Repeat Injury Research Articles

Paper 14: Evaluation of Outcomes at Mean 2.75 years after Repair of Lateral Meniscus Oblique Radial Tears during ACL Reconstruction

Objectives: Lateral meniscus oblique radial tears (LMORTs) commonly occur in the setting of anterior cruciate ligament (ACL) rupture. Despite publications pertaining to the prevalence, biomechanics, and surgical repair techniques of LMORTs, studies reporting outcomes following LMORT repair are lacking. The purpose of this study was to examine clinical and patient-reported outcomes following the surgical repair of LMORTs during ACL reconstruction. Methods: A retrospective chart review was conducted on 845 patients that underwent a meniscus repair at a single institution between 2017 and 2019. Operative reports, procedure notes, and operative images were manually reviewed to identify LMORTs. Subsequent knee surgery, meniscus repair failure, and postoperative complications were also extracted during the chart review. Postoperative complications were defined as reinjury, pain, stiffness, recurrent swelling, weakness, instability, or superficial wound infections. Patients were contacted postoperatively for evaluation of patient reported outcomes including the Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale (MARS), and Visual Analog Scale (VAS). Results: Twenty-five patients (68% male) were identified who underwent repair of an LMORT in the same setting as an ACL reconstruction during the study period. Mean age was 21.1 ± 4.6 years old, and the mean body mass index was 26.9 ± 5.1 kg/m2. Mean follow-up was 33.1 ± 25.7 months. There were no reported failures of the LMORT repair. Postoperative complications were reported in 9 patients (36%). Seven of these patients underwent repeat arthroscopy of the index knee for stiffness, pain, and/or repeat injury. However, of the patients who had repeat arthroscopy at the same institution (6 patients), all demonstrated complete healing of the LMORT repair site during arthroscopic evaluation. For patients completing patient-reported outcome measures, there was a minimum follow-up period of 43 months from the initial date of surgery. The mean KOOS, MARS, and VAS were 86.3 ± 8.1, 6.7 ± 4.2, and 2.0 ± 1.3, respectively. Conclusions: Surgical repair of LMORTs results in low failure risk, low complication rates, and favorable patient-reported outcome measures. Further work is needed to evaluate for differences in outcomes between meniscus repair versus partial meniscectomy versus observation of these LMORT lesions.

Poster 303: Outcomes Following Repair of Radial Meniscus Tears Compared to Bucket Handle Meniscus Tears

Objectives: Preserving the meniscus has become a priority in managing meniscal tears with advancement of meniscus repair techniques. Meniscal repair, as opposed to partial meniscectomy, reduces risk of development and progression of knee osteoarthritis. Radial meniscus tears have traditionally been associated with a poor prognosis because they occur perpendicular to circumferential meniscal fibers, compromising hoop tension. Advances in surgical technique and biologic augmentation have facilitated repair of these complex injuries. The purpose of this study was to compare post-operative complication and surgical revision rates in patients who underwent repair of a radial meniscus tear versus bucket-handle meniscus tear. We hypothesized the outcomes of repair of radial meniscus tear would be similar to a matched group of patients who underwent repair of a bucket handle meniscus tear. Methods: A retrospective study was performed to identify patients who underwent repair of radial meniscus tear. Chart review was performed for 1506 patients who underwent meniscus repair from 2012 to 2019, and demographic information, type of meniscus tear, concomitant ACL reconstruction, post-operative complications, repeat surgeries, and failure at the repair site were detailed in a database. Patients who underwent repair of a radial tear were matched with patients who underwent repair of a bucket-handle tear based on sex, age (within 5 years), BMI (within 5 kg/m2), meniscus laterality, and concomitant ACL reconstruction. Isolated meniscus repairs were augmented with platelet rich plasma (PRP). Results: Fifty patients (age, 31.8 ± 15.2 years; BMI, 30.2 ± 6.4 kg/m2) were identified who underwent a radial meniscus tear repair. Of these patients, 16 (32.0%) were female and 23 (46.0%) underwent concomitant ACL reconstruction. Complications including recurrent swelling, stiffness, persistent pain, and repeat injury were reported in 15 patients (30.0%). Six patients underwent repeat surgery (12.0%). Four repeat surgical patients, who had previously undergone meniscus repair and concomitant ACL reconstruction, were found to have an intact radial repair at the time of second surgery, and underwent repeat surgery for a reason unrelated to the radial tear repair (e.g. cyclops lesion, synovectomy, new meniscus tear). Two patients had a radial tear repair failure that required surgical revision (4.0%). Radial tear repair patients who underwent concomitant ACL reconstruction differed significantly from those who did not only in age (ACL group, 26.0 ± 10.9 y; non-ACL group, 36.6 ± 16.7 y; p = 0.03). There were no significant differences in post-operative complications, repeat surgeries, or failures between the radial and bucket-handle tear repair patients. Conclusions: Repair of radial meniscus tears with contemporary techniques and biological enhancement with either ACL reconstruction or PRP can be expected to have similar outcomes to repairs of bucket handle meniscus tears.

