There is limited information regarding direct comparisons of the outcome of osteochondral autograft transfer (OAT) mosaicplasty and microfracture for the treatment of isolated articular cartilage ...defects of the knee. The purpose of this retrospective comparative study was to compare the general health outcomes, knee function, and Marx Activity Rating Scale scores for patients treated with OAT or microfracture for symptomatic chondral defects of the femoral condyles or trochlea. We hypothesized that the patients in the two treatment groups would have similar clinical outcomes at intermediate-term follow-up.
Ninety-six patients with full-thickness cartilage defects of the femoral condyles or trochlea were treated with either OAT mosaicplasty (n = 48) or microfracture (n = 48). The average age of the patients (thirty-two male and sixteen female in each group) at the time of surgery was 29.7 years in the OAT group and 32.5 years in the microfracture group. Patients were prospectively evaluated at baseline and at one, two, three, and five years postoperatively with use of validated clinical outcome measures including the Short Form-36 (SF-36) physical component, International Knee Documentation Committee (IKDC), Knee Outcome Survey activities of daily living, and Marx Activity Rating Scale instruments. Comparisons between outcomes before and after treatment or between outcomes after microfracture and mosaicplasty were made with use of two-tailed tests.
At the time of the latest follow-up, both groups demonstrated significant increases in SF-36 physical component, Knee Outcome Survey activities of daily living, and IKDC scores compared with baseline. These scores did not differ significantly between the two groups at any of the follow-up time points. However, the OAT group demonstrated a significantly greater improvement in the Marx Activity Rating Scale scores from baseline to the two-year (p = 0.001), three-year (p = 0.03), and five-year (p = 0.02) time points compared with the microfracture group.
In the present retrospective comparative study, the hypothesis that patients treated with microfracture or OAT mosaicplasty for symptomatic articular cartilage defects of the femoral condyles or trochlea would have similar clinical outcomes at intermediate-term follow-up was affirmed for general health outcome and for knee function. However, patients treated with OAT mosaicplasty maintained a superior level of athletic activity compared with those treated with microfracture.
Multi-center, prospective, cohort study.
To assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III) in measuring functional ability in persons with spinal cord injury ...(SCI).
Inpatient rehabilitation hospitals in the United States (US).
Functional ability was measured with the SCIM III during the first week of admittance into inpatient acute rehabilitation and within one week of discharge from the same rehabilitation program. Motor and sensory neurologic impairment was measured with the American Spinal Injury Association Impairment Scale. The Functional Independence Measure (FIM), the default functional measure currently used in most US hospitals, was used as a comparison standard for the SCIM III. Statistical analyses were used to test the validity and reliability of the SCIM III.
Total agreement between raters was above 70% on most SCIM III tasks and all κ-coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.81 and intraclass correlation coefficients were above 0.81. Cronbach's-α was above 0.7, with the exception of the respiration task. The coefficient of Pearson correlation between the FIM and SCIM III was 0.8 (P<0.001). For the respiration and sphincter management subscale, the SCIM III was more responsive to change, than the FIM (P<0.0001).
Overall, the SCIM III is a reliable and valid measure of functional change in SCI. However, improved scoring instructions and a few modifications to the scoring categories may reduce variability between raters and enhance clinical utility.
Background:
Posterior tibial tendon dysfunction (PTTD) is a pathological condition that can cause failure of the posterior tibial tendon (PTT). Initially, patients with PTTD are often asymptomatic, ...making early identification and treatment challenging. Certain ultrasound (US) characteristics have been implicated in the presence of tendinopathy, but their frequency has yet to be assessed in the PTT. The purpose of this study was to identify and report on the frequency of incidental, or potentially early subclinical, tendinopathic US characteristics in asymptomatic PTTs.
Methods:
Following institutional review board approval, 150 participants underwent a bilateral-comprehensive US assessment. The resulting images were reviewed and assessed to identify the presence of abnormalities demonstrated to represent tendinopathy.
Results:
Overall, 266 tendons were assessed and 128 (48.1%) were determined to have at least one tendinopathic trait. Specifically, 51 (19.2%) had circumferential fluid, 69 (25.9%) had noncircumferential fluid, 22 (8.3%) had thickening, 31 (11.7%) had heterogenicity, 19 (7.1%) had hyperemia, and 2 (0.8%) had calcification. Additionally, Caucasian participants were found to be nearly 3 times more likely to have tendinopathic findings when compared with African American participants.
Conclusion:
Sixty-seven percent of participants and 48.1% of PTTs evaluated had at least one tendinopathic feature identified on US. The prevalence rates of these findings, observed in participants, were as follows: noncircumferential fluid, circumferential fluid, heterogenicity, and thickening. Knowing the frequency of these traits may help clinicians to identify subclinical tendinopathy in the PTT before it progresses to PTTD.
Level of Evidence:
Level IV, case series.
