Notes

Atherogenic Dyslipidemia and also Recurring General Chance Following Stroke or even Temporary Ischemic Strike.
igh-stakes evaluations.
The primary study objective was to describe the incidence of osteochondral damage (OD) in our cohort of patients with patellar instability (PI). The secondary objective was to assess for associations between patient demographic characteristics, duration of PI, and quantitative radiographic measurements of anatomic risk factors for PI and OD in this cohort.

A retrospective chart review identified patients treated for PI at a tertiary referral center between 2013 and 2018. Patients were evaluated for osteochondral injury with either magnetic resonance imaging if treated nonoperatively or operative reports if treated surgically. The Caton-Deschamps ratio, proximal tibial tubercle-to-trochlear groove (pTT-TG) distance, distal tibial tubercle-to-trochlear groove (dTT-TG) distance, lateral trochlear inclination (LTI) angle, lateral patellar inclination (LPI) angle, and sulcus angle were calculated from magnetic resonance imaging scans. Trochlear dysplasia is an important risk factor for PI that can be reliabilile) and the incidence of OD in our cohort of patients with PI. The frequency of dislocation or subluxation and patient demographic characteristics were not significantly associated with OD.

Level III, retrospective prognostic study.
Level III, retrospective prognostic study.
To assess whether biologic augmentation in addition to core decompression (CD), compared with CD alone, improves clinical and radiographic outcomes in the treatment of nontraumatic osteonecrosis of the femoral head (ONFH). Our hypothesis was that biologic augmentation would reduce the progression of osteonecrosis and therefore also the rate of conversion to total hip arthroplasty (THA).

A systematic review was performed in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) statement. Six databases were searched Central, MEDLINE, Embase, Scopus, AMED, and Web of Science. Studies comparing outcomes of CD versus CD plus biologic augmentation (with or without structural augmentation), with a reported minimum level of evidence of III and ≥24 months of follow-up, were eligible. Procedural success was conceptualized as (1) avoidance of conversion to THA and (2) absence of radiographic disease progression. Risk of bias was assessed using the Joanna Briggs Institute critIII studies.
III, systematic review of level I, II, and III studies.
The purpose of this study was to investigate the role of preoperative bone marrow lesion (BML) size and location on (1) postoperative patient reported outcomes and (2) postoperative failure and time to failure after osteochondral allograft (OCA) transplantation.

Consecutive patients from two senior surgeons who underwent isolated OCA transplantation to the knee from 2009-2018 were identified for the case series. Preoperative magnetic resonance imaging (MRI) was evaluated for BMLs based on two classification systems (Welsch, et al. and Costa-Paz, et al.) by two independent graders. BMLs associations with minimum 1-year postoperative outcomes were evaluated and the effect of BML classification on survivorship was investigated with Kaplan-Meier curves.

Seventy-seven patients who underwent isolated OCA transplantation (mean follow-up 39.46 ± 22.67 months) and had a preoperative MRI were included. Within this cohort, 82% of patients demonstrated a BML. The preoperative Costa-Paz et al. classification was significantly positively correlated with the postoperative function VAS, IKDC, and VR-12 Physical raw scores for both graders (p<0.05). Failure occurred in 5 of 65 (8%) patients at a mean of 22.86 ± 12.04 months postoperatively. The presence of BML alone did not significantly affect survival (p=0.780). However, for one grader the Welsch et al. classification was associated with increased risk of graft failure (p=0.031).

Preoperative subchondral BMLs were present in 82% of patients undergoing OCA transplantation. We found that more severe BMLs based on the Costa-Paz classification, with increasing involvement in the juxta-articular surface, were correlated with higher postoperative patient-reported functional outcomes after OCA. BMLs may be associated with an increase in graft failure but their role in this remains unclear.

IV, Retrospective Case Series.
IV, Retrospective Case Series.
To establish the minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) after arthroscopic meniscal repair and identify the factors associated with achieving these outcomes.

This is a retrospective study with prospectively collected data. Patient-reported outcome measures (PROMs) were collected from April 2017 to March 2020. All patients who underwent arthroscopic meniscal repair and completed both preoperative and postoperative PROMs were included in the analysis. MCID and PASS were calculated via half the standard deviation of the delta PRO change from baseline (for International Knee Documentation Committee Score [IKDC]) and via anchor-based methodology (Knee Injury and Osteoarthritis Outcome Score [KOOS] subscales).

Sixty patients were included in the final analysis. The established MCID threshold values were 10.9 for IKDC, 12.3 for KOOS Symptoms, 11.8 for KOOS Pain, 11.4 for KOOS Activities of Daily Living (ADL), 16.7 for KOOS Sport, and 16.9 for KOOS Qualityh medial and lateral menisci, and horizontal and complex tear classifications were associated with decreased likelihood of achieving these outcomes.

