoperative TAC to establish Femoral Anatomic Point
Authors: Córdoba Camilo Hernández
Published: December 2018

Objectives:

In recent years, the reconstruction of the LPFM has gained importance. The most used technique is with autograft of hamstring tendons. In some series, reports of complications are greater than 26%. This work aims to demonstrate the utility of the quadriceps autograft for the reconstruction of the LPFM, without patellar tunnels and without the use of intraoperative fluoroscopy.

Methods:

Patients with a clinical history of at least two episodes of dislocation were included. Radiographic series, axial CT, patellae, 3D CT and MRI were taken in all patients. 24 patients, 16 women and 8 men, with an average age of 23 years, met the selection criteria.

Results:

In our study we observed the improvement of scores on the scales of Lysholm, Tegner and Kujala in the postoperative period with controls at 6, 12 and 18 months. No new episodes of patellar dislocation or other relevant complications. There was a return in all cases to sports activity.

Conclusion:

This study reaffirms that the quadriceps tendon is a graft that reproduces better the anatomy of the LPFM, presents figures comparable or better functionally with the other grafts used at present. With the preoperative protocol of TAC3D, the adductor and medial epicondyle tubules have been identified individually and with the anatomical specificity of each patient, giving greater certainty in the anatomical location of the LPFM femoral insert. With the additional advantages of decreasing surgical time, and avoiding unnecessary radiation in the surgical team.
Patellar dislocation: osteochondral graft of patella and medial patellofemoral ligament reconstruction
Authors: Nardin Lisandro , Savá Matías , Calvet Oscar , Mercier Fernando , Barck Abel , Aparicio José Luis
Published: December 2018

Objectives:

The incidence of acute femoro-patellar luxation is 6/100000 persons for year. This injury is common among young patients with predominance in women. It has high levels of recurrence (40%) after the first injury. The objective of our study is to assess post-surgical results in patients with relapsing patellar dislocation, after a reconstruction of Medial Patellofemoral Ligament (MPFL) with semitendinous autologous graft associated with autologous osteochondral transplant of patella.

Methods:

An observational descriptive study (cases serie) with a restrospective transversal cross section was carried out. Six male patients that were treated between March 2014 and March 2016 were evaluated. They were monitored / followed up in an average of 24 months. The functional subjective results were assessed following Kujala patellofemoral pain score.

Results:

Out of the six patients, all of them were male, with an average age of 19. They were followed-up for an average of 24 months. The results of the Kujala score were 86 points in the posoperative period.

Conclusion:

The reconstruction of Medial Patellofemoral Ligament (MPFL) with semitendinous autologous graft associated with autologous osteochondral transplant of patella has show excellent short and long-term clinical results with return of patients to their usual normal activities.
Vancomycin presoaking of hamstring grafts removes the risk of infection in primary anterior cruciate ligament reconstruction
Authors: Figueroa Francisco , Figueroa David , Calvo Rafael , Vaisman Alex , López Mario , Goñi Ignacio
Published: December 2018

Background:

Several strategies have been studied to decrease the rate of infection after hamstring autograft anterior cruciate ligament (ACL) reconstruction. Our group started presoaking grafts with Vancomycin in November 2015 to decrease this risk.

Purpose:

The objective of the study is to compare the success of this protocol against the immediate previous period in which we did not use the protocol.

Study design:

Retrospective cohort. Level III.

Methods:

Consecutive periods were studied: April 2013-October 2015 (pre Vancomycin protocol) and November 2015- May 2018 (Vancomycin protocol). All patients that underwent a hamstring autograft primary ACL reconstruction during the periods studied were included. The final outcome was the presence of postoperative septic arthritis in both groups. Diagnosis of septic arthritis was made using the clinical picture plus cytological analysis of a joint aspiration (cell count > 50.000/uL + > 90% neutrophils) Statistical analysis was made using the Fisher’s exact test. Significance was set in p < 0.05.

Results:

490 patients were included in the study, 230 in the pre Vancomycin protocol an 260 in the Vancomycin protocol. 4 postoperative septic arthritis were noted in the pre Vancomycin protocol (1.7%) while no septic arthritis was noted in the post Vancomycin protocol patients during the period studied. (p < 0.05) The 4 postoperative infections were presented at an average 21.7 days (range 16-25). Staphylococcus epidermidis was isolated in 2 of the cases, and in the other 2 no organism was isolated.

