Cartilage and Meniscus Injuries Are More Common in Patients Undergoing Delayed Multiligament Reconstruction

2020 ◽  
Author(s):  
Alan G. Shamrock ◽  
James R. Hall ◽  
Christina J. Hajewski ◽  
Qiang An ◽  
Kyle R. Duchman
Keyword(s):  
Surgical Intervention ◽  
Intervention Group ◽  
Knee Injuries ◽  
High Energy ◽  
Injury Mechanism ◽  
Surgical Reconstruction ◽  
Injury Rates ◽  
Chondral Injury ◽  
The Relationship ◽  
And Cartilage

AbstractThe purpose of this study was to describe the pattern of meniscus and cartilage pathology in multiligament knee injuries (MLKIs) and determine the relationship between surgical timing and injury mechanism with degree of intra-articular injury. Patients with surgically treated MLKIs over a 15-year period were retrospectively reviewed and grouped based on surgical intervention, time to intervention, and injury mechanism. The presence or absence of meniscus and chondral injury were recorded at the time of surgery. Surgical intervention within 6 weeks of injury was deemed acute, while surgery occurring more than 6 weeks from injury was classified as delayed. Over the 15-year study period, 207 patients with MLKIs were identified. Compared with acutely managed patients, the delayed intervention group had significantly more meniscus (p = 0.03) and cartilage (p < 0.01) pathology. Meniscus injury rates in MLKIs sustained during sporting activity did not differ from nonsporting injuries (p = 0.63). However, the nonsporting group had significantly more chondral injuries (p < 0.01). High-energy injury mechanism was associated with increased cartilage (p = 0.02), but not meniscus (p = 0.61) injury rates. In conclusion, surgical reconstruction of MLKIs delayed for more than 6 weeks was associated with increased meniscus and cartilage pathology.

scholarly journals Delay in Surgical Management of Multiligament Knee Injuries is Associated with Cartilage and Meniscus Injury

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0030
Author(s):  
Alan G. Shamrock ◽  
James Hall ◽  
Christina Hajewski ◽  
Qiang An ◽  
Kyle R. Duchman
Keyword(s):  
Intervention Group ◽  
Knee Injuries ◽  
Injury Pattern ◽  
Surgical Reconstruction ◽  
Ligament Injury ◽  
Meniscus Injury ◽  
Cartilage Injuries ◽  
Multiligament Knee Injuries ◽  
Delayed Intervention ◽  
And Cartilage

Objectives: Multiligament knee injuries (MLKIs) are potentially devastating injuries and can lead to significant functional impairment. Long-term outcomes and reconstructive options for MLKIs have been well described, however limited data exists on meniscus and chondral injuries in the setting of a multiligament deficient knee. The purpose of this study was to describe the pattern of meniscus and cartilage pathology in operative MLKIs and determine the relationship between surgical timing and degree of intra-articular injury. Methods: Consecutive patients with surgically treated MLKIs involving two or more ligaments (ACL, PCL, MCL, or PLC) over a 15-year period at a single large academic institution were retrospectively reviewed. Subjects were grouped based on their ligament injury pattern and the presence or absence of meniscus and chondral injury were recorded. Surgical intervention within 6 weeks of injury was deemed acute, while surgery occurring more than 6 weeks from injury was classified as delayed. Chi square and logistic regression were utilized for statistical analysis, with significance set at p<0.05. Results: In the 15-year study period, 207 patients with MLKIs (age: 28.4 +/- 12.1 years; 74.9% male) were surgically treated at our institution. There were 104 meniscal (50.2%) and 70 chondral (33.8%) injuries in the cohort. The most common ligamentous injury pattern was ACL/MCL (n=47, 22.7%) and ACL/PCL (n=47, 22.7%), followed by ACL/PCL/MCL (n=35, 16.9%) [Table 1]. Meniscectomy (n=52, 50.0%) was the most frequently performed procedure for meniscus injuries followed by meniscus repair (n=32, 30.8%). Compared to acutely managed patients, the delayed intervention group had significantly more meniscus pathology (57.1% vs 42.1%, p=0.03) and were more likely to undergo meniscectomy compared to repair (p=0.002). Of the 70 cartilage injuries, 11 (15.7%) required surgical debridement. Chondral pathology was more frequently present in the delayed intervention group compared to the acutely managed group (p=0.003). Meniscus injury rates in MLKIs sustained during sporting activity did not differ from non-sporting injuries (p=0.59) however, the non-sporting group had significantly more cartilage injuries (42.0% vs 18.1%, p<0.001). Conclusion: Surgical reconstruction of MLKIs delayed for more than 6 weeks was associated with increased meniscus and cartilage pathology. This may be the result of the severity of the initial injury, which may warrant surgical delay in more severe cases, or persistent knee instability placing the meniscus and chondral surface at risk for injury.

