Manual Maximum Research Articles

Poster 341: Nonoperative Treatment of MCL Tears in ACL/MCL Injuries Does Not Increase ACL Retear Rates

Objectives: There continues to be controversy regarding the treatment of medial collateral ligament (MCL) tears when torn in conjunction with the anterior cruciate ligament (ACL). There is a push to acutely repair or reconstruct the MCL in this setting due to lower revision rates following the ACL reconstruction (ACLR). However, most nonoperative treatment philosophies are focused on immobilization through bracing instead of the more rigid casting approach. The purpose of this study was to determine if there was a difference in ACL retear rates or postoperative stability between those with ACL/MCL injuries and isolated ACL injuries when the MCL was treated nonoperatively, including rigid casting prior to the ACLR. Methods: Between 1982 and 2022, 6047 patients planning to have an ACLR were enrolled into the study. The population was determined with inclusion criteria of a primary ACLR using a patellar tendon graft with minimum 1-year follow up. Patients were excluded with revision ACLR, lateral side or posterior cruciate ligament involvement, or lacking postoperative KT data. Patients were divided into two groups, isolated ACLR (N = 5670) and ACL/MCL (N = 377). All MCL tears were treated nonoperatively and when indicated, they were casted in 30° of flexion and changed weekly until a solid end point was achieved and patients had the ability to bear full weight on the involved side. Once medial side stability was attained, preoperative rehabilitation commenced and range of motion was normalized before the ACLR. Postoperatively, all patients followed the same accelerated rehabilitation program. The KT manual maximum (MM) difference between knees, in millimeters, was used for analysis. Graft retear rate was determined through subjective surveys sent yearly to each patient after surgery. To reduce confounding bias in the analysis, the ACL/MCL patients were control matched 1:1 to the isolated ACL injury patients based on sex, age, postoperative activity rating, and surgery timing, which led to 304 patients in each group. Results: Prior to matching, both groups had similar mean ages and rates of having postoperative activity levels ≥7, however, the ACL/MCL group showed higher rates of males (69.0%) and subacute surgery (71.9%) compared to the isolated ACLR group (59.7% males and 56.6% subacute surgery). After matching, the mean age for both groups was similar (ACL/MCL: 24.6 years, isolated ACLR: 24.9 years) and they showed identical rates of males, postoperative activity rating ≥7, and subacute surgery at 66.4%, 90.4%, and 73.0%, respectively. The KT MM difference for the ACL/MCL group was not statistically significantly different when compared to the isolated ACLR group (1.8mm vs 1.6mm; p=0.196). The ACL retear rate for the ACL/MCL group was 7.9% compared to 6.6% for the isolated ACLR group, which was not statistically significantly different, p = 0.531. Conclusions: When the MCL is treated nonoperatively, including the use of a cast, before an ACLR, postoperative stability and rates of ACL retears are similar to those with an isolated ACL tear. Due to similar outcomes for both groups, surgeries to the MCL, and thus potential complications that can come with it, can be avoided. We postulate that the lack of differences in laxity and retear rates for the ACL/MCL group may be due to more rigid cast immobilization for the MCL, as opposed to bracing. Further study is needed to evaluate this hypothesis.

Poster 342: Return to Sport Rates and Objective Measures after ACL Reconstruction for High Level Basketball Players

Objectives: Return to sports (RTS) decisions for high-level basketball players after an anterior cruciate ligament reconstruction (ACLR) are multifactorial. The literature focuses mainly on sports performance metrics and lacks objective rehabilitation measures. The purpose of this study was to determine objective measure differences following an ACLR between basketball players competing at the college/professional, high school, and recreational levels. Our hypothesis was that basketball players competing at the college/professional level would have superior performance with objective measures following an ACLR, compared to those competing at the high school and recreational levels. Methods: Patients were retrospectively selected based on the following inclusion criteria: ACLR with a contralateral patellar tendon graft (PTG), preoperative activity level of ≥8 on the modified Tegner activity rating scale, ≤25 years old, and reported playing basketball. Exclusions included: revisions, bilateral procedures, or were missing data needed for analysis. Patients were split based on their preoperative activity level (level 8 = recreational, level 9 = high school, level 10 = college/professional). Each patient received a mini open, contralateral PTG utilizing the same surgical methods and followed the same accelerated rehabilitation approach. Postoperative outcome measures included the difference in extension range of motion (ROM) at 2 weeks, difference in flexion ROM at 3 months, percent deficit in isokinetic quadriceps strength and single leg hop for distance at 4 months, and the manual maximum difference on the KT arthrometer at 2 months. Statistical analysis included chi-square and analysis of variance where appropriate. Results: Of the 329 patients, 69 were level 8, 224 were level 9, and 36 were level 10 with mean ages of 19.6, 16.4, and 19.1 years, respectively. The percent of males differed by group with level 8 at 78.3%, level 9 at 29.5%, and level 10 at 27.8% (p < 0.001). The overall rate of return to competitive basketball for the cohort was 96.0%. The rate of return to competitive basketball was not statistically significantly different among the groups with level 10 having the highest rate (97.2%), followed by level 9 (96.4%) and then level 8 (94.2%), p = 0.659. Level 10 athletes had the lowest strength deficit with a mean of 9.3%, compared to 12.5% for level 9, and 15.6% for level 8, p=0.017. Single leg hop deficit was also different among groups with level 10 at 6.9%, level 9 at 6.2%, and level 8 at 10.4%, p < 0.001. Knee ROM and stability were not statistically different among the groups. Conclusions: The rate of return to competitive basketball is the same among all high-level basketball players. Objectively, level 10 athletes had superior strength and single leg hop performance compared to recreational basketball players. Although the return to competitive basketball rate is the same among all groups, recreational basketball players tend to be weaker than college/professional players, therefore, added emphasis on this aspect of their rehabilitation would be beneficial for this population.

