Integrated hip fracture care pathway (IHFCP): reducing complications and improving outcomes.

Introduction: Hip fractures in elderly people are increasing. A five-year Integrated Hip Fracture Care Pathway (IHFCP) was implemented at our hospital for seamlessly integrating care for these patients from admission to post discharge. We aimed to evaluate how IHFCP improved process and outcome measures in these patients. Methods: A study was conducted over a five-year period on patients with acute fragility hip fracture who were managed on IHFCP. The evaluation utilised a descriptive design, with outcomes analysed separately for each of the five years of the programme. First-year results were treated as baseline. Results: The main improvements in process and outcome measures over five years, when compared to baseline, were: (a) increase in surgeries performed within 48 hours of admission from 32.5% to 80.1%; (b) reduced non-operated patients from 19.6% to 11.9%; (c) reduced average length of stay at acute hospital among surgically (from 14.0 ± 12.3 days to 9.9 ± 1.0 days) and conservatively managed patients (from 19.1 ± 22.9 to 11.0 ± 2.5 days); (d) reduced 30-day readmission rate from 3.2% to 1.6%; and (e) improved Modified Functional Assessment Classification of VI to VII at six months from 48.0% to 78.2%. Conclusion: The IHFCP is a standardised care path that can reduce time to surgery, average length of stay and readmission rates. It is distinct from other orthogeriatric care models, with its ability to provide optimal care coordination, early transfer to community hospitals and post-discharge day rehabilitation services. Consequently, it helped to optimise patients' functional status and improved their overall outcome.

Functional Characterization of BrF3'H, Which Determines the Typical Flavonoid Profile of Purple Chinese Cabbage.

Flavonols and anthocyanins are the two major classes of flavonoids in Brassica rapa. To elucidate the flavonoid biosynthetic pathway in Chinese cabbage (B. rapa L. subsp. pekinensis), we analyzed flavonoid contents in two varieties of Chinese cabbage with normal green (5546) and purple (8267) leaves. The 8267 variety accumulates significantly higher levels of quercetin, isorhamnetin, and cyanidin than the 5546 variety, indicating that 3'-dihydroxylated flavonoids are more prevalent in the purple than in the green variety. Gene expression analysis showed that the expression patterns of most phenylpropanoid pathway genes did not correspond to the flavonoid accumulation patterns in 5546 and 8267 varieties, except for BrPAL1.2 while most early and late flavonoid biosynthetic genes are highly expressed in 8267 variety. In particular, the flavanone 3'-hydroxylase BrF3'H (Bra009312) is expressed almost exclusively in 8267. We isolated the coding sequences of BrF3'H from the two varieties and found that both sequences encode identical amino acid sequences and are highly conserved with F3'H genes from other species. An in vitro enzymatic assay demonstrated that the recombinant BrF3'H protein catalyzes the 3'-hydroxylation of a wide range of 4'-hydroxylated flavonoid substrates. Kinetic analysis showed that kaempferol is the most preferred substrate and dihydrokaempferol (DHK) is the poorest substrate for recombinant BrF3'H among those tested. Transient expression of BrF3'H in Nicotiana benthamiana followed by infiltration of naringenin and DHK as substrates resulted in eriodictyol and quercetin production in the infiltrated leaves, demonstrating the functionality of BrF3'H in planta. As the first functional characterization of BrF3'H, our study provides insight into the molecular mechanism underlying purple coloration in Chinese cabbage.

Stochastic chromatin packing of 3D mitotic chromosomes revealed by coherent X-rays.

