Arthroscopic management of an intraarticular osteochondroma of the hip.

The role of hip arthroscopy in the management of femoroacetabular impingement (FAI) has been advancing rapidly. In this case report, we describe the use of hip arthroscopy to successfully treat a femoral neck osteochondroma that caused a symptomatic labral tear in a 37 year old woman. Hip arthroscopy offers several advantages to surgical dislocation of the hip in the management of intraarticular pathology and FAI. Hip arthroscopy is minimally invasive without the significant trauma to hip musculature, is useful in treatment of labral tears generated by FAI, and can be used to resect small lesions on the femoral head

Comparing Outcomes Between the Over-the-Top and All-Epiphyseal Techniques for Physeal-Sparing ACL Reconstruction: A Narrative Review.

A variety of techniques are used for physeal-sparing anterior cruciate ligament (ACL) reconstruction; however, there is no clear consensus on the ideal surgical technique, the frequency of complications, and how to best avoid growth disturbance. The purpose of this study was to compare outcomes and complications between over-the-top and all-epiphyseal ACL reconstruction techniques. The hypothesis was that both physeal-sparing reconstruction techniques are efficacious, with similar risk of growth disturbance and complications. The Embase and PubMed databases were queried for studies on ACL ruptures in the skeletally immature population from 1985 to 2018. Full-text English studies were included (N = 160). Studies reporting rerupture and/or complications after physeal-sparing ACL reconstruction, specifically growth disturbance, were included (n = 10). Studies were separated into 2 groups: an all-epiphyseal group with femoral and tibial fixation points within the epiphysis and a group that had over-the-top femoral and tibial physeal-sparing reconstruction. Complications not specific to the pediatric population were excluded. Demographics, evaluation of skeletal maturity, surgical technique, growth disturbance, rerupture, and patient-reported outcome scores were collected. Data were analyzed in aggregate. The 10 studies included 482 knees. The mean age was 12.0 years; 81% of patients were male; and mean follow-up was 47.7 months. A total of 178 patients underwent all-epiphyseal reconstruction, and 298 had the femoral graft placed over the top. The rerupture rate was 9.0% (16 of 178) in the all-epiphyseal group and 7.2% (14 of 195) in the over-the-top group, of which 82% required revision reconstruction. Six patients had overgrowth in the all-epiphyseal group (mean, 1.8 cm) and 1 patient in the over-the-top group (1.5 cm). Three angular deformities occurred, all of which were in the over-the-top group. Both physeal-sparing ACL reconstruction techniques are successful. Overgrowth was more common in the all-epiphyseal group and angular deformity in the over-the-top group. Rerupture rates were similar between the groups. The authors recommend standardization of skeletal age assessment and baseline lower extremity alignment films

Imaging-Based Prevalence of Superior Labral Anterior-Posterior Tears Significantly Increases in the Aging Shoulder.

BackgroundSuperior labral anterior-posterior (SLAP) tears can be associated with pain and shoulder dysfunction. Relatively little is known about the age-related prevalence of SLAP tears.PurposeTo investigate the age-related prevalence of imaging-diagnosed SLAP tears in a heterogeneous grouping of shoulder conditions in a large cohort at a single institution with multiple blinded reviewers.Study designCross-sectional study; Level of evidence, 3.MethodsA total of 281 shoulder magnetic resonance imaging (MRI) scans obtained over 8 months were reviewed by a musculoskeletal radiologist and an orthopaedic surgeon. The mean ± SD age of the group was 49.6 ± 15.5 years, and 107 of the patients were female (38.1%). Patients were divided into 4 age groups: 35 years or younger, 36 to 50 years, 51 to 65 years, and older than 65 years. Statistical analyses were completed by use of the Fisher exact test to compare proportions of SLAP tears between age groups, odds ratios to determine the likelihood of having a SLAP tear in each age group, and a logistic regression to control for associated abnormalities.ResultsThere was a significant diffference in the proportion of SLAP tears found on the MRIs for each age group (P < .001). Patients were significantly more likely to have SLAP tears if aged 51 to 65 years (66.7%; odds ratio [OR], 2.00; 95% CI, 1.27-3.15) and if older than 65 years (81.2%; OR, 4.31; 95% CI, 2.36-7.88). No increased prevalence was observed in patients aged 35 years or younger (47.5%; OR, 0.91; 95% CI, 0.55-1.50) or 36 to 50 years (51.8%; OR, 1.08; 95% CI, 0.70-1.67). Logistic regression demonstrated that age was the only significant predictor for having a SLAP tear (P < .001). Kappa values were 0.46 to 0.65 between reviewers, indicating moderate to substantial agreement.ConclusionAn increasing prevalence of MRI-based SLAP tears was observed with increasing patient age. Patients older than 50 years were significantly more likely to have superior labral abnormalities regardless of other shoulder injury or disease

