Finite element graft stress for anteromedial portal, transtibial, and hybrid transtibial femoral drillings under anterior translation and medial rotation: an exploratory study.

Stress concentration on the Anterior Cruciate Ligament Reconstruction (ACLr) for femoral drillings is crucial to understanding failures. Therefore, we described the graft stress for transtibial (TT), the anteromedial portal (AM), and hybrid transtibial (HTT) techniques during the anterior tibial translation and medial knee rotation in a finite element model. A healthy participant with a non-medical record of Anterior Cruciate Ligament rupture with regular sports practice underwent finite element analysis. We modeled TT, HTT, AM drillings, and the ACLr as hyperelastic isotropic material. The maximum Von Mises principal stresses and distributions were obtained from anterior tibial translation and medial rotation. During the anterior tibia translation, the HTT, TT, and AM drilling were 31.5 MPa, 34.6 Mpa, and 35.0 MPa, respectively. During the medial knee rotation, the AM, TT, and HTT drilling were 17.3 MPa, 20.3 Mpa, and 21.6 MPa, respectively. The stress was concentrated at the lateral aspect of ACLr,near the femoral tunnel for all techniques independent of the knee movement. Meanwhile, the AM tunnel concentrates the stress at the medial aspect of the ACLr body under medial rotation. The HTT better constrains the anterior tibia translation than AM and TT drillings, while AM does for medial knee rotation.

Preseason multiple biomechanics testing and dimension reduction for injury risk surveillance in elite female soccer athletes: short-communication.

BACKGROUND: Injury risk is regularly assessed during the preseason in susceptible populations like female soccer players. However, multiple outcomes (high-dimensional dataset) derived from multiple testing may make pattern recognition difficult. Thus, dimension reduction and clustering may be useful for improving injury surveillance when results of multiple assessment tools are available. AIM: To determine the influence of dimension reduction for pattern recognition followed by clustering on multiple biomechanical injury markers in elite female soccer players during preseason. METHDOLOGY: We introduced the use of dimension reduction through linear principal component analysis (PCA), non-linear kernel principal component analysis (k-PCA), t-distributed stochastic neighbor embedding (t-sne), and uniform manifold approximation and projection (umap) for injury markers via grid search. Muscle strength, muscle function, jump technique and power, balance, muscle stiffness, exercise tolerance, and running performance were assessed in an elite female soccer team (n = 21) prior to the competitive season. RESULTS: As a result, umap facilitated the injury pattern recognition compared to PCA, k-PCA, and t-sne. One of the three patterns was related to a team subgroup with acceptable muscle conditions. In contrast, the other two patterns showed higher injury risk profiles. For our dataset, umap improved injury surveillance through multiple testing characteristics. CONCLUSION: Dimension reduction and clustering techniques present as useful strategies to analyze subgroups of female soccer players who have different risk profiles for injury.

Explainable Machine Learning Techniques to Predict Muscle Injuries in Professional Soccer Players through Biomechanical Analysis.

There is a significant risk of injury in sports and intense competition due to the demanding physical and psychological requirements. Hamstring strain injuries (HSIs) are the most prevalent type of injury among professional soccer players and are the leading cause of missed days in the sport. These injuries stem from a combination of factors, making it challenging to pinpoint the most crucial risk factors and their interactions, let alone find effective prevention strategies. Recently, there has been growing recognition of the potential of tools provided by artificial intelligence (AI). However, current studies primarily concentrate on enhancing the performance of complex machine learning models, often overlooking their explanatory capabilities. Consequently, medical teams have difficulty interpreting these models and are hesitant to trust them fully. In light of this, there is an increasing need for advanced injury detection and prediction models that can aid doctors in diagnosing or detecting injuries earlier and with greater accuracy. Accordingly, this study aims to identify the biomarkers of muscle injuries in professional soccer players through biomechanical analysis, employing several ML algorithms such as decision tree (DT) methods, discriminant methods, logistic regression, naive Bayes, support vector machine (SVM), K-nearest neighbor (KNN), ensemble methods, boosted and bagged trees, artificial neural networks (ANNs), and XGBoost. In particular, XGBoost is also used to obtain the most important features. The findings highlight that the variables that most effectively differentiate the groups and could serve as reliable predictors for injury prevention are the maximum muscle strength of the hamstrings and the stiffness of the same muscle. With regard to the 35 techniques employed, a precision of up to 78% was achieved with XGBoost, indicating that by considering scientific evidence, suggestions based on various data sources, and expert opinions, it is possible to attain good precision, thus enhancing the reliability of the results for doctors and trainers. Furthermore, the obtained results strongly align with the existing literature, although further specific studies about this sport are necessary to draw a definitive conclusion.

