Adjustable- Versus Fixed-Loop Devices for Femoral Fixation in ACL Reconstruction: An In Vitro Full-Construct Biomechanical Study of Surgical Technique-Based Tibial Fixation and Graft Preparation.

BACKGROUND: Femoral suspensory fixation for anterior cruciate ligament (ACL) reconstruction has evolved from fixed- to adjustable-loop devices. However, there are still controversies regarding undesired lengthening of adjustable-loop devices. HYPOTHESIS: Adjustable-loop fixation will achieve similar elongation to that of fixed-loop devices, and intraoperative preconditioning will reduce initial elongation for adjustable-loop constructs. STUDY DESIGN: Controlled laboratory study. METHODS: Three adjustable-loop devices (GraftMax, TightRope, and Ultrabutton) and 2 fixed-loop devices (Endobutton and RetroButton) were used in an intraoperative surgical technique workflow according to an in vitro model with porcine bone and bovine tendons (8 specimens per device; N = 40 constructs tested). Each construct underwent 1000 cycles of position- and force-controlled dynamic loading, whereby a total elongation threshold of 3 mm was defined as clinical failure. Constructs were finally pulled to failure at 50 mm/min. RESULTS: There were no statistically significant differences among the devices for total or dynamic elongation. Total elongation (mean ± SD) for adjustable-loop constructs was 4.13 ± 1.46 mm for GraftMax, 2.78 ± 0.85 mm for TightRope, and 2.76 ± 0.45 mm for Ultrabutton; for the fixed-loop devices, total elongation was 2.85 ± 0.74 mm for Endobutton and 2.85 ± 1.03 mm for RetroButton. The GraftMax had a significantly lower initial force (95.5 ± 58.0 N) after retensioning, with the highest initial elongation (0.99 ± 0.60 mm). The Ultrabutton showed the greatest force loss (-105.9 ± 13.5 N) during position control cycling, which was significantly different from the GraftMax (-22.3 ± 28.2 N), with the smallest force loss (P < .001). The TightRope construct had a significantly smaller initial elongation (-0.36 ± 0.22 mm) and the greatest pull-to-failure load (958 ± 40 N) as compared with all of the other devices. CONCLUSION: Adjustable- and fixed-loop configurations achieved statistically comparable fixation strength for total elongation. However, the GraftMax construct exceeded the total elongation threshold of clinical failure. The Ultrabutton produced the greatest loss of force during position control cycling, and the GraftMax button design prevented proper retensioning. The TightRope had a significant greater ultimate strength when compared with all other devices. CLINICAL RELEVANCE: Biomechanical testing according to a surgical technique workflow suggests that adjustable-loop devices can be considered a safe alternative to fixed-loop devices in ACL reconstruction.

Getting "game": pregaming changes during the first weeks of college.

OBJECTIVE: Many students pregame (ie, drink before drinking), but there are scant data evaluating changes following college entry. The authors examined pregaming across the fall quarter and identified predictors of change and initiation in college. PARTICIPANTS: Freshmen (N = 708; 53% female, 100% drinkers) were recruited during university orientation (baseline). METHODS: Self-report data were collected at baseline and end of fall quarter for 3 cohorts (the 2008-2010 academic years) and included demographics, alcohol use, problems, pregaming, personality, and expectancies. RESULTS: Pregaming increased from 61.7% (baseline) to 79.9% (follow-up), with students pregaming twice as often and attaining higher blood alcohol concentration at follow-up. Many (54%) baseline non-pregamers initiated by follow-up. Initiation was associated with increased overall drinking (including heavy episodic drinking), positive expectancies, and greater behavioral activation sensitivity. CONCLUSIONS: Pregaming rapidly escalates upon college entry and students who initiate in college may be at higher risk for alcohol-related problems. Campus prevention and intervention efforts should consider including pregaming in their prevention programming.

Pre-college pregaming: practices, risk factors, and relationship to other indices of problematic drinking during the transition from high school to college.

This study examined alcohol use and pregaming (i.e., drinking before going out) in the transition from high school to college and had 3 objectives: (1) evaluating pregaming prevalence and characteristics during this time, (2) determining whether it represents a unique risk for problematic drinking above-and-beyond traditional measures of consumption (i.e., quantity/frequency: QFI, and heavy episodic drinking: HED), and (3) identifying characteristics of individuals who pregame. Alcohol use and beliefs (i.e., self-reported quantity/frequency, pregaming practices, drinking game participation, alcohol-related problems, and expectancies) were assessed in entering freshmen (N = 1171) with prior alcohol use for the 3 months between high school and starting college. Results revealed that 65% of drinkers pregamed in the past, and most did so on fewer than 50% of their overall drinking occasions, consuming an average of 3 drinks in 27 min and most (87%) drank afterward. Hierarchical regression analyses indicated that pregaming frequency explained an additional 7.0% of variance in problematic alcohol use above-and-beyond overall drinking and demographic risk factors (e.g., gender, ethnicity, and Greek affiliation: R2 = .43 for overall model). Separate analyses indicated that demographics did not moderate the relationship between pregaming and problems. Regression analyses predicting pregaming frequency identified 7 characteristics associated with this outcome including demographics (gender, ethnicity, Greek affiliation), heavy drinking, drinking game frequency, and 2 scales of the Alcohol Expectancy Inventory (AEI: Attractive and Woozy). Findings implicate pregaming as a common practice during the transition to college, and highlight the need for additional studies examining pregaming changes across the freshman year.