Maternal Depression and Children's Screen Overuse.

BACKGROUND: It is known that there are various factors associated with children's screen overuse. The aim of this study was to examine the effect of maternal depression on 2-5-year-old children's overuse of various household screen devices. METHODS: Participants were from the Internet-Cohort for Understanding of internet addiction Risk factors/Rescue in Early livelihood (I-CURE) study, an observational prospective cohort study in Korea. Screen time for six types of screen devices (smartphone, television, computer, tablet, video gaming console, and portable gaming console) were assessed by parental questionnaire. Maternal depression was measured by the Korean version of the Beck Depression Inventory II. Logistic regression models were run to determine the association between maternal depression and children's screen overuse. RESULTS: Maternal depression was associated with children's television overuse after adjusting for other factors (odds ratio, 1.954; P = 0.034). Contrary to expectation, the relationship between maternal depression and screen time was not present on other devices such as smartphones, computers and tablets. CONCLUSION: Maternal depression is related with 2-5-year-old children's television overuse. Interventions in maternal depressive symptoms and the associated changes in parent-child relationship can be useful for preventing children's television overuse.

Inter-segmental motions of the foot in healthy adults: Gender difference.

BACKGROUND: Multi-segment Foot Models (MFM) have increased in use for both clinical and research applications; however, little is known about the gender differences of inter-segmental motions within the foot and ankle during gait. The objectives of this study were to analyze the gender differences of inter-segmental foot motion during gait in healthy young adults using a MFM with a 15-marker set. METHODS: One hundred healthy adults (50 males, 50 females) between 20 and 35 years of age who had normal function and no radiographic abnormality, were evaluated. Inter-segmental angles (ISA) (hindfoot, forefoot, and hallux) were calculated at each time point. The ISAs at specific phases of the gait cycle, the change in ISAs between the phases, and the range of motion for each ISA across the entire gait cycle were compared between genders. RESULTS: The kinematic curve of the inter-segmental foot motions showed a characteristic pattern during the whole gait cycle. Although the hallux of female was aligned in a more valgus angulation during gait, the overall patterns of the inter-segmental foot motions were quite similar for both genders. Most differences in the inter-segmental foot motions between men and women were observed in the range of motion. Considering the stance phase of gait-cycle, the range of motion in the sagittal and transverse plane of the hindfoot was greater in females than in males. The sagittal range of motion of the hallux was also greater in females, mainly due to higher plantar flexion. CONCLUSIONS: The gender differences of the inter-segmental foot motion were investigated during gait in healthy young adults using a MFM with a 15-marker set. Females had a larger range of motion in the sagittal plane of the hallux and in the sagittal and transverse plane of the hindfoot.

Reference values of hematology, biochemistry, and blood type in cynomolgus monkeys from cambodia origin.

Cynomolgus monkeys as nonhuman primates are valuable animal models because they have a high level of human gene homology. There are many reference values for hematology and biochemistry of Cynomolgus monkeys that are needed for proper clinical diagnosis and biomedical research conduct. The body weight information and blood type are also key success factors in allogeneic or xenogeneic models. Moreover, the biological parameters could be different according to the origin of the Cynomolgus monkey. However, there are limited references provided, especially of Cambodia origin. In this study, we measured average body weight of 2,518 Cynomolgus monkeys and analyzed hematology and serum biochemistry using 119 males, and determined blood types in 642 monkeys with Cambodia origin. The average body weight of male Cynomolgus monkeys were 2.56±0.345 kg and female group was 2.43±0.330 kg at the age from 2 to 3 years. The male group showed relatively sharp increased average body weight from the 3 to 4 age period compared to the female group. In hematology and biochemistry, it was found that most of the data was similar when compared to other references even though some results showed differences. The ABO blood type result showed that type A, B, AB, and O was approximately 15.6, 33.3, 44.2, and 6.9%, respectively. The main blood type in this facility was B and AB. These biological background references of Cambodia origin could be used to provide important information to researchers who are using them in their biomedical research.

Clinical Implications of Femoral Anthropometrical Features for Total Knee Arthroplasty in Koreans.

