bluuebunny/crossref_metadata_2025_split huggingface dataset:
Novel computer-based testing shows multi-domain cognitive dysfunction in patients with multiple sclerosis
Authors: Smith Andrew D , Duffy Charles , Goodman Andrew D 
Published: April 2018

Background Although cognitive dysfunction is a leading cause of disability and poor quality of life in patients with multiple sclerosis (MS), it is infrequently tested in routine clinical evaluation. Development of a cognitive testing paradigm that captured MS-related cognitive dysfunction and could be obtained in a routine clinical setting may increase surveillance and recognition of cognitive dysfunction. Objectives This was a pilot study to determine if Cognivue could find cognitive performance differences between patients with MS and healthy controls (HC). Methods: A total of 24 patients with MS and 12 HCs between 18 and 50 years old were enrolled. Baseline testing included an Expanded Disability Scale (EDSS), paced auditory serial additions test (PASAT), symbol digit modalities test (SDMT) and Cognivue. Subjects then had repeat testing every 1–2 months for a maximum of three tests. Results Significant differences were found between MS and HC on SDMT, PASAT, and Cognivue Total score. Most Cognivue subtests showed significant differences between MS and HC. Cognivue scores correlated with both SDMT and PASAT and had high test-retest reliability in HCs. Conclusion Cognivue was able to detect multi-domain cognitive dysfunction in MS. Further studies to determine validity of Cognivue in MS with comparison with neuropsychological testing and sensitivity to clinical change are still needed.
A randomised, controlled clinical trial of narrowband UVB phototherapy for clinically isolated syndrome: The PhoCIS study
Authors: Hart Prue H , Jones Anderson P , Trend Stephanie , Cha Lilian , Fabis-Pedrini Marzena J , Cooper Matthew N , d’Este Catherine , Geldenhuys Sian , Carroll William M , Byrne Scott N , Booth David R , Cole Judith M , Lucas Robyn M , Kermode Allan G 
Published: April 2018

Background The natural history of multiple sclerosis (MS) typically presents with the clinically isolated syndrome (CIS), an episode of neurological symptoms caused by central nervous system inflammation or demyelination that does not fulfil the diagnostic criteria for MS. Objective As preclinical studies have suggested that exposure to ultraviolet radiation (UVR) could regulate the development of MS, the Phototherapy for CIS (PhoCIS trial) was established to examine the effects of narrowband UVB phototherapy on patients with CIS, and their conversion to MS. Methods Of the 20 participants, half received 24 sessions of narrowband UVB exposure over eight weeks; participants in both arms were followed for 12 months. All participants were supplemented to 25-hydroxyvitamin D3 levels of >80 nmol/l. Results By 12 months, 100% of those in the no phototherapy arm and 70% in the phototherapy arm had converted to MS, although this difference was not statistically significant. Conclusion This study provides a basis for further studies to determine if there are any benefits of the therapeutic effects of narrowband UVB radiation on MS progression.
The type of approach (medial versus lateral) influences TKA component rotation in total knee arthroplasty - a clinical study using 3D-CT
Authors: Schiapparelli Filippo-Franco , Amsler Felix , Hirschmann Michael 
Published: April 2018