Design of Automatic Loading and Unloading Manipulator for CNC Gear Milling Machine

Background: At present, due to the widespread use of robotic arms for the automatic loading and unloading of CNC gear milling machines, there has been an increase in patents related to robotic arms. However, these robotic arms have issues of low efficiency and large space occupation. To solve these problems, a CNC gear milling machine with an automatic loading and unloading manipulator device needs to be designed. Methods: This paper first designs the overall scheme of the automatic loading and unloading manipulator, and then uses Solidworks to establish a three-dimensional model. Finite element analysis software is used to analyze and simulate the deformation, stress distribution, and service life of the key components in the overall device. Finally, a prototype of the robotic arm is created based on the simulation optimization results. Results: This paper designs a new type of automatic loading and unloading manipulator device for CNC gear milling machines, which is different from existing patents in that all its components are installed inside the machine tool protective cover. In production experiments, the operation was found to be stable and reliable, and the loading and unloading process was completed at a speed of 11s/time, consistently exceeding the manual maximum speed of 19s/time. The results indicate that the proposed clamp storage system and core rod perforation feeding method are effective. Conclusion: The new design solves the problems of low efficiency and large space occupation in existing robotic arm patents.

Primary Anterior Cruciate Ligament Reconstruction with Suture Tape Augmentation: A Case Series of 252 Patients.

Anterior cruciate ligament reconstruction (ACLR) using suture tape augmentation to internally brace is a relatively new technique. The primary goal of this study was to prospectively collect patient-reported outcomes (PROs) and surgical history from patients who underwent primary ACLR with internal bracing to determine if internal bracing resulted in a low graft failure rate while maintaining acceptable PROs. A total of 252 patients with a mean age of 23.6 years (95% confidence interval [CI]: 22.1-25.1) and a mean follow-up of 37.9 months (95% CI: 35.8-40.0) were included in this study. Patients who underwent primary ACLR with internal brace augmentation between July 12, 2016 and July 31, 2021 were eligible. A total of 222 patients were contacted via telephone and administered the visual analog scale (VAS), the single assessment numeric evaluation (SANE), the Lysholm knee score scale, and, if applicable, the short version ACL return to sport after injury (SV-ACL-RSI) survey. Additionally, patients were asked to give an updated orthopaedic history. Thirty additional patients were included from either our institution's registry or by completing their surveys in-office or by e-mail. The minimal clinically important difference (MCID) and patient-acceptable symptom states (PASS) were calculated based on our patient population and applied to each individual patient. The patients' electronic health record (EHR) was searched for pre- and postoperative clinical data including KT-1000 arthrometer measurements. Two patients (0.8%) had subsequent graft failures and one patient (0.4%) required a revision surgery. MCID was achieved in 242 patients (96.0%) for the Lysholm, 227 patients (90.1%) for the SANE, and 146 patients (57.9%) for the VAS. PASS was achieved in 214 patients (84.9%) for the Lysholm, 198 patients (78.6%) for the SANE, and 199 (80.0%) patients for the VAS, postoperatively. Of note, 65 patients (25.8%) exceeded the PASS threshold for the VAS preoperatively. A total of 127 patients (84.4%) met the cutoff of ≥60/100 for the SV-ACL-RSI survey postoperatively. Postoperative KT-1000 measurements showed near-identical side-to-side differences at both the 13.6-kg pull and manual maximum pull. When stratifying patients based on age at the time of surgery, it was noted that patients younger than 25 years had significantly higher SANE scores (91.6 [95% CI: 90.2-92.9] vs. 82.6 [95% CI: 79.0-86.2]; p < 0.0001) and lower VAS pain scores (0.7 [95% CI: 0.5-0.8] vs. 1.2 [95% CI: 0.8-1.5]; p = 0.004). Primary ACLR with internal bracing led to acceptable patient outcomes and a graft failure rate of less than 1%. LEVEL OF EVIDENCE:: case series, IV.

