Handheld-Load-Specific Jump Training over 8 Weeks Improves Standing Broad Jump Performance in Adolescent Athletes.

This study investigated the effects of handheld-load-specific jump training on standing broad jump (SBJ) performance in youth athletes and the biomechanics changes involved. METHODS: Fifteen male athletes (mean age, body weight, height, and body mass index were 14.7 ± 0.9 years, 59.3 ± 8.0 kg, 1.73 ± 0.07 m, 19.8 ± 2, respectively) underwent 15 SBJ training sessions over 8 weeks. The data were collected over three phases: before training, after training, and after training with 4 kg loading. Ten infrared high-speed motion-capture cameras and two force platforms, whose sampling rates were 250 and 1000 Hz, respectively, were used to record the kinematic and kinetic data. Visual three-dimensional software was used for the data analyses. RESULTS: Jump performance and all biomechanics variables, including joint and takeoff velocities, ground reaction force, takeoff impulse, and mechanical outputs, improved after training. CONCLUSIONS: SBJ training under handheld loading resulted in considerable acute improvements as well as training transfer after 8 weeks. Moreover, explosive ability was effectively enhanced. The present findings serve as a reference for SBJ assessment and jump-related training.

Acute Effects of Handheld Loading on Standing Broad Jump in Youth Athletes.

The study aimed to investigate the acute effects of handheld loading on standing broad jump (SBJ) performance and biomechanics. Fifteen youth male athletes (mean age: 14.7 ± 0.9 years; body mass: 59.3 ± 8.0 kg; height: 1.73 ± 0.07 m) volunteered to participate in the study. Participants were assigned to perform SBJ with and without 4 kg dumbbells in a random order. Kinematic and kinetic data were collected using 10 infrared high-speed motion-capture cameras at a 250 Hz sampling rate and two force platforms at a 1000 Hz sampling rate. A paired t-test was applied to all variables to determine the significance between loading and unloading SBJs. Horizontal distance (p < 0.001), take-off distance (p = 0.001), landing distance (p < 0.001), horizontal velocity of center of mass (CoM; p < 0.001), push time (p < 0.001), vertical impulse (p = 0.003), and peak horizontal and vertical ground reaction force (GRF; p < 0.001, p = 0.017) were significantly greater in loading SBJ than in unloading SBJ. The take-off vertical velocity of CoM (p = 0.001), take-off angle (p < 0.001), peak knee and hip velocity (p < 0.001, p = 0.007), peak ankle and hip moment (p = 0.006, p = 0.011), and peak hip power (p = 0.014) were significantly greater in unloading SBJ than in loading SBJ. Conclusions: Acute enhancement in SBJ performance was observed with handheld loading. The present findings contribute to the understanding of biomechanical differences in SBJ performance with handheld loading and are highly applicable to strength and conditioning training for athletes.

Automated Measurement of Lumbar Lordosis on Radiographs Using Machine Learning and Computer Vision.

STUDY DESIGN: Cross sectional database study. OBJECTIVE: To develop a fully automated artificial intelligence and computer vision pipeline for assisted evaluation of lumbar lordosis. METHODS: Lateral lumbar radiographs were used to develop a segmentation neural network (n = 629). After synthetic augmentation, 70% of these radiographs were used for network training, while the remaining 30% were used for hyperparameter optimization. A computer vision algorithm was deployed on the segmented radiographs to calculate lumbar lordosis angles. A test set of radiographs was used to evaluate the validity of the entire pipeline (n = 151). RESULTS: The U-Net segmentation achieved a test dataset dice score of 0.821, an area under the receiver operating curve of 0.914, and an accuracy of 0.862. The computer vision algorithm identified the L1 and S1 vertebrae on 84.1% of the test set with an average speed of 0.14 seconds/radiograph. From the 151 test set radiographs, 50 were randomly chosen for surgeon measurement. When compared with those measurements, our algorithm achieved a mean absolute error of 8.055° and a median absolute error of 6.965° (not statistically significant, P > .05). CONCLUSION: This study is the first to use artificial intelligence and computer vision in a combined pipeline to rapidly measure a sagittal spinopelvic parameter without prior manual surgeon input. The pipeline measures angles with no statistically significant differences from manual measurements by surgeons. This pipeline offers clinical utility in an assistive capacity, and future work should focus on improving segmentation network performance.