Conclusion:

Vancomycin presoaking of hamstring autografts in primary ACL reconstruction eliminated the risk of postoperative septic arthritis during the studied period compared to the immediate previous period, where no Vancomycin presoaking was used.
Endoscopic Carpal Tunnel Release: Results and Complications in 126 cases
Authors: Pereira Enrique , Argüelles Santiago , Rodriguez Martin , Soutullo Jorge , Santos Gustavo , Gelo Melania
Published: December 2018

Objectives:

To report the results and complications of a two portal endoscopic carpal tunnel release (ECTR) with the use of a clear tube for assessing the quality of decompression of the median nerve.

Methods:

Retrospective analysis of 126 consecutive cases (126 patients) where a two portal ECTR was performed. The demographic and physical examination data were obtained from the medical history. For evaluation, the preoperative and postoperative Quick DASH and the Boston Questionnaire were used and the complications were recorded.

Results:

The Quick DASH average was 33.7 preoperative (SD 11.05) and 6.8 postoperative (SD 6.44) P<0.001. The Boston Questionnaire´s median average was 1.24 (SD 0.26) for symptoms and 1.18 (SD 0.22) for function. We recorded seven minor complications (5.5%): two cases of transient hypoesthesia and a permanent one of the third web space, three cases of superficial infection, and one case of postoperative neuropathic pain. No major complications or reoperations were documented.

Conclusion:

Two portal ECTR with the use of a clear tube for assessing the quality of decompression is a safe, effective, predictable and reproducible technique for treatment of idiopathic carpal tunnel syndrome. The complication rate is low when performed by a trained surgeon
Spontaneous Healing in complete ACL ruptures: results at eight-year mean follow-up
Authors: Costa-Paz Matias , Garcia-Mansilla Ignacio , Ayerza Miguel , Muscolo D. Luis
Published: December 2018

Objectives:

The injured anterior cruciate ligament (ACL) has a limited healing capacity leading to persisting instability. Although several studies have reported spontaneous healing of torn ACLs, it is difficult to determine its healing potential and whether patients will be able to return to sports activities. In 2011, we published a series of 14 patients with spontaneous healing following a complete ACL rupture, the mean follow up was 30 months (range 25-36 months). The purpose of this study was to evaluate the long-term results of spontaneous healing in complete ACL ruptures in the same group of patients.

Methods:

We retrospectively reviewed a cohort of 14 patients with acute ACL injury established by physical examination and MRI (proximal third in eight patients and the midligament in six). Twelve patients were male and average age at injury was 31 years (range, 23-41 years), All patients were athletically active before the injury and suffered the lesion during a sport activity. Surgery was indicated in all patients, but it was postponed for different reasons, including related labor problems, need to travel, illnesses, planned holidays, and the patient’s personal decision not to undergo surgery. Most of the patients let the injury run its course with no bracing and unspecific rehabilitation protocol. The primary outcomes of this study were rerupture rate and time between injury and surgery.

Results:

Twelve patients out of 14 were reevaluated (86%), with a mean follow up of 8 years (3-14). Ten were men, with a mean age of 38 years (range, 25-51 years). Five patients had an ACL reconstruction during follow-up, with a mean time between injury and surgery of 5 years (range 3-14). Initial injury was located in the proximal third in two patients and in the midligament in three.

Conclusion:

Although favorable initial evolution at 30 months after a complete ACL lesion, our series show a re-rupture rate or “scar tissue” rupture of 40% at a mean follow-up of 8 years.
Nonsurgical treatment of partial ACL tears: intraarticular injection of Platelet-rich plasma did not change the progression rate to knee instability
Authors: Zicaro Juan Pablo , Yacuzzi Carlos , Garcia-Mansilla Ignacio , Costa-Paz Matias
Published: December 2018

Objective

Diagnosis and treatment of partial tears of the ACL remains controversial. Patients that present a hard end positive Lachman and negative pivot shift in the context of a partial tear in the magnetic resonance imaging (MRI) have a healing potential that could avoid surgery. Platelet-Rich-Plasma (PRP) provides certain growth factors that could improve healing and therefore, clinical outcomes after partial ACL tears. The aim of this study was to report the results of autologous intraarticular PRP injection in patients with partial ACL tears.

