Risk factors for early symptomatic femoroacetabular impingement following in situ fixation of slipped capital femoral epiphysis.

In situ fixation of slipped capital femoral epiphysis (SCFE) results in residual deformity that can cause femoroacetabular impingement (FAI). It is unknown what factors could help differentiate patients who are more likely to become symptomatic. We performed a retrospective review of 55 hips treated with in situ pinning for SCFE and subsequent secondary deformity correction procedure for symptomatic FAI and compared them to 39 asymptomatic hips with SCFE deformity using multivariable analysis. Case patients were slightly older than controls (12.6 vs 11.3 years, p = 0.0002) but had similar BMI. The mean epiphyseal-diaphyseal angle was 56° in cases versus 44° in controls (p = 0.0019). Cases were significantly more likely to have obligate external rotation with hip flexion, external foot progression, flexion <90°, antalgic limp, and Trendelenburg lurch. On radiographs, most cases had a head-neck offset ≤0 mm, a distinct metaphyseal corner prominence, acetabular retroversion, and an alpha angle ≥60°. Most controls also had head-neck offset ≤0 mm. Pre-pinning, older age (OR = 1.98 per year, p = 0.0016) and initial epiphyseal-diaphyseal angle (OR = 1.04 per degree, p = 0.018) significantly increased the odds of having symptomatic FAI. Post-pinning, external foot progression increased the odds of symptomatic FAI by 10.48 (p = 0.017), and an alpha angle ≥60° resulted in 11.4 times higher odds of symptomatic FAI (p = 0.011). The linear correlation between epiphyseal-diaphyseal and alpha angle was poor (r = 0.28). Older age and initial epiphyseal-diaphyseal pre-pinning mildly increased the odds of eventual symptomatic FAI. This information can help the surgeon to predict which patients may develop symptomatic FAI.

Treatment for Post-Slipped Capital Femoral Epiphysis Deformity.

In situ pinning of slipped capital femoral epiphysis (SCFE) is a safe and effective treatment modality, but often results in residual deformity leading to femoroacetabular impingement, which may limit patient activities and predispose to early onset arthritis. Enhanced understanding of the implications of femoroacetabular impingement and new surgical techniques have prompted interest in treating post-slipped capital femoral epiphysis deformity to both improve current symptoms and delay or prevent hip arthrosis.

Combined Tibial Tubercle Osteotomy and Medial Patellofemoral Ligament Reconstruction for Recurrent Lateral Patellar Instability in Patients With Multiple Anatomic Risk Factors.

PURPOSE: To report the outcomes for combined tibial tubercle osteotomy (TTO) and medial patellofemoral ligament (MPFL) reconstruction and assess for potential risk factors for recurrent instability and/or poor outcomes. METHODS: The medical record at our institution was reviewed for patients treated with MPFL reconstruction and TTO for recurrent lateral patellar instability from 1998 to 2014. Preoperative imaging was assessed for trochlear dysplasia according to the Dejour classification (high grade = B, C, D) and the presence of patella alta using the Caton-Deschamps ratio (>1.2). The indication for combined MPFL reconstruction and TTO was MPFL insufficiency and a lateralized tibial tubercle. Outcomes were determined by recurrent instability, return to sport, and Kujala and International Knee Documentation Committee (IKDC) scores. RESULTS: Thirty knees in 28 patients (14 M, 14 F) with a mean age of 22.6 ± 9.1 years (range, 13-51 years) were included with a mean follow-up of 48 ± 28 months (24-123 months). Seventy-three percent (22/30) had high-grade trochlear dysplasia, and 63% (19/30) had patella alta. One patient had a postoperative dislocation and 1 had a subluxation event. The Caton-Deschamps ratio decreased by a mean of 0.2 (P = .001), leaving 30% with postoperative patella alta. The mean postoperative scores were as follows: Tegner = 5 ± 2, Kujala = 89 ± 16 (45-100), and IKDC = 85 ± 17 (44-100). Eighty-three percent (15/18) returned to their preoperative sport. Female gender was a risk factor for lower IKDC (77.3 vs. 92.6, P = .01) and Kujala (82.2 vs. 95.0, P = .03) scores. Medialization greater than 10 mm was directly correlated to lower IKDC (P = .02) and Kujala (P = .01) scores. CONCLUSIONS: The combination of MPFL reconstruction and TTO in patients with trochlear dysplasia results in low recurrence of instability. Patients on average had good subjective outcomes and were able to return to sport. Female gender and tibial tubercle medialization greater than 10 mm were associated with worse outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Are Female Soccer Players at an Increased Risk of Second Anterior Cruciate Ligament Injury Compared With Their Athletic Peers?

