Primary Anterior Cruciate Ligament Repair Using Suture Tape Augmentation: A Case Series of 29 Patients With Minimum 2-Year Follow-Up.

PURPOSE: To evaluate clinical outcomes and patient-reported outcomes of patients who underwent primary anterior cruciate ligament (ACL) repair using suture tape augmentation. METHODS: Patients with a proximal tear of the ACL who underwent primary ACL repair with a minimum 2-year follow-up were included. The exclusion criteria included multiligamentous knee injuries, midsubstance tears, tibial avulsion fractures, and distal tears. Demographic characteristics, injury pattern, concomitant injury pattern, and patient-reported outcome measures were recorded. Patients were evaluated at a minimum 2-year follow-up for clinical success, defined as stability not requiring revision ACL reconstruction, and for patient-reported outcome measurements. Failure was defined as the need for revision surgery. RESULTS: The mean follow-up period was 2.8 ± 0.9 years. Thirty-five patients met the inclusion criteria, with an average age of 32.2 ± 7.2 years, and 2-year follow-up was obtained for 29 of these patients. Revision surgery was required in 2 of the 29 patients (6.9%); successful treatment was achieved in the remaining 93.1%. The Single Assessment Numeric Evaluation score and Knee Injury and Osteoarthritis Outcome Score for the 27 successfully treated patients were recorded, with 70.4% having Single Assessment Numeric Evaluation scores of 80 or greater. CONCLUSIONS: This case series shows that primary surgical repair of proximal ACL tears using suture tape augmentation results in a low rate of revision surgery. LEVEL OF EVIDENCE: Level IV, prospective case series.

Do Professional Society Advocacy Campaigns Have an Impact on Pediatric Orthopaedic Injuries?

PURPOSE: The American Academy of Orthopaedic Surgeons (AAOS) and the American Academy of Pediatrics (AAP) both advocate for childhood injury prevention by publishing recommendations to orthopaedic surgeons, pediatricians, and the public. Popular topics of advocacy campaigns have included trampolines, all-terrain vehicles (ATVs), and lawnmowers. The purpose of this study was to investigate the temporal relationship between AAOS/AAP advocacy and pediatric orthopaedic injury rates, using these topics as examples. We hypothesized that pediatric orthopaedic injury rates decline in years, following related AAOS/AAP recommendations. METHODS: A retrospective review of fractures associated with trampolines, lawnmowers, and ATVs among patients aged 2 to 18 years from 1991 to 2014 was performed using the National Electronic Injury Surveillance System (NEISS). Fracture rates and percent changes year-to-year were calculated. A timeline of AAOS and AAP advocacy statements published on the products was created. RESULTS: Trampoline-related fractures rose 14% yearly from 1991 to 1999, reached a plateau from 1999 to 2003, corresponding with a 1999 AAP statement. Injury rates dropped 4.3% from 2006 to 2010 after 2005 and 2006 statements, and reached another plateau thereafter, as 2010 and 2012 statements were published. ATV-related fractures rose 14% yearly between 1997 and 2002, then dropped 15% from 2007 to 2010 following yearly AAP or AAOS statements from 2004 to 2007. From 2010 to 2014, the injury rate held constant during which time 2010, 2013, and 2014 statements were published. Lawnmower injury rates did not fall despite statements in 1998 and 2001 and a poster campaign in 2001. A 25% drop from 2007 to 2008 coincided with an AAOS statement in 2008. Fracture rates further dropped 31% from 2009 to 2011 and 21% from 2012 to 2014, amidst 2012 and 2014 statements. For ATV-related and lawnmower-related injuries, more male individuals were affected than female individuals, and for ATVs alone, injury rates increased with age. CONCLUSIONS: Although AAOS/AAP statements did not universally coincide with dropping fracture rates, statements often were associated with substantial decreases in following years. This is likely because injury prevention messages are dispersed from providers to the public over time and outcomes depend on highly variable patient behaviors. LEVEL OF EVIDENCE: Level V-systematic review of descriptive data.

EphA7 signaling guides cortical dendritic development and spine maturation.