Methods

Prospective cohort of patients between 2015 and 2017 with acute ACL partial tear, treated either with autologous PRP therapy combined with a rehabilitation protocol (group 1) or rehabilitation alone (group 2). The primary outcome was to evaluate return to sports and recurrent knee instability requiring surgery. We performed pre and postoperative subjective evaluation using Tegner, IKDC and Lysholm scores and an objective evaluation using KT1000 arthrometer. and return-to-sports were performed. An MRI was performed at 6 months. Platelets and leukocyte concentration in PRP preparation was analyzed

Results

A total of 40 patients were included in this study, 21 in group 1 and 19 in group 2. Median age was 26 yeas (IQR 22-35), 85% (n=34) were men with a median follow up of 12 months (IQR 8–15). Eighteen patients (85%) in group 1 and 15 (79%) patients in group 2 were Tegner 7 or above. All patients returned to sports at a mean of 3.8 months in group 1 and 4.2 months in group 2. Five (23,8%) patients in group 1 (1 proximal and 4 mid-third lesions) and four (21%) in group 2 (3 proximal and 1 mid-third lesion) failed and had an ACL reconstruction because of knee instability ( p 0.99). All after a new sport trauma. Lysholm score improved from 62 (SD 20) to 70 (SD 24) in group one and from 67 (SD 14) to 74 (SD 16) in group 2. IKDC score improved from 51 (SD 11) to 68 (SD 19) in group 1 and from 55 (SD 17) to 69 (SD 9) in group 2. Side-to-side difference in arthrometric KT1000 evaluation was less than 3 mm in 80% of patients that did not fail. In MRI studies, twenty-two (55%) had a proximal ACL lesion and eighteen (45%) a mid-substance ACL lesion. Fifteen (71%) patients in group 1 and twelve (63%) in group 2 presented an improvement in signal intensity at 6 months. The platelet concentration was 478% and the leukocyte concentration was 9% in relation to the patient´s baseline serum concentration.

Conclusion

Return to sports after a partial ACL tear was similar in both groups. Almost 25% of patients progressed to knee instability, without significant differences between those treated or not with an intra-articular PRP injection. Longer follow-up is required before any conclusions.
Similar results for revision ACL with and without a lateral extra-articular reconstruction. A prospective evaluation
Authors: Zicaro Juan Pablo , Yacuzzi Carlos , Garcia-Mansilla Ignacio , Costa-Paz Matias
Published: December 2018

Objectives

Lateral extra-articular augmentation procedure (LEAP) has been proposed as an additional technique in the setting of revision ACL Reconstruction (ACLR). Few case series have been reported. The purpose of this study was to compare the clinical results and return to sports of a consecutive series of patients treated for revision ACLR with and without a LEAP.

Methods

We prospectively evaluated a series of patients treated for isolated revision ACL between 2014 and 2015 (group 1) and revision ACL associated with a LEAP from 2015 to 2016 (group 2). We analyzed the surgical technique and graft used for primary and revision ACL and for the LEAP. All patients were evaluated at one-year follow-up with Lysholm score and IKDC evaluation, return to sports and MRI evaluation.

Results

Thirty-six patients were evaluated, eighteen patients in each group. For the revision ACL procedures, 14 autografts and 4 allografts were used in group 1 and 16 autografts and 2 allografts in group 2. For the LEAP, in 13 cases we performed a lateral tenodesis using ilio-tibial band and in 5 patients we used allograft. The mean age was 32 years (SD 8,5) for group 1 and 28,4 (SD 6,5) for group 2. In group 1, the median Lysholm and IKDC scale was 90 (IQR 27) and 80 (IQR 40) respectively, and in group 2 the median was 90 (IQR 48) and 67,5 (IQR 33) respectively. The difference for IKDC was statistically significant (p=0,000). Eight patients return to sports in group 1 and seven in group 2. The MRI shown and homogeneous neoligament in 66% of patients in group 1 and 61% in group 2.

