Normal Extension Research Articles

Poster 321: Predictive Value of Functional Assessments During Perioperative Rehabilitation in Anterior Cruciate Ligament Reconstruction (ACLR)

Objectives: Perioperative rehabilitation is critical to restoring function and preventing reinjury in ACLR patients. Single-leg hop and isokinetic strength testing are commonly utilized by clinicians to assess patient progress. The impact of early stage progress on later stage outcomes is, however, not well understood. This study aimed to identify the effects of early postoperative isokinetic quadriceps strength and single-leg hop performance on functional recovery after primary ACLR, to determine the manner in which changes in these parameters during perioperative rehabilitation relate to fast and successful functional recovery. Methods: Patients having a primary ACLR were consented into a long-term study and were retrospectively reviewed with the following inclusion criteria: ACLR using a contralateral patellar tendon graft with normal extension ROM and stability at 2 months postoperative, per the International Knee Documentation Committee (IKDC) objective form. Patients were excluded with a preoperative modified Tegner level <7. Predictor variables included 180°/second isokinetic quadriceps strength test (preoperative, 2 months, 4 months) and single leg hop for distance (preoperative and 4 months). Strength was assessed using limb symmetry index (LSI) with the ACLR knee strength being divided by the graft donor knee strength, percent of preoperative normal, and percent change over time at each interval, while hop testing was normalized to height. Outcome variables assessed were return to sport (RTS) time in months, return to preoperative modified Tegner level in the first 12 months after surgery (yes/no), and Cincinnati Knee Rating System (CKRS) at 12 months postoperative. Stepwise multiple regression analysis was used to predict RTS time, return to preoperative modified Tegner level, and CKRS based on demographics and objective measures. Results: A total of 1093 patients were eligible for analysis and 607 were used for the RTS model, 724 for the return to preinjury Tegner level model, and 705 for the CKRS model. Mean age for the cohort was 19.6 ± 5.5 years (range, 11.9-39.7) and 52.1% were male. In the model predicting RTS time, the following variables reduced RTS time: female sex, younger age, higher preoperative LSI, higher ACLR knee strength gains from preoperative to 2 month, and higher normalized single leg hop distance. In the model predicting a return to preoperative Tegner level, the following variables increased the likelihood: younger age, lower preoperative Tegner level, lower strength deficits with LSI at 2 months, and higher normalized single leg hop distance. In the model predicting CKRS scores, the following variables increased the score: younger age and higher normalized single leg hop distance. Model statistics can be seen in Table 1. Conclusions: The study found several early rehabilitation performance measures significantly influenced key outcomes. Perioperative rehabilitation should promote early relative gains in quadriceps strength for the ACLR knee, maintaining limb symmTaetry, and maximizing single leg hop distance to encourage faster RTS, higher subjective scores, and improve the likelihood of patients returning to preoperative activity levels. By quantifying the importance and predictiveness of these rehabilitation performance metrics, clinicians may improve their protocols to promote superior outcomes following ACLR.

Long-term functional result of vascularized bone graft for kienbock disease: A case report

Introduction: Kienbock's disease, or lunatomalacia, was a condition of aseptic osteonecrosis of the os lunatum, which can be progressively developed with a state of lunatum collapse, followed by complete os carpal collapse. This disease has been known for a long time, but until now, the exact cause of this disease could not be explained. . Case Presentation: We reported a 32-year-old female patient with pain in the right wrist; the pain was felt for five years before the surgery and is getting worse. On physical examination, Phalen's and Reverse Phalen's tests found pain and limited movement in the right wrist area. A collapse of the os lunatum was found after a radiological examination. The evaluation using the DASH score was an improvement in clinical conditions with the absence of pain on the right wrist after surgery using a vascularized bone graft. The clinical evaluation using Phalen's and Reverse Phalen's tests showed normal flexion and wrist extension results with no movement limitation around 0-90° flexion-extension. The wrist pronation and supination also showed normal results with pronation angles around 0-75° and supination angles around 0-85°. Conclusion: There were clinical, functional, and radiographic improvements in younger female patients with Kienbock's Disease treated with vascularized bone graft surgery six years after surgery.

