Can generative artificial intelligence pass the orthopaedic board examination?

Background: Resident training programs in the US use the Orthopaedic In-Training Examination (OITE) developed by the American Academy of Orthopaedic Surgeons (AAOS) to assess the current knowledge of their residents and to identify the residents at risk of failing the Amerian Board of Orthopaedic Surgery (ABOS) examination. Optimal strategies for OITE preparation are constantly being explored. There may be a role for Large Language Models (LLMs) in orthopaedic resident education. ChatGPT, an LLM launched in late 2022 has demonstrated the ability to produce accurate, detailed answers, potentially enabling it to aid in medical education and clinical decision-making. The purpose of this study is to evaluate the performance of ChatGPT on Orthopaedic In-Training Examinations using Self-Assessment Exams from the AAOS database and approved literature as a proxy for the Orthopaedic Board Examination. Methods: 301 SAE questions from the AAOS database and associated AAOS literature were input into ChatGPT's interface in a question and multiple-choice format and the answers were then analyzed to determine which answer choice was selected. A new chat was used for every question. All answers were recorded, categorized, and compared to the answer given by the OITE and SAE exams, noting whether the answer was right or wrong. Results: Of the 301 questions asked, ChatGPT was able to correctly answer 183 (60.8%) of them. The subjects with the highest percentage of correct questions were basic science (81%), oncology (72.7%, shoulder and elbow (71.9%), and sports (71.4%). The questions were further subdivided into 3 groups: those about management, diagnosis, or knowledge recall. There were 86 management questions and 47 were correct (54.7%), 45 diagnosis questions with 32 correct (71.7%), and 168 knowledge recall questions with 102 correct (60.7%). Conclusions: ChatGPT has the potential to provide orthopedic educators and trainees with accurate clinical conclusions for the majority of board-style questions, although its reasoning should be carefully analyzed for accuracy and clinical validity. As such, its usefulness in a clinical educational context is currently limited but rapidly evolving. Clinical relevance: ChatGPT can access a multitude of medical data and may help provide accurate answers to clinical questions.

Decompression Alone in the Setting of Adult Degenerative Lumbar Scoliosis and Stenosis: A Systematic Review and Meta-Analysis.

STUDY DESIGN: Systematic review and meta-analysis.OBJECTIVESSurgical decompression alone for patients with neurogenic leg pain in the setting of degenerative lumbar scoliosis (DLS) and stenosis is commonly performed, however, there is no summary of evidence for outcomes. METHODS: A systematic search of English language medical literature databases was performed for studies describing outcomes of decompression alone in DLS, defined as Cobb angle >10˚, and 2-year minimum follow-up. Three outcomes were examined: 1) Cobb angle progression, 2) reoperation rate, and 3) ODI and overall satisfaction. Data were pooled and weighted averages were calculated to summarize available evidence. RESULTS: Across 15 studies included in the final analysis, 586 patients were examined. Average preoperative and postoperative Cobb angles were 17.6˚ (Range: 12.7 - 25˚) and 18.0 (range 14.1 - 25˚), respectively. Average change in Cobb angle was an increase of 1.8˚. Overall rate of reoperation ranged from 3 to 33% with an average of 9.7%. Average ODI before surgery, after surgery, and change in scores were 56.4%, 27.2%, and an improvement of 29% respectively. Average from 8 studies that reported patient satisfaction was 71.2%. CONCLUSIONS: Current literature on decompression alone in the setting of DLS is sparse and is not high quality, limited to patients with small magnitude of lumbar coronal Cobb angle, and heterogenous in the type of procedure performed. Based on available evidence, select patients with DLS who undergo decompression alone had minimal progression of Cobb angle, relatively low reoperation rate, and favorable patient-reported outcomes.

Scoliosis Surgery: A Social Media Analysis of Content, Tone, and Perspective.