DNA molecules are atomic-scale information storage molecules that promote reliable information transfer via fault-free repetitions of replications and transcriptions. Remarkable accuracy of compacting a few-meters-long DNA into a micrometer-scale object, and the reverse, makes the chromosome one of the most intriguing structures from both physical and biological viewpoints. However, its three-dimensional (3D) structure remains elusive with challenges in observing native structures of specimens at tens-of-nanometers resolution. Here, using cryogenic coherent X-ray diffraction imaging, we succeeded in obtaining nanoscale 3D structures of metaphase chromosomes that exhibited a random distribution of electron density without characteristics of high-order folding structures. Scaling analysis of the chromosomes, compared with a model structure having the same density profile as the experimental results, has discovered the fractal nature of density distributions. Quantitative 3D density maps, corroborated by molecular dynamics simulations, reveal that internal structures of chromosomes conform to diffusion-limited aggregation behavior, which indicates that 3D chromatin packing occurs via stochastic processes.

ZnO-CuO Core-Hollow Cube Nanostructures for Highly Sensitive Acetone Gas Sensors at the ppb Level.

This paper presents a ZnO-CuO p-n heterojunction chemiresistive sensor that comprises CuO hollow nanocubes attached to ZnO spherical cores as active materials. These ZnO-CuO core-hollow cube nanostructures exhibit a remarkable response of 11.14 at 1 ppm acetone and 200 °C, which is a superior result to those reported by other metal-oxide-based sensors. The response can be measured up to 40 ppb, and the limit of detection is estimated as 9 ppb. ZnO-CuO core-hollow cube nanostructures also present high selectivity toward acetone against other volatile organic compounds and demonstrate excellent stability for up to 40 days. The outstanding gas-sensing performance of the developed nanocubes is attributed to their uniform and unique morphology. Their core-shell-like structures allow the main charge transfer pathways to pass the interparticle p-p junctions, and the p-n junctions in each particle increase the sensitivity of the reactions to gas molecules. The small grain size and high surface area of each domain also enhance the surface gas adsorption.

Efficacy of intraoperative wireless ultrasonography for uterine incision among patients with adherence findings in placenta previa.

AIM: We evaluated the effectiveness of intraoperative wireless ultrasonography in determining the location of uterine incision during cesarean delivery in patients with placenta previa who have sonographic adherence findings in order to assess intraoperative blood loss and maternal morbidity. METHODS: A prospective study using wireless sonography, including 15 patients with previa, was conducted among women with singleton pregnancies who delivered by cesarean section between August 1, 2017, and August 30, 2019. Retrospective study for the control group included 32 patients with placenta previa who underwent cesarean section between January 1, 2016, and July 31, 2017, without wireless sonography. Patients with previa who had adherence findings in prenatal sonography were included in both groups. Logistic regression was used to identify the association between massive intraoperative bleeding loss and use of wireless ultrasound sonography. RESULTS: Intraoperative blood loss was significantly reduced in the study group compared to that in the control group (P = 0.009). The hospital stay was significantly shorter in the study group compared to the control group (5 days vs 6 days, P < 0.001). The use of intraoperative wireless sonography (P = 0.01) had a significant association with massive intraoperative hemorrhage in multivariable analysis. CONCLUSION: Our study is the first study to apply a wireless ultrasound sonography device in women with placenta previa during cesarean section to examine maternal morbidity. This latest wireless ultrasound sonography device is advantageous for uterine incision guidance in women with placenta previa and improves maternal morbidity by reducing intraoperative hemorrhage.

Saccharibacillus brassicae sp. nov., an endophytic bacterium isolated from kimchi cabbage (Brassica rapa subsp. pekinensis) seeds.

