High-quality dietary protein (essential amino acids matched to reproductive needs) partially breaks the lifespan and reproduction trade-off in lubber grasshoppers.

Finding interventions to break the trade-off between reproduction and lifespan can provide insight into physiological limitations of animals. Effects of dietary protein quality on the trade-off are currently unclear, but clarity could lead to better designed diets that match animal needs. Dietary amino acid blends matching yolk proteins support reproduction and extend lifespan in fruit flies. To test if this is conserved across species, we matched dietary amino acids to vitellogenin to test reproduction and lifespan in adult females of the lubber grasshopper. Specifically, we compared varying degrees of protein quality by manipulating dietary essential amino acids. We identified a high-quality protein diet (amino acids matched to vitellogenin, or reproductive needs) that increased reproduction and matched lifespan in comparison to diets that differed only in the ratios of essential amino acids (i.e., were isocaloric and isonitrogenous). All these diets had longer lifespan but lower reproductive output than fully fed controls. In a separate experiment, full reproduction was possible on the high-quality artificial diet when offered at a 78% higher protein quantity and with a larger lettuce supplement (~ 17% of ad libitum). Additionally, we observed that as dietary protein quality was decreased (i.e., diets were less matched to vitellogenin), reproduction was reduced, and lifespan was extended in the more extreme scenarios. Taken together, these results indicate that the balance of dietary essential amino acids plays an important role in the lifespan and reproduction trade-off, while more work needs to be conducted to find the optimal diet mix for this species.

Management and Return to Play of the Elite Athlete for Common Sports-Related Injuries About the Foot.

Foot injuries are one of the most commonly injured areas of the body in many collegiate and professional sports. The wide range of pathology, pathophysiology, mechanisms of injury, differences in sport demands, evolution of treatment, and variable return-to-play time lines make it difficult, at times, for physicians to treat these injuries. Modern diagnostic tools, surgical treatment devices, and rehabilitation protocols have allowed for more accurate and rapid diagnosis, an improved ability to reestablish normal anatomy, and accelerated return to play for many sports-related foot injuries. This summary will provide the most up-to-date, evidence-based treatment options for common sports-related foot injuries along with the authors' preferred method of treatment and return-to-play algorithms for the elite athletes.

Two-Year Survivorship and Patient-Reported Outcomes of a Prospectively Enrolled Cohort of INFINITY Total Ankle Arthroplasties.

BACKGROUND: The INFINITY total ankle implant is a widely and successfully used option for total ankle arthroplasty. The purpose of this study is to assess the 2-year survivorship, complication rates, patient-reported outcomes, and radiologic findings of prospectively enrolled patients undergoing a fixed-bearing total ankle arthroplasty (TAA). This study sought to determine if factors such as traditional vs patient-specific instrumentation, preoperative degree of arthritis, deformity, or etiology of arthritis impact surgical or clinical outcomes. METHODS: A total of 143 prospectively enrolled patients (148 ankles) underwent TAA with a fixed-bearing total ankle implant between 2017 and 2019 at 9 different institutions by 9 different surgeons. A total of 116 completed 2-year follow-up. Patients were stratified by instrumentation used, degree of preoperative deformity, the Canadian Orthopaedic Foot and Ankle Society (COFAS) grading system, and etiology of arthritis. Outcomes used included implant survivorship and adverse events within 2 years of surgery. Additionally, patient-reported outcomes and radiographs were collected at 6-month, 1-year, and 2-year postoperatively. PROMs used included Ankle Osteoarthritis Score (AOS), Patient-Reported Outcomes Measurement Information System (PROMIS) global health score, the Foot and Ankle Outcome Score (FAOS), and patient satisfaction (rated from excellent to poor). RESULTS: Implant survivorship at 2 years was 97.79%. There were 17 reoperations (11.5%), with 4 of the implants requiring revision (2.7%). Significant improvements in all PROMs were observed among all subgroups at all postoperative time points without significant variation between subgroups. Patients classified as COFAS type 2 arthritis preoperatively demonstrated significantly more improvement in FAOS Total Symptom Score at the 1- and 2-year measurements than COFAS type 3 patients at both time points. CONCLUSION: Total ankle arthroplasty with a fixed-bearing implant system is a safe and reliable treatment option for patients with end-stage arthritis regardless of degree of deformity or COFAS grading. LEVEL OF EVIDENCE: Level II, prospective cohort study.