INTRODUCTION: The purpose of this study was to analyze posts shared on social media sites, Twitter and Instagram, referencing scoliosis surgery for tone, content, and perspective of the posts. METHODS: Public Twitter and Instagram posts from November 2020 to April 2021 were isolated using the hashtag #ScoliosisSurgery or the words "scoliosis surgery." A total of 5,022 Instagram and 1,414 Twitter posts were collected, of which 500 of each were randomly selected to be analyzed by the authors for the variables previously listed. RESULTS: Of the Instagram posts, 91.8% were associated with an image, and 47.8% were postoperative. 96.9% of the posts had either a positive or neutral tone. 38% delivered a progress update, and 29.9% disseminated education or sought to provide awareness. 48.6% of the posts were from the perspective of the patient. Of the Twitter posts, 60.1% contained only words, and 37.8% were postoperative. 75% of the posts had either a negative or neutral tone. 38.4% described a personal story, and 19.3% provided a progress update. 42.3% of the posts were from the perspective of the patient. CONCLUSION: Patients reported a positive tone on Instagram, displaying their progress updates and demonstrating contentment with scoliosis surgery, and a negative tone on Twitter, showing discontentment toward inadequate access to surgery. Although both platforms were used to distribute information and provide awareness, only a small percentage of posts were from physicians and hospitals, indicating opportunities for surgeons to use social media to connect with patients.

Can MRI knee joint measurements predict the population at risk of ACL injury?

BACKGROUND: Anterior cruciate ligament (ACL) injuries have been increasing significantly over time. The relationship between the ACL injury and the knee joint structures is poorly understood. The purpose of this study is to examine whether the measurements of different structures in the knee joint are linked with ACL injury in affected patients. METHODS: This retrospective case-control study included patients who suffered from ACL tears and underwent magnetic resonance imaging (MRI). A control group of patients with no knee pathologies on MRI was included. Fourteen knee variables, including lateral meniscus (LM) posterior horn height, length, depth, and volume; medial meniscus (MM) posterior horn height, length, depth, and volume; lateral and medial (MFC) femoral condyle sphere diameter; lateral and medial tibial plateau length; and patella tendon horizontal and vertical diameter, were collected. A multivariate logistic regression including LM posterior horn depth, MM posterior horn length, MM volume, MFC sphere diameter, and patella tendon horizontal diameter and receiver operating characteristic curve, was used to compare the two groups. RESULTS: A total of 85 patients were included in our study; 54 suffered from ACL injuries and 31 as a control group with normal knee MRI. Logistic regression revealed that increased LM posterior horn depth (OR = 1.27; 95% CI = 1.03-1.56; p = 0.028), decreased MM posterior horn length (OR = 0.71; 95% CI = 0.55-0.93; p = 0.013), and MFC sphere diameter (OR = 1.20; 95% CI = 1.01-1.43; p = 0.035) were independent risk factors for ACL rupture. The MFC sphere diameter yielded the highest area under the curve: 0.747 (95% CI, 0.632-0.862). No difference was found in the other measurements between the two groups. CONCLUSIONS: Concerning the difference in anatomical variations, the lateral meniscus posterior horn depth and medial femoral condyle sphere diameter were higher, while medial meniscus posterior horn length was lower in patients with an ACL injury. These structural knee measurements could have a possible increase in the likelihood of sustaining an ACL injury and can be used by clinicians to predict ACL injury.

Predictors of adherence with home quarantine during COVID-19 crisis: the case of health belief model.

Although Jordan has applied lockdown in response to COVID-19 pandemic, many people were not adherent to the quarantine. We aimed to examine the attitudes of the Jordanians and how these attitudes can predict their adherence using the health belief model (HBM). A cross-sectional study of 5057 participants using an internet-based questionnaire was conducted during lockdown. Multivariable ordinal regression analyses were used to estimate predictors of adherence to home quarantine. Overall, 646 (12.8%), 2078 (41.2%), and 2317 (46%) of participants showed poor, intermediate, and strict adherence, respectively. Of the HBM constructs, seriousness (ß= 0.116, 95% CI 0.027 to 0.205), benefits (ß= 0.056, 95% CI 0.002 to 0.110) and barriers (ß= -0.025, 95% CI -0.035 to -0.015) were significant predictors. We identified income insecurity (ß= -0.096, 95% CI -0.144 to -0.046), social withdrawal (ß= -0.062, 95% CI -0.121 to -0.004), religious concerns (ß= -0.149, 95% CI -0.202 to -0.096) and health consequences (ß= 0.065, 95% CI 0.011 to 0.11) as barriers. Governmental instructions were the only predictive external cue (ß= 0.055, 95% CI 0.004 to 0.014). Our findings suggest that a high number of Jordanians are adherent with the quarantine, demonstrating the ability of governmental policies in tackling potential barriers.

The Effect of a Single Intravenous Corticosteroid Administration on Pain after Knee Arthroscopy: A Prospective, Double-Blind, Non-Randomized Controlled Clinical Trial.

