Shift Test Research Articles

A Longitudinal Analysis of the Internal Rotation and Shift (IRO/Shift) Test Following Arthroscopic Repair of Superior Rotator Cuff Lesions.

Although the use of clinical tests to diagnose superior rotator cuff pathology is common, there is paucity in the research regarding the accuracy of such tests following arthroscopic repair. The aim of this study was to determine the accuracy of the IRO/Shift test compared to the Jobe test at 3 months and 6 months post-surgery for superior rotator cuff repair. Arthroscopic repair was conducted on 51 patients who were subsequently seen for clinical evaluation at 3 and 6 months following surgery. At 3 months post-surgery only 27% of the patients had a negative IRO/Shift test and 18% had a negative Jobe test. However, at 6 months 88% of the patients presented with a negative IRO/Shift test and 61% a negative Jobe test. When compared to each other, the IRO/Shift test and the Jobe test had 90% agreement pre-operatively, 71% agreement at 3 months post-surgery, and 67% agreement at 6 months. These results demonstrate that the accuracy of the IRO/Shift test and the Jobe test improved between 3 and 6 months following arthroscopic surgery of the superior rotator cuff, with the IRO/Shift test having better accuracy.

Scapular dyskinesis and loss of cervical lordosis in myofascial pain syndrome and its effects on pain and posture disorders.

This study aimed to evaluate scapular dyskinesia and loss of cervical lordosis in myofascial pain syndrome and its effects on pain and posture disorders. In this cross-sectional study, 101 individuals (74 females, 27 males; mean age: 44.3±8.8 years; range, 25 to 60 years) with chronic neck pain were recruited between January 2021 and February 2021. Demographic and clinical data of the patients were recorded. Visual Analog Scale (VAS), posture evaluation form, the scapular dyskinesia test, the lateral scapular shift test, and Cobb's methods for cervical angle measurements were used in the evaluation of the patients. In the study population, 52.25% of patients had loss of cervical lordosis, and 44.5% of patients had scapular dyskinesia. It was observed that the VAS activity score was significantly higher in individuals with loss of cervical lordosis, all VAS scores and pain duration were significantly higher in individuals with scapular dyskinesia (p<0.05). Shoulder elevation, rounded shoulder, forward head posture, and kyphosis were significantly higher in patients with scapular dyskinesia, while thoracic kyphosis was significantly higher in patients with both scapular dyskinesia and loss of cervical lordosis (p<0.05). The presence of trigger points was found to be significantly higher in patients with scapular dyskinesia and in patients with both scapular dyskinesia and loss of cervical lordosis (p<0.05). In patients with chronic neck pain diagnosed with myofascial pain syndrome, the presence of loss of cervical lordosis and scapular dyskinesia have negative effects on pain and posture.

Arthroscopic lateral collateral ligament imbrication of the elbow: short-term clinical results.

Chronic posterolateral rotatory instability (PLRI) of the elbow results from an insufficient lateral collateral ligament (LCL) complex. Arthroscopic LCL imbrication may prove a minimally invasive alternative to open lateral ulnar collateral ligament (LUCL) reconstruction with a quicker rehabilitation. The purpose of this study is to analyze the validity of a modified arthroscopic imbrication technique. We hypothesized that arthroscopic LUCL imbrication would yield stable elbows in patients with grade 1 or 2 chronic PLRI at a minimum of 2 year of follow-up. We retrospectively assessed data of all PLRI patients who underwent arthroscopic LUCL imbrication from 2010 to 2013 (n=20). Stage 3 PLRIs (frank ulnohumeral dislocations) were excluded from this treatment. After confirmation of PLRI during standard elbow arthroscopy, a doubled absorbable suture is shuttled through as much LCL tissue as possible (from the lateral ulnar border to the area proximal to the lateral epicondyle) and the sutures are tied. This results in a plication of the entire LCL complex. Objective elbow stability was assessed using a combination of the pivot shift, table top, and posterior drawer tests. Of 20 included patients, 18 were stable subjectively and objectively at a minimum of 2 year of follow-up. Mean Mayo Elbow Performance Score improved from 48 preoperatively to 88.9 at final follow-up (P<.001). Mean Quick-Disabilities of the Arm, Shoulder, and Hand score improved from 53 preoperatively to 10.3 at final follow-up (P<.001). One patient developed elbow stiffness. Two patients reported tenderness of the subcutaneous PDS knots. As a less invasive alternative to open LCL reconstruction using a graft, arthroscopic LCL imbrication has demonstrated acceptable rates of perceived elbow stability among patients with stage 1 or 2 PLRI.

