Biceps Tenodesis for Type II SLAP Tears.

Tears of the superior glenoid labrum are a common cause of shoulder pain and disability, especially in overhead athletes such as pitchers, swimmers, and volleyball players. Type II SLAP lesions have been the most clinically important superior labral pathology, and the management of this lesion has been a very controversial topic. Currently, there are no high level studies in the literature to guide treatment. While the few level 3 and level 4 evidence studies that are available following arthroscopic repair of type II SLAP lesions all report reasonable overall patient satisfaction, persistent postoperative pain is common and associated with a low return to pre-injury level of sports participation. There has been a recent school of thought that biceps tenodesis, which maintains the length-tension relationship of the long head of biceps, should be the procedure of choice for patients with isolated type II SLAP lesions. The current paper reviews the role biceps tenodesis plays in the management of type II SLAP tears.

The Masters Athlete: A Review of Current Exercise and Treatment Recommendations.

CONTEXT: With the ever-increasing number of masters athletes, it is necessary to understand how to best provide medical support to this expanding population using a multidisciplinary approach. EVIDENCE ACQUISITION: Relevant articles published between 2000 and 2013 using the search terms masters athlete and aging and exercise were identified using MEDLINE. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 3. RESULTS: Preparticipation screening should assess a variety of medical comorbidities, with emphasis on cardiovascular health in high-risk patients. The masters athlete should partake in moderate aerobic exercise and also incorporate resistance and flexibility training. A basic understanding of physiology and age-related changes in muscle composition and declines in performance are prerequisites for providing appropriate care. Osteoarthritis and joint arthroplasty are not contraindications to exercise, and analgesia has an appropriate role in the setting of acute or chronic injuries. Masters athletes should follow regular training regimens to maximize their potential while minimizing their likelihood of injuries. CONCLUSION: Overall, masters athletes represent a unique population and should be cared for utilizing a multidisciplinary approach. This care should be implemented not only during competitions but also between events when training and injury are more likely to occur. STRENGTH OF RECOMMENDATION TAXONOMY SORT: B.

Rapid mobilization decreases length-of-stay in joint replacement patients.

BACKGROUND: Physiotherapy after total joint replacement enhances postoperative recovery. Implementing a pathway to include earlier postoperative mobilization can reduce the hospital length-of-stay as well as cost. QUESTIONS: Does a rapid rehabilitation program con- sisting of physical therapy on the day of surgery affect the hospital length-of-stay on patients undergoing either total hip or total knee replacements? Is there a difference in the effectiveness of rapid rehabilitation between patients under- going Total Hip and Total Knee Replacements? Can these patients tolerate day of surgery physical therapy sessions? PATIENTS AND METHODS: Nine-hundred hip and knee arthro- plasty patients were divided into two groups for analysis. Group 1 participated in a rapid rehabilitation physical therapy program that began with physical therapists in the recovery room. Group 2 received a standard physical therapy protocol starting the day after surgery. Progression with rehabilitation was followed, and length of hospital stay between the two groups was compared. RESULTS: Total length-of-stay was 3.9 days for the rapid rehabilitation group and was 4.4 days (p < 0.001) for the standard therapy group. We found the rapid rehabilitation group had a significantly shorter length-of-stay than patients who began therapy on postoperative day one. In addition to decreased length-of-stay, rapid rehabilitation also resulted in direct savings considering fewer hospital resources were utilized over the decreased time in-house. CONCLUSIONS: Rapid mobilization of total joint replacement patients in the recovery room can be accomplished safely and reduces the overall length of hospital stay for over 70 % of patients.

Tissue-specific expression patterns of Arabidopsis NF-Y transcription factors suggest potential for extensive combinatorial complexity.