BACKGROUND: Knee arthroscopy is a standard surgical procedure that is nowadays widely performed as day-case surgery. The aim of the study was to observe the effect of a single dose of intravenous corticosteroid on pain after undergoing knee arthroscopy for non-bony procedures. METHODS: A prospective, double-blind study design was adopted. Patients undergoing knee arthroscopy for non-bony procedures were prospectively assigned into two equal groups: control (those who were not given steroids) and treatment (those who were given eight milligrams of dexamethasone intravenously 15 min prior to the inflation of the tourniquet). The pain was assessed pre-operatively on admission and on the first post-operative day during the morning round in five different movements using a visual analogue scale (VAS). RESULTS: A total of 60 patients were included in the study. There was no significant difference in the pre-and post-operatively scores between both groups. The treatment group experienced a significant reduction in post-operative morphine requirements, with 80% of patients who did not receive dexamethasone requiring post-operative morphine compared to only 53.3% of patients who did (p = 0.027). CONCLUSIONS: Pre-operative intravenous administration of a single dose of dexamethasone may decrease opioid requirements for adequate pain control after knee arthroscopy.

The Effect of Subsidence on Segmental and Global Lordosis at Long-term Follow-up After Anterior Cervical Discectomy and Fusion.

OBJECTIVE: Subsidence following anterior cervical discectomy and fusion (ACDF) may lead to disruptions of cervical alignment and lordosis. The purpose of this study was to evaluate the effect of subsidence on segmental, regional, and global lordosis. METHODS: This was a retrospective cohort study performed between 2016-2021 at a single institution. All measurements were performed using lateral cervical radiographs at the immediate postoperative period and at final follow-up greater than 6 months after surgery. Associations between subsidence and segmental lordosis, total fused lordosis, C2-7 lordosis, and cervical sagittal vertical alignment change were determined using Pearson correlation and multivariate logistic regression analyses. RESULTS: One hundred thirty-one patients and 244 levels were included in the study. There were 41 one-level fusions, 67 two-level fusions, and 23 three-level fusions. The median follow-up time was 366 days (interquartile range, 239-566 days). Segmental subsidence was significantly negatively associated with segmental lordosis change in the Pearson (r = -0.154, p = 0.016) and multivariate analyses (beta = -3.78; 95% confidence interval, -7.15 to -0.42; p = 0.028) but no associations between segmental or total fused subsidence and any other measures of cervical alignment were observed. CONCLUSION: We found that subsidence is associated with segmental lordosis loss 6 months following ACDF. Surgeons should minimize subsidence to prevent long-term clinical symptoms associated with poor cervical alignment.

Validation of the cultural adaptation of the Kujala score in Arabic.

BACKGROUND: Patellofemoral pain is a common condition. The Kujala score is a well-established scoring system to assess anterior knee pain and has been translated into many languages including Arabic. The purpose of this cross-sectional study is to culturally adapt the Arabic version of the Kujala score and determine its validity. METHODS: The Kujala score is composed of 13 multiple-choice questions. We modified two questions in the score; running and squatting, and were replaced with questions related to walking on different terrain and prostration, each with the same number of answer choices as the original questions so as not to affect the final score. These modifications were written in Arabic by the same group who translated and validated the original score into Arabic. The original and modified Kujala scores was printed and given to patients complaining of patellofemoral pain to be filled during their visit to the orthopedic outpatient clinics. Final scores for the original and modified questionnaires were calculated. Data was analyzed using SPSS statistics version 21.0 measuring Cronbach's alpha, intraclass correlation coefficient, and Pearson correlation. RESULTS: Ninety-four patients were included in the study, 28 (29.8%) men and 66 (70.2%) women. The mean age for the included patients was 43.67 (± 14.46) years. The mean score for the modified initial questionnaire was 63.91 (± 16.32), and the mean score for the modified re-test questionnaire was 66.52 (± 17.50). There was a statistically significant difference between the mean scores (p = 0.041), with a mean difference of 1.97 (95% CI 0.08 to 3.856). We found a significant strong correlation between the score before and after changing the questions with a p value of < 0.001. CONCLUSIONS: The culturally modified Arabic Kujala questionnaire is shown to be a valid, well-designed tool and an appropriate method of measuring patellofemoral pain.

Impact of plastic surgery medical training on medical students' knowledge, attitudes, preferences, and perceived benefits: Comparative study.

