Notes

[The sociological facets of medical worker turnover].
To assess the interchangeability of various existing answering scales within the subjective part of the Constant-Murley Score (CMS) and to determine the effect of the different answering scales on the inter- and intraobserver reliability.

In this prospective, single-center, cross-sectional trial, patients with shoulder problems were included from June to September 2018. Subjects recruited were 18 years or older, presented various shoulder complaints, e.g., diagnosis of osteoarthritis, subacromial pain syndrome, rotator cuff or biceps tendon problems, or frozen shoulder. An extended version of the CMS was prepared including the same questions multiple times but with varying answer scales. Six versions were made with random order of the questions. The answering scales were a verbal and paper based visual analog scale (VAS), smiley face scale, Numeric Rating Scale (NRS), and categories. Internal consistency of the various CMS, Spearman correlation coefficients, intraobserver, and interobserver agreement was t.

Level I, prospective cross-sectional study.
Level I, prospective cross-sectional study.
To generate national estimates of sports-related traumatic lumbar spine injury incidence rates using the National Electronic Injury Surveillance System (NEISS) database and determine any sports- and sex-specific epidemiologic patterns of these traumatic injuries.

Data regarding traumatic lumbar spine injuries sustained through sporting activities from 2009 to 2018 were extracted from the NEISS, a database generating nationwide estimates through patient information collected during emergency department visits from 100 NEISS hospitals across the United States. The estimated number of injuries was calculated using weights assigned by the NEISS database depending on the geographic location of the injury.

A total of 497 traumatic lumbar spine injuries were identified over the course of 10 years, suggesting 19,208 estimated injuries. The estimated average injury rate was 6.1 injuries per million persons per year. When analyzed by sex, the incidence rate of traumatic lumbar spine injury was 3.6 injuries per mi
Level III, retrospective comparative study.
To quantify the amount of strain across an anterior cruciate ligament reconstruction (ACLR) before and after a lateral meniscus (LM) posterior root complex tear and determine whether a meniscal root repair effectively protects the ACLR against excessive strain.

Fresh-frozen cadaveric knees were tested with an 88-N anterior drawer force and an internal and external torque of 5-Nm applied at 0°, 15°, 30°, 60°, and 90° of flexion. A simulated pivot shift was also applied at 0, 15, and 30° of flexion. Rotation and translation of the tibia, and strain across the ACL graft were recorded. Testing was repeated for the following four conditions ACL-intact, ACLR with intact LM, ACLR with LM posterior root complex tear, and ACLR with root repair.

The kinematic data from 12 fresh frozen cadaveric knees underwent analysis. Only 11 specimens had usable strain data. Sectioning the meniscofemoral ligaments and the LM posterior root increased rotational and translational laxity at 30° of knee flexion. ACLR graft strain significantly increased when an anterior load and internal torque were applied. Repair of the LM posterior root reduced strain when the knee was internally rotated but was unable to normalize strain when an anterior force was applied.

This cadaveric biomechanical study suggests injury to the LM posterior root complex increases rotational and anterior laxity of the knee and places increased strain across reconstructed ACL grafts. Subsequent root repair did not result in a statistically significant reduction in strain.

This study provides quantitative data on the implications of a LM posterior root injury in the setting of an ACL reconstruction to help guide clinical decision-making.
This study provides quantitative data on the implications of a LM posterior root injury in the setting of an ACL reconstruction to help guide clinical decision-making.
The purpose of the study is to describe the functional and structural outcomes of the arthroscopic 4-strand, knotless, double-row construct with suture tapes for the surgical treatment of displaced and/or comminuted greater tuberosity fractures of the humerus.

Patients were enrolled between December 2012 and January 2018. The main inclusion criteria were a comminuted and/or displaced tuberosity fracture with a displacement of at least 5 mm in any plane fixed under arthroscopy using a 4-strand, knotless, double-row construct. The technique involves reducing the displaced fragment with 2 medially placed, transtendinous anchors and compressing the greater tuberosity using the tapes from these medial anchors in 2 laterally placed anchors. The exclusion criteria were a fracture that was more than 10 days old at the time of surgery or a history of shoulder surgery and 3- or 4-part fractures. The postoperative rehabilitation protocol was similar for all patients. Constant scores, Quick Dash, return to work and sies of knotless double-row constructs contributed to postoperative satisfactory functional results and healing of greater tuberosity fracture. In addition, range of motion was early, and no hardware removal was required. However, care should be taken with osteopenic bone where anchorage can fail.

Level IV, case series.
Level IV, case series.
To determine whether patients who are prescribed ibuprofen after arthroscopic rotator cuff repair have significantly different patient-reported outcomes for pain, function, and overall health at baseline and 1 and 2 years after operation relative to patients only prescribed opioids.

