Objective Clinical Outcomes Research Articles

Long-term clinical outcome of tendon transfer and tendon graft for extensor tendon ruptures in rheumatoid hands

PurposeTo evaluate the objective and subjective long-term clinical outcomes of tendon transfer and tendon graft for extensor tendon ruptures in rheumatoid hands.MethodsWe evaluated the long-term clinical outcomes of tendon transfer and tendon graft for extensor tendon ruptures in rheumatoid hands of 37 patients (43 hands) followed up for a mean of 14 years (range, 10–21 years).ResultsThe mean time from rupture to surgery was 13.1 weeks (range, 3–48 weeks). The mean extension lag of the metacarpophalangeal joint was 8.7° (range, 0–40°), the mean pulp-to-palm distance was 0.4 cm (range, 0–3 cm), and the mean overall satisfaction rate was 86.5 (range, 70–100). There were no significant differences in clinical outcomes between tendon transfers and tendon grafts. There was a significant correlation between extension lag of the metacarpophalangeal joint and overall satisfaction rate (R2 = 0.155; p = 0.009). Time to surgery was significantly correlated with extension lag of the metacarpophalangeal joint (R2 = 0.437; p = 0.001) in the tendon graft group.ConclusionsBoth tendon transfer and tendon graft for extensor tendon ruptures in rheumatoid hands achieve satisfactory results that are maintained for an average of 14 years. In cases of tendon graft, the time to surgery should be considered, and there is concern over extension lag of MP joint.Level of EvidenceIV

Comparative outcomes of patient-specific instrumentation, the conventional method and navigation assistance in open-wedge high tibial osteotomy: A prospective comparative study with a two-year follow up

BackgroundTo compare and analyze the correction precision, clinical outcomes and complications among the three methods of performing open-wedge high tibial osteotomy (HTO), including patient-specific instrumentation (PSI), conventional method and navigation assistance. MethodsIn this prospective, single-center study, we randomly assigned patients with knee osteoarthritis in a 1:1:1 ratio to undergo Open-wedge high tibial osteotomy (OWHTO) with conventional method, navigation assistance or PSI. The primary outcome was the target/observed hip–knee–ankle (HKA) angle difference at 1 month postoperatively. Secondary outcomes were changes in the postoperative posterior tibial slope (PTS) at 1 month and clinical outcomes including knee pain on a visual analogue scale (ranging from 0 to 100, with higher scores indicating more severe pain), Lysholm and Western Ontario and McMaster Universities Osteoarthritis Index (ranging from 0 to 240) scores at 1 month, 6 months, 12 months, and 24 months. ResultsFrom 2017 through 2019, a total of 608 patients were screened; of those patients, 144 were enrolled, with 48 in each group. The primary outcome of the HKA difference was 2.6 ± 2.0° in the conventional group, 2.3 ± 1.5° in the navigation group and 0.6 ± 1.0° in the PSI group (P < 0.001). Secondary outcomes including changes in the postoperative PTS and clinical outcomes at 1 month, 6 months, and 12 months were in the same direction as the primary outcome. There were no significant differences in the complications among the three groups. ConclusionsIn the present study, none of the three methods showed superiority in objective correction precision and clinical outcomes at 2 years.

Assessment of microcirculatory function during hemodialysis.

Patients with chronic kidney disease characteristically exhibit microcirculatory dysfunction, in combination with vascular damage. Hemodialysis superimposes additional circulatory stress to the microvasculature (repetitive ischemic insults/cumulative damage) resulting in high mortality. Intradialytic monitoring and hemodialysis delivery is currently limited to macrovascular/systemic assessment and detection of intradialytic systemic hypotension. Monitoring of the microcirculation has the potential to provide valuable information on hemodialysis-induced circulatory stress likely to result in end-organ ischemia (with/without systemic hypotension) generating an opportunity to intervene before tissue injury occurs. Various noninvasive technologies have been used assessing the microcirculation in hemodialysis patients at rest. Some technologies have also been applied during hemodialysis studying the effects of treatment on the microcirculation. Despite the approach used, results are consistent. Hemodialysis patients have impaired microcirculations with treatment adding additional stress to inadequately regulated vascular beds. Utility/practicality/clinical relevance vary significantly between methodologies. Intradialytic monitoring of the microcirculation can provide additional insights into a patient's individual response to treatment. However, this valuable perspective has not been adopted into clinical practice. A microcirculatory view could provide a window of opportunity to enable a precision medicine approach to treatment delivery improving current woefully poor subjective and objective clinical outcomes.

