Patellar tendon restoration techniques: a systematic review of outcomes for repair and reconstruction methods.

PURPOSE: This systematic review aims to delineate the various methods to repair or reconstruct the patellar tendon using the available literature. METHODS: MEDLINE and PubMed electronic databases were searched for English language clinical studies involving patellar tendon rupture repair or reconstruction that reported patient-reported outcome scores (PROS) between January 1st, 1953 and June 17th, 2021. Data was extracted on full text articles to collect functional outcome scores and rupture category, including acute, chronic, post-total knee arthroplasty (TKA) and post-anterior cruciate ligament reconstruction (ACLR). RESULTS: Twenty-three studies with a total of 738 patients were included. Of the 14 studies including acute repairs, mean postoperative Lvsholm scores ranged from 84 to 99.5. Knee Society Score (KSS) and knee range of motion (ROM) measurement were the most widely reported outcomes in the chronic setting. The average postoperative KSS scores ranged from 70 to 87.7. Of the six studies that included patellar tendon repairs/reconstructions in the setting of prior TKA, the most frequently reported outcomes were KSS scores and knee ROM measurements. The average postoperative KSS scores for the three cohorts reporting reconstruction with allograft ranged from 79 to 88 as compared to the average postoperative KSS score for reconstruction with autograft of 70. CONCLUSION: Despite this heterogeneity, we concluded: (1) in the primary setting, cerclage augmentation yields the lowest lysholm scores and should not be considered, although primary repairs with and without augmentation yield comparable postoperative lysholm scores, (2) in the chronic setting, repair with augmentation and reconstruction yielded similar results aside from in post-TKA patients where allograft reconstruction yielded superior KSS scores.

Object Weight and Hand Dominance Impact Kinematics in a Functional Reach-to-Drink Task in School-Aged Children.

This study evaluates the effects of object weight and hand dominance on the end-point kinematics of the hand-to-mouth (withdrawal) movement in a functional reach-to-drink task for typically developing school-aged children. Using 3D motion capture, speed (average velocity and peak velocity), straightness (ratio), and smoothness (number of velocity peaks and log dimensionless jerk) of hand movements were calculated for the withdrawal motion with three different bottle weights (empty, half-filled, and full). Average velocity (550.4 ± 142.0 versus 512.1 ± 145.6 mm/s) and peak velocity (916.3 ± 234 versus 842.7 ± 198.4 mm/s) were significantly higher with the empty versus half-filled bottle and with the non-dominant (average: 543.5 ± 145.2 mm/s; peak: 896.5 ± 207 mm/s) versus dominant (average: 525.2 ± 40.7 mm/s; peak: 864.2 ± 209.2 mm/s) hand. There were no differences in straightness or smoothness. These findings indicate that increasing weight in reach-to-drink task puts greater constraints on the task. The slower movements with the dominant hand might denote better precision control than the non-dominant hand. The quantitative motion capture results show average values for the kinematic variables for a functional reach-to-drink task in a typically developing population of school-aged children with changing weights of the bottles that are relevant to a real-life scenario. These results could inform the design of individualized therapeutic interventions to improve functional upper-extremity use in children with neurodevelopmental motor disorders.

Individuals with a ventral hernia who report moderate to high fear have worse functional performance than those with low fear.

