Purpose
This study aimed to identify independent predictive factors for return to sports (RTS) after anterior cruciate ligament (ACL) reconstruction in competitive-level athletes and to determine ...optimal cut-off values for these factors at 6 months after surgery.
Methods
A total of 124 competitive athletes (50 males and 74 females; mean age, 17.0 years; preinjury Tegner activity scale > 7) who underwent primary ACL reconstruction were enrolled. Assessments at 6 months after surgery consisted of knee functional tests quadriceps index, hamstrings index, and single-leg hop for distance (SLH) and 2 self-report questionnaires IKDC subjective score and ACL-Return to Sport after Injury scale (ACL-RSI). At 1 year after surgery, athletes were classified into the RTS group (
n
= 101) or non-RTS group (
n
= 23) based on self-reported sports activities. After screening possible predictive factors of RTS, multivariate logistic regression and receiver operating characteristic curve analyses were performed to identify independent factors.
Results
Multivariate logistic regression analysis identified SLH (odds ratio, 2.861 per 10 unit increase;
P
< 0.001) and ACL-RSI (odds ratio, 1.810 per 10 unit increase;
P
= 0.001) at 6 months as independent predictors of RTS at 1 year after surgery. Optimal cut-off values of SLH and ACL-RSI were 81.3% (sensitivity = 0.891; specificity = 0.609) and 55 points (sensitivity = 0.693; specificity = 0.826), respectively.
Conclusion
In competitive athletes, SLH < 81% and ACL-RSI < 55 points at 6 months after surgery were associated with a greater risk of unsuccessful RTS at 1 year after surgery. SLH and ACL-RSI at 6 months could serve as screening tools to identify athletes who have difficulties with returning to sports after ACL reconstruction.
Level of evidence
III.
Background:
Many factors are involved in causing patellar instability or recurrent patellar dislocations. However, factors affecting the outcomes of anatomic medial patellofemoral ligament (MPFL) ...reconstruction have not been fully documented.
Purpose:
To evaluate the rate of recurrent patellar instability after isolated MPFL reconstruction and to elucidate factors affecting the outcomes of isolated MPFL reconstruction using multivariable statistics.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
A total of 42 patients (44 knees) who underwent isolated, anatomic MPFL reconstruction using a semitendinosus autograft without any additional patellar stabilization procedures for treating recurrent patellar dislocations were included in this study. All patients were followed for more than 2 years; the mean follow-up period was 3.2 years (range, 2-9 years). Postoperative patellofemoral instability was diagnosed when the patient complained of recurrent patellar subluxations or dislocations or had a positive apprehension sign during follow-up. Preoperative radiographic findings were obtained using plain radiography and computed tomography. Femoral tunnel positions were assessed on postoperative radiographs. The strength of the relationship between postoperative patellofemoral instability and potential risk factors such as preoperative age, sex, body mass index, patellar type, sulcus angle, congruence angle, lateral tilt angle, patellar height, tibial tubercle–trochlear groove (TT-TG) distance, degree of trochlear dysplasia, and femoral bone tunnel position were evaluated by univariate and multivariate logistic regression analyses.
Results:
At follow-up, 2 knees had experienced a redislocation (4.5%). A positive apprehension sign was still evident in 8 knees (18.2%). Three factors, including the sulcus angle, the congruence angle, and trochlear dysplasia, were extracted by single linear regression analysis. Univariate logistic regression analysis showed that the sulcus angle (odds ratio OR, 1.11; 95% CI, 1.01-1.22; P = .04) and trochlear dysplasia (OR, 3.04; 95% CI, 1.39-6.63; P = .01) were associated with postoperative patellofemoral instability. Trochlear dysplasia was independently associated with postoperative patellofemoral instability by multivariable logistic regression analysis (P < .05). An increased TT-TG distance exerted a significant effect on the outcomes of MPFL reconstruction, particularly in patients with type D trochlea.
Conclusion:
Severe trochlear dysplasia is the most important predictor of residual patellofemoral instability after isolated MPFL reconstruction. In addition, an increased TT-TG distance affected the outcomes in patients with type D trochlea. Additional patellar stabilization procedures should be considered for patients with severe trochlear dysplasia and an increased TT-TG distance.