Anthropometric features of Asians femora and their clinical relevance with regard to TKA are not rigorously investigated. We attempted to determine how well current prostheses accommodate femoral anthropometric features of Koreans and whether the presence of condylar or trochlear overhang or underhang adversely affects functional outcomes. We hypothesized that current prostheses do not accommodate Korean female femora well, and that overhang or underhang would adversely affect outcomes. Condylar and trochlear mediolateral (ML) widths and condylar anteroposterior (AP) heights were measured, and ML/AP ratios were calculated in 1025 osteoarthritic knees that underwent TKA. Besides gender difference, wide individual variation exists in condylar and trochlear widths and ML/AP aspect ratios for given AP heights. Size options of current prostheses could not cover the wide ranges of ML widths for given AP heights. The knees with condylar overhang more than 4mm showed lower maximum flexion angle postoperatively (P=0.005).

Correlation between static radiographic measurements and intersegmental angular measurements during gait using a multisegment foot model.

BACKGROUND: Radiographic examination is a widely used evaluation method in the orthopedic clinic. However, conventional radiography alone does not reflect the dynamic changes between foot and ankle segments during gait. Multiple 3-dimensional multisegment foot models (3D MFMs) have been introduced to evaluate intersegmental motion of the foot. In this study, we evaluated the correlation between static radiographic indices and intersegmental foot motion indices. METHODS: One hundred twenty-five females were tested. Static radiographs of full-leg and anteroposterior (AP) and lateral foot views were performed. For hindfoot evaluation, we measured the AP tibiotalar angle (TiTA), talar tilt (TT), calcaneal pitch, lateral tibiocalcaneal angle, and lateral talcocalcaneal angle. For the midfoot segment, naviculocuboid overlap and talonavicular coverage angle were calculated. AP and lateral talo-first metatarsal angles and metatarsal stacking angle (MSA) were measured to assess the forefoot. Hallux valgus angle (HVA) and hallux interphalangeal angle were measured. In gait analysis by 3D MFM, intersegmental angle (ISA) measurements of each segment (hallux, forefoot, hindfoot, arch) were recorded. RESULTS: ISAs at midstance phase were most highly correlated with radiography. Significant correlations were observed between ISA measurements using MFM and static radiographic measurements in the same segment. In the hindfoot, coronal plane ISA was correlated with AP TiTA (P < .001) and TT (P = .018). In the hallux, HVA was strongly correlated with transverse ISA of the hallux (P < .001). CONCLUSION: The segmental foot motion indices at midstance phase during gait measured by 3D MFM gait analysis were correlated with the conventional radiographic indices. CLINICAL RELEVANCE: The observed correlation between MFM measurements at midstance phase during gait and static radiographic measurements supports the fundamental basis for the use of MFM in analysis of dynamic motion of foot segment during gait.

Assessment of early renal allograft dysfunction with blood oxygenation level-dependent MRI and diffusion-weighted imaging.

PURPOSE: To investigate blood oxygenation level-dependent (BOLD) MRI and diffusion-weighted imaging (DWI) at 3 T for assessment of early renal allograft dysfunction. MATERIALS AND METHODS: 34 patients with a renal allograft (early dysfunction, 24; normal, 10) were prospectively enrolled. BOLD MRI and DWI were performed at 3 T. R2* and apparent diffusion coefficient (ADC) values were measured in cortex and medulla of the allografts. Correlation between R2* or ADC values and estimated glomerular filtration rate (eGFR) was investigated. R2* or ADC values were compared among acute rejection (AR), acute tubular necrosis (ATN) and normal function. RESULTS: In all renal allografts, cortical or medullary R2* and ADC values were moderately correlated with eGFR (P < 0.05). Early dysfunction group showed lower R2* and ADC values than normal function group(P < 0.05). AR or ATN had lower R2* values than normal allografts (P < 0.05), and ARs had lower cortical ADC values than normal allografts (P < 0.05). No significant difference of R2* or ADC values was found between AR and ATN (P > 0.05). CONCLUSION: BOLD MRI and DWI at 3 T may demonstrate early functional state of renal allografts, but may be limited in characterizing a cause of early renal allograft dysfunction. Further studies are needed.

Repeatability of a multi-segment foot model with a 15-marker set in healthy adults.

