Research productivity during orthopedic surgery residency correlates with pre‑planned and protected research time: a survey of German‑speaking countries

Purpose The purpose of this study was to identify modifiable factors associated with research activity among residents working in orthopedic surgery and traumatology. Methods Residents at 796 university-affiliated hospitals in Austria, Germany, and Switzerland were invited to participate. The online survey consisted of questions that ascertained 13 modifiable and 17 non-modifiable factors associated with the residents’ current research activities. Responses of 129 residents were analyzed. Univariate linear regression was used to determine the association of individual factors with the current research activity (hours per week). The impact of significant non-modifiable factors (with unadjusted p values < 0.05) was controlled for using multivariate linear regression. Results The univariate analysis demonstrated six non-modifiable factors that were significantly associated with the current research activity: a University hospital setting (p < 0.001), an A-level hospital setting (p = 0.024), Swiss residents (p = 0.0012), the completion of a dedicated research year (p = 0.007), female gender (p = 0.016), and the department’s size (p = 0.048). Multivariate regression demonstrated that the number of protected research days per year (p < 0.029) and the percentage of protected days, that were known 1 week before (p < 0.001) or the day before (p < 0.001), were significantly associated with a higher research activity. Conclusions As hypothesized, more frequent and predictable protected research days were associated with higher research activity among residents in orthopedic surgery and traumatology. Level of evidence III

Tonhöhenzuordnung und psychometrische Funktion zur Frequenzunterscheidung bei erwachsenen Cochlea-Implantat-Trägern

Objectives: The purpose of this study was to investigate pitch perception in cochlear implant (CI) listeners using the Nucleus CI24RE implant in the low frequency range. In particular, we were interested in the possibility that conventional adaptive procedures can be applied in CI listeners. Additionally, the test-retest variability was investigated. Methods: 27 CI-listeners performed a 2-AFC frequency discrimination task with sinusoidal bursts at a base frequency of 494Hz with target frequencies that vary in steps of quarter-tones (qt) between one and fifteen qt. For each subject six hundred intervals were presented and no feedback was provided during the test. The retest was performed within 4 weeks. In addition, speech recognition tests in silence and with ambient noise were performed. Data of test and retest for each subject were fitted using a logistic function. Results: Reliable fits with small confidence intervals were obtained for 85% of the measurements. However, for eight measurements, the CI-listeners’ psychometric functions were non monotonic and thus could not be fitted. The average frequency discrimination limen was 2.6±1.1 qt for the test condition and 2.5±1.1 qt for the retest condition. No significant correlations for pitch perception abilities and speech perception were found. Discussion: In most of the CI listeners frequency discrimination limen could be measured with high reproducibility. Since a significant number of subjects showed non-monotonic psychometric functions for pitch perception, adaptive psychoacoustic procedures should be used carefully.Hintergrund und Ziele: Die Fähigkeit zur Unterscheidung von Frequenzen ist eine wichtige Voraussetzung für das Verstehen von Sprache und Musik. In der vorliegenden Arbeit wurde die Fähigkeit von Cochlea-Implantat (CI)-Trägern zur Frequenzdiskrimination untersucht. Des Weiteren wurde der Frage nach der Reliabilität dieser Untersuchung sowie dem Verlauf der psychometrischen Kurve der Tonhöhenunterscheidung der Probanden nachgegangen. Außerdem wurden die Ergebnisse der Diskriminationstests mit Ergebnissen von Sprachverständlichkeitstests verglichen und auf ihre klinische Relevanz hin untersucht. Methoden: 27 CI-Träger mit mindestens sechs Monaten CI-Erfahrung wurden in einem Test dazu aufgefordert, aus einem vorgespielten Tonpaar immer den von der Frequenz her höher empfundenen Ton anzugeben. Das Tonpaar bestand immer aus einem Grundton mit der Frequenz von 494 Hz sowie einem zweiten Ton, dessen Frequenz in einem Intervall zwischen einem bis 15 Vierteltönen zum Grundton höher wurde. Konnte der Proband keinen Unterschied in der Tonhöhe der beiden Töne ausmachen, wurde er aufgefordert einfach per Ratewahrscheinlichkeit auf einen der beiden Töne zu tippen. Nach einer Trainingsphase von 40 Tonpaaren, in der der Proband auch Rückmeldung über die Richtigkeit seiner Antworten bekam, wurde der eigentliche Test mit 600 Tonpaaren ohne Feedback gestartet. Innerhalb von vier Wochen absolvierte jeder Proband einen Retest, dessen Versuchsaufbau exakt dem des Tests entsprach. Zusätzlich wurden Sprachtests durchgeführt und die Ergebnisse dieser Tests mit den Ergebnissen der Frequenzunterscheidungstests verglichen. Ergebnisse und Beobachtungen: Grundsätzlich ließ sich die erwartet schlechtere Fähigkeit der CI-Träger gegenüber normalhörenden Personen zur Tonhöhenunterscheidung nachweisen. Die durchschnittliche Diskriminationsschwelle, also das Frequenzintervall, das CI-Träger gerade noch als zwei unterschiedliche Töne wahrnehmen, lag bei 2,6 ± 1,1 Vierteltöne für den Test und bei 2,5 ± 1,1 Vierteltöne für den Retest. Bei 46 der 54 Messungen ergaben sich für den Test beziehungsweise Retest psychometrische Funktionen mit einem monotonen Verlauf. Das bedeutet, dass die Fähigkeit zur Unterscheidung von zwei Frequenzen schlechter wird, je kleiner der Abstand der beiden getesteten Frequenzen ist. Die übrigen acht Messungen der psychometrischen Funktionen zeigten einen nicht monotonen Verlauf und konnten nicht zur Ermittlung der Diskriminationsschwelle herangezogen werden. Insgesamt ähnelten die monotonen psychometrischen Kurven von CI-Trägern in ihrem Verlauf stark denen von Normalhörenden, jedoch blieb eine gewisse Verschiebung der Kurven zu größeren Intervallen hin und ein flacherer Anstieg der Funktion zu beobachten. Die Ergebnisse der Sprachtests korrelierten in keiner Weise mit denen des Frequenzdiskriminationstests. Praktische Schlussfolgerungen: Die grundsätzlich herabgesetzte Fähigkeit der CI-Träger gegenüber Normalhörenden zur Frequenzdiskrimination ist einer der Faktoren, die für das teilweise schlechte Verstehen von Sprache und Musik bei CI-Trägern verantwortlich sind. Ein weiterer Faktor wurde bei der Betrachtung der acht nicht-monotonen psychometrischen Kurven deutlich: Die Nicht-Monotonie zeigte, dass bei manchen Probanden Tonhöhenverwechslungen stattfanden, die das Verstehen von komplexen Tönen oder gar Musik nahezu unmöglich macht. Zusätzlich zeigte sich, dass im Allgemeinen der Gebrauch von psychoakustischen Auswahltests bei CI-Trägern vermieden werden sollte, da nicht vorausgesetzt werden kann, dass alle Testergebnisse reliabel sind