The process by which excitatory neurons are generated and mature during the development of the cerebral cortex occurs in a stereotyped manner; coordinated neuronal birth, migration, and differentiation during embryonic and early postnatal life are prerequisites for selective synaptic connections that mediate meaningful neurotransmission in maturity. Normal cortical function depends upon the proper elaboration of neurons, including the initial extension of cellular processes that lead to the formation of axons and dendrites and the subsequent maturation of synapses. Here, we examine the role of cell-based signaling via the receptor tyrosine kinase EphA7 in guiding the extension and maturation of cortical dendrites. EphA7, localized to dendritic shafts and spines of pyramidal cells, is uniquely expressed during cortical neuronal development. On patterned substrates, EphA7 signaling restricts dendritic extent, with Src and Tsc1 serving as downstream mediators. Perturbation of EphA7 signaling in vitro and in vivo alters dendritic elaboration: Dendrites are longer and more complex when EphA7 is absent and are shorter and simpler when EphA7 is ectopically expressed. Later in neuronal maturation, EphA7 influences protrusions from dendritic shafts and the assembling of synaptic components. Indeed, synaptic function relies on EphA7; the electrophysiological maturation of pyramidal neurons is delayed in cultures lacking EphA7, indicating that EphA7 enhances synaptic function. These results provide evidence of roles for Eph signaling, first in limiting the elaboration of cortical neuronal dendrites and then in coordinating the maturation and function of synapses.

Sagittal spinopelvic changes after posterior spinal fusion in adolescent idiopathic scoliosis.

PURPOSE: This article examines if longer posterior spinal fusions with instrumentation (PSFI) into the lumbar spine (L3/4) alter spinopelvic parameters compared with selective fusions to T12/L1/L2 in adolescent idiopathic scoliosis (AIS) patients. METHODS: We analysed radiographs of 84 AIS patients, 58 (69%) females and 26 (31%) males, who underwent PSFI at an mean age of 15 years ± 2.5 years, range 10 years to 21 years, between 1st January 2007 and 31st December 2014. Radiographic parameters were measured pre- and post-operatively at most recent follow-up (range 2 years to 8.2 years): pelvic incidence (PI), lumbar lordosis (LL, L1-S1 and L4-S1), sagittal vertical alignment (SVA), scoliosis angle and proximal junctional kyphosis (PJK). PI-LL was calculated. Data was analysed using t-tests or Wilcoxon rank-sum tests. RESULTS: In total, 32 patients underwent a selective fusion with lowest instrumented vertebra (LIV) T12-L2, and 52 patients underwent a fusion with LIV L3-L4. In both groups, scoliosis angle was significantly corrected at follow-up (p < 0.005).Pre-operatively, both groups had similar LL (L1-S1) and PI-LL. Post-operatively, LL increased in the L3-4 fusion group (p < 0.005) but did not change in the selective fusion group (p = 0.116). This change in LL in the L3-4 fusion group affected the post-operative PI-LL (T12-L2 fusion -4.9° versus L3-4 fusion -13.6°, p = 0.002). No differences were seen in PI, SVA or LL L4-S1 between groups. Radiographic PJK occurred in seven of the L3-4 patients with and without PJK (noPJK -8.8° versus PJK -25.8°, p = 0.026). CONCLUSIONS: In patients who underwent a fusion ending at L3 or L4, LL was increased. This altered the PI-LL relationship, and appeared to increase the risk of PJK. LEVEL OF EVIDENCE: III.

EphA7 isoforms differentially regulate cortical dendrite development.