Low-Profile Modifications of the Losee Pivot Shift Test for Assessment of an ACL-Deficient Knee in the Awake Patient

Background: Pivot shift test results have demonstrated widely inconsistent sensitivities when used on awake clinic patients. We believe the painful valgus force applied during traditional pivot shift techniques is the primary culprit and can be circumvented with our novel examination technique. Indications: The reason for publishing this examination technique is to maximize the sensitivity and accuracy of the pivot shift examination in the awake patient. Technique Description: Four major modifications of Ronald Losee’s original valgus-based examination technique are introduced. These are the 4 general modifications: minimizing the sagittal plane arc of motion, avoiding applying valgus force to the knee, application of gentle anteriorly directed force to the lateral tibia, and performing the examination on the patient’s noninjured knee first. We also provide detailed description of the hand placement during the Albright-Losee pivot shift test. (1) Once the patient is relaxed, the examiner’s hands are placed as follows: (1) the ulnar side of the examiner’s thumb is applied to the posterior aspect of the fibular head. The fingers are placed above the patella on the distal femur as shown in the video. (2) With the examiner’s hands in the correct position, the knee is flexed to 20° to 30°. One-to-3 pounds of anterior translatory force is then applied by the side of the thumb to the fibular head while the knee is taken slowly toward extension. Pathological anterior tibial translation can be expected to begin in a 20° to 30° range short of the patient’s complete knee extension. The examiner must be conscious not to provide any valgus or additional internal or external rotation of the leg. Results: This examination is useful for reproducing the subluxation phenomenon in anterior cruciate ligament (ACL)-deficient knees. Our work has shown that these modifications yield an accuracy of 95.51% and a sensitivity of 94.7% in 353 knees examined by 71 clinicians. Discussion/Conclusion: The Albright-Losee pivot shift test is an easy to perform, highly sensitive, and highly specific test. In our recently submitted American Journal of Sports Medicine manuscript, the Albright-Losee pivot shift test suggested to be of greater value than Lachman test. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Relevance of the Scaphoid Shift Test for the Investigation of Scapholunate Ligament Injuries

Background: Although it is part of the common clinical examination of scapholunate ligament pathologies, there are only little data on the diagnostic value of the scaphoid shift test. The aim of this study was to evaluate the scaphoid shift test in a large cohort of patients. Materials and Methods: We retrospectively analysed 447 patients who underwent the scaphoid shift test and wrist arthroscopy because of various suspected injuries of the wrist, correlating the results of clinical examination with data obtained during the wrist arthroscopy. Sensitivity, specificity, and positive and negative predictive values were calculated and evaluated. Results: The sensitivity of the scaphoid shift test was low (0.50) when examining the whole cohort. In a subgroup of patients specifically referred for suspected scapholunate ligament injury, the sensitivity was higher (0.61), but the specificity was low (0.62). In detecting more serious lesions (Geissler 3 + 4), the scaphoid shift test demonstrated higher sensitivity (0.66). Conclusions: An isolated scaphoid shift test may only be of limited value in the diagnosis of scapholunate ligament lesions and should, therefore, be viewed as a useful tool for a preliminary assessment, but a negative test should not prevent the surgeon from indicating a more extensive diagnostic workup.

Therapeutic and stabilization exercises after manual therapy in patients with non-specific chronic neck pain: A randomised clinical trial

ObjectiveThis study aimed to determine and compare the effects of therapeutic and stabilization exercises prescribed to patients after manual therapy sessions on pain, neck range of motion and disability. MethodsThirty patients with non-specific chronic neck pain were recruited. After the initial examination, one session of manual therapy was conducted. The examinations were repeated to assess the effect of manual therapy on pain intensity and neck range of motion. After manual therapy, patients were randomly allocated into two groups: stabilization exercise group (SEG) and therapeutic exercise group (2 days/week/6 week). Pain intensity was assessed using the visual analog scale. Joint movements assessed using goniometer and the lateral scapular shift test for scapular dyskinesia. In addition, disability status was assessed using a neck disability index. ResultsIn all patients, manual therapy decreased pain intensity and increased joint movements (p < 0.05). After 6 weeks of exercise therapy, pain intensity, neck flexion, extension, lateral flexion movement and disability improved in SEG (p < 0.05). ConclusionThis study demonstrated that stabilization exercises combined with manual therapy had more positive effects among patients with non-specific chronic neck pain. Implications for practice•The treatment for non-specific chronic neck pain should be supported with exercises after manual therapy sessions for reducing neck pain.•Instead of therapeutic isometric exercises, which are often clinically prescribed as home exercises, stabilization exercises may be preferred as they are performed by maintaining the neutral position of the neck and include stretching.

