Whether Patients with Anterior Cruciate Ligament Reconstruction Walking at a Fast Speed Show more Kinematic Asymmetries?

OBJECTIVE: Knee kinematic asymmetries after anterior cruciate ligament reconstruction (ACLR) are correlated with poor clinical outcomes, such as the progression of knee cartilage degenerations or reinjuries. Fast walking in patients with knee conditions may exacerbate knee kinematic asymmetries, but its impact on ACLR patients is uncertain. The aim of this study is to investigate if fast walking induces more knee kinematic asymmetries in unilateral ACLR patients. METHODS: This cross-sectional study enrolled 55 patients with unilateral ACLR from January 2020 to July 2022. There were 48 males and seven females with an average age of 30.6 ± 6.4 years. Knee kinematic data were collected at three walking speeds: self-selected, fast (150% normal), and slow (50% normal). A 3D knee kinematic analysis system measured the data, and self-reported outcomes assessed comfort levels during walking. We used SPM1D for two-way repeated ANOVA and posthoc paired t-tests to analyze kinematic differences in groups. RESULTS: In fast walking, ACLR knees exhibited more transverse kinematic asymmetries than intact knees, including greater external rotation angle (1.8°, 38%-43%; gait cycle [GC], p < 0.05 & 1.8-2.7°, 50%-61% GC, p < 0.05) and increased proximal tibial translation (2.1-2.5 mm, 2%-6% GC, p < 0.05 & 2.5-3.2 mm, 92%-96% GC, p < 0.05). Additionally, ACLR knees showed greater posterior tibial translation than intact knees (3.6-3.7 mm, 7%-8% GC, p < 0.05) during fast walking. No posterior tibial translation asymmetries were observed in slow walking compared to normal walking levels. ACLR knees have the most comfortable feelings in slow walking speed, and the most uncomfortable feelings in fast walking speed levels (29%). CONCLUSIONS: Fast walking induces additional external tibial rotation and proximal and posterior tibial translation asymmetries in ACLR patients. This raises concerns about long-term safety and health during fast walking. Fast walking, not self-selected speed, is beneficial for identifying postoperative gait asymmetries in ACLR patients.

Comparing the Accuracy of Seven Scoring Systems in Predicting Survival of Lung Cancer Patients With Spinal Metastases: An External Validation From Two Centers.

STUDY DESIGN: Retrospective case series. OBJECTIVE: To investigate the accuracy of seven scoring systems for the prediction of survival in lung cancer patients with spinal metastases (SPM). SUMMARY OF BACKGROUND DATA: Although survival scoring systems have been developed for surgical decision-making, the reliability and validity of these models are unclear for specific cancer types. As the prevalence of patients with lung cancer increases, it is imperative to determine the accuracy of these models for lung cancer patients with SPM. MATERIALS AND METHODS: This is a retrospective study of a cohort of lung cancer patients with SPM who underwent spine surgery between 2019 and 2021 at two centers. The optimal area under the curve (AUC) was calculated to evaluate the accuracy of seven candidate scoring systems at 3, 6, and 12 months. Calibration and decision curve analysis was used for further validation. RESULTS: A total of 166 patients (mean age: 58.98±10.94; 105 males and 61 females) with SPM were included. The median postoperative survival was 12.87±0.93 months. The modified Bauer score, revised Tokuhashi score, Linden score, Tomita score, the Skeletal Oncology Research Group nomogram, and the New England Spinal Metastasis Score in prediction survival at 3, 6, and 12 months showed a slightly weaker AUC (range 0.464-0.659). The AUC of the Katagiri-New score in predicting 1-year survival for lung cancer patients was the highest (0.708; range 0.619-0.798). The decision curve analysis showed that the Katagiri-New score led to a greater net benefit than the strategies of changing management for all patients or none of the patients. CONCLUSIONS: This study suggests that the most commonly used models have limitations in predicting survival in patients undergoing spinal surgery for metastatic lung cancer and underestimate survival. In this sample of lung cancer patients, the Katagiri-New Scoring system score had the best performance in predicting 1-year survival. LEVEL OF EVIDENCE: 4.

