Tendon graft through the coracoid tunnel versus under the coracoid for coracoclavicular/acromioclavicular reconstruction shows no difference in radiographic or patient-reported outcomes.

INTRODUCTION: The purpose of this prospective study was to report the outcomes of two different methods in CC and AC reconstruction for the treatment of AC separation using a tendon graft and knot-hiding titanium clavicular implant. MATERIALS AND METHODS: Twenty-seven patients with Rockwood grade III and V acromioclavicular (AC) separations were randomized into two groups. The primary outcome was whether taking the tendon graft through the coracoid risked a fracture. The following were secondary outcomes: follow-up of clavicular wound healing and Nottingham Clavicle score, Constant score, and Simple Shoulder Test results obtained preoperatively and 24 months postoperatively. The anteroposterior radiographic change between the clavicular and coracoid cortexes and the clavicular tunnel diameter was measured postoperatively and 24 months postoperatively. General patient satisfaction with the outcome (poor, fair, good, or excellent) was assessed 2 years postoperatively. RESULTS: No coracoid fractures were detected. No issues in clavicular wound healing were detected. The mean Nottingham Clavicle score increased from a preoperative mean of 42.42 ± 13.42 to 95.31 ± 14.20 (P < 0.00). The Constant score increased from a preoperative mean of 50.81 ± 17.77 to 96.42 ± 11.51 (P < 0.001). The Simple Shoulder Test score increased from a preoperative mean of 7.50 ± 2.45 to 11.77 ± 1.18 (P < 0.001). The changes were significant. The coracoclavicular distance increased from 11.88 ± 4.00 to 14.19 ± 4.71 mm (P = 0.001), which was significant. The clavicular drill hole diameter increased from 5.5 to a mean of 8.00 ± 0.75 mm. General patient satisfaction was excellent. CONCLUSIONS: There were no significant differences between the two groups. There were no implant related complications in the clavicular wound healing. The results support the notion that good results are achieved by reconstructing both the CC and AC ligaments with a tendon graft. STUDY REGISTRATION: This clinical trial was registered on Clinicaltrials.gov.

Costs and duration of orthodontic-surgical treatment with mandibular advancement surgery.

OBJECTIVES: The aim was to analyse the costs and duration of orthodontic-surgical treatment with mandibular advancement in the public health care sector in Finland. MATERIALS: The study was conducted as a retrospective registry study in a public district hospital on all nonsyndromic patients that were ethnic Finns and treated with full fixed appliances and mandibular advancement surgery in 2016-2020. RESULTS: The mean treatment duration of the included 45 patients was 28.1 months, including 18.9 months pre and 9.2 months postoperative orthodontics. The median number of visits was 27, including 17 visits before and 9 visits after surgery. The mean total treatment time was 14.5 h. The mean total direct costs per course of treatment were 7574 € to the municipality and 947 € to the patient. The costs positively correlated with the duration of the treatment (rho = 0.71, P = .000), but were not associated to gender or age of patient. The mean surgery time was 78 minutes, and significantly less with an experienced surgeon (P = .002). It was calculated that the mean minimum treatment costs would be 45% of the present total, achievable with a patient with optimum dental arches at the start of treatment. LIMITATIONS: The major limitation of the study is the relatively small number of study subjects. CONCLUSION: A 55% share of the costs is influenced by case- and operator-dependent factors. This indicates that the complexity and performance of the orthodontic phases of treatment are important determinants in the cost structure.

Military performance of men with attention-deficit/hyperactivity disorder: findings from a follow-up study in the Northern Finland birth cohort 1986.

PURPOSE: The aim of this study was to assess the military performance of men with adolescent attention-deficit/hyperactivity disorder (ADHD) and men with childhood ADHD (in remission during adolescence) as compared with controls without ADHD. METHODS: The study employs the general population-based Northern Finland Birth Cohort 1986 (NFBC1986) together with data received from the Finnish Defence Forces (FDF). A total of 38 men with childhood ADHD and 67 with adolescent ADHD were compared with 160 controls. RESULTS: The men with adolescent ADHD were more often deemed unfit for military service, had more military health care visits, more often committed at least one offence during service, received poorer evaluations for team leadership skills and indulged in more alcohol consumption and smoking than the controls, while those with childhood ADHD did not differ from the controls in their military fitness, but received poorer evaluations for team leadership skills and smoked more than did the controls. CONCLUSION: The conscripts with adolescent ADHD performed worse on many military parameters, but the men with ADHD in remission did not seem to suffer from such negative effects on military performance. The childhood ADHD group in particular was nevertheless somewhat limited in size, which might have led to a Type II error.

Calcaneal Bone Bruise After Surgery for Insertional Achilles Tendinopathy.