Indication and technique for arthroscopic stabilization of anterior shoulder instability with multidirectional laxity

&lt;jats:title&gt;Abstract&lt;/jats:title&gt;&lt;jats:p&gt;As concomitant hyperlaxity has been identified as an independent risk factor for failure following anterior shoulder stabilization, the treatment of this special pathology remains challenging. There is a broad consensus that a clear differentiation to multidirectional instability and isolated anteroinferior instability should be ensured to avoid unsatisfactory outcomes. Typical features of this patient collective include positive clinical tests for anteroinferior instability and multidirectional shoulder hyperlaxity, findings of an anterior labral lesion and general capsular redundancy in the radiologic assessment, while tests for posterior instability are negative. Surgical treatment should consist of an anteroinferior capsulolabroplasty with concomitant posteroinferior plication to reduce pathological capsular volume. Although there is a lack of clinical evidence, biomechanical investigations suggest that a four-anchor construct with three anterior anchors and one posteroinferior anchor may be sufficient to restore glenohumeral stability. This surgical approach is presented and discussed in the current article.&lt;/jats:p&gt

Edge-Machine-Learning-Assisted Robust Magnetometer Based on Randomly Oriented NV-Ensembles in Diamond

Quantum magnetometry based on optically detected magnetic resonance (ODMR) of nitrogen vacancy centers in nano- or micro-diamonds is a promising technology for precise magnetic-field sensors. Here, we propose a new, low-cost and stand-alone sensor setup that employs machine learning on an embedded device, so-called edge machine learning. We train an artificial neural network with data acquired from a continuous-wave ODMR setup and subsequently use this pre-trained network on the sensor device to deduce the magnitude of the magnetic field from recorded ODMR spectra. In our proposed sensor setup, a low-cost and low-power ESP32 microcontroller development board is employed to control data recording and perform inference of the network. In a proof-of-concept study, we show that the setup is capable of measuring magnetic fields with high precision and has the potential to enable robust and accessible sensor applications with a wide measuring range

Patients return to sports and to work after successful treatment of septic arthritis following anterior cruciate ligament reconstruction

