The evolution of patient-reported outcome measures after a first lateral ankle sprain: A prospective study.

PURPOSE: A lateral ankle sprain is the most common musculoskeletal injury in the physically active population. However, it is unclear how the clinical condition evolves during the period after the injury and what proportion of patients develops chronic symptoms. Therefore, the purpose of this study is to assess the evolution of patient-reported outcome measures after a first time lateral ankle sprain. METHODS: A prospective clinical study assessed the patient-reported outcome measures (PROMs) of a consecutive group of 100 patients during 1 year after a first lateral ankle sprain. The Karlsson score and Foot and Ankle Outcome Score (FAOS) were assessed at 6 weeks, 3 months, 6 months, 9 months and 1 year. The Cumberland Ankle Instability Tool (CAIT)-score was assessed at 6 months, 9 months and 1 year. The difference between the time points of all scores was analysed using the positive change over time (binomial test versus 50%) and the difference in score (signed rank test). The time to sustained excellent level was also assessed overall and in several subgroups: age, gender, degree of injury (2 or 3), avulsion fracture, use of crutches, use of cast. Differences between subgroups were assessed by a generalized log-rank test. RESULTS: All clinical scores demonstrated an improvement up to 12 months after the sprain. The median Karlsson score (interquartile range) improved from 62 (50-80) at 6 weeks to 90 (72-100) at 3 months, to 97 (82-100) at 6 months to 100 (90-100) at 9 months, to 100 (100-100) at 1 year. The analysis of positive change over time demonstrated a significant positive change (P-value <.0005) between all time points except between 6 weeks and 12 weeks when using the FAOS quality score. The difference in score demonstrated a significant change (P-value <.01) between all time points except between 36 weeks and 48 weeks when using the FAOS pain and FAOS sports score. Age and presence of an avulsion fracture were correlated with a slower recovery and worse results. At 1 year, in total 13 patients (13%) had a worse outcome corresponding to a Karlsson score < 81 or CAIT score < 24. CONCLUSION: The clinical condition after a first ankle sprain demonstrated a significant improvement in PROMs between the different time points in the first year. Twelve months after a first lateral ankle sprain 13% had a fair or poor outcome. Higher age and presence of an avulsion fracture were correlated with a slower recovery and worse results. This information is useful in clinical practice to predict further progression and inform patients. Moreover, it is valuable to improve treatment strategies. LEVEL OF EVIDENCE: Level II (prospective cohort study).

Contributions of Hyperactive Mutations in Mpro from SARS-CoV-2 to Drug Resistance.

The appearance and spread of mutations that cause drug resistance in rapidly evolving diseases, including infections by the SARS-CoV-2 virus, are major concerns for human health. Many drugs target enzymes, and resistance-conferring mutations impact inhibitor binding or enzyme activity. Nirmatrelvir, the most widely used inhibitor currently used to treat SARS-CoV-2 infections, targets the main protease (Mpro) preventing it from processing the viral polyprotein into active subunits. Our previous work systematically analyzed resistance mutations in Mpro that reduce binding to inhibitors; here, we investigate mutations that affect enzyme function. Hyperactive mutations that increase Mpro activity can contribute to drug resistance but have not been thoroughly studied. To explore how hyperactive mutations contribute to resistance, we comprehensively assessed how all possible individual mutations in Mpro affect enzyme function using a mutational scanning approach with a fluorescence resonance energy transfer (FRET)-based yeast readout. We identified hundreds of mutations that significantly increased the Mpro activity. Hyperactive mutations occurred both proximal and distal to the active site, consistent with protein stability and/or dynamics impacting activity. Hyperactive mutations were observed 3 times more than mutations which reduced apparent binding to nirmatrelvir in recent studies of laboratory-grown viruses selected for drug resistance. Hyperactive mutations were also about three times more prevalent than nirmatrelvir binding mutations in sequenced isolates from circulating SARS-CoV-2. Our findings indicate that hyperactive mutations are likely to contribute to the natural evolution of drug resistance in Mpro and provide a comprehensive list for future surveillance efforts.

LAFEM: A Scoring Model to Evaluate Functional Landscape of Lysine Acetylome.