Effects of ActiGraph’s filter, epoch length and non-wearing time algorithm on step counts in people with COPD

ABSTRACT The influence of the ActiGraph® processing criteria on estimating step counts in chronic obstructive pulmonary disease (COPD) remains uncertain. This study aimed to assess the influence of filters, epoch lengths and non-wearing time (NWT) algorithms on steps/day in people with COPD. ActiGraph GT3X+ was worn on the waist for seven days. Steps were detected using different filters (normal and low-frequency extension [LFE]), epoch lengths (15s and 60s), and NWT algorithms (Choi and Troiano). Linear mixed-effects model was applied to assess the effects of filter, epoch length, NWT algorithm on steps/day. Lin’s concordance correlation and Bland-Altman were used to measure agreement. A total of 136 people with COPD (107 male; 69 ± 8 years; FEV1 51 ± 17% predicted) were included. Significant differences were found between filters (p < 0.001), but not between epoch lengths or NWT algorithms. The LFE increased, on average, approximately 7500 steps/day compared to the normal filter (p < 0.001). Agreement was poor (<0.3) and proportional bias was significant when comparing steps/day computed with different filters, regardless of the epoch length and NWT algorithm. Filter choice but not epoch lengths or NWT algorithms seem to impact measurement of steps/day. Future studies are needed to recommend the most accurate technique for measuring steps/day in people with COPD.

Enhanced Muscle Activation Using Robotic Assistance Within the Electromechanical Delay: Implications for Rehabilitation?

Robotic rehabilitation has been shown to match the effects of conventional physical therapy on motor function for patients with neurological diseases. Rehabilitation robots have the potential to reduce therapists' workload in time-intensive training programs as well as perform actions that are not replicable by human therapists. We investigated the effects of one such modality that cannot be achieved by a human therapist: assistance and resistance within the electromechanical delay between muscle activation and muscle contraction during arm extension. We found increased muscle activation when providing robotic assistance within this electromechanical delay. Assistance provided within this delay moves the participant's arm quicker than their own muscle and increases the subsequent peak voluntary muscle activation compared to normal arm extension by 68.97 ± 80.05 % (SE = 0.021; p = 0.007 ). This is surprising since all previous literature shows that muscle activation either decreases or does not change when participants receive robotic assistance. As a consequence, traditional robotic rehabilitation incrementally reduces assistance as the patient improves to maintain levels of muscle activation which is suggested to be important for neuronal repair. The present result may enable therapists to no longer have to choose between providing assistance or increasing muscle activation. Instead, therapists may be able to provide assistance while also increasing muscle activation.

Arthroscopic Tenotomy of the Flexor Hallucis Longus to Treat Checkrein Deformity.

Checkrein deformity is a rare entity that results in alteration of the normal flexion and extension of the hallux, caused by a retraction or adhesion of the flexor hallucis longus (FHL) in its tendinous or muscular portion. It is usually caused by the sequelae of ankle and tibia fractures, such as adhesions and neuropathies, and often undiagnosed compartment syndromes. Its treatment is mainly surgical, and different techniques of release or lengthening of the FHL have been described. We present the clinical case of a 61-year-old patient treated by a simple arthroscopic tenotomy of the FHL at the retromalleolar level of the ankle, with complete functional recovery and absence of recurrence after 2 years of evolution. We recommend that this procedure should be considered for this pathology due to its technical simplicity, low iatrogenicity, early recovery, and theoretical absence of recurrence.Level of Evidence: Level V: Expert opinion, case report.