PURPOSE: Ventral hernia repairs (VHR) are performed to restore the integrity of the abdominal wall. Fear of movement, or kinesiophobia, may develop in patients with ventral hernia due to pain and functional impairments, however it has not yet been objectively measured in this patient population. The purpose of this study was to test the hypothesis that in patients with ventral hernia awaiting surgical repair, higher levels of kinesiophobia would be associated with poorer mobility, abdominal core function, and quality of life. METHODS: Seventy-seven participants scheduled for ventral hernia repair were enrolled as part of an ongoing randomized controlled trial (NCT05142618). The Tampa Scale of Kinesiophobia (TSK-11) is an 11-item questionnaire that asks about fear of movement and physical activity restriction. Participants were split into groups based on their TSK-11 score (minimal, low, moderate to high). Primary outcome measures included the five-time sit-to-stand (5xSTS), Quiet Unstable Sitting Test (QUeST), and the Hernia-Related Quality-of-Life (HerQLeS) survey. A one-way ANOVA with a Bonferroni correction compared QUeST, 5xSTS, and HerQLes results between groups. RESULTS: Groups were significantly different on 5xSTS (minimal: 11.4 ± 2.6 s, low: 13.8 ± 3.1 s, moderate to high: 17.8 ± 9.8 s; p = 0.001) and HerQLes (minimal: 58.0 ± 27.8, low: 49.4 ± 22.0, moderate to high: 30.6 ± 25.3; p = 0.003) but not QUeST (minimal: - 2.8 ± 2.5, low: - 6.8 ± 10.0, moderate to high: - 5.5 ± 5.0; p = 0.16). CONCLUSION: Individuals with moderate to high kinesiophobia have worse pre-operative performance-based (5xSTS) and self-reported (HerQLes) function and quality of life than those with minimal and low kinesiophobia. Future research should examine the influence of kinesiophobia on post-operative outcomes as it may be a potent target for rehabilitation.

Safety and efficacy of tenalisib in combination with romidepsin in patients with relapsed/refractory T-cell lymphoma: results from a phase I/II open-label multicenter study.

Tenalisib, a selective phosphoinositide-3-kinase δ/γ, and salt-inducible-kinase-3 inhibitor has shown efficacy and was well-tolerated in patients with T-cell lymphoma (TCL). In vitro studies suggest a synergistic anti-tumor potential for the combination of tenalisib with the histone-deacetylase inhibitor, romidepsin. This multicenter, open-label, phase I/II study was designed to characterize the safety, efficacy and pharmacokinetics of oral tenalisib twice-daily and intravenous romidepsin administered on days 1, 8 and 15 in 28-day cycles in adults with relapsed/refractory TCL. Phase I/dose escalation determined the maximum tolerated dose (MTD)/optimal doses of tenalisib and romidepsin. The phase II/dose expansion assessed the safety and anti-tumor activity of the combination at MTD/optimal dose. Overall, 33 patients were enrolled. In dose escalation, no dose-limiting toxicity was identified. Hence, the recommended doses for dose expansion were tenalisib 800 mg twice daily orally, and romidepsin 14 mg/m2 intravenous. Overall treatment-emergent adverse events of any grade reported in >15% of patients were nausea, thrombocytopenia, increased aspartate aminotransferase, increased alanine aminotransferase, decreased appetite, neutropenia, vomiting, fatigue, anemia, dysgeusia, weight loss, diarrhea, and hypokalemia. Twenty-three patients (69.7%) had related grade ≥3 treatment-emergent adverse events. The overall objective response rate in evaluable patients was 63.0% (peripheral TCL: 75% and cutaneous TCL: 53.3%), with a complete response and partial response of 25.9% and 37.0% respectively. The median duration of response was 5.03 months. Co-administration of tenalisib and romidepsin did not significantly alter the pharmacokinetics of romidepsin. Overall, tenalisib and romidepsin combination demonstrated a favorable safety and efficacy profile supporting its further development for relapsed/refractory TCL (clinicaltrials gov. Identifier: NCT03770000).

ABVENTURE-P pilot trial of physical therapy versus standard of care following ventral hernia repair: Protocol for a randomized controlled trial.

