Long-Term Outcomes in Anterior Cruciate Ligament Reconstruction: A Systematic Review of Patellar Tendon Versus Hamstring Autografts.

BACKGROUND: Much controversy still exists surrounding graft choice in anterior cruciate ligament (ACL) reconstruction. Over the past decade, an increase in comparative studies with longer follow-up has enhanced our understanding of current graft options and outcomes. PURPOSE: To describe the long-term comparative outcomes of ACL reconstruction with autograft bone-patellar tendon-bone (BPTB) versus autograft hamstring (HS) ACL reconstruction with regard to clinical and radiographic outcomes. STUDY DESIGN: Systematic review; Level of evidence, 2. METHODS: A search of the PubMed, MEDLINE, Cochrane, and Scopus databases was performed to identify studies in the English language with outcome data comparing ACL reconstruction utilizing autograft BPTB and autograft HS; only studies with a minimum 5-year follow-up were included. Outcome data included failure and complications, manual and instrumented laxity, patient-reported outcomes, and radiographic risk of osteoarthritis. RESULTS: Twelve studies with a total of 953 patients met the inclusion criteria. Of these studies, 8 were level 1 evidence and 2 were level 2. Mean follow-up was 8.96 years (range, 5-15.3 years). No differences in graft failure or manual or instrumented laxity were seen in any studies. Lower clinical outcomes scores and greater motion loss were seen in BPTB patients in 1 and 2 studies, respectively. Two of 4 studies reporting on anterior knee pain, and 3 of 7 that recorded kneeling pain found it more frequently among BPTB patients. One study found significantly increased reoperation rates in HS patients, while another found a similar result in BPTB, and 1 study reported a significant increase in contralateral ACL tears in BPTB patients. Three of 5 studies reporting on radiographic evidence of osteoarthritis noted significantly increased rates in BPTB patients. CONCLUSION: This systematic review comparing long-term outcomes after ACL reconstruction with either autograft BPTB or autograft HS suggests no significant differences in manual/instrumented laxity and graft failures between graft types. An increase in long-term anterior knee pain, kneeling pain, and higher rates of osteoarthritis were noted with BPTB graft use

Pain Management After Outpatient Anterior Cruciate Ligament Reconstruction: A Systematic Review of Randomized Controlled Trials.

BACKGROUND: Effective pain management after anterior cruciate ligament (ACL) reconstruction improves patient satisfaction and function. PURPOSE: To collect and evaluate the available evidence from randomized controlled trials (RCTs) on pain control after ACL reconstruction. STUDY DESIGN: Systematic review. METHODS: A systematic literature review was performed using PubMed, Medline, Google Scholar, UpToDate, Cochrane Reviews, CINAHL, and Scopus following PRISMA guidelines (July 2014). Only RCTs comparing a method of postoperative pain control to another method or placebo were included. RESULTS: A total of 77 RCTs met inclusion criteria: 14 on regional nerve blocks, 21 on intra-articular injections, 4 on intramuscular/intravenous injections, 12 on multimodal regimens, 6 on oral medications, 10 on cryotherapy/compression, 6 on mobilization, and 5 on intraoperative techniques. Single-injection femoral nerve blocks provided superior analgesia to placebo for up to 24 hours postoperatively; however, this also resulted in a quadriceps motor deficit. Indwelling femoral catheters utilized for 2 days postoperatively provided superior analgesia to a single-injection femoral nerve block. Local anesthetic injections at the surgical wound site or intra-articularly provided equivalent analgesia to regional nerve blocks. Continuous-infusion catheters of a local anesthetic provided adequate pain relief but have been shown to cause chondrolysis. Cryotherapy improved analgesia compared to no cryotherapy in 4 trials, while in 4 trials, ice water and water at room temperature provided equivalent analgesic effects. Early weightbearing decreased pain compared to delayed weightbearing. Oral gabapentin given preoperatively and oral zolpidem given for the first week postoperatively each decreased opioid consumption as compared to placebo. Ibuprofen reduced pain compared to acetaminophen. Oral ketorolac reduced pain compared to hydrocodone-acetaminophen. CONCLUSION: Regional nerve blocks and intra-articular injections are both effective forms of analgesia. Cryotherapy-compression appears to be beneficial, provided that intra-articular temperatures are sufficiently decreased. Early mobilization reduces pain symptoms. Gabapentin, zolpidem, ketorolac, and ibuprofen decrease opioid consumption. Despite the vast amount of high-quality evidence on this topic, further research is needed to determine the optimal multimodal approach that can maximize recovery while minimizing pain and opioid consumption. CLINICAL RELEVANCE: These results provide the best available evidence from RCTs on pain control regimens after ACL reconstruction

