The Effect of Non-Steroidal Anti-Inflammatory Drugs on Tendon-to-Bone Healing: A Systematic Review with Subgroup Meta-Analysis.

Background: There is some concern that non-steroidal anti-inflammatory drugs (NSAIDs) may impair the healing of certain musculoskeletal tissues. However, the effect of NSAIDs on the specialized fibrocartilaginous transition at the tendon-to-bone interface remains largely unknown. Thus, the purpose of the present study is to investigate the effect of NSAIDs on tendon-to-bone healing following acute injury or surgery. Methods: A systematic review was performed according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed (MEDLINE), Embase, Cumulative Index to Nursing and Allied Health (CINAHL), and SportDiscus databases were searched from the time of database inception to May 14, 2018 to identify all clinical and basic science studies investigating the effect of NSAIDs on tendon-to-bone healing. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) and SYstematic Review Center for Laboratory animal Research (SYRCLE) risk of bias assessment tools for clinical and basic science studies, respectively. A qualitative synthesis of the literature was performed with a subgroup meta-analysis of homogeneous basic science studies. Results: A total of 13 studies, including three clinical and 10 basic science studies, were included. The overall methodological quality of the included clinical studies was poor, while assessment of the basic science studies revealed consistent areas at high or unclear risk of bias. Of the included clinical studies, a single study reported a higher rate of rotator cuff repair failure with selective (COX-2) NSAID use compared with non-selective NSAID use, while no clinical failures were noted with NSAID use following distal biceps tendon repair. Basic science studies had heterogeneous outcome reporting. A subgroup analysis of homogeneous animal studies revealed no significant effect of all NSAIDs (Standard Mean Difference [SMD] -1.05, 95% Confidence Interval [CI] -2.39-0.30, p=0.13) or non-selective NSAIDs on load to failure (SMD -0.62, 95% CI -1.26-0.02, p=0.06). Conclusions: The current literature does not provide sufficient evidence for or against the use of NSAIDs following acute injury or surgical repair of the tendon-bone interface.Level of Evidence: IV.

Correction to: Behaviour and risk assessment of fluopyram and its metabolite in cucumber (Cucumis sativus) fruit and in soil.

Unfortunately, the original publication of this paper contains a mistake. The correct name of the 3rd Author is Sunny H. Patel. The original article has been corrected.

Behaviour and risk assessment of fluopyram and its metabolite in cucumber (Cucumis sativus) fruit and in soil.

A field experiment was conducted to estimate residue persistence of fluopyram and its metabolite benzamide in cucumber fruits and soil and their risk assessment in humans and soil environment. Fluopyram (Kafka, 400 SC) was applied as soil drench twice at the interval of 15 days at the rate of 250 (standard dose) and 500 (double dose) g a.i. ha-1 (active ingredient per hectare). Cucumber fruits were collected at 0 (1 h), 1, 3, 5, 7, 10, 15, 20, 30, 40 and 50 days after second application. Soil samples were collected on 15th day after second application. Drench application resulted in detection of residues on the third day in standard dose at the levels of 0.056 mg kg-1 in cucumber fruit. The residue level increased until 20 days reaching 0.092 mg kg-1 followed by decrease to 0.068 mg kg-1 on 30th day after application. In double dose, the residues started accumulating from 0 day with initial levels of 0.093 mg kg-1 and persisted until 30th day. The levels varied between 0.123 and 0.184 mg kg-1 until 15th day of application followed by decrease to 0.127 mg kg-1 by 30th day. The residues reached below determination level (< 0.05 mg kg-1) on 40th day in both the doses after second application. The residue of metabolite benzamide was below determination level (< 0.05 mg kg-1) at both the doses. Hazard quotient (HQ) for residues levels at 15th and 30th day was less than one (HQ < 1). Hence, a pre-harvest interval of 15 days is suggested. Present data can be used to establish maximum residue limit (MRL) in India. The residue of fluopyram in soil on 15th day and the data on soil adsorption coefficient of fluopyram from literature suggests moderate mobility of fluopyram in soil. However, residues of metabolite of benzamide were not detected in soil. Further studies on translocation of fluopyram in soil over the time can be conducted for better understanding of environmental risk. To our knowledge, this is the first report on residue levels of fluopyram in any crop when applied as soil drench.

Prevalence and Management of Coracoid Fracture Sustained During Sporting Activities and Time to Return to Sport: A Systematic Review.

BACKGROUND: Coracoid fractures sustained during sporting activities are rare. Previous reports are limited to individual case reports, small case series, and retrospective analyses. PURPOSE: To systematically review the literature and identify coracoid fractures sustained during sporting activities to determine fracture prevalence, sporting activities/mechanisms, management, and time to return to sport. STUDY DESIGN: Systematic review. METHODS: A systematic review was conducted investigating all studies in the literature published between January 1970 and April 2017 that reported on athletes sustaining coracoid fractures during sporting activity. The systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used PubMed, Biosis Previews, SPORTDiscus, PEDro, and EMBASE databases. Inclusion criteria were studies detailing (1) coracoid fractures with reported sporting activity causing injury, (2) fracture management (operative vs nonoperative), and (3) patient outcome. Exclusion criteria were (1) studies concerning fractures secondary to nonsporting activities (mechanical falls, motor vehicle accidents) and (2) studies not reporting fracture management or patient outcomes. Sporting activities, the presence or absence of associated acromioclavicular (AC) joint injury, fracture management, patient outcomes, and time to return to sport were analyzed. RESULTS: A total of 21 cases of coracoid fractures sustained during sporting activity were identified; acute trauma was responsible for 71% (n = 15/21) of fractures, and the remaining injuries were secondary to fatigue fractures. Concurrent AC joint injury was present in 60% (n = 9/15) of athletes sustaining acute trauma and in no athlete with fatigue fractures. Fractures were treated conservatively in 76% (n = 16/21) of patients, with only 19% (n = 3/16) of athletes reporting complications. Mean overall time to return to sport was 2.8 ± 2.0 months; no significant differences in return to sport were noted in athletes with traumatic versus fatigue fractures or those with or without AC joint injury. CONCLUSION: Coracoid fractures secondary to sporting activities are rare, occurring primarily from direct trauma with associated AC joint injury, and are treated successfully with nonoperative management. No difference in return to sport was found regardless of fracture mechanism, treatment, or the presence of associated AC joint injury.