Effect of repeated sciatic nerve crush on the conditioning lesion response: Generating an experimental animal model to prolong the denervation period while maintaining peripheral nerve continuity

Peripheral nerves exhibit long-term residual motor dysfunction following injury. The length of the denervation period before nerve and muscle reconnection is an important factor in motor function recovery. We aimed to investigate whether repeated nerve crush injuries to the same site every 7 days would preserve the conditioning lesion (CL) response and to determine the number of nerve crush injuries required to create an experimental animal model that would prolong the denervation period while maintaining peripheral nerve continuity. Rats were grouped according to the number of sciatic nerve crushes. A significant decrease in the soleus muscle fiber cross-sectional area was observed with increased crushes. After a single crush, macrophage accumulation and macrophage chemotaxis factor CCL2 expression in dorsal root ganglia were markedly increased, which aligned with the gene expression of Ccl2 and its receptor Ccr2. Macrophage numbers, histological CCL2 expression, and Ccl2 and Ccr2 gene expression levels decreased, depending on the number of repeated crushes. Histological analysis and gene expression analysis in the group with four repeated crushes did not differ significantly when compared with uninjured animals. Our findings indicated that repeated nerve crushes at the same site every 7 days sustained innervation loss and caused a loss of the CL response. The experimental model did not require nerve stump suturing and is useful for exploring factors causing prolonged denervation-induced motor dysfunction. Significance StatementThis study elucidates the effects of repeated nerve crush injury to the same site on innervation and conditioning lesion responses and demonstrates the utility of an experimental animal model that recapitulates the persistent residual motor deficits owing to prolonged denervation without requiring nerve transection and transection suturing.

Pediatric Trauma Recidivism: A Statewide Risk Factor Analysis of the Maryland Health Services Cost Review Commission (HSCRC)

BackgroundNational estimates suggest pediatric trauma recidivism is uncommon but are limited by short follow up and narrow ascertainment. We aimed to quantify the long-term frequency of trauma recidivism in a statewide pediatric population and identify risk factors for re-injury. MethodsThe Maryland Health Services Cost Review Commission Dataset was queried for 0–19-year-old patients with emergency department or inpatient encounters for traumatic injuries between 2013 and 2019. We measured trauma recidivism by identifying patients with any subsequent presentation for a new traumatic injury. Univariate and multivariable regressions were used to estimate associations of patient and injury characteristics with any recidivism and inpatient recidivism. ResultsOf 574,472 patients with at least one injury encounter, 29.6% experienced trauma recidivism. Age ≤2 years, public insurance, and self-inflicted injuries were associated with recidivism regardless of index treatment setting. Of those with index emergency department presentations 0.06% represented with an injury requiring inpatient admission; unique risk factors for ED-to-inpatient recidivism were age >10 years (aOR 1.61), cyclist (aOR 1.31) or burn (aOR 1.39) mechanisms, child abuse (aOR 1.27), and assault (aOR 1.43). Among patients with at least one inpatient encounter, 6.3% experienced another inpatient trauma admission, 3.4% of which were fatal. Unique risk factors for inpatient-to-inpatient recidivism were firearm (aOR 2.48) and motor vehicle/transportation (aOR 1.62) mechanisms of injury (all p < 0.05). ConclusionsPediatric trauma recidivism is more common and morbid than previously estimated, and risk factors for repeat injury differ by treatment setting. Demographic and injury characteristics may help develop and target setting-specific interventions. Level of EvidenceIII (Retrospective Comparative Study)

Recent insights from non-mammalian models of brain injuries: an emerging literature.

