Digital Photographic Measurements of the Proximal Femoral Anatomy

Objective: This study evaluated the morphology of the proximal femur in the Thai population, especially the femoral head-neck relationship and the femoral neck-shaft relationship, using digital photographs. Methods: The morphology of each proximal femur was evaluated via the standard anteroposterior and cephalocaudal views of digital photographs. The femoral head-neck junction morphology was evaluated for translation, rotation, and concavity. The femoral neck-shaft anatomy was measured with the neck-shaft angle and the neck version. Results: Fifty-nine Thai femora with an average age of 45.4 years were evaluated. For the femoral head-neck translation, the average superior/inferior offset ratio was 1.01, and the average anterior/posterior offset ratio was 0.97. For the femoral head-neck rotation, the average anteroposterior and lateral physeal angles were 77.5° and 81.9°, respectively. Regarding the head-neck junction concavity, the average gamma, delta, alpha, and beta angles were 45.6°, 44.5°, 45.5°, and 36.2°, respectively. The average femoral neck-shaft angle was 129.5°, and the average femoral neck version was 5.7° of anteversion. Conclusion: Thai femora had their heads located almost at the center of the femoral neck, and they were rotated in abduction and anteversion relative to the neck axis. The femoral head-neck junctions showed less concavity anteriorly and superiorly

Making Every "Point" Count: Identifying the Key Determinants of Team Success in Elite Men’s Wheelchair Basketball

Wheelchair basketball coaches and researchers have typically relied on box score data and the Comprehensive Basketball Grading System to inform practice, however, these data do not acknowledge how the dynamic perspectives of teams change, vary and adapt during possessions in relation to the outcome of a game. Therefore, this study aimed to identify the key dynamic variables associated with team success in elite men’s wheelchair basketball and explore the impact of each key dynamic variable upon the outcome of performance through the use of binary logistic regression modelling. The valid and reliable template developed by Francis, Owen and Peters (2019) was used to analyse video footage in SportsCode from 31 games at the men’s 2015 European Wheelchair Basketball Championships. The 31 games resulted in 6,126 rows of data which were exported and converted into a CSV file, analysed using R (R Core Team 2015) and subjected to a data modelling process. Chi-square analyses identified significant (p<0.05) relationship between Game Outcome and 19 Categorical Predictor Variables. Automated stepwise binary regression model building was completed using 70% of the data (4,282 possessions) and produced a model that included 12 Categorical Predictor Variables. The accuracy of the developed model was deemed to be acceptable at accurately predicting the remaining 30% of the data (1,844 possessions) and produced an area under the receiver operating characteristic curve value of 0.759. The model identified the odds of winning are more than double when the team in possession are in a state of winning at the start of the possession are increased five-fold when the offensive team do not use a 1.0 or 1.5 classified player but are increased six-fold when the offensive team use three or more 3.0 or 3.5 players The final model can be used by coaches, players and support staff to devise training and game strategies that involve selecting the most appropriate offensive and defensive approaches when performing ball possessions to enhance the likelihood of winning in elite men’s wheelchair basketball

Determination of patellar tendon length for anterior cruciate ligament reconstruction using an anteroposterior knee radiograph

Background/Objective: Graft-tunnel length mismatch is a common intraoperative technical problem for anterior cruciate ligament reconstruction (ACLR) using a bone-patellar tendon-bone graft (BPTB). The patella-to-condyle and the patella-to-notch distances are two measurements in an anteroposterior knee radiograph. The objective of this study was to evaluate the sensitivities, specificities and reliabilities of those 2 measurements for detecting patients who had a patellar tendon length exceeding 45 mm. Methods: Preoperative plain radiographs of patients who underwent ACLR with a BPTB graft were evaluated independently by two orthopaedic surgeons 3 times each at 2-weekly intervals. The sensitivities and specificities of the two measurements for detecting patients who have a patellar tendon length exceeding 45 mm were calculated. The optimal cutoff point was estimated using Youden index, and the receiver operating characteristic (ROC) curve and area under the curve (AUC) were evaluated with a 95% CI. As for the inter- and intra-rater reliabilities, intraclass correlation coefficients (ICC) were determined. Results: One hundred and twenty-seven patients with an average age of 29.5 years old were evaluated. The mean patellar tendon length was 41.3 ± 5.0 mm. Patients with a length more than 45 mm (20 patients, 16%) had significantly higher patella-to-condyle and patella-to-notch distances, and more frequent use of bone staples for distal graft fixation than patients with a length ≤ 45 mm. To detect patients with a patellar tendon length over 45 mm, the optimal cutoff point for the patella-to-condyle distance was set at 14.5 mm, which had a sensitivity of 80%, specificity of 71%, and AUC of 0.76. In the case of the patella-to-notch distance, the cutoff point of 5.5 mm had a sensitivity of 80%, specificity of 66%, and AUC of 0.73. The intra- and inter-rater reliabilities of the two measurements were excellent, with ICCs of over 0.90. Conclusions: Preoperative measurements of the patella-to-condyle and the patella-to-notch distances in AP knee radiographs can be valuable tools, with good sensitivities and specificities, for the determination of the patellar tendon length when using a BPTB graft for an ACLR. They had an acceptable level of discrimination capability and excellent reliability. Keywords: Patellar tendon length, Anterior cruciate ligament reconstruction, Bone-patellar tendon-bone graft, Graft-tunnel length mismatch, Radiographic measurement, Anteroposterior knee radiograp

