Multidirectional instability in female athletes

Multidirectional instability (MDI) of the shoulder is characterized by generalized shoulder capsular laxity and symptomatic shoulder instability in more than one direction with one direction of instability as inferior. Generalized ligamentous laxity and specifically shoulder laxity, has been associated with female athletes. While males are at a higher risk of shoulder instability due to a number of extrinsic risk factors including participation in higher risk contact/collision activities, females are particularly susceptible to MDI due to their association with increased joint laxity. Patients with MDI often have a loose patulous capsule and display altered glenohumeral and scapulothoracic mechanics. The mainstay of treatment is physical therapy focusing on strengthening the dynamic stabilizers of the shoulder. In cases of failed rehabilitation, operative management most frequently includes either open or arthroscopic capsular shift with reasonably good outcomes and return to sport. Sex-related differences concerning shoulder instability risk and pathophysiology may influence treatment decisions and outcome measures. An understanding of the factors concerning shoulder instability specific to the female athlete is important in management and prevention of injury

Latarjet Surgery Leads to Decreased Rates of Subjective Instability Compared to Bankart Repair with Concomitant Remplissage

Background: Predictive factors for performing remplissage concomitantly with arthroscopic Bankart repair include the presence of humeral or glenoid defects \u3e11% and/or revision surgery. International and societal consensus statements support these findings, as surgeons recommend the Latarjet procedure for patients with significant glenoid bone loss (\u3e15-20%) while remplissage is recommended for patients with off-track or engaging Hill-Sachs lesions without significant glenoid bone loss. While several studies have compared outcomes between Latarjet surgery and remplissage, these studies have only evaluated patients with engaging Hill-Sachs lesions, not consecutive patient cohorts indicated for each surgery. Purpose: To compare rates of recurrent instability, re-operation, revision, and return to play (RTP), as well as patient-reported outcomes including the American Shoulder and Elbow Surgeon Score (ASES), Single Assessment Numeric Evaluation (SANE), and Oxford Shoulder Instability Score (OSI) between Latarjet surgery and arthroscopic labral repair plus remplissage surgery (Remplissage) patients

Republication of “Open Repair of Acute Achilles Tendon Ruptures: Is the Incidence of Clinically Significant Wound Complications Overestimated?”

Background: Conflicting evidence exists regarding the optimal management of acute Achilles tendon ruptures. Operative repair is thought to afford patients a lower risk of rerupture, albeit at a higher overall risk of wound complications. Methods: A retrospective chart review of 369 consecutive patients undergoing open repair of acute Achilles tendon ruptures performed by a single foot and ankle fellowship-trained orthopedic surgeon was undertaken. Healing was classified as no complications, complications without prolonging treatment, complications requiring prolonged local treatment, and complications requiring operative intervention. A statistical analysis comparing the rates of complications in this cohort to that reported in the literature was conducted. Results: There were a total of 33 (8.94%) wound complications. Compared to the rates reported in the literature, no significant difference was detected (P = .3943; CI 6.24-12.33). However, when the complications not requiring additional treatment or prolonged care were excluded, only 9 wound complications (2.44%) were identified—a significantly lower complication rate than that reported in the literature (P \u3c .0001; CI 1.12-4.58). There were only 2 (0.54%) major complications requiring operative intervention, also a significantly lower rate than in the literature (P \u3c .0001; CI 0.067-1.94). Conclusion: In the past, wound-healing complications have been cited as a concern when treating patients operatively. We found that when solely looking at healing complications prolonging the patients’ overall recovery, a significantly lower rate of complications existed compared to that reported in the literature. Level of Evidence: Level IV

Expression of p16 Within Myenteric Neurons of the Aged Colon: A Potential Marker of Declining Function.

Human colonic neuromuscular functions decline among the elderly. The aim was to explore the involvement of senescence. A preliminary PCR study looked for age-dependent differences in expression of CDKN1A (encoding the senescence-related p21 protein) and CDKN2A (encoding p16 and p14) in human ascending and descending colon (without mucosa) from 39 (approximately 50: 50 male: female) adult (aged 27-60 years) and elderly donors (70-89 years). Other genes from different aging pathways (e.g., inflammation, oxidative stress, autophagy) and cell-types (e.g., neurons, neuron axonal transport) were also examined. Unlike CDKN1A, CDKN2A (using primers for p16 and p14 but not when using p14-specific primers) was upregulated in both regions of colon. Compared with the number of genes appearing to upregulate in association with temporal age, more genes positively associated with increased CDKN2A expression (respectively, 16 and five of 44 genes studied for ascending and descending colon). Confirmation of increased expression of CDKN2A was sought by immunostaining for p16 in the myenteric plexus of colon from 52 patients, using a semi-automated software protocol. The results showed increased staining not within the glial cells (S100 stained), but in the cytoplasm of myenteric nerve cell bodies (MAP2 stained, with identified nucleus) of ascending, but not descending colon of the elderly, and not in the cell nucleus of either region or age group (5,710 neurons analyzed: n = 12-14 for each group). It was concluded that increased p16 staining within the cytoplasm of myenteric nerve cell bodies of elderly ascending (but not descending) colon, suggests a region-dependent, post-mitotic cellular senescence-like activity, perhaps involved with aging of enteric neurons within the colon