Analysis of the functionality of voice and video communication systems

The article contains a comparison of the functionality and qualitative verification of voice and video communication systems, through tests of voice message shift in time, at different data rates, tests of system use cases and the study of the popularity of applications in various environments and age groups, thanks to an electronic survey . The systems examined were: Microsoft Teams, Zoom, Signal, WhatsApp, Cisco Webex Meetings. The following hypothesis was made: Voice and video communication systems are very popular systems among users, and their functional capabilities are similar.

Early Clinical Outcomes of ACL Reconstruction Using Semitendinosus Tendon Combined with LARS Synthetic.

Objective To compare the early clinical outcomes of ACL reconstruction using the augmented semitendinosus tendon combined with LARS synthetic material and the autologous hamstring tendons. Methods A total of 68 eligible patients with ACL rupture were reconstructed using either 4-strand autologous hamstring tendons, representing the control group, or the LARS synthetic material augmented grafts. The duration of postoperative swelling and recovery exercise was recorded. Lysholm and IKDC scores were used for evaluation of knee joint function. Lachman and pivot shift tests were conducted to evaluate stability. Results The scores of the three knee functions in cases of the augmentation group were significantly higher than those of the control group 6 months after surgery (P < 0.05). There were no significant differences in Tegner score in the two groups 12 months after surgery (P > 0.05). In general, the augmentation group returned to exercise 12 weeks after surgery, while the control group required 30 weeks. Conclusions The present study indicates that synthetic material augmentation grafts allow earlier return to exercise and display more satisfactory results compared with the control group.

Diversification dynamics of chameleons (Chamaeleonidae)

AbstractChameleons are charismatic and common lizards across Madagascar, Africa, and some surrounding regions. Little is known about their diversification dynamics and how this relates to their ecology, so we estimated diversification rate variation and consider this in the context of three hypotheses previously proposed in the literature. First, that the transoceanic dispersal from Africa to Madagascar on two separate occasions has resulted in fast radiation of Malagasy chameleons. Second, that the substantial floral turnover in their distributions within South Africa has resulted in rapid radiations of the endemic dwarf chameleons (Bradypodion). Finally, that the evolution of distinct ecomorphs of chameleon has fuelled fast diversification via adaptive radiations. We use the most recent and complete phylogeny of chameleons to estimate the diversification dynamics of the group using three methods: BAMM (which estimates constant or gradually changing diversification regimes and tests for shifts in these), MEDUSA (which tests for rate shifts in particular clades), and ClaDS (which estimates branch‐specific diversification rates). Our results from all analyses estimate a diversification rate increase in a clade containing most of the genusBradypodion, a group containing the South African dwarf chameleons which occur in recognized biodiversity hotspots in diverse habitats. We find no evidence for shifts resulting from dispersal events to Madagascar or related to the strong ecomorphological divergence of short‐tailed chameleon lineages (Brookesia,Palleon,Rhampholeon, andRieppeleon). The single burst of diversification within chameleons was in a clade which was associated with geographic areas which have experienced rapid habitat turnover and vicariance over the last ~10 million years. This suggests that ‘habitat vicariance’ resulting from ecological changes in vegetation has contributed to the diversity of species in this area by increasing diversification rates.

Evaluation of the short-term outcomes of anatomic ACL reconstruction with hamstring autograft in patients with generalized joint laxity: A retrospective case-control study.