Compositional and Dynamic Controls on Mafic—Silicic Magma Interactions at Continental Arc Volcanoes: Evidence from Cordón El Guadal, Tatara-San Pedro Complex, Chile

Heterogeneous andesitic and dacitic lavas on Cordón El Guadal bear on the general problem of how magmas of differing compositions and physical properties interact in shallow reservoirs beneath continental arc volcanoes. Some of the lavas contain an exceptionally large proportion (<40%) of undercooled basaltic andesitic magma in various states of disaggregation. Under-cooled mafic magma occurs in the silicic lavas as large (<40 cm) basaltic andesitic magmatic inclusions, as millimeter-sized crystal-clots of Mg-rich olivine phenocrysts plus adhering Carich plagioclase microphenocrysts (An50-70), and as uniformly distributed, isolated phenocrysts and microphenocrysts. Compositions and textures of plagioclase phenocrysts indicate that inclusion-forming magmas are hybrids formed by mixing basaltic and dacitic melts, whereas textural features and compositions of groundmass phases indicate that the andesitic and dacitic lavas are largely mechanical mixtures of dacitic magma and crystallized basaltic andesitic magma. This latter observation is significant because it indicates that mechanical blending of undercooled mafic magma and partially crystallized silicic magma is a possible mechanism for producing the common porphyritic texture of many calc-alkaline volcanic rocks. The style of mafic-silicic magma interaction at Cordon El Guadal was strongly dependent upon the relative proportions of the endmembers. Equally important in the Guadal system, however, was the manner in which the contrasting magmas were juxtaposed. Textural evidence preserved in the plagioclase phenocrysts indicates that the transition from liquid-liquid to solid-liquid mixing was not continuous, but was partitioned into periods of magma chamber recharge and eruption, respectively. Evidently, during periods of recharge, basaltic magmas rapidly entrained small amounts of dacitic magma along the margins of a turbulent injection fountain. Conversely, during periods of eruption, dacitic magma gradually incorporated small parcels of basaltic andesitic magma. Thus, the coupled physical-chemical transition from mixed inclusions to commingled lavas is presumably not coincidental. More likely, it probably provides a partial record of the dynamic processes occurring in shallow magma chambers beneath continental are volcanoe

Return to Play Following Shoulder Stabilization: A Systematic Review and Meta-analysis.

BackgroundAnterior shoulder instability can be a disabling condition for the young athlete; however, the best surgical treatment remains controversial. Traditionally, anterior shoulder instability was treated with open stabilization. More recently, arthroscopic repair of the Bankart injury with suture anchor fixation has become an accepted technique.HypothesisNo systematic reviews have compared the rate of return to play following arthroscopic Bankart repair with suture anchor fixation with the Bristow-Latarjet procedure and open stabilization. We hypothesized that the rate of return to play will be similar regardless of surgical technique.Study designSystematic review; Level of evidence, 4.MethodsWe performed a systematic review and meta-analysis focused on return to play following shoulder stabilization. Inclusion criteria included studies in English that reported on rate of return to play and clinical outcomes following primary arthroscopic Bankart repair with suture anchors, the Latarjet procedure, or open stabilization. Statistical analyses included Student t tests and analyses of variance.ResultsSixteen papers reporting on 1036 patients were included. A total of 545 patients underwent arthroscopic Bankart repair with suture anchors, 353 with the Latarjet procedure, and 138 with open repair. No significant difference was found in patient demographic data among the studies. Patients returned to sport at the same level of play (preinjury level) more consistently following arthroscopic Bankart repair (71%) or the Latarjet procedure (73%) than open stabilization (66%) (P &lt; .05). Return to play at any level and postoperative Rowe scores were not significantly different among studies. Recurrent dislocation was significantly less following the Latarjet procedure (3.5%) than after arthroscopic Bankart repair (6.6%) or open stabilization (6.7%) (P &lt; .05).ConclusionThis systematic review demonstrates a greater rate of return to play at the preinjury level following arthroscopic Bankart repair and the Latarjet procedure than open stabilization. Despite this difference, &gt;65% of all treated athletes returned to sport at their preinjury levels, with other outcome measures being similar among the treatment groups. Therefore, arthroscopic Bankart repair, the Latarjet procedure, and open stabilization remain good surgical options in the treatment of the athlete with anterior shoulder instability