Traumatic brain injury (TBI) is a major global health concern and is increasingly recognized as a risk factor for neurodegenerative diseases including Alzheimer's disease (AD) and chronic traumatic encephalopathy (CTE). Repetitive TBIs (rTBIs), commonly observed in contact sports, military service, and intimate partner violence (IPV), pose a significant risk for long-term sequelae. To study the long-term consequences of TBI and rTBI, researchers have typically used mammalian models to recapitulate brain injury and neurodegenerative phenotypes. However, there are several limitations to these models, including: (1) lengthy observation periods, (2) high cost, (3) difficult genetic manipulations, and (4) ethical concerns regarding prolonged and repeated injury of a large number of mammals. Aquatic vertebrate model organisms, including Petromyzon marinus (sea lampreys), zebrafish (Danio rerio), and invertebrates, Caenorhabditis elegans (C. elegans), and Drosophila melanogaster (Drosophila), are emerging as valuable tools for investigating the mechanisms of rTBI and tauopathy. These non-mammalian models offer unique advantages, including genetic tractability, simpler nervous systems, cost-effectiveness, and quick discovery-based approaches and high-throughput screens for therapeutics, which facilitate the study of rTBI-induced neurodegeneration and tau-related pathology. Here, we explore the use of non-vertebrate and aquatic vertebrate models to study TBI and neurodegeneration. Drosophila, in particular, provides an opportunity to explore the longitudinal effects of mild rTBI and its impact on endogenous tau, thereby offering valuable insights into the complex interplay between rTBI, tauopathy, and neurodegeneration. These models provide a platform for mechanistic studies and therapeutic interventions, ultimately advancing our understanding of the long-term consequences associated with rTBI and potential avenues for intervention.

Return to Sport After Pediatric Anterior Cruciate Ligament Reconstruction: A Systematic Review of the Criteria

Background: Postoperative rehabilitation is an important component of recovery after anterior cruciate ligament (ACL) reconstruction (ACLR), facilitating successful return to sport (RTS) by reducing risk factors for repeat injury. Purpose: This systematic review aimed to determine the best protocol for RTS after ACLR in children. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, Embase, PEDro, SPORTDiscus, and Web of Science databases were searched from October 3, 2014, to November 3, 2022. The inclusion criteria were the pediatric population (<18 years old) after ACLR with clear RTS criteria and/or mean/median time to RTS. Multiligament knee injuries were excluded from this study. The methodologic quality of the included articles was assessed using the methodological index for non-randomized studies (MINORS). The highest possible score was 24 points for comparative studies (ie, a study comparing 2 protocols or more). Noncomparative studies or studies with a single protocol could score a maximum of 16 points as assessed by the MINORS score. Results: The search yielded 1816 titles, and 24 were retained based on the inclusion and exclusion criteria. Every study was published between 2015 and 2022. Among the 24 studies included, 13 were retrospective and 11 were prospective. The mean MINORS score for the noncomparative studies was 13 of 16 (n = 23) and 23 of 24 for the comparative study (n = 1). The studies were categorized into unspecified clearance (n = 10), milestone based (n = 13), and combined time and milestone (n = 1). A total of 1978 patients (57% female) were included in the review. The mean age at ACLR was 14.7 years. The most common endpoint used was graft rupture (0% to 35%). In the unspecified group, the quickest RTS was 5.8 months and the longest was 9.6 months. Statistically significant risk factors for ACL reinjury included younger age and earlier RTS. The latter was a significant contributor to graft failure for combined time-based and milestone-based RTS. In the milestone-based group, the most common criteria were ≥90% limb symmetry measured using hamstring strength, quadriceps strength, and/or hop tests. The mean RTS time was 6.8 to 13.5 months. Conclusion: RTS should be delayed, when possible, especially in the younger population. A combination of quantitative tests and qualitative tests is also recommended. However, optimal RTS criteria have yet to be determined. Future prospective studies should focus on comparing the different times and milestones currently available.