Hernia disease is one of the most common reasons patients seek surgical treatment, yet nearly 1 in 4 patients seeking ventral hernia repair in the United States suffer from chronic pain, disability, and diminished physical activity. The relationships between the anterior abdominal wall, lower back, diaphragm, and pelvic floor are critical in providing function and quality of life, yet management of hernia disease has been limited to surgical restoration of anatomy without taking into consideration the functional relationships of the abdominal core. Therefore, the primary goal of this study is to evaluate the feasibility of implementing physical therapy targeted to improving stability and function in this population. A secondary goal is to estimate whether pre-operative abdominal core function predicts responsiveness to physical therapy. This study is a registry-based randomized controlled trial (NCT05142618: Pilot Trial of Abdominal Core Rehabilitation To Improve Outcomes After Ventral Hernia Repair (ABVENTURE-P)). All participants will be randomized to one of two post-operative treatment arms: standard of care plus up to 16 sessions of physical therapy, or standard of care alone. Primary timepoints include pre-operative (baseline) and ten weeks after surgery, with intermediate or secondary timepoints 30 days, 6 months, and 1 year post-operative. At each timepoint, participants will undergo functional and patient-reported outcome testing. We will also collect data on retention rate and treatment adherence. An intention to treat approach is planned for all analyses, using all participants who were randomized and have available data at the 10-week timepoint. This is a pilot and feasibility trial, hence our goals are to establish safety and initial efficacy of the PT intervention, retention and adherence to both PT and control arms, whether pre-operative abdominal core function predicts responsiveness to PT, and to collect a large enough sample to power a future definitive multi-center randomized controlled trial.

A comparative study on characteristics of composite (Cr3C2-NiCr) clad developed through diode laser and microwave energy.

A typical ferrite/martensitic heat-resistant steel (T91) is widely used in reheaters, superheaters and power stations. Cr3C2-NiCr-based composite coatings are known for wear-resistant coatings at elevated temperature applications. The current work compares the microstructural studies of 75 wt% Cr3C2- 25 wt% NiCr-based composite clads developed through laser and microwave energy on a T91 steel substrate. The developed clads of both processes were characterized through a field emission scanning electron microscope (FE-SEM) attached with energy-dispersive X-ray spectroscopy (EDS), X-ray diffraction (XRD) and assessment of Vickers microhardness. The Cr3C2-NiCr based clads of both processes revealed better metallurgical bonding with the chosen substrate. The microstructure of the developed laser clad shows a distinctive dense solidified structure, with a rich Ni phase occupying interdendritic spaces. In the case of microwave clad, the hard chromium carbide particles consistently dispersed within the soft nickel matrix. EDS study evidenced that the cell boundaries are lined with chromium where Fe and Ni were found inside the cells. The X-ray phase analysis of both the processes evidenced the common presence of phases like chromium carbides (Cr7C3, Cr3C2, Cr23C6), Iron Nickel (FeNi3) and chromium-nickel (Cr3Ni2, CrNi), despite these phases iron carbides (Fe7C3) are observed in the developed microwave clads. The homogeneous distributions of such carbides in the developed clad structure of both processes indicated higher hardness. The typical microhardness of the laser-clad (1142 ± 65HV) was about 22% higher than the microwave clad (940 ± 42 HV). Using a ball-on-plate test, the study analyzed microwave and laser-clad samples' wear behavior. Laser-cladding samples showed superior wear resistance due to hard carbide elements. At the same time, microwave-clad samples experienced more surface damage and material loss due to micro-cutting, loosening, and fatigue-induced fracture.

Task-Related Differences in End-Point Kinematics in School-Age Children with Typical Development.

Understanding whether and how children with typical development adapt their reaches for different functional tasks could inform a more targeted design of rehabilitation interventions to improve upper extremity function in children with motor disabilities. This prospective study compares timing and coordination of a reach-to-drink, reach-to-eat, and a bilateral reaching task in typically developing school-aged children. Average speed, straightness, and smoothness of hand movements were measured in a convenience sample of 71 children, mean age 8.77 ± 0.48 years. Linear mixed models for repeated measures compared the variables by task, phases of the reach, task x phase interactions, and dominant versus non-dominant hands. There were significant main effects for task and phase, significant task x phase interactions (p < 0.05), and a significant difference between the dominant and non-dominant hand for straightness. Hand movements were fastest and smoothest for the reach-to-eat task, and least straight for the bilateral reaching task. Hand movements were also straighter in the object transport phases than the prehension and withdrawal phases. These results indicate that children with typical development change their timing and coordination of reach based on the task they are performing. These results can inform the design of rehabilitation interventions targeting arm and hand function.