IV, retrospective case series.
IV, retrospective case series.
The aims of this study were to confirm the relationship between osseous coverage and labral size and toinvestigate the severity of intra-articular damage in borderline dysplastic hips in correlation to labral size.

Patients treated with primary hip arthroscopy for symptomatic labral tears between 2010 and 2018 were considered for this study. selleckchem Patients were included if they had preoperative radiographic measures and intraoperative assessments of the labra and cartilage. The study group was divided into borderline dysplastic and nondysplastic groups via 3 measurements lateral center edge angle (LCEA), acetabular index (Ax), and anterior center edge angle (ACEA). Undercoverage was defined as LCEA ≤ 25°, Ax ≥ 10°, and ACEA ≤ 20°. The labrum was measured in four quadrants anterosuperior (AS), anteroinferior (AI), posterosuperior (PS), and posteroinferior (PI). Additionally, to assess cartilage damage in borderline dysplastic hips, hips with average labral size in the top quartile were compared to hips with averII, case-control study.
To evaluate the biomechanical properties of the labral suction seal in the native labrum and after rim preparation, labral augmentation, and labral reconstruction.

Eight hemi-pelvises were dissected to the level of labrum and mounted for biomechanical testing. Each specimen was tested in axial distraction starting with the native labrum and then sequentially following rim preparation from 12 to 3 o'clock, labral augmentation, and segmental labral reconstruction using the iliotibial band allograft. In each condition, the specimens were compressed to 250 N and then distracted at 10 mm/s with force and displacement continuously recorded. Each test was repeated 3 times, and the mean peak force, displacement at peak force, and work were calculated. Data were reported as a percentage of the intact values to account for sex and size differences. Statistical testing was performed via a repeated-measures analysis of variance with a post hoc Tukey analysis.

Peak loads occurred within 2.21 to 3.11 mm of displaceme

The results show that the suction seal is not significantly changed following rim preparation. Relative to the rim preparation, labral augmentation may re-create the labral suction seal better than labral reconstruction.

This study provides a biomechanical basis for surgical decision making and clinical management of patients with labral tears of the hip.
This study provides a biomechanical basis for surgical decision making and clinical management of patients with labral tears of the hip.
To assess recurrent instability of the shoulder following open Latarjet performed as the primary stabilization procedure or as a salvage procedure.

A retrospective, comparative cohort study was performed for a consecutive series of patients in the Military Health System who underwent open Latarjet from January 1, 2010, to December 31, 2018. All patients were diagnosed with recurrent anterior shoulder instability and had a minimum of 2 years of postoperative follow-up. Patients were categorized as either having a primary Latarjet (PL; no prior shoulder stabilization procedure) or salvage Latarjet (SL; ≥1 previous arthroscopic surgical stabilization procedures).

A total of 234 Latarjet procedures were performed in 234 patients. The overall recurrent instability rate was 15.8% (37/234), the overall reoperation rate was 16.7% (36/234), and the overall complication rate was 14.2% (33/234) over a mean 5.0 years of follow-up. There were 99 PL procedures and 135 SL procedures. The SL group had significantly more recurrent instability than the PL group (SL 28/135, 20.7%; PL 9/99, 9.1%; P= .0158). There was no difference in overall reoperation rates (SL 26/135, 19.3%; PL 13/99, 13.1%; P= .2140) or complication rates (SL 20/135, 14.8%; PL 13/99, 13.3%; P= .9101).

The rate of recurrent instability following the Latarjet procedure in an active, high-risk population is 15.8%. Primary Latarjet was found to have lower rates of recurrence compared with salvage Latarjet procedures (9.1% versus 20.7%).

III.
III.
To assess the efficacy of platelet-rich plasma (PRP) for lateral epicondylitis and evaluate its impact on pain and functional outcomes.

This study followed Preferred Reporting Items and Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted in September 2019 and repeated in April 2020 using electronic databases PubMed, MEDLINE, and the Cochrane Library. Baseline and 3-, 6-, and 12-month data were extracted for visual analog scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH), and modified Mayo Clinic performance index for the elbow (MAYO) scores. Only level 1 studies with patients who had not undergone surgery were included. Outcomes data, study design, demographic variables, PRP formulation, and comparator treatments were recorded. Statistical analyses of pooled weighted mean differences (WMDs) were performed and compared with estimated minimal clinically important difference (MCID) values. The Coleman Methodology Score (CMS) was used to assess methodbsolute difference estimate for their respective MCIDs but fell short of the 10% estimate.

Considering the small number of comparable studies, lack of quantification of specific PRP content, considerable heterogeneity between randomized control trials, and most effect sizes being equivocal within the framework of 2 estimated MCID values, the authors can neither scientifically support nor discourage the usage of PRP for lateral epicondylitis despite finding statistically significant improvements in pain and functional outcomes.

I, prognostic.
I, prognostic.
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