Suspension arthroplasty using the palmaris longus tendon with a suture button for thumb trapeziometacarpal arthritis: a retrospective observational study

BackgroundThis study was performed to assess the clinical and radiographic results at a minimum of 2 years after ligament reconstruction suspension arthroplasty (LRSA) that comprised full trapeziectomy and suspensionplasty using the palmaris longus tendon and the Mini TightRope (Arthrex, Naples, FL) for advanced thumb carpometacarpal arthritis. MethodsWe clinically and radiographically evaluated 26 thumbs in 26 patients who had undergone LRSA at least 2 years previously. The mean follow-up period was 35.9 months. We evaluated the subjective clinical outcomes (visual analogue scale and Quick Disabilities of the Arm, Shoulder, and Hand scores) and objective clinical outcomes (range of motion, pinch strength, grip strength, and trapezial space height ratio). ResultsAt the final follow-up evaluation, the mean visual analogue scale score was 11.1 (standard deviation (SD) 13.4) and the mean Quick Disabilities of the Arm, Shoulder, and Hand questionnaire score was 9.39 (SD 10.1). The mean palmar and radial abduction were 62.3° (SD 11.8°) and 63.8° (SD 9.09°), respectively. The mean key pinch and grip strength were 3.92 (SD 1.07) kg and 19.7 (SD 7.77) kg, respectively. The mean trapezial space ratio was 0.21 (SD 0.10). The subjective clinical outcomes, range of motion, and pinch strength were significantly improved compared with preoperatively. ConclusionsLRSA for advanced-stage thumb carpometacarpal osteoarthritis relieves pain, improves range of motion and strength, and obtains favourable subjective patient-reported clinical outcomes.

Posterior hip fracture-dislocation associated with posterior wall fracture of the acetabulum and ipsilateral comminuted trochanteric fracture of the femur: A case report.

Introduction and importanceTraumatic posterior dislocation of the hip is often associated with fractures of the femoral head and posterior wall of the acetabulum. However, hip fracture-dislocation that includes the posterior wall of the acetabulum and the ipsilateral femoral trochanter is rare. There is no consensus on the bone that should be operated on first, the operative position, and the choice of implant for femoral fixation.Case presentationA 67-year-old man was brought to our emergency department after a 2-m fall. He was diagnosed with a hip fracture-dislocation associated with posterior wall acetabular fracture and ipsilateral femoral trochanteric fracture. Surgical reconstruction was performed with intramedullary nail (IMN) fixation of the femoral trochanteric lesion, followed by anatomically rigid acetabular fixation in the lateral decubitus position. At the 5-year follow-up after the injury, the patient showed good objective and subjective clinical outcomes.Clinical discussionFixing the femur first could allow an easier reduction and traction. The lateral decubitus position was useful, because fixation of the femur and the acetabulum could be performed without changing the position. When fixing the femoral trochanteric lesion, attention was paid to reduce the anteromedial cortex of the proximal fragment extramedullarly to the distal fragment to prevent complications such as cutout and implant breakage.ConclusionAnatomically rigid fixation of the posterior wall of the acetabulum secondary to IMN fixation of the femur, with anteromedial cortical support in the lateral decubitus position, could achieve good objective and subjective clinical outcomes.

Modified pin and plate fixation for low intercondylar fractures of the humerus: biomechanical study corroborated with a case series.