A shallow physics-informed neural network for solving partial differential equations on static and evolving surfaces

In this paper, we introduce a shallow (one-hidden-layer) physics-informed neural network (PINN) for solving partial differential equations on static and evolving surfaces. For the static surface case, with the aid of a level set function, the surface normal and mean curvature used in the surface differential expressions can be computed easily. So, instead of imposing the normal extension constraints used in literature, we write the surface differential operators in the form of traditional Cartesian differential operators and use them in the loss function directly. We demonstrate a series of performance study for the present methodology by solving Laplace–Beltrami equations and surface diffusion equations on complex static surfaces. With just a moderate number of neurons used in the hidden layer, we are able to attain satisfactory prediction results. We then extend the present methodology to solve the advection–diffusion equation on an evolving surface with a given velocity. To track the deforming surface, we additionally introduce a network, in which a prescribed hidden layer is employed to enforce the topological structure of the surface and learn the homeomorphism between the surface and the prescribed topology. The proposed network structure is designed to track the surface and solve the equation simultaneously. Again, the numerical results show comparable accuracy as the static cases. As an application, we simulate surfactant transportation on a droplet surface under shear flow and obtain some physically plausible results.

Treatment of Hoffa fracture of femoral condyle with anchor combined with auxiliary fixation.

A Hoffa fracture is an unstable intra-articular break that is generally treated with surgery. To evaluate the feasibility and clinical outcomes of using a suture anchor combined with auxiliary fixation for the treatment of a lateral femoral condyle Hoffa fracture. The study retrospectively reviewed 8 patients (5 males and 3 females) with a lateral femoral condyle Hoffa fracture who had been treated by combining a suture anchor with auxiliary fixation between January 2016 and April 2020. The mean age of patients was 37.5 years (ranging from 23 to 45). According to Letenneur's classification, there were 4 cases of type I, 2 cases of type II, and 2 cases of type III fractures. The clinical outcomes were assessed using Letenneur's functional assessment. The follow-up duration ranged between 14-24 months. All patients achieved primary healing of the incision and fracture union, as well as normal flexion and extension of the knee joint, with 7 cases showing excellent outcomes and 1 case showing a good outcome. No postoperative complications, such as fracture displacement, anchor loosening, or fracture malunion, occurred in this series. Our results indicated that a suture anchor, combined with external fixation, was an effective treatment for a lateral femoral condyle Hoffa fracture. Accordingly, this procedure is worthy of wider clinical application.

Effect of Data Reduction Techniques on Daily Moderate to Vigorous Physical Activity Collected with ActiGraph® in People with COPD.

ActiGraph® is a valid, frequently used, accelerometer to quantify moderate to vigorous physical activities (MVPA) in people with COPD. The impact of ActiGraph processing techniques on this population is unknown. This study aimed to explore the effect of data reduction techniques on MVPA in people with COPD. MVPA/day, through ActiGraph GT3X+, was estimated using: Troiano, Freedson 98 and FreedsonVM3 cutoffs, 15-s and 60-s epochs, and normal and low-frequency extension (LFE) filters. Cutoff, epoch, and filter effects were explored with Aligned Rank Transform-ANOVA. Lin's concordance correlation coefficients and Bland-Altman plots were used to evaluate agreement and bias between different techniques. The analysis included 136 people with COPD (79% male; 68 ± 8 years; FEV1 51 ± 17% predicted). MVPA/day differed according to cutoff, filter, and epoch selection (p-value < 0.001). FreedsonVM3 cutoff, 15-s epochs, and LFE yielded the highest MVPA (45 min/day, 68% of physically active participants). Troiano cutoff, 60-s epochs, and normal filter yielded the lowest MVPA (8 min/day, 20% of physically active participants). Only comparisons between Troiano and Freedson98 cutoffs presented an almost perfect agreement. ActiGraph data reduction techniques affected MVPA/day estimates and their interpretation at the individual and group level. Studies using different processing criteria should not be compared in people with COPD. Future studies with a gold standard are required to ascertain which processing technique produces the most accurate MVPA estimates in COPD. Meanwhile, future trials employing the ActiGraph GT3X+ may consider estimating MVPA based on Freedson VM3 cutofffs, 60-s epochs, and normal filter.

