OBJECTIVETo investigate whether parental family history of diabetes influences cardiovascular outcomes in type 2 diabetes.RESEARCH DESIGN AND METHODSWe studied 1,294 type 2 diabetic patients (mean age 64.1 years, 51.2% female) recruited to a community-based cohort study from 1993 to 1996 and followed until mid-2006. A data linkage system assessed all-cause and cardiac mortality, incident myocardial infarction, and stroke. Cox proportional hazards modeling was used to determine the influence of maternal or paternal family history on these outcomes.RESULTSA maternal family history of diabetes was reported by 20.4% of the cohort, 8.3% reported paternal family history, and 2.0% reported both parents affected. Maternal and paternal family history was associated with earlier age of diabetes onset, and maternal family history was associated with worse glycemic control. For all patients, maternal family history was significantly associated with reduced risk of all-cause mortality and cardiac mortality. When analyzed by sex, maternal family history had no effect on male patients, whereas female patients with diabetic mothers had significantly reduced hazard ratios for death from all causes (0.63 [95% CI 0.41–0.96]; P = 0.033), for death from cardiac causes (0.32 [0.14–0.72]; P = 0.006), and for first myocardial infarction (0.45 [0.26–0.76]; P = 0.003). Paternal family history status was not associated with these outcomes.CONCLUSIONSA maternal family history of diabetes confers relative protection against cardiovascular disease in female patients but not in male patients with type 2 diabetes. Paternal family history is associated with risks equivalent to those without a family history of diabetes. Some of the clinical heterogeneity of type 2 diabetes is related to maternal transmission effects with differential impact on male and female patients.

Arthroscopic repair of subscapularis tendon tears has shown to be a reliable and reproducible technique and is now considered the gold standard method over open repair. However, most arthroscopic techniques use several working portals and the procedure can be technically challenging and time-consuming, especially when knot-tying is required and when multiple anchors are used. Recently, single-portal knotless techniques have been popularized for upper-third lesions (e.g. Lafosse type 1 or 2 tears). Here, we describe a technique of repairing complete tears of the subscapularis tendon (Lafosse type 3 and 4) using knotless suture anchors through a single portal. This technique is quick and allows a safe anatomic footprint repair to the lesser tuberosity.

BackgroundThe use of local infiltration analgesia in the setting of knee arthroplasty is well established. There are no studies to date which have directly compared differences in infiltration techniques. The purpose of this study is to establish if a difference in patient outcomes exists when the infiltrate is injected into the periarticular tissues or directly into the joint.MethodsOne hundred and forty-two consecutive patients waitlisted for primary total knee arthroplasty were enrolled after primary exclusion criteria were applied. These included the following: allergy to study drugs, inability to receive spinal anaesthesia, and planned bilateral surgery. Patients were divided into two groups, a periarticular infiltration group (group A) and an intraarticular infiltration group (group B). Secondary exclusion criteria of regular opioid use, psychiatric illness, and serious medical comorbidity left a total of 47 patients in group A and 54 patients in group B. Both groups received a combination of 30 mg ketorolac, 500 μg of adrenaline, and 300 mg of ropivacaine, and normal saline. This was either injected into the periarticular tissues during surgery (group A) or intraarticularly after closure of the wound (group B).Primary outcome measures included opioid consumption during the first 24 h postoperatively and over the total admission, and visual analogue scales (VAS) on postoperative day 1 and at discharge. Secondary measures included Oxford Knee Score, knee flexion, length of stay, haemoglobin drop, and transfusion requirement.Ethics approval was granted by the hospital review board. The trial is registered in the Australian New Zealand Clinical Trials Registry, registration ACTRN12615000488505.ResultsNo statistically significant differences in postoperative analgesic use were observed between the two groups. However, there was a trend toward decreased postoperative patient-controlled analgesia use in the periarticular group (mean 53.1 vs 68.3 mg morphine equivalents; p = 0.093), as well as a statistically significant reduction in postoperative visual analogue pain scores. No statistically significant differences were observed for haemoglobin drop, range of motion, or pre- to 6-week postoperative Oxford Score difference.ConclusionsOur study is the first we are aware of to directly compare a periarticular to intraarticular injection technique when using local infiltration analgesia for total knee arthroplasty. Our results show no clear statistically significant benefit with either technique. The periarticular group showed a statistically significant reduction in postoperative VAS pain scores alongside a trend in that group toward reduced overall opioid use.

Background: The treatment of traumatic anterior shoulder instability in professional Australian Football League (AFL) players is challenging, with an emphasis on early return to play and avoidance of instability recurrence. Purpose: To investigate return-to-sport (RTS) outcomes and complications after 2 different procedures for traumatic anterior shoulder instability in professional AFL players. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed our surgical database for professional AFL players who underwent capsulolabral stabilization or open Latarjet procedure by a single surgeon between 2006 and 2017. Outcomes included RTS, on-field performance, and complications. Between-group analyses for RTS and complications were estimated using Kaplan-Meier survival analyses. Within-group analyses for on-field performance data were performed using paired t tests with significance set at .05. Results: A total of 58 capsulolabral stabilization procedures in 54 players and 32 Latarjet procedures in 29 players were included in the analysis; 93.1% of capsulolabral patients and 96.9% of Latarjet patients returned to professional AFL. The median RTS time was 6.8 months for the capsulolabral group and 7.3 months for the Latarjet group. There was no significant difference in RTS rates between the 2 groups ( P = .270). Of those undergoing surgery early in the season, 75% of the capsulolabral and 71% of Latarjet group were able to RTS within the same season, at a mean time of 16.9 weeks and 18.8 weeks, respectively. There was a significant difference in instability recurrence, with 19% for the capsulolabral group and no recurrence in the Latarjet group ( P = .017). There was no significant reduction in player on-field performance in either group ( P < .05). Conclusion: In this study, the median RTS in AFL players was approximately 7 months after capsulolabral and Latarjet surgery with no compromise to on-field performance. Instability-related complications occurred only in the capsulolabral group, and the incidence increased with time.

Background: We retrospectively reviewed return to sport times and results for a series of professional Australian Rules football (AFL) players after clavicle fracture management using a precurved Titanium (Acumed) plate and screws. We allowed very early use and aimed to assess if this construct is strong enough to withstand collision sport activities before radiological union is confirmed. Methods: We reviewed 14 consecutive senior listed AFL players who underwent plate fixation by the senior author over a 10 year period. Outcome measures were taken between 12 and 36 months post operatively and included time to return to play, Nottingham Clavicle Score (NCS) and the Oxford Shoulder Score.    Results: The median time for return to training was 3.5 weeks and 6 weeks for return to full competition.  All fractures eventually united. Three of the players that returned before 6 weeks post-operatively suffered significant impacts that caused a bend in the titanium plates. One of these required revision fixation surgically due to perceived weakness in the bent plate construct and cosmetic deformity. The mean Nottingham Clavicle Score and Oxford Shoulder Score were 87.9 and 45.1 points respectively. Survival analysis showed that more than half of the players returned to training at 4 weeks and over 80% at 12 weeks.   Discussion: The decision to operate early on AFL players who suffered a clavicle fracture in competition play resulted in excellent longterm results. However, the decision to return some players earlier than accepted times for bony union resulted in bending of plates in a significant number, and the risk of further injury must be weighed up in a collision sport.  The early return to play time had no adverse effects on performance and participant satisfaction was high, as reflected by the Nottingham Clavicle score and the Oxford shoulder score.