The relative ability of the NOEC (no-observed-effect concentration) and ECx (the effect concentration corresponding to x-percent response) to determine benchmark toxicant concentrations, which are ...expected to ensure environmental safety, when there are large uncertainties in data was investigated with Monte Carlo simulations. We assumed a hypothetical true concentration-response function, and examined how random fluctuations of responses around the true responses affected the NOEC and ECx values. For assessment of the relative performances of these endpoints, we adopted two criteria: how large uncertainties were allowed for the minimum requirement for safety to be met, and the probability with which the estimated endpoints exceeded the minimum requirement for safety. The results of simulations indicated that, when there were small uncertainties in the data, performance of the NOEC was comparable with or slightly better than the ECx (EC5 and EC10) in providing benchmark concentrations that satisfied the minimum requirement for safety. With larger random variation of data (the coefficient of variation in responses between replicates within treatments or in the control was noticeably larger than 10 percent), the NOEC performed considerably worse than the ECx in terms of the frequency of simulated runs in which the endpoints exceeded the minimum requirement of safety. We conclude that the NOEC is as relevant as the ECx for risk assessment of chemicals under limited situations.
Background:
Open reduction and internal fixation (ORIF) has been widely performed because the osteochondral component of the osteochondritis dissecans (OCD) lesion is the most suitable for ...reconstructing the joint structure.
Purpose:
To evaluate radiological healing in terms of reconstructed bony structure after ORIF with bone graft by computed tomography (CT), to identify preoperative prognostic factors for failure, and to determine the cutoff value of radiological healing for risk of failure.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
A retrospective cohort study of 42 patients (44 knees) who underwent internal fixation with bone graft for OCD lesions of the knee from 2004 to 2018 was conducted. All patients were evaluated 6 months postoperatively, and if not healed 6 months after surgery, they were evaluated by CT periodically thereafter. Radiological healing was judged according to the following 3 criteria: (1) reossification of the OCD lesion, (2) bony continuity between the OCD lesion and basal floor, and (3) reconstructed bony surface of the femoral condyle reconstructed to match the normal joint. Then, the percentage of the radiological healing area was calculated as the ratio of the healing length to the total lesion length. The nonhealing area was calculated by multiplying the sum of the total nonhealing length. Clinical failure was defined as any definitive reoperation for the same OCD lesion, such as fragment excision, or a cartilage restoration procedure. After 6 months, all eligible patients underwent arthroscopy to check for protrusion of the absorbable pin into the joint; the removal of an absorbable pin protruding into the joint was not considered a failure.
Results:
Clinical failure was recorded for 4 cases (9.1%). The mean overall percentage of the radiological healing area of OCD 6 months after ORIF with bone graft was 79.5% ± 24.4%, and the mean overall nonhealing area at 6 months was 87.8 ± 107.9 mm2. The percentages of radiological healing area of stable (International Cartilage Regeneration & Joint Preservation Society OCD II) lesions and femoral condylar (lateral femoral condyle + medial femoral condyle) lesions were significantly lower than unstable lesions and femoral groove lesions, respectively (P = .01 and P = .03, respectively). On receiver operating characteristic curve analysis, the cutoff points for predicting a significantly increased risk of failure were 33.9% (sensitivity, 100%; specificity, 100%; area under the curve, 1) for the percentage of radiological healing area and 222.9 mm2 (sensitivity, 95%; specificity, 100%; area under the curve, 0.956) for the nonhealing area 6 months postoperatively.
Conclusion:
A stable lesion and a femoral condylar lesion were the predictors of poor radiological healing on CT images 6 months after ORIF with bone graft. The risk of failure was increased significantly in cases with only approximately one-third of the lesion healed or in cases with large nonhealing areas at 6 months postoperatively.
We conducted a broad-scale ecological effect assessment of agricultural chemicals where we combined biomonitoring databases of riverine invertebrate communities with predictions of environmental ...concentrations of chemicals, based on an exposure evaluation model for Japanese rivers. One of the difficulties of broad-scale assessment arises from the use of biomonitoring databases for which the monitoring sites are often spread across different geographic regions, with varying species compositions and heterogeneous environmental factors. This problem was circumvented using a trait-based approach, which extracts patterns of ecological properties of species response to changes in either chemical concentration or environmental factors. We identified groups of species that had particular trait categories that were negatively correlated with herbicide pollutants (the predicted concentration divided by the acute toxic concentration). Numerical abundances of species groups classified by trait categories had more sensitive responses to herbicide pollutants than total species abundance. However, a finding that trait diversity and species diversity indexes in the communities examined did not change with herbicide pollutants means that the two indexes showed resistance to chemical stresses. We inferred that the reason for the greater resistance in terms of trait and species diversity was that compositional changes of species caused by increasing herbicide pollutions were simply a shift from communities composed of susceptible species to those composed only of tolerant species.