In contrast to anterior cruciate ligament reconstruction, there is a paucity of primary studies that address the issue of return to play after anterior shoulder stabilization for glenohumeral ...instability. Most studies focused on clinical outcomes after anterior shoulder stabilization provide little detail on the authors' assessment protocols used in determining return to sport readiness. In fact, many issues germane to the postoperative rehabilitation process (biologic healing, motion recovery, strength recovery, and sport-specific considerations) remain poorly defined, and are not typically addressed using validated shoulder outcomes instruments. Sports medicine surgeons need more objective criteria on which to base their clinical decision making with athletes treated for anterior glenohumeral instability.
Purpose
To perform a meta-analysis of RCTs evaluating donor site morbidity after bone–patellar tendon–bone (BTB), hamstring tendon (HT) and quadriceps tendon (QT) autograft harvest for anterior ...cruciate ligament reconstruction (ACLR).
Methods
PubMed, OVID/Medline and Cochrane databases were queried in July 2022. All level one articles reporting the frequency of specific donor-site morbidity were included. Frequentist model network meta-analyses with
P
-scores were conducted to compare the prevalence of donor-site morbidity, complications, all-cause reoperations and revision ACLR among the three treatment groups.
Results
Twenty-one RCTs comprising the outcomes of 1726 patients were included. The overall pooled rate of donor-site morbidity (defined as anterior knee pain, difficulty/impossibility kneeling, or combination) was 47.3% (range, 3.8–86.7%). A 69% (95% confidence interval 95% CI: 0.18–0.56) and 88% (95% CI: 0.04–0.33) lower odds of incurring donor-site morbidity was observed with HT and QT autografts, respectively (
p
< 0.0001, both), when compared to BTB autograft
.
QT autograft was associated with a non-statistically significant reduction in donor-site morbidity compared with HT autograft (OR: 0.37, 95% CI: 0.14–1.03, n.s.). Treatment rankings (ordered from best-to-worst autograft choice with respect to donor-site morbidity) were as follows: (1) QT (
P
-score = 0.99), (2) HT (
P
-score = 0.51) and (3) BTB (
P
-score = 0.00). No statistically significant associations were observed between autograft and complications (n.s.), reoperations (n.s.) or revision ACLR (n.s.).
Conclusion
ACLR using HT and QT autograft tissue was associated with a significant reduction in donor-site morbidity compared to BTB autograft. Autograft selection was not associated with complications, all-cause reoperations, or revision ACLR. Based on the current data, there is sufficient evidence to recommend that autograft selection should be personalized through considering differential rates of donor-site morbidity in the context of patient expectations and activity level without concern for a clinically important change in the rate of adverse events.
Level of evidence
Level I.
Supervised learning is the most common form of machine learning utilized in medical research. It is used to predict outcomes of interest or classify positive and/or negative cases with a known ground ...truth. Supervised learning describes a spectrum of techniques, ranging from traditional regression modeling to more complex tree boosting, which are becoming increasingly prevalent as the focus on “big data” develops. While these tools are becoming increasingly popular and powerful, there is a paucity of literature available that describe the strengths and limitations of these different modeling techniques. Typically, there is no formal training for health care professionals in the use of machine learning models. As machine learning applications throughout medicine increase, it is important that physicians and other health care professionals better understand the processes underlying application of these techniques. The purpose of this study is to provide an overview of commonly used supervised learning techniques with recent case examples within the orthopedic literature. An additional goal is to address disparities in the understanding of these methods to improve communication within and between research teams.
The meta-analysis has become one of the predominant studies designs in orthopaedic literature. Within recent years, the network meta-analysis has been implicated as a powerful approach to comparing ...multiple treatments for an outcome of interest when conducting a meta-analysis (as opposed to two competing treatments which is typical of a traditional meta-analysis). With the increasing use of the network meta-analysis, it is imperative for readers to possess the ability to independently and critically evaluate these types of studies. The purpose of this article is to provide the necessary foundation of knowledge to both properly conduct and interpret the results of a network meta-analysis.
Background:
Graft failure after osteochondral allograft transplantation (OCA) of the knee is a devastating outcome, often necessitating subsequent interventions. A comprehensive understanding of the ...risk factors for failure after OCA of the knee may provide enhanced prognostic data for the knee surgeon and facilitate more informed shared decision-making discussions before surgery.
Purpose:
To perform a systematic review and meta-analysis of risk factors associated with graft failure after OCA of the knee.
Study Design:
Systematic review and meta-analysis; Level of evidence, 4.
Methods:
The PubMed, Ovid/MEDLINE, and Cochrane databases were queried in April 2021. Data pertaining to study characteristics and risk factors associated with failure after OCA were recorded. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and graft failure by generating effect estimates in the form of odds ratios (ORs) with 95% CIs, while mean differences (MDs) were calculated for continuous data. Qualitative analysis was performed to describe risk factors that were variably reported.
