Surgical technique for arthroscopic onlay suprapectoral biceps tenodesis with an all-suture anchor.

The long head of the biceps is a frequent pain generator in the shoulder. Tendinopathy of the long head of the biceps may be treated with biceps tenodesis. There has been great debate about the optimal technique for biceps tenodesis, without a clear distinction between different techniques. Biceps tenodesis fixation may include interference fixation, suspensory fixation, all-suture anchors, and soft tissue fixation. In this technical note, we describe an all-arthroscopic onlay suprapectoral biceps tenodesis with an all-suture anchor

Imaging-Based Prevalence of Superior Labral Anterior-Posterior Tears Significantly Increases in the Aging Shoulder.

BackgroundSuperior labral anterior-posterior (SLAP) tears can be associated with pain and shoulder dysfunction. Relatively little is known about the age-related prevalence of SLAP tears.PurposeTo investigate the age-related prevalence of imaging-diagnosed SLAP tears in a heterogeneous grouping of shoulder conditions in a large cohort at a single institution with multiple blinded reviewers.Study designCross-sectional study; Level of evidence, 3.MethodsA total of 281 shoulder magnetic resonance imaging (MRI) scans obtained over 8 months were reviewed by a musculoskeletal radiologist and an orthopaedic surgeon. The mean ± SD age of the group was 49.6 ± 15.5 years, and 107 of the patients were female (38.1%). Patients were divided into 4 age groups: 35 years or younger, 36 to 50 years, 51 to 65 years, and older than 65 years. Statistical analyses were completed by use of the Fisher exact test to compare proportions of SLAP tears between age groups, odds ratios to determine the likelihood of having a SLAP tear in each age group, and a logistic regression to control for associated abnormalities.ResultsThere was a significant diffference in the proportion of SLAP tears found on the MRIs for each age group (P < .001). Patients were significantly more likely to have SLAP tears if aged 51 to 65 years (66.7%; odds ratio [OR], 2.00; 95% CI, 1.27-3.15) and if older than 65 years (81.2%; OR, 4.31; 95% CI, 2.36-7.88). No increased prevalence was observed in patients aged 35 years or younger (47.5%; OR, 0.91; 95% CI, 0.55-1.50) or 36 to 50 years (51.8%; OR, 1.08; 95% CI, 0.70-1.67). Logistic regression demonstrated that age was the only significant predictor for having a SLAP tear (P < .001). Kappa values were 0.46 to 0.65 between reviewers, indicating moderate to substantial agreement.ConclusionAn increasing prevalence of MRI-based SLAP tears was observed with increasing patient age. Patients older than 50 years were significantly more likely to have superior labral abnormalities regardless of other shoulder injury or disease

All aboard, destination: Seamless

A key enabler for e-Research in Australia is to give researchers seamless access to resources, including each other. Significant investments have been made, and are continuing to be made, in supplying the above resources. Convergence, a key driver of current developments in telecommunications, media and information technology industries, has brought about the rapid evolution of digital, information and communications technologies and has created an environment in which the paradigms of research have changed. Convergence is not just about the technology evolution. It is about services and about new ways of doing business and of interacting with society. It has created growing demand by researchers for services including seamless access to data held in universities, publicly funded research agencies, government agencies and industry; access to data generated by scientific facilities and access to computational capability. The emergence of new services and the development of existing services are expected to provide researchers with more opportunities. They may want access from anywhere anytime to any service, independently of the technology used, or the geographical point of such access within a trusted environment. At the same time the evolution of the capability and sophistication of scientific instruments and facilities has seen an explosion in the quantum of data produced by experimentation, and the complexity of analyses conducted through data sharing. Globalisation amplifies the international dimension of convergence. The global reach of the Internet has already shown a need for international solutions to a number of key issues such as security, intellectual property rights, privacy and interoperability. The effective re-use of research data on a national basis is the primary goal of the government and institutional investments into national data infrastructure. The investments will deliver access services; and outreach services for researchers and institutions that can enhance the effective use of data within a federated research data management system. The outcome will be the ability for all researchers to identify, locate, access and analyse any available research data, regardless of origin or scale, to interface with the outside world, within trusted environments for example the Australian Access Federation. The key facilitators for this are adequate physical resources, middleware, access to data including data collection and generation; data storage and the physical management of stored data; the evolution of standards to enable data to be used and interpreted; and access regimes to permit data to be accessible. The Australian Government, in partnership with research communities, state governments and key research agencies, is working towards coordinating the advancement of Australia’s national e-Research capabilities. The timely development of these capabilities, in an increasingly competitive international environment, will entail the careful coordination and bringing together of distributed initiatives and projects already undertaken by research communities, many institutions and jurisdictions. e-Research capabilities will also underpin the implementation of the Australian Government’s Research Quality Framework (RQF). A key enabler of the RQF will be the Accessibility Framework, which will set out the principles governing the need for improved access to the outcomes and outputs of publicly-funded research. Ongoing work through the NCRIS Platforms for Collaboration capability will determine the strategic and balanced investments in system-wide infrastructure and ICT enabled services to support Australian researchers. Only by a concerted, strongly-directed, intervention-based strategy and national cooperation will the critical mass be achieved to more fully enable Australian researchers with e-Research capabilities. By combining our resources, we will enhance the chances and opportunities for our researchers in the years to come

