Deepening trochleoplasty with a thick osteochondral flap for patellar instability:Clinical and functional outcomes at mean 6 year follow-up

Background: In patients with patellar instability and severe trochlear dysplasia, trochleoplasty has become increasingly used as part of the surgical management. Hypothesis: Deepening trochleoplasty for severe dysplasia in patellofemoral instability improves function and increases sports participation. Study Design: Case series; Level of evidence, 4. Methods: Between 1995and 2010 the thick-flap deepening trochleoplasty was performed in 90 patients (107 knees) with severe trochlear dysplasia. Data was collected prospectively pre-operatively, at 6 weeks and 1-year follow-up. The patients were surveyed retrospectively to determine the clinical and functional outcomes including sports and exercise participation at a minimum of 2 years, with complete data available in 92%. Results: With a minimum follow-up of 2 years, average of 6 years (range 2 – 19 years). The Kujala score had a median and interquartile range (IQR) of 63 (47-75) pre-operatively rising to 79 (68-91) at 1 year follow-up and 84 (73-92) at final follow-up (p< 0.05). Seventy-two per cent were satisfied with their knee function at 1 year follow-up rising to 79% at final follow-up (p <0.0001). Sports and exercise participation increased from 36 patients (40%) pre-operatively to 60 (67%) at final follow-up. The numbers involved in competitions increased slightly from 10 (11%) to 11 (12%). Of those sports that involved twisting (e.g. soccer, cricket, badminton), the proportion of patients participation increased from 16 (18%) to 22 (24%), whereas in non-twisting sports (e.g. running, swimming, cycling) it increased from 24 (27%) to 47 (52%) of whom 14 (16%) used walking as exercise. Conclusion: The thick-flap deepening trochleoplasty improves the clinical and functional outcomes for patients with symptomatic patellar instability with severe trochlear dysplasia. These results improve over time and beyond the 1 year clinical follow-up. However trochleoplasty does not lead to a significant improvement in sports participation at a competitive level. It does improve the sports and exercise patient participation, principally in non-twisting sports activities

On strongly chordal graphs that are not leaf powers

A common task in phylogenetics is to find an evolutionary tree representing proximity relationships between species. This motivates the notion of leaf powers: a graph G = (V, E) is a leaf power if there exist a tree T on leafset V and a threshold k such that uv is an edge if and only if the distance between u and v in T is at most k. Characterizing leaf powers is a challenging open problem, along with determining the complexity of their recognition. This is in part due to the fact that few graphs are known to not be leaf powers, as such graphs are difficult to construct. Recently, Nevries and Rosenke asked if leaf powers could be characterized by strong chordality and a finite set of forbidden subgraphs. In this paper, we provide a negative answer to this question, by exhibiting an infinite family \G of (minimal) strongly chordal graphs that are not leaf powers. During the process, we establish a connection between leaf powers, alternating cycles and quartet compatibility. We also show that deciding if a chordal graph is \G-free is NP-complete, which may provide insight on the complexity of the leaf power recognition problem

Reconfiguration of Cliques in a Graph

We study reconfiguration problems for cliques in a graph, which determine whether there exists a sequence of cliques that transforms a given clique into another one in a step-by-step fashion. As one step of a transformation, we consider three different types of rules, which are defined and studied in reconfiguration problems for independent sets. We first prove that all the three rules are equivalent in cliques. We then show that the problems are PSPACE-complete for perfect graphs, while we give polynomial-time algorithms for several classes of graphs, such as even-hole-free graphs and cographs. In particular, the shortest variant, which computes the shortest length of a desired sequence, can be solved in polynomial time for chordal graphs, bipartite graphs, planar graphs, and bounded treewidth graphs

Recurrent dislocation of the patella accompanying hypotrochlea of the femur and malalignment of the patella

This case report describes a rare case of recurrent dislocation of the patella which was accompanied with trochlear dysplasia and malalignment of the patella in a 15-year-old girl. She complained of hemoarthrosis and recurrent patellar dislocation in the early knee flexion phase. Plain radiography and computed tomography (CT) showed patellar malalignment (quadriceps angle 20°) and severe dysplasia of the trochlea of the femur (sulcus angle 170°). Surgery was performed, consisting of trochleoplasty in addition to proximal and distal realignment. Trochleoplasty was undertaken using a modified Dejour technique. After surgery, the patient complained of joint contracture. Arthroscopic release of fibrous tissue relieved symptoms and obtained normal range of motion without patellar dislocation. Postoperative radiography and CT demonstrated improvement of the quadriceps angle (10°) and sulcus angle (140°)

Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Arthroscopy is often used to treat patients with chronic patellofemoral pain syndrome (PFPS). As there is a lack of evidence, we conducted a randomized controlled trial to study the efficacy of arthroscopy in patients with chronic PFPS.</p> <p>Methods</p> <p>A total of 56 patients with chronic PFPS were randomized into two treatment groups: an <it>arthroscopy group </it>(<it>N </it>= 28), treated with knee arthroscopy and an 8-week home exercise program, and a <it>control group </it>(<it>N </it>= 28), treated with the 8-week home exercise program only. The arthroscopy included finding-specific surgical procedures according to current recommendations. The primary outcome was the Kujala score on patellofemoral pain and function at 9 months following randomization. Secondary outcomes were visual analog scales (VASs) to assess activity-related symptoms. We also estimated the direct healthcare costs.</p> <p>Results</p> <p>Both groups showed marked improvement during the follow-up. The mean improvement in the Kujala score was 12.9 (95% confidence interval (CI) 8.2–17.6) in the arthroscopy group and 11.4 (95% CI 6.9–15.8) in the control group. However, there was no difference between the groups in mean improvement in the Kujala score (group difference 1.1 (95% CI -7.4 - 5.2)) or in any of the VAS scores. Total direct healthcare costs in the arthroscopy group were estimated to exceed on average those of the control group by €901 per patient (<it>p </it>< 0.001).</p> <p>Conclusion</p> <p>In this controlled trial involving patients with chronic PFPS, the outcome when arthroscopy was used in addition to a home exercise program was no better than when the home exercise program was used alone.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN 41800323</p

Iliotibial band release as an adjunct to the surgical management of patellar stress fracture in the athlete: a case report and review of the literature

Stress fracture of the patella is rare. In this report, a case of patellar stress fracture occurring in an amateur athlete is presented, and an operative adjunct to the surgical management of this condition is proposed

The association between family and community social capital and health risk behaviours in young people: an integrative review

Background: Health risk behaviours known to result in poorer outcomes in adulthood are generally established in late childhood and adolescence. These ‘risky’ behaviours include smoking, alcohol and illicit drug use and sexual risk taking. While the role of social capital in the establishment of health risk behaviours in young people has been explored, to date, no attempt has been made to consolidate the evidence in the form of a review. Thus, this integrative review was undertaken to identify and synthesise research findings on the role and impact of family and community social capital on health risk behaviours in young people and provide a consolidated evidence base to inform multi-sectorial policy and practice.&lt;p&gt;&lt;/p&gt; Methods: Key electronic databases were searched (i.e. ASSIA, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Embase, Medline, PsycINFO, Sociological Abstracts) for relevant studies and this was complemented by hand searching. Inclusion/exclusion criteria were applied and data was extracted from the included studies. Heterogeneity in study design and the outcomes assessed precluded meta-analysis/meta-synthesis; the results are therefore presented in narrative form.&lt;p&gt;&lt;/p&gt; Results: Thirty-four papers satisfied the review inclusion criteria; most were cross-sectional surveys. The majority of the studies were conducted in North America (n=25), with three being conducted in the UK. Sample sizes ranged from 61 to 98,340. The synthesised evidence demonstrates that social capital is an important construct for understanding the establishment of health risk behaviours in young people. The different elements of family and community social capital varied in terms of their saliency within each behavioural domain, with positive parent–child relations, parental monitoring, religiosity and school quality being particularly important in reducing risk.&lt;p&gt;&lt;/p&gt; Conclusions: This review is the first to systematically synthesise research findings about the association between social capital and health risk behaviours in young people. While providing evidence that may inform the development of interventions framed around social capital, the review also highlights key areas where further research is required to provide a fuller account of the nature and role of social capital in influencing the uptake of health risk behaviours.&lt;p&gt;&lt;/p&gt