INTRODUCTION: Misconceptions surrounding the discipline of plastic surgery are widespread among not only the public, but medical students and professionals, as well. The purpose of this study was to explore how the inclusion of plastic surgery rotation into the medical curriculum affects medical students' knowledge, attitudes and preferences regarding plastic surgery specialization and referral.   Design and Methods: A descriptive-correlational design was utilized to collect data from 200 medical students in the final two years of education from two separate six-year medical programs in Jordan. Data was collected using self-reported questionnaires regarding knowledge of surgical procedures allocation, attitude towards plastic surgery, preference of specialization, and benefits of plastic surgery to physicians and patients. RESULTS: Analysis showed that medical students of plastic surgery integrate rotation (program A) had a higher average score of correct procedure-allocation (M = 12.57, SD = 3.14), compared to non-integrated plastic survey rotation program (program B) (M = 8.29, SD = 3.05) 8.29. About 83% of students in program A had their knowledge on plastic surgery from direct exposure to a plastic surgeon, compared to 43% of program B, and 24% of students in program A reported that their perception of plastic surgery influenced by media compared to 62% of those in program B. CONCLUSIONS: medical students who have been exposed to plastic surgery education are more confident about procedures of plastic surgery specialty and had more reliable sources of knowledge about plastic surgery than those who were not exposed to plastic surgery rotation.

Prevalence and trends in urinary incontinence among women in the United States, 2005-2018.

BACKGROUND: Women are disproportionately affected by urinary incontinence compared with men. Urinary incontinence results in physical and psychological adverse consequences and impaired quality of life and contributes to significant societal and economic burden. Previous studies reported high urinary incontinence burden in the United States. However, the current prevalence and recent trends in urinary incontinence and its subtypes among US women have not been described. In addition, correlates of urinary incontinence among US women have not been systematically evaluated in the contemporary population. OBJECTIVE: The purpose of this study was to determine the prevalence and trends in urinary incontinence among adult women in the United States from 2005 to 2018. In addition, this study aimed to investigate the relationship of urinary incontinence subtypes with several sociodemographic, lifestyle, health-related, and gynecologic factors. STUDY DESIGN: We used data from the National Health and Nutrition Examination Survey, a nationally representative series of surveys that was designed to evaluate the health status of the US population. Data on urinary incontinence from 7 consecutive 2-year cycles (2005-2006 to 2017-2018) were used for this study. A total of 19,791 participants aged ≥20 years were included. Weighted prevalence estimates and 95% confidence intervals were calculated in each study cycle for stress, urgency, and mixed urinary incontinence. Multivariate-adjusted weighted logistic regression was used to investigate the temporal trends in urinary incontinence, in addition to determining the association between urinary incontinence subtypes with several participants' factors. RESULTS: In the 2017-2018 cycle, stress urinary incontinence was the most prevalent subtype (45.9%; 95% confidence interval, 42.1-49.7), followed by urgency urinary incontinence (31.1%; 95% confidence interval, 28.6-33.6) and mixed urinary incontinence (18.1%; 95% confidence interval, 15.7-20.5). The prevalence rates of urgency and mixed urinary incontinence were higher in women aged 60 years and older (urgency, 49.5% [95% confidence interval, 43.9-55.2]; mixed, 31.4% [95% confidence interval, 26.2-36.6]) than in those aged 40 to 59 years (urgency, 27.9% [95% confidence interval, 23.6-32.1]; mixed, 15.9% [95% confidence interval, 12.9-19.0]) and those aged 20 to 39 years (urgency, 17.6% [95% confidence interval, 13.8-21.5]; mixed, 8.3% [95% confidence interval, 5.4-11.3]). The overall prevalence of stress and mixed urinary incontinence was stable throughout 2005 to 2018 (both Ptrend=.3), with increases in mixed urinary incontinence among women aged 60 years and older (P=.001). The prevalence of urgency urinary incontinence significantly increased, particularly among women aged 60 years and older (both P=.002). Age, obesity, smoking, comorbidities, and postmenopausal hormone therapy were associated with higher prevalence of all types of urinary incontinence. Black women were less likely to report stress urinary incontinence but more likely to report urgency urinary incontinence. CONCLUSION: Although the estimated overall prevalence of stress and mixed urinary incontinence remained stable from 2005 to 2018, the prevalence of urgency and mixed urinary incontinence significantly increased among women aged 60 years and older. All subtypes of urinary incontinence were higher among women with obesity and comorbidities, those who used postmenopausal hormone therapy, and those who smoke.