BACKGROUND: Several 3D multi-segment foot models (MFMs) have been introduced for the in vivo analysis of dynamic foot kinematics. However, reproducibility of a model should be checked and ascertained before clinical utilization of a MFM. The purpose of this study was to determine the reliability of recently introduced MFM with a 15-marker set by assessing the participant's stride-to-stride (intra-session) and visit-to-revisit (inter-session) repeatability. METHODS: Twenty healthy adults with a mean age of 28.9 years (10 males and 10 females) were tested. Three representative strides from five separate trials were used for analysis from each session. Kinematic data of foot segmental motion was collected and tracked using the Foot3D Multi-Segment Software (Motion Analysis Co., Santa Rosa. CA). A retest was performed in the same manner at an interval of 4 weeks. Coefficients of multiple correlation (CMC) and intra-class correlation coefficient (ICC) were calculated in order to assess the intra-session and inter-session repeatability. RESULTS: Inter-segment foot angles from healthy adults from a MFM with 15-marker set showed a narrow range of variability during the gait cycle. The mean intra-session ICC was 0.981 (±0.010), which was interpreted as excellent. The mean intra-session CMC was 0.948 (±0.027), which was interpreted as very good repeatability. The mean inter-session ICC was 0.886 (±0.047) and the mean inter-session CMC was 0.801 (±0.077), which were interpreted as excellent and good repeatability, respectively. CONCLUSION: We demonstrated a MFM with a 15-marker set had high intra-session and inter-session repeatability, especially in sagittal plane motion. We thought this MFM would be applicable to evaluation of the segmental foot motion during gait.

Prediction of chronicity of anterior cruciate ligament tear using MRI findings.

BACKGROUND: The estimation of anterior cruciate ligament (ACL) tear is required in certain cases involving legal and financial administration, such as the worker's compensation and/or insurance. The aim of this study is to propose and evaluate a quantitative evaluation instrument to estimate the chronicity of the ACL tear, based on the four magnetic resonance imaging (MRI) findings. METHODS: One hundred and fifty one cases of complete ACL tear confirmed by arthroscopy were divided into 4 groups according to the time from ACL injury to MRI acquisition: acute (< 6 weeks), subacute (6 weeks to 3 months), intermediate (3 months to 1 year), and chronic (> 1 year). The four MRI findings including ACL morphology, joint effusion, posterior cruciate ligament angle, and bone bruise were analyzed for temporal changes among the 4 groups. Binary logistic regression equations were formulated using the MRI findings to estimate the chronicity of ACL tear in a quantitative manner, and the accuracy of the formulated regression equations was evaluated. RESULTS: The four MRI findings showed substantial temporal correlation with the time-limits of ACL injury to be included in the estimation model. Three predictive binary logistic equations estimated the probability of the ACL injury for the three cutoff time-limits of 6 weeks, 3 months, and 1 year with accuracies of 82.1%, 89.4%, and 89.4%, respectively. CONCLUSIONS: A series of predictive logistic equations were formulated to estimate the chronicity of ACL tear using 4 MRI findings with chronological significance.

Photoplethysmography and continuous-wave Doppler ultrasound as a complementary test to ankle-brachial index in detection of stenotic peripheral arterial disease.

PURPOSE: We evaluated the sensitivity and specificity of ankle-brachial index (ABI), photoplethysmography (PPG), and continuous-wave Doppler ultrasound (CWD) in the detection of anatomically stenotic peripheral arterial disease (PAD). METHODS: Ninety-seven patients (194 legs) patients who had coincidentally undergone computed tomography angiography (CTA), ABI, PPG, and CWD for the evaluation of PAD were retrospectively reviewed. Sensitivity and specificity were measured. RESULTS: Among 194 legs, 163 (84%) legs had stenotic PAD on CTA. Overall sensitivity of ABI, PPG, and CWD was 69.3%, 81.6%, and 90.8% and specificity was 96.8%, 77.4%, and 64.5%, respectively. Ankle-brachial index showed a statistically significantly decreased sensitivity (14.8%) for below trifurcation level stenosis compared with CWD (92%) and PPG (67%). The sensitivity of ABI was also significantly decreased in single level and moderate stenosis (45.1% and 42.1%, respectively). In contrast, the sensitivity of CWD and PPG was not significantly decreased. CONCLUSION: The ABI showed significantly decreased sensitivity especially in stenosis below the trifurcation level. Both PPG and CWD were complementary to ABI in these groups of patients.