Protein lysine acetylation is a critical post-translational modification involved in a wide range of biological processes. To date, about 20,000 acetylation sites of Homo sapiens were identified through mass spectrometry-based proteomic technology, but more than 95% of them have unclear functional annotations because of the lack of existing prioritization strategy to assess the functional importance of the acetylation sites on large scale. Hence, we established a lysine acetylation functional evaluating model (LAFEM) by considering eight critical features surrounding lysine acetylation site to high-throughput estimate the functional importance of given acetylation sites. This was achieved by selecting one of the random forest models with the best performance in 10-fold cross-validation on undersampled training dataset. The global analysis demonstrated that the molecular environment of acetylation sites with high acetylation functional scores (AFSs) mainly had the features of larger solvent-accessible surface area, stronger hydrogen bonding-donating abilities, near motif and domain, higher homology, and disordered degree. Importantly, LAFEM performed well in validation dataset and acetylome, showing good accuracy to screen out fitness directly relevant acetylation sites and assisting to explain the core reason for the difference between biological models from the perspective of acetylome. We further used cellular experiments to confirm that, in nuclear casein kinase and cyclin-dependent kinase substrate 1, acetyl-K35 with higher AFS was more important than acetyl-K9 with lower AFS in the proliferation of A549 cells. LAFEM provides a prioritization strategy to large scale discover the fitness directly relevant acetylation sites, which constitutes an unprecedented resource for better understanding of functional acetylome.

Inner Retinal Layer Changes Reflect Changes in Ambulation Score in Patients with Primary Progressive Multiple Sclerosis.

The establishment of surrogate markers to detect disability progression in persons with multiple sclerosis (PwMS) is important to improve monitoring of clinical deterioration. Optical coherence tomography (OCT) could be such a tool. However, sufficient longitudinal data of retinal neuroaxonal degeneration as a marker of disease progression exist only for PwMS with a relapsing-remitting course (RRMS) so far. In contrast, longitudinal data of retinal layers in patients with primary-progressive MS (PPMS) are inconsistent, and the association of OCT parameters with ambulatory performance in PwMS has rarely been investigated. We aimed to investigate the relative annual rates of change in retinal layers in PwMS (RRMS and PPMS) compared with healthy controls (HC) using OCT and to evaluate their association with ambulatoryfunctionalscore (AS) worsening in PPMS. A retrospective analysis of a longitudinal OCT dataset of the retinal layers of PwMS and HC from two MS centers in Germany was performed. Walking ability was measured over a standardized distance of 500 m, and changes during the observation period were categorized using the AS and the expanded disability status scale (EDSS). 61 HC with 121 eyes and 119 PwMS (PPMS: 57 patients with 108 eyes; RRMS: 62 patients with 114 eyes) were included. The median follow-up time for PwMS was 3 years. The relative annual change of pRNFL (peripapillary retinal nerve fiber layer) and INL (inner nuclear layer) was significantly different in PwMS compared with HC. RRMS and PPMS subgroups did not differ in the annual atrophy rates. In patients with PPMS, worsening of the AS was significantly associated with increased thinning of the TMV (total macular volume), GCIP (ganglion cell and inner plexiform layer), and ONPL (outer nuclear and outer plexiform layer) (all p-value < 0.05, r > 0.30). For every -0.1% decrease in the TMV, GCIP, and ONPL, the risk of a deterioration in the AS increased by 31% (hazard ratio (HR): 1.309), 11% (HR: 1.112), and 16% (HR: 1.161), respectively. In addition, worsening EDSS in PPMS was significantly associated with the relative annual atrophy rates of pRNFL, TMV, and GCIP (all p-value < 0.05). Disability progression in PPMS can be measured using OCT, and increasing annual atrophy rates of the inner retinal layers are associated with worsening ambulation. OCT is a robust and side-effect-free imaging tool, making it suitable for routine monitoring of PwMS.

Outcomes After Derotational Distal Femoral Osteotomy for Recurrent Patellar Dislocations With Increased Femoral Anteversion: A Systematic Review and Meta-analysis.