Strain ATSA2T was isolated from surface-sterilized kimchi cabbage (Brassica rapa subsp. pekinensis) seeds and represents a novel bacterium based on the polyphasic taxonomic approach. A phylogenetic analysis based on 16S rRNA gene sequences showed that strain ATSA2T formed a lineage within genus Saccharibacillus and was most closely to Saccharibacillus deserti WLG055T (98.1%) and Saccharibacillus qing-shengii H6T (97.9%). The whole-genome of ATSA2T comprised a 5,619,468 bp of circular chromosome with 58.4% G + C content. The DNA-DNA relatedness values between strain ATSA2T and its closely related type strains S. deserti WLJ055 and S. qingshengii H6T were 26.0% and 24.0%, respectively. Multiple gene clusters associated with plant growth promotion activities (stress response, nitrogen and phosphorus metabolism, and auxin biosynthesis) were annotated in the genome. Strain ATSA2T was Gram-positive, endospore-forming, facultatively anaerobic, and rod-shaped It grew at 15-37°C (optimum 25°C), pH 6.0-10.0 (optimum pH 8.0), and in the presence of 0-5% (w/v) NaCl (optimum 1%). The major cellular fatty acids (> 10%) of strain ATSA2T were anteiso-C15:0 and C16:0. MK-7 was the major isoprenoid quinone. The major polar lipids present were diphosphatidylglycerol, phosphatidylglycerol, and three unknown glycolipids. Based on its phylogenetic, genomic, phenotypic, and chemotaxo-nomic features, strain ATSA2T is proposed to represent a novel species of genus Saccharibacillus, for which the name is Saccharibacillus brassicae sp. nov. The type strain is ATSA2T (KCTC 43072T = CCTCC AB 2019223T).

Effect of backlash hysteresis of surgical tool bending joints on task performance in teleoperated flexible endoscopic robot.

BACKGROUND: The tendon-sheath mechanism provides flexibility but degrades the task performance of the flexible endoscopic robot because of the inherent backlash hysteresis problem. Previous studies have only focused on reducing backlash hysteresis. The goal of this study is to identify the backlash hysteresis criteria of surgical tool bending joints to maintain efficient surgical performance. METHODS: A test platform for a surgical tool has been developed that has initial backlash hysteresis under 5° and can adjust the backlash hysteresis intentionally. Performance variation has been investigated in three bench-top endoscopic tasks in which various backlash hysteresis conditions were intentionally adjusted. RESULTS: A clear drop-off in task performance has been observed when the backlash hysteresis of the bending joints was greater than 10° regardless of the type of task and link length. CONCLUSIONS: The backlash hysteresis of surgical tool bending joints should be reduced to at least 10° to maintain efficient performance in robotic endoscopic surgery.

Report: Cytotoxic activity of phytochemicals from the stem bark of Calophyllum castaneum.

Phytochemical investigation on the dichloromethane stem bark extract of Calophyllum castaneum resulted in the isolation of five compounds, namely isoblancoic acid (1), blancoic acid (2), euxanthone (3), friedelin (4) and friedelinol (5). All these compounds were isolated for the first time from this plant. Their chemical structures were elucidated based on the spectroscopic analyses. The cytotoxicity of compounds 1-5 was assessed on a panel of cancer cell lines including bone (Saos-2, mg63), colorectal (HT29, Caco-2, HCC2998, SW48, HCT116, KM12), liver (HepG2), lung (H1299, Calu-3), and brain (C6), using 5-fluorouracil as positive control. Pronounced antiproliferative activities were observed for compound 1 which exhibited a comparable activity with the positive control, against brain (C6) and colorectal (SW48, KM12, HCT116) cancer cell lines showing IC50 values in the range of 14 to 65µM. Meanwhile, compound 5 displayed a greater cytotoxic effect showing at least 2-fold more strongly than the positive control, against C6 brain cancer cells. The assay findings have unveiled the therapeutic value of phytochemicals from Calophyllum castaneum as anti-cancer agents.

Return to sports after the latarjet procedure: high return level of non-collision athletes.