Vitamin B12 Deficiency Among the Healthy Jordanian Adult Population: Diagnostic Levels, Symptomology and Risk Factors.

BACKGROUND: Compared to the data available for developed countries, there is a marked scarcity of information on the levels and symptomology of vitamin B12 deficiency in developing countries, particularly in the Middle Eastern region. OBJECTIVE: To explore (a) the risk factors associated with a deficiency of vitamin B12, and (b) the baseline (cut-off) serum level of vitamin B12 for a clinically-symptomatic deficiency in the Jordanian adult population. METHODS: A total of 485 subjects were included in this study. Blood samples were drawn for biochemical analysis and data regarding socio-demographics, general health, anthropometric measures, and past medical, surgical, and medication history were collected. To explore the cut-off point, we compared all parameters included in a standard complete blood count as well as the main symptoms reported to be associated with B12 deficiency between groups of different B12 cut-off values, consisting of those above and below 200, 175, 150 and 125 pg/ml. RESULTS: Low dairy intake habits, age, recurrent headaches, heartburn, and peptic ulcer disease were found to be significantly associated with lower vitamin B12 levels. Surprisingly, daily smoking was associated with significantly higher B12 levels. The results revealed that none of the included potential indicators of B12 deficiency could be considered an indicative feature of deficiency. There were no significant differences neither in the symptoms nor in the CBC parameters between any of the tested study groups. CONCLUSION: Low dairy intake, older ages, recurrent headaches, heartburn, and peptic ulcer disease all could be considered as risk factors of having low vitamin B12 levels within the Jordanians. Also, they tend to have lower levels of vitamin B12 levels, in comparison to countries in the West, without necessarily having deficiency symptoms. The cut-off value to diagnose functional B12 deficiency could be less than 125 pg/ml for the Jordanians. More local studies are needed to establish an accurate vitamin B12 cut-off value for the population in Jordan.

The expression of urokinase-type plasminogen activator system in upper tract urothelial carcinoma and its prognostic value after radical nephroureterectomy.

BACKGROUND: To evaluate the expression pattern and prognostic role of the urokinase-type plasminogen activator (uPA) system in patients who underwent radical nephroureterectomy (RNU) for nonmetastatic upper tract urothelial carcinoma (UTUC). METHODS: A total of 732 patients who were treated with RNU for clinically nonmetastatic UTUC comprised our analytical cohort. Immunohistochemical staining of uPA, uPA receptor (uPAR) and uPA inhibitor (PAI-1) was performed using Murine IgG1 monoclonal antibodies. Outcomes of interest were recurrence-free survival, cancer-specific survival, and overall survival. RESULTS: The median age of the patients was 69.8 years and 56.6% of them were males. Overall, overexpression of uPA, uPAR, and PAI-1 was observed in 292 (39.9%), 346 (47.3%), and 345 (47.1%) patients, respectively. The uPA system components showed a statistically significant association with adverse clinicopathologic features such as lymphovascular invasion, multifocality, sessile tumors, and advanced pathologic stage (P < 0.01). On multivariable models, higher pathologic tumor stage, multifocality, and lymph node involvement were associated with RFS, OS, and CSS, but not the overexpression of uPA, uPAR, or PAR-1. In patients with organ-confined disease (≤pT2N0), however, uPA was significantly associated with RFS (hazard ratio [HR]: 2.04, 95% confidence interval [CI]: 1.21-3.43), OS (HR: 1.59, 95% CI:1.08-2.24) and CSS (HR: 2.55, 95% CI:1.44-4.52). uPA improved the predictive accuracy of a standard post-RNU model for all 3 endpoints, in organ-confined disease, by a prognostically significant margin. CONCLUSIONS: Overexpression of uPA system components was associated with adverse clinicopathologic characteristics and survival outcomes on the univariable, but not multivariable analyses. uPA expression was an independent predictor of survival outcomes in patients with organ-confined disease. While the clinical value of the uPA system remains limited in this cohort, further studies are needed to identify a marker or constellation of markers of high predictive value to help in counseling and treatment planning of UTUC patients.

Total hip arthroplasty for Protrusio Acetabuli in a young adult Osteogenesis Imperfecta features and Marfanoid features: A case report.