Quantifying anterior knee pain during specific activities after using the bone-patellar tendon-bone graft for arthroscopic anterior cruciate ligament reconstruction

Background/objective: There has been much debate about the optimal graft choice for an anterior cruciate ligament (ACL) reconstruction. Anterior knee pain is a common donor site problem when using a bone-patellar tendon-bone (BPTB) graft. However, knowledge of the characteristics of anterior knee pain during different daily activities is still limited. This study aimed to determine the incidence of anterior knee pain and to quantify the degree of pain during a range of daily living activities. Methods: Thirty-five patients who were scheduled to undergo an ACL reconstruction with an autologous BPTB graft between February 2015 and December 2016 were enrolled. A visual analogue scale (VAS) for pain was recorded during each of the following activities: ascending at 30-degree slope, ascending and descending stairs, running, jumping, squatting, kneeling, sitting cross-legged, and sitting one-legged. Demographic data, the range of motion, the area of decreased sensation, and the IKDC score were collected and compared 3 and 6 months postoperatively. Results: The 35 male patients had a mean age of 29.7 years. Postoperatively, the mean IKDC scores were 58.1 ± 9.8 at 3 months and 72.7 ± 10.5 at 6 months. The incidences of overall anterior knee pain were 62.9% and 34.3% at the 3- and 6-month time points. Kneeling was the only activity that produced severe pain. At 3 months postoperatively, kneeling's mean VAS pain score was 3.9 ± 2.9 (2.9, 4.9; 95% CI for mean for 17 patients [48.5%] with considerable pain), whereas at 6 months postoperatively, it was 2 ± 2.5 (1.2–2.9; 95% CI for mean for 9 patients [25.7%] with considerable pain). The area of numbness of the proximal leg decreased from 12.8 ± 18.3 cm2 (6.4, 19.2; 95% CI for mean) to 3.2 ± 9.1 cm2 (0.1, 6.5; 95% CI for mean) at 3 and 6 months postoperatively. Conclusions: Kneeling was the most challenging activity in terms of creating considerable levels of anterior knee pain in patients who had undergone an ACL reconstruction using a BPTB graft. Other knee activities, however, did not create moderate or severe degrees of anterior knee pain. Both anterior knee pain and numbness at the proximal leg improved over time.Trial registration number: TCTR2018–0630002. Keywords: Anterior cruciate ligament reconstruction, Anterior knee pain, Bone-patellar tendon-bone graft, Incidence and kneelin

Medical Services during the 24th Summer Universiade

Background: International sports competitions are one of the mass gathering events which require a well-planned medical care system for large numbers of participants. The Universiade, the World University Games, is organized for university athletes every two years. Methods: The medical service organization was presented and the medical care for injuries and illnesses provided during the 24th Summer Universiade were described. Results: During 1 to 23 August 2007, a total of 5,641 patients aged 12-89 years (including 1,700 athletes) received medical care. There were 2,535 cases (44.9%) using the Athletesั Village Polyclinic, 2,755 cases (48.8%) using the on-site medical units, and 351 cases (6.2%) using Thammasat Hospital. For the patients presented at the Athletesั Village Polyclinic, muscle strain was the most common injury (n=287, 34.1%), and musculoskeletal system problems were the most common illnesses (n= 484, 27.33%). Nineteen patients required hospital admission at Thammasat Hospital. Conclusion: This information might be useful for planning medical services in international multi-sport competitions in the future