Total Knee Arthroplasty in Patients with Prior Meniscus Surgery: A Matched Case Control Study

Introduction: Meniscus surgery is one of the most commonly performed orthopedic surgical procedures in the United States. However, outcomes following a Total Knee Arthroplasty (TKA) in patients with a history of prior knee arthroscopy are varied with small patient cohorts, warranting further research. The research question investigates how the clinical outcomes of TKA compare between patients with and without prior meniscectomy history. It is hypothesized that there will be no significant difference in clinical outcomes between the two cohorts. Methods: The study design is a retrospective case-control study. The study population included patients from Rothman Institute with TKA and prior meniscal surgery on the ipsilateral knee. Patients were matched on a 2:1 basis to the control group undergoing TKA without meniscal history. Physician chart notes, operative reports, and images were reviewed to compare outcomes. The outcomes were based on postoperative complications, including the rate of revision, re-operation, infection, and clinical outcome score. Results: 1028 patients met the inclusion criteria for the study population and were available for analysis. To date, 111 patients have been analyzed. Preliminary data shows that 97% (108) of the study population experienced no TKA complications. 2.7% (3) of the analyzed patients experienced TKA complications, warranting revision. Statistical analysis between the study and control group complication rates is pending. Discussion: The results implicate that there is no statistical difference between the two cohorts, which may support the hypothesis. This data might serve as a point of education for TKA patients and provide modifiable risk factors for meniscectomy patients

Autism Symptoms and Internalizing Psychopathology in Girls and Boys with Autism Spectrum Disorders

Findings regarding phenotypic differences between boys and girls with ASD are mixed. We compared autism and internalizing symptoms in a sample of 8-18 year-old girls (n = 20) and boys (n = 20) with ASD and typically developing (TYP) girls (n = 19) and boys (n = 17). Girls with ASD were more impaired than TYP girls but did not differ from boys with ASD in autism symptoms. In adolescence, girls with ASD had higher internalizing symptoms than boys with ASD and TYP girls, and higher symptoms of depression than TYP girls. Girls ages 8-18 with ASD resemble boys with ASD and not TYP girls, and appear to be at increased risk for affective symptoms in the teen years

Open Repair of Acute Achilles Tendon Ruptures: Is the Incidence of Clinically Significant Wound Complications Overestimated?

Background: Conflicting evidence exists regarding the optimal management of acute Achilles tendon ruptures. Operative repair is thought to afford patients a lower risk of rerupture, albeit at a higher overall risk of wound complications. Methods: A retrospective chart review of 369 consecutive patients undergoing open repair of acute Achilles tendon ruptures performed by a single foot and ankle fellowship-trained orthopedic surgeon was undertaken. Healing was classified as no complications, complications without prolonging treatment, complications requiring prolonged local treatment, and complications requiring operative intervention. A statistical analysis comparing the rates of complications in this cohort to that reported in the literature was conducted. Results: There were a total of 33 (8.94%) wound complications. Compared to the rates reported in the literature, no significant difference was detected ( P = .3943; CI 6.24-12.33). However, when the complications not requiring additional treatment or prolonged care were excluded, only 9 wound complications (2.44%) were identified—a significantly lower complication rate than that reported in the literature ( P < .0001; CI 1.12-4.58). There were only 2 (0.54%) major complications requiring operative intervention, also a significantly lower rate than in the literature ( P < .0001; CI 0.067-1.94). Conclusion: In the past, wound-healing complications have been cited as a concern when treating patients operatively. We found that when solely looking at healing complications prolonging the patients’ overall recovery, a significantly lower rate of complications existed compared to that reported in the literature. Level of Evidence: Level IV

Subscapularis Repair During Reverse Total Shoulder Arthroplasty Using a Stem-Based Double-Row Repair: Sonographic and Clinical Outcomes