Establishing fracture union of low and comminuted intercondylar fractures of the humerus is inherently challenging. The purposes of the present study were to investigate the biomechanical effectiveness of pin & plate (PP) fixation compared to other dual-plating techniques by finite element analysis, and to present a technical description as well as retrospectively review the outcomes of PP fixation in such difficult fractures. Low-level intercondylar fracture 3D models of the humerus were virtually stabilized with three fixations on lateral side including PP, lateral pre-contoured locking compression plate (L-LCP), and variable angle lateral pre-contoured locking plate (VA-L-LCP) whereas medial pre-contoured locking compression plate (M-LCP) on medial side. Loading conditions under consideration were axial compression, internal rotation, posterior bending, and valgus rotation. Regarding the clinical series, eight patients with intra-articular and comminuted fractures of the distal humerus (6 intercondylar fractures, 1 fracture-subluxation, and 1 isolated lateral condylar fracture) were operated by isolated PP fixation or combinations of PP and the other standard implants. Data were collected on fracture union, perioperative complications, and objective clinical outcomes. Biomechanical results revealed the most instability of the fracture occurring under posterior bending. PP fixation presented comparable fracture stability and fragment displacement compared to other dual-plating fixations, except stress on the Kirschner wire under internal rotation which was higher than other fixations. Regarding the clinical series, fracture union was achieved in all cases with an average union time of 17weeks (range 12-20). All except one patient had good-to-excellent MEPS results with an average Disabilities of the Arm, Shoulder, and Hand (DASH) score of 14.6 (range 0-45) and an average arc of elbow motion of 107.5 degrees (range 60-140). By the biomechanical performance, PP fixation is a reliable technique for fixation of low intercondylar fractures of the humerus. Supported by the clinical outcomes, the present technique could be an alternative for this particular fracture especially when severe comminution prevents the use of the standard dual plating technique.

Improvement in Medication Adherence after Pharmacist Intervention Is Associated with Favorable Clinical Outcomes in Patients with Ulcerative Colitis.

Background/AimsAlthough pharmacist intervention for patients with chronic diseases has been shown to improve medication adherence, few studies have evaluated its effects on the objective clinical outcomes. We investigated the impact of pharmacist intervention on medication adherence and clinical outcomes in patients with ulcerative colitis (UC).MethodsPatients with UC and low medication adherence were divided into two groups, based on pharmacist intervention. Their medication possession ratio and nonadherence rate for 6 months before and after the baseline were investigated. The partial Mayo score, flare-up incidence, and factors influencing flare-up events for 1 year after the baseline were analyzed.ResultsOf 99 patients, 33 and 66 were included in the intervention and control groups, respectively. The nonadherence rate significantly declined in the intervention group 6 months after the baseline (60.6% before vs 30.3% after; p=0.013). The groups showed a significant difference regarding time-related partial Mayo scores (p=0.002). Intervention was significantly negatively correlated with time and the partial Mayo score (r2=0.035, p=0.013). A significant difference was observed in the flare-up incidence (33.3% in the intervention group vs 54.6% in the control group; p=0.046). Multivariate logistic regression indicated that pharmacist intervention (adjusted odds ratio, 0.370; 95% confidence interval, 0.145 to 0.945; p=0.038) independently reduced the flare-up risk.ConclusionsPharmacist intervention significantly decreased the nonadherence rate, improved the partial Mayo score, and reduced the flare-up incidence compared with the control group in a cohort of UC patients identified to have low medication adherence.

Reliability and validity of the modified McGowan grade in patients with cubital tunnel syndrome.

This study aimed to assess the reliability and validity of the modified McGowan grading system and to determine its ability to distinguish the severity of cubital tunnel syndrome (CuTS) between the different grades. We prospectively enrolled 39 consecutive patients with CuTS from March 2018 to December 2020. Inter- and intra-observer reliability was assessed by two orthopaedic surgeons with a minimum 2-week interval using Cohen kappa coefficients. Validity was assessed by Spearman's correlation with objective clinical outcomes (grip strength, Semmes-Weinstein monofilament test [SWMT], static two-point discrimination [2PD], and motor conduction velocity [MCV]). In addition, the relationship between the grading system and patient-reported outcomes (Disabilities of the Arm, Shoulder and Hand score and Boston Questionnaire) was evaluated using Spearman's correlation. The ability to distinguish the severity between the different grades was assessed using the Kruskal-Wallis analysis. The inter-observer kappa value was 0.54 and intra-observer kappa value was 0.59, which imply a moderate reliability. The modified McGowan grade had a moderate correlation with objective clinical outcomes (grip strength [r = - 0.350, p = 0.029], SWMT [r = 0.552, p < 0.001], 2PD [r = 0.456, p = 0.004], and MCV [r = - 0.394, p = 0.021]). However, patient-reported outcomes did not correlate with this grading system. Kruskal-Wallis analysis revealed significant differences between grades in terms of SWMT, 2PD, grip strength, and Boston Questionnaire functional score (p = 0.006, 0.025, 0.014, and 0.043, respectively); however, these differences were statistically significant only for a limited number of parts. The modified McGowan grade has a moderate inter- and intra-observer reliability. This grading system moderately correlates with objective sensory-motor functions and MCV of patients with CuTS. However, the modified McGowan grade does not reflect the patient's perceived disabilities and has a weakness in distinguishing the severity of patients' conditions among the different grades.

