“Scopen” Scope to Open Hamstring Repair Sivasundaram, Lakshmanan; Hevesi, Mario; Rice, Morgan W. ...
Video journal of sports medicine,
04/2022, Letnik:
2, Številka:
4
Journal Article
Odprti dostop
Background:
Hamstring injuries at the musculotendinous junction are relatively common. However, injuries to the proximal hamstring account for just 12% of hamstring injuries. Surgical repair of these ...injuries including both open and endoscopic techniques are becoming increasingly more common.
Indications:
Surgical intervention is generally reserved for cases with 2 or more torn tendons and at least 2 centimeters of retraction.
Technique Description:
The combined open and endoscopic technique utilizes direct posterior and posterolateral portals. After visualizing the posterior femoral cutaneous (PFCN) and sciatic nerves (SN), the proximal hamstring tear is identified, and the shaver is used to remove any surrounding adhesions and aid in clearing any hematoma. The ischial tuberosity is prepared using a shaver, radiofrequency ablation, and a 5.5 mm, round arthroscopic burr. Two, 4.5 mm, doubled-loaded anchors are placed into the ischium. The incision for the open portion of the case is created by incising the skin between the direct posterior and posterolateral portals. A dissection is continued down to the gluteal fascia, and the gluteal fascia is incised in line with the surgical incision. The gluteus maximus is retracted then the hamstring stump is secured with a stay suture and brought outside the surgical incision for inspection. The double-loaded sutures are passed in a running locking technique. The other suture limbs are then passed through the central aspect of the tendon and tensioned to reduce the proximal hamstring onto the prepared tuberosity.
Results:
Significant postoperative improvements in patient-reported outcomes have been reported for open and endoscopic repairs in isolation, but to date there are no outcomes studies on the combined “Scopen” technique. Postoperative complications may include numbness or neuropraxia, re-rupture, infection, and deep vein thrombosis (DVT).
Discussion:
The endoscopic portion allows an improved view and preservation of the SN and PFCN, as well as a detailed view of the ischial tuberosity for decortication and anchor placement in comparison with a purely open approach. In comparison with a purely endoscopic approach, this combined approach can be used in patients with retraction >4 cm, and can also be utilized for chronic, retracted tears as well.
Graphical Abstract
This is a visual representation of the abstract.
We have for the first time estimated volcanic emission of volatile metals for a large regional volcanic source showing permanent activity, namely the Indonesian Arc. We have done this by normalizing ...concentrations of metals ratios in volcanic plumes to SO
2 emission rates. Metal/SO
2 ratios measured in magmatic gases are used to estimate emissions from eruptive activity, whereas those measured in fumarolic gases are used to estimate emissions from non-eruptive activity. The SO
2 emission rate obtained is 3.5 × 10
6 tons per year, which represents about 20% of the annual worldwide volcanic flux of SO
2. The obtained trace metal (
210Po, Pb, Bi, Cd, Zn and Cu) fluxes account for only about 5 to 30% of their global volcanic flux. These relatively low values for trace metal emissions (relative to the volcanic activity and the number of active volcanoes of the region) appear to reflect the andesitic magma composition of the volcanoes of the arc.
Laboratory findings revealed a white blood cell count of 3030/mm3, haemoglobin level 12.8 g/dL, and low platelet count of 34 000/mm3. Computed tomography (CT) scans showed a distended gallbladder ...with several gallstones and bile duct stones. ...the intraluminal space of the gallbladder was filled with heterogeneous material, and extravasation of the contrast agent was suspected in the arterial phase (Fig 1). Pathological evaluation revealed a gallbladder haematoma with 30 to 40 gallstones (Fig 3). ...venous vessels were remarkably dilated in the vicinity of the haemorrhagic site on CD31 immunostaining.
Background:
Limited literature exists regarding how postoperative physical therapy (PT) may affect outcomes in patients with femoroacetabular impingement syndrome (FAIS) undergoing hip arthroscopy. ...Additionally, it is unknown how PT measures relate to traditional orthopaedic patient-reported outcomes (PROs).