Conclusion

Despite there was a statistically significant difference in IKDC results in favor of group 2, we found no differences in return to sports, Lysholm score and MRI imaging when a LEAP was associated at one year follow-up.
Autologous Collagen-Induced Chondrogenesis: clinical outcomes at minimum two-years follow-up
Authors: Costa-Paz Matías , Zícaro Juan Pablo , Rómoli Agustín Molina , Yacuzzi Carlos
Published: December 2018

Objectives:

Different surgical approaches are currently available to treat knee chondral defects. The technique used in this article combines microfractures with the use of an injectable atelocollagen matrix (Cartifill®). The matrix covers the defect and improves the mechanical stability of the blood clot and maintains the chondrogenic progenitor cells and growth factors in the defective area. The aim of our study is to evaluate and describe the results in a series of patients treated with atelocollagen matrix and microfractures.

Methods:

All patients treated with atelocollagen matrix due to a cartilage lesion with a minimum follow-up of 24 months were evaluated. Patients undergoing associated surgeries (osteotomies, meniscectomies, mosaicplasty, ligament reconstruction) in the same surgical procedure were included in the study. Clinical function was assessed before and after surgery with the International Knee Documentation Committee (IKDC), the Lysholm score and the Visual Analogue Scale (VAS). Radiographic and magnetic resonance control were requested according to availability.

Results:

Twelve patients met the inclusion criteria. Three women. Average age of 50 years. Eight applications in medial condyle, 2 in lateral condyle and 4 in trochlea. One post-operative arthrofibrosis was recorded. One of the patients underwent an articular replacement of his knee 10 months after the surgery with finalization of follow-up. The pre / post-operative average was 39/52 (IKDC), 37/76 (Lysholm) and 8.5 / 3.5 (VAS).

Conclusion:

In our series, atelocollagen matrix combined with microfractures improved the clinical symptoms of patients with severe knee articular cartilage injury. However, a better selection of patients who require this procedure should be applied in future interventions.
Meniscal Allograft Transplantation: results at 6-year Mean Follow-up
Authors: Costa-Paz Matías , Yacuzzi Carlos , De-Cicco Franco Luis , Theaux Juan Ignacio , Zicaro Juan Pablo , Ayerza Miguel
Published: December 2018

Objectives

The purpose of this study was to evaluate the clinical and imaging results in a series of patients who underwent a meniscal allograft transplant (MAT).

Methods

A retrospective study was performed. The International Knee Documentation Committee (IKDC) score, Lysholm score, and physical examinations were reviewed to measure clinical outcomes after MAT. Osteoarthritic changes were assessed by Plain radiography according to Kellgren-Lawrence (KL) classification and meniscal extrusion by magnetic resonance imaging (MRI). Surgical technique and related procedures were analyzed. Complications were registered. The minimum follow-up was 2 years.

Results

Surgeries were performed in 41 patients, 36 fulfilled the inclusion criteria. Twenty-five were male and 11 women. The mean age was 35 years old (SD 8). The mean follow-up was 71 months (range 24 to 184). The mean time between meniscectomy and meniscal transplant was 12.8 years (SD 6,7). Twenty-three were lateral menisci. The following related procedures were performed: Seven ACL reconstructions, 3 ACL revisions, 19 mosaicplasties and 3 osteotomies. The mean preoperative results of IKDC and Lysholm scores were 30.3 (SD 15.5) and 43.8 (SD 16.8) respectively and postoperative results were 78.8 (SD 21.1) and 61.1 (SD 15) respectively. There were no significative radiographic changes at the end of the follow-up. Mean KL preoperative was 2 (IQR 1) and last follow up was 2 (IQR 1) p= 0.053. Preoperative KL grade 1: 33%, grade 2: 50% and grade 3: 17% and last follow up KL grade 1: 22%, grade 2 56% and grade 3 22%. The average percentage of extruded meniscus was 53% in 22 patients evaluated with MR (range 19% to 100%). Five presented arthrofibrosis that required mobilization under anesthesia and partial meniscectomy of the MAT was required in 6 patients. Two transplants failed.

Conclusion

Although 53% of meniscal extrusion was observed in the MR, we found no correlation with clinical outcomes. MAT achieved good clinical results without osteoarthritic changes after a mean of 6-years follow-up, with 5% of failure. MAT appears to be a safe and effective treatment, which should be considered as a suitable option in the clinical practice.
Meniscal Repair: Failure rate and clinical outcomes with minimum two years follow-up
Authors: Zicaro Juan Pablo , Yacuzzi Carlos , Garrido Nicolas , Garcia-Mansilla Ignacio , Costa-Paz Matias
Published: December 2018

Objectives

The purpose of our study was to evaluate the clinical outcomes and failure rate of a series of patients who underwent meniscal repair with a minimum two-years of follow-up.

