Background: Isolated injuries of the scapholunate interosseous ligament (SLIL) are insufficient to produce dorsal intercalated segment instability. There is no consensus about which additional ligamentous stabilizers are critical determinants of dorsal intercalated segment instability. The aim of this study was to evaluate the role of the long radiolunate (LRL), scaphotrapeziotrapezoid (STT), and dorsal intercarpal (DIC) ligaments in preventing dorsal intercalated segment instability. Methods: Thirty fresh-frozen forearms were randomized to 5 ligament section sequences to study the SLIL, LRL, STT, and DIC ligaments. The DIC-lunate insertion (DICL) and scaphoid insertion (DICS) were studied separately; the DIC insertions on the trapezium and triquetrum were left intact. Loaded posteroanterior and lateral fluoroscopic images were obtained at baseline and repeated after each ligament was sectioned. After each sequence, the wrists were loaded cyclically (71 N). The radiolunate angle was measured with load. Dorsal intercalated segment instability was defined as an increase of >15° in the radiolunate angle compared with baseline. Results: Division of the SLIL did not increase the radiolunate angle. Section of the SLIL+LRL or SLIL+DICL significantly increased the radiolunate angle but did not produce dorsal intercalated segment instability. Section of the SLIL+STT or SLIL+DICL+DICS produced dorsal intercalated segment instability. Conclusions: In order to produce dorsal intercalated segment instability, complete scapholunate injuries require the disruption of at least 1 critical ligament stabilizer of the scaphoid or lunate (the STT or DICL+DICS). Clinical Relevance: When treating SLIL tears with dorsal intercalated segment instability, techniques to evaluate the volar and dorsal critical stabilizers of the proximal carpal row should be considered.
Anterior cruciate ligament (ACL) rupture is a common injury in young athletes. To restore knee stability and function, patients often undergo ACL reconstruction (ACLR). Historically, there has been a focus in this population on the epidemiology of ACL injury, the technical aspects of ACL reconstruction, and post-operative functional outcomes. Although increasingly recognized as an important aspect in recovery, there remains limited literature examining the psychological aspects of post-operative rehabilitation and return to play following youth ACL reconstruction. Despite technical surgical successes and well-designed rehabilitation programs, many athletes never reach their preinjury athletic performance level and some may never return to their primary sport. This suggests that other factors may influence recovery, and indeed this has been documented in the adult literature. In addition to restoration of functional strength and stability, psychological and social factors play an important role in the recovery and overall outcome of ACL injuries in the pediatric population. Factors such as psychological readiness to return-to-play (RTP), motivation, mood disturbance, locus of control, recovery expectations, fear of reinjury, and self-esteem are correlated to the RTP potential of the young athlete. A better understanding of these concepts may help to maximize young patients’ outcomes after ACL reconstruction. The purpose of this article is to perform a narrative review of the current literature addressing psychosocial factors associated with recovery after ACL injury and subsequent reconstruction in young athletes. Our goal is to provide a resource for clinicians treating youth ACL injuries to help identify patients with maladaptive psychological responses after injury and encourage a multidisciplinary approach when treating young athletes with an ACL rupture.
After adjusting for acetabular defect severity, both PoTa and PoTi acetabular components had excellent survival at mean 44.4-month (range 4.3-91.5 months) follow-up when used in primary and revision THA.
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