Evaluation of transplanted kidneys using blood oxygenation level-dependent MRI at 3 T: a preliminary study.

OBJECTIVE: The objective of our study was to investigate the feasibility and reproducibility of blood oxygenation level-dependent (BOLD) MRI using different gradient echoes at 3 T in patients with renal allografts and healthy volunteers and to evaluate whether BOLD MRI can be used to distinguish between cases of acute allograft rejection and normally functioning allografts. SUBJECTS AND METHODS: BOLD MRI at 3 T was performed of eight patients with normal allografts, four patients with acute allograft rejection, and 10 healthy volunteers. Multiple fast-field echo sequences were performed at gradient echoes of 8, 16, and 20 to obtain T2(*)-weighted images. The reproducibility of BOLD MRI was evaluated in patients with normal allografts. RESULTS: Cortical and medullary R2(*) values were not significantly different between healthy volunteers and patients with normal allografts, but medullary R2(*) values were significantly greater than cortical R2(*) values in both groups for all three protocols (p < 0.01). Medullary R2(*) values were significantly lower in cases of acute allograft rejection than in normal allografts for all three protocols (p < 0.001). The mean difference in cortical or medullary R2(*) values was 3.8% or less in all protocols. CONCLUSION: BOLD MRI performed using different gradient echoes at 3 T is feasible and reproducible in patients with renal allografts and can show significant changes in medullary oxygenation in patients with acute rejection.

Pain management by periarticular multimodal drug injection after anterior cruciate ligament reconstruction: a randomized, controlled study.

PURPOSE: We aimed to determine the efficacy of periarticular (PA) multimodal drug cocktail (MDC) infiltration for pain control after anterior cruciate ligament reconstruction with an autogenous bone-patellar tendon-bone graft. METHODS: We randomly assigned 100 patients to five study groups (20 per group): control group, no injection; intra-articular (IA) ropivacaine group, IA injection of ropivacaine alone; IA MDC group, IA injection of MDC; PA MDC group, PA injection of MDC; and IA + PA MDC group, IA and PA injections of MDC. The MDC consisted of ropivacaine, morphine, ketorolac, epinephrine, and cefuroxime. The five groups were compared in terms of pain levels during the first night after surgery and on postoperative days 1, 2, and 14; patient satisfaction was assessed on postoperative day 14. RESULTS: The PA MDC and IA + PA MDC groups had less pain during the first night than patients in the other three groups (P < .001) and were more likely to have the same amount of pain or less pain on postoperative day 1 than their preoperative expectation (P = .05). However, there were no group differences in patient satisfaction on postoperative day 14. No MDC-related side effect was reported. CONCLUSIONS: The MDC injection, particularly when delivered periarticularly, provides an effective, safe means of reducing early postoperative pain after anterior cruciate ligament reconstruction at minimal cost. In addition, a single IA injection would have no value in pain relief, regardless of types of drugs. LEVEL OF EVIDENCE: Level I, randomized controlled trial.

Clinical and genetic factors affecting tacrolimus trough levels and drug-related outcomes in Korean kidney transplant recipients.

PURPOSE: The purpose of this study was to characterize the effects of clinical and genetic variables on the pharmacokinetics and complications of tacrolimus during the first year after kidney transplantation. METHODS: One hundred and thirty-two Korean kidney recipients who received tacrolimus were genotyped for ABCB1 (exons 12, 21, and 26) and CYP3A5 (intron 3). Tacrolimus trough levels, dose, or dose-adjusted trough levels and complications were compared among patients during the early stage (3, 7, 14, 30, and 90 days) and up to 1 year according to the genotypes. RESULTS: A donor source-adjusted linear mixed model with multilevel analysis adjusting for age, body weight, hematocrit, and serum creatinine showed that CYP3A5 genotype is associated with dose-adjusted level of tacrolimus (p < 0.001). The influence of ABCB1 polymorphisms on the pharmacokinetics or complications of tacrolimus was less certain in our study. The incidence of acute rejections was significantly higher in recipients of cadaveric donor kidney (p < 0.05). CONCLUSIONS: A generalized estimating equation model analysis showed that alopecia and hyperlipidemia were associated with dose-adjusted level of tacrolimus (p < 0.001). Genotype of CYP3A5 variants along with significant clinical covariates may be useful in individualizing tacrolimus therapy in kidney transplantation patients.