PURPOSE: The purpose of this study was to compare the clinical outcomes, including the level of return to sport, of collision and non-collision athletes who had the Latarjet procedure. METHODS: A total of 56 shoulders of 29 collision and 27 non-collision athletes were retrospectively analyzed. All study participants underwent the Latarjet procedure between 2007 and 2014. Median age at the time of surgery was 26.5 years(18-43) and follow-up duration was 67.0 months(24-113). RESULTS: At the final follow-up, 54 (96.4%) patients returned to sports. Nine patients (16.1%) returned to the same level of sports. In a group of collision athletes, 1 patient (3.4%) returned to the same level, 16 (55.2%) returned to lower level, 10 (34.5%) changed sports, and 2 (6.9%) quit sports. In a group of noncollision athletes, 8 (29.6%) returned to same level, 11 (40.7%) returned at a lower level and 8 (29.6%) changed sports. The level of return to sports in collision group was statistically different from that in noncollision group (p = 0.046). The mean VAS, Rowe and UCLA scores improved significantly in both groups (p < 0.001) with no statistically significant difference between both groups. CONCLUSIONS: Although the clinical outcomes were not significantly different between collision and non-collision athletes, the level of return to sports was significantly higher in the non-collision group than in the collision group. The result suggests that the level of physical demand according to sport type is an important prognostic factor which predicts the level of return to sport after the Lartarjet procedure in athletes. LEVEL OF EVIDENCE: IV.

A new chromanone acid from the stem bark of Calophyllum teysmannii.

A new chromanone acid, namely caloteysmannic acid (1), along with three known compounds, calolongic acid (2), isocalolongic acid (3) and stigmasterol (4) were isolated from the stem bark of Calophyllum teysmannii. All these compounds were evaluated for their cytotoxic and antioxidant activities in the MTT and DPPH assays, respectively. The structure of compound 1 was determined by means of spectroscopic methods including 1D and 2D NMR experiments as well as HR-EIMS spectrometry. The stereochemical assignment of compound 1 was done based on the NMR results and X-ray crystallographic analysis. The preliminary assay results revealed that all the test compounds displayed potent inhibitory activity against HeLa cancer cell line, in particular with compound 1 which exhibited the highest cytotoxic activity comparable to the positive control used, cisplatin. However, no significant antioxidant activity was observed for all the test compounds in the DPPH radical scavenging capacity assay.

Comparison of surgically induced astigmatism following iris-claw PIOL insertion with scleral, limbal, or corneal incisions.

PURPOSE: To compare surgically induced astigmatism (SIA) based on incision site and evaluate the clinical results and astigmatic stability of iris-claw phakic intraocular lens (Artisan lens; Ophtec BV, Groningen, Netherlands) implantation. METHODS: Eighty-five eyes of 53 patients with myopia who underwent Artisan lens implantation with a 6.2-mm incision and follow-up of 6 months were retrospectively observed. SIA was assessed using keratometric astigmatism at 6 months postoperatively for the incision sites of the sclera, limbus, and cornea, and the efficacy, safety, predictability, and astigmatic stability were also calculated. RESULTS: SIA obtained using Naeser's polar method (KP[90]SIA) was -0.48 ± 0.35 for scleral incisions, -0.99 ± 0.35 for limbal incisions, and -1.14 ± 0.54 for corneal incisions. Corresponding net astigmatism values, as calculated with KP(90)SIA and KP(135)SIA, were 0.70 ± 0.48 (177°), 1.04 ± 0.37 (175°), and 1.21 ± 0.57 (1°), respectively, with SIA increasing the nearer the incision was to the cornea center. Six months after surgery, the efficacy index was 1.03 and the safety index was 1.08. Ninety-eight percent of patients were within 1.50 diopters of attempted refraction. CONCLUSIONS: The values of SIA after Artisan lens insertion showed significant differences among three incision locations, despite the absence of significant differences in preoperative steep corneal axis astigmatism values at the incision locations. It would be applicable for refractive surgery in the aspect of minimizing astigmatism after surgery.

The effect of oral anticoagulation on the prevalence and management of haematuria in a contemporary Australian patient cohort.