Quantification of Agricultural Terrace Degradation in the Loess Plateau Using UAV-Based Digital Elevation Model and Imagery

Agricultural terraces are important artificial landforms on the Loess Plateau of China and have many ecosystem services (e.g., agricultural production, soil and water conservation). Due to the loss of rural labor, a large number of agricultural terraces have been abandoned and then the degradation of terraces, caused by rainstorm and lack of management, threatens the sustainability of ecological services on terraces. Our previous study has found its geomorphological evidence (sinkhole and collapse). However, no quantitative indicators of terrace degradation are identified from the perspective of microtopography change. A framework for quantifying terrace degradation was established in this study based on unmanned aerial vehicle photogrammetry and digital topographic analysis. The Pujiawa terraces in the Loess Plateau were selected as study areas. Firstly, the terrace ridges were extracted by a Canny edge detector based on high-resolution digital elevation model (DEM) data. The adaptive method was used to calculate the low and high thresholds automatically. This method ensures the low complexity and high-edge continuity and accuracy of the Canny edge detector, which is superior to the manual setting and maximum inter-class variance (Otsu) method. Secondly, the DEMs of the terrace slope before degradation were rebuilt through the terrain analysis method based on the extracted terrace ridges and current DEM data. Finally, the degradation of terraces was quantified by the index series in the line, surface and volume aspects, which are the damage degrees of the terrace ridges, terrace surface and whole terrace. The damage degrees of the terrace ridges were calculated according to the extracted and generalised terrace ridges. The damage degrees of the terrace surface and whole terrace were calculated based on the differences of DEMs before and after degradation. The proposed indices and quantitative methods for evaluating agricultural terrace degradation reflect the erosion status of the terraces in topography. This work provides data and references for loess terrace landscape protection and its sustainable management.

Reduced Incidence of Revision Anterior Cruciate Ligament Reconstruction With Internal Brace Augmentation.

Revision rates and outcome measures after anterior cruciate ligament reconstruction (ACLR) with suture tape as an internal brace is not well-documented because of the emerging nature of the technique. ACLR with internal bracing (IB) would lead to decreased revision ACLR compared with traditional ACLR while exhibiting comparable patient outcomes. Cohort study; Level of evidence, 3. A total of 200 patients were included in this study. Patients aged between 13 and 39 years at the time of surgery who underwent primary autograft ACLR with IB between 2010 and 2020 and were enrolled in our institution's registry with a minimum of 2-year follow-up were identified and matched 1 to 1 with a non-internal brace (no-IB) group based on concomitant procedures and patient characteristics. Pre- and postoperatively, patients completed the Knee injury and Osteoarthritis Outcome Score, Marx activity rating scale, Veterans RAND 12-Item Health Survey, and visual analog scale for pain. Knee laxity measurements via the KT-1000 arthrometer were included in the pre- and postoperative objective clinical assessments. A total of 100 IB patients were matched with 100 no-IB patients based primarily on concomitant procedures and secondarily on patient characteristics. The IB group underwent significantly fewer revision ACLRs (1% vs 8%; P = .017). Even though the no-IB group had a significantly longer mean final follow-up time (48.6 months [95% CI, 45.4-51.7] vs 33.4 months [95% CI, 30.3-36.5]; P < .001), the time elapsed from the original ACLR to the revision did not differ significantly between groups, and the mean ages for the IB and no-IB groups were comparable (19 vs 19.9 years). All postoperative patient-reported outcome scores between the 2 groups were comparable and significantly improved postoperatively except for the Marx score, which significantly decreased stepwise for both groups postoperatively. KT-1000 measurements significantly improved in both groups after surgery with the IB and no-IB cohorts yielding comparable results at the manual maximum pull (0.97 vs 0.65 mm). ACLR with IB resulted in a significantly decreased risk of revision ACLRs while maintaining comparable patient-reported outcomes. Therefore, incorporating an internal brace into ACLR appears to be safe and effective within these study parameters.