The purpose of this study was to investigate if the type of approach (medial parapatellar approach (MPA) versus lateral parapatellar subvastus approach with tibial tubercle osteotomy (LPA)) influences the rotation of femoral and/or tibial component and leg axis in total knee arthroplasty (TKA). This study included 200 consecutive patients in whom TKA was performed using either a parapatellar medial (n=162, MPA) or parapatellar lateral subvastus approach with tibial tubercle osteotomy (n=38, LPA). All patients underwent clinical follow-up, standardised radiographs and computed radiography (CT). TKA components’ position and the whole leg axis were assessed on 3D reconstructed CT scans (sagittal, coronal and rotational). Mean values of TKA component position and the whole leg alignment of both groups were compared using a T-test. The tibial component was graded as internally rotated (< 3° of external rotation (ER)), neutral rotation (equal or between 3° and 6° of ER) and and externally rotated (>6° ER). The femoral component was graded as internally rotated (< 3° of internal rotation (IR)), neutral rotation (equal or between -3° IR and 3° of ER) and externally rotated (>3° ER). There was no significant difference in terms of whole leg axis after TKA between both groups (MPA: 0.2° valgus ± 3.4; LPA: 0.0° valgus ± 3.5). Means of tibial component position were 2.7° ER ± 6.1 (MPA) and 7.6° ER ± 5.4 (LPA). Patients of group LPA presented a significantly less internally rotated (LPA: 18.4%; MPA: 48.8%) and more externally rotated (LPA: 52.6%; MPA: 22.8%) tibial component (p<0.001). No significant differences were seen for the femoral component position, tibial valgus/varus and tibial slope. The type of approach significantly influences the tibial TKA component rotation. It appears that a MPA tends to internally rotate the tibial TKA component and a LPA tends to externally rotate the tibial TKA.
The stem fixation technique do influence the tibial alignment in TKA revisions. A comparative study between cemented and cementless / hybrid cemented tibial stems using 3D-CT
Authors: Schiapparelli Filippo-Franco , Amsler Felix , Hirschmann Michael 
Published: April 2018

Purpose of the study was to investigate if the fixation technique for intramedullary stems in total knee arthroplasty revisions (rTKA), influence the alignment of the components, leg axis and the rates of complications, reoperations and revisions. Sixteen patients with cemented tibial stems (Group C) and twenty-six patients with either cementless or hybrid cemented tibial stems (Group PF) were collected. All patients underwent regular clinical follow-up (41.5 months) and postoperative 3D-CT scans. Mean values of the three-dimensional rTKA component position and of the leg axis were compared between groups with the T-test. The tibial components were graded on the transversal plane into internal, neutral and external rotated, and, on the coronal plane, in neutral and varus/valgus aligned. The graded measurements and the incidences of postoperative complications, reoperations and revisions were analysed with a Chi2-Test. The mean measurements of the component position did not significantly differ between groups (p < 0.05). Group C showed a tendency to internal rotation (Group C: 62.5%; Group PF: 34.6%) and a significant higher coronal alignment accuracy (p = 0.004). Group PF instead a tendency to external rotation (Group C: 25.0%; Group PF: 46.2%) (p = 0.094). Both groups presented a neutral leg alignment (Group C: 0.00° ± 3.37; Group PF: 1.04° ± 2.6) (p = 0.268). Group PF showed a tendency to more complications (Group C: 35.7%; Group PF: 60.9%; p = 0.138). No significant differences were seen between rates of reoperations (Group C: 35.7%; Group PF: 30.4%; p = 0.565) and revisions (Group C: 28.6%; Group PF: 8.7%; p = 0.894). The stem fixation technique influence the tibial component alignment. A more accurate coronal alignment was achieved in Group PF.
Experiences with an intra-articular pain catheter in approx. 3.000 TKR over a period of 6.5 years
Authors: Mai Burkhard 
Published: April 2018

The optimal pain treatment after a TKR has been under discussion for a long time. With the use of pain catheters you can save analgesics and opiates. A femoral and sciatic nerve catheter became already established. Disadvantages are a the time-consuming application of the catheter with neuro-tracer or ultrasound as well as facing possible palsy, especially of the extension muscle of the knee, which disturbs the autonomous mobility of the patients. Would it be possible to treat the postoperative pain sufficiently and preserve the active mobility of the patients by using an intraarticular pain catheter, that will not influence the muscle power, which can also be used time-sparing during TKR surgeries in combination with an external, continuous local anesthesia from a portable valve-controlled reservoir? We report on case series of our clinic from July 2010 till October 2017, which included more than 3.000 TKRs. We made use of 4 different catheter and pump systems (for example the Painbuster). The LA used was Ropivacaine. With a postoperative rate of fluid flow of 10-15 ml/h in a concentration of 3,75 mg/ml (0,375%) Ropivacaine Hydrochloride over a period of 2-3 days, we achieved a good pain reduction comparable to a femoral catheter and perfusor application of 2,0 mg/ml (0,2%) Ropivacaine. Most patients feel strong pain following a TKR due to the special vulnerability of the knee joints with large inner surface of the joint and thin soft-tissue coverage. The established pain catheters positioned beside the femoral nerve need a relative long turnover time (the time from the end of the previous surgical procedure to the beginning of the next) and have an important disadvantage of palsy of the quadriceps muscle with the risk of falling due to the immobilization of the patient. The intra-articular painbuster systems lead to excellent pain reduction and fast mobilization of the patient with full control of muscle power. The application of the catheter during the operation is not time consuming and you will not face longer turnover and surgery times.
A Tomahawk Shaped Femur is a Risk Factor for Anterior Cruciate Ligament Injury
Authors: Pfeiffer Thomas , Burnham Jeremy , Herbst Elmar , Shafizadeh Sven , Musahl Volker 
Published: April 2018