Utilization Trends, Patient-Demographics, and Comparison of Medical Complications of Sliding Hip Screw or Intramedullary Nail for Intertrochanteric Fractures: A Nationwide Analysis from 2005 to 2014 of the Medicare Population.

Background: Studies demonstrate an increase incidence of intertrochanteric fractures within the United States. Matched studies evaluating intertrochanteric fractures managed with either sliding hip screw (SHS) or intramedullary nail (IMN) within the Medicare population are limited. The purpose of this study was to investigate: 1) annual utilization trends; 2) patient demographics; and 3) complications including mortality. Methods: A retrospective query using a nationwide database was performed. Patients undergoing SHS or IMN for intertrochanteric fractures were identified. The query yielded a total of 37,929 patients utilizing SHS (n = 11,665) or IMN (n = 26,264). Patients were matched 1:1 based on comorbidities. Primary outcomes included: utilization trends, patient demographics, 90-day complications, and 90-day readmission rates. Linear regression analyses were used to compare utilization trends. Pearson's c2 analyses were used to compare patient-demographics, medical complications, and 90-day readmission rates. A p-value less than 0.05 was considered statistically significant. Results: Linear regression analysis demonstrated a statistically significant decrease in utilization of SHS for IT fractures (p<0.0001); whereas utilization for IMN stayed consistent (p=0.36). IMN had significantly higher prevalence of comorbidities compared to SHS, notably, hyperlipidemia (70.6 vs. 62.6%; p<0.0001). Based on 1:1 match, IMN patients had significantly higher rates of 90-day medical complications, such as respiratory failure (11.0 vs. 8.1%; p<0.0001) and VTE (4.2 vs. 3.2%; p<0.001; however, there was not a statistical difference in postoperative infection (1.4 vs. 1.5%, p=0.06). There was no statistical difference in 90-day mortality between IMN and SHS cohorts (0.19 vs .13%, p = 0.249). Conclusion: This analysis demonstrates a difference in utilization of SHS and IMN for patients with IT fractures. Patients with IMN had significantly higher prevalence of comorbid conditions and incidence of 90-day postoperative complications compared to SHS patients. The study can be utilized by orthopaedic surgeons to potentially anticipate healthcare utilization depending on implant selection. Level of Evidence: III.

The influence of receiving real-time visual feedback on breathing during treadmill running to exhaustion.

Breathing plays a vital role in everyday life, and specifically during exercise it provides working muscles with the oxygen necessary for optimal performance. Respiratory inductance plethysmography (RIP) monitors breathing through elastic belts around the chest and abdomen, with efficient breathing defined by synchronous chest and abdomen movement. This study examined if providing runners with visual feedback through RIP could increase breathing efficiency and thereby time to exhaustion. Thirteen recreational runners (8F, 5M) ran to exhaustion on an inclined treadmill on two days, with visual feedback provided on one randomly chosen day. Phase angle was calculated as a measure of thoraco-abdominal coordination. Time to exhaustion was not significantly increased when visual feedback was provided (p = 1). Phase angle was not significantly predicted by visual feedback (p = 0.667). Six participants improved phase angle when visual feedback was provided, four of whom increased time to exhaustion. Four participants improved phase angle by 9° or more, three of whom increased time to exhaustion. Participants who improved phase angle with visual feedback highlight that improving phase angle could increase time to exhaustion. Greater familiarization with breathing techniques and visual feedback and a different paradigm to induce running fatigue are needed to support future studies of breathing in runners.

Is modular control related to functional outcomes in individuals with knee osteoarthritis and following total knee arthroplasty?