Background: An increased femoral anteversion angle (FAA) is a predisposing factor for recurrent patellar dislocations (RPDs), and combined procedures including derotational distal femoral osteotomy (DDFO) have been shown to be good options. Purpose: To investigate the safety and effectiveness of combined DDFO on clinical and radiological outcomes to treat RPDs with an increased FAA. Study Design: Systematic review; Level of evidence, 4. Methods: This review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. We searched 7 databases for articles from inception to March 10, 2023, that reported outcomes after combined DDFO in patients with an RPD and increased FAA. Two reviewers independently extracted data and assessed study quality. Outcomes evaluated were functional scores, redislocation rates, complications, satisfaction, and radiological parameters. A meta-analysis was performed to pool functional scores, with data reported as mean differences (MDs) and 95% confidence intervals (CIs). Results: Included were 8 studies of 189 knees from 183 patients, with a mean patient age of 22.4 years and a mean follow-up of 33.4 months. The mean preoperative FAA ranged from 31° to 42.70°, and the mean postoperative FAA ranged from 10° to 19.08°. Significant improvements were found in the Kujala score (MD, 26.96 [95% CI, 23.54 to 30.37]), Lysholm score (MD, 26.17 [95% CI, 22.13 to 30.22]), visual analog scale score for pain (MD, -2.61 [95% CI, -3.12 to -2.10]), and Tegner activity score (MD, 1.33 [95% CI, 0.86 to 1.79]). No subluxation or redislocation occurred. The overall complication rate was 10.6%, and most of the complications were pain (60%) and limited knee activity (20%). The overall satisfaction rate was 83.3%. The patellar tilt angle significantly decreased from 40.7° ± 11.9° to 20.5° ± 8.7° and from 26.35° ± 6.86° to 11.65° ± 2.85° in 2 studies. Conclusion: Combined DDFO was found to be safe and effective for the treatment of RPDs and an increased FAA by addressing both patellar dislocations and torsional malalignment. However, because of the lack of comparisons, it remains to be investigated when DDFO should be combined in such patients.

Arabic Translation of the Knee Outcome Survey-Sports Activities Scale With Cross-cultural Adaptation and Validation.

Background: There are few sports-specific knee functional scales in the Arabic language. The Knee Outcome Survey-Sports Activities Scale (KOS-SAS) is a validated sports-specific patient-reported outcome measure that assesses knee function in an athletic population. Purpose: To provide a validated Arabic version of the KOS-SAS (KOS-SAS-Ar) while achieving cross-cultural adaptation for use in an Arabic-speaking population with sports-related knee disorders. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: There were 2 independent translators who conducted a forward translation of the KOS-SAS, followed by a backward translation by different translators. Subsequently, researchers and expert invitees judged the conceptual content and cultural adaptations of the final translation. A total of 276 patients completed the KOS-SAS-Ar as well as the International Knee Documentation Committee (IKDC) subjective assessment of knee function and a visual analog scale (VAS) for pain. Statistical analysis was performed for test-retest reliability, convergent validity, construct validity, and factor analysis. Results: The test-retest reliability of the KOS-SAS-Ar was high (r = 0.9). The items of the KOS-SAS-Ar had statistically significant internal consistency, with a Cronbach alpha of .924 (P < .0001). The KOS-SAS-Ar Symptoms subscore correlated with the VAS pain score (P < .0001), and the KOS-SAS-Ar Functional Limitations subscore correlated with the IKDC subjective score (P < .0001). The construct validity of the KOS-SAS-Ar was satisfactory (Kaiser-Meyer-Olkin value = 0.868; Bartlett test: P < .0001). Factor analysis showed a statistical correlation among the 11 items of the KOS-SAS-Ar. Conclusion: The KOS-SAS-Ar demonstrated favorable reliability and validity, and it appears to be a suitable tool for Arabic-speaking patients with sports-related knee conditions.

Effect of hip CPM on gross motor function and development of the hip joint: a single-center randomized controlled study on spastic cerebral palsy children with hip dysplasia.

Objective: To investigate the effectiveness of hip continuous passive motion (hCPM) on hip development at skeletal maturity and gross motor function for spastic cerebral palsy children with hip dysplasia. Methods: Prospective case-control research of hCPM with goal-directed training versus merely goal-directed training. On the basis of goal-directed training, the hCPM group used the hip joint CPM instrument (the external fixator was connected to the power device to make the hip joint carry out continuous passive movement) for 40-60 min, twice a day, and five times a week, and received continuous training for 8 weeks simultaneously. The control group received only goal-directed training for 8 weeks. Functional outcomes pertaining to the affected hip joints were assessed via gross motor function measure (GMFM), migration percentage (MP), acetabular index (AI), and Harris hip functional score (HHS) at the time of enrollment and the end of the intervention. Results: The case-control research included 65 participants (mean age = 46.20 months, SD = 17.09 months; Gross Motor Function Grading System level: III = 41, IV = 24) who were randomly selected to either the hCPM (n = 45) or the control group (n = 20). No differences were found in baseline (acquisition phase) GMFM, MP, AI, or HHS (t = -1.720, P = 0.090; t* = 1.836, P* = 0.071; t# = -1.517, P# = 0.139; t* = -1.310, P* = 0.195; t# = -1.084, P# = 0.097; t = -1.041, P = 0.301). At the 8-week follow-up, GMFM, MP, AI, and HHS significantly improved over baseline in the hCPM group (hCPM group: t = 18.59, 20.172*, 40.291#, 16.820*, 32.900#, 28.081; P < 0.001). Between-group differences at 8-week follow-up times points favored the hCPM group for GMFM (t = -2.637, P = 0.011), MP (t* = 2.615, P* = 0.014; t# = 3.000, P# = 0.006), AI (t* = 2.055, P* = 0.044; t# = 2.223, P# = 0.030), HHS (t = -4.685, P < 0.001) (*: left side; #: right side). Conclusion: Spastic cerebral palsy children with hip dysplasia achieved meaningful functional improvement after 8 weeks of goal-directed training with hCPM therapy.