The shape of a neuron facilitates its functionality within neural circuits. Dendrites integrate incoming signals from axons, receiving excitatory input onto small protrusions called dendritic spines. Therefore, understanding dendritic growth and development is fundamental for discerning neural function. We previously demonstrated that EphA7 receptor signaling during cortical development impacts dendrites in two ways: EphA7 restricts dendritic growth early and promotes dendritic spine formation later. Here, the molecular basis for this shift in EphA7 function is defined. Expression analyses reveal that EphA7 full-length (EphA7-FL) and truncated (EphA7-T1; lacking kinase domain) isoforms are dynamically expressed in the developing cortex. Peak expression of EphA7-FL overlaps with dendritic elaboration around birth, while highest expression of EphA7-T1 coincides with dendritic spine formation in early postnatal life. Overexpression studies in cultured neurons demonstrate that EphA7-FL inhibits both dendritic growth and spine formation, while EphA7-T1 increases spine density. Furthermore, signaling downstream of EphA7 shifts during development, such that in vivo inhibition of mTOR by rapamycin in EphA7-mutant neurons ameliorates dendritic branching, but not dendritic spine phenotypes. Finally, direct interaction between EphA7-FL and EphA7-T1 is demonstrated in cultured cells, which results in reduction of EphA7-FL phosphorylation. In cortex, both isoforms are colocalized to synaptic fractions and both transcripts are expressed together within individual neurons, supporting a model where EphA7-T1 modulates EphA7-FL repulsive signaling during development. Thus, the divergent functions of EphA7 during cortical dendrite development are explained by the presence of two variants of the receptor.

Ultrasound elastography of the patellar tendon in young, asymptomatic sedentary and moderately active individuals.

BACKGROUND: The recent use of ultrasound elastography to study patellar tendon softness has demonstrated increased tendon softness in high-level athletes. We hypothesized that measurable alterations in patellar tendon softness may be present in young asymptomatic subjects engaging in moderate levels of physical activity. METHODS: This was a cross-sectional study. Gray-scale ultrasound and ultrasound elastography of the right and left patellar tendons were performed in young asymptomatic sedentary subjects and moderately active subjects who engaged in at least 30 min of physical activity 4-5 times weekly. The distribution of soft, intermediate and stiff tissue within each tendon was analyzed. Tendon softness was correlated with subject age, gender and level of athletic activity. RESULTS: Sixty patellar tendons in 30 subjects were evaluated (18 males, 12 females, mean age 22.5 years). Seventeen subjects were defined as "active" and 13 as "sedentary." All tendons had a normal gray-scale sonographic appearance. Tendon softness was significantly higher in active subjects (P = 0.01) and decreased with age (P = 0.04). In sedentary individuals there was no significant correlation between age and tendon softness (P = 0.404). Similarly, gender showed no correlation with tendon softness (P > 0.05). CONCLUSIONS: Patellar tendon softness is higher in young subjects and in those engaging in moderate physical activity. This may reflect an adaptation to increased tendon load. Tendon softness in active subjects decreases with age, while it remains at a constant value in sedentary individuals. LEVEL OF EVIDENCE: Level 3.

Spinal fusion surgery: A historical perspective.

The vast majority of technological advances in spinal fusion surgery have occurred within the past 50 years. Despite this, there existed a rich history of innovation, ingenuity, and resourcefulness among the spine surgeons of centuries before. Here, we pay tribute to this history, highlighting the important characters, their devices, and their thoughts, as they sought to alleviate human suffering from spinal deformity.

E-learning in orthopedic surgery training: A systematic review.

E-learning is the use of internet-based resources in education. In the field of surgical education, this definition includes the use of virtual patient cases, digital modeling, online tutorials, as well as video recordings of surgical procedures and lectures. In recent years, e-learning has increasingly been considered a viable alternative to traditional teaching within a number of surgical fields. Here we present (1) a systematic review of literature assessing the efficacy of e-learning modules for orthopedic education and (2) a discussion of their relevance. A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted according to the guidelines defined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). The search yielded a total of 255 non-duplicate citations that were screened using predetermined inclusion/exclusion criteria. A total of 9 full text articles met inclusion criteria, which included the use of an objective outcome measure to evaluate an orthopedic e-learning module. Six studies assessed knowledge using a multiple-choice test and 4 assessed skills using a clinical exam. All studies showed positive score improvement pre- to post-intervention, and a majority showed greater score improvement than standard teaching methods in both knowledge (4/6 studies) and clinical skills (3/4 studies). E-learning represents an effective supplement or even alternative to standard teaching techniques within orthopedic education for both medical students and residents. Future work should focus on validating specific e-learning programs using standardized outcome measures and assessing long-term knowledge retention using e-learning platforms.