Purpose:
To evaluate how the duration of PT may correlate with outcomes in patients with FAIS using both the Lower Extremity Functional Scale (LEFS) and standard orthopaedic PRO measures.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Patients from a single institution who underwent primary hip arthroscopy for FAIS between 2013 and 2016 were identified. Patients with a minimum 2-year follow-up and fully documented PT notes were included and stratified into 3 cohorts based on timing of PT discharge: 0 to 3 months, 3 to 6 months, and 6 to 12 months. Predictive regression models were developed to analyze the rate of improvement (ROI) in LEFS score as it relates to (1) postoperative day (POD) and (2) postoperative PT session number. Two-year PROs were collected, correlated with LEFS scores, and compared among cohorts.
Results:
A total of 95 patients were included (mean ± SD age, 34.6 ± 11.7 years; range, 14-55 years). Mean LEFS scores increased significantly from the initial score at 6 weeks, 3 months, and the time of PT discharge (P < .01 for all). The predicted ROI in LEFS score was 3.39% per PT session for sessions 0 to 13, 1.43% for sessions 14 to 27, and 0.37% for sessions 28 to 40. Patients who underwent 3 to 6 months of PT had significantly better Hip Outcome Score (HOS) relative to the 0- to 3-month cohort and significantly better visual analog scale (VAS) scores for satisfaction relative to the 6- to 12-month cohort. The predicted ROI in LEFS score was 0.96% per day from POD 0 to 45, 0.22% from POD 46 to 139, and 0.03% after POD 139. Moderate correlations were seen between LEFS score at the time of discharge and all 2-year PROs as follows: HOS Activities of Daily Living subscale (r = 0.488), HOS Sports-Specific subscale (r = 0.500), modified Harris Hip Score (r = 0.465), 12-item International Hip Outcome Tool (r = 0.494), VAS pain score (r = −0.346), and VAS satisfaction score (r = 0.459).
Conclusion:
Patients undergoing hip arthroscopy for FAIS derived substantial benefit from each PT visit during their first 13 PT sessions and then a smaller, yet still meaningful benefit from sessions 13 through 27. After session 40, or approximately 4.5 to 5 months, patients no longer benefited from additional PT sessions. Based on PRO scores, patients discharged from PT between 3 and 6 months had the best 2-year outcomes. LEFS score had moderate correlation with orthopaedic PRO scores.
To perform a systematic review of studies reporting on minimum 5-year outcomes of patients undergoing primary hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) to determine ...whether capsular management influences patient-reported outcomes (PROs), rates of clinically significant outcome, and rates of revision surgery or conversion to total hip arthroplasty (THA).
PubMed, Scopus, and Google Scholar were searched around the terms hip arthroscopy, FAIS, five-year follow-up, and capsule management. Articles available in English, presenting original data, and reporting minimum 5-year follow-up after HA using either PROs or conversion to THA or revision surgery were included. Quality assessment was completed using MINORS assessment. Articles were stratified into unrepaired and repaired capsule cohorts (excluding periportal capsulotomy techniques).
Eight articles were included. MINORS assessment ranged from 11-22, with excellent (k = 0.842) inter-rater reliability. Populations without capsular repair were identified in 4 studies including a total of 387 patients, at an age of 33.1 to 38.0 years and follow-up range of 60.0 to 77 months. Populations with capsular repair were identified in 5 studies including a total of 835 patients, at an age range of 33.6 to 43.1 years and follow-up range of 60.0 to 78.0 months. All studies included PROs and all reported significant improvement (P < .05) at the 5-year timepoint, with modified Harris Hip Score (mHHS) being the most frequent (n = 6). No differences were noted between groups regarding any of the measured PROs. Average rates of achieving MCID and PASS for mHHS were similar between patients without capsular repair (MCID 71.1%, PASS 73.7%, n = 1) and with capsular repair (MCID 66.0%-90.6%, PASS 55.3%-87.4%, n = 4). Conversion to THA occurred in 12.8% to 18.5% and 0.0% to 29.0% for patients with an unrepaired and repaired capsule, respectively. Revision HA occurred in 15.4% to 25.5% and 3.1% to 15.4% in unrepaired and repaired capsular patients, respectively.