Absence of the primary cilia formation gene Talpid3 impairs muscle stem cell function

Skeletal muscle stem cells (MuSC) are crucial for tissue homoeostasis and repair after injury. Following activation, they proliferate to generate differentiating myoblasts. A proportion of cells self-renew, re-enter the MuSC niche under the basal lamina outside the myofiber and become quiescent. Quiescent MuSC have a primary cilium, which is disassembled upon cell cycle entry. Ex vivo experiments suggest cilia are important for MuSC self-renewal, however, their requirement for muscle regeneration in vivo remains poorly understood. Talpid3 (TA3) is essential for primary cilia formation and Hedgehog (Hh) signalling. Here we use tamoxifen-inducible conditional deletion of TA3 in MuSC (iSC-KO) and show that regeneration is impaired in response to cytotoxic injury. Depletion of MuSC after regeneration suggests impaired self-renewal, also consistent with an exacerbated phenotype in TA3iSC-KO mice after repeat injury. Single cell transcriptomics of MuSC progeny isolated from myofibers identifies components of several signalling pathways, which are deregulated in absence of TA3, including Hh and Wnt. Pharmacological activation of Wnt restores muscle regeneration, while purmorphamine, an activator of the Smoothened (Smo) co-receptor in the Hh pathway, has no effect. Together, our data show that TA3 and primary cilia are important for MuSC self-renewal and pharmacological treatment can efficiently restore muscle regeneration.

Frequency of injuries and orthopaedic conditions sustained by flyball dogs

Abstract The risk of injury to canine flyball competitors has been noted as similar to that reported for canine agility, affecting approximately one third of competitors throughout their careers. To date, no studies have examined whether elements such as consistently turning in one direction during the box turn are associated with specific types of injuries. The aims of this study were to describe the frequency and types of injuries experienced by flyball dogs and to evaluate variables that may affect injury occurrence at specific anatomical sites which may give insight into potential ways of reducing injury risk. An online questionnaire, sent to owners, was used to obtain data on 75 dogs that had sustained an injury whilst training or competing in flyball in the last five years. Among the 75 dogs, the most common location was the shoulder region (n = 17; 16.8% of injured dogs), followed by the back and trunk (n = 16; 15.8%). Back injuries had the highest recorded number of repeat injuries n = 66 (24.63%), and when all individual injuries were considered, 44.40% (n = 119) of them occurred on the forelimbs. The most common type of injury was inflammation to soft tissue. There was a statistically significant association between the direction the dog turns at the box and the side of occurrence of injuries at the shoulder (X2(2) = 13.71, ), with injuries most likely to occur to the limb on the inside of the turn (left turn = left shoulder). For hip injuries, there was also an association with the most affected side and the side of the box turn (X2(2) = 6.702, ), with injuries most likely to occur on the limb at the outside of the turn (left turn = right hip). These findings identify new risk factors for injury within flyball which can be used to improve welfare and safety for competitors.

Evaluation Of The Relationship Of Kinesiophobia With Anxiety, Upper Extremity Disability And Quality Of Life In Patients With Frozen Shoulders

Abstract Introduction Frozen shoulder is a painful shoulder disease in which glenohumeral joint movements are actively and passively restricted in all directions. If not treated, it can cause various psychological diseases and muscle and joint diseases. Kinesiophobia; this is defined as a fear of physical activity resulting from excessive sensitivity and an uncomfortable feeling due to painful or repeated injury. In this study, it was aimed to evaluate the relationship of kinesiophobia to upper extremity disability, anxiety and quality of life in patients with frozen shoulder. Materials and methods Fırat University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, between September 2020 and March 2021; As a result of clinical evaluation and radiological examinations, patients were enrolled between the ages of 18–75 and who agreed to participate in the study; 48 patients were diagnosed with frozen shoulder and met the inclusion and exclusion criteria of the study and were included in the patient group; Fourty healthy subjects aged between 18–75 years, who did not have shoulder disease and who met the inclusion and exclusion criteria of the study, were included in the control group. A total of 88 cases were included in the study. The following scales were used. TAMPA kinesiophobia scale to assess kinesiophobia in patients and control group, Beck Anxiety scale to assess anxiety in patient group; The Disabilities of The Arm, Shoulder and Hand (DASH) scale to assess upper extremity disability; Short Form (SF)-36 was used to assess quality of life. Results TAMPA kinesiophobia scale was found to be significantly different in the patient group when the patient group and control group were compared. According to the correlation analysis, the TAMPA kinesiophobia scale showed a positive correlation with the Beck-Anxiety and DASH scales in the patient group, while a negative correlation was found with the SF36-Physical function, emotional role difficulty and social functionality. Conclusion In patients with frozen shoulder, kinesiophobia seems to be associated with increased anxiety and upper extremity disability, as well as low quality of life. Structural disorders as well as psychological factors should be taken into account among the reasons for the prolonged limitation of movement and delayed recovery. When the physicians serving in the primary care are experienced with patient management with frozen shoulder, as evaluated for therapeutic purposes, planning psychological support treatments in addition to medical and physical therapy will increase the quality of health care provided to patients.