Acetabular rim length: an anatomical study to determine reasonable graft sizes for labral reconstruction.

The purpose of this article is to determine normative values for the length of the acetabular rim and detect differences between gender, age, ethnicity, height and leg length. Six measurements were taken on the acetabular rim of 143 cadaveric skeleton specimens (286 acetabula) using a coordinate-measuring device: circumferential (excluding acetabular notch), anterior inferior iliac spine (AIIS)-anterior, AIIS-posterior, 12-3 o'clock, 12-9 o'clock and 11-5 o'clock. Museum specimen height data and leg length data from a previous study were recorded for 109 of 143 specimens. Intraclass correlation coefficients were calculated. Student t-tests compared mean values. Multiple regression analysis was used to determine the relationship between acetabular rim length and gender, age, ethnicity, height and leg length. The average acetabular rim length in males for circumferential, AIIS-anterior, AIIS-posterior, 12-3, 12-9 and 11-5 o'clock were 15.8, 4.2, 11.7, 4.9, 4.7 and 9.5 cm, respectively; and for females: 13.7, 3.7, 10.0, 4.3, 4.1 and 8.3 cm, respectively. Intraclass correlation coefficients were 0.953, 0.930, 0.958, 0.857, 0.913 and 0.951, respectively, for each measurement. All six measurements were significantly larger for males (P < 0.001). Multiple regression analysis demonstrated a significant relationship between gender and rim length for all six measurements (P < 0.001) and between height and leg length and acetabular rim length for five of the six measurements exclusive of AIIS-anterior (P < 0.001). No significant trends between age or ethnicity and rim length were found. Average acetabular rim lengths were established. The acetabular rim is significantly longer in males and correlates with height and leg length. Age and ethnicity do not appear to be significant predictors of acetabular rim length. Normative values for acetabular rim lengths may assist in hip preservation surgery.

Value of knee MRI in the diagnosis and management of knee disorders.

The primary objectives of this study were to determine how frequently knee magnetic resonance imaging (MRI) changes (1) diagnosis, (2) diagnostic confidence, and (3) management. A secondary objective was to correlate these changes with specific patient/physician characteristics and develop a prediction model using these characteristics. Six orthopedic specialists prospectively completed surveys when ordering knee MRI (n=93). Pre-MRI surveys recorded history, symptoms, signs, diagnosis, diagnostic confidence, and planned management. Post-MRI surveys recorded diagnosis, confidence, and planned management. Changes in diagnosis, management, and diagnostic confidence were correlated with patient/physician characteristics using chi-square and logistic regression tests. A multiple variable model was created with the most significant variables from the univariate analysis, and a c-index was used for cross-validation. Magnetic resonance imaging changed diagnosis in 29.3% and management in 25.3% of cases. Confidence in diagnoses after MRI increased, on average, by 10.6%. Change in diagnosis was significantly correlated with lateral joint line pain (P=.012) and tenderness (P=.006). The 3 most significant predictors for change in management were ligament pathology (P=.017), medial-sided pain/tenderness (P=.051), and age (P=.133). A 3-variable model using these predictors was significantly better than chance alone at predicting management changes (c-index: model=0.766; cross-validation=0.661). Magnetic resonance imaging frequently changed diagnosis and management and improved diagnostic confidence in a large minority of patients with internal derangement of the knee, even after evaluation by subspecialized physicians. A statistical model using specific patient characteristics can be created to predict when MRI will change management.

Motion artifact on computed tomography scan suggesting an unstable 3-column spine injury: case report of a "near miss" root cause of unneeded surgery.

BACKGROUND: Polytrauma patients often present with altered mental status, thus making clinical examination challenging. Due to its reliability for detecting traumatic injuries to the spine, computed tomography (CT) is generally the imaging study of choice when the mechanism of injury and/or preliminary exam suggests spinal injury. However, motion artifact may lead to false diagnoses. CASE REPORT: A 19-year-old intoxicated female involved in a high-speed motor vehicle crash suffered multiple spine, head, chest, and abdominal injuries. CT scan also suggested an unstable three column ligamentous injury at L2-3. Preparations were made for surgery the following morning, by which time her mental status had improved. She was re-examined in the operating room prior to induction by anesthesia and no focal lumbar pain or tenderness was detected. Imaging was further reviewed and motion artifact at the L2-3 level was noted. The surgery was cancelled. CONCLUSION: Motion artifact mimicked an unstable three column ligamentous injury at the L2-3 level. Findings on CT scan should always be correlated to physical exam in order to avoid wrongful surgical intervention.