Application of the suture anchor in the treatment of Hoffa fractures of the lateral femoral condyle

BackgroundTo evaluate the feasibility and clinical effect of the suture anchor combined with external fixation in the treatment of the lateral femoral condyle Hoffa fracture.MethodsIn this study, a retrospective study was conducted to analyze the feasibility of treating fourteen patients (eight men and six women) with Hoffa fractures admitted to our Hospital from January 2016 to October 2021 with combined external fixation using incisional reduction anchor nailing. The age of the patients ranged from 23 to 45 years, with an average of 37.5 years. According to Letenneur’s classification, there were eight cases of type I, three cases of type II, and three cases of type III. The functional assessment of Letenneur was used to measure the clinical outcome.ResultsAll patients had one-stage wound healing, and all patients were followed up for 12 to 18 months after surgery, and all fractures healed well, with normal knee flexion and extension activities, and no complications such as fracture displacement, anchor nail loosening, or fracture malunion were observed. The clinical outcome was evaluated according to the functional evaluation criteria of Letenneur et al. The clinical outcome of fourteen patients: excellent in thirteen cases and good in one case, with an overall excellent rate of 100%.ConclusionsOur study results indicate that the use of anchor nailing combined with external fixation for Hoffa fractures of the femoral condyle has some clinical reference significance because it is less invasive, has fewer complications, does not require secondary removal, and is worthy of clinical application.Trial registration: Retrospectively registered.

Poster 327: Objectively measuring knee extension is critical when analyzing long term outcomes after an anterior cruciate ligament reconstruction

Objectives: Structural abnormalities, such as meniscus tears and chondral injuries, seen at the time of an anterior cruciate ligament (ACL) reconstruction, as well as abnormal objective measures, like knee extension stiffness, can lead to unfavorable short term outcomes following surgery. Furthermore, a lack of full knee extension in the short term has been shown to lead to a lack of full knee extension in the long term. However, long term outcomes based on knee extension are unknown as they are typically judged with subjective data only or are based on whether or not the patient had meniscus tears or chondral injuries seen at the time of surgery. The purpose of this study was to determine long term functional outcome differences after an ACL reconstruction, for those with varying structural abnormalities, based on normal and abnormal knee extension. Methods: Between 1982 and 2012, 3432 patients having an ACL reconstruction using a patellar tendon graft were enrolled into the study. Exclusion criteria included revisions, bilateral involvement, and osteoarthritis (OA) at the time of surgery. Patients were split into four groups based on structural abnormalities, normal (group 1), meniscus tear (group 2), chondral injury (group 3), and a combination of meniscus tear and chondral injury (group 4). Patients followed up for data collection and radiographs at a minimum 10 years postoperative. Abnormal knee extension was defined as more than 2° off compared to the noninvolved knee, per the International Knee Documentation Committee (IKDC) objective criteria. The IKDC subjective was collected and radiographs were graded based on the medial and lateral compartment. Additionally, short term knee extension at 2 months postoperative was compared to long term knee extension. Results: Of the 3432 patients, 899 (26%) had subjective, objective, and radiographic data at a mean 17.7 ± 6.2 years (range, 10-39) while another 898 (26%) had subjective data only at a mean 20.2 ± 7.4 years (range, 10-39). Patients with abnormal knee extension at 2 months postoperative were 6.4 times more likely to have abnormal knee extension at long term follow up ( p&lt;.001). At long term follow up, 84% of patients had normal knee extension. The rate of moderate to severe knee OA for groups 1-4 was 6%, 12%, 18%, and 25%, respectively ( p&lt;.05). The rate of moderate to severe OA and IKDC scores, when spilt based on knee extension, can be seen in table 1. Overall, patients with abnormal knee extension were 4.8 times more likely to have OA compared to those with normal knee extension. Patients with a meniscus tear were 2.1 times more likely to have OA and those with chondral injuries were 2.7 times more likely to have OA, when compared to those without a structural abnormality, p&lt;.05. Conclusions: Abnormal knee extension early after surgery can negatively affect knee extension long term as those that are lacking motion early rarely have normal knee extension long term. Abnormal knee extension long term can lead to lower subjective scores and higher rates of OA when compared to those with normal knee extension. A loss of knee extension long term results in more negative outcomes than meniscus tears or chondral injuries. Objectively measuring knee extension long term after surgery can help explain positive and negative outcomes for patients, regardless of their meniscus or chondral status at the time of surgery. [Table: see text]