DOP83 Normalisation of biomarkers and improvement in clinical outcomes in patients with Crohn’s Disease treated with risankizumab in the phase 3 ADVANCE, MOTIVATE, and FORTIFY studies

Abstract Background The efficacy of risankizumab (RZB), an interleukin 23 p19 inhibitor, in patients with Crohn’s disease (CD) has been reported. Normalisation of high-sensitivity C-reactive protein (hs-CRP) and faecal calprotectin (FCP) are intermediate treatment targets in CD. Here, we evaluated changes in these objective inflammatory biomarkers and clinical outcomes with RZB treatment. Methods In 2 phase 3, randomised, double-blind studies (ADVANCE, NCT03105128; MOTIVATE, NCT03104413), patients with moderately to severely active CD received 12-week intravenous (IV) RZB induction therapy or placebo (PBO). Patients with clinical response to RZB IV induction were rerandomised in a 52-week maintenance study (FORTIFY, NCT03105102) to receive subcutaneous (SC) RZB or PBO (ie, RZB withdrawal). Induction analyses included patients who received either 600 mg RZB IV or PBO for 12 weeks. Maintenance analyses included patients who received 360 mg RZB SC every 8 weeks or withdrawal (PBO SC) for 52 weeks. Outcomes assessed were normalisation of hs-CRP and FCP concentrations at week 12 of induction and at week 52 of maintenance in patients with elevated biomarkers at baseline (hs-CRP &amp;gt; 5 mg/L and/or FCP &amp;gt; 250 μg/g), clinical biomarker response (defined as enhanced clinical response [≥ 60% average daily stool frequency (SF) decrease and/or ≥ 35% average daily abdominal pain score (APS) decrease] and ≥ 50% reduction in hs-CRP or FCP), and clinical biomarker remission (defined as clinical remission per CD Activity Index or SF/APS criteria and normal hs-CRP or FCP) during maintenance treatment. Nonresponder imputation was used for missing data. Results Greater proportions of patients receiving RZB vs PBO achieved normalisation of hs-CRP and FCP at the end of the 12-week induction period and the 52-week maintenance period (P &amp;lt; .0001 for all; Table). Among patients with clinical response to RZB IV induction and entered maintenance, rates of clinical biomarker response were maintained through week 52 in patients receiving 360 mg RZB SC and declined over time among patients in the withdrawal (PBO SC) arm (Figure A). Rates of clinical biomarker remission increased over time in patients receiving 360 mg RZB SC. At week 52, clinical remission and normalisation of hs-CRP or FCP was achieved by 41% of patients receiving RZB vs 28%–29% of patients in the withdrawal (PBO SC) arm (Figure B-C). The safety profile of RZB in CD was previously reported. Conclusion Normalisation of objective biomarkers of inflammation in CD was achieved with RZB induction and maintenance therapy. Improvements in both clinical outcomes and biomarker levels were sustained with continuous RZB maintenance therapy and decreased over time in patients discontinuing RZB.

Comparable Subjective and Objective Clinical Outcomes After Fibular or Combined Tibial-Fibular-based Reconstruction of the Posterolateral Corner of the Knee: A Systematic Review and Meta-analysis.

To compare subjective and objective outcomes of fibular and combined tibial-fibular (TF)-based posterolateral corner (PLC) reconstruction. A systematic review of literature reporting outcomes of posterolateral corner reconstruction was conducted including outcome studies of surgically treated PLC injuries with a minimum 1-year follow-up, postoperative subjective and objective outcomes including the patient-reported outcome scorings of Lysholm score, International Knee Documentation Committee evaluation (subjective and objective), dial test, and varus stress radiographs. The 32 studies included comprised 40 cohorts: 12 cohorts (n = 350 knees) used a fibular-based technique, and 28 cohorts (n = 593 knees) used a combined TF-based technique. No statistically significant differences were found in patient-reported outcomes or objective clinical measurements comparing the two techniques using the Lysholm score (P = 0.204, τ2 = 3.46), International Knee Documentation Committee evaluation (subjective P = 0.21 τ2 = 15.57; objective P = 0.398), dial test (P = 0.69), or varus stress radiographs (P = 0.98, τ2 = 0.08). This study found no statistically significant differences in subjective or objective clinical outcome measurements after fibular-based versus combined TF-based PLC reconstruction. Further prospective evaluation comparing long-term clinical outcomes, complications, and surgical time may help to elucidate a preferred reconstructive technique.