The effects of dietary amino acid balance on post-embryonic development in a lubber grasshopper.

Effects of dietary protein quality on insect development (not just growth) are unclear. Dietary amino acid blends matching yolk proteins support reproduction and juvenile development in Drosophila melanogaster. We matched amino acids to vitellogenin and tested development of juvenile male lubber grasshoppers, which do not produce vitellogenin. Last instars were fed classic dry diets with amino acids substituted for proteins. Matching amino acids to vitellogenin allowed molting to adulthood, while an unmatched isonitrogenous diet did not. Health on dry diets was poor, so we developed wet diets with agar, horse feed, and amino acids. Juveniles fed these diets matched to vitellogenin developed comparably to juveniles fed lettuce. However, wet diets with amino acids dissimilar to vitellogenin (low-quality) slowed development but maintained size at adulthood. We observed no compensatory feeding on low-quality diets. Theory suggests accumulation of proteins permits development. To detect a threshold, we started last juvenile instars on high-quality diets, then abruptly switched them to low-qualities diets. When switched to the poor-quality diet at 6d, grasshoppers molted at a similar age (∼17d) to grasshoppers continuously on the high-quality diet. Total hemolymph proteins levels were unaffected by the timing of diet switches. Last, methionine is essential but can be noxious at high levels. Diets with low-quality protein except for methionine slowed growth early but did not alter the time or size at molt. Overall, the feeding threshold is solely due to essential amino acids, and low-quality protein diets slowed development but did not affect adult size.

Injury Surveillance and Evaluation of Medical Services Utilized During the 2016 Track and Field Olympic Trials.

BACKGROUND: Injury surveillance systems have been implemented at world championships, yet no previous work has determined the burden of injuries during the United States Track and Field Olympic Trials. Additionally, the type of medical service providers utilized throughout the meet has not been reported, leaving it unclear whether optimal staffing needs are being met. PURPOSE: To describe the incidence of injuries presenting to the medical team at the 2016 US Track and Field Olympic Trials (Eugene, Oregon) by event type and competitor demographics. STUDY DESIGN: Descriptive epidemiology study. METHODS: A retrospective review was performed of all documented injuries and treatments recorded from June 28 through July 10, 2016. Descriptive statistics and the prevalence of newly incurred injuries were calculated for registered athletes and nonathlete (ie, support) staff. The incidence of acute injuries was analyzed for registered athletes, as stratified by athlete sex and event type. RESULTS: A total of 514 individuals were seen during the trials: 89% were athletes and 11% were supporting staff. Physicians treated 71 injuries and 14 illnesses. Of diagnosed injuries, 85% (n = 60) occurred among athletes, with hamstring strains (16.7%, n = 10) being the most prevalent. A mean of 124 medical services (median, 137; interquartile range, 65.5-179.5) were provided each day of the trials. Among medical services, 41.8% were attributed to massage therapists for athletes, while chiropractic services were the most utilized service (47.1%) by the support staff. There was an overall incidence of 59.7 injuries per 1000 registered athletes, with jumpers (109.4 per 1000) and long-distance athletes (90.4 per 1000) being the most commonly seen athletes. CONCLUSION: Throughout the trials, athletes participating in jumping and long-distance events were the most commonly seen by physicians, creating the potential need for an increase in staffing of physicians during meet periods when these events occur. The provided medical services appeared to follow the number of athletes competing during the trials and the need for recovery treatments after competition. Findings from this study should inform future strategy for staffing and policy development at Olympic Trials and other elite-level track and field events in the United States.

Minimal Preoperative Degenerative Arthritis May Not Predict Poor TKA Outcome.

