Relationship Between Timing of Anterior Cruciate Ligament Reconstruction and Chondral Injuries: A Systematic Review and Meta-analysis.

BACKGROUND: After anterior cruciate ligament (ACL) injury, the optimal timing of ACL reconstruction and the influence of this timing on chondral damage remain unclear. PURPOSE: To assess the effect of timing of ACL reconstruction on the presence of chondral injuries via a systematic review and meta-analysis. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 4. METHODS: Two reviewers independently performed systematic literature searches of 5 online databases using the Cochrane methodology for systematic reviews. Eligibility criteria were any comparative study of patients aged >16 years that assessed the relationship between timing of primary ACL reconstruction surgery and rates of chondral injuries. Meta-analysis was conducted using a random-effects model. RESULTS: After screening, 14 studies (n = 3559 patients) out of 2363 titles met the inclusion criteria: 3 randomized controlled trials (n = 272), 3 prospective cohort studies (n = 398), and 8 retrospective cohort studies (n = 2889). In analysis of the studies, chondral injury rates were compared between ACL reconstructions performed before and after 3 time points: 3, 6, and 12 months after injury (eg, ≤3 vs >3 months). The rates of chondral injury increased with each time point. The increase was mostly due to low-grade injuries at 3 months (estimated odds ratio, 1.914; 95% CI, 1.242-2.949; P = .003), with the increase in high-grade injuries becoming predominant after 12 months (estimated odds ratio, 3.057; 95% CI, 1.460-6.40; P = .003). CONCLUSION: Our findings suggest that delaying ACL reconstruction surgery results in a higher rate of chondral injuries and the severity of these lesions worsens with time. These findings are comparable with those of our previously published study, which demonstrated a higher risk of meniscal tears associated with delayed ACL surgery. When ACL reconstruction is indicated, surgery ≤3 months after injury is associated with a lower risk of intra-articular damage. REGISTRATION: CRD42016032846 (PROSPERO).

Context-Aware Query Selection for Active Learning in Event Recognition.

Activity recognition is a challenging problem with many practical applications. In addition to the visual features, recent approaches have benefited from the use of context, e.g., inter-relationships among the activities and objects. However, these approaches require data to be labeled, entirely available beforehand, and not designed to be updated continuously, which make them unsuitable for surveillance applications. In contrast, we propose a continuous-learning framework for context-aware activity recognition from unlabeled video, which has two distinct advantages over existing methods. First, it employs a novel active-learning technique that not only exploits the informativeness of the individual activities but also utilizes their contextual information during query selection; this leads to significant reduction in expensive manual annotation effort. Second, the learned models can be adapted online as more data is available. We formulate a conditional random field model that encodes the context and devise an information-theoretic approach that utilizes entropy and mutual information of the nodes to compute the set of most informative queries, which are labeled by a human. These labels are combined with graphical inference techniques for incremental updates. We provide a theoretical formulation of the active learning framework with an analytic solution. Experiments on six challenging datasets demonstrate that our framework achieves superior performance with significantly less manual labeling.

Synthetic augmented suture anchor reconstruction for a complete traumatic distal triceps tendon rupture in a male professional bodybuilder with postoperative biomechanical assessment.

Bodybuilding is a high-risk sport for distal triceps tendon ruptures. Management, especially in high-demanding athletes, is operative with suture anchor refixation technique being frequently used. However, the rate of rerupture is high due to underlying poor tendon quality. Thus, additional augmentation could be useful. This case report presents a reconstruction technique for a complete traumatic distal triceps tendon rupture in a bodybuilder with postoperative biomechanical assessment. A 28-year-old male professional bodybuilder was treated with a synthetic augmented suture anchor reconstruction for a complete triceps tendon rupture of his right dominant elbow. Postoperative biomechanical assessment included isokinetic elbow strength and endurance testing by using multiple angular velocities to simulate the "off-season" and "precompetition" phases of training. Eighteen months postoperatively and after full return to training, the biomechanical assessment indicated that the strength and endurance of the operated elbow joint was fully restored with even higher ratings compared to the contralateral healthy arm. The described reconstruction technique can be considered as an advisable option in high-performance athletes with underlying poor tendon quality due to high tensile strength and lack of donor site morbidity, thus enabling them to restore preinjury status and achieve safe return to sports.

Iatrogenic injury of profunda femoris artery branches after intertrochanteric hip screw fixation for intertrochanteric femoral fracture: a case report and literature review.

A case of arterial rupture of the profunda femoris arterial branches, following dynamic hip screw (DHS) fixation for an intertrochanteric femoral fracture, is presented. Bleeding is controlled by coil embolization, but, later on, the patient underwent orthopedic material removal due to an infection of a large femoral hematoma.

Treatment of proximal humeral chondrosarcoma with resection and allograft.

Chondrosarcoma of the proximal humerus is an uncommon malignant bone tumor, and limited information is available about treatment. We retrospectively reviewed 31 patients treated by resection and replacement with allograft implants during the past 24 years. The patients were followed up for an average of more than 16 years. Despite some allograft complications, the overall success rate for the grafts was 77%, and patient survival was 96%. Only 1 patient died. Two patients required amputation for local recurrences, and the remainder did reasonably well despite some functional problems. On the basis of this study and by comparison data, we believe that proximal humeral chondrosarcomas are less malignant than chondrosarcomas in other sites. In comparing them against 26 metallic implants, we believe that resection and allograft implantation remains a generally successful treatment, although the improvement of the metallic devices over the years has made this technique more available and acceptable.

Chondromyxoid fibroma: a rarely encountered and puzzling tumor.

Chondromyxoid fibroma is an uncommon bone neoplasm, accounting in our series for less than 1% of all connective tissue tumors. The tumor is more common in males, and located mostly in the metaphyseal areas of the lower extremity. The tumor is benign and there have been no reports of metastases. The method of treatment that has been used since the initial identification of the tumor has been curettage, which has a 20-25% recurrence rate. In our 30 patients, the average length of followup was 11 years (range, 1-29 years. Most of the tumors were in the pelvis, proximal tibia, distal femur, and foot. Tumors that were treated with curettage alone did less well than those that were packed with allograft bone or polymethylmethacrylate. Tumors treated by excision did not recur. The most difficult problem with chondromyxoid fibroma is pathologic identity because it often is confused with more aggressive tumors that may metastasize.