Poster 344: Reduced Incidence of Anterior Cruciate Ligament Reconstruction Revision with Internal Brace Augmentation: A Retrospective Matched Cohort Study with a minimum 2-year Follow-up

Objectives: The primary purpose of this study was to investigate retear rates in patients who underwent ACLR with and without internal bracing in a matched cohort study. Additionally, we also sought to investigate if there were any differences in clinical and patient-reported outcomes between the groups. We hypothesized that ACLR with internal bracing would reduce the incidence of revisions in a safe and effective manner. Methods: A total of 200 patients were included in this study. Patients between the ages of 13-39 at the time of surgery who underwent primary autograft ACLR with internal bracing (IB group) between October 2010 and July 2020 and were enrolled in our institution’s registry with a minimum of 2-year follow-up were identified and matched 1:1 with a non-internal brace (no-IB) group based on patient demographics and concomitant procedures. Every patient completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale (MARS), Veterans RAND 12-Item Health Survey (VR- 12), and the Visual Analog Scale (VAS) pre- and postoperatively. KT-1000 arthrometer measurements were included in the pre- and postoperative objective, clinical assessments. Results: The IB group underwent significantly less revision ACLRs (1% vs. 8%, p = 0.017). Additionally, the average time elapsed from the original ACLR to the revision did not differ significantly and the average ages for the IB and the no-IB groups were comparable (19.0-years-old vs. 19.9-years-old). 5 patients in the no-IB group underwent a total of 9 meniscal procedures among them at the time of their revision ACLR compared to just one in the IB group (p = 0.009). There were also 4 patients in the no-IB group that underwent anterolateral ligament reconstruction at the time of their revisions (4 vs. 0, p = 0.043). All postoperative patient-reported outcome measures (PROMs) significantly increased in both groups with the exception of the MARS score which significantly decreased in both groups postoperatively. KT-1000 measurements significantly improved in both groups following surgery with the IB and no-IB cohorts yielding comparable results at the manual maximum pull (0.97mm vs. 0.65mm). Conclusions: ACLR with internal bracing resulted in an 88% decrease in revision ACLRs while maintaining comparable patient reported outcomes. Incorporating an Internal brace into ACLR is therefore safe and effective within these study parameters. [Table: see text][Table: see text][Table: see text]

Implementation of ERP for Student Training and Placement

Training and Placement is the crucial part of any educational institute in which most of the work till now is being done manually of papered work. The aim of this project is Automation of Training and Placement unit of College or academic institutes. The project will include minimum manual work and maximum optimization, abstraction and security. This is a web application which will help students as well as the administration authority to carry out each and every activity in this department. It also provides a requested list of candidates to recruit the students based on given query. Administrator logging in may also search any information put up by the students. This project will aid colleges to practice full IT deployment. This will also help in fast access procedures in placement related activities.

Good stability and mid-term subjective outcomes after repeated anterior cruciate ligament (ACL) revision surgery using allografts.

To evaluate the mid-term clinical outcomes of a cohort of patients who underwent multiple ACL revision reconstructions. The hypothesis was that patients with pre-existing meniscal deficiency conditions, malalignment and cartilage degeneration would have obtained lower results. All cases of multiple ACL revisions performed with allograft tissue at one single sport-medicine institution were extracted and patients with a minimum 2years of follow-up were included. WOMAC, Lhysolm, IKDC, and Tegner activity level before the injury and at last follow-up was collected and laxity evaluated with KT-1000 arthrometer and KiRA triaxial accelerometer. From a cohort of 241 ACL revisions, 28 patients (12%) with Repeated ACL Revision reconstructions were included. Fourteen cases (50%) were considered "Complex" due to the addition of meniscal allograft transplantation (8) or meniscal scaffold (3) or high tibial osteotomy (3). The remaining 14 cases (50%) were considered as "Isolate". The mean WOMAC score was 84.6 ± 11.4, Lysholm 81.7 ± 12.3, subjective IKDC 77.2 ± 12.1, and median Tegner score 6 (IQR 5-6) at pre-injury and at final follow-up. Statistically significant inferior values of WOMAC (p = 0.008), Lysholm (p = 0.02) and Subjective IKDC (p = 0.0193) were detected between "Complex" and "Isolate" revision groups. Higher average values of anterior translation at KT-1000 at both 125 N (p = 0.03) and manual maximum displacement test (p = 0.03) were reported in "Complex" with respect to "Isolate" revisions. Four patients were considered as failures and occurred in patients with "Complex" revisions, none occurred in the "Isolate" (30% vs 0%; p = 0.04). Good mid-term clinical results can be obtained after repeated ACL revision with allograft in patients who experienced multiple failures; however, those who need additional procedure due to malalignment or post-meniscectomy syndrome reported lower objective and subjective results. III.