Fourteen days free-living evaluation of an open-source algorithm for counting steps in healthy adults with a large variation in physical activity level

BackgroundThe number of steps by an individual, has traditionally been assessed with a pedometer, but increasingly with an accelerometer. The ActiLife software (AL) is the most common way to process accelerometer data to steps, but it is not open source which could aid understanding of measurement errors. The aim of this study was to compare assessment of steps from the open-source algorithm part of the GGIR package and two closed algorithms, AL normal (n) and low frequency extension (lfe) algorithms to Yamax pedometer, as reference. Free-living in healthy adults with a wide range of activity level was studied.ResultsA total 46 participants divided by activity level into a low-medium active group and a high active group, wore both an accelerometer and a pedometer for 14 days. In total 614 complete days were analyzed. A significant correlation between Yamax and all three algorithms was shown but all comparisons were significantly different with paired t-tests except for ALn vs Yamax. The mean bias shows that ALn slightly overestimated steps in the low-medium active group and slightly underestimated steps in high active group. The mean percentage error (MAPE) was 17% and 9% respectively. The ALlfe overestimated steps by approximately 6700/day in both groups and the MAPE was 88% in the low-medium active group and 43% in the high active group. The open-source algorithm underestimated steps with a systematic error related to activity level. The MAPE was 28% in the low-medium active group and 48% in the high active group.ConclusionThe open-source algorithm captures steps fairly well in low-medium active individuals when comparing with Yamax pedometer, but did not show satisfactory results in more active individuals, indicating that it must be modified before implemented in population research. The AL algorithm without the low frequency extension measures similar number of steps as Yamax in free-living and is a useful alternative before a valid open-source algorithm is available.

Bureaucratic Reversals and Local Diversity

Normal bureaucracy tends to centralise, standardise and simplify, and to serve better those people and places that are less poor and more accessible. Field bureaucracies have done well (a) where simple standardised programmes have found uniform conditions – like the human body with smallpox and yaws eradication campaigns, or irrigated plains with green revolution packages, and (b) where they have created and sustained uniform conditions, as with technically exacting time‐bounded programmes for single commodities such as tea and milk. For the diverse, complex, and risk‐prone farming systems found outside green revolution areas, normal agricultural research and extension for single commodities has a more limited part to play. Reversals are needed and occurring – to perceive, permit, and promote diversity, searching for what farmers need and providing not a package of practices but a basket of choices. This complementary paradigm of reversals in agricultural research – to decentralise, and to serve diversity and complexity – raises the question of its wider relevance and application in other domains and bureaucracies, to fit and meet the varied conditions and needs of those who are poorer, less accessible, and less powerful.

$q$-Difference Operator on $L_q^{2}( 0, + \infty )$

In this research, the minimal and maximal operators defined by $q$- difference expression are given in the Hilbert space $L_q^{2}( 0, + \infty )$. The existence problem of a $q^{-1}$-normal extension for the minimal operator is mentioned. In addition, the sets of the minimal operator spectrum and the maximal operator spectrum are examined.

Granulosa tumor: two spontaneous pregnancies after combined medico-surgical treatment: case report and review of the literature

BackgroundGranulosa tumor is a rare tumor that arises from the mesenchyme and the sexual cord of the ovary. The prognosis is generally excellent, and treatment is mainly based on surgery, followed by chemotherapy depending on the extension of the disease. However, “the obstetrical prognosis” is compromised.Case presentationWe report the case of a 32-year-old Caucasian patient who was diagnosed during a primary infertility assessment with an ultrasound image of a 39 mm organic left ovarian cyst confirmed on pelvic magnetic resonance imaging with infiltration of the uterosacral space. Tumor markers, including cancer antigen 125, alpha fetoprotein, and β-human chorionic gonadotropin, were normal. Histological study of biopsies of the ovarian lesion taken during exploratory laparoscopy confirmed the diagnosis of adult granulosa tumor. After a normal extension assessment including a thoracoabdominopelvic computed tomography scan and a positron emission tomography scan, the patient underwent complete conservative surgery and the disease was classified as stage Ic. Three cycles of adjuvant chemotherapy according to the “BEP” protocol combining bleomycin, etoposide, and cisplatin were performed after oocyte cryopreservation. After a 5-year follow-up period, the patient had no sign of tumor progression and had two spontaneous pregnancies, the first occurring 3 months after the end of chemotherapy and the second 14 months later.ConclusionGranulosa cell tumor remains a rare tumor whose management considerably compromises fertility and reduces the chances of having a spontaneous pregnancy. The particularity of our observation is that the diagnosis of the granulosa tumor was made following a primary infertility assessment and that the patient had two spontaneous pregnancies 3 months after the end of a medico-surgical treatment known to be very gonadotoxic.