Clinical outcomes following reverse total shoulder arthroplasty with tuberosity excision for treatment of proximal humerus fractures: a case series

Reverse total shoulder arthroplasty (RTSA) has become an increasingly popular treatment option for complex 3- and 4-part proximal humerus fractures in elderly patients. The literature has demonstrated that tuberosity repair likely improves postoperative range of motion (ROM). However, the difference between tuberosity repair and excision may not be appreciable to patients in their day-to-day lives. This case series reports both objective and subjective clinical outcomes of patients who underwent RTSA with tuberosity excision for proximal humerus fractures. We reviewed the records of 41 patients who underwent RTSA for complex 3- and 4- part proximal humerus fractures. All RTSA procedures were performed by a single surgeon between 2014 and 2017. All patients underwent RTSA with extended proximal stem cementation and tuberosity excision. Postoperative outcomes were measured at least 2 years postoperatively and included ROM measurements for forward flexion, internal rotation, abduction, and external rotation. Patient-reported outcome measures included Simple Shoulder Test scores, American Shoulder and Elbow Surgeons scores, and Penn Shoulder Score were also reported. In this case series, we report on 41 patients, 33 females and 8 males. Objective measurements of ROM for forward flexion, abduction, and external rotation were 125, 95, and 36 degrees, respectively. On average, patients had an internal rotation score of 2.06 and were able to get their thumb to their iliac crest. Clinical outcome scores of these patients were 9.11, 77.79, and 74.12 for the Simple Shoulder Test, American Shoulder and Elbow Surgeons, and Penn Shoulder Score, respectively. Strength of the deltoid was 5/5 in all 41 patients. When compared with the current literature, our tuberosity excision patients demonstrated deficits in forward flexion and abduction, with preserved external rotation. Our clinical outcome score measurements were consistent with clinical outcome measurements from previous studies of patients undergoing RTSA with tuberosity repair. We believe that tuberosity excision may be a reasonable and simpler surgical option for surgeons with lower volumes of shoulder fractures and patients with multiple comorbidities and higher surgical risk, owing to the similarity of outcome scores between our cohort and previous tuberosity repair groups.

Clinical Outcomes and Postoperative Complications After All-Epiphyseal Double-Bundle ACL Reconstruction for Skeletally Immature Patients.

Background:The treatment strategy for pediatric anterior cruciate ligament (ACL) tears, especially in patients with open physes, remains controversial.Purpose:To assess clinical outcomes and postoperative complications after all-epiphyseal double-bundle ACL (DB-ACL) reconstruction for patients with open physes.Study Design:Cohort study; Level of evidence, 3.Methods:Included were 102 patients aged ≤15 years who underwent ACL reconstruction at a single institution and had a minimum of 2 years of follow-up. Of these patients, 18 had undergone all-epiphyseal DB-ACL reconstruction (mean age, 12.4 ± 1.2 year) and 84 had undergone conventional DB-ACL reconstruction (mean age, 14.1 ± 0.9 year). The outcomes of the all-epiphyseal group were compared with those of the conventional group. Objective clinical outcomes included KT-1000 arthrometer measurements of side-to-side difference in anterior tibial translation, Lachman test grade, and pivot-shift test grade. Radiographic angular deformity (defined as >3° of the side-to-side difference in femorotibial angle) and incidence of second ACL injury were also compared.Results:The postoperative side-to-side difference in laxity significantly improved from 6.1 ± 2.4 to 0.6 ± 0.9 mm in the all-epiphyseal group (P = .001), and postoperative laxity was similar to that of the conventional group (0.4 ± 0.8 mm; P = .518). A Lachman grade 1 positive result was observed in 20% of the all-epiphyseal group and 3% of the conventional group (P = .042), and a pivot-shift grade 1 positive result was observed in 22% of the all-epiphyseal group and 4% of the conventional group (P = .074). A total of 4 patients (26.7%) in the all-epiphyseal group and 4 (6.1%) in the conventional group demonstrated angular deformity (P = .035). The incidence of postoperative ipsilateral ACL tear was 16.7% in the all-epiphyseal group and 23.8% in the conventional group (P = .757). The incidence of contralateral ACL tear was 11.1% in the all-epiphyseal group and 14.3% in the conventional group (P ≥ .999).Conclusion:All-epiphyseal DB-ACL reconstruction for skeletally immature patients achieved satisfactory clinical outcomes compared with conventional DB-ACL reconstruction. The incidence of ipsilateral graft rupture was relatively high in both groups. The all-epiphyseal group had a significantly higher incidence of angular deformity.