Bruck nets and partial Sherk planes

In Bachmann's Aufbau der Geometrie aus dem Spiegelungsbegriff (1959), it was shown that a finite metric plane is a Desarguesian affine plane of odd order equipped with a perpendicularity relation on lines, and conversely. Sherk (1967) generalised this result to characterise the finite affine planes of odd order by removing the 'three reflections axioms' from a metric plane. We show that one can obtain a larger class of natural finite geometries, the so-called Bruck nets of even degree, by weakening Sherk's axioms to allow non-collinear points.Comment: We have removed the condition from our main theorem that there is a constant number of lines on any point. Instead, we have replaced it with the much weaker condition that there is a line all of whose points are thick (incident with more than 2 lines

Finite-element modelling of mechanobiological factors influencing sesamoid tissue morphology in the patellar tendon of an ostrich

The appearance and shape of sesamoid bones within a tendon or ligament wrapping around a joint are understood to be influenced by both genetic and epigenetic factors. Ostriches (Struthio camelus) possess two sesamoid patellae (kneecaps), one of which (the distal patella) is unique to their lineage, making them a good model for investigating sesamoid tissue development and evolution. Here we used finite-element modelling to test the hypothesis that specific mechanical cues in the ostrich patellar tendon favour the formation of multiple patellae. Using three-dimensional models that allow application of loading conditions in which all muscles, or only distal or only proximal muscles to be activated, we found that there were multiple regions within the tendon where transformation from soft tissue to fibrocartilage was favourable and therefore a potential for multiple patellae based solely upon mechanical stimuli. While more studies are needed to better understand universal mechanobiological principles as well as full developmental processes, our findings suggest that a tissue differentiation algorithm using shear strain and compressive strain as inputs may be a roughly effective predictor of the tissue differentiation required for sesamoid development

Arthroscopic Anterior Shoulder Stabilization With Incorporation of a Comminuted Bony Bankart Lesion.

Bony Bankart lesions are a common finding in patients with anterior glenohumeral dislocation. Although there are no defined guidelines, small bony Bankart fractures are typically treated arthroscopically with suture anchors. The 2 main techniques used are double- and single-row suture anchor stabilization, with debate over superiority. Biomechanical studies have shown improved reduction and stabilization with the double-row over the single-row suture anchor technique; however, this has not been reported for small or comminuted bony fragments. Both techniques have shown promising preliminary clinical outcomes. In this Technical Note, we describe our preferred technique for arthroscopic instability repair using a single-row all-suture anchor method with the incorporation of a comminuted bony Bankart fragment in the lateral decubitus position

Zannichellia contorta

This species is native to southern, central and eastern Spain, with an old record from the Atlas Mountains in northern Morocco requiring confirmation. The species is very sensitive to eutrophication and deterioration of water quality. The Area of Occupancy (AOO) has been estimated to be less than 500 km2 based on confirmed records and knowledge that its habitat is in continuous decline and at least 40% of the known localities have disappeared, especially in southern Spain. Moreover, an ongoing continuing decline in AOO, habitat quality and number of subpopulations of this species due to the increase in nutrients concentration from waters of the streams where it lives, which stops its growth, has been observed. The same process of habitat deterioration is happening in central and eastern Spain. The population of this species is severely fragmented with more than half of its subpopulations being isolated with no exchange possibilities and suspected to have reached no viable levels. It therefore qualifies to be listed in the category Endangered (EN B2ab(ii,iii,iv)) in the Mediterranean region. Resource and habitat protection and site management are needed. Other recommended conservation measures are ex situ conservation, population and distribution research, and habitat and population monitoring

Do Outcomes of Arthroscopic Subscapularis Tendon Repairs Depend on Rotator Cuff Fatty Infiltration?