An assessment of the diagnosis, treatment, and outcomes of lower extremity stress fractures in pediatric and adolescent populations.

OBJECTIVES: To present one of the first descriptive case series of pediatric and adolescent lower extremity stress injuries, their management, and outcomes in athletes and non-athletes. METHODS: The IRB-approved retrospective study included patients under 18 years at a tertiary children's hospital who were diagnosed with a lower extremity stress fracture/reaction. Demographic data, mechanism of injury, physical exam, radiographic findings, treatment, & outcomes were collected. Descriptive statistical analysis was conducted. RESULTS: Ninety-seven patients with stress injuries on clinical exams and on radiographs or MRI were included. The average age when diagnosed was 11.7 years (range 1.1-18 years) and the most common injuries were to the tibia (n = 33, 28.4%) and the least common involved were the cuneiforms (n = 4, 3.4%). Patients under the age of 14 were more likely to experience cuboid and calcaneal stress injuries (mean age 5.5 and 8.3 years respectively). Nineteen patients (19.6%) had high-risk stress fractures, with the average age of 14.9 years versus 11.6 for those with low risk (p-value = 0.01) and return to activity time being 15 weeks compared to 10.5 (p-value = 0.027). The most common forms of treatment were controlled ankle motion (CAM), walker boots (58.6%), and physical therapy (PT) (38.1%). The mean Lower Extremity Function Score of the patient population was 73.8, indicating no clinically important difference from full functionality. CONCLUSION: Lower extremity stress injuries in this cohort were most seen in the tibia, although patients younger than 14 had a high number of cuboid and calcaneal stress injuries. Those with high-risk stress fractures were older and took longer to recover from when compared to low-risk injuries. Treatment is commonly conservative, with CAM boots and PT being the most frequently utilized interventions and serving as a successful approach to treatment, with patients returning to activity at an average of 11.4 weeks, which is comparable to similar studies.

The outcome of type 1 pelvic resection and reconstruction with pedicle screw-rod system without bone grafting in malignant pelvic tumour: A case series and short term review.

INTRODUCTION: There is no consensus regarding the reconstruction method for type 1 resections around the pelvis. Various methods are currently used, such as resection without reconstruction, bone graft (autologous, recycled, allograft) with simple fixation, and pedicle screw-rod fixation with or without bone grafting. We aim to study the outcome of pedicle screw-rod reconstruction without bone grafting in type 1 pelvic resections involving sacroiliac joint to show that pedicle screw-rod construct alone is stable and has low risk of failure. MATERIAL AND METHODS: This is a retrospective review of eight patients who underwent type 1 resection of malignant pelvic tumours and reconstruction with a pedicle screw-rod system between 2011 and 2018. All patients who underwent type 1 resection and reconstruction with pedicle screw without bone grafting were included into this study. We reported their clinical (complication and radiological outcome), oncological (local recurrence and metastasis), and functional outcome based on Musculoskeletal Tumour Society Score (MSTS) and The Toronto Extremity Salvage Score (TESS) at their last follow-up. RESULTS: Eight patients were recruited into the study. The mean follow-up period was 58.5 months (range: 40 - 121 months). There were three postoperative complications in three different patients: superficial infection, surgical hernia with ipsilateral femoral avascular necrosis (AVN), and femoral nerve injury. At the end of the study period, one patient passed away due to disease progression, one patient was alive with disease, and the rest were disease-free. Mean MSTS score during last follow-up was 77.1% (range: 66.7% - 93.3%), while mean TESS score was 75.6% range (63.3% - 80.2%). There were no cases of implant failure. CONCLUSION: Type 1 pelvic reconstruction with a pedicle screw-rod system is stable without a concurrent biological reconstruction, and it is feasible, with few complications, and an excellent functional outcome.