Subjective and objective clinical outcomes of a new trifocal toric intraocular lens and effect of femtosecond laser cataract surgery.

To evaluate the clinical outcomes and quality of life following implantation of PanOptix toric intraocular lens (IOL) and to compare the outcomes following femtosecond laser assisted cataract surgery (FLACS) and standard cataract surgery (SCS). This comparative retrospective study included 79 eyes of 55 patients underwent cataract or refractive lens exchange surgery between April 2017 and January 2020 in Bayindir Hospital and Kaskaloglu Eye Hospital. Corneal (CA) and refractive astigmatism (RA), uncorrected visual acuities for distant, intermediate, and near (UDVA, UIVA, and UNVA), low contrast distance visual acuity, rotational stability, defocus curves, photopic and mesopic contrast sensitivity (CS), visual function-14 (VF-14) test, presence of dysphotopsia, and need for spectacles were evaluated at postoperative third month. Outcomes were compared between FLACS and SCS group. The mean UDVA, UIVA, and UNVA were 0.05 ± 0.07, 0.08 ± 0.08, and 0.06 ± 0.07 logMAR, respectively. All patients achieved ⩾0.3 logMAR uncorrected visual acuity for all distances. UDVA was found significantly better in FLACS group (p = 0.03). All eyes had ⩽1 D of subjective postoperative RA. Defocus curve had two peaks at 0 and -1.50 D. Spectacle independence was achieved in 88.7% of patients. Photopic and mesopic CS was within normal range in all patients. The mean VF-14 score was 98 ± 2. The mean IOL axis rotation was 2.1° ± 2.3°. Only one patient reported seeing disturbing halos. This trifocal toric IOL effectively reduced refractive astigmatism and provided excellent visual outcomes with high spectacle independence, patients' satisfaction, and good rotational stability. FLACS might have an impact on optimal postoperative results.

'Mini-Max' knotless acetabular labrum repair: repair construct rationale and allocation in a consecutive case series with minimum 1-year clinical outcomes.

ABSTRACTTo describe the ‘mini-Max’ approach to labrum repair using non-absorbable 2.4-mm knotless suture anchors and report objective clinical outcomes with a large single-surgeon cohort. Level 3 retrospective case series. A retrospective review was conducted to report the use and allocation of non-absorbable 2.4-mm knotless suture anchors during ‘mini-Max’ labral repair from 2015 to 2018. Descriptive analysis of the labral damage severity, size and number of anchors used to arthroscopically repair the acetabular labrum was performed. Paired-samples t-tests were performed to evaluate whether preoperative and 1-year follow-up patient-reported outcomes (PROs) were statistically significant. An analysis of variance was performed comparing PROs with categorized number of labral anchors. A total of 390 patients were queried in this study, with 330 (85%) diagnosed intraoperatively with acetabular labral tears. A total of 245 patients (137 females and 108 males) with a mean age of 30.1 ± 11.6 years (mean ± SD) at the time of surgery underwent ‘mini-Max’ labral refixation. Of the 245 labral tears, 88 (35.9%) were graded as mild, 113 (46.1%) as moderate and 44 (18.0%) as severe. Labral repairs required an average of 2.1 ± 0.67 anchors across all patients included. Forty-one repairs (16.7%) required one anchor, 139 (56.7%) required two anchors, 63 (25.7%) required three anchors and 2 (0.8%) required four anchors. Significant improvements were reported for all PROs (P ≤ .001) at a minimum of 1-year follow-up. Arthroscopic ‘mini-Max’ labral repair using non-absorbable knotless suture anchors is a safe and effective technique for improving the lives of patients suffering from symptomatic acetabular labrum tears.