Methods

We retrospectively reviewed patients treated with meniscal repair between 2004 and 2016. We included patients with at least 2 years of follow-up. Surgical details such as the affected menisci, type of rupture and meniscal repair technique used were analyzed. Clinical and functional outcomes were evaluated using Lysholm and IKDC scores. Patients were studied with x-rays and magnetic resonance imaging (MRI). We analyzed the failure rate (defined as a re-rupture that required surgery). We compared failure rate for isolated meniscal repair vs associated with Anterior cruciate ligament reconstruction (ACLR). Also we compared patients operated before and after 2014.

Results

One hundred sixty nine patients were operated during that period of time. Ten patients did not meet inclusion criteria and forty were lost in follow-up. Out of the 119 patients evaluated, 35 had bucket-handle lesions, 25 tears in the posterior horn treated with all inside sutures and 59 body and posterior horn lesions treated with a combined suture technique. The mean postoperative Lysholm score was 85 (SD 14) and IKDC 70 (SD 10). The mean return to sports time was 8 months (range 2-19). An MRI was performed in 71 patients. The overall failure rate was 21% (24 /119) at a mean time of 20 months (range 2-60 months) and 26% (9/35) for bucket-handle lesions at a mean time of 21 months (range 2-60 months). Failure rate for the 48 isolated lesions was 20% at a mean of 23 months and 19% for 70 associated to ACLR at a mean of 17 months (p=0.53). Isolated bucket-handle lesions had failure rate of 27% at a mean of 27 months and when associated to ACLR this was 23% at a mean of 12 months (p=1.0) Overall failure rate for patients treated before 2014 was 27% (18/67) and 12% after 2014 (6/52) (p=0.03). For bucket-handle lesions before 2014 was 36% (8/23) and 8% after 2014 (1/12) (p=0.03). Isolated bucket-handle lesions failure rate was 45% (5/11) before 2014 and 0% (0/7) after 2014 (p=0.01) and when associated to ACLR, it was 25% (3/12) before 2014 and 20% (1/5) after 2014 (p=0.09).

Conclusion

Overall failure rate of our series was 21%. We found no differences between isolated lesions and associated to ACLR. There was a statistically significant difference regarding failure rate results for those operated before and after 2014. This might be the result of an improvement in the surgical devices, modifications in the technique and the number of sutures for each procedure.
Arthoscopy partial meniscectomy: results after more than one year follow up in working compensation vs. Non-working compensation parients
Authors: Villalba Juan Francisco , Gutiérrez Daniel E. , Bennett Cristian , Hernández Emilio , Medina Daniela
Published: December 2018

Objectives:

The aim of the study was to retrospectively evaluate and compare the results of arthroscopic partial meniscectomy for meniscus tears in working compensation vs. non-working compensation patients.

Methods:

Sixty patients treated in our institution between June 2016 and May 2017 with the diagnosis of acute meniscus tears that did not respond to conservative treatment were evaluated. All lesions were diagnosed with previous MRI. There were 30 patients under working compensation insurance and 30 under another insurance system (53 men, and 7 women). The age ranged between 18 and 45 years. Thirty-six tears were located in the internal menisci and twenty-four in the external menisci. The average follow-up was 18 months. Lysholm and EVA scores were obtained.

Results:

Of the 30 non-working compensation patients, 28 evolved favorably with an improvement in the Lysholm score of 53 to 93 points and EVA of 7 to 1 points on average and returned to activity prior to the injury. Two of them continued with mild discomfort, without affecting their daily routines. In working compensation patients 14 evolved favorably, with improvement in the Lysholm score of 48 to 74 points and EVA 7 to 2 points on average and return to their usual work activity. Sixteen of them presented moderate pain with partial job return or required change of tasks.