Comparison of Effectiveness and Safety in Treating Acute Acromioclavicular Joint Dislocation with Five Different Surgical Procedures: A Systematic Review and Network Meta-Analysis.

This network meta-analysis aims to evaluate the comparative effectiveness and safety of suture anchors (SA), tendon grafts (TG), hook plates (HP), Tight-Rope (TR), and EndoButton (EB) in the treatment of acute acromioclavicular joint (ACJ) dislocation. The Embase, PubMed, and Web of Science databases were searched from their inception date to June 3, 2022. Studies included all eligible randomized controlled trials (RCTs) and cohort studies with the comparison of five different fixation systems among SA, TG, HP, TR, and EB were identified. All studies were reviewed, performed data extraction, and assessed the risk of bias independently by two reviewers. The primary outcomes are Constant-Murley score (CMS) improvement for assessing clinical efficacy, and complications. The second outcomes are visual analog scale (VAS) for assessing pain relief and the coracoclavicular distance (CCD) for assessing postoperative joint reduction. Version 2 of the revised Cochrane risk of bias tool for randomized trials (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS-I) were used to assess the RCTs and non-randomized trials, respectively. The continuous outcomes were presented as mean differences (MD), and risk ratios (OR) were used for dichotomous outcomes, both with 95% confidence intervals (CI). Surface under the cumulative ranking curves (SUCRA) results were calculated to offer a ranking of each intervention. We identified 31 eligible trials, including 1687 patients in total. HP showed less CMS improvement than TR and EB in both the Network Meta-analysis (NMA) and pairwise meta-analysis. HP also showed less CMS improvement than SA in NMA. For pain relief, HP performed worse than TR both in pairwise meta-analysis and NMA. No significant differences were found for the measured value of CCD. Both TR and EB showed a lower incidence of complications than HP in pairwise meta-analysis. The rank of SUCRA for CMS improvement was as follows: SA, TR, EB, TG, and HP; for pain relief: TR, EB, TG, SA, and HP; for CCD: HP, TR, SA, EB, and TG. For complications, HP showed the highest rank, followed by TG, EB, TR, and SA. SA shows better clinical effectiveness and reliable safety in the treatment of acute ACJ dislocation. Although HP is the most widely used surgical option currently, it should be carefully taken into consideration for its high incidence of complications.

External validation of the SORG machine learning algorithms for predicting 90-day and 1-year survival of patients with lung cancer-derived spine metastases: a recent bi-center cohort from China.

BACKGROUND CONTEXT: The survival prediction of lung cancer-derived spinal metastases is often underestimated by several scores. The SORG machine learning (ML) algorithm is considered a promising tool to predict the risk of 90-day and 1-year mortality in patients with spinal metastases, but not been externally validated for lung cancer. PURPOSE: This study aimed to externally validate the SORG ML algorithms on lung cancer-derived spinal metastases patients from two large-volume, tertiary medical centers between 2018 and 2021. STUDY DESIGN/SETTING: Retrospective, cohort study. PATIENT SAMPLE: Patients aged 18 years or older at two tertiary medical centers in China are treated surgically for spinal metastasis. OUTCOME MEASURES: Mortality within 90 days of surgery, mortality within 1 year of surgery. METHODS: The baseline characteristics were compared between the development cohort and our validation cohort. Discrimination (receiver operating curve), calibration (calibration plot, intercept, and slope), the overall performance (Brier score), and decision curve analysis was used to assess the overall performance of the SORG ML algorithms. RESULTS: This study included 150 patients with lung cancer-derived spinal metastases from two medical centers in China. Ninety-day and 1-year mortality rates were 12.9% (19/147) and 51.3% (60/117), respectively. Lung Cancer with targeted therapies had the lowest Hazard Ratio (HR=0.490), showing an optimal protecting factor. The AUC of the SORG ML algorithm for 90-day mortality prediction in lung cancer-derived spinal metastases is 0.714. While the AUC for 1-year mortality prediction is 0.832 (95CI%, 0.758-0.906). The algorithm for 1-year mortality was well-calibrated with an intercept of 0.13 and a calibration slope of 1.00. However, the 90-day mortality prediction was underestimated with an intercept of 0.60 and a slope of 0.37. The SORG ML algorithms for 1-year mortality showed a greater net benefit than the "treats all or no patients" strategies. CONCLUSIONS: In the latest cohort of lung cancer-derived spinal metastases in China, the SORG algorithms for predicting 1-year mortality performed well on external validation. However, 90-day mortality was underestimated. The algorithm should be further validated by single primary tumor-derived metastasis treated with the latest comprehensive treatment in diverse populations.