Text Neck Syndrome and Associated Risk Factors: Prevalence in Medical Students

Text neck depicts repeated stress injury and irritation of neck due to smart phone usage or other handheld devices over a sustained period. Objective: To evaluate the prevalence of text neck syndrome in medical students of Abbottabad. Methods: Descriptive cross sectional study was conducted at various government and private medical colleges of Abbottabad. A sample size of 300 students was estimated suitable for the study calculated via Epitool, a total 300 students of age group 17-30 years were asked to fill 2 well- standardized questionnaires namely Neck Disability Index (NDI) &amp; Nomophobia Pain Questionnaire(NPQ) after seeking informed consent. Convenient sampling technique was opted for data collection. The data was further analysed by using SPSS. Results: Among 300 subjects, 4.333% subjects showed mild nomophobia, 54% subjects reported moderate nomophobia, while 41.67% subjects had severe nomophobia. According to the Neck Disability Index (NDI), 6.333% subjects showed no disability, 41.67% subjects showed mild disability, 30% subjects showed moderate disability, 12.67% subjects showed severe disability while 0.333% subjects showed complete disability. There was significant positive correlation observed between NDI and NMP-Q with Pearson correlation co-efficient value of 0.88. Conclusions: The study revealed a high prevalence of Text Neck Syndrome in medical students, despite of their awareness and education, primarily due to gadget addiction.

Construction and validation of a novel and severe hepatic injury model in swine focuses on research and training. Observational study

Some hepatic wound models have been developed in pigs with the aim of reproducing liver injury; however, the wound shape, severity, and outcome differ among them. The novel injury profile employed in this study differed from that used elsewhere for standardized, repeatable, reproducible, incising-penetrating, vascular, and severe injury in swine. It is made with a cutting object that penetrates deep into the hepatic parenchyma, always affecting the two suprahepatic veins at the point where they merge into the common trunk.The primary outcome was reproducibility and replicability of the surgical method.The secondary outcome was the analysis of some variables (blood loss, survival, and flow) to validate the model.•This novel method of liver injury provides a liver injury with the following characteristics: standardized, incise-penetrated, deep, bloody, and severe.•This model can be used for research (trauma, hepato-bilio-pancreatic, pharmaceutical) and training (damage control surgery).•Method name: Incising-Penetrating, Vascular and Severe Liver Injury Model in Swine.

Emerging Quantitative Imaging Techniques in Sports Medicine.

This article describes recent advances in quantitative imaging of musculoskeletal extremity sports injuries, citing the existing literature evidence and what additional evidence is needed to make such techniques applicable to clinical practice. Compositional and functional MRI techniques including T2 mapping, diffusion tensor imaging, and sodium imaging as well as contrast-enhanced US have been applied to quantify pathophysiologic processes and biochemical compositions of muscles, tendons, ligaments, and cartilage. Dual-energy and/or spectral CT has shown potential, particularly for the evaluation of osseous and ligamentous injury (eg, creation of quantitative bone marrow edema maps), which is not possible with standard single-energy CT. Recent advances in US technology such as shear-wave elastography or US tissue characterization as well as MR elastography enable the quantification of mechanical, elastic, and physical properties of tissues in muscle and tendon injuries. The future role of novel imaging techniques such as photon-counting CT remains to be established. Eventual prediction of return to play (ie, the time needed for the injury to heal sufficiently so that the athlete can get back to playing their sport) and estimation of risk of repeat injury is desirable to help guide sports physicians in the treatment of their patients. Additional values of quantitative analyses, as opposed to routine qualitative analyses, still must be established using prospective longitudinal studies with larger sample sizes.

Using repeat injury assessments in adult sockeye salmon (Oncorhynchus nerka) to predict spawning success and describe severity of migration conditions