Difference in implant design affects midflexion rotational laxity in cruciate-retaining total knee arthroplasty: a computer navigation study

PurposeThis study aimed to compare midflexion rotational laxity between two different design concept models of cruciate-retaining total knee arthroplasty: symmetrical surface design of neutral joint line obliquity and asymmetrical surface design of varus joint line obliquity.MethodsSixty-three knees that underwent cruciate-retaining total knee arthroplasty were evaluated. Manual maximum passive rotational stress without acceleration was applied to the knees under navigation monitoring. Pre-operative and post-operative internal and external rotational angles were measured at 30°, 45°, 60°, and 90° knee flexion.ResultsThe post-operative internal rotational laxity was significantly increased compared with pre-operative levels at 30°, 45°, 60°, and 90° flexion among all subjects (mean 9.7° vs 11.1°, 10.6° vs 11.6°, 11.2° vs 12.9°, and 13.2° vs 14.9°; p = 0.01, 0.04, 0.001, and 0.008, respectively). The post-operative external rotational laxity was significantly decreased compared to pre-operative levels at 30°, 45°, 60°, and 90° flexion among all subjects (mean 10.8° vs 6.8°, 12.5° vs 9.4°, 12.8° vs 10.0°, and 11.3° vs 9.5°; p < 0.0001, < 0.0001, < 0.0001, and 0.0008, respectively). The post-operative total rotational laxity significantly decreased, compared with pre-operative levels, at 30° and 45° flexion among all subjects (mean 20.4° vs 17.9°, and 23.1° vs 21.1°; p = 0.002 and 0.04, respectively). The post-operative total rotational laxity was significantly smaller in asymmetrically designed total knee arthroplasty than in symmetrically designed total knee arthroplasty at 30°, 45°, and 60° flexion (mean 19.3° vs 15.8°, 22.8° vs 18.7°, and 24.4° vs 20.8°; p = 0.03, 0.03, and 0.02, respectively), whereas no significant difference was observed at 90° flexion.ConclusionCompared to symmetrical surface design, asymmetrical surface design resulted in lower rotational laxity at the midflexion range in cruciate-retaining total knee arthroplasty.Level of evidenceIII.

Range of Motion, Strength, and Function After ACL Reconstruction Using a Contralateral Patellar Tendon Graft.

Regaining preinjury levels of activity and progressing rehabilitation factors after anterior cruciate ligament (ACL) reconstruction have shown mixed results. To evaluate the timing and rate of return for knee range of motion (ROM), stability, strength, and subjective scores after ACL reconstruction with contralateral patellar tendon graft (PTG). Case series; Level of evidence, 4. Included were 2148 patients (1238 male patients, 910 female patients) who underwent primary ACL reconstruction with a contralateral PTG between 1995 and 2017 and had complete objective data through 3 months of follow-up. All patients participated in a rehabilitation program specific to goals for each knee. Patients were evaluated objectively with goniometric measurement of ROM, isokinetic quadriceps strength testing, and laxity with a KT-2000 arthrometer. Subjective data were collected at 2 and 5 years. Normal extension on the reconstructed knee was attained for 95% of patients at 1 week postoperatively; normal flexion on the reconstructed knee was reached by 77% of patients by 3 months. At 3 months postoperatively, mean limb symmetry index strength was 104%, and the strength on the ACL-reconstructed and graft-donor knees was 87% and 86% of their respective preoperative strength. Mean manual maximum side-to-side difference in laxity was 2.0 mm at 1 month. Most patients (90%) returned to level 8 sports or higher and did so at an average of 5.7 months. Mean International Knee Documentation Committee scores for the ACL-reconstructed and graft-donor knees were 89 and 91 at 2 years (n = 1015 patients) and 84 and 90 at 5 years (n = 1275 patients), respectively. Mean Cincinnati Knee Rating Scale scores for the ACL-reconstructed and graft-donor knees were 92 and 96 at 2 years (n = 1184) and 88 and 94 at 5 years (n = 1236), respectively. For patients who underwent ACL reconstruction with a contralateral PTG, postoperative ROM and strength were restored quickly by splitting the rehabilitation into different goals between the two knees. Using a contralateral PTG, this structured rehabilitation plan can lead to a relatively quick return to sport and good subjective long-term outcomes.

Outcomes Following Bone-patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction In Patients &lt;30 Years: Allograft Vs. Autograft

PURPOSE: The purpose of this study was to investigate differences in failure rates and functional outcomes between patients <30 years of age that underwent allo- or autograft Bone-Patellar Tendon-Bone (BPTB) ACLR. METHODS: All patients aged 16-30 years who underwent a BPTB allo- or autograft ACLR with bioabsorbable interference screws by a single surgeon (1995-2019) were included. Exclusion criteria were follow-up <2 years, osteochondral drilling, revision ACLR, and multi-ligamentous injuries. The allograft was always <5 years than patient age and not terminally irradiated. Meniscal repairs were completed as necessary. All patients completed a decelerated, conservative rehab program with required bracing for 3 months and return to pivoting sports >6 months. An independent physical exam including knee ROM and stability testing, (manual max KT-1000, Lachman, pivot shift) was performed. Patients completed Lysholm, IKDC, Tegner and pain Visual Analogue Score (VAS) to assess clinical outcomes. Failure was defined as positive Lachman or pivot shift test or MRI evidence of re-tear. RESULTS: 13 patients with BPTB allograft (5 male/8 female; 24.3 ± 4.0 years) and 35 patients with BPTB autograft (28 males/7 females; 22.3 ± 4.2 years) ACLR were included (p = 0.136). Average follow-up was 11.7 ± 3.9 years in the allograft group and 13.9 ± 5.9 years in the autograft group (p = 0.685). There were no significant differences in functional outcomes between groups (Lysholm: p = 0.226; IKDC: p = 0.107; Tegner: p = 0.610). There was no significant difference in laxity between groups (KT-1000 30 lbs: p = 0.131; manual maximum: p = 0.416; side to-side difference 30 lbs: p = 0.310; side-to-side difference manual max: p = 0.472). All patients returned to preoperative sports (Tegner score ≥ 5). Overall failure rate was 1.8% (1/48) with 1 failure in the autograft group (p = 0.548). CONCLUSION: In this cohort of young patients, no difference in failure rate was seen between allograft and autograft. At a mean of >10-year follow-up, laxity and all patient reported outcomes were not different between the groups. Careful selection of an allograft for use in ACLR and a decelerated rehabilitation program can be a good alternative in young patients >30 years to return to preoperative sports with no evidence of increased failure rates in this cohort.