scholarly journals Acute Versus Delayed Surgical Intervention in Multiligament Knee Injuries: A Systematic Review

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110278
Author(s):  
Ryan S. Marder ◽  
Husain Poonawala ◽  
Jorge I. Pincay ◽  
Frank Nguyen ◽  
Patrick F. Cleary ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Surgical Intervention ◽  
Intervention Group ◽  
Knee Injuries ◽  
Cochrane Library ◽  
The Mean ◽  
Multiligament Knee Injuries ◽  
Level 2

Background: The optimal timing of surgical intervention for multiligament knee injuries remains controversial. Purpose: To review the clinical and functional outcomes after acute and delayed surgical intervention for multiligament knee injuries. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a search of the PubMed, Embase, Cochrane Library, and Web of Science databases from inception to September 2020. Eligible studies reported on knee dislocations, multiligament knee injuries, or bicruciate ligament injuries in adult patients (age, ≥18 years). In addition to comparing outcomes between acute and delayed surgical intervention groups, we conducted 3 subgroup analyses for outcomes within isolated knee injuries, knee injuries with concomitant polytrauma/fractures, and high-level (level 2) studies. Results: Included in the analysis were 31 studies, designated as evidence level 2 (n = 3), level 3 (n = 8), and level 4 (n = 20). These studies reported on 2594 multiligament knee injuries sustained by 2585 patients (mean age, 25.1-65.3 years; mean follow-up, 12-157.2 months). At the latest follow-up timepoint, the mean Lysholm (n = 375), International Knee Documentation Committee (IKDC) (n = 286), and Tegner (n = 129) scores for the acute surgical intervention group were 73.60, 67.61, and 5.06, respectively. For the delayed surgical intervention group, the mean Lysholm (n = 196), IKDC (n = 172), and Tegner (n = 74) scores were 85.23, 72.32, and 4.85, respectively. The mean Lysholm (n = 323), IKDC (n = 236), and Tegner (n = 143) scores for our isolated subgroup were 83.7, 74.8, and 5.0, respectively. By comparison, the mean Lysholm (n = 270), IKDC (n = 236), and Tegner (n = 206) scores for the polytrauma/fractures subgroup were 83.3, 64.5, and 5.0, respectively. Conclusion: The results of our systematic review did not elucidate whether acute or delayed surgical intervention produced superior clinical and functional outcomes. Although previous evidence has supported acute surgical intervention, future prospective randomized controlled trials and matched cohort studies must be completed to confirm these findings.

scholarly journals The interstellar medium in young supernova remnants: key to the production of cosmic X-rays and $\gamma $-rays

2021 ◽  
Vol 366 (6) ◽  
Author(s):  
Hidetoshi Sano ◽  
Yasuo Fukui
Keyword(s):  
Interstellar Medium ◽  
Supernova Remnants ◽  
Cosmic Ray ◽  
High Energy ◽  
X Rays ◽  
Interstellar Gas ◽  
High Energy Radiation ◽  
Dense Cores ◽  
The Relationship ◽  
Turbulent Velocity Field