Pacific salmon (Oncorhynchus spp.) are semelparous and anadromous, and during their up-river migration to spawn can experience injuries and mortality from fisheries interactions and adverse environmental conditions. There is the potential to improve models used to predict those losses by including information on surficial fish condition, but for this information to be useful, we need to understand how injuries change over time, and how injury type influences this change. To do this, we used repeated individual assessments to examine whether injuries accrued during migration on Fraser River sockeye salmon (O. nerka), assessed in the last leg of their migration or on arrival at the spawning grounds, could be used to predict their final injury score at death after spawning. We found that injury scores increased over the spawning period, but this was not driven by any specific type of migration-related injury, and fish initially scored as ‘uninjured’ had the largest increase in injury score, indicating a ceiling effect to our scoring method. Females with higher migration-related injury scores were more likely to experience pre-spawn mortality. Initial injury score accrued during migration was positively correlated with final injury score after spawning but only when initially assessed 45 km from the spawning grounds, and females that spawned accrued more injuries than females that did not spawn. Thus our method was able to use pre-spawn injury scores to predict spawning success but was limited in its ability to use post-spawn injury scores to describe severity of migration conditions. This highlights the need to better understand injury and disease dynamics and further refine injury assessment and scoring methods at the individual level if information on surficial fish condition is to be used to either describe or predict migration severity or pre-spawn mortality at the population level.

An Autonomous Continuous Bladder Irrigation System.

Introduction and Objective: Continuous bladder irrigation (CBI) is used in a variety of clinical settings, including post-transurethral surgery and the emergency department. Currently, CBI administration relies on nurses to diligently monitor and switch irrigation bags, as well as titrate the inflow rate based on effluent color. Inappropriate administration can result in discomfort to patients, clot urinary retention, repeat injury to the pathologic or surgical site, extended hospital stays, and even operative management. Our objective was to create an autonomous CBI system that decreases the incidence of disrupted irrigation flow and monitors the outflow to alert clinicians of critical events. Methods: 3D printing and off-the-shelf microcontrollers were used to design a device to fit the needs identified by stakeholders at our institution. An in vitro model of the bladder was created to test our design. The mechanical, electrical, and software subsystems were adjusted accordingly to meet our design requirements. Results: Our in vitro CBI model was able to simulate routine CBI administration with sudden bleeding. Bovine blood was used to simulate the bleeding events. A device was created that met identified stakeholder needs. Accurate detection of critical bleeding events, catheter blockage, and empty irrigation bags were achieved. The device responds to bleeding appropriately by increasing the irrigation rate. When the catheter is blocked, it stops the irrigation and alerts the nurse. Our system accurately titrated the irrigation rate to match a set outflow blood level parameter, conserving irrigation and minimizing nursing workload. Continuous monitoring of CBI effluent was recorded. Conclusions: We anticipate our device will decrease the cognitive load on nurses in busy clinical settings and improve workflow. Moreover, the detection of critical events will likely decrease patient morbidity. Continuous monitoring of the CBI outflow may prove to be a new clinical decision-making tool for ongoing hematuria. Clinical trial is pending.

FORENSIC MEDICAL ASSESSMENT OF THE VOLUME OF REPEATED TRAUMATIC BRAIN INJURY (CASE FROM EXPERT PRACTICE)

Repeated traumatic brain injuries (TBI) pose a unique challenge for both clinical and forensic-medical investigations. The link between the consequences of repeated traumas and previous injuries can be extremely complex due to the similarity of symptoms and pathological changes observed in repeat injuries.&#x0D; Results. The case demonstrates that a severe closed TBI previously suffered by the victim could have contributed to the occurrence of intracranial complications upon subsequent TBI, leading to altered directions of cavitation waves as a result of head impacts and the formation of new contusional foci within previously affected areas, as well as the development of intracranial hemorrhages. The previously suffered severe traumatic brain injury should only be regarded as an unfavorable factor that did not serve as a condition for the development of the repeated TBI and was not causally linked to it but could have facilitated the formation of the extent of the repeated TBI.&#x0D; Conclusions. The presented case highlights that a comprehensive approach utilizing additional laboratory and instrumental diagnostic methods allows for the differentiation of TBIs occurring at different time intervals. Further research on repeated traumatic brain injuries is necessary.

Paper 32: Meniscus Repair Outcomes and Reoperation Rate in Patients Over the Age of 40