The effects of initial graft tension on femorotibial relationship following anatomical rectangular tunnel anterior cruciate ligament reconstruction using bone–patellar tendon–bone graft

BackgroundThe purpose of this study was to elucidate the effects of the difference of initial graft tension on the femorotibial relationship on an axial plane and its chronological change following anatomical anterior cruciate ligament (ACL) reconstruction. MethodsA total of 63 patients who underwent anatomical ACL reconstruction were included in this study. The graft was fixed at full knee extension with manual maximum (higher graft tension; group H) and 80 N (lower graft tension; group L) pulls in 31 and 32 patients, respectively. The femorotibial positional relationship in axial computed tomography at 1 week and 1 year postoperatively were retrospectively evaluated. The side-to-side differences (SSDs) and the amount of changes of SSDs over 1 year were compared between groups. ResultsThe SSDs of the external rotational angle of the tibia in group H were significantly larger than those in group L at postoperative 1 week (2.7 ± 3.9° vs. 0.3 ± 3.3°; P < 0.01). The amount of internal rotational changes of SSDs of the internal–external rotational angles over 1 year in group H was significantly larger than that in group L (−3.6 ± 3.9° vs. − 0.3 ± 2.7°; P < 0.01). No significant differences were observed on the anterior–posterior translation distance and medial–lateral shift distance. ConclusionThe application of higher initial graft tension resulted in excessive external rotation of the tibia to the femur at 1 week postoperatively in anatomical ACL reconstruction, and the excessive early external tibial rotation had resolved over 1 year.

Design Paper on Online Training and Placement System (OTaP)

The management of Training and Placement is supported by paper-based systems, databases, spreadsheets and E-mail communications. Training and Placement is the crucial part of any educational institute in which most of the work till now is being done manually. The aim of this project is Automation of Training and Placement unit of RGIT (Rajiv Gandhi Institute of Technology). The project will include minimum manual work and maximum optimization, abstraction and security. This is a web application which will help students as well as the administration authority to carry out each and every activity in this department. The system is an application that can be accessed throughout the RGIT (Rajiv Gandhi Institute of Technology) organization with proper login provided. This system can be used as an application for the Training and Placement Officers (TPO) of the college to manage the student information with regard to placement. Students logging should be able to upload their information in the form of a CV. The key feature of this project is that it is a onetime registration. The application provides the facility of maintaining the details of the students. It also provides a requested list of candidates to recruit the students based on given query. Administrator logging in may also search any information put up by the students. This project will aid colleges to practice full IT deployment. This will also help in fast access procedures in placement related activities.

A comparison of teres minor and infraspinatus muscle activation in the prone position.

BackgroundThe electromyography (EMG) activity of the teres minor (TMi) and infraspinatus (IS) muscle has been demonstrated to vary depending on the arm position, such as in the coronal or scapular position, during intervention exercises. This may be reflected by different EMG activities demonstrated between the TMi and IS muscle during the acceleration and deceleration phases of the pitching motion. Tenderness in the scapular attachment site of the TMi muscle is often seen in baseball pitchers after pitching but not the attachment site of the IS muscle. However, few studies have investigated an interaction between TMi and IS muscle activity across different resistance exercises with different arm positions. The purpose of this study was to identify the feature of TMi and IS muscle activity in the presence of manual resistance applied in the prone position.MethodsEighteen collegiate baseball players volunteered their participation. Raw EMG amplitudes of the TMi, IS, posterior deltoid, middle deltoid, and upper trapezius muscles on the dominant shoulder were measured during intervention exercises. All subjects performed manual isometric resistance exercises: horizontal abduction (HABD) and external rotation (ER) of the glenohumeral joint with 40% of the manual maximum strength test in prone. The subjects also performed each of the HABD and ER resistance exercises with the arm actively positioned at 0° and 45° of ER of the glenohumeral joint in the coronal and scapular planes.ResultsBoth TMi and IS muscle activities significantly increased with the arm positioned at 45° of ER compared with 0° of ER regardless of the exercise (P < .05). TMi activity was significantly greater with HABD resistance than IS muscle activity regardless of the arm positions, whereas it was significantly less with ER resistance than IS muscle activity.ConclusionThe findings of this study indicated that the TMi and IS muscles were most highly activated during the HABD resistance with the arm actively positioned at 45° of ER in the coronal plane. The results of this study have clinical implications regarding the careful selection of arm position in both exercise and clinical examination for the TMi and IS muscles.