Evaluation of the MicroScan MICroSTREP plus antimicrobial panel for testing ß-hemolytic streptococci and viridans group streptococci.

BACKGROUND: In order to determine the clinical usefulness of the MicroScan (Siemens Healthcare Diagnostics, USA) MICroSTREP plus antimicrobial panel (MICroSTREP) for testing antimicrobial susceptibility of ß-hemolytic streptococci (BHS) and viridans group streptococci (VGS), we compared the accuracy of MICroSTREP with that of the CLSI reference method. METHODS: Seventy-five BHS and 59 VGS isolates were tested for antimicrobial susceptibility to ampicillin, penicillin, cefotaxime, meropenem, erythromycin, clindamycin, levofloxacin, and vancomycin by using MICroSTREP and the CLSI agar dilution method. RESULTS: The overall essential agreement with regard to minimum inhibitory concentrations (MICs) (within ±1 double dilution) between MICroSTREP and the CLSI reference method was 98.2%, and categorical agreement (CA) was 96.9%. For the BHS isolates, the CA for erythromycin was 96.0%, whereas that for cefotaxime, meropenem, levofloxacin, and vancomycin (for ampicillin, penicillin, and clindamycin; 98.7%) was 100%. For the VGS isolates, the CA for penicillin was 84.7% and that for erythromycin, clindamycin, and vancomycin (for meropenem, 86.5%; for ampicillin, 88.1%; and for cefotaxime and levofloxacin, 96.6%) was 100%. All categorical errors of penicillin and ampicillin in the VGS isolates were minor. CONCLUSIONS: The accuracy of MICroSTREP is comparable to that of the CLSI reference method, suggesting that this panel can be effective for testing antimicrobial susceptibility of BHS and VGS.

Outcome of rotator cuff repair in large-to-massive tear with pseudoparalysis: a comparative study with propensity score matching.

BACKGROUND: Active range of motion deficit is one of the alleged negative influencing factors of rotator cuff repair. Recently, with the popularity of reverse total shoulder arthroplasty (RTSA), there is a tendency toward performing RTSA in cases of nonarthritic large-to-massive tears with pseudoparalysis. HYPOTHESIS: Rotator cuff repair in patients with active motion deficit may yield inferior outcome. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Among 195 complete repairs of large-to-massive rotator cuff tears, 35 patients experienced painful pseudoparalysis preoperatively. Propensity score matching (1-to-1) was performed between pseudoparalytic and nonpseudoparalytic groups. Finally, 29 patients in each group were matched using the following variables: age, gender, dominance, onset period, aggravation period, number of tendons involved, retraction, operation method (arthroscopic or mini-open), rows of repair (single or double), number of anchors, and fatty degeneration of the supraspinatus, infraspinatus, and subscapularis. At least 1 year after surgery (mean, 30.5 months), range of motion, visual analog scale for pain and satisfaction, Constant score, Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES) score, and University of California, Los Angeles shoulder rating scale (UCLA score) were evaluated. Healing of repaired cuffs was evaluated by computed tomography arthrography. RESULTS: Range of motion was improved in both groups after rotator cuff repair. Active forward elevation had significantly improved postoperatively in the pseudoparalytic group (P < .001). All functional outcome scores improved at the final follow-up visit compared with preoperative values (all P < .05). Preoperative Constant, ASES, and UCLA scores were significantly inferior in the pseudoparalytic group, but all except the Constant score showed no differences between the 2 groups at the final follow-up (P = .04). Postoperatively, 7 patients (24.1%) in the pseudoparalytic and 1 (3.4%) in the nonpseudoparalytic group showed pseudoparalysis (P = .03). Among 37 patients who underwent postoperative computed tomography arthrography, cuff healing was achieved in 6 of 18 (33.3%) in the pseudoparalytic and 9 of 19 (47.4%) in the nonpseudoparalytic group (P = .385). CONCLUSION: Recovery from pseudoparalysis after rotator cuff repair was evident in a large portion of the study group, and postoperative function and cuff healing were not different according to the presence of pseudoparalysis. Considering possible complications and longevity of RTSA, rotator cuff repair should be the first-line treatment option for large-to-massive tears.