Three-dimensional assessment of accuracy for open reduction and internal fixation of the subcondylar fracture and its implications on the TMJ function

This study used three-dimensional cone beam computed tomography (CBCT) to assist the accuracy of open reduction and internal fixation (ORIF) for the unilateral subcondylar fracture and the long-term temporomandibular joint (TMJ) function impairment.Bilateral TMJs were analyzed postoperatively on CBCT images, involving the following three-dimensional (3D) parameters: condylar position and inclination; circumferential joint space, ramus, and mandible length; and the volumetric joint space. The inclusion criteria for adult patients included having a displaced fracture >5°, a shortening in ramus length >2 mm, and mouth opening limitation. The non-fracture side was used as the comparison group. The Helkimo index was employed for the clinical assessment of the outcomes, while the paired student t-test and Pearson coefficient test were used to compare both sides.The study included 60 joints in 30 consecutive patients. The condylar inclination to the horizontal plane on the fracture and non-fracture sides was 9.29 ± 3.9°, 12.46 ± 4.2°, (p < 0.001) and was positively related to the subjective (Helkimo Hi) and objective (Helkimo Di) clinical outcomes. In contrast, the condylar position to the midsagittal plane in the fracture and non-fracture sides was 51.95 ± 3.5 mm, 50.17 ± 3.6 mm (P = 0.038), and was positively related to the objective outcomes. Additionally, the objective outcome was negatively related to the change of the posterior joint space. ConclusionThe three-dimensional assessments seem to demonstrate that the ORIF is an accurate approach for obtaining a three-dimensional reduction to the displaced subcondylar fracture.

Outcomes of Arthroscopic Latarjet As a Revision Procedure for Treatment of Recurrent Anterior Shoulder Instability After Failed Arthroscopic Bankart Repair. A Case Series

To assess subjective and objective clinical outcomes, recurrence and complication rates after arthroscopic Latarjet as a revision procedure after failed arthroscopic Bankart repair.

Differences in oral food challenge reaction severity based on increasing age in a pediatric population

BackgroundFood allergy reactions range from mild to severe with differences in age appearing to be an important factor associated with reaction severity. ObjectiveTo define differences in oral food challenge (OFC) reaction severity in pediatric patients from infancy to adolescence using objective clinical outcomes and standardized reaction grading tools. MethodsRetrospective review of all positive OFC results at 2 large institutions between September 2016 and February 2019. Reaction severity was defined by presence of cardiovascular, neurologic, lower respiratory, or laryngeal symptoms, epinephrine requirement, and grading using 2 established food allergy reaction scales. ResultsInfants and toddlers had fewer reactions involving cardiovascular, neurologic, lower respiratory, or laryngeal symptoms compared with older age groups. Epinephrine was also required less frequently during reactions in infants and toddlers, compared with older age groups. There was no difference in reaction severity in infants and toddlers based on clinical history of eczema. Increasing age was significantly correlated with increased epinephrine requirement (R2 = 0.12, P = .002), elevated Consortium of Food Allergy Research score (R2 = .012, P = .003), and approached significance for increased Practical Allergy score (R2 = .005, P = .05). History of asthma and sesame allergy were identified to be positively correlated with more severe reactions. ConclusionInfants and young toddlers have less severe reactions during OFCs compared with older age groups supporting early food introduction practices. In children under 12 months of age, severe reactions are most rare calling into question screening practices using specific allergy testing before food introduction. Standardized reaction grading tools may be valuable instruments to categorize reaction severity during OFCs.

Clinical Outcome of a Modified Coracoid Tunnel-Free Coracoclavicular Sling Technique With Remnant Preservation for the Treatment of High-Grade Acromioclavicular Joint Separation: A Report of 48 Cases With 2 to 5 Years of Follow-up