Youth Single-Sport Specialization in Professional Baseball Players.

Background: An increasing number of youth baseball athletes are specializing in playing baseball at younger ages. Purpose: The purpose of our study was to describe the age and prevalence of single-sport specialization in a cohort of current professional baseball athletes. In addition, we sought to understand the trends surrounding single-sport specialization in professional baseball players raised within and outside the United States (US). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A survey was distributed to male professional baseball athletes via individual team athletic trainers. Athletes were asked if and at what age they had chosen to specialize in playing baseball at the exclusion of other sports, and data were then collected pertaining to this decision. We analyzed the rate and age of specialization, the reasons for specialization, and the athlete\u27s perception of injuries related to specialization. Results: A total of 1673 professional baseball athletes completed the survey, representing 26 of the 30 Major League Baseball (MLB) organizations. Less than half (44.5%) of professional athletes specialized in playing a single sport during their childhood/adolescence. Those who reported specializing in their youth did so at a mean age of 14.09 ± 2.79 years. MLB players who grew up outside the US specialized at a significantly earlier age than MLB players native to the US (12.30 ± 3.07 vs 14.89 ± 2.24 years, respectively; Conclusion: This study challenges the current trends toward early youth sport specialization, finding that the majority of professional baseball athletes studied did not specialize as youth and that those who did specialize did so at a mean age of 14 years. With the potential cumulative effects of pitching and overhead throwing on an athlete\u27s arm, the trend identified in this study toward earlier specialization within baseball is concerning

Projective Ribbon Permutation Statistics: a Remnant of non-Abelian Braiding in Higher Dimensions

In a recent paper, Teo and Kane proposed a 3D model in which the defects support Majorana fermion zero modes. They argued that exchanging and twisting these defects would implement a set R of unitary transformations on the zero mode Hilbert space which is a 'ghostly' recollection of the action of the braid group on Ising anyons in 2D. In this paper, we find the group T_{2n} which governs the statistics of these defects by analyzing the topology of the space K_{2n} of configurations of 2n defects in a slowly spatially-varying gapped free fermion Hamiltonian: T_{2n}\equiv {\pi_1}(K_{2n})$. We find that the group T_{2n}= Z \times T^r_{2n}, where the 'ribbon permutation group' T^r_{2n} is a mild enhancement of the permutation group S_{2n}: T^r_{2n} \equiv \Z_2 \times E((Z_2)^{2n}\rtimes S_{2n}). Here, E((Z_2)^{2n}\rtimes S_{2n}) is the 'even part' of (Z_2)^{2n} \rtimes S_{2n}, namely those elements for which the total parity of the element in (Z_2)^{2n} added to the parity of the permutation is even. Surprisingly, R is only a projective representation of T_{2n}, a possibility proposed by Wilczek. Thus, Teo and Kane's defects realize `Projective Ribbon Permutation Statistics', which we show to be consistent with locality. We extend this phenomenon to other dimensions, co-dimensions, and symmetry classes. Since it is an essential input for our calculation, we review the topological classification of gapped free fermion systems and its relation to Bott periodicity.Comment: Missing figures added. Fixed some typos. Added a paragraph to the conclusio

Return-to-Play Guidelines After Patellar Instability Surgery Requiring Bony Realignment: A Systematic Review.