Bony morphologic characteristics have been demonstrated to increase the risk of anterior cruciate ligament (ACL) injury. The purpose of the study was to examine distal femoral morphology relative to ACL injury, reconstruction failure, and contralateral ACL injury. It was hypothesized that an increased posterior femoral condylar depth, quantified as the tomahawk ratio, would correlate with increased risk of primary ACL ruptures, ACL reconstruction failures, and contralateral ACL injuries. Consecutive patients undergoing arthroscopic knee surgery at an academic medical center from 2012-2016 with minimum 24-month follow-up were retrospectively reviewed. Subjects were stratified into four groups: a control group consisting of patients with no ACL injuries and three groups of patients with a primary ACL injury, failed ACL reconstruction, or previous ACL injury with subsequent contralateral ACL injury. Using lateral radiographs, the ratio of posterior condylar depth over total condylar distance was defined as the tomahawk ratio. Analysis-of-variance (ANOVA) and post-hoc testing were used to test for differences in the mean tomahawk ratio between study groups (p<0.05). Receiver Operating Characteristic (ROC) analysis was performed to determine the optimal tomahawk ratio cut-off for detecting increased risk for ACL injury 175 patients met inclusion criteria. The mean tomahawk ratios in the control group, primary ACL injury group, failed ACL reconstruction group, and contralateral ACL injury group were 61.1% (± 2.1), 64.2% (± 3.8), 64.4% (± 3.6), and 66.9% (± 4.0), respectively. Patients with a primary ACL injury, failed ACL reconstruction, or contralateral ACL injury had a significantly higher tomahawk ratio compared to the control group (p<0.008). ROC analysis demonstrated a tomahawk ratio of 63% or greater to be associated with an increased risk for ACL injury with a sensitivity of 83% and a specificity of 71%. The data from this study show that an increased posterior femoral condylar depth, or tomahawk ratio, is associated with increased risk of ACL injury, including primary ACL injury, failed ACL reconstruction, and contralateral ACL injury. Readily identifiable risk factors, such as an increased tomahawk ratio, could assist clinicians in identifying at-risk individuals who may experience greater benefit from targeted ACL injury prevention counseling and intervention. The presence of the tomahawk-shaped femur could also be used to guide treatment decisions and identify ACL reconstruction patients who may benefit from additional surgical procedures such as extra articular tenodesis.
Prevention of knee injuries and ACL ruptures Systematic review and recommendations of the the German Knee Society (DKG): The Stop-X program
Authors: Petersen Wolf , Stoffels Thomas , Achtnich Andrea 
Published: April 2018

Introduction Knee injuries and especially anterior cruciate ligament (ACL) tears are frequent in athletes. Therefore, primary and secondary prevention of sports-related lower limb injuries is an ongoing topic of interest. The aim of present study was to establish guidelines for the prevention of knee and ACL injuries on the basis of evidence-based concepts represented in current literature. A comprehensive literature review regarding prevention programs for knee and ACL injuries was conducted. Several modifiable and non-modifiable risk factors for knee injuries in athletes have been reported in literature. Referring to the ACL, specific injury mechanisms have been identified and are well understood. In particular, it has been demonstrated that dynamic valgus is one of the most important modifiable risk factors. Simple tests like the drop jump test have shown their efficacy in screening and detecting athletes at risk. There is only little evidence for the preventive effect on knee and ACL injuries by single exercises. However, in order to prevent or correct endangering movement patterns including dynamic valgus, several complex prevention programs have been developed in the past. These prevention programs are included in standard warm-up exercises and are focusing on muscle strength, balance, and proprioception, as well as running and flexibility. It is reported that these training programs can reduce the incidence of knee injuries by up to 27% and ACL injuries by up to 51%. Screening, identification, and correction of endangering movement patterns like the dynamic valgus are the first crucial steps in order to prevent knee and ACL injuries in athletes. Furthermore, jumping, running and flexibility exercises as well as balance and strength training are proven to reduce the incidence of these injuries and should, therefore, be integrated into the regular warm up program. Appropriate complete prevention programs are freely accessible via the Internet and should be adapted to the specific sport disciplines
Knee injuries in Rock climbing and Bouldering - An Update
Authors: Lutter Christoph , Popp Dominik , Schöffl Volker 
Published: April 2018