Statistical consideration for bilateral cases in orthopaedic research.

BACKGROUND: Statistical independence means that one observation is not affected by another; however, the principle of statistical independence is violated if left and right-side measures within a subject are considered to be independent, because they are usually correlated and can affect each other. The purpose of the present study was to analyze the violation of statistical independence in recent orthopaedic research papers and to demonstrate the effect of statistical analysis that considered the data dependency within a subject. METHODS: First, all original articles that had been published in The Journal of Bone and Joint Surgery (American Volume) over a two-year period were evaluated. The analysis was designed to identify articles that included bilateral cases and possible violations of statistical independence. Second, a demonstrative logistic regression without consideration of statistical independence was performed and was compared with a statistical analysis that considered data dependency within a subject. Radiographs of 1200 hips in 600 patients were used to examine the differences in terms of odds ratios (with 95% confidence intervals) of the risk factors for hip osteoarthritis. RESULTS: Four hundred and eighty-six original articles were reviewed, and 151 articles (including forty-one articles involving the hip, thirty-four involving the knee, twenty-one involving the foot or ankle, nineteen involving the shoulder, ten involving the hand or wrist, nine involving the elbow, and seventeen involving other structures) were considered to include bilateral cases. Of the 486 articles that were reviewed, 120 articles (25%) (including thirty-six articles involving the hip, twenty-six involving the knee, fifteen involving the foot or ankle, fourteen involving the shoulder, seven involving the elbow, six involving the hand or wrist, and sixteen involving other structures) were found to have possibly violated statistical independence. Demonstrative statistical analysis showed that logistic regression was not robust to the violation of statistical independence. The 95% confidence intervals of the odds ratios for the risk factors showed narrower ranges (1.13 to 2.68 times) when data dependency within a subject was not considered. CONCLUSIONS: Researchers need to consider statistical independence when performing statistical analysis, particularly in studies involving bilateral cases. If data dependency within a subject is not considered, studies involving bilateral cases can bias results, depending on the context of those studies.

Follicular stimulating hormone enhances Notch 1 expression in SK-OV-3 ovarian cancer cells.

OBJECTIVE: Notch is known as a transmembranous receptor family with four homologous forms - Notch 1, Notch 2, Notch 3, and Notch 4 and related to cell fate regulation and angiogenesis. The purpose is to investigate the effect of follicular stimulating hormone (FSH) on the Notch 1 expression and proliferation in ovarian cancer cells. METHODS: Human ovarian cancer cell line, SK-OV-3 and FSH were used. XTT cell proliferation and cell migration assay were carried out with FSH 100 mIU/mL and Notch 1 siRNA. Western blots and reverse transcriptase-polymerase chain reactions (RT-PCR) were carried out to determine the expression level of the Notch 1 protein and mRNA with FSH treatment in 0, 1, 5, 10, 100, 200, 300 mIU/mL concentrations. Immunofluorescent (IF) stains were performed in SK-OV-3 cell cultures with FSH 100 mIU/mL. Student-t tests were used in statistical analyses. RESULTS: The SK-OV-3 have Notch 1 receptors in their natural status. FSH stimulated SK-OV-3 cells in XTT cell proliferation and cell migration assays and notch 1 siRNA inhibited. The expression level of Notch 1 protein and mRNA were increased in a dose dependent pattern according to FSH concentrations compared to untreated cells. IF stains also showed brighter Notch1 expressions in the FSH treated cells compared to the control cells. CONCLUSION: FSH enhances proliferation & migration and Notch 1 signaling in SK-OV-3 cells. The Notch signaling probably supports one of the cell proliferating mechanisms of FSH in ovarian cancer cells.

Gender differences in the correlation between symptom and radiographic severity in patients with knee osteoarthritis.