The propagation and emplacement mechanisms of the Tenteniguada volcanic debris avalanche (Gran Canaria): Field evidence for brittle fault-accommodated spreading

The Tenteniguada volcanic debris avalanche deposit is located on the east of the island of Gran Canaria, Spain. Its internal structure is composed of a complex assemblage of extensional features and shearing structures including normal faults, horst and graben, brittle/ductile boudinage and clastic dike injections. Examination of these features in the field and evaluation of their distribution have allowed the generation of a new conceptual model for the transport and emplacement of this debris avalanche, and potentially others. In the majority of the deposit, the degree of disaggregation is low, with large portions of the original edifice preserved, although displaced by brittle deformation. Greater disaggregation is observed deeper and in the more distal section of the deposit. The findings suggest that the propagation of the volcanic debris avalanche was most likely facilitated by the normal fault-accommodated spreading and extension of the mass, with the majority of stress focused in fault zones. The greater disaggregation exhibited in the deeper and the more distal part of the deposit is likely to be due to greater stress accommodation from fault convergence and momentum transfer respectively. The abundance of competent lava lithologies and scarcity of weaker material that could be easily disaggregated is the most likely reason Tenteniguada did not fully evolve from a slide to a granular flow, and therefore generated a deposit which bears resemblance to non-volcanic blockslide deposits. Therefore, lithological properties are potentially a vital factor for the propagation mechanisms, distribution of stress and consequently the evolution of a debris avalanche from the initial collapse to its emplacement. The present study highlights the importance of dedicated field examinations of sedimentological, morphological, and structural features for providing constraints for models of debris avalanche propagation mechanisms and the factors dictating them.

Foliation boudinage structures in the Mount Isa Cu system

Small-scale foliation boudinage structures occur in rocks that were sampled in drill core from the Mount Isa Cu deposit, northwest Queensland. The necks of foliation boudinage structures plunge gently to the north and south as a result of layer normal shortening and layer parallel extension of the steeply west-dipping Urquhart Shale. Detailed petrographic analysis of the foliation boudinage structures has identified an initial rim of quartz and dolomite, followed by infill and replacement by pyrrhotite and minor chalcopyrite. Foliation boudinage structures formed after dolomitisation and silicification of the shale. They occur most commonly in the unaltered Urquhart Shale where the anisotropy and homogeneity provided by the shale layering is still intact. Infilling of the structures occurred during protracted silica-dolomite alteration, pyrrhotite and chalcopyrite mineralisation. The paragenesis of the foliation boudinage structures is consistent with the established paragenesis of the main Cu mineralisation. Foliation boudinage structures formed over the period from shortening during D4a through to the main Cu mineralisation during D4b west-northwest–east-southeast sinistral-reverse shortening. The timing of foliation boudinage is consistent with a current kinematic model for the Mount Isa system. KEY POINTS First record of foliation boudinage structures at Mount Isa. Foliation boudinage structures with sulfide-dominated infills. Foliation boudinage structures formed as a result of progressive deformation from a D4a dextral-reverse through to D4b sinistral-reverse slip. Foliation boudinage structures are associated with the timing and kinematics of Cu mineralisation at Mount Isa.