Mechanical Thrombectomy in Acute Terminal Internal Carotid Artery Occlusions Using a Large Manually Expandable Stentretriever (Tiger XL Device): Multicenter Initial Experience.

Background: The recently introduced Tigertriever XL Device for treatment of cerebral vessel occlusions combines manual adjustability and maximum length in one device. In this study, we report our initial experience with the Tigertriever XL in terminal ICA occlusions. Methods: Retrospective multicenter analysis of acute terminal ICA occlusions treated by mechanical thrombectomy using the Tigertriever XL Device. Results: 23 patients were treated using the Tigetriever XL due to an acute occlusion of the terminal ICA. The overall successful reperfusion rate after a median of two maneuvers using the Tigertriever XL Device was 78.3% (mTICI 2b-3). In 43.5% (10/23) additional smaller devices were applied to treat remaining occlusions in downstream territories, which resulted in a final successful reperfusion rate of 95.7%. Device related complications did not occur. Two symptomatic intracerebral hemorrhages (sICH) were observed. Conclusions: The Tigertriever XL Device might be a helpful tool in the treatment of ICA terminus occlusions with large clot burden resulting in high reperfusion rates. This is mainly related to the manual adjustability of the device combined with the maximum length.

Anatomical rectangular tunnel anterior cruciate ligament reconstruction provides excellent clinical outcomes.

The purpose of this study was to prospectively evaluate the clinical outcomes following anatomical rectangular tunnel anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone (BTB) graft using an adjustable-length femoral cortical fixation device with enough patients and a high follow-up rate. This study included 125 patients who underwent anatomical rectangular tunnel ACL reconstruction with a BTB graft. A BTB TightRope® was used for femoral graft fixation. Clinical evaluations were performed more than 2years after surgery using the International Knee Documentation Committee (IKDC) Form. Patients interviewed by telephone were only subjectively evaluated. The side-to-side difference in anterior laxity at a manual maximum force was measured using the KT-2000 Arthrometer®. Among the 125 patients, 99 were ultimately included and 26 were lost to follow-up (follow-up rate: 79%). Eight patients had re-tear (re-tear rate: 8%) and six patients had ACL injuries to the contralateral knee. Three patients did not follow our rehabilitation programme. One patient suffered septic arthritis. These 18 patients were considered ineligible for clinical evaluations. Therefore, clinical evaluations were performed in 81 of the 99 patients (64 were available for direct follow-up and 17 were available for a telephone interview). The follow-up period was 30 ± 10months (range 24-68months). According to the IKDC subjective assessment, 48 (59%) and 33 (41%) knees were graded as normal and nearly normal, respectively. A loss of extension (3°-5°) was observed in five patients (8%), whereas one patient (2%) exhibited a loss of flexion (3°-5°). The Lachman test was negative in 63 patients (98%). The pivot shift test was negative in 59 patients (92%). The side-to-side difference in KT value was 0.4 ± 0.7mm (range - 1-4mm). Anatomical rectangular tunnel ACL reconstruction with a BTB graft using an adjustable-length femoral cortical fixation device provided excellent clinical outcomes both subjectively and objectively more than 2years after surgery, whereas 8 of the 99 patients had re-tear of the graft. The adjustable-length femoral cortical fixation device could be safely used in anatomical rectangular tunnel ACL reconstruction with a BTB graft. III.

Deep neural network-based detection and segmentation of intracranial aneurysms on 3D rotational DSA.