BACKGROUND: The effects of gender on the relationship between symptom manifestations and radiographic grades of knee osteoarthritis are not well understood. QUESTIONS/PURPOSES: We therefore determined the increments of symptom progression with regard to radiographic grades of knee osteoarthritis and asked if those increments differed by gender and whether symptom severity was differentially manifested by gender within the same grade. METHODS: We recruited 660 community residents; 368 (56%) women and 292 (44%) men. The mean subject age was 71.5 years (range, 65-91 years). Severity of symptoms was measured using the WOMAC and SF-36 scales, and the radiographic severity using Kellgren-Lawrence grades. Incremental changes in WOMAC and SF-36 scores were compared between adjacent Kellgren-Lawrence grades separately in men and women, and in the overall population. We compared symptom severity between men and women with the same radiographic grade. RESULTS: For the entire cohort, the mean incremental change in symptom severity was not gradual between the adjacent radiographic grades but was greater between Kellgren-Lawrence Grades 1 and 2 and Grades 2 and 3 than between Grades 0 and 1 or Grades 3 and 4. The patterns of incremental changes in symptom severity differed between men and women: women had more severe symptom progression between Kellgren-Lawrence Grades 2 and 3 and Grades 3 and 4 than men. Furthermore, women had worse mean WOMAC and SF-36 scores than men with the same radiographic grade of knee osteoarthritis. CONCLUSIONS: These data suggest symptom progression is not gradual between adjacent radiographic grades, and for the same radiographic grade, symptoms are worse in women. LEVEL OF EVIDENCE: Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Correlation of magnetic resonance imaging findings with the chronicity of an anterior cruciate ligament tear.

BACKGROUND: Although several findings on magnetic resonance imaging have been demonstrated after anterior cruciate ligament injury, sequential changes on magnetic resonance imaging have not been comprehensively studied. We undertook to correlate four specific findings on magnetic resonance imaging of an anterior cruciate ligament injury over time. METHODS: One hundred and forty-five patients with a complete tear of the anterior cruciate ligament confirmed by arthroscopy were divided, according to the time from the injury to the acquisition of the magnetic resonance image, into four groups: acute (within six weeks), subacute (more than six weeks to three months), intermediate (more than three months to one year), and chronic (more than one year). Four findings (anterior cruciate ligament morphology, joint effusion, posterior cruciate ligament angle, and bone bruise) were evaluated for each study group. RESULTS: Strong correlations were found between the magnetic resonance imaging findings and the chronicity of the anterior cruciate ligament tear. Anterior cruciate morphology showed sequential changes with time (p < 0.001). Joint effusion decreased with time, with a significant difference occurring between the acute and subacute groups at six weeks (p < 0.001). The posterior cruciate ligament angle decreased gradually over time (p < 0.001). Finally, the signal contrast of bone-bruising decreased with time, with a significant change occurring after three months (p = 0.049). CONCLUSIONS: Our study confirmed that these four magnetic resonance imaging variables are closely correlated with the chronicity of an anterior cruciate ligament tear, and estimation of the chronicity of the tear can be facilitated by an integrative interpretation of these findings.

Correlations between commonly used clinical outcome scales and patient satisfaction after total knee arthroplasty.

UNLABELLED: Patient satisfaction is becoming increasingly important as a crucial outcome measure for total knee arthroplasty. We aimed to determine how well commonly used clinical outcome scales correlate with patient satisfaction after total knee arthroplasty. In particular, we sought to determine whether patient satisfaction correlates better with absolute postoperative scores or preoperative to 12-month postoperative changes. Patient satisfaction was evaluated using 4 grades (enthusiastic, satisfied, noncommittal, and disappointed) for 438 replaced knees that were followed for longer than 1 year. Outcomes scales used the American Knee Society, Western Ontario McMaster University Osteoarthritis Index scales, and Short Form-36 scores. Correlation analyses were performed to investigate the relation between patient satisfaction and the 2 different aspects of the outcome scales: postoperative scores evaluated at latest follow-ups and preoperative to postoperative changes. The Western Ontario McMaster University Osteoarthritis Index scales function score was most strongly correlated with satisfaction (correlation coefficient=0.45). Absolute postoperative scores were better correlated with satisfaction than the preoperative to postoperative changes for all scales. LEVEL OF EVIDENCE: Level IV (retrospective case series).