Although most orthopedic surgeons presume that patients with more severe degenerative osteoarthritis are better candidates for total knee arthroplasty (TKA), few data have compared outcomes based on the extent of radiographic osteoarthritis. The authors tested the hypothesis that patients with minimal radiographic osteoarthritis would have worse outcomes compared with a matched cohort with severe osteoarthritis. The authors identified 29 patients (31 knees) with minimal degenerative changes who underwent TKA between 2000 and 2004. The authors identified a matched cohort with severe osteoarthritis. Mean follow-up was 5 years (range, 2-10 years). Preoperative knee scores were 63 and 59 in patients with minimal osteoarthritis and severe osteoarthritis, respectively. Postoperative knee scores were 89 and 93, respectively. Preoperative function scores were 57 and 56 in patients with minimal osteoarthritis and severe osteoarthritis, respectively. Postoperative function scores increased to 79 and 72, respectively. Of 31 patients in the minimal osteoarthritis group, 26 (84%) had mild or no pain at the time of last follow-up, whereas 5 (16%) had moderate or severe pain. In the group with severe osteoarthritis, 25 of 31 patients (81%) had mild or no pain at the time of last follow-up, whereas 6 (19%) had moderate or severe pain. In the group with minimal osteoarthritis, 6 of 31 knees (19%) had a complication. Only 1 of 31 knees (3.1%) in the matched cohort had a complication. Fewer than 1% of patients undergoing TKA at the authors' institution had minimal preoperative radiographic osteoarthritis. These patients had a higher risk of complications, but similar pain relief, function, and overall satisfaction compared with a matched group with severe arthritis.

Peroneal tendon displacement accompanying intra-articular calcaneal fractures.

BACKGROUND: Peroneal tendon displacement (subluxation or dislocation) accompanying an intra-articular calcaneal fracture is often undetected and under-treated. The goals of this study were to determine (1) the prevalence of peroneal tendon displacement accompanying intra-articular calcaneal fractures, (2) the association of tendon displacement with fracture classifications, (3) the association of tendon displacement with heel width, and (4) the rate of missed diagnosis of the tendon displacement on radiographs and computed tomography (CT) scans and the resulting treatment rate. METHODS: A retrospective radiographic review of all calcaneal fractures presenting at three institutions from June 30, 2006, to June 30, 2011, was performed. CT imaging of 421 intra-articular calcaneal fractures involving the posterior facet was available for review. The prevalence of peroneal tendon displacement was noted and its associations with fracture classification and heel width were evaluated. RESULTS: Peroneal tendon displacement was identified in 118 (28.0%) of the 421 calcaneal fracture cases. The presence of tendon displacement was significantly associated with joint-depression fractures compared with tongue-type fractures (p < 0.001). Only twelve (10.2%) of the 118 cases of peroneal tendon displacement had been identified in the radiology reports. Although sixty-five (55.1%) of the fractures with tendon displacement had been treated with internal fixation, the tendon displacement was treated surgically in only seven (10.8%) of these cases. CONCLUSIONS: Analysis of CT images showed a 28% prevalence of peroneal tendon displacement accompanying intra-articular calcaneal fractures. Surgeons and radiologists are encouraged to consider this association.

Functional outcomes after ankle arthrodesis in elderly patients.

BACKGROUND: Ankle arthrodesis has been the gold standard operative treatment for ankle arthritis refractory to nonoperative treatment. Although multiple studies have evaluated the outcomes after ankle fusion, none has focused on outcomes in elderly patients. The purpose of this study was to evaluate outcomes of ankle fusion in patients over the age of 70. METHODS: Thirty patients (30 ankles) over the age of 70 who underwent ankle fusion were identified. Average age at the time of surgery was 74.5 years (±3.7). The Foot and Ankle Ability Measure (FAAM) was obtained postoperatively in 22 of the 23 patients still living. Radiographs were followed until union with an average followup of 2.2 years. RESULTS: Union was achieved in 27 of 30 ankles (90%). Postoperative radiographs showed 11 (36.6%) patients had progression of subtalar arthritis. The average postoperative FAAM score was 81.5 (±18.3) with an average followup of 8.5 years (±1.7). Subjectively, when asked to compare present function with their prearthritic state, the average response was 75.1% (±19.6). The average American Orthopaedic Foot and Ankle Society hindfoot score was 73.0 (±11.5). Complications included nonunion, deep infection, and adjacent joint arthritis. CONCLUSIONS: In this clinical cohort, ankle fusion was found to be effective in the treatment of ankle arthritis. Functional outcome was satisfactory and the rate of union was comparable with that previously reported in the literature for younger patients. Although total ankle arthroplasty is becoming increasingly popular, ankle arthrodesis is an effective surgical treatment option in an elderly patient population.