BACKGROUND: Individuals who undergo total knee arthroplasty (TKA) for treatment of knee osteoarthritis often experience suboptimal outcomes. Investigation of neuromuscular control strategies in these individuals may reveal factors that contribute to these functional deficits. The purpose of this pilot study was to determine the relationship between patient function and modular control during gait before and after TKA. METHODS: Electromyography data from 36 participants (38 knees) were collected from 8 lower extremity muscles on the TKA-involved limb during ≥5 over-ground walking trials before (n = 30), 6-months after (n = 26), and 24-months after (n = 13) surgery. Muscle modules were estimated using non-negative matrix factorization. The number of modules was determined from 500 resampled trials. RESULTS: A higher number of modules was related to better performance-based and patient-reported function before and 6-months after surgery. Participants with organization similar to healthy, age-matched controls trended toward better function 24-months after surgery, though these results were not statistically significant. We also observed plasticity in the participants' modular control strategies, with 100% of participants who were present before and 24-months after surgery (10/10) demonstrating changes in the number of modules and/or organization of at least 1 module. CONCLUSIONS: This pilot work suggests that functional improvements following TKA may initially present as increases in the number of modules recruited during gait. Subsequent improvements in function may present as improved module organization. NOTEWORTHY: This work is the first to characterize motor modules in TKA both before and after surgery and to demonstrate changes in the number and organization of modules over the time course of recovery, which may be related to changes in patient function. The plasticity of modular control following TKA is a key finding which has not been previously documented and may be useful in predicting or improving surgical outcomes through novel rehabilitation protocols.

Discover your potential: The influence of kinematics on a muscle's ability to contribute to the sit-to-stand transfer.

Existing methods for estimating how individual muscles contribute to a movement require extensive time and experimental resources. In this study we developed an efficient method for determining how changes to lower extremity joint kinematics affect the potential of individual muscles to contribute to whole-body center-of-mass vertical (support) and anteroposterior (progression) accelerations. A 4-link 2-dimensional model was used to assess the effect of kinematic changes on muscle function. Joint kinematics were systematically varied throughout ranges observed during the momentum transfer phase of the sit-to-stand transfer. Each muscle's potential to contribute to support and progression was computed and compared to simulated potentials estimated by traditional dynamic simulation methods for young adults and individuals with knee osteoarthritis. The new method required 4-10s to compute muscle potentials per kinematic state and computed potentials were consistent with simulated potentials. The new method identified differences in muscle potentials between groups due to kinematic differences, particularly decreased anterior pelvic tilt in young adults, and revealed kinematic and muscle strengthening modifications to increase support. The methods presented provide an efficient, systematic approach to evaluate how joint kinematic adjustments alter a muscle's ability to contribute to movement and can identify potential sources of pathologic movement and rehabilitation strategies.

A Quiet Unstable Sitting Test to quantify core stability in clinical settings: Application to adults with ventral hernia.

BACKGROUND: The abdominal core is comprised of the diaphragm, abdominal wall, and pelvic floor, and serves several important functions for balance, movement, and strength. Injury to this area, such as hernia, can have substantial impact. The Quiet Unstable Sitting Test involves individuals seated on the rounded surface of a BOSU® balance trainer placed on top of a force plate and situated on a flat, elevated surface. METHODS: An ordinal Quiet Unstable Sitting Test core stability score was calculated from center of pressure measurements, with 0 representing "normal" and < 0 indicating worsening stability. Hernia-Related Quality of Life survey summary scores were assessed (higher scores indicating better quality). FINDINGS: A developmental cohort of 32 was used to establish reliability and normative values for the Quiet Unstable Sitting Test. A control group of 32 participants (43.7 ± 16.2 yrs., BMI 29.0 ± 4.9, 66% Female) was then compared to 21 patients with hernia (56.2 ± 12.5 yrs., BMI 29.2 ± 6.3, 24% Female). Hernia patients had median composite score of -2 and median quality of life score of 66, versus median Quiet Unstable Sitting Test of -0.5 and median quality of life of 93 for controls (p ≤ 0.01). Quality of life and Quiet Unstable Sitting Test scores were not correlated (p > 0.05). INTERPRETATION: Hernia patients demonstrated significantly worse core stability and quality of life. These assessments were independent of one another across the entire population, indicating each measure's unique constructs of patient function. Core stability can be reliably measured in a clinical setting and may help with patient activation and rehabilitation.