Approximate optimal guidance for the advanced launch system

A real-time guidance scheme for the problem of maximizing the payload into orbit subject to the equations of motion for a rocket over a spherical, non-rotating earth is presented. An approximate optimal launch guidance law is developed based upon an asymptotic expansion of the Hamilton - Jacobi - Bellman or dynamic programming equation. The expansion is performed in terms of a small parameter, which is used to separate the dynamics of the problem into primary and perturbation dynamics. For the zeroth-order problem the small parameter is set to zero and a closed-form solution to the zeroth-order expansion term of Hamilton - Jacobi - Bellman equation is obtained. Higher-order terms of the expansion include the effects of the neglected perturbation dynamics. These higher-order terms are determined from the solution of first-order linear partial differential equations requiring only the evaluation of quadratures. This technique is preferred as a real-time, on-line guidance scheme to alternative numerical iterative optimization schemes because of the unreliable convergence properties of these iterative guidance schemes and because the quadratures needed for the approximate optimal guidance law can be performed rapidly and by parallel processing. Even if the approximate solution is not nearly optimal, when using this technique the zeroth-order solution always provides a path which satisfies the terminal constraints. Results for two-degree-of-freedom simulations are presented for the simplified problem of flight in the equatorial plane and compared to the guidance scheme generated by the shooting method which is an iterative second-order technique

Do Outcomes of Arthroscopic Subscapularis Tendon Repairs Depend on Rotator Cuff Fatty Infiltration?

Background:Rotator cuff fatty infiltration has been correlated with poorer radiographic and clinical outcomes in supraspinatus and infraspinatus tendon repairs, but this has not been well-studied in subscapularis tendon repairs. Purpose:To evaluate the influence of preoperative rotator cuff fatty infiltration on postoperative outcomes for patients undergoing arthroscopic subscapularis tendon repair. Study Design:Cohort study; Level of evidence, 3. Methods:Patients who underwent arthroscopic subscapularis repair between 2010 and 2016 were retrospectively identified, and demographic data and surgical findings were recorded. The extent of fatty infiltration was determined on preoperative magnetic resonance imaging by the Fuchs modification of the Goutallier classification. At the most recent follow-up, patients completed the Patient-Reported Outcomes Measurement Information System for Upper Extremity (PROMIS-UE) computer adaptive test and a postoperative visual analog scale for pain. The distribution of fatty infiltration was compared between patients undergoing subscapularis tendon repair versus subscapularis tendon repair combined with a posterior cuff repair. Outcomes were compared for patients using Goutallier grade 0-1 versus grade ≥2 changes in each rotator cuff muscle. Multivariate linear regression analysis was performed to evaluate the influence of muscle quality, as well as demographic factors, on PROMIS-UE scores. Significance was defined as P &lt; .05. Results:There were 140 shoulders included (mean age, 61.8 years; 42.1% female; mean follow-up, 51.7 months). The prevalence of Goutallier grade 2 changes or higher was significantly greater in patients with multitendon repair relative to isolated subscapularis tendon repair. For the overall group of all patients undergoing subscapularis tendon repair, whether in isolation or as part of a multitendon repair, PROMIS-UE scores were significantly lower for patients with infraspinatus muscle grade 2 or higher Goutallier changes relative to grade 0 or 1. After adjustment for age, body mass index, patient sex, and fatty infiltration in other rotator cuff muscles, poor infraspinatus muscle quality remained the only significant predictor for lower PROMIS-UE scores. Conclusion:Patients undergoing arthroscopic subscapularis tendon repair with poor infraspinatus muscle quality had worse patient-reported outcomes. This was true whether subscapularis tendon repair was isolated or was performed in conjunction with supraspinatus and infraspinatus tendon repairs

There are many barriers to species’ migrations

Temperature-change trajectories are being used to identify the geographic barriers and thermal ‘cul-de-sacs’ that will limit the ability of many species to track climate change by migrating. We argue that there are many other potential barriers to species’ migrations. These include stable ecotones, discordant shifts in climatic variables, human land use, and species’ limited dispersal abilities. To illustrate our argument, for each 0.5° latitude/longitude grid cell of the Earth’s land surface, we mapped and tallied the number of cells for which future (2060–2080) climate represents an analog of the focal cell’s current climate. We compared results when only considering temperature with those for which both temperature and total annual precipitation were considered in concert. We also compared results when accounting for only geographic barriers (no cross-continental migration) with those involving both geographic and potential ecological barriers (no cross-biome migration). As expected, the number of future climate analogs available to each pixel decreased markedly with each added layer of complexity (e.g. the proportion of the Earth’s land surface without any available future climate analogs increased from 3% to more than 36% with the inclusion of precipitation and ecological boundaries). While including additional variables can increase model complexity and uncertainty, we must strive to incorporate the factors that we know will limit species’ ranges and migrations if we hope to predict the effects of climate change at a high-enough degree of accuracy to guide management decisions

Automated Data Management Information System (ADMIS)

ADMIS stores and controls data and documents associated with manned space flight effort. System contains all data oriented toward a specific document; it is primary source of reports generated by the system. Each group of records is composed of one document record, one distribution record for each recipient of the document, and one summary record