Background: High-grade acromioclavicular (AC) joint separation injuries (Rockwood type IV or V) are surgically indicated because of complete disruption of the AC and coracoclavicular (CC) ligaments, leading to instability and pain. In surgical techniques that require a suspensory system, coracoid tunnel-related complications are not uncommon. Purpose: To report subjective and objective clinical outcomes and complication rates of a modified coracoid tunnel-free CC sling technique combined with CC ligament remnant preservation for a minimum 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: Between January 2014 and January 2017, we prospectively enrolled patients who underwent a modified CC sling technique performed by 1 senior surgeon using the AC TightRope System in a coracoid tunnel-free fashion. The CC distance (CCD) and Rockwood AC joint classification were evaluated on radiographs preoperatively, immediately postoperatively, and at the final follow-up. The visual analog pain score, range of motion, American Shoulder and Elbow Surgeons score, Constant-Murley score, and University of California Los Angeles score were recorded preoperatively and at the final follow-up. Results: In total, 48 of 54 patients (88.9%) were included for the evaluation with a mean ± SD follow-up of 39.3 ± 8.9 months (range, 24.7-64.3 months). The CCD was significantly decreased from 22.7 ± 4.2 to 9.8 ± 2.3 mm (P < .01) immediately after surgery and to 11.2 ± 1.8 mm (P < .01) at final follow-up. At the final follow-up, the side-to-side difference of CCD was 3.5 ± 0.6 mm. Compared with the preoperative level, all subjective evaluations were significantly improved at the final follow-up. We observed that 4 of the 48 patients (8.3%) had a loss of reduction at the final follow-up, but no pain or instability was documented. Further, no coracoid-related complication or other complications were recorded. Conclusion: The coracoid tunnel-free CC sling technique using the AC TightRope System combined with CC ligament remnant preservation demonstrated significant improvement regarding both clinical and radiological outcomes, with a reduction loss rate of 8.3%. It is a safe method that could achieve satisfactory result without any coracoid drilling-related complications.

No difference in subjective and objective clinical outcomes between arthroscopic transtibial and open inlay posterior cruciate ligament reconstruction techniques in the treatment of multi-ligamentous knee injuries

BackgroundThere is controversy regarding the optimal treatment of posterior cruciate ligament (PCL) -based multi-ligamentous injuries. The purpose of this study was to compare the subjective and objective clinical outcomes of arthroscopic transtibial reconstruction and tibial inlay reconstruction. MethodsFrom 2005 to 2013, a total of 135 patients with PCL-based multi-ligamentous injuries were consecutively identified. Patients were operated with the arthroscopic transtibial technique or the open tibial inlay technique group. Other injured structures were reconstructed or repaired simultaneously. All of the patients underwent a preoperative and postoperative physical examination, KT-1000 measurement, stress radiography under anesthesia and subjective evaluations including Tegner score, Lysholm score, American Academy of Orthopedic Surgeons (AAOS) score. ResultsFifty-seven patients (64.8%) underwent arthroscopic transtibial PCL reconstruction, and 31 patients (35.2%) underwent PCL reconstruction with the tibial inlay technique. The average follow up period was 45.9 ± 17.0 months (24–77 months). At the final follow up, for the arthroscopic transtibial group, the side-to-side difference of KT-1000 decreased from 13.5 ± 4.8 mm to 2.4 ± 3.4 mm (P < 0.001); the tibial posterior translation by stress radiograph decreased from 14.9 ± 7.1 mm to 4.6 ± 4.0 mm (P < 0.001). For the open inlay group, the side-to-side difference of KT-1000 decreased from 13.7 ± 5.2 mm to 2.2 ± 3.6 mm (P < 0.001) and the posterior translation by stress radiograph decreased from 14.9 ± 5.9 mm to 4.3 ± 3.9 mm (P < 0.001) at the final follow up. The inter-group clinical outcomes pre- and postoperatively were not significantly different at any time point. ConclusionThere was no statistically significant difference in objective and subjective outcome between the arthroscopic transtibial and open inlay PCL reconstruction in patients with multi-ligamentous injuries.

Motor Indicators for the Assessment of Frozen Shoulder Rehabilitation via a Virtual Reality Training System

Adhesive capsulitis (also known as frozen shoulder) is a common clinical shoulder disorder and can be effectively improved through physical rehabilitation. With advancements in technology, virtual reality (VR) has been increasingly employed in rehabilitation treatments. However, most relevant studies have merely employed traditional assessment tools to assess the therapeutic effects rather than the substantial amount of motor trajectory data or task performance collected by motor training systems. In this research, an innovative frozen shoulder rehabilitation system using a Microsoft Kinect sensor and VR was successfully developed and five task-oriented motor indices and task performance were proposed to assess motor performance. A clinical experiment involving twenty patients was conducted. Objective clinical assessment outcomes verified the effectiveness of the developed system for frozen shoulder rehabilitation. The improvements assessed according to motor indices and task performance were consistent with the objective clinical assessment results. Furthermore, correlation analysis showed that several items in the task performance and motor indices were significantly correlated to clinical assessment items. Moreover, numerous items in the task performance and motor indices capable of predicting the clinical assessment results were identified through stepwise regression analysis. The results of this research can facilitate the subsequent development of new assessment methods.