Systematic Review and Meta-analysis: Does Anterior-Posterior Spinal Fusion Still have a Role in Severe Thoracic Adolescent Idiopathic Scoliosis?

Background: Debate exists as to whether anterior-posterior spinal fusion (APSF), rather than posterior-only spinal fusion (PSF), provides benefit for treating severe thoracic adolescent idiopathic scoliosis (AIS). This systematic review and meta-analysis compare (1) Cobb angle correction, (2) complication and reoperation rate, (3) pulmonary function, (4) number of fused segments, and 5) patient-reported outcome measures (PROMs) in both groups. Methods: Electronic databases were searched to identify studies that met the following inclusion criteria: comparative studies (level 3 or above), severe thoracic curves (≥ 70°), age ≤ 16, AIS aetiology, Lenke 1-4 curves and follow-up ≥ 1 year for ≥ 95% of patient population. Literature was graded for quality and bias using GRADE and MINORS criteria. Results: Eight studies were included, defined by GRADE as low or moderate level evidence. Three studies showed superior curve correction in the APSF group; however, the meta-analysis showed no significant difference in curve correction between groups (95% CI - 3.45-12.96, P = 0.26). There were more complications in the APSF group, without statistical significance (95% CI 0.53-3.39, P = 0.54; I 2 = 0%, P = 0.78). There were no re-operations in either group. Two studies reported pulmonary function; one showed better function in the APSF group, the other better function in the PSF group. One study showed fewer fused segments in the APSF group, however, no significance was observed in the meta-analysis (95%CI - 1.65-0.31, P = 0.18). Three studies reported PROMs with no differences reported between groups. Conclusions: APSF and PSF have been found to have comparable results. The present evidence cannot support recommendations for guidelines on future practice with regards to effect on curve correction, complications, re-operations, pulmonary function or PROMs. Level of evidence: Level III, Systematic review of Level-III studies.

Properties and Function of the Flexor Hallucis Capsularis Interphalangeus Tendon.

INTRODUCTION: The fibrocartilagenous plantar plates of the forefoot are biomechanically important, forming the primary distal attachment for the plantar aponeurosis. They are integral to the function of the windlass mechanism in supporting the arches of the foot in gait. Dissection of the cadaveric hallux revealed an organised sagittal thickening of the dorsal side of the flexor hallucis longus (FHL) sheath, which attached the interphalangeal plantar plate to the metatarsophalangeal (MTP) plantar plate. A description of a similar structure was made in 1984 when it was termed the flexor hallucis capsularis interphalangeus (FHCI) - however, it has not been researched since, and we aim to study it further and identify its characteristics. METHOD: Eight specimens were dissected from four cadavers. Two were stained and examined under magnification in both polarized and non polarized light. The remaining 6 were subjected to micrometer testing of their tensile properties. RESULTS: Both the histological features and mechanical properties were consistent with tendon; with cross sectional area, ultimate tensile strength and stiffness varying between specimens. CONCLUSIONS: Based on its location and properties, the FHCI tendon may be involved in limiting dorsiflexion of the first MTP joint and could have clinical relevance in pathological processes around both the first and second MTP joints. Clin. Anat., 33:689-695, 2020. © 2019 Wiley Periodicals, Inc.

Manipulation and Quantification of Graphene Oxide Flake Size: Photoluminescence and Cytotoxicity.

Single-layered graphene oxide (GO) has exhibited great promise in the areas of sensing, membrane filtration, supercapacitors, bioimaging, and therapeutic carriers because of its biocompatibility, large surface area, and electrochemical, photoluminescent, and optical properties. To elucidate how the physical dimensions of GO affect its intrinsic properties, we employed sonication to produce more than 130 different sizes of GO in aqueous dispersion and implemented new approaches to characterize various GO properties as a function of the average flake size. New protocols were developed to determine and compare the flake size of GO dispersions sonicated with energies up to 20 MJ/g by using dynamic light scattering and atomic force microscopy (AFM). The relationship between the average flake size and sonication energy per unit mass of GO was observed to follow a power law. AFM height measurements showed that the sonication of GO yielded monolayered flakes. Photoluminescence of GO was characterized as a function of the sonication energy (or the average flake size which is the monotonic function of the sonication energy), excitation wavelength, and pH of the dispersion. The strong dependence of the photoluminescence intensity on pH control and the variation of the photoluminescence intensity with different flake sizes were observed. An intense photoluminescence signal, likely related to the separation of the oxidative debris from the GO framework, was found at the highest sonication energies (E ≳ 15 MJ/g) or under extremely alkaline conditions (pH ≳ 11). The cytotoxicity of GO was studied with various flake sizes. Size- and concentration-dependent cytotoxicity was observed for cell lines NIH 3T3 and A549. The NIH 3T3 cell line also demonstrated time-dependent cytotoxicity.

Scapholunate ligament reconstruction using the palmaris longus tendon and suture anchor fixation in chronic scapholunate instability.

BACKGROUND: Multiple reconstruction techniques have been described in the management of chronic scapholunate (SL) instability, either based on the capsulodesis or tenodesis principle. It is uncertain which surgical method produces the best patient outcomes. We describe results of a technique using palmaris longus (PL) tendon for surgical reconstruction of the SL ligament and provide functional outcomes scores. MATERIALS AND METHODS: We surgically reconstructed the SL ligament using a PL tendon graft secured with Mitek® bone anchors. Surgical technique with photographs is provided in the main text. Functional outcomes were measured using the disabilities of the arm, shoulder, and hand and Mayo wrist scores. Patient satisfaction was assessed using a simple measure. RESULTS: Eleven patients attended mid-term followup (mean 45.8 months post-surgery) and had functional outcomes and satisfaction of this procedure that compared favorably to case series that used tenodesis for chronic SL ligament injuries. Almost all patients (n = 10) were able to return to regular employment. The majority of patients (n = 10) were satisfied with their primary reconstruction procedure. CONCLUSION: This technique avoids the use of drill holes to weave tendon through bone, uses an easy to access graft, and exploits the superior pullout strength of anchors while offering satisfactory functional outcomes that are comparable to alternative tenodesis techniques.