Effects of Elbow Crutch Locomotion on Gluteus Medius Activation During Stair Ascending.

Crutches can help with the locomotion of people with walking disorders or functional limitations. However, little is known about hip muscle activation during stair ascending using different crutch locomotion patterns in people without disorders and limitations. Thus, we determined the acute effects of elbow crutch locomotion on gluteus medius (GM) activity during stair ascending. This comparative analytic cross-sectional study enrolled ten healthy men (22.0 ± 0.47 years). Participants climbed up the stairs with elbow crutches using one or two crutches, with ipsilateral or contralateral use, and after loading or unloading a limb. EMG signals were recorded from anterior, middle, and posterior portions of the GM and compared between the crutch conditions. The Kruskal-Wallis test and Dunn's multiple comparison test were performed (α = 5%). The activation of the GM increased with the ipsilateral use of crutches, with two crutches and three points, and when all the load depended only on one limb. GM activation decreased with contralateral use and in the unload limb. In conclusion, ascending stairs with elbow crutches alters the GM activation. The more critical factors were choosing the crutches' lateral use, the number of crutches, and if the limb is loaded or unloaded while ascending the stairs. Our findings can be helpful to increase or decrease the GM activation for those who use or will use crutches.

Steadiness training improves the quadriceps strength and self-reported outcomes in persistent quadriceps weakness following nine months of anterior cruciate ligament reconstruction and failed conventional physiotherapy.

Background Persistent quadriceps weakness may occur after anterior cruciate ligament reconstruction, limiting the strength gain. However, steadiness strengthening might change the inability to gain strength. Hence, we determined whether strength training with force steadiness and visual biofeedback can improve knee quadriceps torque, self-reported pain and knee stability in patients with persistent quadriceps weakness after knee anterior cruciate ligament reconstruction. Methods Twenty-five patients (aged 43.7 ± 12.2 years) with persistent quadriceps weakness following knee anterior cruciate ligament reconstruction and 34-weeks of physiotherapy performed unilateral strength training for both lower limbs. Four-weeks of conventional physiotherapy at week-30 were given, confirming the inability to gain torque. Then, steadiness training (isometric knee extension with visual biofeedback) was given for 7-weeks. Knee quadriceps peak torque, strength improvement, determination of responders to the intervention, coherence of strength gain between limbs, and self-reported outcomes (pain and knee stability) were obtained. Descriptive statistics and data inference using mixed-ANOVA, McNemar test, and χ2 test were described. Findings Quadriceps torque in the reconstructed knee improved (98.2 ± 47.2-155.2 ± 78.9 Nm; p = 0.031) for most patients (84%). Nevertheless, the torque was lower than the healthy side maintaining asymmetry (155.2 ± 78.9 vs. 209.5 ± 101.8 Nm; p = 0.026). There was high (20%) and medium coherence (80%) between limbs. Knee stability and pain improved in 72% of the patients (p < 0.001). Interpretations Steadiness training after anterior cruciate ligament reconstruction followed 9 months of surgery and failed conventional physiotherapy, improves the persistent weakness and self-reported outcomes, but gain strength was dissimilar between limbs.

Intraoperative pivot-shift accelerometry combined with anesthesia improves the measure of rotatory knee instability in anterior cruciate ligament injury.

PURPOSE: The knee stiffness acquired following an Anterior Cruciate Ligament (ACL) injury might affect clinical knee tests, i.e., the pivot-shift maneuver. In contrast, the motor effects of spinal anesthesia could favor the identification of rotatory knee deficiencies prior to ACL reconstruction. Hence, we hypothesized that the intra-operative pivot-shift maneuver under spinal anesthesia generates more acceleration in the lateral tibial plateau of patients with an injured ACL than without. METHODS: Seventy patients with unilateral and acute ACL rupture (62 men and 8 women, IKDC of 55.1 ± 13.8 pts) were assessed using the pivot-shift maneuver before and after receiving spinal anesthesia. A triaxial accelerometer was attached to the skin between Gerdys' tubercle and the anterior tuberosity to measure the subluxation and reduction phases. Mixed ANOVA and multiple comparisons were performed considering the anesthesia and leg as factors (alpha = 5%). RESULTS: We found a higher acceleration in the injured leg measured under anesthesia compared to without anesthesia (5.12 ± 1.56 m.s- 2 vs. 2.73 ± 1.19 m.s- 2, p < 0.001), and compared to the non-injured leg (5.12 ± 1.56 m.s- 2 vs. 3.45 ± 1.35 m.s- 2, p < 0.001). There was a presence of significant interaction between leg and anesthesia conditions (p < 0.001). CONCLUSIONS: The pivot-shift maneuver performed under anesthesia identifies better rotatory instability than without anesthesia because testing the pivot-shift without anesthesia underestimates the rotatory subluxation of the knee by an increased knee stiffness. Thus, testing under anesthesia provides a unique opportunity to determine the rotational instability prior to ACL reconstruction.