Rock climbing and bouldering is undergoing a worldwide “boom” and has recently been selected for the next Olympic summer games. Besides ground falls, an injury mechanism in this sport is the so-called heel hook position, which is used more frequently today due to changing training and competition modes, especially in indoor bouldering. With the rising number of knee injuries in climbing and bouldering, we now aimed to analyze this specific injury mechanisms and its underlying pathologies. Among 50 climbing athletes with unspecific knee pain, we identified 9 patients with injuries of the lower extremities after performing a heel hook. The outcome was evaluated at a minimum of 6 months after the injury and classified in a sport-specific score. After clinical examination and exclusion of the minor injuries we performed ultrasound and/or magnetic resonance imaging. Patients were treated conservatively with initial partial immobilization and early functional therapy with physiotherapy. Only one patient with a partial meniscus tear needed a surgical procedure. All patients reported sudden dorsal-sided pain in the knee while performing the hook. Seven also reported hearing a snapping sound, similar to those reported in achilles tendon tears. Walking was difficult in all cases and all were limping. Five patients were diagnosed a strain of the lateral collateral ligament and two patients a lateral meniscus tear. The other patients had either a partial tear of the PCL, or a strain of the distal hamstring tendons. In 8 of 9 cases, we received “good” to “excellent” outcomes with a conservative approach. The popping sound at the time of injury may correspond to a change of the pivot of the tractus ileotibialis that then “jumps” over the condyle. While the hook is performed, there is frequently an active knee flexion involved, which thus changes the pivot of the tractus. In climbing and bouldering, injuries of the knee will further increase due to modern training and competition modes requiring the use of heel hooks. MRI shows the proper diagnosis and the proper therapeutic approach is conservative treatment. The outcome after heel hook injuries is good to excellent in most of the cases. Warm-up routine, an avoidance of muscular imbalances, and flexibility training can help to avoid injuries during heel hook.
The Popliteus Bypass Graft is biomechanically superior to the isometric Larson Technique for posterolateral instabilities of the knee
Authors: Drenck Tobias C. , Domnick Christoph , Preiss Achim , Frosch Karl-Heinz , von Glahn Mathias 
Published: April 2018