Combination of Fusiform Capsulectomy of the Posterior Capsule and Percutaneous Flexion Tendon Release in the Treatment of Fused Knee with Severe Flexion Contracture During Total Knee Arthroplasty-A Report of Six Cases.

Purpose: This clinical research aims to assess the safety and efficacy of a combination of fusiform capsulectomy of the posterior capsule and percutaneous flexion tendon release in the treatment of a fused knee with severe flexion contracture during total knee arthroplasty (TKA). Methods: A retrospective analysis was performed in three patients (six knees) who had preoperative severe bony fused flexion contracture (>80°) prior to TKA and received a combination of fusiform capsulectomy of posterior capsule and percutaneous flexion tendon release during TKA between January 2016 and December 2019. The range of motion (ROM), knee functional score, postoperative complications, and radiographic results were evaluated. Result: Three patients (six knees) were enrolled in this study. The mean duration of follow-up was 42.83 ± 15.77 months. The postoperative knee ROM was 100.0 (76.0, 102.75) (p < 0.01). The knee society score (KSS) clinical score increased from a preoperative 30.0 (25.0, 36.0) to a postoperative 64.0 (65.0, 78.0) (p < 0.01), and the KSS function score increased from a preoperative 0.0 (0.0, 30.0) to a postoperative 55.0 (40.0, 55.0) (p < 0.01). No implant loosening, infection, neurovascular complications, or revision were recorded in the cohort until the last follow-up. Conclusion: The technique of a combination of fusiform capsulectomy of the posterior capsule and percutaneous flexion tendon release is an effective and safe method during primary TKA for a fused knee with severe flexion contracture.

Outcomes following surgical management of proximal hamstring tendon avulsions : a systematic review and meta-analysis.

AIMS: Avulsion of the proximal hamstring tendon origin can result in significant functional impairment, with surgical re-attachment of the tendons becoming an increasingly recognized treatment. The aim of this study was to assess the outcomes of surgical management of proximal hamstring tendon avulsions, and to compare the results between acute and chronic repairs, as well as between partial and complete injuries. METHODS: PubMed, CINAHL, SPORTdiscuss, Cochrane Library, EMBASE, and Web of Science were searched. Studies were screened and quality assessed. RESULTS: In all, 35 studies (1,530 surgically-repaired hamstrings) were included. Mean age at time of repair was 44.7 years (12 to 78). A total of 846 tears were acute, and 684 were chronic, with 520 tears being defined as partial, and 916 as complete. Overall, 92.6% of patients were satisfied with the outcome of their surgery. Mean Lower Extremity Functional Score was 74.7, and was significantly higher in the partial injury group. Mean postoperative hamstring strength was 87.0% of the uninjured limb, and was higher in the partial group. The return to sport (RTS) rate was 84.5%, averaging at a return of 6.5 months. RTS was quicker in the acute group. Re-rupture rate was 1.2% overall, and was lower in the acute group. Sciatic nerve dysfunction rate was 3.5% overall, and lower in the acute group (p < 0.05 in all cases). CONCLUSION: Surgical treatment results in high satisfaction rates, with good functional outcomes, restoration of muscle strength, and RTS. Partial injuries could expect a higher functional outcome and muscle strength return. Acute repairs result in a quicker RTS with a reduced rate of re-rupture and sciatic nerve dysfunction. Cite this article: Bone Jt Open 2022;3(5):415-422.

Elbow dislocation with and without an associated fracture in children: A prospective study of functional outcomes following 3 weeks of immobilization.