BACKGROUND: Female soccer players have a well-known risk for anterior cruciate ligament (ACL) injury, but few studies have reported on second ACL injuries in this population. PURPOSE: To (1) report the rates of subsequent ACL injury (ipsilateral graft rupture or contralateral tear) in competitive female soccer players, (2) compare these rates with those of other female athletes of similar competitive level, (3) determine risk factors for second ACL injury, and (4) report clinical outcome scores in this population. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The medical records at a single institution were reviewed for female patients who were injured during a competitive athletic event and treated with primary ACL reconstruction (ACLR) between 1998 and 2013. Patients were followed for a mean of 68.8 months postoperatively (range, 24-115.2 months). Clinical outcome was obtained via Lysholm and International Knee Documentation Committee (IKDC) scores. Soccer players were matched 1:1 to non-soccer athletes for age, activity level, and graft type. RESULTS: A total of 180 female ACLR patients with a mean ± SD age of 19.6 ± 6.9 years met the study inclusion and exclusion criteria (90 soccer players and 90 non-soccer players). Soccer players sustained more second ACL injuries, including both graft failures (11% vs 1%; P < .01) and contralateral ACL tears (17% vs 4%; P < .01), compared with non-soccer players. Of the 67 patients who returned to soccer after ACLR (mean age, 17.5 years; range, 13-27 years), significantly more had graft tears compared with those who did not return to soccer (15% vs 0%, respectively; P = .04); however, the difference in contralateral ACL tears (19% for returning players vs 9% for those who did not return; P = .34) was not significant. Relatively older age (odds ratio, 1.5 per year; P = .03) was a significant risk factor for ACL graft tear but not for contralateral ACL injury. Both groups had similar mean Lysholm (96 vs 95) and IKDC scores (95 vs 96) at final follow-up. CONCLUSION: Twenty-eight percent of all female soccer players and 34% of those players who returned to soccer had a second ACL tear. Soccer players had an increased rate of both graft tear and contralateral ACL injury compared with similar non-soccer athletes. Older age and return to soccer were significant risk factors for graft rupture.

Predicting Reading Difficulty in First Grade Using Dynamic Assessment of Decoding in Early Kindergarten: A Large-Scale Longitudinal Study.

The purpose of this study was to examine and compare the classification accuracy of early static prereading measures and early dynamic assessment reading measures administered to 600 kindergarten students. At the beginning of kindergarten, all of the participants were administered two commonly used static prereading measures. The participants were then administered either a dynamic assessment featuring an onset-rime decoding strategy or a dynamic assessment featuring a sound-by-sound strategy. At the end of first grade, those same participants' reading ability was assessed using multiple reading measures. Results indicated that the dynamic assessments yielded significantly higher classification accuracy over the static measures, but that the classification accuracy of the two dynamic assessments did not differ significantly. Sensitivity for the static measures was less than 80%, and specificity ranged from 33% to 51%. The sensitivity and specificity for the dynamic assessments was greater than 80% for all children, with the exception of specificity for the Hispanic children, which was at or greater than 70%. Results also indicated that the combination of static and dynamic measures did not improve the classification accuracy over the dynamic assessments alone. Dynamic assessment appears to be a promising approach to classifying young children at risk for future reading difficulty.

Intervention efficacy and intensity for children with speech sound disorder.

PURPOSE: Clinicians do not have an evidence base they can use to recommend optimum intervention intensity for preschool children who present with speech sound disorder (SSD). This study examined the effect of dose frequency on phonological performance and the efficacy of the multiple oppositions approach. METHOD: Fifty-four preschool children with SSD were randomly assigned to one of three intervention conditions. Two intervention conditions received the multiple oppositions approach either 3 times per week for 8 weeks (P3) or once weekly for 24 weeks (P1). A control (C) condition received a storybook intervention. Percentage of consonants correct (PCC) was evaluated at 8 weeks and after 24 sessions. PCC gain was examined after a 6-week maintenance period. RESULTS: The P3 condition had a significantly better phonological outcome than the P1 and C conditions at 8 weeks and than the P1 condition after 24 weeks. There were no significant differences between the P1 and C conditions. There was no significant difference between the P1 and P3 conditions in PCC gain during the maintenance period. CONCLUSION: Preschool children with SSD who received the multiple oppositions approach made significantly greater gains when they were provided with a more intensive dose frequency and when cumulative intervention intensity was held constant.