Patients undergoing hip arthroscopy for FAI had significant improvement in PRO scores at minimum 5-year follow-up, and scores did not differ between patients who underwent capsular repair and those who did not. Similar rates of markers of clinical benefit and THA conversion were achieved by both groups; however, lower rates of revision hip arthroscopy were demonstrated in the capsular repair cohort.
Level IV; systematic review of Level II-IV studies.
The highly complex structure of the human brain is strongly shaped by genetic influences. Subcortical brain regions form circuits with cortical areas to coordinate movement, learning, memory and ...motivation, and altered circuits can lead to abnormal behaviour and disease. To investigate how common genetic variants affect the structure of these brain regions, here we conduct genome-wide association studies of the volumes of seven subcortical regions and the intracranial volume derived from magnetic resonance images of 30,717 individuals from 50 cohorts. We identify five novel genetic variants influencing the volumes of the putamen and caudate nucleus. We also find stronger evidence for three loci with previously established influences on hippocampal volume and intracranial volume. These variants show specific volumetric effects on brain structures rather than global effects across structures. The strongest effects were found for the putamen, where a novel intergenic locus with replicable influence on volume (rs945270; P = 1.08 × 10(-33); 0.52% variance explained) showed evidence of altering the expression of the KTN1 gene in both brain and blood tissue. Variants influencing putamen volume clustered near developmental genes that regulate apoptosis, axon guidance and vesicle transport. Identification of these genetic variants provides insight into the causes of variability in human brain development, and may help to determine mechanisms of neuropsychiatric dysfunction.
To assess 5-year outcomes and survival rate of hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) and to determine achievement rates of clinically significant outcomes.
Three ...databases were searched around the following terms: hip arthroscopy, FAIS, and 5-year follow-up. Articles available in English, presenting original data, and reporting minimum 5-year follow-up after primary HA using either patient-reported outcomes (PROs) or conversion to total hip arthroplasty (THA) and/or revision surgery were included. Quality assessment was completed using MINORS assessment, and relative agreement was calculated using Cohen’s kappa.
Fifteen articles were included. MINORS assessment ranged from 11 to 22, with excellent (k = 0.842) inter-rater reliability between reviewers. 2,080 patients were included at a follow-up range of 60.0-84 months. Labral repair was the most commonly performed procedure (range: 8.0%-100%). All studies included PROs, and all reported statistically significant improvement (P < .05) at the 5-year timepoint. The most frequent PRO was modified Harris Hip Score (mHHS) (n = 8). Nine studies reported on clinically significant outcome achievement, with mHHS being the most common (n = 8). The rate of achieving minimal clinically important difference (MCID) ranged from 64 to 100%, patient-acceptable symptomatic state (PASS) ranged from 45 to 87.4%, and substantial clinical benefit (SCB) ranged from 35.3 to 66%. Conversion to THA and revision surgery varied across studies, with ranges of 0.0%-17.9% (duration: 28.8-87.1 months) and 1.3%-26.7% (duration: 14.8-83.7 months), respectively. The most common definition of failure was conversion to THA or revision (n = 7). Increased age (n = 5) and greater joint degeneration (n = 4) were the most common predictors of clinical failure.
Patients undergoing primary hip arthroscopy for FAIS demonstrated significant improvement at 5-year follow-up, with maintained rates of achievement of MCID, PASS, and SCB. Survival rate of HA at 5 years is overall high, with ranges of 0.0-17.9% and 1.3-26.7% conversion to THA or revision surgery, respectively. Across studies, increased age and greater joint degeneration were the most commonly cited predictors of clinical failure.