OBJECTIVE: • To examine the effect of oral anticoagulation (OA) on the prevalence and inpatient management of haematuria in a contemporary Australian patient cohort. PATIENTS AND METHODS: • Patients across all inpatient units who had diagnosis-related group (DRG) coding for haematuria were identified from April 2010 to September 2011. • A retrospective chart review was performed to identify the type of anticoagulation (if any), requirement for bladder irrigation or blood transfusion, length of stay (LOS) and cause of haematuria. • Patients for whom the anticoagulation status was uncertain were excluded from analysis. • Statistical significance was determined by Pearson's chi-square tests and Student's t-tests. RESULTS: • In all, 335 admissions with DRG coding for haematuria were identified from hospital records, of which 268 admissions had clear documentation of anticoagulation. There were 118 emergency admissions and 150 elective admissions for day case cystoscopy. The mean age of the patients was 66 years and the male:female ratio was 5:1. In all, 123 admissions were for patients on some form of anticoagulation (46%). • Patients were on anticoagulation in 53% of the 118 emergency admissions for gross haematuria. These comprised patients on aspirin (28%), clopidogrel (4%), warfarin (10%), combined aspirin and warfarin (1%) and combined aspirin and clopidogrel (10%). • The use of OA was a significant predictor of the need for intervention among the 118 emergency admissions (86% vs 62%, P = 0.003). • In particular, dual antiplatelet therapy in the form of aspirin and clopidogrel was associated with an increased requirement for bladder irrigation (92%) when compared with patients on other forms of anticoagulation (84%) or none at all (62%, P = 0.01). • The mean LOS for patients admitted to hospital with haematuria was 5.6 days. Patients on warfarin had a statistically significant longer LOS than the other groups (13.7 vs 4.5 days, P < 0.001). A cause for haematuria was identified in 120 of the 234 patients (51%). Of these, the most common was benign prostatic hyperplasia (21%), followed by bladder urothelial carcinoma (17%). CONCLUSION: • In our cohort of patients, about half of all admissions with haematuria were for patients on some form of OA. • OA use increased the need for intervention, especially for patients on dual antiplatelet therapy.

Phenylethanoid glycosides isolated from Paraboea paniculata.

Phytochemical studies of the leaves and rhizomes of Paraboea pa niculata (Gesneriaceae) are reported for the first time. Three phenylethanoid glycosides were isolated and characterized as 3,4-dihydroxyphenethyl-(3"-O-beta-D-apiofuranosyl)-beta-D-glucopyranoside, calceoralarioside E, and acteoside. These isolates exhibited weak cytotoxic activity against the K-562 cell line with a 50% of cell killing rate of 40.18 microM, 27.05 microM, and 27.24 microM, respectively. In the DPPH free radical scavenging assay, their IC50 values were determined as 75.89 microM, 25.00 microM, and 26.04 microM, respectively.

Artomandin, a new xanthone from Artocarpus kemando (Moraceae).

A new furanodihydrobenzoxanthone, artomandin (1), together with three other flavonoid derivatives, artoindonesianin C, artonol B, and artochamin A, as well as ß-sitosterol were isolated from the stem bark of Artocarpus kemando. The structures of these compounds were determined on the basis of spectral evidence. All of these compounds displayed inhibition effects to a very susceptible degree in cancer cell line tests. Compound 1 also exhibited significant antioxidant capacity in the free radical 1,1-diphenyl-2-picrylhydrazyl tests.

Distinct expression patterns of two Arabidopsis phytocystatin genes, AtCYS1 and AtCYS2, during development and abiotic stresses.

The phytocystatins of plants are members of the cystatin superfamily of proteins, which are potent inhibitors of cysteine proteases. The Arabidopsis genome encodes seven phytocystatin isoforms (AtCYSs) in two distantly related AtCYS gene clusters. We selected AtCYS1 and AtCYS2 as representatives for each cluster and then generated transgenic plants expressing the GUS reporter gene under the control of each gene promoter. These plants were used to examine AtCYS expression at various stages of plant development and in response to abiotic stresses. Histochemical analysis of AtCYS1 promoter- and AtCYS2 promoter-GUS transgenic plants revealed that these genes have similar but distinct spatial and temporal expression patterns during normal development. In particular, AtCYS1 was preferentially expressed in the vascular tissue of all organs, whereas AtCYS2 was expressed in trichomes and guard cells in young leaves, caps of roots, and in connecting regions of the immature anthers and filaments and the style and stigma in flowers. In addition, each AtCYS gene has a unique expression profile during abiotic stresses. High temperature and wounding stress enhanced the expression of both AtCYS1 and AtCYS2, but the temporal and spatial patterns of induction differed. From these data, we propose that these two AtCYS genes play important, but distinct, roles in plant development and stress responses.