Purpose!#!To determine specific return to sports (RTS) and return to work (RTW) rates of patients with septic arthritis following anterior cruciate ligament reconstruction (ACLR), and to assess for factors associated with a diminished postoperative return to physical activity after successful eradication of the infection.!##!Methods!#!In this study, patients who were treated for postoperative septic arthritis of the knee following anterior cruciate ligament reconstruction between 2006 and 2018 were evaluated at a minimum follow-up (FU) of 2 years. Patients' outcomes were retrospectively analyzed using standardized patient-reported outcome scores including the Lysholm score and the subjective IKDC score, as well as return to sports and return to work questionnaires to assess for the types, number, and frequency of sports performed pre- and postoperatively and to evaluate for potential occupational changes due to septic arthritis following ACLR. To assess for the signifiance of the graft at follow-up, outcomes were compared between patients with a functioning graft at FU and those without, as well as between patients with initial graft retention and those with graft removal and consecutive revision ACLR.!##!Results!#!Out of 44 patients eligible for inclusion, 38 (86%) patients at a mean age of 36.2 ± 10.3 years were enrolled in this study. At a mean follow-up of 60.3 ± 39.9 months, the Lysholm score and the subjective IKDC score reached 80.0 ± 15.1 and 78.2 ± 16.6 points, respectively. The presence of a graft at FU yielded statistically superior results only on the IKDC score (p = 0.014). There were no statistically significant differences on the Lysholm score (n.s.) or on the IKDC score (n.s.) between patients with initial graft retention and those with initial removal who had undergone revision ACLR. All of the included 38 patients were able to return to sports at a median time of 8 (6-16) months after their last surgical intervention. Among patients who performed pivoting sports prior to their injury, 23 (62.2%) returned to at least one pivoting sport postoperatively. Overall, ten patients (26.3%) returned to all their previous sports at their previous frequency. The presence of a graft at FU resulted in a significantly higher RTS rate (p = 0.010). Comparing patients with initial graft retention and those with graft removal and consecutive revision ACLR, there was no statistically significant difference concerning the RTS rate (n.s.). Thirty-one patients (83.8%) were able to return to their previous work.!##!Conclusion!#!Successful eradication of septic arthritis following anterior cruciate ligament reconstruction allows for a postoperative return to sports and a return to work particularly among patients with ACL-sufficient knees. However, the patients' expectations should be managed carefully, as overall return rates at the pre-injury frequency are relatively low.!##!Level of evidence!#!IV

The acutely injured acromioclavicular joint – which imaging modalities should be used for accurate diagnosis? A systematic review

Abstract Background The management of acute acromioclavicular (AC) joint injuries depends on the degree of injury diagnosed by the Rockwood classification. Inadequate imaging and not selecting the most helpful imaging protocols can often lead to incorrect diagnosis of the injury. A consensus on a diagnostic imaging protocol for acute AC joint injuries does not currently exist. Therefore we conducted a systematic review of the literature considering three diagnostic parameters for patients with acromioclavicular (AC) joint injuries: 1) Assessment of vertical instability; 2) Assessment of horizontal instability; 3) Benefit of weighted panoramic views. Methods Internet databases were searched in March 2016 using the terms (“AC joint” OR “acromioclavicular joint”) AND (MRI OR MR OR radiograph OR X-ray OR Xray OR ultrasound OR “computer tomography” OR “computed tomography” OR CT). Diagnostic, prospective, retrospective, cohort and cross- sectional studies were included to compare their use of different radiological methods. Case reports, cadaveric studies, and studies concerning chronic AC injuries and clinical outcomes were excluded. Results This search returned 1359 citations of which 1151 were excluded based on title, 116 based on abstract and 75 based on manuscript. 17 studies were included for review and were analyzed for their contributions to the three parameters of interest mentioned above. The inter- and intra-observer reliability for diagnosing vertical instabilities of the clavicle using x-ray alone show a high level of reproducibility while for horizontal instabilities the values were much more variable. In general, digitally measured parameters seem to be more precise and reliable between investigators than visual classification alone. Currently, evidence for the value of weighted views and other additional diagnostic imaging to supplement standard x-rays is controversial. Conclusion To date there is no consensus on a gold standard for diagnostic measures needed to classify acute AC joint injuries. The inter- and intra-observer reliability for diagnosing vertical instabilities of the clavicle using bilateral projections show a high level of reproducibility while for horizontal instabilities the results are much more inconsistent. There is currently no clear consensus on a protocol for image-based diagnosis and classification of acute AC joint injuries, leading to a lack of confidence in reproducibility and reliability

Reattachment of the flexor and extensor tendons at the epicondyle in elbow instability: a biomechanical comparison of techniques