The outcomes of anterior cruciate ligament reconstruction (ACLR) in patients with generalized joint laxity (GJL) are not clearly understood. In this study, we compared the outcomes of ACLR with quadruple hamstring autograft between GJL and non-GJL patients. In a retrospective case-control study, 36 patients with GJL, according to the Beighton and Horan Joint Mobility Index, who underwent ACLR surgery, were included. Forty-four group-matched non-GJL patients were included in the control group. The mean follow-up of the patients was 20.65 ± 6.93‏ months. The outcomes of ACLR were evaluated by the Lachman test, pivot shift test, anterior tibial translation and KT-1000 side-to-side difference, and International Knee Documentation Committee (IKDC) scale. The results of the Lachman and pivot shift test were not significantly different between the GJL and non-GJL patients (P = 0.67 and P = 0.27, respectively). The mean anterior tibial translation was 7.06 ± 1.41mm in the GJL group and 6.11 ± 1.53mm in the non-GJL group (P = 0.006). The mean KT-1000 side-to-side difference was 2.25 ± 1.31mm in the case and 2.5 ± 1.44mm in the control group (P = 0.42). The mean IKDC score of the patients was not significantly different between the GJL and non-GJL groups (66.1 ± 20.6 vs. 69.9 ± 16.1, P = 0.35). ACLR failure occurred in 2 (5.5%) patients of the GJL group and no patients of the control group (P = 0.21). The present findings suggest ACLR with quadruple hamstring autograft as an adequate treatment for GJL patients, at least in short-term follow-up.

Consensus Delphi study on guidelines for the assessment of anterior cruciate ligament injuries in children.

Background: Knee examination guidelines in minors are intended to aid decision-making in the management of knee instability. Clinical question: A Delphi study was conducted with a formal consensus process using a validated methodology with sufficient scientific evidence. A group consensus meeting was held to develop recommendations and practical guidelines for use in the assessment of instability injuries in children. Key findings: there is a lack of evidence to analyse anterior cruciate ligament injuries in children and their subsequent surgical management if necessary. Diagnostic guidelines and clinical assessment of the patient based on a thorough examination of the knee are performed and a guide to anterior cruciate ligament exploration in children is developed. Clinical application: In the absence of a strong evidence base, these established guidelines are intended to assist in that decision-making process to help the clinician decide on the most optimal treatment with the aim of benefiting the patient as much as possible. Following this expert consensus, surgical treatment is advised when the patient has a subjective sensation of instability accompanied by a pivot shift test ++, and may include an anterior drawer test + and a Lachman test +. If these conditions are not present, the conservative approach should be chosen, as the anatomical and functional development of children, together with a physiotherapy programme, may improve the evolution of the injury.

A comparison between the shoulder shifting test and seated reaching test by bland–altman plot: A pilot study

Background The Seated Reach Test (SRT) is an assessment tool for evaluating the sitting balance of individuals with a spinal cord injury (SCI). We developed the Shoulder Shifting Test (SST), which is a tool for measuring the reaching distance of individuals with difficulty in raising their arms, such as individuals with tetraplegia. Objective To investigate the agreement between the SST and the SRT and the usefulness of the SST. Subjects and Methods Sixteen subjects with SCI (age 52.9 ± 13.0 yrs; four with tetraplegia) performed the SST and the SRT. We determined the correlation coefficient to determine the relationship between the two tests. A Bland–Altman analysis was performed to confirm the systematic error, and the relative error (RE) was used to determine the compatibility of the two tests in three directions (front, right, left). We assessed the SST's usefulness by determining how many of 47 subjects (age 59.6 ± 13.6 yrs; 23 with tetraplegia) could not perform the SRT and how many could perform the SST. Results The tests were strongly correlated. No systematic errors between the tests were observed. In all three directions, >75% of the subjects had an RE <20%. Eleven of the 47 subjects with SCI were unable to perform either test. Four to ten of the 36 subjects performed the SST due to the difficulty in raising their arms. Conclusion The SST was compatible with the SRT, and the sitting balance of more individuals with SCI could be assessed by the combination of these tests.

Results of following selective bundle reconstruction in partial anterior cruciate ligament tears by All-inside technique

Objectives: To evaluate the outcome of selective reconstructive anterior cruciate ligament (ACL) surgery using the All-inside technique with a four-strand semitendinosus or gracilis autograft tendon. Subject and methods: 34 patients were diagnosed with a partial tear of the ACL and underwent selective reconstructive surgery at the Orthopedic Center, Military Hospital 103 from November 2018 to September 2020. Lysholm knee scale and IKDC class were used to access post-operatively clinical outcomes. Stability was evaluated using the anterior drawer test, the Lachman test, the Pivot shift test, and the Rolimeter measure at 20o of knee flexion. Results: The pre-operative and post-operative Lysholm scores were 49.5 ± 18.4 and 94.47 ± 6.81, respectively (p &lt; 0.001). Pre-operatively, most patients were classified as C and on the IKDC score. At the final follow-up, IKDC scores included 22 class A, 10 class B, 2 class C (p &lt; 0.001). The pre- and post-operative laxity measured by Rolimeter were 5.15 ± 1.5 mm and 1.74 ± 1.34 mm, respectively (p &lt; 0.001). Pre-operatively and post-operatively, the Pivot-shift was absent in all cases. Conclusion: Selective reconstruction of the injured ACL bundle restores knee stability and function. All-inside technique can be used to reconstruct the rupture ACL bundle with many advantages. Longer follow-up is needed to fully evaluate clinical outcomes after selective reconstruction in partial ACL tears.&#x0D; * Keywords: All-inside; Partial tear; Selective reconstruction.