INTRODUCTION: The initial management of elbow dislocations in children, emergency reduction and brachial-antebrachial-palmar (BABP) immobilization, remains the most widely used method. Osteosynthesis could be associated in case of fractures. On the other hand, there is no consensus on the duration of immobilization in the recent literature. The objective of this study was to describe the medium-term functional results of a prospective cohort of children presenting with an elbow dislocation immobilized for 3 weeks, with or without an associated fracture. The hypothesis of this study was that 3 weeks of immobilization was sufficient and made it possible to obtain a satisfactory, rapid functional recovery without residual instability. MATERIAL AND METHOD: All children with an elbow dislocation with or without an associated fracture were included. The dislocation was urgently reduced and subsequent surgery could be indicated in the event of associated injuries. All the children had 3 weeks of immobilization with a BABP cast. Radiological and clinical follow-up was carried out for 2 years. The parameters evaluated were: 3 functional scores and the range of motion (ROM) of the elbow. Clinical or radiological complications were sought. RESULTS: A total of 50 children were included, the mean age was 10.6 years (± 2.6). Functional score results were "good' or "excellent' at 3 months of follow-up, "excellent' at 6 months and thereafter. The mean limitation in ROM at the last follow-up was 4.7° (± 7.2°) with all ranges combined. Eighty-two percent of children had a mean limitation in ROM of less than 10°. None of the children presented with a recurrence of elbow dislocation and instability. CONCLUSION: Immobilization of elbow dislocations for 3 weeks in children confers good medium-term functional results without exposing them to the risk of instability, whether or not the dislocation is associated with a fracture. LEVEL OF EVIDENCE: II; Prospective cohort study.

Predictive clinical factors in rheumatoid arthritis using disease activity and functional score.

OBJECTIVES: Rheumatoid arthritis (RA) is a chronic inflammatory arthritis that may lead to severe joint pain. There are several scores to evaluate the disease activity of RA. This study aimed to evaluate if clinical factors which representing activity scores and health assessment score. MATERIAL AND METHODS: This study was conducted prospectively by including adult patients with RA. Clinical factors and 5 RA disease activity and health assessment scores were evaluated. Each activity score was executed for clinical predictors by using multivariate linear regression analysis. RESULTS: There were 33 female adult patients in the study. The average (SD) age was 52.33 (11.11) years, while the duration of RA was 7.65 years. The DAS28 ESR had 1 predictor: RA duration with a coefficient of -0.04. For DAS28 CRP, CDAI, and SDAI scores, body mass index (BMI) and RA duration were independent factors for the scores with negative coefficient values. For the HAQ score, both age and rheumatoid duration were positively associated with the score. The coefficients of both factors were 0.02 and 0.03, respectively. CONCLUSIONS: Age, RA duration, and BMI were associated with RA activity and functional score. Body mass index is a potential modifiable factor that may be associated with RA activities.

Plate Osteosynthesis or Figure-of-Eight Brace: Which One Is Better in Midshaft Clavicle Fractures?

Introduction Fracture of the clavicle bone is a very common injury owing to its subcutaneous location. Controversy exists about the optimal treatment of midshaft clavicle fractures in the presence of significant displacement and comminution of the fracture. Traditionally, non-surgical management was considered the first treatment option for most clavicle fractures. However, recent evidence shows that the non-surgical option causes more complications than previously reported. The purpose of this study was to compare the clinical and radiological outcomes of conservative treatment and surgical treatment for midshaft clavicle fractures. Materials and methods A total of 45 patients meeting the inclusion criteria were included in this randomized study. The patients were allocated to two groups: conservative and operative on an alternate basis. Patients in the conservative group were managed with figure-of-eight bandage, whereas patients in the operative group were treated surgically by plate fixation. Primary outcome was recorded at six weeks, three months, six months, and 12 months follow-up using the Disabilities of the Arm, Shoulder, and Hand (DASH) and American Shoulder and Elbow Surgeons (ASES) scores. We also assessed patient's satisfaction after the treatment, fracture union, and complication rates among the study cohort. Results The ASES scores were significantly better in the operative group at three months and six months follow-up; however, at 12 months follow-up, there was no significant difference in the score between the groups. Although not statistically significant, the DASH score was better in the operative group than in the conservative group at all the follow-ups. This study showed that the time to union was lesser, rate of non-union was lower, and return to work was faster on the operative group. The mean satisfaction score in the operative and conservative groups was 4.16±0.76 and 4.05±1.24, respectively (p = 0.76). Conclusion This study suggests that open reduction and internal fixation with plate reduced the incidence of mal-union and non-union; however, surgical treatment showed no significant difference in the functional outcome as compared to conservative treatment.

WEVar: a novel statistical learning framework for predicting noncoding regulatory variants.