Conclusion:

The results of partial meniscectomy in non-work-related patients were excellent to good, with 96% return to daily activities. Regarding work-related patients, regular results were obtained, with a return to their usual work activity of only 53%.
Reconstruction of medial patellofemoral ligament arthroscopically assisted: a prospective case series with short-term clinical follow-up
Authors: Jaramillo Germán A. , Luna Diego F. , Gómez Narly V. , Arias Rubén D.
Published: December 2018

The medial patellofemoral ligament (MPFL) is one of the most important anatomical structure that stabilize the patella, during its injury a repetitive dislocation occurs. The reconstruction of this ligament, it seeks to avoid the recurrence of these episodes, for which there are various surgical techniques, one of these the arthroscopy, it can reduce adverse events of the procedure. The aim of this study is to describe the clinical follow-up of patients who had a reconstruction of the MPFL arthroscopically assisted. This is a prospective case series carried out in two hospitals of Medellín city, between 2010 and 2016. For the clinical follow-up, Lysholm, Kujala and Tegner knee scores were performed before and 12 months after the surgical procedure. Were applied Shapiro Wilk tests to evaluate normality and T-student to compare the results of the scores. We follow fifteen patients, 16 reconstructions of MPFL, of these 12 were female. The average time between the first dislocation and surgery was 12 months. Statistically significant differences were found when comparing the three scores before and after surgery (p= <0.05). Most patients improved pain and no patient required reoperation in the follow-up period. The reconstruction of MPFL arthroscopically assisted is a minimal access method that allows identifying the anatomical insertions of the MPFL, and is a safe technique that causes low morbidity and satisfactory clinical evolution of the patients.
Comparative results between two femoral fixation methods in hamstring graft anterior cruciate ligament reconstruction
Authors: Abalo Eduardo , Mallea Andrés , Previgliano Juan Pablo , Pinotti Norberto
Published: December 2018

Introduction:

Femoral graft fixation in the anterior cruciate ligament reconstruction is a key factor to the success of this procedure. The aim of this study is to compare two different femoral fixation methods in the anterior cruciate ligament reconstruction.

Material and methods:

147 patients with an anterior cruciate ligament reconstruction with quadruple hamstring grafts were retrospectively analyzed. 16 were female and 131 male, average age was 26.3 years. The minimum follow-up was 12 months with an average of 62 months. Patients were divided into two groups according to the femoral graft fixation: in ninety eight patients a transverse fixation was used, and in forty nine a cortical fixation with femoral button. Tibial interference screws were used for both groups. Clinical evaluation with Lysholm Score and IKDC was performed.

Results:

Lysholm score results show no significant differences between the groups, being 94.24 points in the group with the transversal fixation system and 93.26 in the other group. According to the IKDC, 141 patients presented a normal or close to normal knee and 1 patient presented an abnormal knee. Five patients presented graft rupture (3.4%), 3 from the cortical fixation with button group (6.12%) and two with transverse fixation (2.04%).

Conclusion:

In this study, cortical button femoral fixation for autogenous hamstring ACL reconstruction had no significant difference in terms of clinical outcomes compared with suspensory transfemoral fixation.
Rotational knee instability, Extra articular technique
Authors: Lapera Miguel , Gigante Facundo , Zabala Manuel Perez , Adjigogovic Esteban , Sylvester Francisco , Abuye Hernán Fernández , Baigorria José
Published: December 2018

Objectives:

The Associated Extra-Articular Technique (AET) with Lateral Tenodesis (LT) to the current techniques of intra-articular reconstruction of the Anterior Cruciate Ligament (ACL) could potentially improve the laxity of the knee and act synergically in controlling the phenomenon of the pivot displacement in cases of severe rotational instability.

Methods:

Twenty-two consecutive patients were selected who met all the inclusion criteria and underwent reconstruction of the ACL with double bundle and AET between February 2012 and May 2013. The inclusion criteria in this study was the presence of moderate to severe rotational instability as revealed by a score of pivot test of 2 to 3 (on a scale ranging from 0 = negative, to 3 = subluxation). The least time between trauma and surgery was 3 months, and average age under 40 years old.

Results:

The mean time of follow-up was 32.4 ± 3.9 months. In all cases, the Lysholm and IKDC test scores improved significantly (p <0.0001). The differential laxity above the average was 8 ± 1.9 mm before surgery and significantly reduced to 0.7 ± 0.8 mm at the last follow-up (p <0.0001). Prior to surgery, patients had a Grade 3 Pivot Shift according to the IKDC criteria. After surgery, 15 patients had turned to a negative Pivot (Grade 0), and 7 patients were Grade 1.

Conclusion:

The lateral extra-articular reconstruction is generally used to control the internal rotation laxity of the tibia, and we are convinced that the combination of the LT with the reconstruction of the double bundle LCA would reduce the rotational translation during the pivot test.