Debridement arthroplasty for post-traumatic stiff elbow: intraoperative factors affecting the clinical results of surgical treatment.

BACKGROUND: This study evaluated the outcomes of debridement arthroplasty for stiff elbows, as well as the factors affecting clinical outcomes after surgical treatment. METHODS: Eighteen patients with post-traumatic stiff elbows were treated with debridement arthroplasty using a posterior approach. The mean patient age was 33 years (range, 16 to 59 years), and the average follow-up period was 59 months (range, 24 to 141 months). The patient's ability to perform activities of daily living, including combing their hair, feeding themselves, performing hygiene, and putting on shirt and shoes, were evaluated using the Mayo Elbow Performance Score. RESULTS: At the last follow-up, 16 elbows had painless motion. Two patients continued to complain of mild intermittent pain. The flexion and extension improved to 121 degrees and 10 degrees after surgery, respectively, indicating an average 34 degrees increase in elbow flexion range and an average 25 degrees increase in elbow extension range (p < 0.001, p < 0.001). The Mayo Elbow Performance Score at the last follow-up was excellent in nine elbows (50%) and good in nine elbows (50%). CONCLUSIONS: Debridement arthroplasty is a predictable procedure for the treatment of intractable stiff elbow, provided that the elbow is stable and congruous.

Bridging the gap in immobile massive rotator cuff tears: augmentation using the tenotomized biceps.

BACKGROUND: Numerous operative techniques have been described for the treatment of massive rotator cuff tears with severe retraction where anatomical repair is impossible. PURPOSE: To evaluate the outcome of massive rotator cuff tears repaired using the biceps interposition technique. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between April 2000 and April 2004, 31 shoulders with irreparable massive rotator cuff tears and associated degenerative lesions of the biceps tendon were included for analysis. Open procedures were performed in 15 cases (open group), while 16 patients underwent arthroscopic procedures (arthroscopic group). The mean follow-up period was 32 months (range, 24-67 months). RESULTS: The overall University of California at Los Angeles score at the last follow-up was 31.1 points (range, 21-35). The clinical outcome was excellent in 15 (48.4%) and good in 13 (41.9%) cases. Three patients (9.7%) had poor outcome. There was 1 case of reoperation in the open group for a retear. The mean preoperative Constant score, which was 44.6 points (range, 8-70) in the open group and 51.8 points (range, 24-70) in the arthroscopic group, improved to 80.7 points (range, 37-88) in the former and 83.5 points (range, 57-96) in the latter. The University of California at Los Angeles score improved from preoperative means of 11.3 points (range, 6-16) and 13.6 points (range, 6-19) to 29.5 points (range, 9-33) and 32.6 points (range, 21-35), respectively. However, the differences between the scores in both the categories were not statistically significant (P = .412 and .198, respectively). According to the postoperative repair integrity analyzed with use of magnetic resonance imaging in 14 of 16 cases with arthroscopic augmentation, 9 (64.3%) presented complete healing. CONCLUSION: The biceps tendon interposition technique for massive rotator cuff tears offers a possible improvement in the clinical outcomes and is comparable to that of conventional repair. As well, the augmentation technique using the tenotomized biceps as potential graft for rotator cuff tears is particularly useful in bridging the gap in immobile massive rotator cuff tears with posterior defects and retraction.

Muscle strength after anterior shoulder stabilization: arthroscopic versus open Bankart repair.