Osteogenesis Imperfecta is an inherited disease characterized by easily-broken bones, which manifests as multiple fractures with minimal trauma, joint laxity, sclerosis, blue sclera, and several other manifestations. Protrusio acetabuli is defined as the displacement of the femoral head so that it lies medial to the ischioilial line. In a skeletally mature patient with both Marfan syndrome and PA, an eventual hip arthroplasty is the only method available for correction of the deformity. However, in patients with Osteogenesis Imperfecta and PA, THA remains a controversial treatment. A 14-year-old male patient diagnosed with Osteogenesis Imperfecta Type 1A presented to the orthopedic surgery clinic complaining of groin pain of 1-year duration radiating to the thigh and knee. The patient was found to have radiologic signs of protrusion acetabuli. The patient was started with bisphosphonate and after medical failure, underwent a Total Hip Arthroplasty (THA). In post-operative follow-ups, the patient had relief of pain and was able to walk more comfortably and without a lump. The previously operated hip was examined and showed no signs of infection, dislocation, or fracture. Radiographic studies show no evidence of prosthesis failure or loosening with valgus position of the femoral stem and neutral acetabular angle. Ten years after the primary arthroplasty, the previously operated hip had maintained its stability and had no related complications. Despite the controversy surrounding the treatment of younger patients with hip failure, using total hip arthroplasty, this patient exhibited excellent results, with vast improvement in their symptoms and stability.

Determining the risk of acute kidney injury in patients who underwent total joint replacement: A retrospective study.

OBJECTIVES: Total joint replacement (TJR) is a commonly performed procedure worldwide, and postoperative acute kidney injury (AKI) is one of the complications that determine the overall prognosis in various surgical settings. We aimed to identify the risk of AKI after TJR (primary and revision) and determine the factors associated with postoperative AKI. METHODS: We performed a retrospective study of 1068 patients (>18 years) who underwent TJR between 2014 and 2019 at a tertiary medical center. Patients' demographic, clinical, and laboratory data were reviewed. RESULTS: A total of 1068 patients were included in this study [mean age, 60.5 ± 13 years; 260 men (24.3%); 808 women (75.7%)]. A total of 962 patients (90.1%) underwent primary joint replacement (PJR) and 106 underwent joint revision (9.9%). Sixty-six patients (6.2%) had postoperative AKI. Primary total hip replacement patients had a lower risk of AKI than patients with other types of TJR (3.0%; p = 0.024). The factors associated with AKI (adjusting for known confounders) included male gender [adjusted odds ratio (AOR): 1.751; 95% confidence interval (CI): 1.01-3.03; p = 0.046], diabetes mellitus (DM) [AOR: 2.806; 95% CI: 1.687-5.023; p ≤ 0.001], hypertension (HTN) [AOR: 1.751; 95% CI: 1.159-3.442; p = 0.013], and the use of vancomycin as a prophylactic antibiotic [AOR: 1.691; 95% CI: 1.1-2.913; p = 0.050]. Chronic kidney disease (CKD) [AOR: 1.00; 95% CI: 0.432-2.27; p = 0.981] was not found to be a significant risk factor. CONCLUSION: In this study, the risk of preoperative AKI in patients who underwent TJR was 6.2%. Male gender, preoperative comorbidities such as DM and HTN, and preoperative use of vancomycin were associated with increased risk of postoperative AKI.

Use of magnetic resonance imaging to determine laterality of meniscal size in healthy volunteers.

INTRODUCTION: The menisci are responsible for several functions. They are shock absorbers during dynamic loading on the knee and provide a broader surface area on which to distribute stress evenly to the tibia and femur. These functions allow for smoother movement and greater stability of the knee joint. Meniscal injury can be a great impediment to the function of the knee. Therefore, in the case of meniscal injury, our main concern is the relief of patient symptoms, followed by consequent restoration of meniscal function to the greatest of our ability. To prevent the long terms effects of a meniscectomy, meniscal allograft transplantation (MAT) was developed. The potential of using the size of the contralateral healthy menisci, to determine the size of the menisci to be replaced, will be discussed. METHODS: Knee MRIs done on healthy patients in the past 5 years were reviewed. Magnetic Resonance Imaging was performed using a 3-T scanner. Each individual was examined with knee joints in full extension. Measurements were performed two separate times, two weeks apart. A mean of three measurements was made during each session to reduce error. Thirty-eight normal bilateral knee joints MRIs remained (16 males, 22 females). Participants were sampled from the institutional Picture Archiving and Communication System (PACS). Age, gender, and the medial meniscal and lateral meniscal size of both knees were recorded. The laterality of the menisci was compared between both knees in each patient. RESULTS: A total of 38 patients were included in this study, with a mean age of 37.39 (±9.50) years. They were 16 (42.1%) men and 22 (57.9%) women. We didn't find any significant difference in the mid-coronal section between left and right knees meniscal measurements. None of the measurements were significantly different between men and women. There was no significant difference in the medial mid-sagittal section or lateral mid-sagittal section between left and right knee meniscal measurements. CONCLUSION: The results obtained in this study may support the use of MRI of the bilateral knee to obtain an appropriately sized allograft.