Display omitted
•We assessed herbicide effects on invertebrate communities.•We used biomonitoring databases of riverine invertebrate communities (River Environmental Database) and the exposure evaluation of Japanese rivers (PeCHREM/G-CIEMS models) for this assessment.•Species abundance of particular trait categories significantly decreased with increased herbicide pollutants.•Species number, total abundance and wet biomass non-significantly decreased with increased herbicide pollutants.•Trait diversity was unaffected by herbicide pollutants.
Purpose
The purpose of this study was to evaluate the change in cross-sectional area (CSA) of bone-patellar tendon-bone (BTB) autografts up to 5 years after the anatomic rectangular tunnel (ART) ...anterior cruciate ligament reconstruction (ACLR). The changing pattern in CSA might be a potential indicator of the graft remodeling process.
Methods
Ninety-six (62 males, 34 females, mean age 27.0 years) patients were enrolled in this study with a total of 220 MRI scans after ART BTB ACLR to evaluate the CSA of the ACL autografts. The patients with first time unilateral ACLR that consented to undergo MRI evaluations at postoperative periods were included in this study. Intraoperatively, the CSA of the graft was measured directly using a custom-made area micrometer at the midpoint of the graft. Postoperatively, using an oblique axial slice MRI that was perpendicular to the long axis of the graft, the CSA of the graft was measured with digital radiology viewing program “SYNAPSE” at the midpoint of the graft. The postoperative MRI scans were classified into seven groups according to the period from ACLR to MRI evaluation: Group 0–2 months (m.), Group 3–6 m., Group 7–12 m., Group 1–2 years (y.), Group 2–3 y., Group 3–4 y., and Group 4 y.-. The percent increase of the CSA was calculated by dividing the postoperative CSA by the intraoperative CSA.
Results
The postoperative CSA was significantly larger than the intraoperative CSA in each group, with the exception of Group 0–2 m. The mean percent increase of the CSA in Group 0–2 m., 3–6 m., 7–12 m., 1–2 y., 2–3 y., 3–4 y., 4 y.- was 101.8 ± 18.2, 188.9 ± 27.4, 190.9 ± 43.7, 183.3 ± 28.9, 175.2 ± 27.9, 163.9 ± 19.8, 164.5 ± 25.4% respectively. The percent increase in Group 3–6 m., 7–12 m., 1–2 y., 2–3 y., 3–4 y., and 4 y.- was significantly greater than that in Group 0–2 m
.
Conclusions
The CSA of the BTB autografts after the ART BTB ACLR increases rapidly by 3–6 months after ACLR, reached a maximum value of 190% at around 1 year, decreases gradually after that, and reaches a plateau at around 3 years. The current study might help clinicians to estimate an individual BTB autograft's remodeling stages when considering returning patients to sports.
Level of evidence
IV
Communities with species that are tolerant to environmental stresses may be able to maintain the ecosystem functions under the stress, because the tolerant species can compensate for the loss of ...sensitive species. In this study, we focused on the food chain efficiency (FCE), the trophic transfer across three trophic levels, as an important process for ecosystem function, and examined the conditions under which such compensation could occur with aquarium experiments using an insecticide (methomyl) as the stressor. Our aquariums included one of two pairs of insecticide-tolerant and insecticide-sensitive cladoceran species, and a fish as the predator. The response of FCE to the insecticide stress, as indicated by the fish biomass production, depended on the zooplankton species combinations. FCE and total zooplankton biomass were maintained in the pair in which the compensatory changes of species abundances were clear, whereas they decreased in the pair in which the compensatory changes were not clear. This indicated the compensatory dynamics in the zooplankton community responsible for the observed resistance to the stress. We inferred the driving factors for the compensatory dynamics and the community resistance with respect to species traits of ecological importance, and concluded that a dissimilarity between species as regards the tolerance trait and a clear trade-off between the tolerance and the competitive ability was required to drive the compensatory dynamics, and a similarity or a superiority of the tolerant species as regards the functional effect trait (the predator avoidance and the reproductive potential) were required to maintain FCE.
Radial/oblique tears of the midbody of the lateral meniscus significantly impair the ability of the meniscus to withstand the tibiofemoral load, requiring meniscal repair. However, healing status ...after meniscal repair has not been fully elucidated. This study aimed to evaluate arthroscopic findings after inside-out suture repair for isolated radial/oblique tears of the midbody of the lateral meniscus.
From 2011 to 2015, 18 consecutive patients with isolated radial/oblique tears of the midbody of the lateral meniscus underwent arthroscopic inside-out repair with the tie-grip suture technique. All knees were stable with no previous surgery. All patients were evaluated by second-look arthroscopy at six months postoperatively. Activities including jogging were not allowed until meniscal status was evaluated arthroscopically. To analyze factors associated with healing rates, age, time from injury to initial surgery, and tear zone were compared.