Lateral Extra-articular Tenodesis: A Technique With an Iliotibial Band Strand Without Implants.

The main goal in anterior cruciate ligament reconstruction (ACLR) should be to restore normal knee biomechanics so the chances of failure decrease. The persistence of knee instability after ACLR goes from 0.7% to 20%. Several factors have been identified and studied, but there are some selected cases in which it seems that without adding lateral extra-articular tenodesis (LET) it is not possible to control rotational instability. Data exist supporting that LET could reduce pivot shift (PS), without losing flexion/extension range of motion nor adding risk of osteoarthritis. Recently, LET has been used in addition to ACLR to add restriction to internal tibial rotation forces, and different authors have shown their techniques to achieve this task. Also, biomechanical studies have compared different techniques for LET procedures. This article aims to describe our technique performing a modified Macintosh LET as an addition to ACLR in selected patients who require extra internal tibial rotation control. This is a reproducible, easy to learn, and inexpensive procedure in terms that only a high resistance suture is needed and not any other implant, such as a stapler, anchors, or screws, reducing the risk of tunnel coalition.

The skull of the Miocene Spheniscus urbinai (Aves, Sphenisciformes): osteology, brain morphology, and the cranial pneumatic systems.

Spheniscus urbinai represents one of four extinct Spheniscus species from the Cenozoic of southern South America, known from several poorly described diversely complete skulls and postcranial elements. Here, we present a review of the cranial osteology of all known specimens (collected in Argentina, Chile, and Peru), including a paleoneurological analysis using CT scans, and an exploration of its cranial pneumaticity compared to other extinct and living seabirds. Our results show that among Spheniscus species, S. urbinai exhibits slightly greater cranial pneumaticity than the living species. Additionally, we confirm previous findings which indicate that the marked reduction of cranial pneumaticity-which is characteristic of living penguins-occurred early during the Eocene (as observed in the Antarctic penguin MLP 12-I-20-1, but not in the coeval Anthropornis).

Return to play after anterior cruciate ligament reconstruction among amateur soccer players / Volver a jugar después del ligamento cruzado anterior reconstrucción entre futbolistas aficionados

OBJECTIVE: The aim of the present study is to assess the return to play among amateur soccer league players after anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHOD: The surgical protocols of ACL reconstruction surgeries performed in a sports medicine clinic from July 1st, 2013, to June 30th, 2014, were included in the study. Only the charts of amateur soccer league players who played once or twice a week were selected. The follow-up time was calculated as the number of months between surgery and the telephone survey. At the follow-up, the current status of the soccer playing was recorded. Those patients who were no longer playing in a team were asked what kind of sport they were currently practicing, as well as the main reason for not returning to team playing. RESULTS: A total of 61 (25.6%) patients met the inclusion criteria. The mean follow-up time was of 22.4 3.4 months. At the follow-up, 30 (49.1%) patients were playing in amateur soccer teams. Among the patients who were no longer playing in a team, 19 (61.2%) were playing soccer occasionally, 11 (35.4%) were practicing other sports, and 1 developed a sedentary life style. The reasons for not returning to team playing were: fear of reinjury in 26%; knee symptoms in 26%; lack of confidence in the knee in 23%, family or job commitments in 23%; and not being eligible to participate in competitive sports in 2%. CONCLUSION: After an average of two years of ACL reconstruction, only half of the amateur soccer league players return to play.

A homozygous CEP57 c.915_925dupCAATGTTCAGC mutation in a patient with mosaic variegated aneuploidy syndrome with rhizomelic shortening in the upper and lower limbs and a narrow thorax.

Mosaic variegated aneuploidy syndrome (MVA) is a rare autosomal recessive disorder characterized by random chromosome gains and losses. Mutations in BUB1B and CEP57 genes have been involved in MVA. Here we report on a male child with MVA due to c.915_925dupCAATGTTCAGC mutation in the CEP57 gene. Our patient was homozygous for this mutation and he is the first case with rhizomelic shortening of both the upper and lower limbs and mild respiratory insufficiency due to a narrow thorax. It is also the second MVA Mexican family reported with this mutation that lives in the northwestern region of Mexico, suggesting a "local founding effect". Additional cases are needed to better understand the MVA genotype-phenotype relationship.