Background: Recurrent patellar instability can be treated nonoperatively or surgically, and surgical management may vary based on the causative pathology in the structures surrounding the patella. Although isolated soft tissue reconstruction is among the most common operative treatments, certain patient populations require bony realignment for adequate stabilization. Purpose: To evaluate postoperative guidelines, including return to play and rehabilitation, after bony procedures involving the tibial tubercle for patellar instability. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review on return-to-play guidelines was conducted with studies published from 1997 to 2019 that detailed procedures involving bony realignment by tibial tubercle osteotomies and tibial tubercle transfers with or without soft tissue reconstruction. Exclusion criteria included animal or cadaveric studies, basic science articles, nonsurgical rehabilitation protocols, and patients with mean agecriteria, rehabilitation protocols, and bias. Results: Included in the review were 39 studies with a total of 1477 patients and 1598 knees. Mean patient age ranged from 17.5 to 34.0 years, and mean follow-up ranged from 23 to 161 months. All 39 studies described postoperative rehabilitation; however, only 16 studies specifically outlined return-to-play criteria. The most commonly cited return-to-play criterion was quadriceps strength (62.5%). Range of motion (50.0%), physical therapy protocols (18.8%), and radiographic evidence of healing (18.8%) were other cited objective criteria for return-to-play. Four of 16 (25.0%) studies described subjective criteria for return to play, including pain, swelling, and patient comfort and confidence. Of the 11 studies that described a timeline for return to play, the range was between 2 and 6 months. Conclusion: The results revealed that 100% of papers evaluated lacked adequate return-to-play guidelines. Moreover, timelines significantly varied among studies. More clearly defined return-to-play guidelines after tibial tubercle transfer for patellar instability are required

The Carnegie Supernova Project: Analysis of the First Sample of Low-Redshift Type-Ia Supernovae

We present the analysis of the first set of low-redshift Type Ia supernovae (SNe Ia) by the Carnegie Supernova Project. Well-sampled, high-precision optical (ugriBV) and near-infrared (NIR; YJHKs) light curves obtained in a well-understood photometric system are used to provide light-curve parameters, and ugriBVYJH template light curves. The intrinsic colors at maximum light are calibrated to compute optical--NIR color excesses for the full sample, thus allowing the properties of the reddening law in the host galaxies to be studied. A low value of Rv~1.7, is derived when using the entire sample of SNe. However, when the two highly reddened SNe in the sample are excluded, a value Galactic standard of Rv~3.2 is obtained. The colors of these two events are well matched by a reddening model due to circumstellar dust. The peak luminosities are calibrated using a two-parameter linear fit to the decline rates and the colors, or alternatively, the color excesses. In both cases, dispersions in absolute magnitude of 0.12--0.16 mag are obtained, depending on the filter-color combination. In contrast to the results obtained from color excesses, these fits give Rv~1--2, even when the two highly reddened SNe are excluded. This discrepancy suggests that, beyond the "normal" interstellar reddening produced in the host galaxies, there is an intrinsic dispersion in the colors of SNe Ia which is correlated with luminosity but independent of the decline rate. Finally, a Hubble diagram is produced by combining the results of the fits for each filter. The resulting scatter of 0.12 mag appears to be limited by peculiar velocities as evidenced by the strong correlation between the distance-modulus residuals among the different filters. The implication is that the actual precision of SN Ia distances is 3--4%.Comment: 76 pages, 20 figures, accepted for publication in A