Objectives: Meniscus injuries remain a common source of morbidity in patients over the age of 40. Historically, meniscus injuries in this age group have been treated non-operatively or with surgical management limited to debridement procedures. There is strong evidence for repair over meniscectomy in younger patients, however literature remains sparce regarding repair outcomes and re-operation rates for patients over the age of 40. The objectives of this study were to document patient reported outcomes, complications, and re-operation rates for meniscus repairs in patients above the age of 40 and determine what patient demographics or injury characteristics correlated with reoperation. Methods: A retrospective chart review was conducted at a single academic institution after obtaining IRB approval. An initial query of patients over the age of 40, was performed via the CPT code 29882. Inclusion criteria consisted of patient age greater than 40 at time of initial meniscal repair. Exclusion criteria consisted of prior surgery in the ipsilateral knee, meniscal root repair, septic arthritis postoperatively, and any form of knee trauma postoperatively. Patients that met inclusion criteria were chart reviewed for relevant data including demographic information, comorbidities, surgical procedure information such as type of implant used, laterality of meniscus tear, type of tear and pattern, and revision/re-operation data. Patients were then contacted to answer full 100-point KOOS (Knee Injury and Osteoarthritis Outcome Score) questionnaires. Results: 413 total patients met inclusion criteria. The average age at time of surgery was 46 years (IQR, 43-51), and 214 patients were female (51.8%). KOOS scores were reported at a median follow-up of 24-months (IQR, 3-62). Median symptom, pain, activity of daily living (ADL), sport, and quality of life (QoL) subscales were reported as 78.6 (IQR, 60.7-92.9), 87.5 (IQR, 69.4-97.2), 94.1 (IQR, 82-100), 80.0 (IQR, 55-95), and 68.8 (IQR, 40.6-81.3), respectively. A total of 74 patients underwent reoperation (17.8%). There was no significant difference in reoperation rates when stratified by age group (40-49, 50-59, 60-69) (p=0.515). Reoperation rates were not affected by type of implant used for initial meniscus repair (Fast-fix anchor, Omnispan meniscal anchor, Meniscal cinch implant, Fiberwire, MaxBraid suture, Ethibond suture, PDS suture or Bionics meniscal arrow) (p&gt;0.7). Average number of all-inside anchors used for repair was 2 (IQR, 2-3) and did not correlate with reoperation (p=0.49). Location of initial meniscus tear (body or posterior horn) and tear pattern did not correlate with reoperation rates (p&gt;0.36, p&gt;0.28 respectively). A total of 47 patients complained of postoperative stiffness, of which 28 (6.7%) underwent lysis of adhesions and/or arthroscopic debridement (p=.042). Twenty-five patients sustained a meniscal re-tear or injury, of which 17 underwent reoperation with partial or total meniscectomy. Of the total patient cohort, only seven patients ultimately went on to require ipsilateral total knee arthroplasty (1.6%). Conclusions: Patients over the age of 40 who underwent meniscus repair showed favorable reported outcomes at a mean 2-year follow-up. Reoperation rates were associated with postoperative stiffness and repeat injury. Re-operation rates in patients over 40 are comparable to reported rates of younger patients who undergo meniscus repair.

Comparison of Isometric Hand Grip Strength among Computer Operators and Non-Computer Operators

Background: Most frequently self-reported work-related illness are due to musculoskeletal disorders. Highly repetitive tasks with grasping of the hands, repetitive flexing of the wrist, vibrations and localized mechanical pressure play a role in development of repeated stress injury. Many computer users complain about wrist fatigue, discomfort or pain after typing. Aim: To assess and compare isometric grip strength of computer operators and non-computer operators. Methods: This study was conducted at the Shalimar Institute of Health Sciences. A sample of 30 computer operators and 30 controls (non-computer operators) were recruited after screening hand ultrasonography. Purposive sampling was used. Isometric grip is measured with a hand-held dynamometer. Subjects were asked to hold the dynamometer with full exertion. Each reading is from a maximum contraction period of three seconds with a 30-second pause. Results: Average Hand Grip Strength of computer operators was 27.71±11.19kg and non-computer users was 37.05±11.09kg. The results were statistically significant with the p-value of 0.002. Practical Implications: Continuous computer use reduces hand grip strength therefore those who are having long term use of computers must go for hand grip strength exercises to maintain normal hand grip strength. Conclusion: Computer operators have less isometric hand grip strength than non-computer operators as it was concluded in this study. MeSH words: Isometric hand grip strength, computer operators, non-computer operator

Child physical abuse screening in a pediatric ED; Does TRAIN(ing) Help?