Accurate diagnosis and measurement of intracranial aneurysms are challenging. This study aimed to develop a 3D convolutional neural network (CNN) model to detect and segment intracranial aneurysms (IA) on 3D rotational DSA (3D-RA) images. 3D-RA images were collected and annotated by 5 neuroradiologists. The annotated images were then divided into three datasets: training, validation, and test. A 3D Dense-UNet-like CNN (3D-Dense-UNet) segmentation algorithm was constructed and trained using the training dataset. Diagnostic performance to detect aneurysms and segmentation accuracy was assessed for the final model on the test dataset using the free-response receiver operating characteristic (FROC). Finally, the CNN-inferred maximum diameter was compared against expert measurements by Pearson's correlation and Bland-Altman limits of agreement (LOA). A total of 451 patients with 3D-RA images were split into n = 347/41/63 training/validation/test datasets, respectively. For aneurysm detection, observed FROC analysis showed that the model managed to attain a sensitivity of 0.710 at 0.159 false positives (FP)/case, and 0.986 at 1.49 FP/case. The proposed method had good agreement with reference manual aneurysmal maximum diameter measurements (8.3 ± 4.3 mm vs. 7.8 ± 4.8 mm), with a correlation coefficient r = 0.77, small bias of 0.24 mm, and LOA of -6.2 to 5.71 mm. 37.0% and 77% of diameter measurements were within ±1 mm and ±2.5 mm of expert measurements. A 3D-Dense-UNet model can detect and segment aneurysms with relatively high accuracy using 3D-RA images. The automatically measured maximum diameter has potential clinical application value.

Clinical and radiological results after Internal Brace suture versus theall-inside reconstruction technique in anterior cruciate ligament tears 12 to 18 months after index surgery.

Anterior cruciate ligament (ACL) injury can lead to reduced function, meniscal lesions, and early joint degeneration. Preservation of a torn ACL using the Internal Brace technique might re-establish normal knee kinematics, avoid donor-site morbidity due to tendon harvesting, and potentially maintain proprioception of the knee. Fifty subjects were recruited for this study between December 2015 and October 2016. Two groups of individuals who sustained a unilateral ACL rupture were included: those who underwent surgery with preservation of the injured ACL (Internal Brace technique; IB) and those who underwent ACL reconstruction using a hamstring tendon graft (all-inside technique; AI). Subjective self-administered scores were used: the German version of the IKDC Subjective Knee Form (International Knee Documentation Committee), the German version of the WOMAC (Western Ontario and McMaster Universities Arthritis Index), SF-36 (short form), the German version of the KOOS (Knee Osteoarthritis Outcome Score), and the German version of themodified Lysholm Score by Lysholm and Gillquist. Anterior tibial translation was assessed using the KT-1000 Arthrometer (KT-1000 Knee Ligament Arthrometer, MEDmetric Corp., San Diego, CA, USA). Magnetic resonance evaluation was performed in all cases. Twenty-three subjects (46 %) were men, and the mean age was 34.7 years. The objective IKDC scores were "normal" in 15 and 14 patients, "nearly normal" in 11 and 7patients, and "abnormal" in 1 and 2 patients, in the IB and AI groups, respectively. KT-1000 assessment showed a sideto-side difference of more than 3 mm on maximum manual testing in 11 (44 %) and 6 subjects (28.6 %) in the IB and AI groups, respectively. In the postoperative MRI, 20 (74 %) and 22 subjects (96 %) in the IB and AI groups had an intact ACL. Anterior tibial translation was significantly higher in the IB group compared with the AI group in the manual maximum test. Preservation of the native ACL with the Internal Brace primary repair technique can achieve comparable results to ACL reconstruction using Hamstring autografts over a short term. Clinically relevant limitations such as a higher incidence of pathologic laxity, with patients more prone to pivot-shift phenomenon were observed during the study period.

Assessment of the reliability of a non-invasive elbow valgus laxity measurement device

PurposeThe purpose of this study was to assess the reliability of a new objective measurement tool to measure the valgus stress laxity of the ulnar collateral ligament (UCL) of the elbow, the “Elbow Tester”. The anterior oblique portion of the ulnar collateral ligament (UCL) of the elbow is the primary static restraint to valgus stress during the overhead throwing motion. The main research question was if the “Elbow Tester” that we have developed was reliable and reproducible for further use in research and daily practice.MethodsThree different examiners tested both elbows of 11 volunteers for UCL laxity. Each elbow was tested 5 times using a standard 2 Nm valgus load, and 3 times using a manual maximum valgus load. One examiner tested the volunteers again 1 week later. The outcomes of elbow valgus laxity were compared between examiners. The intraobserver reliability was assessed using an intraclass correlation coefficient (ICC) and interobserver reliability was also assessed with a mixed model repeated ANOVA test.ResultsThe device demonstrated a high level of intraobserver reliability with both the 2 Nm valgus force and manual maximum valgus force, using a minimum of three trials as determined by an ICC > 0.9 for all examiners. The interobserver reliability was moderate using the 2 Nm valgus load with an ICC value of 0.72 and significant different outcomes of elbow valgus laxity amongst examiners (p < 0.01). A high interobserver reliability (ICC value of 0.90) was observed using manual maximum valgus force and no differences between outcomes (p > 0.53).ConclusionThe noninvasive valgus elbow tester demonstrates high interobserver and intraobserver reliability using manual maximum valgus force and can be used for further research and daily practice.