Background:Rotator cuff fatty infiltration has been correlated with poorer radiographic and clinical outcomes in supraspinatus and infraspinatus tendon repairs, but this has not been well-studied in subscapularis tendon repairs. Purpose:To evaluate the influence of preoperative rotator cuff fatty infiltration on postoperative outcomes for patients undergoing arthroscopic subscapularis tendon repair. Study Design:Cohort study; Level of evidence, 3. Methods:Patients who underwent arthroscopic subscapularis repair between 2010 and 2016 were retrospectively identified, and demographic data and surgical findings were recorded. The extent of fatty infiltration was determined on preoperative magnetic resonance imaging by the Fuchs modification of the Goutallier classification. At the most recent follow-up, patients completed the Patient-Reported Outcomes Measurement Information System for Upper Extremity (PROMIS-UE) computer adaptive test and a postoperative visual analog scale for pain. The distribution of fatty infiltration was compared between patients undergoing subscapularis tendon repair versus subscapularis tendon repair combined with a posterior cuff repair. Outcomes were compared for patients using Goutallier grade 0-1 versus grade ≥2 changes in each rotator cuff muscle. Multivariate linear regression analysis was performed to evaluate the influence of muscle quality, as well as demographic factors, on PROMIS-UE scores. Significance was defined as P < .05. Results:There were 140 shoulders included (mean age, 61.8 years; 42.1% female; mean follow-up, 51.7 months). The prevalence of Goutallier grade 2 changes or higher was significantly greater in patients with multitendon repair relative to isolated subscapularis tendon repair. For the overall group of all patients undergoing subscapularis tendon repair, whether in isolation or as part of a multitendon repair, PROMIS-UE scores were significantly lower for patients with infraspinatus muscle grade 2 or higher Goutallier changes relative to grade 0 or 1. After adjustment for age, body mass index, patient sex, and fatty infiltration in other rotator cuff muscles, poor infraspinatus muscle quality remained the only significant predictor for lower PROMIS-UE scores. Conclusion:Patients undergoing arthroscopic subscapularis tendon repair with poor infraspinatus muscle quality had worse patient-reported outcomes. This was true whether subscapularis tendon repair was isolated or was performed in conjunction with supraspinatus and infraspinatus tendon repairs

Self-reported Mental Disorders Negatively Influence Surgical Outcomes After Arthroscopic Treatment of Femoroacetabular Impingement.

Background:Femoroacetabular impingement (FAI) is responsible for hip pain and dysfunction, and surgical outcomes depend on multiple factors. The presence of mental disorders negatively influences outcomes of multiple orthopaedic conditions, although the impact on FAI surgery is unclear. Hypothesis:The authors hypothesized that a preoperative self-reported history of mental disorders would negatively influence patient-reported outcome measures after FAI surgery. Study Design:Cohort study; Level of evidence, 3. Methods:A matched-cohort study was performed by reviewing a prospectively collected database of cases of arthroscopic management of FAI with a single surgeon over a 2-year period. Demographics and radiographic parameters were recorded for all patients. Patients completed the Hip Outcome Score-Activity of Daily Living Subscale (HOS-ADL), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), and modified Harris Hip Score (mHHS) prior to surgery and 2 years after surgery. Unpaired and paired t tests were used to compare results between and within cohorts at baseline and follow-up. Statistical significance was defined as P < .05. Results:The cohort included 301 patients, with 75 and 226 patients reporting and not reporting a history of mental disorders, respectively. Before treatment, all patient-reported outcome measures were significantly lower among patients reporting a history of mental disorders (P < .01 for HOS-ADL, HOS-SSS, and mHHS). Patients in both groups demonstrated significant improvements (P < .0001) in HOS-ADL, HOS-SSS, and mHHS when preoperative outcome measures were compared with follow-up. Patients with reported mental disorders had significantly lower scores after surgery as compared with patients without mental disorders (P < .0001 for HOS-ADL, HOS-SSS, and mHHS). Conclusion:The presence of a reported mental disorder is associated with lower patient-reported outcomes before and after surgical management of FAI. Statistically significant and clinically relevant improvements were observed for patients who reported mental disorders. The magnitude of these improvements was not as large as that for an age- and sex-matched control group without a self-reported mental disorder

Prevalence of vertebral fractures on chest radiographs of elderly African American and Caucasian women.

The prevalence of vertebral fractures on routine chest radiographs of elderly Caucasian women was only 1.3 times higher than in African American (AA) women, a difference considerably smaller than reported in population studies. AAs with medical problems may have higher risk of vertebral fractures than previously suspected.IntroductionEarlier studies noted a 1.9- to 3.7-fold higher prevalence of vertebral fractures in Caucasian (CA) compared to African American (AA) women. These studies, however, may have suffered from selection bias. We reported that among women referred for bone density testing, the prevalence of vertebral fractures in AA was the same as in CA women. Suspecting that the latter might have been due to a referral bias, we examined the racial difference in the prevalence of vertebra fractures on chest radiographs of patients seeking general medical care, not selected for osteoporosis.MethodsConsecutive chest radiographs (N = 1,200) of women over age 60 were evaluated using Genant's semi-quantitative method. Patients' race and the presence of diseases or medications associated with increased fracture risk were ascertained from the electronic medical records.ResultsAmong 1,011 women (76% AA) with usable radiographs, 11% had moderate or severe vertebral fractures. The prevalence of vertebral fractures was 10.3% in 773 AA and 13% in 238 CA women (p = 0.248 for difference between races). The lack of difference persisted after controlling for age, smoking, use of glucocorticoids, or presence of cancer, rheumatoid arthritis, organ transplantation, and end-stage renal disease. Among all subjects, CA women were more likely to be diagnosed and treated for osteoporosis (p <0.001).ConclusionAmong subjects seeking medical care, the difference in the prevalence of vertebral fractures between AA and CA women is smaller than previously suspected. Greater attention to the detection of vertebral fractures and the management of osteoporosis is warranted in AA women with medical problems