Understanding the functional consequence of noncoding variants is of great interest. Though genome-wide association studies or quantitative trait locus analyses have identified variants associated with traits or molecular phenotypes, most of them are located in the noncoding regions, making the identification of causal variants a particular challenge. Existing computational approaches developed for prioritizing noncoding variants produce inconsistent and even conflicting results. To address these challenges, we propose a novel statistical learning framework, which directly integrates the precomputed functional scores from representative scoring methods. It will maximize the usage of integrated methods by automatically learning the relative contribution of each method and produce an ensemble score as the final prediction. The framework consists of two modes. The first 'context-free' mode is trained using curated causal regulatory variants from a wide range of context and is applicable to predict regulatory variants of unknown and diverse context. The second 'context-dependent' mode further improves the prediction when the training and testing variants are from the same context. By evaluating the framework via both simulation and empirical studies, we demonstrate that it outperforms integrated scoring methods and the ensemble score successfully prioritizes experimentally validated regulatory variants in multiple risk loci.

Predictive Factors of Recovery after an Acute Lateral Ankle Sprain: A Longitudinal Study.

A prominent feature of ankle sprains is their variable clinical course. The difficulty of providing a reliable early prognosis may be responsible for the substantial rate of poor outcomes after an ankle sprain. The aim of the present study was to evaluate the prognostic value of objective clinical measures, pain, and functional scores for ankle sprain recovery. Fifty-two participants suffering from lateral ankle sprain were included. Sprain status was assessed four weeks following injury and included evaluations of ankle range of motion, strength, function, and pain. Seven months following injury, a second assessment classified the patients into recovered and non-recovered groups using ankle ability measures. Following a predictor pre-selection procedure, logistic regressions evaluated the association between the four-week predictors and the seven-month recovery status. Twenty-seven participants (52%) fully recovered and 25 did not (48%). The results of the logistic regressions showed that walking pain was negatively associated with the probability of recovering at seven months (odds ratio: 0.71, 95% CI: 0.53-0.95). Pain four weeks after ankle sprain had relevant predictive value for long-term recovery. Special attention should be paid to patients reporting persistent pain while walking four weeks following sprain to reduce the risk of chronicity.

A long-term cross-sectional study with modified forgotten joint score to assess the perception of artificial joint after total knee arthroplasty.

BACKGROUND AND PURPOSE: The ultimate goal for an arthroplasty surgeon is to provide the patient a joint that feels more like a natural joint. The Modified Forgotten Joint Score (MFJS) is a newly introduced functional scoring system that has a superior ability to assess this property among arthroplasty patients. The objective of this study is to evaluate the long-term temporal association of the MFJS and total knee arthroplasty (TKA). METHODS: We assessed 360 patients post TKA with MFJS questionnaire. The patient groups were distributed at follow-up intervals of 3 weeks (n = 55), 6 months (n = 45), 1 year (n = 57), 2 years (n = 40), 3 years (n = 49), 5 years (n = 49), 7 years (n = 39), and 10 years (n = 26). Higher score suggests a forgotten artificial joint. RESULTS: Post-operative mean MFJS scores were 64.4 ± 7.6 at 3 weeks, 87.7 ± 5.6 at 6 months, 89.2 ± 3.1 at 1 year, 89.9 ± 2.6 at 2 years, 89.4 ± 3.2 at 3 years, 89.1 ± 4 at 5 years, 84.5 ± 8.8 at 7 years, and 82.7 ± 11.9 at 10 years. The score at 3 weeks was significantly lesser than the average scores at other follow-up intervals. The score at 6 months was significantly higher compared to the score at 10 years. The average score at 1 year, 2 years, 3 years, and 5 years were significantly higher compared to the average score at 7 years and 10 years. CONCLUSION: The trend of the MFJS score was found to drastically improve from 3 weeks to 6 months and peak in 2 years after which the score tends to attain a plateau up to 5 years following which there is a decline in the score at 7- and 10-years post-surgery. Age did not have an influence on the variation in functional score in any of the follow-up groups. MFJS has a strong positive correlation with the well-recognised KOOS scoring system. LEVEL OF EVIDENCE: IV.

A Comparative Study of Salter Versus Pemberton Osteotomy in Open Reduction of Developmental Dysplastic Hips and Clinical Evaluation on Bhatti's Functional Score System.