Shoulder girdle resection: surgical technique modification and introduction of a new classification system.

OBJECTIVE: Different classification systems for surgical tumor resections in the proximal humerus and scapula have been described, but none are specific or have been recently revised. The purpose of this article is to report modified surgical techniques and a new classification system for resections in the humerus and scapula. METHODS: Thirty-two patients with shoulder girdle bone tumors were operated upon. Two separate new classifications were assigned to resections in the humerus (types I-IV) and scapula (types I-III). An annotation is added to signify deltoid preservation (A) or sacrifice (B). Modified surgical techniques were devised. RESULTS: For extra-articular resections of the proximal humerus, we show that sacrificing the acromion and coracoid process is not required. Preservation of these structures can improve cosmetic shoulder outcome. For tumors with no large medial component, we show that there is no need to detach the muscle attachment from the coracoid process allowing earlier elbow extension postoperatively. After a mean follow-up period of 46 months, only two patients developed local recurrence. Postoperative infection was seen in two and stem loosening in one patient. The average MSTS functional score for all patients was 83%. CONCLUSION: Our modified surgical techniques saved structures which were unnecessarily resected with no advantage in surgical series. We reserved the integrity of more muscular tissues and attachments leading to less restriction during the rehabilitation process. This new classification system is realistic, easy to implement, and applicable to all patients.

Prednisolone-induced virginal mammary hypertrophy: Case report.

INTRODUCTION: Virginal mammary hypertrophy (VMH) is a rare benign disorder of the breast characterized by excessive enlargement of one or both breasts. It usually presents during adolescence. Drug-induced VMH has been scarcely reported in case reports. Review of the literature showed that prednisolone-induced gigantomastia was reported in a single study on a 47-year-old female. In this study, a case of VMH in a 17-year-old girl following prednisolone treatment will be described. Clinical presentation, clinical findings, diagnostic work-up, management and follow up are discussed. PRESENTATION OF CASE: A 17-year-old, single female presented to the plastic surgery department at our institute with progressive enlargement of both breasts, 2 months following treatment with prednisolone. Incisional biopsy excluded other breast differential diagnoses. The patient was managed surgically with bilateral mammaplasty with free nipple-areola graft. A total of 8.325 kg of breast tissue was resected. Follow-up 48 months postoperatively revealed good patient satisfaction with no recurrence of breast hypertrophy. DISCUSSION: Although the estrogen theory is regarded as the most credible explanation for VMH, several cases of drug-induced mammary hypertrophy have been reported. This study may be the first reported case of adolescent prednisolone-induced VMH. Mammaplasty is an accepted treatment despite its possible association with a higher recurrence rate. CONCLUSION: VMH may be a rare complication of prednisolone treatment. It should be considered in patients presenting with breast hypertrophy following steroid administration.

Surgical Technique and Outcome of Custom Joint-Sparing Endoprosthesis as a Reconstructive Modality in Juxta-Articular Bone Sarcoma.