The Effect of Tunnel Position on In-situ Force Vector Direction in Single Bundle and Double Bundle ACL Reconstruction

INTRODUCTION Recent studies have examined the magnitude of the in-situ force carried by replacement grafts in ACL reconstruction as well as the insitu force of the native ACL METHODS Sixteen fresh frozen cadaveric knees were used. Eight (n = 8) were used for the following techniques: 1. Anteromedial bundle reconstruction (AM-AM), 2. Posterolateral bundle reconstruction (PL-PL), 3. Classical vertical SB reconstruction (PL-HighAM), 4. Double bundle reconstruction (DB). The other eight (n = 8) knees were used for anatomical middle position SB reconstruction (MID-MID). A robotic/universal force-moment sensor (UFS-Model 4015; JR3 Inc. Woodland, CA) testing system was used. The robotic system was capable of controlling the displacement and the force/moment applied to the knee in all 6 DOF based on a mathematical description of knee kinematics and kinetics via a personal computer and a custom MATLAB program with a multitask operating system (Math Works Inc., Natick, MA, USA). The robot arm has repeatability of motion within ± 0.02 mm at each joint. The universal force/moment sensor (UFS) has reliability within ± 0.2 N and ± 0.1 Nm according to the manufacturer. Each specimen was rigidly secured to the robot via custom Aluminum cylinders and an epoxy compound. An anterior load of 89N was applied (KT) to the intact knee and the anterior tibial translation (ATT) was recorded at 0, 15, 30, 60 and 90 degrees of flexion. The knee was then removed from the robot and the ACL was carefully transected arthroscopically. The knee was then secured back to the robot and the kinematics of the intact state were repeated. An in-situ force vector composed of three dimensional force components in the anteriorposterior, medial-lateral, and superior-inferior directions was then determined 2 . A positive value was used for medial and negative for lateral. A similar protocol was used for each of the five reconstructed techniques to obtain the 3-D force components of the in-situ force vector of the replacement grafts. Once the intact and replacement ACL in-situ force vectors were determined, the 3-D angle between the two vectors, termed here the deviation angle, was determined and illustrated in RESULTS At 0° of knee flexion, the deviation angle of in-situ force vector for DB reconstruction was significantly lower than PL-PL reconstruction (p=0.018) and the deviation angle for MID-MID reconstruction was lower than all reconstruction techniques but not significantly (p = 0.028). At 15° of knee flexion, the deviation angle for PL-HighAM was significantly smaller than that for AM-AM reconstruction (p=0.018). The deviation angle for MID-MID reconstruction was lower than all reconstruction techniques but not significantly (p = 0.028). At 30° knee flexion, the deviation angle for PL-HighAM was significantly lower than PL-PL and AM-AM reconstruction. The deviation angle for DB was smaller than all techniques but not significantly ( p=0.028). At 60° knee flexion, deviation angle for PL-HighAM, DB, and MID-MID were all significantly smaller than PL-PL (p=0.018). At 90° knee flexion deviation angle for PL-HighAM, DB, and MID-MID were all significantly lower than PL-PL and PL-HighAM was also significantly lower than AM-AM (p=0.018) DISCUSSION In the present study, a deviation angle from the intact in-situ force vector was used as a quantitative measure to compare the effectiveness of various ACL reconstruction techniques. PL-HighAM, DB and MID-MID reconstruction have lower deviation angles in all flexion angles than AM-AM and PL-PL reconstructions. It is important to note however, the in-situ force vector has a magnitude and direction and the present study did not take magnitude into account. Also, the present study only determined deviation angles for simulated KT. Although, the ACL&apos;s primary role is to resist ATT, recent studies have shown that the ACL also may provide rotationally stability. In the future it may be of interest to examine the in-situ force vectors for simulated pivot shift and determine which tunnel position compares best with the intact ACL. One further limitation is that the present study is a time-zero study and the effect of graft healing was not a factor. ACKNOWLEDGEMENTS The support of the Albert B. Ferguson, Jr. MD Orthopaedic Fund of The Pittsburgh Foundation is gratefully acknowledged