BackgroundChild maltreatment is distressingly prevalent yet remains under-recognized by healthcare providers. In 2015 the Ohio Children's Hospital Association developed the Timely Recognition of Abusive INjuries (TRAIN) collaborative in an effort to promote child physical abuse (CPA) screening. Our institution implemented the TRAIN initiative in 2019. The objective of this study was to examine the effects of the TRAIN initiative at this institution.MethodsIn this retrospective chart review we recorded the incidence of sentinel injuries (SIS) in children presenting to the Emergency Department (ED) of an independent level 2 pediatric trauma center. SIS were defined and identified by a diagnosis of ecchymosis, contusion, fracture, head injury, intracranial hemorrhage, abdominal trauma, open wound, laceration, abrasion, oropharyngeal injury, genital injury, intoxication, or burn in a child < 6.01 months of age. Patients were stratified into pre-TRAIN (PRE), 1/2017–9/2018, or post-TRAIN (POST), 10/2019–7/2020, periods. Repeat injury was defined as a subsequent visit for any of the previously mentioned diagnoses within 12 months of the initial visit. Demographics/visit characteristics were analyzed using Chi square analysis, Fischer’s exact test, and student’s paired t-test.ResultsIn the PRE period, 12,812 ED visits were made by children < 6.01 months old; 2.8% of these visits were made by patients with SIS. In the POST period there were 5,372 ED visits, 2.6% involved SIS (p = .4). The rate of skeletal surveys performed on patients with SIS increased from 17.1% in the PRE period to 27.2% in the POST period (p = .01). The positivity rate of skeletal surveys in the PRE versus POST period was 18.9% and 26.3% respectively (p = .45). Repeat injury rates did not differ significantly in patients with SIS pre- versus post-TRAIN (p = .44).ConclusionImplementation of TRAIN at this institution appears to be associated with increased skeletal survey rates.

Mathematical model of mechanobiology of acute and repeated synaptic injury and systemic biomarker kinetics.

Blast induced Traumatic Brain Injury (bTBI) has become a signature casualty of military operations. Recently, military medics observed neurocognitive deficits in servicemen exposed to repeated low level blast (LLB) waves during military heavy weapons training. In spite of significant clinical and preclinical TBI research, current understanding of injury mechanisms and short- and long-term outcomes is limited. Mathematical models of bTBI biomechanics and mechanobiology of sensitive neuro-structures such as synapses may help in better understanding of injury mechanisms and in the development of improved diagnostics and neuroprotective strategies. In this work, we formulated a model of a single synaptic structure integrating the dynamics of the synaptic cell adhesion molecules (CAMs) with the deformation mechanics of the synaptic cleft. The model can resolve time scales ranging from milliseconds during the hyperacute phase of mechanical loading to minutes-hours acute/chronic phase of injury progression/repair. The model was used to simulate the synaptic injury responses caused by repeated blast loads. Our simulations demonstrated the importance of the number of exposures compared to the duration of recovery period between repeated loads on the synaptic injury responses. The paper recognizes current limitations of the model and identifies potential improvements.

Video Analysis of 26 Cases of Second ACL Injury Events in Collegiate and Professional Athletes.

Significant effort has gone into the identification and quantification of the underlying mechanisms of primary ACL injury. Secondary ACL injury is observed in approximately 1/4 to 1/3 of athletes who return to sport following ACL reconstruction. However, little has been done to evaluate the mechanisms and playing circumstances surrounding these repeat injuries. The purpose of this study was to characterize the mechanisms of non-contact secondary ACL injuries using video analysis. It was hypothesized that in video recordings of secondary ACL injury, athletes would exhibit greater frontal plane hip and knee angles, but not greater hip and knee flexion, at 66 ms following initial contact (IC) as compared to at IC and 33ms following IC. Cross-Sectional Study. Twenty-six video recordings of competitive athletes experiencing secondary ACL ruptures via noncontact mechanisms were analyzed for lower extremity joint kinematics, playing situation, and player attention. Kinematics were assessed at IC as well as 33 ms (1 broadcast frame) and 66 ms (2 broadcast frames) following IC. Knee flexion and knee frontal plane angles were greater at 66 ms than IC (p ≤ 0.03). Hip, trunk, and ankle frontal plane angles were not greater at 66 ms than IC (p ≥ 0.22). Injuries were distributed between attacking play (n=14) and defending (n=8). Player attention was most commonly focused on the ball (n=12) or an opponent (n=7). A single-leg landing accounted for just over half of the injuries (54%), while a cutting motion accounted for the remainder of the injuries (46%). Secondary ACL injury was most likely to occur during landing or a sidestep cut with player attention external to their own body. Knee valgus collapse combined with limited hip motion was identified in the majority of secondary injuries. Level IIIb.