Patients who underwent a rotator cuff repair by a total of 3 surgeons and participated in the outcomes registry from 2012 to 2016 were screened for inclusion in this study. Inclusion criteria were primary arthroscopic rotator cuff repair, at least 2 years from the date of surgery and over the age of 18. Exclusion criteria were revision and open rotator cuff repair. All patients followed the standard postoperative rehabilitation protocol for rotator cuff repair. Patients were divided into 2 cohorts. Group I included patients who received ibuprofen/nonsteroidal anti-inflammatory agents (NSAID) after surgery (n= 281), and Group II consisted of patients who did not receive ibuprofen/NSAID after surgery (n= 182). Patient-reported onificant differences in patient-reported outcomes for all metrics between the group prescribed ibuprofen and the group that was not prescribed ibuprofen at 1 and 2 years after surgery or in change from baseline.

Patients receiving ibuprofen did as well as patients who did not receive ibuprofen after arthroscopic rotator cuff repair on patient-reported outcome measures assessing shoulder pain, function, and overall health.

Level III, retrospective comparative study.
Level III, retrospective comparative study.
The aim of this study was to determine the correlation between functional outcome scores and treatment success after arthroscopic rotator cuff repair.

We conducted a retrospective cohort study of patients who underwent unilateral rotator cuff repair at a tertiary hospital between 2010 and 2015. University of California at Los Angeles Shoulder Score (UCLASS), Constant Shoulder Score (CSS), and Oxford Shoulder Score (OSS) were measured before and at 6, 12, and 24 months after surgery. Patients were divided into 2 groups at each follow-up (1) those with successful treatment and (2) those with unsuccessful treatment. Treatment success was defined as simultaneous fulfilment of 3 criteria clinically significant improvement in pain, expectations for surgery met, and patient satisfied with surgery.

A total of 214 subjects met the inclusion criteria. UCLASS was a consistent significant predictor of treatment success at 6 months (odds ratio [OR] 1.192,
= .005, 95% confidence interval [CI] 1.054-1.348), 12 months (OR 1.274,
<.001, 95% CI 1.153-1.406), and 24 months (OR 1.266,
< .001, 95% CI 1.162-1.380). Lower preoperative CSS was significant in predicting treatment success at 6 months (OR 0.952,
= .001, 95% CI 0.926-0.979), while larger tear size was significant in predicting treatment success at 24 months (OR 1.773,
= .043, 95% CI 1.019-3.083).

UCLASS is a better tool for predicting treatment success than CSS and OSS in patients undergoing arthroscopic rotator cuff repair, up to a minimum of 24 months' follow-up. A holistic assessment of shoulder function, taking into account both subjective and objective evaluation of function, as well as patient-reported satisfaction, is important in determining treatment success after arthroscopic rotator cuff repair.

III, retrospective comparative study.
III, retrospective comparative study.
To assess the postoperative objective, subjective, and functional outcomes as well as complication rates in osteochondral defect patients treated with bone marrow aspirate concentrate (BMAC) and cartilage-derived matrix (CDM) during knee arthroscopy.

A retrospective chart review was performed for patients treated arthroscopically with BMAC and CDM between August 2015 and August 2018 and had more than 1-year follow-up. Demographic factors such as age, sex, body mass index, and comorbidities were collected for all patients. Size and location of the osteochondral lesions also were documented.

A total of 14 patients were identified with a mean follow-up of 19 months. On average, patients were 34 years of age (range 16-58 years) and 43% were female. Postoperatively, knee flexion increased by 8° from 124° to 132° (
= .002). All patients regained full extension; however, 1 patient later acquired a 2° extension contracture after a traumatic event. The average hamstring strength significantly increased from 4.1 to 4.6 postoperatively (
= .33). The average quadriceps strength significantly increased from 4.0 to 4.5 postoperatively (
= .007). selleck products Mean visual analog scale scores significantly decreased postoperatively (4.5 vs 1.4;
= .001). There was a significant increase in Knee Outcome Survey Activities of Daily Living scores (53.8 vs 92.9;
= .007). Mean Knee Outcome Survey-Sports scores also increased, although this was nonsignificant (28.2 vs 79.5;
= .560). No significant differences were noted in pain and functional outcomes when stratified by the osteochondral defect size and location. Complications included a stitch abscess, Baker's cyst, and residual pain treated with hyaluronic acid injection.

This study demonstrated arthroscopic BMAC and CDM implantation appears to be safe and has the potential to improve patient outcomes in the short-term postoperative period.

IV, therapeutic case series.
IV, therapeutic case series.
To describe which patients are the most likely to undergo surgical management within the same calendar year as their emergency department visit for anterior shoulder instability.

The State Emergency Department Databases and State Ambulatory Surgery and Services Databases from Florida were used. All patients presenting to the emergency department for anterior shoulder subluxation or dislocation between January 1 and September 30, 2017, were selected. Bivariate analysis was performed for associations with demographic variables. A binary logistic regression was performed with all significant factors to assess which were predictors of undergoing surgery the same calendar year.

While controlling for all significant factors, we found that patients with recurrent dislocations were 3.14 times more likely to have surgery within the same year (
= .037). Patients younger than 40 years were also 2.04 times more likely to have surgery than those aged 40 years or older (
< .001). White patients were 2.47 times more likely to have surgery than black patients (
< .
Website: https://www.selleckchem.com/products/prostaglandin-e2-cervidil.html