Prevalence of FAI radiographic hip abnormalities in elite soccer players: are there differences related to skeletal maturity?

BACKGROUND: Femoroacetabular impingement (FAI) can be a source of hip pain in young adults. Some reports have revealed that participation in high-impact sports may play a role in the development of cam deformity, and there is a higher prevalence of signs of cam impingement in asymptomatic adolescents who participate in soccer and basketball than in non-athlete controls; however, current evidence is scarce regarding the initiation and development of deformities. PURPOSE: The aim of this study was to evaluate the prevalence of radiographic hip abnormalities related to FAI in young elite soccer players and compare this with findings in a group of adult elite soccer players. SUBJECTS AND METHODS: Anteroposterior pelvic and cross-table hip radiographs were obtained for 75 young elite soccer players with skeletal immaturity (group 1) and for 75 adult elite soccer players (group 2), all of whom were previously asymptomatic and had no history of hip disease. After exclusion, group 1 included 72 patients, and group 2 included 70 patients. Radiological signs of FAI were evaluated. RESULTS: 34 subjects in groups 1 and 2 demonstrated cam morphology. The prevalence of pincer morphology was 30 in group 1 and 36 in group 2. However, these differences were not statistically significant. CONCLUSION: We found no differences in the prevalence of FAI radiological signs between soccer players in their late adolescence and adult soccer players.

Characterization of a Complex Chromosomal Rearrangement Involving a de novo Duplication of 9p and 9q and a Deletion of 9q.

Rearrangements of the distal region of 9p are important chromosome imbalances in human beings. Trisomy 9p is the fourth most frequent chromosome anomaly and is a clinically recognizable syndrome. Kleefstra syndrome, previously named 9q subtelomeric deletion syndrome, is either caused by a submicroscopic deletion in 9q34.3 or an intragenic mutation of EHMT1. We report a Mexican male patient with abnormal development, dysmorphism, systemic anomalies and a complex chromosomal rearrangement (CCR). GTG-banding revealed a 46,XY,add(9)(q34.3) karyotype, whereas array analysis resulted in arr[hg19] 9p24.3p23(203,861-11,842,172)×3, 9q34.3(138,959,881-139,753,294)×3, 9q34.3(139,784,913-141,020,389)×1. Array and karyotype analyses were normal in both parents. Partial duplication of 9p is one of the most commonly detected autosomal structural abnormalities in liveborn infants. A microdeletion in 9q34.3 corresponds to Kleefstra syndrome, whereas a microduplication in 9q34.3 shows a great clinical variability. Here, we present a CCR in a patient with multiple congenital anomalies who represents the first case with partial 9p trisomy, partial 9q trisomy and partial 9q monosomy.

Retorno deportivo en atletas de alto rendimiento después de reconstrucción de ligamento cruzado anterior de rodilla: análisis de factores y estrategias / Return to sport on high demand athletes before anterior cruciate ligament reconstruction: analysis of factors and strategies

Nuestro equipo de trabajo piensa que el éxito en la obtención del retorno deportivo pre lesión se basa no solo en la habilidad del cirujano y la técnica empleada. Definimos tres factores claves para lograr el retorno al deporte en forma satisfactoria: 1- Cirugía: con una adecuada selección de la técnica empleada, el tipo de injerto y los métodos de fijación y la aplicación de estimuladores biológicos a la cicatrización: Concentrado Plaquetario Autólogo con sus respectivos factores de crecimiento. Todo esto definido en base al paciente, su edad, sexo, tipo de deporte y nivel de competencia. 2- Rehabilitación acelerada: en esta etapa el kinesiólogo y fisioterapeuta recuperan la función de la rodilla operada y su capacidad funcional preparando al paciente para su entrenamiento funcional. 3- Entrenamiento funcional: fase en la cual se trabaja intensamente la neuro propiocepción, lo automatización de los gestos técnicos según cada deporte. Objetivo Describir los factores críticos involucrados en la obtención de una exitosa reconstrucción de ligamento cruzado anterior en deportistas de alto rendimiento Material y Método: Se analiza en forma retrospectiva 212 deportistas de alto rendimiento, 152 hombres y 60 mujeres, con un rango de edad de 15 a 28 años. Previo a autorizar el retorno al deporte se evalúa con resonancia magnética, evaluación isocinetica y pruebas funcionales según deporte. Resultados: Con esta evaluación integral el retorno deportivo fue de 94,5 por ciento en forma global, siendo en hombres un 97 por ciento y en mujeres 88 por ciento, en un plazo promedio de 7 meses. El retorno al entrenamiento se inicia en promedio a partir del 4 mes, con un rango entre el 4° Y 5° mes dependiendo del deporte. El 54 por ciento de los pacientes se reconstruyó utilizando tendón patelar y el 46 por ciento empleando isquiotibiales (semitendinoso/gráciles) Conclusiones: La reconstrucción de LCA en deportistas de alto rendimiento debe considerar una serie de factores en la toma de decisiones, ya que lograr un retorno al deporte al mismo nivel pre lesional no solo depende de una adecuada técnica quirúrgica.

