Background While published studies on return to play for various sports exist in the literature, there is a relative paucity of data regarding the effect of ACL reconstruction on the ability of American high school and collegiate football players to return to play at the same level of competition as before their injury, or to progress to play at the next level of competition. Purpose The purpose of this study was threefold: 1) to identify the percentage of high school and collegiate American football players who successfully returned to play at their previous level of competition; 2) to investigate self-reported performance for those players able to return to play or reason(s) for not returning to play; 3) to elucidate risk factors responsible for players not being able to return to play or not returning to the same level of performance. Study Design Retrospective cohort study; level of evidence, 2. Methods This study was a retrospective analysis of prospective patients taken from the Multicenter Orthopaedic Outcomes Network (MOON) cohort who identified football as their primary or secondary sport. Identified patients were then questioned in a structured interview regarding their ACL injury, participation in football prior to their injury, and factors associated with returning to play. Data was analyzed for player position, concurrent meniscal/ligamentous/chondral pathology, surgical technique and graft used for ACL reconstruction, and issues pertaining to timing and ability to return to play. Results 147 players (68 high school, 26 collegiate) met our criteria and were contacted from the 2002 and 2003 MOON cohorts. Return-to-play rates for all high school and collegiate athletes were similar (63% and 69%, respectively). Based on player perception, 43% of the players were able to return to play at the same self-described performance level. Approximately 27% felt they did not perform at a level attained prior to their ACL tear, and 30% were unable to return to play at all. Although 2/3 of players reported some “other interest” contributing to their decision not to return, at both levels of competition fear of re-injury or further damage was cited by ~50% of the players who did not return to play. Analysis of patient-reported outcome scores at a minimum of two years after surgery between patients who returned to play and those that did not demonstrated clinically and statistically significant differences in the IKDC, Marx activity, and KOOS knee related quality of life subscales in the collegiate players. Similar clinical differences were not statistically significant in the high school students. Player position did not have a statistically significant effect on the ability to return to play for high school players, and 41% of “skilled” position players and 50% of “non-skilled” position players were able to return to play at the same performance level. Conclusion Return-to-play percentages for amateur American football players following ACL reconstruction are not as high as would be expected. While tech...

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Understanding the development of cortical interneuron phenotypic diversity is critical because interneuron dysfunction has been implicated in several neurodevelopmental disorders. Here, tyrosine hydroxylase (TH)-immunoreactive neurons in the developing and adult rat cortex were characterized in light of findings regarding interneuron neurochemistry and development. Cortical THimmunoreactive neurons were first observed two weeks postnatally and peaked in number three weeks after birth. At subsequent ages, the number of these cell profiles was gradually reduced, and they were seen less frequently in adults. No DNA fragmentation or active caspase 3 was observed in cortical TH cells at any age examined, eliminating cell death as an explanation for the decrease in cell number. Although cortical TH cells reportedly fail to produce subsequent catecholaminergic enzymes, we found that the majority of these cells at all ages contained phosphorylated TH, suggesting that the enzyme may be active and producing L-DOPA as an end-product. Morphological criteria and colocalization of some TH cells with glutamic acid decarboxylase suggests that these cells are interneurons. Previously, parvalbumin, somatostatin, and calretinin were demonstrated in nonoverlapping subsets of interneurons. Cortical TH neurons colocalized with calretinin but not with parvalbumin or somatostatin. These findings suggest that the transitory increase in TH cell number is not due to cell death but possibly due to alterations in the amount of detectable TH present in these cells, and that at least some cortical TH-producing interneurons belong to the calretinin-containing subset of interneurons that originate developmentally in the caudal ganglionic eminence.

Background: Prompt administration of antibiotics is a critical component of open fracture treatment. Traditional antibiotic recommendations have been a first-generation cephalosporin for Gustilo Type-I and Type-II open fractures, with the addition of an aminoglycoside for Type-III fractures and penicillin for soil contamination. However, concerns over changing bacterial patterns and the side effects of aminoglycosides have led to interest in other regimens. The purpose of the present study was to describe the adherence to current prophylactic antibiotic guidelines. Methods: We evaluated the antibiotic-prescribing practices of 24 centers in the U.S. and Canada that were participating in 2 randomized controlled trials of skin-preparation solutions for open fractures. A total of 1,234 patients were evaluated. Results: All patients received antibiotics on the day of admission. The most commonly prescribed antibiotic regimen was cefazolin monotherapy (53.6%). Among patients with Type-I and Type-II fractures, there was 61.1% compliance with cefazolin monotherapy. In contrast, only 17.2% of patients with Type-III fractures received the recommended cefazolin and aminoglycoside therapy, with an additional 6.7% receiving piperacillin/tazobactam. Conclusions: There is moderate adherence to the traditional antibiotic treatment guidelines for Gustilo Type-I and Type-II fractures and low adherence for Type-III fractures. Given the divergence between current practice patterns and prior recommendations, high-quality studies are needed to determine the most appropriate prophylactic protocol.

In conclusion, the MJ approach allows similar access to landmarks important for reduction and fixation while exposing only 20% of the surface area typically visualized with the CJ approach.