Using a Combined All-Inside, Inside-Out, and Outside-In Technique to Repair Bucket-Handle Medial Meniscal Tears Without a Safety Incision.

We describe a combined all-inside, inside-out, and outside-in technique for the repair of unstable bucket-handle medial meniscal tears. Notably, a greater incidence of neurovascular complications has been associated with meniscal repair techniques that employ an accessory skin incision, especially when damage involves the body of the medial meniscus. However, with the operative knee in relative extension, passing inside-out needles anteromedial to the posterior horn and posterior to the semitendinosus tendon and saphenous nerve allows for the needles to exit the posteromedial knee through a "safe zone." Therefore, we reduce iatrogenic damage by avoiding the necessity of a large safety incision while still maintaining suture placement versatility and meniscal fragment stabilization. Thus, the objective of this Technical Note is to outline an efficient technique for treating bucket-handle medial meniscal tears that yields a strong, durable repair while avoiding damage to adjacent neurovascular structures and eliminating the need for a posteromedial safety incision.

Superior Patellar Dislocation Reduced by Intra-articular Injection: A Case Report and Review of Literature.

CASE: A 53-year-old woman presented with a locked knee after an atraumatic hyperextension episode. Imaging showed an anterior tilt of the patella hinging over the superior trochlear margin, consistent with a superior patellar dislocation. The patella spontaneously reduced on an intra-articular injection with 15 mL of lidocaine in normal saline, after which she was able to actively range her knee. CONCLUSION: Superior patellar dislocations are rare and usually result from a sudden forced contraction of the quadriceps, trapping the patella over superior trochlear osteophytes. Reduction is possible through an intra-articular local anesthetic injection, without manipulation of the patella.

Closing the Gender Gap: Barriers to Success for Recruitment and Retention of the Female Orthopaedic Surgery Applicant.

¼ Orthopaedic surgery reports one of the lowest proportions of female residents among all medical specialties. While the number of female medical students has increased, our field has been particularly slow to respond to the gender gap. ¼ There are several barriers to increased female representation in orthopaedics, including "jock" culture and male dominance, the residency application process, pregnancy and lifestyle concerns, a limited number of mentors and role models, and lack of early exposure to the field. ¼ Organizations such as the American Academy of Orthopaedic Surgeons (AAOS), the Ruth Jackson Orthopaedic Society, The Perry Initiative, Nth Dimensions, and the J. Robert Gladden Society, as well as social media channels, are working to close the gender gap, but there is still more that needs to be done. ¼ By acknowledging and addressing these barriers, both at an individual and institutional level, we can hopefully bring more women into the field. This will ultimately benefit not only ourselves, but our patients as well.

Anatomic Medial Patellofemoral Ligament Reconstruction Without Bone Tunnels or Anchors in the Patella.

Medial patellofemoral ligament reconstruction is an essential component of surgical treatment for recurrent dislocation of the patella. Various techniques have been described, most of which potentially increase the risk of patellar fracture. We present a new technique for anatomic medial patellofemoral ligament reconstruction without using suture anchors or patellar tunnels, therefore, eliminating the risk of iatrogenic patellar fracture and making a revision procedure easier in case of failure.

Matrix-induced intensity fluctuations in the fluorescence from single oligo(phenylenevinylene) molecules.

Single molecule spectroscopy on oligo(phenylenevinylene) (OPV) chromophores shows that the fluorescence intermittency strongly correlates to the rigidity of the environment surrounding the molecules. For OPV single molecules, environmental rigidity inhibits twisting about the vinyl linkages, the molecular motion associated with the observed "off" (nonabsorbing) state. By increasing the rigidity of a single molecule's environment, we can tune its room temperature fluorescence from rapid, sub-millisecond "blinking" fluctuations (fluid polymer environment) to completely "on" with no blinking observed (molecules adsorbed to a rigid bare glass substrate). The difference in fluorescence intermittency from environment to environment is immediately apparent and explicit in single molecule intensity trajectories under cw (continuous wave) excitation, demonstrating the sensitivity of these chromophores to their surroundings and emphasizing the importance of morphological control in real-world applications involving phenylenevinylene-based materials.