Injuries of the posterior cruciate ligament (PCL) are most often accompanied by injuries of the posterolateral corner (PLC) and the ligamentum collaterale fibulare (LCL). This leads to a combined dorsal- and external rotational instability. In Germany most of these types of injuries are treated by an arthroscopic reconstruction of the PCL and combined posterolateral augmentation in the way, of an isometric “Larson-Procedure”. Techniques, which reconstruct the LCL and PLC in a more anatomic way provide better clinical results according to current literature. Comparative studies of these two types of reconstructions do not exist, biomechanical studies are inhomogeneous and the isometric Larson-technique has not been adequately tested so far. In this study the isometric (extra anatomic) Larson-technique was tested against a more anatomic reconstruction of the LCL and PLC with a popliteus bypass graft. 20 human knee specimen were divided into Group A and B. The PCL, as well as the PLC and LCL were dissected and kinematic measurements were determined using a robotic and optical tracking system. The knee kinematics were determined for 134 N posterior loads, 10 Nm varus loads and 5 Nm external rotational loads in 0°, 20°, 30°, 60° and 90° of knee flexion. All specimens underwent a double bundle PCL reconstruction. In Group A the reconstruction of the PLC was accomplished by a popliteus bypass graft and an additional anatomic LCL graft. In Group B the reconstruction was performed using a Larson-technique with a single femoral tunnel and a sling through the head of the fibular. The protocol was repeated and the differences in the two groups where analyzed (2W-Anova and t-Test, p=0,05) Both groups gained a significant increase of instability after dissecting the ligamentous structures (deficient) in all algorithms tested. Postoperatively both groups achieved a significant improvement in all these parameters. Group A with the popliteus bypass technique revealed significant 37±8% less external rotational instability compared to group B (p<0,03). In contrast to group A, group B presents a remaining increase of external rotation compared to the intact knee. The popliteus bypass in group A reduced the external rotational instability to less than 1,3 degree difference compared to the intact state on average. No significant results were found between the two groups in terms of varus instability and posterior loads. In this study we showed for the first time, that the most frequently used posterolateral reconstruction technique (isometric Larson) has limited biomechanical properties compared to a more anatomic reconstruction (popliteus bypass) in terms of reducing external rotation. Whether this is the cause of the remaining posterolateral instability in patients treated with the Larson technique and whether it can be prevented by using a popliteus bypass graft is subject of future clinical studies.
Effects of gracilis tendon harvest on in vivo knee joint kinematics
Authors: Flies Anne , Agres Alison , Kraus Natascha 
Published: April 2018

The gracilis tendon is a commonly used autologous tendon graft in orthopedic surgery (e.g. anterior cruciate ligament (ACL), medial patellofemoral ligament (MPFL) or chronic acromioclavicular joint (ACJ) reconstruction) but also for example in anal incontinence surgery for formation of a neosphincter. In previous studies the effects of gracilis tendon harvest were analyzed after ACL rupture, its reconstruction and rehabilitation. However, all of these three incidents influence the outcome. Thus, the purpose of the present study was to evaluate the effect of isolated gracilis tendon harvest from uninjured knees on knee kinematics during daily activities. Patients between 18 to 60 years with harvest of their gracilis tendon for reconstruction of the ACJ were included. Exclusion criteria were previous surgeries or injuries of their knees. Knee kinematics were evaluated during gait analysis using an infrared optical motion capture system with 10 cameras (T20 S cameras, Vicon, Oxford, United Kingdom) and reflective skin markers. A set of 59 markers was attached on anatomical landmarks of the patients’ lower extremities, pelvis, spine and shoulders with double-sided tape. The position of these markers was tracked at 120 Hz during the trials. Daily activities such as walking and running were performed. Additionally, kick-backs were performed to analyze maximal active knee flexion an important function of gracilis muscle. To quantify the tibiofemoral motion and reduce soft tissue artifacts, the OSSCA (OCST, SARA, and SCoRE combined approach) technique was used. (Boeth 2013) The D’Agostino&Pearson Test was used to test for a Gaussian distribution. For parametric data the dependent t-test, otherwise the Wilcoxon test was used. Sixteen patients were evaluated. However, four had to be excluded after MRIs showed an accidental harvest of the semitendinosus tendon. The mean age was 43 years [standard deviation (SD) 13 years] and time to follow up was 44 months (SD 25). The affected limb showed an increased abduction of 1,38° (SD 4,05; p=0,31) during walking and 0,65° (SD 5,23; p=0,70) during running, as well as an increased rotational translation of 2,26 mm (SD 3,62; p=0,08) during walking and 1,38 mm (SD 3,27; p=0,21) during running. The mean anterior-posterior translation was larger for the healthy limb with 1,15 mm (SD=5,30; p=0,08) during walking and with 2,43 mm (SD=5,99; p=0,23) during running. A larger mean knee flexion angle was measured for the healthy limb during walking, running and kick-backs (mean difference during walking: 3,05°; SD=7,15; p=0,28; running: 2,39°; SD=7,34; p=0,33; kick-backs: 5,31°; SD=8,59; p=0,10). However, none of these results reached statistical significance. These results show that gracilis tendon harvest in healthy knees does not lead to altered knee kinematics. However, the small size of our cohort should be taken into consideration. These data support the use of the gracilis tendon as autologous graft for reconstructive surgery.