The Distance to NGC 1316 (Fornax A) From Observations of Four Type Ia Supernovae

The giant elliptical galaxy NGC 1316 (Fornax A) is a well-studied member of the Fornax Cluster and a prolific producer of Type Ia supernovae, having hosted four observed events since 1980. Here we present detailed optical and near-infrared light curves of the spectroscopically normal SN 2006dd. These data are used, along with previously published photometry of the normal SN 1980N and SN 1981D, and the fast-declining, low-luminosity SN 2006mr, to compute independent estimates of the host reddening for each supernova, and the distance to NGC 1316. From the three normal supernovae, we find a distance of 17.8 +/- 0.3 (random) +/- 0.3 (systematic) Mpc for Ho = 72. Distance moduli derived from the "EBV" and Tripp methods give values that are mutually consistent to 4 -- 8%. Moreover, the weighted means of the distance moduli for these three SNe for three methods agree to within 3%. This consistency is encouraging and supports the premise that Type Ia supernovae are reliable distance indicators at the 5% precision level or better. On the other hand, the two methods used to estimate the distance of the fast-declining SN 2006mr both yield a distance to NGC 1316 which is 25-30% larger. This disparity casts doubt on the suitability of fast-declining events for estimating extragalactic distances. Modest-to-negligible host galaxy reddening values are derived for all four supernovae. Nevertheless, two of them (SN 2006dd and SN 2006mr) show strong NaID interstellar lines in the host galaxy system. The strength of this absorption is completely inconsistent with the small reddening values derived from the supernova light curves if the gas in NGC 1316 is typical of that found in the interstellar medium of the Milky Way. In addition, the equivalent width of the NaID lines in SN 2006dd appear to have weakened significantly some 100-150 days after explosion.Comment: 50 pages, 13 figures, 10 tables; constructive comments welcome. Accepted for publication in A

The Carnegie Supernova Project. I. Third Photometry Data Release of Low-redshift Type Ia Supernovae and Other White Dwarf Explosions

We present final natural-system optical (ugriBV) and near-infrared (YJH) photometry of 134 supernovae (SNe) with probable white dwarf progenitors that were observed in 2004-2009 as part of the first stage of the Carnegie Supernova Project (CSP-I). The sample consists of 123 Type Ia SNe, 5 Type Iax SNe, 2 super-Chandrasekhar SN candidates, 2 Type Ia SNe interacting with circumstellar matter, and 2 SN 2006bt-like events. The redshifts of the objects range from to 0.0835; the median redshift is 0.0241. For 120 (90%) of these SNe, near-infrared photometry was obtained. Average optical extinction coefficients and color terms are derived and demonstrated to be stable during the five CSP-I observing campaigns. Measurements of the CSP-I near-infrared bandpasses are also described, and near-infrared color terms are estimated through synthetic photometry of stellar atmosphere models. Optical and near-infrared magnitudes of local sequences of tertiary standard stars for each supernova are given, and a new calibration of Y-band magnitudes of the Persson et al. standards in the CSP-I natural system is presented.Fil: Krisciunas, Kevin. Texas A&M University; Estados UnidosFil: Contreras, Carlos. University Aarhus; Dinamarca. Las Campanas Observatory; ChileFil: Burns, Christopher R.. Las Campanas Observatory; ChileFil: Phillips, M. M.. Las Campanas Observatory; ChileFil: Stritzinger, Maximilian D.. Las Campanas Observatory; Chile. University Aarhus; DinamarcaFil: Morrell, Nidia Irene. Las Campanas Observatory; ChileFil: Hamuy, Mario. Universidad de Chile; ChileFil: Anais, Jorge. Las Campanas Observatory; ChileFil: Boldt, Luis. Las Campanas Observatory; ChileFil: Busta, Luis. Las Campanas Observatory; ChileFil: Campillay, Abdo. Las Campanas Observatory; ChileFil: Castellón, Sergio. Las Campanas Observatory; ChileFil: Folatelli, Gaston. Las Campanas Observatory; Chile. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas; ArgentinaFil: Freedman, Wendy L.. University of Chicago; Estados UnidosFil: González, Consuelo. Las Campanas Observatory; ChileFil: Hsiao, Eric Y.. Florida State University; Estados Unidos. University Aarhus; Dinamarca. Las Campanas Observatory; ChileFil: Krzeminski, Wojtek. Las Campanas Observatory; ChileFil: Persson, Sven Eric. Carnegie Observatories;Fil: Roth, Miguel. Gmto Corporation; Chile. Las Campanas Observatory; ChileFil: Salgado, Francisco. Leiden Observatory Research Institute; . Las Campanas Observatory; ChileFil: Serón, Jacqueline. Las Campanas Observatory; Chile. Cerro Tololo Inter American Observatory; ChileFil: Suntzeff, Nicholas B.. Texas A&M University; Estados UnidosFil: Torres, Simón. Soar Telescope; Chile. Las Campanas Observatory; ChileFil: Filippenko, Alexei V.. University of California at Berkeley; Estados UnidosFil: Li, Weidong. University of California at Berkeley; Estados UnidosFil: Madore, Barry F.. Jet Propulsion Laboratory, California Institute Of Technology; . Las Campanas Observatory; ChileFil: DePoy, D.L.. Texas A&M University; Estados UnidosFil: Marshall, Jennifer L.. Texas A&M University; Estados UnidosFil: Rheault, Jean Philippe. Texas A&M University; Estados UnidosFil: Villanueva, Steven. Texas A&M University; Estados Unidos. Ohio State University; Estados Unido