Can C7 Slope Be Used as a Substitute for T1 Slope? A Radiographic Analysis.

STUDY DESIGN: Retrospective radiographic study. OBJECTIVES: T1 slope is an important parameter of sagittal spinal balance. However, the T1 superior endplate can be difficult to visualize on radiographs due to overlying anatomical structures. C7 slope has been proposed as a potential substitute for T1 slope when the T1 superior endplate is not well visualized. The objective of this study was 2-fold: (1) to assess the correlation between C7 and T1 slopes on upright cervical spine radiographs and (2) to evaluate the interrater reliability of C7 slope. METHODS: Cervical spine radiographs taken between December 2017 and June 2018 at a single institution were reviewed. Two observers measured upper C7 slope, lower C7 slope, and T1 slope. The correlations between upper and lower C7 slope and T1 slope were evaluated, and linear regression analyses were performed. Interrater reliability of C7 slope was also assessed. RESULTS: In this cohort of 152 patients, there was a strong correlation between upper C7 slope and T1 slope (r = 0.91, P < .001), as well as between lower C7 slope and T1 slope (r = 0.90, P < .001). T1 slope could be estimated from the linear regression equation, T1 slope = 0.87 × C7 slope + 7, with an overall model fit of R 2 = 0.8. There was strong interrater reliability for upper (intraclass correlation coefficient [ICC] = 0.95, P < .001) and lower C7 slope (ICC = 0.96, P < .001). CONCLUSIONS: Both the upper and lower C7 slope are strongly correlated with T1 slope and can be used as a substitute to estimate T1 slope when the superior endplate of T1 is not well visualized.

Postoperative Complications Associated With Metabolic Syndrome Following Adult Spinal Deformity Surgery.

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: The objective of this study was to examine the effect of metabolic syndrome on 30-day postoperative complications following corrective surgery for the adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA: Metabolic syndrome has been shown to increase the risk of cardiovascular morbidity and mortality. Few studies have examined the effect of metabolic syndrome on patients with ASD undergoing surgery. MATERIALS AND METHODS: We performed a retrospective cohort study of patients who underwent spinal fusion for ASD. Patients were divided into 2 groups based on the presence or absence of metabolic syndrome, which was defined as a combination of hypertension, diabetes mellitus, and obesity. Baseline patient characteristics and operative variables were compared between the 2 groups. We also compared the incidence of 30-day postoperative complications between the 2 groups. A multivariable regression analysis was then performed to identify 30-day postoperative complications that were independently associated with metabolic syndrome. RESULTS: A total of 6696 patients were included with 8.3% (n=553) having metabolic syndrome. Patients with metabolic syndrome were more likely to have renal comorbidity (P=0.042), bleeding disorder (P=0.011), American Society of Anesthesiology classification ≥3 (P<0.001), and undergo a long fusion (P=0.009). Patients with metabolic syndrome had higher rates of 30-day mortality (P=0.042), superficial surgical site infection (P=0.006), sepsis (P=0.003), cardiac complications (P<0.001), pulmonary complications (P=0.003), pulmonary embolism (P=0.050), prolonged hospitalization (P=0.010), nonhome discharge (P=0.007), and reoperation (P=0.003). Metabolic syndrome was an independent risk factor for cardiac complications [odds ratio (OR)=4.2; 95% confidence interval (CI): 1.7-10.2; P=0.001], superficial surgical site infection (OR=2.8; 95% CI: 1.4-5.7; P=0.004), sepsis (OR=2.2, 95% CI: 1.2-3.9; P=0.009), reoperation (OR=1.7; 95% CI: 1.2-2.5; P=0.006), pulmonary complications (OR=1.7; 95% CI: 1.1-2.5; P=0.017), and prolonged hospitalization (OR=1.4; 95% CI: 1.0-1.9; P=0.039). CONCLUSIONS: Recognition and awareness of the relationship between metabolic syndrome and postoperative complications following ASD surgery is important for preoperative optimization and perioperative care.

Altering the natural history of rheumatoid arthritis: The role of immunotherapy and biologics in orthopaedic care.