AbstractWe review recent progress in elucidating the relationship between high-energy radiation and the interstellar medium (ISM) in young supernova remnants (SNRs) with ages of ∼2000 yr, focusing in particular on RX J1713.7−3946 and RCW 86. Both SNRs emit strong nonthermal X-rays and TeV $\gamma $ γ -rays, and they contain clumpy distributions of interstellar gas that includes both atomic and molecular hydrogen. We find that shock–cloud interactions provide a viable explanation for the spatial correlation between the X-rays and ISM. In these interactions, the supernova shocks hit the typically pc-scale dense cores, generating a highly turbulent velocity field that amplifies the magnetic field up to 0.1–1 mG. This amplification leads to enhanced nonthermal synchrotron emission around the clumps, whereas the cosmic-ray electrons do not penetrate the clumps. Accordingly, the nonthermal X-rays exhibit a spatial distribution similar to that of the ISM on the pc scale, while they are anticorrelated at sub-pc scales. These results predict that hadronic $\gamma $ γ -rays can be emitted from the dense cores, resulting in a spatial correspondence between the $\gamma $ γ -rays and the ISM. The current pc-scale resolution of $\gamma $ γ -ray observations is too low to resolve this correspondence. Future $\gamma $ γ -ray observations with the Cherenkov Telescope Array will be able to resolve the sub-pc-scale $\gamma $ γ -ray distribution and provide clues to the origin of these cosmic $\gamma $ γ -rays.

EP.FRI.154 Could Antiangiogenic Drugs be the Solution to Tendon Injury? A Literature Review on the use of Antiangiogenic Drugs for Tendon Regeneration

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Chris Kirchhoff
Keyword(s):  
Literature Review ◽  
Surgical Intervention ◽  
Healing Process ◽  
Intervention Group ◽  
Tendon Healing ◽  
Flow Diagram ◽  
Current Evidence ◽  
Control Group ◽  
Cross Sectional ◽  
Antiangiogenic Drugs

Abstract Background Tendinopathy accounts for more than half of reported musculoskeletal injuries worldwide. The subsequent healing process results in a disorganised tendon structure secondary to neovascularisation, forming a bulky tendon with overall reduced strength. Current treatment options remain controversial as re-rupture rates following surgical intervention are high. It has been proposed that the use of anti-vascular endothelial growth factors could improve tendon healing. Methods This literature review employed a systematic approach. The search strategy incorporated an adjusted PICO format and PRISMA flow diagram. Search findings were critically appraised using the CASP tool checklist. Identified studies investigated the effect of injectable anti-angiogenic drugs on tendon healing.  Results Three final studies were identified. Tempfer et al. showed a reduction in cross sectional tendon area in the intervention group (5.6mm²+1.8), comparatively to the control group (9.1mm² +2.0), and increased tendon strength in the intervention group (47.7N+6.41) comparatively to the control group(32.41N+9.23). Dallaudiere (2014) et al. showed reduced cross-sectional area in the intervention group (0.95mm²+0.01) compared with the control group (0.75mm²+0.01). Dallaudiere (2013) et al. also showed reduced cross sectional areas in the intervention group (1.10mm²+0.01) compared with the control group (1.11mm²+0.03).  Conclusion All studies supported the use of anti-angiogenic drugs to support tendon healing. The use of injectable anti-angiogenic drugs may potentially serve in conjunction with surgical intervention or as an alternative minimally invasive intervention to improve tendon rehabilitation. This review recommends that further randomised control studies will be needed to strengthen the current evidence. 

scholarly journals Low-Energy Multiligament Knee Injuries Are Associated With Higher Postoperative Activity Scores Compared With High-Energy Multiligament Knee Injuries: A Systematic Review and Meta-analysis of the Literature

2020 ◽  
pp. 036354652096208
Author(s):  
Robert S. Dean ◽  
Nicholas N. DePhillipo ◽  
David H. Kahat ◽  
Nathan R. Graden ◽  
Christopher M. Larson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Motor Vehicle ◽  
Meta Analysis ◽  
Knee Injuries ◽  
High Energy ◽  
Low Energy ◽  
Vehicle Accidents ◽  
Injury Mechanisms ◽  
Outcome Scores ◽  
Multiligament Knee Injuries