Anatomic structures at risk: curved hindfoot arthrodesis nail--a cadaveric approach.

Retrograde intramedullary nailing of the hindfoot and ankle is an established procedure for salvage of severe foot and ankle deformity, arthritis, tumor, and instability. In the present study, retrograde hindfoot (tibiotalocalcaneal) arthrodesis nailing was performed using a standardized technique on 7 cadaver specimens by trained senior surgeons. The specimens were then dissected to determine the distance of the subcalcaneal structures at risk from the insertion point of the nail. The findings showed that the distance of the lateral neurovascular bundle from the edge of the nail was 6.5 (range 3.5 to 8, 95% confidence interval 5.9 to 7.1) mm. No neurovascular bundle was compromised, and all were within a previously described "safe window."

A comparison of methods to quantify the in-season training load of professional soccer players.

PURPOSE: To compare various measures of training load (TL) derived from physiological (heart rate [HR]), perceptual (rating of perceived exertion [RPE]), and physical (global positioning system [GPS] and accelerometer) data during in-season field-based training for professional soccer. METHODS: Fifteen professional male soccer players (age 24.9 ± 5.4 y, body mass 77.6 ± 7.5 kg, height 181.1 ± 6.9 cm) were assessed in-season across 97 individual training sessions. Measures of external TL (total distance [TD], the volume of low-speed activity [LSA; <14.4 km/h], high-speed running [HSR; >14.4 km/h], very high-speed running [VHSR; >19.8 km/h], and player load), HR and session-RPE (sRPE) scores were recorded. Internal TL scores (HR-based and sRPE-based) were calculated, and their relationships with measures of external TL were quantified using Pearson product-moment correlations. RESULTS: Physical measures of TD, LSA volume, and player load provided large, significant (r = .71-.84; P < .01) correlations with the HR-based and sRPE-based methods. Volume of HSR and VHSR provided moderate to large, significant (r = .40-.67; P < .01) correlations with measures of internal TL. CONCLUSIONS: While the volume of HSR and VHSR provided significant relationships with internal TL, physical-performance measures of TD, LSA volume, and player load appear to be more acceptable indicators of external TL, due to the greater magnitude of their correlations with measures of internal TL.

The effects of different speed training protocols on sprint acceleration kinematics and muscle strength and power in field sport athletes.

A variety of resistance training interventions are used to improve field sport acceleration (e.g., free sprinting, weights, plyometrics, resisted sprinting). The effects these protocols have on acceleration performance and components of sprint technique have not been clearly defined in the literature. This study assessed 4 common protocols (free sprint training [FST], weight training [WT], plyometric training [PT], and resisted sprint training [RST]) for changes in acceleration kinematics, power, and strength in field sport athletes. Thirty-five men were divided into 4 groups (FST: n = 9; WT: n = 8; PT: n = 9; RST: n = 9) matched for 10-m velocity. Training involved two 60-minute sessions per week for 6 weeks. After the interventions, paired-sample t-tests identified significant (p ≤ 0.05) within-group changes. All the groups increased the 0- to 5-m and 0- to 10-m velocity by 9-10%. The WT and PT groups increased the 5- to 10-m velocity by approximately 10%. All the groups increased step length for all distance intervals. The FST group decreased 0- to 5-m flight time and step frequency in all intervals and increased 0- to 5-m and 0- to 10-m contact time. Power and strength adaptations were protocol specific. The FST group improved horizontal power as measured by a 5-bound test. The FST, PT, and RST groups all improved reactive strength index derived from a 40-cm drop jump, indicating enhanced muscle stretch-shortening capacity during rebound from impacts. The WT group increased absolute and relative strength measured by a 3-repetition maximum squat by approximately 15%. Step length was the major limiting sprint performance factor for the athletes in this study. Correctly administered, each training protocol can be effective in improving acceleration. To increase step length and improve acceleration, field sport athletes should develop specific horizontal and reactive power.

Factors that differentiate acceleration ability in field sport athletes.

Speed and acceleration are essential for field sport athletes. However, the mechanical factors important for field sport acceleration have not been established in the scientific literature. The purpose of this study was to determine the biomechanical and performance factors that differentiate sprint acceleration ability in field sport athletes. Twenty men completed sprint tests for biomechanical analysis and tests of power, strength, and leg stiffness. The sprint intervals analyzed were 0-5, 5-10, and 0-10 m. The subjects were split into a faster and slower group based on 0- to 10-m velocity. A 1-way analysis of variance determined variables that significantly (p ≤ 0.05) distinguished between faster and slower acceleration. All subject data were then pooled for a correlation analysis to determine factors contributing most to acceleration. The results showed that 0- to 5-m (∼16% difference) and 0- to 10-m (∼11% difference) contact times for the faster group were significantly lower. Times to peak vertical and horizontal force during ground contact were lower for the faster group. This was associated with the reduced support times achieved by faster accelerators and their ability to generate force quickly. Ground contact force profiles during initial acceleration are useful discriminators of sprint performance in field sport athletes. For the strength and power measures, the faster group demonstrated a 14% greater countermovement jump and 48% greater reactive strength index. Significant correlations were found between velocity (0-5, 5-10, and 0-10 m) and most strength and power measures. The novel finding of this study is that training programs directed toward improving field sport sprint acceleration should aim to reduce contact time and improve ground force efficiency. It is important that even during the short sprints required for field sports, practitioners focus on good technique with short contact times.