The efficacy and medium-term outcomes of ligament advanced reinforcement system compared with auto-grafts in anterior cruciate ligament reconstruction: At least 2years follow-up.

Background: Graft choice is an important step in the pre-operative plan of anterior cruciate ligament reconstruction (ACLR). The four-strand hamstring tendon (4SHT) is the most widely used auto-graft, while the Ligament Advanced Reinforcement System (LARS) is the newest typical biomaterial for ACLR. The physical activity level (PAL) before injury can affect the efficacy and outcomes of ACLR. This study aims to compare the efficacy and functional outcomes between ACLR using LARS and 4SHT in patients different PALs. Methods: This was a prospective paired case-control study. ACL rupture patients included from 1 January 2017 to 31 December 2019 were subsequently divided into the high and plain PAL groups, according to their baseline PAL before injury. Clinical assessments included: Lachman test, pivot shift test, ligament laxity, Lysholm and International Knee Documentation Committee (IKDC) scores, and rate of returning to sports. The minimum follow-up was 2 years (y). Results: A total of 58 patients had accomplished the 2 y follow-up (missing rate: 6.5%). In the high PAL group (n = 22), the positive rate of A–P laxity of the LARS subgroup was lower than the 4SHG subgroup (p = 0.138), while the Lysholm score (p = 0.002), IKDC score (p = 0.043), and rate of returning to sports (p = 0.010) of the LARS were higher than the 4SHG at 1 year follow-up; the positive rates of A–P laxity (p = 0.009) and pivot test (p = 0.027) were lower in the LARS than the 4SHG at 2 y follow-up. In the plain PAL group (n = 36), the positive rate of A–P laxity in the LARS subgroup was lower than the 4SHG at 1 year follow-up (p = 0.017); the positive rates of A–P laxity (p = 0.001), Lachman (p = 0.034), and pivot tests (p = 0.034) in the LARS were also lower than the 4SHG at 2 y follow-up, but the IKDC score (p = 0.038) and rate of returning to sports (p = 0.019) in the 4SHG were higher than the LARS. Conclusion: In patients with high PAL, LARS can acquire better knee stability, sooner functional recovery, and returning to sports than 4SHG, while in patients without high PAL, 4SHG acquires better functional outcomes and a higher rate of returning to sports.

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

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

The Optimal Time Window for Complex Training in Order to Increase Repeated Sprint Ability in Professional Ice Hockey Players

ABSTRACT&#x0D; The goal of this study was to investigate the post-activation performance enhancement (PAPE) and optimal time window following complex training (CT) to increase ice-hockey player skating speed and endurance. Ten professional ice-hockey players (age= 19.8±1.23 years, height= 1.8± 0.06 m, weight= 83.37±4.79 Kg,) from the American Hockey League (AHL, n=7) and the National Hockey League (NHL, n=3) were assigned randomly into two groups. Both groups completedthe same CT training protocol, designed to induce post-activation potentiation (PAP). One group completed the training 8 hours prior to testing (8HPT), and the other 4 hours (4HPT) before testing. The CT PAP training protocol consisted of 3 sets of 5 repetitions of trap high bar deadlifts superset with 6 box jumps on a 20-inch plyometric box. The effect of CT PAP training on performance was assessed using the following testing: the countermovement jump (CMJ), the static squat jump (SSJ), the stationary broad jump (BJ), reactive strength index (RSI), eccentric utilization ratio (EUR), the double leg incremental drop jump tests (DJ), and on ice 40 meter sprint time during the Peterson On-Ice repeated shift Test (POIT). Results showed significant improvements for both groups for the after CT PAP training for the SJ (4HPT: p= 0.04), BJ (8HPT: p= 0.02; 4HPT: p=0.03), POIT (8HPT: Sprint 4, 5, 6, 8: p&lt;0.05; 4HPT: Sprint 2, 3: p&lt;0.05), POIT total sprint time (8HPT: p= 0. 01), mean 40-meter sprint time (8HPT: Sprint 1, 2, 3, 4, 5, 6 and 8: p&lt;0.05; 4HPT: Sprint 2, 3, 4, 5, 6 and 7: p&lt;0.05), and total 40 meter sprint time (8HPT and 4HPT: Sprint 2 p= 0.03). However, no significant difference (p≥0.05) was found following CT PAP training for the CMJ, DJ, and RPE. Thus, the present study suggests that PAP has a greater effect on jumping and on ice-hockey repeated sprint performance when completed 8 hours before. Nonetheless, CT PAP training appears to be beneficial to improve the rate of force development and performance when performed more than 4 hours before the competition in professional North-American ice-hockey players. The present protocol and timing window can be utilized by strength and conditioning specialists to improve on-ice repeated sprint performance of professional ice-hockey players.