Non-localized ligand-to-metal charge transfer excited states in (Cp)2Ti(IV)(NCS)2.

The bent d(0) titanium metallocene (Cp)(2)Ti(NCS)(2) exhibits an intense phosphorescence from a ligand-to-metal charge transfer triplet excited state at 77 K in an organic glass substrate and a poly(methyl methacrylate) plastic substrate. Quantum chemical calculations and spectroscopic studies show that the orbital parentage of this triplet state arises from the promotion of an electron from an essentially nonbonding symmetry adapted pi molecular orbital located on the NCS(-) ligands to a d(z)2-(y)2 orbital located on the Ti metal. Standard infrared spectroscopy of (Cp)(2)Ti(NCS)(2) in its ground electronic state at 77 K reveals a pair of closely spaced absorptions at (2072 cm(-1), 2038 cm(-1))(glass) and (2055 cm(-1), 2015 cm(-1))(plastic) that are assigned, respectively, to the symmetric and antisymmetric CN stretching modes of the two coordinated NCS(-) ligands. Low-temperature (77 K) time-resolved infrared spectroscopy that accesses the phosphorescing triplet excited state on the ns time scale shows an IR bleach that is coincident with the two ground state CN stretching bands and an associated grow-in of a pair of new IR bands at slightly lower energies (2059 cm(-1), 2013 cm(-1))(glass) and (2049 cm(-1), 1996 cm(-1))(plastic) that are assigned, respectively, to the symmetric and antisymmetric CN stretches in the emitting triplet state. These transient IR bands decay with virtually identical lifetimes to those observed for the phosphorescence decays when measured under identical experimental conditions. Singular value decomposition analysis of the time-resolved infrared data shows that the observed transient IR features arise from the same electronic manifold as measured through luminescence studies. The close similarity between the ground state and excited-state CN stretching bands in (Cp)(2)Ti(NCS)(2) indicates that symmetry breaking does not occur in forming the charge-transfer triplet excited-state manifold; i.e., electron density is withdrawn from a delocalized pi MO spread across both NCS(-) ligands. Calculations at several levels of theory reveal a delocalized ligand-to-metal charge transfer excited triplet manifold. These calculations closely reproduce the relative intensity ratios and frequencies of the symmetric and antisymmetric transient infrared vibrations in the CN region. This study is the first time-resolved infrared investigation of a ligand-to-metal charge-transfer excited state and the first to be performed at cryogenic temperatures in thin-film organic glass and plastic substrates.

Conformation and luminescence of isolated molecular semiconductor molecules.

In this article, we describe, for the first time, direct comparisons of the detailed structures of two small molecule organic semiconductors, oligo(phenylenvinylene) (OPV) molecules with chains of five and six phenyl rings (5R-OC(8)H(17) and 6R-OC(8)H(17)), respectively, and their luminescence properties on a single molecule level. Our data originate from a combination of two powerful diagnostic tools in physical chemistry: ion mobility and single molecule fluorescence spectroscopy. These techniques enable us to precisely determine the shapes of isolated molecules in the gas phase and to correlate these structures to the emission from single molecules supported on bare glass substrates. The principal structural uncertainty in OPVs is the (possible) presence and location of cis-vinylene linkages (cis-defects) in the oligomer. The results show that the structures observed in the gas phase are strongly correlated to the categories of molecules observed in the single molecule polarization anisotropy measurements with nearly identical distributions for the two OPV molecules studied. Each category is also characterized by the luminescence efficiency of the molecules in each class, providing a direct correlation between the luminescence efficiency and the shape of the molecule. This combination of techniques provides a level of information far beyond that obtained via any other analytical technique.