Background: Treatment of the subscapularis in reverse total shoulder arthroplasty (RTSA) is a controversial topic, with conflicting evidence regarding outcomes after repair. Purpose/Hypothesis: The purpose of this study was to report clinical and sonographic outcomes of a through-implant double-row suture technique for subscapularis repair in RTSA and to compare clinical outcomes and range of motion (ROM) between patients with an intact subscapularis tendon repair versus those whose tendon repair was not intact. The authors hypothesized that the novel repair technique would find more than 80% of tendons intact on ultrasound, with significant improvement in clinical outcome scores and ROM. The authors also hypothesized that patients with an intact subscapularis tendon repair would have better clinical outcomes compared with those with a nonintact tendon repair. Study Design: Case series; Level of evidence, 4. Methods: The study included all patients who underwent RTSA by 1 of 2 surgeons between August 2016 and March 2017 with the through-implant double-row suture technique for subscapularis repair. Subscapularis tendon integrity was assessed postoperatively via ultrasound at minimum 1-year follow-up. American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and pain visual analog scale (VAS) scores were recorded at the final follow-up visit in addition to ROM measures. Results: A total of 48 patients (31 males, 17 females; mean age, 68.9 +/- 7.4 years; mean follow-up, 13.8 +/- 2.1 months) were included. On ultrasound, the subscapularis was intact in 83.3% of patients. Regarding preoperative versus postoperative outcome scores, the ASES score (mean +/- SD) significantly improved from 38.3 +/- 14.7 to 81.9 +/- 13.6, the SANE score significantly improved from 29.8 +/- 24.2 to 75.5 +/- 21.0, and the VAS pain score significantly improved from 5.9 +/- 2.1 to 1.2 +/- 1.6 (P < .001 for all). Forward flexion and external rotation significantly improved. No significant difference existed in clinical outcome scores or ROM between patients with intact versus torn subscapularis tendons based on ultrasound. Conclusion: Subscapularis repair using a stem-based double-row repair technique during RTSA demonstrated an overall healing rate of 83.3%, as evidenced by ultrasound examination at short-term follow-up. Integrity of subscapularis repair did not affect clinical outcome or ROM.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Beach Chair Versus Lateral Decubitus Surgical Positioning for Arthroscopic Anterior Shoulder Stabilization: A Retrospective Comparison of Clinical and Patient-Reported Outcomes

Background: Surgical positioning can affect both perioperative and postoperative complication rates. It is unclear whether beach-chair versus lateral decubitus positioning affects outcomes in patients undergoing arthroscopic anterior shoulder stabilization surgery. Purpose: The purpose of this study was to compare recurrent instability, complications, and patient-reported outcomes between patients who underwent arthroscopic anterior shoulder stabilization in the beach-chair versus the lateral decubitus positions. It was hypothesized that recurrent instability, complications, and patient-reported outcomes would not be affected by surgical positioning. Study Design: Cohort study; Level of evidence, 3. Methods: The authors reviewed the medical records of patients who underwent shoulder stabilization (Current Procedural Terminology codes 29806 and 29807) from 2015 to 2019. Patients were included only if anterior instability was confirmed, arthroscopic surgery was performed in response to shoulder instability, and a minimum of 2 years of follow-up data were available. Data collected for eligible patients included perioperative and postoperative complications, recurrent instability, reoperation, and revision. Patients also completed surveys for the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Oxford Shoulder Instability (OSI) score, and a return to any level of sport (RTS) questionnaire. Results: Overall, 294 patients (162 lateral decubitus and 132 beach-chair positions) were included, with an average follow-up of 2.4 ± 1.6 years. There were no significant differences in demographics between groups, nor were there differences in the rates of postoperative dislocations, subjective instability, reoperations, revisions, or complications. There was a trend toward a higher revision rate in the beach-chair group (beach-chair, 6.1% vs lateral decubitus, 1.9%; Conclusion: Surgical positioning for arthroscopic anterior shoulder stabilization did not significantly affect recurrent instability, complications, and patient-reported outcomes. Both beach-chair and lateral decubitus positioning provided good outcomes for anterior shoulder stabilization, with an overall recurrent dislocation rate of 7.8% at a mean of 3.3 years after surgery

Microwave Radiometer Technology Acceleration Mission (MiRaTA): Advancing Weather Remote Sensing with Nanosatellites

The Microwave Radiometer Technology Acceleration (MiRaTA) is a 3U CubeSat NASA Earth Science Technology Office (ESTO) mission under development for a 2016 launch. Microwave radiometry and GPS radio occultation (GPSRO) measurements of all-weather temperature and humidity provide key contributions toward improved weather forecasting. The MiRaTA mission will validate new technologies in both passive microwave radiometry and GPS radio occultation: (1) new ultra-compact and low-power technology for multi-channel and multi-band passive microwave radiometers, and (2) new GPS receiver and patch antenna array technology for GPS radio occultation retrieval of both temperature-pressure profiles in the atmosphere and electron density profiles in the ionosphere. In addition, MiRaTA will test (3) a new approach to spaceborne microwave radiometer calibration using adjacent GPSRO measurements. Radiometer measurement quality can be substantially improved relative to present systems through the use of proximal GPSRO measurements as a calibration standard for radiometric observations, reducing and perhaps eliminating the need for costly and complex internal calibration targets. MiRaTA will execute occasional pitch-up maneuvers so that radiometer and GPSRO observations sound overlapping volumes of atmosphere through the Earth\u27s limb. To validate system performance, observations from both microwave radiometer (MWR) and GPSRO instruments will be compared to radiosondes, global high-resolution analysis fields, other satellite observations, and to each other using radiative transfer models. Both the radiometer and GPSRO payloads, currently at TRL5 but to be advanced to TRL7 at mission conclusion, can be accommodated in a single 3U CubeSat. The current plan is to launch from an ISS orbit at ~400 km altitude and 52° inclination for low-cost validation over a ~90-day mission to fly in 2016. MiRaTA will demonstrate high fidelity, well-calibrated radiometric sensing from a nanosatellite platform, thereby enabling new architectural approaches for mission implementation at lower cost and risk with more flexible access to space