Effects of remnant preservation in anterior cruciate ligament reconstruction: A systematic review and meta-analysis

BackgroundCompared with standard anterior cruciate ligament (ACL) reconstruction, it is controversial whether anterior cruciate ligament reconstruction (ACLR) with remnant preservation can lead to better clinical outcomes. We conducted a systematic study and meta-analysis to assess the differences in clinical efficacy between the two.MethodWe searched for clinical randomized controlled studies and cohort studies included in the Cochrane library, PubMed, and Embase from March 2012 to March 2022 in English. The included studies were ACLR with or without remant preservation, and the data were extracted and the quality of the included studies was assessed by two authors, respectively. Revman 5.4 was used for statistical analysis and conclusions were presented.ResultTen articles containing a total of 777 patients were finally included. There was no significant difference in postoperative Lachman test [OR = 1.66, 95%CI (0.79, 3.49), P = 0.18 > 0.05], Tegner score [SMD = −0.13, 95%CI (−0.47, 0.22), P = 0.46 > 0.05], synovial coverage rate by second-look arthroscopy [OR = 1.55, 95%CI (0.66, 3.65), P = 0.32 > 0.05], the rate of cyclops lesion [OR = 3.92, 95%CI (0.53, 29.29), P = 0.18 > 0.05], joint range of motion [SMD = 0.27, 95%CI (−0.13, 0.68), P = 0.19 > 0.05] and re-injury rate [OR = 0.57, 95%CI (0.18, 1.74), P = 0.32 > 0.05] between the two groups. There were statistically significant differences in postoperative Lysholm score [SMD = 0.98, 95% CI (0.32, 1.64), P = 0.004 < 0.05], International Knee Documantation Committee grade (IKDC grade) [OR = 2.19, 95%CI (1.03, 4.65), P = 0.04 < 0.05], Pivot shift test [OR = 1.71, 95%CI (1.06, 2.77), P = 0.03 < 0.05], KT1000/2000 arthrometer side-to-side difference [SMD = −0.22, 95%CI (−0.42, −0.03), P = 0.02 < 0.05], operation time [SMD = 11.69, 95%CI (8.85, 14.54), P = 0.00001 < 0.05] and degree of tibial tunnel enlargement [SMD = −0.66, 95%CI (−1.08, −0.23), P = 0.002 < 0.05].ConclusionThis meta-analysis concluded that remnant preservation significantly had better results in terms of patient functional score (Lysholm, IKDC), knee stability (Pivot shift test, postoperative side-to-side anterior laxity) and tibial tunnel enlargement. In terms of complications (incidence of Cyclops lesions, range of motion, re-injury rate), no significant differences were seen between the two groups. Although many studies concluded that remnant preservation could bring better synovial coverage, this meta-analysis indicated that there is insufficient evidence to support it, possibly due to different remnant preservation procedures.The potential risks associated with longer operation times are also worth considering.

IRO/Shift Test Is Comparable to the Jobe Test for Detection of Supraspinatus Lesions.