Irreducible Radical Field Extensions

This paper is devoted to irreducible radical field extensions, i.e., extensions that can be obtained by adjunction of roots of irreducible binomials. We find a criterion for cyclotomic extensions to be irreducible radical. This criterion developes the Gauss–Wantzel theorem about constructible polygons. We also prove that any normal solvable extension of some field K is irreducible radical until K has all roots of unity. This generalizes Abel’s theorem, which fills the gap in the uncomplete Ruffini proof of the impossibility theorem for the general equation of degree five or higher. Finally, we prove that the root set of any irreducible solvable polynomial coincides with the value set of some radical formula using irreducible radical extensions.

Structural inheritance and style within the Getic Depression, South Carpathians, Romania

The Carpathians are part of the Alpine orogen, and the Getic Depression (or Getic fold belt) is located to the south of the South Carpathian. Underthrust beneath the fold belt is the Moesian Platform lower plate. This foreland depocenter can reach a depth of up to 10 km and evolved in an oblique convergent setting from latest Cretaceous-Paleogene and was shortened during the Badenian-middle Sarmatian (middle to late Miocene, 16–8 Ma) and Pliocene to recent. Thus far, in previous publications, the role of the structural grain of the lower plate was poorly constrained. For the fold belt, contrasting interpretations implied a range of shortening magnitudes and contrasting fault pattern. This contribution shows seven balanced cross sections that rely on seismic reflection and well data. One section, just outside and to the south of the fold belt, gives insights into the fault network of the Moesian Platform. In that section we see 35 km of north westward directed normal sense extension that creates a set of rotated fault blocks. Growth strata within the half grabens attest to Permo-Lower Triassic extension age. The individual normal faults merge at depth into a common detachment that rises monotonously towards the east and forms a domal-shaped, arched detachment. This is the structural grain that we project down plunge towards the north beneath the fold belt. The interpreted six sections that lie in the tectonic transport direction show that structures in the western part of the Getic fold belt are compatible with the inversion on the underlying Permo-Lower Triassic extensional fault. Ubiquitous truncation of Oligocene strata by overlying units suggest inversion started during late Oligocene (intra-Burdigalian). The Badenian-Sarmatian shortening further deforms the pre-existing contractional features and the shortening increases from 5 km on the west to at least 17 km on the east. NW-SE oriented transfer zones with normal faults separate the fold belt domains with diverging displacement vectors and eastward increasing shortening. Two main salt levels within the fold belts’ sediment pile are laterally discontinuous hence they only have local significance in the deformation. The frontal part of the fold belt consists predominantly of Badenian-Sarmatian synkinematic units as the fold belt propagated into the foredeep units, this interpretation requires less shortening in the frontal structures compared to earlier solutions. Due to the lack of characteristic features on the studied sections, we infer that the Getic fold belt did not evolve as a transtensional depocenter during the lower Miocene as suggested by earlier publications.

Research on Resilience Evaluation and Enhancement of Deep Foundation Pit Construction Safety System

Deep foundation pit (DFP) projects have been a high incidence area of safety accidents because of their own high danger and complexity. Therefore, it is necessary to study the resilience of their construction safety system. This paper systematically identifies the key factors affecting the resilience of deep foundation pit construction based on the analysis of the composition of the deep foundation pit construction safety system (DFPCTSS), the synergistic relationship of its subsystems in the face of the interference and impact of internal and external disaster-causing factors, and the causal mechanism of typical accidents in DFP accidents and the emergent process of system resilience. A resilience evaluation indicator system based on four capacity dimensions of prevention absorption, resistance, recovery, and learning adaptation was constructed by using the fuzzy Delphi method, which is characterized by the resilience emergence process. Then the correlation and weight of evaluation indexes were analyzed based on the DEMATEL–ANP method, the boundary cloud parameters of the resilience evaluation grade were set according to the normal extension cloud model, and the membership degree of the resilience evaluation level was calculated to complete the evaluation of the resilience level. Finally, taking a DFP project of a metro station as an example, the above model was used to evaluate the resilience level of its construction safety system, and suggestions for resilience enhancement were put forward. The results show that the evaluation results are consistent with the actual situation of the project, and the evaluation model is conducive to providing a systematic analysis method and improvement countermeasures for deep foundation pit construction safety management from the perspective of resilience.

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.