Introduction The medial patellofemoral ligament (MPFL) is the primary soft-tissue stabilizer of the patella and it is often reconstructed in patients with recurrent patella instability. This biomechanical analysis evaluates the integrity of four methods of MPFL reconstruction subjected to cyclic loading using a porcine model. Methods Four techniques of MPFL reconstruction were analyzed using a 4 mm flexor tendon graft, all with two points of patellar fixation to best recreate the native MPFL anatomy. The four techniques were: (1) interference screw technique, (2) suture anchor technique, (3) converging tunnel technique, and (4) two bone tunnel technique. Maximum load, yield load, and stiffness of the graft fixation/bone complex were analyzed, and statistics were performed with SPSS and significance set at a p-value of < 0.05. Results The converging tunnel technique demonstrated the highest maximum load and yield load, significantly higher than the interference screw or suture anchor groups (p = 0.007). In addition, the converging tunnel technique demonstrated the greatest stiffness with significantly greater stiffness than the two bone tunnel techniques (p = 0.016). Conclusion The combination of strength and stiffness, the avoidance of patella implants, and the creation of a single transosseous tunnel make the converging tunnel technique a desirable technique for MPFL reconstructions.
BACKGROUND Osteochondral allografts are an increasingly popular treatment for the repair of articular cartilage lesions. Current tissue bank protocols require bacteriological testing that takes from 21 to 28 days to process. During this time, tumor necrosis factor-alpha TNF-α (a pro-apoptotic cytokine) is upregulated resulting in loss of chondrocyte viability. To date, etanercept (a cytokine inhibitor) has not been studied in the current storage paradigm with the intention of preserving cell viability. HYPOTHESIS/PURPOSE To assess whether or not the addition of Etanercept can improve the chondrocytic viability of osteochondral allograft during storage. STUDY DESIGN Controlled, randomized and blinded in vitro laboratory study. METHODS Osteochondral allografts were harvested from eight Boer goat femurs and placed into storage media and stored at 4°C for 28 days. The experimental group was supplemented with 10 µg/mL of Etanercept. After storage, cell viability was assessed by live/dead staining and confocal microscopy. Specimens were also analyzed histologically and underwent histomorphological analysis. TNF-α expression was measured with semi-quantitative PCR. RESULTS At 28 days, the percent viability of the superficial zone in etanercept-treated allografts was maintained at significantly higher levels than those measured in the untreated group (69.3 ± 9.4 compared to 47.8 ± 19.1, p=0.01). No difference was found histologically between the etanercept and the untreated group (i.e. safranin-O staining for GAG expression). Histomorphologic assessment showed no difference in indentation stiffness or roughness between groups. TNF-α expression was significantly decreased in the etanercept group compared to the untreated group. CONCLUSION Etanercept was able to maintain cell viability of osteochondral allografts significantly better than the current storage paradigm after 28 days storage. CLINICAL RELEVANCE Maintaining the viability of the superficial zone will benefit outcomes by facilitating joint articulation via improved lubrication. Additionally, maintaining the cellular viability for increased periods of time may allow a greater window of time in which a suitable recipient may be found.
Snowboarders are at significantly higher risk of sustaining humerus fractures than skiers. In skiers, humerus fractures show no laterality and most often involve the proximal humerus. In contrast, snowboarders more often fracture the left humerus at the diaphysis.
BackgroundThe rise in disability due to back pain has been exponential with escalating medical and societal costs. The relative contribution of individual prognostic indicators to the pattern of recovery remains unclear. The objective of this study was to determine the prognostic value of demographic, psychosocial, employment and clinical factors on outcome in patients with low back painMethodsA prospective cohort study with six-month follow-up was undertaken at a multidisciplinary back pain clinic in central London employing physiotherapists, osteopaths, clinical psychologists and physicians, receiving referrals from 123 general practitioners. Over a twelve-month period, 593 consecutive patients referred from general practice with simple low back pain were recruited. A baseline questionnaire was developed to elicit information on potential prognostic variables. The primary outcome measures were change in 24-item Roland Morris disability questionnaire score at six months as a measure of low back related functional disability and the physical functioning scale of the SF-36, adjusted for baseline scores.ResultsRoland Morris scores improved by 3.8 index points (95% confidence interval 3.23 to 4.32) at six months and SF-36 physical functioning score by 10.7 points (95% confidence interval 8.36 to 12.95). Ten factors were linked to outcome yet in a multiple regression model only two remained predictive. Those with episodic rather than continuous pain were more likely to have recovered at six months (odds ratio 2.64 confidence interval 1.25 to 5.60), while those that classified themselves as non-white were less likely to have recovered (0.41 confidence interval 0.18 to 0.96).ConclusionsAnalysis controlling for confounding variables, demonstrated that participants showed greater improvement if their episodes of pain during the previous year were short-lived while those with Middle Eastern, North African and Chinese ethnicity demonstrated minimal improvement. The study did not support previous findings that a wide range of factors could predict outcome.
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