A girl with 15q overgrowth syndrome and dup(15)(q24q26.3) that included telomeric sequences.

Distal 15q trisomy or tetrasomy is associated with a characteristic phenotype that includes mild to moderate intellectual disability, abnormal behavior, speech impairment, overgrowth, hyperlaxity, long face, prominent nose, puffy cheeks, pointed chin, small ears, and hand anomalies (mainly arachno- and camptodactyly). We present the case of a 13-yr-old girl with the main clinical features of 15q overgrowth syndrome and a 46,XX,dup(15)(q24q26.3)[117]/46,XX[3].ish dup(15)(q24q26.3) (SNPRN+,PML+,subtel++,tel++) de novo karyotype. The findings in this case are consistent with those in the previous distal 15q trisomy cases that presented with overgrowth and mental retardation. Further, the rearranged chromosome had a double set of directly oriented telomeric and subtelomeric sequences.

Comparison of magnetic resonance imaging findings in anterior cruciate ligament grafts with and without autologous platelet-derived growth factors.

PURPOSE: To determine whether the use of platelet-rich plasma gel (PRPG) affects magnetic resonance imaging (MRI) findings in the anterior cruciate ligament (ACL) graft during the first year after reconstruction. METHODS: A prospective single-blinded study of 50 ACL reconstructions in 50 patients was performed. In group A (study group) PRPG was added to the graft with a standardized technique, and in group B (control group) no PRPG was added. An MRI study was performed postoperatively between 3 and 9 months in group A and between 3 and 12 months in group B. The imaging analysis was performed in a blind protocol by the same radiologist. RESULTS: The mean heterogeneity score value at the time of MRI, assigned by the radiologist, was 1.14 in group A and 3.25 in group B. Both groups were comparable in terms of sex and age (P < .05). The mean time to obtain a completely homogeneous intra-articular segment in group A (PRPG added) was 177 days after surgery, and it was 369 days in group B. Using the quadratic predictive model, these findings show that group A (PRPG added) needed only 48% of the time group B required to achieve the same MRI image (P < .001). CONCLUSIONS: ACL reconstruction with the use of PRPG achieves complete homogeneous grafts assessed by MRI, in 179 days compared with 369 days for ACL reconstruction without PRPG. This represents a time shortening of 48% with respect to ACL reconstruction without PRPG.

Cytogenetic studies in children with Down syndrome and acute leukemia.

The frequency of chromosomal alterations was compared among four children groups: those with Down syndrome and acute leukemia (DS/AL), those with acute leukemia (AL), those with only Down syndrome (DS) and healthy children (NC). The frequency of acquired chromosome abnormalities was larger in the AL group, followed by the DS/AL. The gaps and isogaps were more frequent in children with only DS. The polymorphisms of the constitutive heterochromatin were larger in the DS/AL group. These findings appear to imply that more genetic changes are necessary to develop AL in the case of healthy children compared to children with DS.

Traslocación 5;15 familiar asociada al síndrome de Prader Willi / 5;15 familial translocation associate to prader-willi syndrome

El síndrome de Prader-Willi se caracteriza por hipotonía muscular, talla baja, obesidad, infantilismo sexual y retardo mental; se ha reconocido heterogeneidad genética. Se presenta un paciente de seis años de edad con estas características clínicas y con deleción 15q13--pter por translocación 5/15 familiar. Se discuten aspectos clínicos, cromosómicos y de asesoramiento genético.

Anemia de Fanconi: a propósito de un paciente / Fanconi's Anemia

La anemia de Fanconi, entidad autosómica recesiva se caracteriza por pancitopenia, malformaciones congénitas e inestabilidad cromosómica; las manifestaciones clínicas suelen iniciarse a los seis años de edad. Se presenta un paciente de 19 meses de edad cuyo diagnóstico se estableció en fase preanémica. Se discuten aspectos génicos y cromosómicos de la entidad y la importancia de establecer el diagnóstico en etapa temprana.