Emergency Department Utilization Is Low After Outpatient Elective Rotator Cuff Repair.

INTRODUCTION: The purpose of this study was to establish emergency department (ED) utilization rate and reasons for presentation to the ED after outpatient rotator cuff repair (RCR) and determine preoperative predictors for these ED visits. METHODS: Patients who underwent outpatient RCR between 2014 and 2015 were retrospectively evaluated using the New York and Florida State Databases. The primary outcome was all-cause 7- and 30-day ED utilization rates. Reasons for presentation to the ED were recorded and stratified. Univariate and multivariate analyses were done to identify independent predictors of ED utilization. RESULTS: The 7- and 30-day ED visit rates were 3.2% and 5.0%, respectively. The most common cause for an ED visit after outpatient RCR at 7- and 30-days postoperatively were postoperative pain (29.0%) and GI complaints (16.3%), respectively. African American race (odds ratio [OD], 1.69; P < 0.001), Hispanic race (OD, 1.47; P = 0.005), and comorbid diagnoses of hypertension (OD, 1.51; P < 0.001), diabetes (OD, 1.58; P < 0.001), and/or schizophrenia (OD, 5.14; P < 0.001) were independent risk factors for an ED visit at up to 30 days postoperatively. Those with Medicare (OD, 2.01; P < 0.001) or Medicaid (OD, 2.61; P < 0.001) were more than twice as likely to present to the ED within 30 days than those with private health insurance. DISCUSSION: ED utilization after outpatient RCR is uncommon with postoperative pain as the most common chief concern for ED visits within the first 7 days and GI issues as the most common reason for ED encounters at up to 30 days postoperatively. Hypertension, diabetes, renal failure, liver disease, rheumatologic diseases, schizophrenia, depression, and Medicare and Medicaid insurance were independent predictors of ED encounters at up to 30 days postoperatively. Procedures done at freestanding surgery centers were protective against ED utilization. LEVEL OF EVIDENCE: Level III, Retrospective Cohort.

Effects of age and knee osteoarthritis on the modular control of walking: A pilot study.

BACKGROUND: Older adults and individuals with knee osteoarthritis (KOA) often exhibit reduced locomotor function and altered muscle activity. Identifying age- and KOA-related changes to the modular control of gait may provide insight into the neurological mechanisms underlying reduced walking performance in these populations. The purpose of this pilot study was to determine if the modular control of walking differs between younger and older adults without KOA and adults with end-stage KOA. METHODS: Kinematic, kinetic, and electromyography data were collected from ten younger (23.5 ± 3.1 years) and ten older (63.5 ± 3.4 years) adults without KOA and ten adults with KOA (64.0 ± 4.0 years) walking at their self-selected speed. Separate non-negative matrix factorizations of 500 bootstrapped samples determined the number of modules required to reconstruct each participant's electromyography. One-way Analysis of Variance tests assessed the effect of group on walking speed and the number of modules. Kendall rank correlations (τb) assessed the association between the number of modules and self-selected walking speed. RESULTS: The number of modules required in the younger adults (3.2 ± 0.4) was greater than in the individuals with KOA (2.3 ± 0.7; p = 0.002), though neither cohorts' required number of modules differed significantly from the unimpaired older adults (2.7 ± 0.5; p ≥ 0.113). A significant association between module number and walking speed was observed (τb = 0.350, p = 0.021) and individuals with KOA walked significantly slower (0.095 ± 0.21 m/s) than younger adults (1.24 ± 0.15 m/s; p = 0.005). Individuals with KOA also exhibited altered module activation patterns and composition (which muscles are associated with each module) compared to unimpaired adults. CONCLUSION: These findings suggest aging alone may not significantly alter modular control; however, the combined effects of knee osteoarthritis and aging may together impair the modular control of gait.

Impact of depressive disorders on primary total shoulder arthroplasties: a matched control analysis of 113,648 Medicare patients.