All aspects of plant and animal development are controlled by complex networks of transcription factors. Transcription factors are essential for converting signaling inputs, such as changes in daylength, into complex gene regulatory outputs. While some transcription factors control gene expression by binding to cis-regulatory elements as individual subunits, others function in a combinatorial fashion. How individual subunits of combinatorial transcription factors are spatially and temporally deployed (e.g. expression-level, posttranslational modifications and subcellular localization) has profound effects on their control of gene expression. In the model plant Arabidopsis (Arabidopsis thaliana), we have identified 36 Nuclear Factor Y (NF-Y) transcription factor subunits (10 NF-YA, 13 NF-YB, and 13 NF-YC subunits) that can theoretically combine to form 1,690 unique complexes. Individual plant subunits have functions in flowering time, embryo maturation, and meristem development, but how they combine to control these processes is unknown. To assist in the process of defining unique NF-Y complexes, we have created promoter:beta-glucuronidase fusion lines for all 36 Arabidopsis genes. Here, we show NF-Y expression patterns inferred from these promoter:beta-glucuronidase lines for roots, light- versus dark-grown seedlings, rosettes, and flowers. Additionally, we review the phylogenetic relationships and examine protein alignments for each NF-Y subunit family. The results are discussed with a special emphasis on potential roles for NF-Y subunits in photoperiod-controlled flowering time.

Costal cartilage autografts to simulated degenerative intervertebral discs in the rat.

STUDY DESIGN: An autograft of costal cartilage was transplanted into the rat intervertebral space in the proximal tail following 2 weeks of simulated degeneration by chondroitinase ABC (CABC). OBJECTIVES: The purpose of this study was to evaluate costal cartilage transplantation into a degenerated disc as a possible therapy. SUMMARY OF BACKGROUND DATA: Reversal of degenerative disc dehydration is an attractive goal. Costal cartilage is plentiful, hydrophilic, and avascular, leading us to speculate that it would survive transplantation into the degenerated disc, increase proteoglycan content, and restore disc height. MATERIALS AND METHODS: Costal cartilage fragments were transplanted into a single proximal intervertebral disc in each of the rats' tails following a 2-week period of simulated degeneration. The intervertebral space was measured on radiographs under 2.5x magnification taken pretreatment and 21 days posttreatment. Each specimen was sagittally sectioned, mounted, and stained. The slides were graded for proteoglycan content. RESULTS: A 64% increase in intervertebral disc height was observed in the implant group compared with a 4% increase in sham operated group and a 39% increase in the CABC only group. Histology demonstrated a viable implant in 7 of 9 rats. The transplant group had significantly more proteoglycan staining than either the CABC group or sham group (P < 0.05). CONCLUSIONS: Costal cartilage transplantation may rehydrate degenerated intervertebral discs and might serve as a promising model for understanding and perhaps modifying this complex degenerative disease.

The effect of levodopa or levodopa-carbidopa (sinemet) on fracture healing.

OBJECTIVES: Levodopa (L-dopa) and L-dopa/carbidopa were evaluated to determine their effectiveness in the stimulation of bone healing of fractures at risk for nonunions. METHODS: Forty-two retired breeder female Sprague-Dawley rats were divided into 2 experimental groups and 1 control. Thirty-six rats were evaluated for results. The right femur of each rat was fractured and an intramedullary omega pin was inserted to create a 2 mm bone gap. The rats were administered either 0.2 g/kg/d of L-dopa, 0.2/0.02 g/kg/d L-dopa/carbidopa in their feed, or plain powdered chow (Sham control group). The rats were killed at 5 weeks postsurgery. The femurs were excised, radiographed, and mechanically tested. Bone healing was assessed. Bone stiffness, ultimate load, and energy to failure were determined under 3 point bending using an Instron materials testing system. RESULTS: The femurs of 30% of the Sham rats healed compared with 50% of the L-dopa/carbidopa and 84% of the L-dopa treated femurs. The healed L-dopa rat femurs had significantly greater ultimate load (P = 0.037) and energy to failure (P = 0.004) than the healed Sham rats. There were no significant differences between the L-dopa/carbidopa group and either the Sham or L-dopa group. CONCLUSIONS: These results confirm that L-dopa administration increases the healing in nonunion fractures. The combination of L-dopa/carbidopa did not significantly increase fracture healing.