To determine how the internal rotation and shift (IRO/shift) test compares to the gold standard of clinical tests (Jobe test) for diagnosing supraspinatus lesions and to confirm these clinical results with surgical findings, 100 symptomatic patients were clinically examined between October 2018 and November 2019. All 100 patients were evaluated using both the IRO/shift test and Jobe test. A total of 48 of these patients received surgical intervention. Based on these data, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for both the IRO/shift test and Jobe test were calculated. The IRO/shift test had a sensitivity of 96% (95% CI: 82–100%), specificity of 50% (95% CI: 27–73%), PPV of 73% (95% CI: 56–86%), NPV of 91% (95% CI: 59–100%), and an accuracy of 77% (95% CI: 63–88%). The Jobe test had a sensitivity of 89% (95% CI: 72–98%), specificity of 60% (95% CI: 36–81%), PPV of 76% (95% CI: 58–89%), NPV of 80% (95% CI: 52–96%), and an accuracy of 77% (95% CI: 54–81%). These results suggest that the IRO/shift test is comparable to the Jobe test, which is often viewed as the gold standard clinical examination for assessing supraspinatus lesions. This study was approved by the Ethics Commission of the Martin Luther University Halle-Wittenberg (reference number: 2018-05).

Single Bundle Versus Double Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

Anterior cruciate ligament (ACL) tear is considered as one of the most common sport-related musculoskeletal injuries. Double bundle (DB) and single bundle (SB) surgical techniques has been widely adopted for ACL reconstruction. This systematic review aimed to provide updated evidence by comparing the short-term, mid-term, and long-term knee stability and functional outcomes of DB and SB reconstruction techniques. We searched Medline, Web of Science, and CENTRAL. We have selected randomized controlled trials (RCTs) that compared DB and SB ACL reconstruction techniques for primary isolated ACL tear. We have assessed the following outcomes: pivot shift test, Lachman test, KT-1000/2000 knee ligament arthrometer, Lysholm knee function score, Tegner activity score, and graft failure. We have used the standardized mean difference (SMD) was to summarize the continuous outcomes while risk ratio (RR) was used to summarize the dichotomous outcomes. A total of 34 RCTs that enrolled 2,992 participants deemed eligible. Overall, DB showed significantly better outcomes in terms of pivot shift test (RR = 0.61, 95% confidence interval (CI) 0.49-0.75), Lachman test (RR = 0.77, 95% CI 0.62 to 0.95), and KT 1000/2000 arthrometer (SMD = -0.21, 95% CI -0.34 to -0.08). No discernible difference was found between DB and SB techniques in the overall Lysholm score (SMD = 0.12, 95% CI -0.03 to 0.27), Tegner score (SMD = 0.03, 95% CI -0.17 to 0.24), or graft failure rate (RR = 0.78, 95% CI 0.33 to 1.85). Our review suggests that DB ACL reconstruction technique shows significantly better knee stability and functional outcomes than SB at short-term follow-up. However, both techniques exhibit similar outcomes at mid-term and long-term follow-up. The online version contains supplementary material available at 10.1007/s43465-022-00718-0.

Modeling the spatial and temporal dynamics of land‐based polar bear denning in Alaska

AbstractAlthough polar bears (Ursus maritimus) of the Southern Beaufort Sea (SBS) subpopulation have commonly created maternal dens on sea ice in the past, maternal dens on land have become increasingly prevalent as sea ice declines. This trend creates conditions for increased human–bear interactions associated with local communities and industrial activity. Maternal denning is a vulnerable period in the polar bear life cycle, and den disturbance could lead to den abandonment, cub mortality, and negative population impacts. We used published long‐term data to parameterize a Bayesian hierarchical model of annual land den abundance during 2000–2015, in 4 regions of northern Alaska, USA, with current or potential future oil and gas activity. We also estimated long‐term (1982–2015) shifts in the spatial distribution of land dens within and among regions using kernel density estimation and assessed the influence of local and regional sea ice and snow conditions on den site selection using a random forest resource selection function. Our objectives were to quantify current den distribution and abundance, test for distributional shifts over time, and investigate if those shifts could be attributed to environmental variables related to den habitat. We estimated that between 2000 and 2015, the SBS contained a median 123 dens in a typical year, of which 68 occurred on land. The region between the Colville and Canning rivers, where most current oil and gas activity occurred, also contained the largest fraction of land dens. Overall, land dens were disproportionately concentrated on barrier islands and on land within 30 km of the coast. The probability of dens occurring on land varied from 1982–1999 to 2000–2015 in all regions, and the overall distribution of land dens shifted west between those periods. This regional‐scale change in den distribution was predictable based on spatial and temporal heterogeneity in snow and sea ice conditions within 50 km of individual den locations. Land denning is likely to become increasingly common with continued sea ice loss, and our results and modeling framework could be used to design additional mitigation strategies for reducing the risk of incidental take due to den disturbance.