INTRODUCTION: The purpose of this study was to investigate whether patients with depressive disorders undergoing primary total shoulder arthroplasty have higher rates of (1) in-hospital lengths of stay, (2) readmission rates, (3) medical complications, and (4) implant-related complications. METHODS: A retrospective query was performed using a national claims database. Study group patients were matched to controls in a 1:5 ratio according to age, sex, and medical comorbidities. The query yielded 113,648 patients who were with (n = 18,953) and without (n = 94,695) depressive disorders. Pearson's χ2 analyses were used to compare patient demographics. Logistic regression analyses were used to calculate odds-ratios of complications and readmission rates. Welch's t-tests were used to test for significance for in-hospital lengths of stay. A p-value less than 0.003 was considered statistically significant. RESULTS: Study group patients had significantly longer in-hospital lengths of stay (2.7 days versus 2.3 days; p < 0.0001). Patients who have depressive disorders had higher incidences and odds of readmissions (9.4 versus 6.15%; odds-ratio: 1.6, p < 0.0001), medical complications (2.7 versus 0.9%; odds-ratio: 3.0, p < 0.0001), and implant-related complications (6.1 versus 2.4%; odds-ratio: 2.59, p < 0.0001) compared to controls. CONCLUSION: Depressive disorder patients have longer in-hospital lengths of stay and increased odds of readmissions and complications following primary total shoulder arthroplasty.

Measuring Vestibular Contributions to Age-Related Balance Impairment: A Review.

Aging is associated with progressive declines in both the vestibular and human balance systems. While vestibular lesions certainly contribute to imbalance, the specific contributions of age-related vestibular declines to age-related balance impairment is poorly understood. This gap in knowledge results from the absence of a standardized method for measuring age-related changes to the vestibular balance pathways. The purpose of this manuscript is to provide an overview of the existing body of literature as it pertains to the methods currently used to infer vestibular contributions to age-related imbalance.

Effects of spinal coupling and marker set on tracking of spine models during running.

Despite the wide-spread use of musculoskeletal simulations and its use in estimating spinal loads, much is not known about how to best collect experimental data for modelling purposes. The primary purposes in this study were to determine the effects of tracking of running motion capture data to a model (1) with and without coupling of lumbar spine segments, and (2) with varying combinations of spinal markers. Running trials were collected from 7 participants, with each at three different speeds. The motion data was fit to the Full-Body Lumbar Spine Model (FBLS) with coupling of the lumbar spine enabled (CS) and disabled and therefore rigid (RS) in OpenSim through the Inverse Kinematics tool (IK). Different combinations of markers were chosen as tracking inputs for IK to represent experimental data collection with different marker sets. Root-mean-square (RMS) marker errors of all 13 markers along the spine for each gait cycle were calculated. The CS model resulted in 23.7% lower errors than the RS model (p < 0.001). The marker subset analysis showed that increasing the number of markers in the experimental data collection decreases the error, with the four marker tracking subsets with the highest number of markers tracked having the lowest errors. The location of the marker and timing in the gait cycle did not affect marker error. When spinal mechanics are of interest, the inclusion of a coupled lumbar spine in the model and a larger spinal marker set help better track experimental kinematics when fitting to a model.

High Number of Door Openings Increases the Bacterial Load of the Operating Room.

Background: Operating room (OR) traffic and door openings have emerged as potential modifiable risk factors for the development of surgical site infections. Methods: This study compared the microbial load of a Control OR without traffic versus a Simulated OR with the traffic in a typical orthopedic surgery case. Air particle counts and colony forming units (CFUs) were measured. A novel iOS app was developed to provide real-time door counts. Results: There were 1,862 particles >5.0 mcm in the Simulated OR compared with 56 in the Control OR. The CFUs from plates in the Simulated OR ranged from 4-22 (on brain heart infusion [BHI] agar), 2-266 (on mannitol salt agar [MSA]), and 1-19 (on Pseudomonas isolation agar [PIA]), while all plates in the Control OR grew 0-1 CFUs. Conclusions: High number of door openings leads to more airborne bacteria in the OR and viable bacterial on OR surfaces. The increased bacterial load throughout the OR was independent of distance from the door.