Second-look arthroscopy revealed complete healing in four (22%) patients, partial healing in seven (39%), and failure to heal in seven (39%). Significant differences were observed for tear zone (p < 0.0001), but not for age and timing of repair.
Arthroscopic evaluation revealed that inside-out repair with the tie-grip suture technique for isolated radial/oblique tears of the midbody of the lateral meniscus achieved complete or partial healing only in 61% of patients. Satisfactory results were observed particularly in patients with tears extending to the vascular zone, whereas those with tears in the avascular zone failed to achieve healing. Therefore, the operative indication of inside-out repair for radial/oblique tears of the midbody of the lateral meniscus might be limited to tears extending into the vascular zone. Given that 39% of cases were arthroscopically considered a failure even if patients complained of no symptoms in daily life, decisions should be made carefully to allow patients to return to sports activities.
Although anatomical anterior cruciate ligament reconstruction (ACLR) can provide satisfactory outcomes, little is known about how this procedure impacts patellar height. Since harvesting ...bone-patellar tendon-bone (BTB) autografts is a potential risk factor for decreased patellar height, we examined changes in patellar height after anatomical ACLR with BTB autograft with a focus on the size of the harvested graft.
Subjects were 84 patients (49 males, 35 females; mean age, 23 years) who underwent primary anatomical ACLR with central third BTB autograft. Preoperative to postoperative Caton-Deschamps index (CDI) ratio was calculated using lateral knee radiographs before and 6 months after surgery. The length and cross-sectional area (CSA) of the graft were measured intraoperatively, and the CSA of the contralateral patellar tendon was measured by ultrasound 6 months postoperatively. The difference in graft CSA relative to the contralateral tendon CSA, expressed as a percentage (gCSA:ctCSA percentage), was also calculated.
Patellar height decreased slightly after surgery (preoperative CDI: 0.856 ± 0.113; postoperative CDI: 0.841 ± 0.113), with a mean difference between preoperative and postoperative CDIs of -0.015 (range: -0.293 to 0.101). Although the CDI of male subjects significantly decreased after surgery (preoperative: 0.852 ± 0.117; postoperative: 0.827 ± 0.115), no significant changes were noted in female subjects (preoperative: 0.862 ± 0.108; postoperative: 0.861 ± 0.108). Graft length and CSA did not significantly impact the CDI ratio (r = -0.138 and r = -0.038, respectively). Moreover, no significant relationship was observed between the gCSA:ctCSA percentage and CDI ratio (r = 0.118).
Although patellar height slightly, but significantly, decreased at 6 months after anatomical ACLR with BTB autograft, it was not affected by the length and CSA of harvested grafts. The decrease in postoperative patellar height was observed only in male subjects, suggesting the potential importance of sex differences in soft tissue healing during the postoperative period.
Here we developed an analytical means of estimating population-level effects of endocrine disruptors on Daphnia magna. Our approach was based on the fact that the endocrine-disrupting juvenile ...hormone analogs induce the production of male neonates if they are exposed to the analogs during a particular period in their prenatal development; the method also assumed that the abnormal production of male neonates in the sake of production of female neonates reduces population growth. We constructed a linear toxicodynamics model to elucidate the period in which D. magna neonates are sensitive to exposure to the analog and also the probability of an individual neonate changing sex under specific exposure concentrations. The proposed model was applied to D. magna reproduction test data obtained under time-varying exposure to pyriproxyfen to derive the maximum-likelihood estimates and the posterior distributions of the model parameters. To quantitatively assess the ecological risk at the population level, we conducted a population dynamics simulation under two time-varying exposure scenarios (i.e., constant or pulsed exposure) by using an age-structured population model. When the change in sex ratio was based on the time-weighted average concentration during the period of sensitivity, change in sex ratio caused approximately equivalent population-level effects as did reproductive inhibition (i.e., reduction in the total number of neonates per female parent) regardless of the exposure scenario. In contrast, when change in sex ratio was based on maximum concentration during the sensitive period, change in sex ratio caused only half the population-level effects as did reproductive inhibition under constant exposure, whereas it caused a much larger population-level effect than did reproductive inhibition under pulsed exposure.
•Simulation model predicting abnormal male production of daphnia by pollutants’ effect.•Simplified dynamic energy budget model simulating reproductive inhibition of daphnia.•These models were fit to chronic reproduction test data based on the Bayesian method.•The two kinds of responses were numerically converted into population-level effects.
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