BACKGROUND: A number of reports have been made on the muscle strength at the last follow-up after arthroscopic or open Bankart repairs. Few have analyzed the change over time in muscle strength and compared the changes between different operative methods. HYPOTHESIS: Muscle strength recovers faster after arthroscopic Bankart repair than after open Bankart repair, and the final muscle strength is not different between the 2 procedures. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Sixty patients with anterior shoulder instability and an isolated Bankart lesion were enrolled for this study. Thirty patients underwent open Bankart repair (open group), and 30 patients went through arthroscopic Bankart repair (arthroscopic group). RESULTS: The open group demonstrated markedly weaker muscle strength during forward elevation than did the arthroscopic group up to 3 months after surgery, but the difference narrowed to about 5% at 6 months (P = .074). At 6 months after surgery, the muscle strength of the open group measured 85.8% +/- 11.5% in forward elevation, 89.5% +/- 10.3% in external rotation, and 89.3% +/- 13.3% in internal rotation. The corresponding figures of the arthroscopic group were 90.6% +/- 8.6%, 92.1% +/- 9.1%, and 92.1% +/- 11.7%. As for external and internal rotations, the open group demonstrated markedly weaker muscle strength 6 weeks after surgery, but the differences were reduced to about 6% and 4%, respectively, at 3 months (P = .092 and .163, respectively). There was no statistically significant difference in final muscle strength 12 months after the operation between the 2 groups (P = .503, .468, and .659, respectively). CONCLUSION: Muscle strength recovered faster with an arthroscopic procedure than with an open procedure during the early postoperative periods, and strength was restored to the level of the unaffected side at 6 months postoperatively. In the group with open Bankart repairs, the muscle strength during forward elevation recovered slower than did external and internal rotation muscle strengths.

Glenoid defect associated with anterior shoulder instability: results of open Bankart repair.

The purpose of the study was to analyse the clinical results of an open Bankart repair for anterior instability in patients with a glenoid defect and those without a glenoid defect, and to identify factors related to the glenoid defect associated with anterior instability. The prospective study involved 20 patients with a glenoid defect (glenoid defect group) and 20 patients without a glenoid defect (control group) who were enrolled after an open Bankart repair. The average age of each group at the time of surgery was 28 and 23 years respectively. The average follow-up periods were 48 and 55 months. There were no significant differences in subjective pain and stability between the two groups. But the final Rowe score decreased significantly as the size of the glenoid defect increased. Redislocation or subluxation was seen in three patients in the glenoid defect group. The open Bankart procedure restored stability and improved shoulder functions in the patients with a glenoid defect associated with anterior instability, even though the glenoid defect group experienced a significant loss in the range of external rotation with the arm at the side, and the final outcome of the surgery depended upon the size of a glenoid defect. This was a therapeutic, level III case-control study.

Arthroscopic double-bundle augmentation of posterior cruciate ligament using split Achilles allograft.

PURPOSE: The purpose of this study was to assess the outcome of arthroscopic double-bundle posterior cruciate ligament (PCL) augmentation using split Achilles allograft. TYPE OF STUDY: Prospective case series. METHODS: We analyzed 27 knees in 26 patients whose PCL had been augmented by the arthroscopic double-bundle technique using split Achilles allograft. There were 19 male and 7 female patients with a mean age of 27.9 years. Follow-up averaged 25 months (range, 12 to 48 months). The clinical results were evaluated according to the Lysholm knee scores. The posterior laxity was radiographically measured with differences of posterior tibial translation between the injured and the uninjured knee. RESULTS: The Lysholm knee scores improved from 59.5 to 91.8 points (P < .05). The average radiographic side-to-side difference of the posterior tibial translation was 12.7 mm (range, 10 to 26 mm) preoperatively and 2.4 mm (range, 0 to 8 mm) at the time of the latest follow-up (P < .05). Eighteen knees (67%) had 0 to 2 mm translation, 6 knees (22%) had 3 to 5 mm, and 3 knees (11%) had 6 to 10 mm. CONCLUSIONS: PCL injuries can be successfully treated with arthroscopic double-bundle augmentation using split Achilles allograft. This technique can preserve remnant fibers and restore both anterolateral and posteromedial bundles of the PCL. LEVEL OF EVIDENCE: Level IV, case series.