Rheumatoid Arthritis (RA) is an idiopathic disease characterized by systemic inflammation, persistent synovitis, and the presence of autoantibodies. Because of the musculoskeletal deformity caused by RA, multiple orthopaedic procedures are regularly performed as part of the treatment. The changing rates of surgery and the rise in new efficacious medical therapy have improved the prognosis for patients with RA. This review will discuss the natural history of rheumatoid arthritis, common medications used to treat it, how disease progression has changed as a function of new biologic immunotherapy, and the role of orthopaedic intervention in this new landscape of advanced rheumatoid care.

Age-related Changes in Cervical Sagittal Alignment: A Radiographic Analysis.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To identify age-related changes in cervical sagittal parameters using standard radiographs. SUMMARY OF BACKGROUND DATA: Cervical sagittal balance is important for the maintenance of neutral head posture and horizontal gaze. Degenerative changes in the cervical spine that occur with aging may alter cervical sagittal balance, which can lead to chronic neck pain and predispose to various cervical spine pathologies. METHODS: We performed a retrospective cohort study of 151 patients with lateral cervical spine radiographs taken at our institution between December 2017 and June 2018. Cervical sagittal parameters were measured, including C1 inclination, C2 slope, C2-C7 Cobb angle, cervical sagittal vertical axis (cSVA), cervical tilt, upper and lower C7 slopes, T1 slope, and T1 slope minus cervical lordosis (TS-CL). The association between age and cervical sagittal parameters was assessed using the Pearson correlation coefficient and a linear regression analysis. An analysis of variance (ANOVA) with Tukey adjustments was then performed to identify differences in cervical sagittal parameters among patients aged 18 to 39 years, 40 to 64 years, and >64 years of age. RESULTS: There were positive correlations between age and C2-C7 Cobb angle (r = 0.231, P = 0.004), upper C7 slope (r = 0.280, P < 0.001), lower C7 slope (r = 0.283, P < 0.001), and T1 slope (r = 0.189, P = 0.020). Upper C7 slope (R = 0.079) and lower C7 slope (R = 0.074) had the strongest correlation with age in the linear regression analysis. The ANOVA found significant differences among the age subgroups in terms of C2-C7 Cobb angle (P = 0.002), upper C7 slope (P < 0.001), lower C7 slope (P < 0.001), and T1 slope (P = 0.031). Patients >64 years old had significantly higher C2-C7 Cobb angle, upper C7 slope, lower C7 slope, and T1 slope. CONCLUSION: Changes in cervical sagittal alignment with age are characterized by increased cervical lordosis and increased thoracic kyphosis. LEVEL OF EVIDENCE: 3.

Predictors of 30-Day Postoperative Pulmonary Complications After Open Reduction and Internal Fixation of Vertebral Fractures.

OBJECTIVE: The purpose of this study was to identify predictors of 30-day postoperative pulmonary complications after open reduction and internal fixation (ORIF) of vertebral fractures. METHODS: We performed a retrospective study using the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2014. Adult patients who underwent ORIF of vertebral fractures were included and divided into 2 groups based on the occurrence of 30-day postoperative pulmonary complications. Baseline patient and operative characteristics were compared between the 2 groups. Multivariate regression (MVR) analysis was performed to identify independent risk factors for pulmonary complications. RESULTS: A total of 900 patients were included in our cohort. The overall 30-day pulmonary complication rate was 5.67%. Patients who had a pulmonary complication after vertebral ORIF were more often men and more often had diabetes, functional dependence, American Society of Anesthesiologists score classification of 3 or higher, pulmonary comorbidity, renal comorbidity, and preoperative anemia. The pulmonary complication group also had a higher incidence of 30-day mortality, prolonged hospitalization, pneumonia, cardiac complications, urinary tract infection, blood transfusion, and sepsis. The MVR analysis found that pulmonary comorbidity (odds ratio [OR], 5.3; 95% confidence interval [CI], 2.5-11.5; P < 0.001), diabetes (OR, 2.1; 95% CI, 1.0-4.2; P = 0.037), partial or dependent functional status (OR, 4.7; 95% CI, 2.2-10.2; P < 0.001), and cervical spine involvement (OR, 3.6; 95% CI, 1.7-8.0; P = 0.001) were independent predictors of pulmonary complications. CONCLUSIONS: Early identification of risk factors for postoperative pulmonary complications is important in the evaluation of patients with vertebral fractures for surgical decision-making, preoperative optimization, and subsequent postoperative care to improve patient outcomes and minimize morbidity.