Abstract Background Elbow dislocation represents a common injury, especially in the younger population. If treated surgically, the reattached tendons require a high amount of primary stability to allow for an early rehabilitation to avoid postoperative stiffness. The purpose of this study was to assess the biomechanical properties of a single and a double row technique for reattachment of the common extensor and common flexor muscles origin. We hypothesized that the double row technique would provide greater stability in terms of pullout forces than the single row technique. Methods Twelve cadaveric specimens were randomized into two groups of fixation methods for the common extensor tendon or the common flexor tendon at the elbow (1): a single row technique using two knotted 3.0 mm suture anchors, and (2) a double row technique using an additional knotless 3.5 mm anchor. The repairs were cyclically loaded over 500 cycles at 1 Hz from 10 N to a maximum of 100 N (extensors) or 150 N (flexors), and then pulled to failure. Stiffness and maximum load at failure and mode of failure were recorded and calculated. Results No significant differences in stiffness were observed between the two techniques for both the extensor and flexor reattachment (P = 0.701 and P = 0.306, respectively). The mean maximum load at failure indicated that the double row construct was significantly stronger than the single row construct. This was found to be true for both the extensor and flexor reattachment (213.6; SD 78.7 N versus 384.1; SD 105.6 N, P = 0.010 and 203.7; SD 65.8 N versus 318.0; SD 64.6 N, P = 0.013, respectively). Conclusions The double row technique provides significant greater stability to the reattached common flexor or extensor origin to the medial or lateral epicondyle. Thus, it should be considered in the development of improved repair techniques for stabilizers of the elbow. Study design Controlled laboratory study

Preoperative patellofemoral anatomy affects failure rate after isolated patellofemoral inlay arthroplasty

Purpose!#!To analyze whether preoperative patellofemoral anatomy is associated with clinical improvement and failure rate after isolated patellofemoral arthroplasty (PFA) using a modern inlay-type trochlear implant.!##!Methods!#!Prospectively collected 24 months data of patients treated with isolated inlay PFA (HemiCAP!##!Results!#!A total of 41 patients (61% female) with a mean age of 48 ± 13 years could be included. Fifteen patients (37%) were considered failures, with 5 patients (12%) revised to TKA and 10 patients (24%) not achieving MCID for WOMAC total or VAS pain. Failures had a significantly higher ISI, and a significantly lower PTI. Furthermore, the proportion of patients with a pathologic ISI (&amp;gt; 1.2), a pathologic PTI (&amp;lt; 0.28), and without trochlear dysplasia were significantly higher in failures. Significantly greater improvements in clinical outcome scores were observed in patients with a higher preoperative grade of patellofemoral OA, ISI ≤ 1.2, PTI ≥ 0.28, TT-PCL distance ≤ 21 mm, and a dysplastic trochlea.!##!Conclusion!#!Preoperative patellofemoral anatomy is significantly associated with clinical improvement and failure rate after isolated inlay PFA. Less improvement and a higher failure rate must be expected in patients with patella alta (ISI &amp;gt; 1.2 and PTI &amp;lt; 0.28), absence of trochlear dysplasia, and a lateralized position of the tibial tuberosity (TT-PCL distance &amp;gt; 21 mm). Concomitant procedures such as tibial tuberosity transfer may, therefore, be considered in such patients.!##!Level of evidence!#!Level III, retrospective analysis of prospectively collected data

Definition of the terms “acute” and “traumatic” in rotator cuff injuries: a systematic review and call for standardization in nomenclature

Background!#!Although of high relevance for clinical decision making, there exists no consensus throughout the literature of the terms 'acute' and 'traumatic' used in the classification of rotator cuff tears. With differing definitions, the comparability of outcome studies may be limited. The aim was to provide a detailed systematic review of the definitions used in the literature and present a suggestion for a standardization in nomenclature based on the findings.!##!Methods!#!Four different internet databases were searched in February 2020 using the terms ('acute' OR 'traumatic' OR 'trauma' OR 'athlete' OR 'young') AND ('rotator cuff tears' OR 'rotator cuff tear' OR 'rotator cuff' OR 'rotator cuff rupture' OR 'supraspinatus' OR 'infraspinatus' OR 'subscapularis' OR 'teres minor'). Prospective, retrospective, cohort and case-control studies as well as case series were included. Systematic reviews, cadaveric or laboratory studies and studies on non-traumatic or non-acute rotator cuff tears were excluded.!##!Results!#!The literature search conducted 10,349 articles of which 10,151 were excluded based on the title, 119 based on the abstract and 33 based on the manuscript. A total of 46 studies were finally included for review and subsequently analyzed. Overall, there exists no consensus neither on the term 'acute' nor on 'traumatic' in the context of rotator cuff tears in the literature. The time span for acute injuries ranged between 2 weeks and 6 months. For traumatic injuries, only 20% of the selected studies described a specific and adequate injury mechanism in combination with adequate imaging.!##!Conclusion!#!The term 'acute' should be reserved for RCT showing muscle edema, wavelike appearance of the central part of the torn tendon and joint effusion, which typically requires adequate imaging within 2 weeks from trauma. Repair of acute tears should occur within 8 weeks from trauma to benefit from possibly superior biological healing capacities. The term 'traumatic' should be used for a sudden onset of symptoms in a previously asymptomatic patient, triggered by an adequate trauma, e.g., a fall on the retroverted arm with an axial cranioventral force or a traumatic shoulder dislocation