Results:
A total of 16 studies consisting of 1401 patients were included. The overall pooled prevalence of failure was 18.9% (range, 10%-46%). There were 44 risk factors identified, of which 9 were explored quantitatively. There was strong evidence to support that the presence of bipolar chondral defects (OR, 4.20 95% CI, 1.17-15.08; P = .028) and male sex (OR, 2.04 95% CI, 1.17-3.55; P = .012) were significant risk factors for failure after OCA. Older age (MD, 5.06 years 95% CI, 1.44-8.70; P = .006) and greater body mass index (MD, 1.75 kg/m2 95% CI, 0.48-3.03; P = .007) at the time of surgery were also significant risk factors for failure after OCA. There was no statistically significant evidence to incontrovertibly support that concomitant procedures, chondral defect size, and defect location were associated with an increased risk of failure after OCA.
Conclusion:
Bipolar chondral defects, male sex, older age, and greater body mass index were significantly associated with an increased failure rate after OCA of the knee. No statistically significant evidence presently exists to support that chondral defect size and location or concomitant procedures are associated with an increased graft failure rate after OCA of the knee. Additional studies are needed to evaluate these associations.
Schistosomes cause morbidity and death throughout the developing world due to the massive numbers of eggs female worms deposit into the blood of their host. Studies dating back to the 1920s show that ...female schistosomes rely on constant physical contact with a male worm both to become and remain sexually mature; however, the molecular details governing this process remain elusive. Here, we uncover a nonribosomal peptide synthetase that is induced in male worms upon pairing with a female and find that it is essential for the ability of male worms to stimulate female development. We demonstrate that this enzyme generates β-alanyl-tryptamine that is released by paired male worms. Furthermore, synthetic β-alanyl-tryptamine can replace male worms to stimulate female sexual development and egg laying. These data reveal that peptide-based pheromone signaling controls female schistosome sexual maturation, suggesting avenues for therapeutic intervention and uncovering a role for nonribosomal peptides as metazoan signaling molecules.
Display omitted
•gli1 is essential for male schistosomes to induce female sexual development•Male:female pairing induces male Sm-nrps expression in a gli1-dependent manner•Sm-nrps is essential for male worms to induce female sexual development•SmNRPS makes β-alanyl-tryptamine, a pheromone that stimulates female development
A nonribosomal peptide produced by male schistosomes when paired with a female is responsible for inducing female sexual development and egg laying.
The NASA Psyche mission will explore the structure, composition, and other properties of asteroid (16) Psyche to test hypotheses about its formation. Variations in radar reflectivity, density, ...thermal inertia, and visible to near‐infrared (VNIR) reflectance spectra of Psyche suggest a highly metallic composition with mafic silicate minerals (e.g., pyroxene) heterogeneously distributed on the surface in low abundance (<10 vol.%). The Psyche spacecraft's Multispectral Imager is designed to map ≥80% of the surface at high spatial resolution (≤20 m/pixel) through a panchromatic filter and provide compositional information for about ≥80% of the surface using seven narrowband filters at VNIR wavelengths (∼400–1,100 nm) and at spatial scales of ≤500 m/pixel. We analyzed 359 reflectance spectra from samples consistent with current uncertainties in Psyche's composition and compared them to published reflectance spectra of the asteroid using a chi‐square test for goodness of fit. The best matches for Psyche include iron meteorite powder, powders from the sulfide minerals troilite and pentlandite, and powder from the CH/CBb chondrite Isheyevo. Comparison of absorption features support the interpretation that Psyche's surface is a metal‐silicate mixture, although the exact abundance and chemistry of the silicate component remains poorly constrained. We convolve our spectra to the Imager's spectral throughput to demonstrate preliminary strategies for mapping the surface composition of the asteroid using filter ratios and reconstructed band parameters. Our results provide predictions of the kinds of surface compositional information that the Psyche mission could reveal on the solar system's largest M‐type asteroid.
Plain Language Summary
Current observations of the asteroid (16) Psyche suggest it to be metal‐rich, but not entirely made of metal. We compared reflected light from a wide variety of Psyche‐relevant materials to measurements of reflected light from the asteroid. This analysis confirms that Psyche's composition could be less metal‐rich than previously thought. Other materials with reflectance properties similar to Psyche are metal‐rich carbonaceous chondrites and sulfide minerals. We show how an instrument on the Psyche spacecraft, which will study the asteroid in detail, can resolve some uncertainties about the surface composition of the asteroid.
Key Points
Visible to near‐infrared spectra of (16) Psyche are consistent with meteorites (irons and metal‐rich chondrites) and sulfides
The Psyche mission's Multispectral Imager can identify and potentially discriminate such materials if present on the surface of Psyche
Imager‐convolved data indicate that the instrument can accurately recover absorption band parameters in certain metal‐silicate mixtures
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