Comparison of Patient Demographics and Utilization Trends of Robotic-Assisted and Non-Robotic-Assisted Unicompartmental Knee Arthroplasty.

Robotic-assisted unicompartmental knee arthroplasty (RAUKA) is an emerging area of interest. The purpose of this study was to compare (1) different patient demographic profiles; (2) annual primary and revision utilization rates; (3) risk factors for revision procedures; and (4) survivorship between RAUKA and manual UKA (MUKA). Using the PearlDiver database, patients who underwent RAUKA or MUKA between 2005 and 2014 within the Medicare database were identified, yielding a total of 35,061 patients (RAUKA = 13,617; manual = 21,444). Patient demographics (age, gender, comorbidities, Charlson-Comorbidity Index, and geographic region) were compared between cohorts. Annual primary and revision utilization rates as well as risk factors for revision procedures were also compared. Kaplan-Meier survivorship was also calculated. The Pearson χ2 test was used to test for significance in patient demographics, whereas the Welch t-test was used to compare the incidence of revisions as well as the revision burden (proportion of revisions to total sum of primary and revision procedures). Multivariate binomial logistic regression analysis was performed to compare risk factors for revision procedures. There were statistically significant differences in RAUKA versus MUKA patients with respect to age (p < 0.001), gender (p < 0.001), and region (p < 0.001). RAUKA procedures performed increased over 12-fold compared with manual, which increased only 4.5-fold. RAUKA procedures had significantly lower revision incidence (0.99 vs. 4.24%, p = 0.003) and revision burden (0.91 vs. 4.23%, p = 0.005) compared with manuals. For patients undergoing RAUKA, normal (19-24 kg/m2) and obese (30-39 kg/m2) body mass index (p < 0.05), congestive heart failure (p = 0.004), hypothyroidism (p < 0.001), opioid dependency (p = 0.002), and rheumatoid arthritis (p < 0.001) were risk factors for a revision procedure. Kaplan-Meier survival curve 3 years following the index procedure to all-cause revisions demonstrated that RAUKA patients maintained nearly 100% survivorship compared with manual patients who had 97.5% survivorship. The data demonstrate increased utilization of RAUKA in the United States. The current data indicated that RAUKA has significantly lower revision rates and improved survivorship compared with patients undergoing non-RAUKA within Medicare patients.

3D Motion Capture May Detect Spatiotemporal Changes in Pre-Reaching Upper Extremity Movements with and without a Real-Time Constraint Condition in Infants with Perinatal Stroke and Cerebral Palsy: A Longitudinal Case Series.

Perinatal stroke (PS), occurring between 20 weeks of gestation and 28 days of life, is a leading cause of hemiplegic cerebral palsy (HCP). Hallmarks of HCP are motor and sensory impairments on one side of the body-especially the arm and hand contralateral to the stroke (involved side). HCP is diagnosed months or years after the original brain injury. One effective early intervention for this population is constraint-induced movement therapy (CIMT), where the uninvolved arm is constrained by a mitt or cast, and therapeutic activities are performed with the involved arm. In this preliminary investigation, we used 3D motion capture to measure the spatiotemporal characteristics of pre-reaching upper extremity movements and any changes that occurred when constraint was applied in a real-time laboratory simulation. Participants were N = 14 full-term infants: N = six infants with typical development; and N = eight infants with PS (N = three infants with PS were later diagnosed with cerebral palsy (CP)) followed longitudinally from 2 to 6 months of age. We aimed to evaluate the feasibility of using 3D motion capture to identify the differences in the spatiotemporal characteristics of the pre-reaching upper extremity movements between the diagnosis group, involved versus uninvolved side, and with versus and without constraint applied in real time. This would be an excellent application of wearable sensors, allowing some of these measurements to be taken in a clinical or home setting.