A combined anterior cruciate ligament/Meniscal injury alters the patellofemoral joint kinematics of anterior cruciate ligament-deficient knees during a single-leg lunge exercise: A cross-sectional study.

Anterior cruciate ligament deficiency (ACLD) is often accompanied by concomitant meniscal tears. The study aimed to assess the kinematic alterations of patellofemoral joint (PFJ) in anterior cruciate ligament deficiency knees with or without meniscal tears during a single-leg lunge. Sixty unilateral anterior cruciate ligament deficiency patients were recruited for the study, including 15 isolated anterior cruciate ligament deficiency patients (group 1), 15 anterior cruciate ligament deficiency patients with medial meniscal tears (group 2), 15 patients with lateral meniscal tears (group 3) and 15 patients with combined medial/lateral meniscal tears (group 4). The patellofemoral joint kinematics were determined by a single fluoroscopic image system. Patellofemoral joint kinematics of contralateral anterior cruciate ligament-intact (ACLI) and anterior cruciate ligament deficiency knees were compared. With or without meniscal tears, anterior cruciate ligament deficiency knees had significantly smaller patellar flexion than the anterior cruciate ligament-intact knees (∼5°-10°; p < 0.05). anterior cruciate ligament deficiency knees had more patellar lateral tilting by approximately 1°-2° than the anterior cruciate ligament-intact knees (p < 0.05) in groups 2, 3, and 4. anterior cruciate ligament deficiency groups with medial meniscal deficiencies showed consistent increased lateral patellar translations (2-4 mm) compared to the anterior cruciate ligament-intact group during a single-leg lunge. The results indicate that meniscal tears alter anterior cruciate ligament deficiency patients' patellofemoral joint kinematics and the types of the meniscal injuries also affect the patellofemoral joint kinematics. Considering the varying effects of meniscal tears on the patellofemoral joint kinematics, specific treatments for anterior cruciate ligament deficiency patients with meniscal tears should be proposed in some closed kinetic chain (CKC) exercise programs, such as single-leg lunge.

6DOF knee kinematic alterations due to increased load levels.

Whether load carriage leads to six-degrees-of-freedom (6DOF) knee kinematic alterations remains unclear. Exploring this mechanism may reveal meaningful knee kinematic information that can be used to improve load carriage conditions, the design of protective devices, and the knowledge of the effects of load carriage on knees. We recruited 44 subjects to explore kinematic alterations from an unloaded state to 60% bodyweight (BW) load carriage. A three-dimensional gait analysis system was used to collect the knee kinematic data. One-way repeated analysis of variance (ANOVA) was used to explore the effects of load levels on knee kinematics. The effects of increasing load levels on knee kinematics were smooth with decreased or increased trends. We found that knees significantly exhibited increased lateral tibial translation (up to 1.2 mm), knee flexion angle (up to 1.4°), internal tibial rotation (up to 1.3°), and tibial proximal translation (up to 1.0 mm) when they went from an unloaded state to 60%BW load carriage during the stance phase (p < 0.05). Significant small knee adduction/abduction angle and posterior tibial translation alterations (<1°/mm) were also identified (p < 0.05). Load carriage can cause significant 6DOF knee kinematic alterations. The results showed that knee kinematic environments are challenging during increased load. Our results contain kinematic information that could be helpful for knee-protection-related activities, such as target muscle training to reduce abnormal knee kinematics and knee brace design.