Level IV, systematic review of Level III and IV studies.
Alzheimer's disease (AD) is characterized by the spread of tau pathology throughout the cerebral cortex. This spreading pattern was thought to be fairly consistent across individuals, although recent ...work has demonstrated substantial variability in the population with AD. Using tau-positron emission tomography scans from 1,612 individuals, we identified 4 distinct spatiotemporal trajectories of tau pathology, ranging in prevalence from 18 to 33%. We replicated previously described limbic-predominant and medial temporal lobe-sparing patterns, while also discovering posterior and lateral temporal patterns resembling atypical clinical variants of AD. These 'subtypes' were stable during longitudinal follow-up and were replicated in a separate sample using a different radiotracer. The subtypes presented with distinct demographic and cognitive profiles and differing longitudinal outcomes. Additionally, network diffusion models implied that pathology originates and spreads through distinct corticolimbic networks in the different subtypes. Together, our results suggest that variation in tau pathology is common and systematic, perhaps warranting a re-examination of the notion of 'typical AD' and a revisiting of tau pathological staging.
Tau is a hallmark pathology of Alzheimer's disease, and animal models have suggested that tau spreads from cell to cell through neuronal connections, facilitated by β-amyloid (Aβ). We test this ...hypothesis in humans using an epidemic spreading model (ESM) to simulate tau spread, and compare these simulations to observed patterns measured using tau-PET in 312 individuals along Alzheimer's disease continuum. Up to 70% of the variance in the overall spatial pattern of tau can be explained by our model. Surprisingly, the ESM predicts the spatial patterns of tau irrespective of whether brain Aβ is present, but regions with greater Aβ burden show greater tau than predicted by connectivity patterns, suggesting a role of Aβ in accelerating tau spread. Altogether, our results provide evidence in humans that tau spreads through neuronal communication pathways even in normal aging, and that this process is accelerated by the presence of brain Aβ.
Background
The enhanced esthetics and demonstrated oncologic safety of nipple-sparing mastectomy (NSM) in selected patients have resulted in increased rates among patients with locally advanced ...breast cancer and/or additional risk factors (obesity, prior radiation, surgery). Limited data exist on complication and reconstruction success rates in a contemporary patient cohort with expanded indications for NSM.
Methods
With institutional review board (IRB) approval, patients treated from 2009 to 2017 with NSM were identified from our prospective breast surgery registry. Main outcomes were 30-day complications requiring treatment and 1-year reconstruction failure rates. Risk factors were assessed using logistic regression.
Results
We evaluated 1301 breasts in 769 women undergoing NSM for cancer (
n
= 555) or risk reduction (
n
= 746) with median age of 48 (range 21–77) years. The overall 30-day complication rate was 7.5% (97/1301 breasts) and declined from 14.8% in 2009 to 6.3% in 2017 (
p
< 0.001), while the proportion of patients with obesity (
p
= 0.007) and treated with neoadjuvant chemotherapy (
p
< 0.001) increased. Prior radiation odds ratio (OR) 2.35,
p
= 0.04, recent/current smoking (OR 3.37,
p
< 0.001), and body mass index (BMI) (OR 1.28 per 5-kg/m
2
increase,
p
= 0.03) significantly increased 30-day complication rates. Reconstruction success at 1 year was 96.7%. Prior radiation (OR 5.65,
p
< 0.001), axillary surgery (OR 2.55,
p
= 0.006), and postoperative adjuvant radiation (OR 3.22,
p
= 0.007) significantly affected 1-year reconstruction failure.
Conclusion
The 30-day complication rates of NSM decreased, despite broadened indications among higher-risk patients over time. These data confirm a team learning curve with NSM and also demonstrate that the nipple-sparing approach is suitable for appropriately selected higher-risk patients for both risk reduction and cancer treatment.
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