Background: Multiligament knee injuries (MLKIs) can result from high-energy injury mechanisms such as motor vehicle accidents or low-energy injury mechanisms such as activities of daily living or sports. Purpose/Hypothesis: The purpose was to conduct a systematic review on postoperative patient-reported outcomes after MLKIs and to conduct a meta-analysis of comparable outcome variables based upon high- versus low-energy injury mechanisms. It was hypothesized that MLKIs with low-energy injury mechanisms would demonstrate significantly improved subjective clinical outcome scores compared with high-energy injuries. Study design: Meta-analysis and systematic review. Methods: A systematic review was performed with the inclusion criteria of postoperative MLKI outcomes based upon high-versus low-energy mechanisms of injury with a minimum 2-year follow-up. Outcome scores included were the Lysholm knee scoring scale, Tegner activity scale, and the International Knee Documentation Committee (IKDC) score. High-energy mechanisms included motor vehicle accidents or falls from a height >5 feet; low-energy mechanisms included sports-related injuries, activities of daily living, or falls from <5 feet. A meta-analysis was performed comparing the outcome scores of high- versus low-energy mechanisms of MLKIs. Results: Overall, 1214 studies were identified, 15 of which were included in the systematic review and meta-analysis. Thirteen studies included surgical reconstructions of all injured ligaments. A total of 641 patients with 275 high-energy and 366 low-energy injuries were grouped for comparison in the meta-analysis. No significant differences in Lysholm scale (78.6 vs 78.0) or IKDC scores (69.0 vs 68.4) were found between high- and low-energy groups at a minimum of 2 years (range, 2-10 years) postoperatively ( P > .05). The low-energy injury group demonstrated significantly higher Tegner activity scale scores (5.0 vs 3.9; P = .03). There was no significant difference in failure rates between groups (3.5% vs 2.0%; P = .23). Conclusion: We found in this systematic review and meta-analysis that patients with low-energy mechanisms of MLKI surgery had improved postoperative Tegner activity scores compared with those patients with high-energy mechanisms after MLKI surgery. However, there were no differences in Lysholm score, IKDC score, or failure rates between high- and low-energy MLKI patients at an average of 5.3 years postoperatively.

scholarly journals DEVELOPMENT OF WAVE POWER GENERATION SYSTEM SUITABLE FOR INNER BAY

2020 ◽  
pp. 39
Author(s):  
Rioko Hirota ◽  
Takaaki Shigematsu ◽  
Kenji Katoh ◽  
Tatsuro Wakimoto ◽  
Shinya Yoshioka
Keyword(s):  
Power Generation ◽  
Particle Velocity ◽  
High Energy ◽  
Wave Power ◽  
Generation System ◽  
Water Particle ◽  
Water Turbine ◽  
Power Generation System ◽  
The Relationship ◽  
Wave Power Generation

With the increasing demand for renewable energy in the world, research contributing to the improvement of the technology level of wave power generation is essential. The authors have been developed a wave power generation system using port facilities in inner bays with high energy-consuming cities. In this study, the relationship between the rotational characteristics of a Savonius water turbine and the water particle velocity was quantitatively evaluated under the calm conditions of the inner bay, such as wave motion, flow, and coexistence of wave and current. According to the experimental results, it is found that the relationship between the rotational circumferential speed and the water particle velocity of the water turbine installed in a wave field tends to be different from that in a flow field and is evaluated by different equations. In addition, the relationship between circumferential velocity and the water particle velocity has also been formulated when installed in a wave-current coexistence field.Recorded Presentation from the vICCE (YouTube Link): https://youtu.be/KX0XBFuao48

scholarly journals A Study on the Relationship between Iron Reserves and the Intensity of Coronary Artery Stenosisin Angiography Candidates

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Khalil Mahmoodi
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Transferrin Saturation ◽  
Intervention Group ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Coronary Artery Stenos ◽  
The Impact ◽  
The Relationship

Various risk factors including blood iron may create coronary artery diseases and lead to myocardial infarction. There are controversies with regard to the impact of blood iron on myocardial infarction. Therefore, the aim of this paper was to investigate the relationship between iron reserves and the intensity of coronary artery stenos is among angiographic candidates in Zanjan, Iran. This was a cross sectional study. Samples were consisted of patients who were hospitalized for diagnostic coronary angiography in hospitals in an urban area of Iran. A convenient sampling method was used to recruit samples via interviews and laboratory examinations for FBS, iron, TIBC, ferritin, creatinine serum, CBC, cholesterol, HDL and LDL. The samples were divided into control and intervention groups. After coronary angiography, the intervention group was evaluated by four different methods including the extent score, stenos is score, vessel score and Duke CAN Index. The samples were consisted of 89 men (60.1%) and 59 women (39.9%). The levels of ferritin (p=0.003) and iron (p=0.002), and transferrin saturation percent (p=0.002) showed significant differences between males and females (p=0.004)

scholarly journals Patterns of orthopaedic injury among hospitalised personal mobility device users and bicycle riders: a comparative study