BACKGROUND: Joint-sparing limb salvage surgery (JSLSS) is an advancement in the techniques and concepts of limb salvage surgery, which makes it possible to save not only the limb affected by malignancy but also the adjacent joint and the epiphyseal plate. In the growing child, this procedure is technically demanding due to the availability of small length of bone for implant purchase. Reconstruction options can be biological reconstruction or endoprosthesis; however, the outcome of endoprosthetic reconstruction after joint-sparing resection is not well described in the literature. PURPOSES: (1) To determine the prosthesis survival rates when using customized Joint-Sparing Endoprosthesis (JSE) after juxta-articular resection of bone tumors, (2) to investigate the rates of local recurrence, (3) to evaluate the need for revision surgery, and (4) to compare the outcome of customized JSE with that of joint-sacrificing techniques. METHODS: In our study, joint sparing is defined as any procedure where a custom-made JSE is used in lieu of sacrificing the adjacent joint whenever the length of the remaining bone segment is not enough to accommodate the stem of a modular implant. Twenty-eight patients received JSE, and 31 joints were spared. Their age ranged from 4 to 55 years with a median age of 13 years. Twenty-one patients received surgery for primary reconstruction and 7 patients for revision of failed bone allograft or modular implant. Twenty-four joints are spared in the lower limbs and 7 in the upper limbs. Osteosarcoma was the most common pathological diagnosis (n = 13). Flat surface HA-coated custom JSE was used to spare 15 joints, and short-stemmed custom JSE was used to spare 16 joints. The length of the remaining bone epiphysis for JSE anchorage from the knee and ankle joints was 25-75 mm, median = 45 mm, and the length of the cortical bone remaining for the proximal femur and distal humerus was 5-70 mm, median = 10 mm. RESULTS: Operative time was 2.5 to 4 hours (avg. 3 hr.) The bone resection surface fitted the prosthesis surface with <2 mm difference. Histological examination of all resected specimens shows clear bone resection margins; 2 patients had positive soft tissue margins. At mean follow-up period of 3 years (6 months-10 years), 6 patients developed local and systemic recurrences, three of them had a pathological fracture at the time of diagnosis (P=0.139), and 4 showed a poor response to chemotherapy (P=0.139), and 4 showed a poor response to chemotherapy (. CONCLUSIONS: Whenever this kind of implant is affordable and can be utilized, particularly in younger age groups, JSE may be a good reconstruction option to avoid the use of expandable implants and to avoid the potentially higher revision and complication rates associated with biological reconstruction, as well as the complications of conventional joint-sacrificing implant, mainly dislocations and polyethylene wear and tear.

Validation of the Arabic version of the Kujala patellofemoral pain scoring system.

BACKGROUND: Patellofemoral knee pain is a common cause of anterior knee pain. The Kujala anterior knee pain score is a scoring system for the clinical assessment of disease severity. The purpose of this cross-sectional study was to validate an Arabic translation of the original Kujala anterior knee pain score to assess Arabic-speaking patients with patellofemoral pain syndrome. METHODS: The Kujala anterior knee pain score was translated into Arabic by a group of native Arabic and native English speakers including orthopedic surgeons, residents, and a medical student. Questionnaires were filled by 127 patients visiting our outpatient department complaining of anterior knee pain diagnosed clinically and after exclusion of other pathologies. Questionnaires were re-filled at least 2 weeks later via phone contact from a member of our team. After exclusions, 97 questionnaires were analyzed for reliability using Cronbach's alpha for the scoring system's internal consistency and intraclass correlation coefficient for test-retest analysis. RESULTS: The mean score of the questionnaire before the follow-up was 62.38 (±17.78) and 64.02 (±18.47) after the follow-up. The scoring system's internal consistency measured via Cronbach's alpha was 0.824. Average ICC for the scoring system was 0.948 (CI: 0.923-0.965) and for single measures, 0.902 (CI: 0.856-0.933). Further, 94.8% of patients were contacted before initiating physiotherapy. Forty-six of the patients (47.4%) showed improvement in their scores when contacted, 44 patients (45.4%) showed a slight worsening of their scores and seven patients' (7.2%) scores were unchanged. CONCLUSIONS: The Arabic translation of the Kujala anterior knee pain score is a valid, reliable, useful, and easy-to-interpret scoring system to assess Arabic-speaking patients with patellofemoral pain syndrome.

Attitudes and barriers towards using complementary and alternative medicine among university students in Jordan.

BACKGROUND: Perceptions towards Complementary and Alternative Medicine (CAM) are highly variable but are improving globally. However, studies conducted in Jordan about CAM are insufficient. This study aims to explore the attitudes and barriers towards using CAM among university students in Jordan. DESIGN AND METHODS: This cross-sectional study was conducted at the University of Jordan. A self-administered paper questionnaire was distributed to 475 students from the Faculties of Medicine, Pharmacy and Engineering of all academic years. Descriptive and multivariate data analysis was done using SPSS v.20. RESULTS: Seventy percent of all the participants have used at least one type of CAM. Younger female pharmacy students were most likely to use CAM. There were significant differences between students of different academic years regarding their opinions on CAM (p < 0.024). The percentage of medical students who believed that combining CAM with modern medicine would improve the overall treatment quality was significantly lower than the other two faculties (p < 0.001). Of the students who never used CAM, 39% did not do because they doubted its effectiveness. CONCLUSION: There is a need for including CAM in the universities' curriculum as mandatory courses for health faculties and elective courses for other disciplines.