The narrative language performance of three types of at-risk first-grade readers.

PURPOSE: This study investigated the narrative language performance of 3 types of readers who had been identified as being at risk through code-based response-to-intervention (RTI) procedures. METHOD: In a retrospective group comparison, 32 at-risk 1st-grade readers were identified: children who resolved without intervention (early resolvers, n = 11), children who met criterion following 4 weeks of intervention (good responders, n = 8), and children who failed to meet criterion following 4 weeks of intervention (poor responders, n = 13). A narrative retell and a norm-referenced language test were obtained before intervention. RESULTS: There were no significant differences between the 3 learner types on the language test. However, the narratives of the good responders were significantly higher than the narratives of the other 2 groups on total number of words, number of different words, and number of communication units. The narratives of early resolvers and good responders differed significantly on the productivity index, number of coordinating conjunctions, and number of episodic elements. There were no other significant differences. CONCLUSION: Types of learners distinguished by a code-based RTI model showed differences in their narrative language. First graders who responded well to code-based reading intervention retold stories that contained more language and better story grammar than first graders who did not respond well to intervention. These results indicate the need to evaluate narrative language performance within RTI, especially for early resolvers.

Structure of the nuclear factor ALY: insights into post-transcriptional regulatory and mRNA nuclear export processes.

ALY is a ubiquitously expressed nuclear protein which interacts with proteins such as TAP that are involved in export of mRNA from the nucleus to the cytoplasm, as well as with proteins that bind the T cell receptor alpha gene enhancer. ALY has also been shown to bind mRNA and to co-localize in the nucleus with components of a multiprotein postsplicing complex that is deposited 20-24 nucleotides upstream of exon-exon junctions. ALY has a conserved RNA binding domain (RBD) flanked by Gly-Arg rich N-terminal and C-terminal sequences. We determined the solution structure of the RBD homology region in ALY by nuclear magnetic resonance methods. The RBD motif in ALY has a characteristic beta(1)alpha(1)beta(2)-beta(3)alpha(2)beta(4) fold, consisting of a beta sheet composed of four antiparallel beta strands and two alpha helices that pack on one face of the beta sheet. As in other RBD structures, the beta sheet has an exposed face with hydrophobic and charged residues that could modulate interactions with other molecules. The loop that connects beta strands 2 and 3 is in intermediate motion in the NMR time scale, which is also characteristic of other RBDs. This loop presents side chains close to the exposed surface of the beta sheet and is a primary candidate site for intermolecular interactions. The structure of the conserved RBD of ALY provides insight into the nature of interactions involving this multifunctional protein.

Proverb Comprehension as a Function of Reading Proficiency in Preadolescents.

PURPOSE: Proverb comprehension through reading was examined in 42 preadolescents (mean age=12:2 [years:months]) attending a rural public middle school. The study was designed to learn about individual differences with respect to reading, word knowledge, and analogical reasoning skills. METHOD: The 42 students were assigned to subgroups of proficient and less proficient readers based on their scores on a school-administered achievement test. Reading tasks were presented to examine their comprehension of unfamiliar concrete (e.g., every bird must hatch its own eggs) and abstract (e.g., gratitude is a heavy burden) proverbs, and their knowledge of nouns contained in the expressions. A nonverbal analogical reasoning task also was administered. RESULTS: Proverb comprehension was found to be associated with reading proficiency, word knowledge, and analogical reasoning. Although all students were considered by their school to be typical achievers, they demonstrated wide individual differences in their ability to interpret unfamiliar concrete and abstract proverbs. Proficient readers outperformed less proficient readers on comprehension of both types of proverbs, knowledge of abstract nouns contained in proverbs, and analogical reasoning. They did not differ, however, on knowledge of concrete nouns, with both subgroups having mastered those words. Educational Implications: The results support the view that reading is an important language modality in older children, significantly related to their understanding of words and figurative expressions. Implications for instruction in proverb comprehension as part of a language arts curriculum are offered for speech-language pathologists working collaboratively with classroom teachers. These guidelines reflect the view that multiple factors (i.e., reading, word knowledge, analogical reasoning) promote proverb comprehension in youth.