2021 ◽  
Author(s):  
TSD Koh ◽  
YL Woo ◽  
TH Wong ◽  
MH Tan
Keyword(s):  
Orthopaedic Surgery ◽  
Surgical Intervention ◽  
High Energy ◽  
Open Fractures ◽  
Inpatient Stay ◽  
Injury Patterns ◽  
Prolonged Hospitalisation ◽  
Personal Mobility ◽  
Mobility Devices ◽  
Mobility Device

Introduction: Personal mobility devices (PMDs), such as electronic scooters or motorised bicycles, are efficient modes of transportation. Their recent popularity has also resulted in an increase in PMD-related injuries. We aimed to characterise and compare the nature of injuries sustained by PMD users and bicycle riders. Methods: This retrospective study compared injury patterns among PMD and bicycle users. 140 patients were admitted between November 2013 and September 2018. Parameters studied included patients’ demographics (e.g. age, gender and body mass index), type of PMD, nature of injury, surgical intervention required, duration of hospitalisation and time off work. Results: Of 140 patients, 46 (32.9%) patients required treatment at the department of orthopaedic surgery. 19 patients were PMD users while 27 were bicycle riders. 16 (84.2%) patients with PMD-related injuries were men. PMD users were significantly younger (mean age 45 ± 15 years) when compared to bicycle riders (mean age 56 ±17 years; p < 0.05). A quarter (n = 5, 26.3%) of PMD users sustained open fractures and over half (n = 10, 52.6%) required surgical intervention. Among 27 bicycle users, 7.4% (n = 2) of patients sustained open fractures and 70.4% (n = 19) required surgical intervention. Both groups had comparable inpatient stay duration and time off work. Conclusion: PMD-related orthopaedic traumas are high-energy injuries, with higher rates of open fractures, when compared to bicycle injuries. In addition, PMD users are significantly younger and of economically viable age. Prolonged hospitalisation and time off work have socioeconomic implications. Caution should be exercised when using PMDs.

scholarly journals Association of Beverage Consumption with Obesity in Healthy Adults

2017 ◽  
Vol 1 (1) ◽  
pp. 37
Author(s):  
Sirine Maher Zahran
Keyword(s):  
Abdominal Obesity ◽  
Weight Status ◽  
Intervention Group ◽  
Overweight And Obesity ◽  
Abu Dhabi ◽  
Major Health ◽  
Sweetened Beverages ◽  
The One ◽  
Relationship Of ◽  
The Relationship

Background: The increased consumption of sugar-sweetened beverages (SSBs) has been found to be an important contributor of calories in the diet. Whether there is an association between the increased consumption of SSBs and the high rates of overweight and obesity is still questionable. The objective of this study was to examine the relationship of weight status and beverages consumed of adults in a residential compound in Abu Dhabi.Methods: Forty nine out of 65 residents form Al Reef Villas in Abu Dhabi agreed to participate in the study. Initial assessments including beverages frequency questionnaire and anthropometry measurements were completed for all participants. Participants who were identified as high beverages consumers were invited to a one-month intervention aiming to limit their beverages consumption. A final assessment was completed for all high consumers of beverages at the end of the one-month intervention.Results: 55% of the subjects were overweight or obese, and 51% had abdominal obesity. 73% consumed 100% fruit juices with no added sugar, 65% consumed soft drinks, and 60 % consumed plain milk and milk products. The majority (69%) consumed tea beverages rather than coffee beverages. There was no association between weight & beverages consumption. The mean energy percentage from beverages was 14.2 (± 11.1) among all participants. 53% were considered high consumers of beverages and 47% (n=23) were considered low consumers of beverages. The one-month intervention showed a significant decrease in % of calories from beverages and weight in the overweight & obese intervention group (p<0.001 and p<0.05) respectively.Conclusion: This study highlighted major health problems in Abu Dhabi including high rates of overweight, obesity, and abdominal obesity. The one-month intervention was effective in reducing the energy percentage from beverages and weight of the overweight and obese participants, but no association was found in this sample between beverages consumption and overweight and obesity.

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