Objective The study was aimed to compare the outcome of Salter's and Pemberton's osteotomy to achieve adequate acetabular coverage in the open reduction of developmental dysplastic hips (DDH). The functional outcome was evaluated as measured on Bhatti's Functional Score System (BFSS). Patients and methods The study includes 60 children with 82 hips of developmental dysplasia in walking-age children. They were operated on for open reduction and Salter's or Pemberton's pelvic osteotomy to achieve concentric anatomical reduction with good anterolateral coverage of the femoral head. Patients for Salter's and Pemberton's osteotomies were randomly selected. Preference was given to Pemberton's osteotomy in cases with double/irregular acetabulum and in bilateral DDH. All patients were operated on by a single surgeon from January 2014 to December 2016 and were followed up till June 2020. The overall radiological outcome was assessed on Severin's classification, comparing the pre and postoperative acetabular index (AI) and the clinical outcome on Bhatti's Functional Score System. Results The overall functional behavior on Bhatti's Functional Scoring revealed satisfactory outcome (excellent and good) in 73.17% (60/82) hips. On the radiological evaluation, 85.36% (70/82) hips achieved satisfactory development of hips (Severin Class IAB and IIAB) while 12.19% (10) hips developed a moderate deformity of the hip (Severin Class III; p>0.05). Comparing outcomes in both the Pemberton and Salter groups, the acetabular index significantly reduced after both procedures (p<0.05), however, the Pemberton group was more effective than the Salter group. Avascular necrosis (AVN) of Caput Femoris was noticed in 9.57% (8) hips, subluxations in 2.43% (2) hips, and impingement and stiffness in 12.19% (10) hips. Salter's group had more numbers of AVN and subluxations as compared to the Pemberton group, whereas impingement and stiffness were more in Pemberton's but none in the Salter group. Conclusion The hips with Pemberton's acetabuloplasty exhibited better acetabular coverage and progressive development of hips as compared to Salter's osteotomy group. Both groups, however, behaved equally on functional assessment with Bhatti's Functional Score System. The risk of subluxation and AVN was found higher in Salter's group, and femoroacetabular impingement in Pemberton's group. Pemberton's osteotomy was the best option for a single-stage open reduction in bilateral DDH in terms of less risk of bleeding, good stability, better postoperative pain control, and a second surgery to remove transfixation K-wires.

Minimum 10 years clinical results of an anatomical short stem with a proximal hydroxyapatite coating.

OBJECTIVES: The CentPillar stem (Stryker Orthopaedics), an anatomical short stem, was designed to match the proximal femoral canal shape in both patients with normal hips and those with developmental dysplasia of the hip (DDH). The long-term outcomes of the CentPillar stem was examined herein. METHODS: In total, 222 hips that underwent total hip arthroplasty using the CentPillar stem were analyzed. DDH was the main reason for surgery (79.3%). Implant survivorship was assessed using Kaplan-Meier analysis. For radiographic evaluation, stress shielding was assessed using the Engh classification. For functional evaluation, patients' ability to perform deep hip bending activities (sit on the floor, squat, and sit straight) was assessed. RESULTS: During a median follow-up of 13.1 years, 2 stem revisions were performed (aseptic loosening and late hematogenous periprosthetic infection), and the overall cumulative implant survival rate was 99.0% at 15 years. In the radiographic evaluation, grade >3 stress shielding was found in only one hip. More than 80% of the patients were able to perform each of the three deep hip bending activities. CONCLUSIONS: Good fixation at the proximal part of the femur was obtained, and the implant survival rate of the CentPillar stem was excellent during a long-term follow-up.

Upfront surgery is not advantageous compared to more conservative treatments such as observation or medical treatment for patients with desmoid tumors.

BACKGROUND: This study compared the clinical and functional outcomes of patients initially treated with observation or medical treatment with those of patients treated with local treatment (surgery alone or surgery with adjuvant radiotherapy) to confirm whether observation or medical treatment is an appropriate first-line management approach for patients with desmoid tumors. METHODS: We retrospectively reviewed the medical records of 99 patients with histologically confirmed primary desmoid tumors treated between 1978 and 2018. The median follow-up period was 57 months. We evaluated event-free survival, defined as the time interval from the date of initial diagnosis to the date of specific change in treatment strategy or recurrence or the last follow-up. RESULTS: An event (specific change in treatment strategy or recurrence) occurred in 28 patients (28.3%). No significant difference in event-free survival was found between the first-line observation/medical treatment and local treatment groups (p = 0.509). The median Musculoskeletal Tumor Society score of the patients treated with first-line local treatment was 29 (interquartile range [IQR], 23-30), whereas that of the patients managed with first-line observation or medical treatment was 21 (IQR, 19-29.5). First-line observation or medical treatment was more frequently chosen for larger tumors (p = 0.045). In the patients treated with local treatment, local recurrence was not related to the surgical margin (p = 0.976). CONCLUSION: Upfront surgery is not advantageous compared to more conservative treatments such as observation or medical treatment for patients with desmoid tumors.