The Pan African Thoracic Society Methods in Epidemiologic, Clinical and Operations Research Program: A story of success told through a history of publications

Objectives: Despite bearing a substantial burden of respiratory diseases, low- and middle-income countries in Africa contribute little to the research literature. Since 2007, the Pan African Thoracic Society’s Methods in Epidemiologic, Clinical, and Operations Research (PATS-MECOR) program has been working to strengthen capacity in lung health research in Africa. The aim of this study was to assess the research productivity of previous PATS-MECOR participants.Materials and Methods: A systematic review of publications attributed to past PATS-MECOR participants up until 2018 was carried out using a systematic search strategy based on their names on PubMed database.Results: A total of 210 participants drawn from 21 African countries attended PATS-MECOR between 2007 and 2016, of which more than three-quarters (76.7%) had ever published. Of the total 1673 included publications, 303 (12.7%) had multiple course attendees as coauthors. The median publication per published participant was 5 (IQR 2–13) articles. The percentages of the first author, second authors, or last authors publications were 371 (22.2%), 239 (14.3%), and 99 (5.9%), respectively. The top three journals published in were PLOS One 108 (6.6%), Lancet 80 (4.9%), and the International Journal of Tuberculosis and Lung Disease 52 (3.2%). The median citation of their publications was 11 (4–26). There was approximately a double-fold rise in the publication output of participants in their 1st year following attendance to PATS-MECOR compared to the year before the course (123, 68.0% vs. 58, 32.0%).Conclusion: The PATS-MECOR training program has been successful in research capacity building for African investigators as evidenced by a growing publication track record. There is a need to ensure sustainability and for increased collaboration and networking among the trained critical mass of researchers in the continent

Thermal Emission of WASP-14b Revealed with Three Spitzer Eclipses

Exoplanet WASP-14b is a highly irradiated, transiting hot Jupiter. Joshi et al. calculate an equilibrium temperature Teq of 1866 K for zero albedo and reemission from the entire planet, a mass of 7.3 +/- 0.5 Jupiter masses and a radius of 1.28 +/- 0.08 Jupiter radii. Its mean density of 4.6 g/cm3 is one of the highest known for planets with periods less than 3 days. We obtained three secondary eclipse light curves with the Spitzer Space Telescope. The eclipse depths from the best jointly fit model are $0.224\%$ +/- $0.018\%$ at 4.5 {\mu}m and $0.181\%$ +/- $0.022\%$ at 8.0 {\mu}m. The corresponding brightness temperatures are 2212 +/- 94 K and 1590 +/- 116 K. A slight ambiguity between systematic models suggests a conservative 3.6 {\mu}m eclipse depth of $0.19\%$ +/- $0.01\%$ and brightness temperature of 2242 +/- 55 K. Although extremely irradiated, WASP-14b does not show any distinct evidence of a thermal inversion. In addition, the present data nominally favor models with day night energy redistribution less than $~30\%$. The current data are generally consistent with oxygen-rich as well as carbon-rich compositions, although an oxygen-rich composition provides a marginally better fit. We confirm a significant eccentricity of e = 0.087 +/- 0.002 and refine other orbital parameters.Comment: 16 pages, 16 figure