Localized Anterior Arthrofibrosis After Soft-Tissue Quadriceps Tendon Anterior Cruciate Ligament Reconstruction Is More Common in Patients Who Are Female, Undergo Meniscal Repair, and Have Grafts of Larger Diameter.

PURPOSE: To determine factors associated with localized anterior arthrofibrosis (cyclops lesion), such as graft size, warranting early reoperation for lysis of adhesions after anterior cruciate ligament reconstruction (ACLR) with all-soft tissue quadriceps tendon (ASTQT) autograft. METHODS: All primary ASTQT autograft ACLRs within a single surgeon's prospectively collected registry with minimum 6-month follow-up were included. Patients who underwent multiligament knee reconstruction or cartilage restoration procedures were excluded. Localized anterior arthrofibrosis was defined as the requirement for a second procedure to achieve debridement and lysis of adhesions owing to the inability to regain terminal extension within 6 months of ACLR. The sex-specific incidence of arthrofibrosis was evaluated relative to age, weight, femoral and tibial tunnel sizes, meniscal repair, and meniscectomy by a binary logistic regression. RESULTS: This study included 721 patients (46% female patients). There were 52 cases of localized anterior arthrofibrosis (7.2%). Female patients had a greater incidence of arthrofibrosis than male patients. Male patients with a femoral tunnel diameter of 9.25 mm or greater had an increased incidence of arthrofibrosis compared with those with a diameter of less than 9.25 mm, whereas a similar cutoff was not found to be statistically significant for female patients. Concomitant meniscal repair was associated with an increased risk of arthrofibrosis. CONCLUSIONS: Female sex and concomitant meniscal repair were associated with an increased localized anterior arthrofibrosis incidence. Furthermore, ASTQT with a femoral tunnel diameter of 9.25 mm or greater in male patients was associated with an increased incidence of arthrofibrosis. LEVEL OF EVIDENCE: Level III, retrospective, comparative prognostic trial.

Mild Hemophilia in a Competitive High School Soccer Player: A Case Report.

In this report, we discuss the case of a now 23-year-old athlete who was diagnosed with mild hemophilia, successfully played varsity soccer throughout high school, and continued to play intramural and club soccer while in college. A prophylactic protocol was developed by the athlete's hematologist to allow his safe participation in contact sports. Similar prophylactic protocols have been discussed by Maffet et al that successfully allowed an athlete to participate in high-level basketball. However, significant barriers still exist for an athlete with hemophilia who wants to engage in contact sports. We discussed how athletes with adequate support networks can participate in contact sports. Decisions need to be made on a case-by-case basis and involve the athlete, family, team, and medical personnel.

School-based mental health clinics.

TOPIC: The research, planning, implementation, and evaluation of school-based mental health clinics located throughout a large metropolitan city, which were established in a joint project by four local mental health centers. PURPOSE: To explain the evolution of the idea of providing school-based mental health to a large, inner-city population, including the delineation of team roles and responsibilities. SOURCES: Nursing, medical, social work, and educational literature. Notes detailing the formation of InteCare, the school-based mental health clinic system. CONCLUSIONS: Providing mental health services in inner-city schools improves access and removes barriers to treatment for this population. Working collegially with school personnel and families significantly improves the academic function of the children, the functioning of the families, and the relationships between parents and schools.

A review of ethics for the radiologic technologist.

Radiologic technology students learn ethical theory, ethical principles and the Code of Ethics. However, over time, the concepts may fade from the radiologic technologist's memory. Periodic review of the ethical concepts and the American Registry of Radiologic Technologists Standards of Ethics are important to maintain a clear understanding of ethical expectations of the radiologic technologist. This article provides examples of potential ethical violations to illustrate each principle in the Code of Ethics and each tenet in the Rules of Ethics. The examples are intended to help readers think about and relate to situations they may encounter. This article is a Directed Reading. Your access to Directed Reading quizzes for continuing education credit is determined by your CE preference. For access to other quizzes, go to www.asrt.org/store.

Rates of femicide in women of different races, ethnicities, and places of birth: Massachusetts, 1993-2007.

To describe the epidemiology of intimate partner violence (IPV) homicide in Massachusetts, an IPV mortality data set developed by the Massachusetts Department of Public Health was analyzed. The rates of death were estimated by dividing the number of decedents over the aged-matched population and Poisson regression was used to estimate the contribution of race, ethnicity, and foreign-born status to the risk of dying from IPV. Out of the total 270 women whose deaths were associated with IPV, 239 (89%) were killed by a male partner. Black women had a risk of dying from IPV of 16.2 per 1,000,000 person-years. Hispanic women also had a higher risk of dying from IPV than non-Hispanic women; incidence risk ratio of 9.7 (Poisson regression 95% confidence interval 6.8-13.8). IPV femicide disproportionately affected Black and Hispanic women. Agencies must consider the importance of providing culturally appropriate services to IPV survivors and their community.