OBJECTIVE: Excision of the posterosuperior corner of the calcaneus (EPCC) is routinely undertaken in athletes after failure of conservative management of insertional Achilles tendinopathy. Some patients can experience sharp calcaneal pain during postoperative rehabilitation, a sign of a calcaneal bone bruise (CBB). DESIGN: Case series, level of evidence IV. SETTING: University teaching hospital. PATIENTS: This study reports 8 patients who developed postoperative CBB after having started impact training too early. INTERVENTION: Patients in whom a diagnosis of CBB had been formulated were followed to return-to-play and resolution of bone edema by MRI. MAIN OUTCOME MEASURES: Detection of CBB after EPCC. RESULTS: After routine EPCC for insertional Achilles tendinopathy, 8 patients presented with sharp pain for a mean 7.1 weeks (median 6 weeks, range 5-11 weeks) before clinical suspicion of CBB. At that stage, MRI showed clear evidence of a bone bruise, with a diagnosis of CBB formulated at an average of 10.8 postoperative weeks (range 6-16 weeks). Calcaneal bone bruise resolved with modified symptom-free loading. Patients returned to play at average on 5.6 months (range 2-9 months) after the diagnosis of postoperative CBB. CONCLUSIONS: We describe 8 athletes who developed painful CBB following routine EPCC for insertional Achilles tendinopathy after having increased their level of activities too soon after the index procedure. In these patients, the diagnosis of postoperative CBB can be formulated by MRI and more cautious rehabilitation implemented.

Is securing normal dentofacial development an indication for tonsil surgery in children? A systematic review and meta-analysis.

OBJECTIVE: Tonsil surgeries are common operations in the field of paediatric otorhinolaryngology. Often, the indication for these operations is hypertrophied tonsils. Paediatric sleep-disordered breathing and mouth-breathing are conventional situations caused by the hypertrophied tonsils. Both of these are further associated with dentofacial development alterations. Securing normal dentofacial development, or restoring it, is often used as an indication for tonsil surgery. In this review and meta-analysis, we assessed the contemporary literature to clarify whether tonsil surgery has an effect on dentofacial development in children. METHODS: Studies with children aged 3-10 years who underwent tonsil surgery and were compared to non-operated controls using dentofacial parameters were included to the review. Search strategies were planned for specific databases. The Newcastle-Ottawa scale was used to assess the risk of bias. A meta-analysis was performed when the data was methodologically homogenous enough to be pooled. RESULTS: The inclusion criteria for the review were fulfilled in 8 studies. The overall quality of the individual studies was judged to be moderate at best. The data were methodologically homogenous enough to be pooled for the meta-analysis in only 2 studies. The results of the meta-analysis revealed that tonsil surgery has a positive effect on the growth direction of the mandible (p < 0.001). CONCLUSIONS: There is modest evidence that suggests that tonsil surgery has a positive effect on the dentofacial development in children with hypertrophied tonsils. Securing normal dentofacial development should be one component, but not the only one, when the indications for tonsil surgery in children are considered.

Craniofacial and occlusal development in 2.5-year-old children with obstructive sleep apnoea syndrome.

OBJECTIVES: Paediatric obstructive sleep apnoea syndrome (OSAS) is associated with a range of changes in craniofacial and occlusal development. There is, however, little knowledge of how early in life these changes can be found. The aim of the present study was to determine whether changes in dental arch morphology, occlusion, facial profile, tonsil size, breathing habit or body mass index (BMI) can already be found among 2.5-year-old children with OSAS. MATERIALS AND METHODS: Fifty-two children were recruited to the study. Of these, OSAS was diagnosed in 9 children and 18 children did not snore in polysomnography. These two groups were subsequently compared when evaluating polysomnographic, otorhinolaryngological and dental variables. RESULTS: Children with OSAS had narrower inter canine width than non-snoring children (P = 0.032). Furthermore, children with OSAS had larger adenoid size with respect to the nasopharyngeal volume (P = 0.020) and more tendency to mouth breathing (P = 0.002). No statistically significant differences were found when comparing palatine tonsil size, occlusal characteristics, soft tissue profile measurements or BMI. LIMITATIONS: The limitation of the study is the small sample size. CONCLUSION: Children with OSAS had narrower upper inter canine width than non-snoring children at the age of 2.5 years. Larger adenoid size and mouth breathing tendency were also more common among children with OSAS. Further studies with larger sample sizes are needed to determine if other changes in craniofacial and occlusal development can be found in this age group.

Central Tendon Injuries of Hamstring Muscles: Case Series of Operative Treatment.

BACKGROUND: As compared with injuries involving muscle only, those involving the central hamstring tendon have a worse prognosis. Limited information is available regarding the surgical treatment of central tendon injuries of the hamstrings. PURPOSE: To describe the operative treatment and outcomes of central tendon injuries of the hamstrings among athletes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Eight athletes (6 top level, 2 recreational) with central hamstring tendon injuries underwent magnetic resonance imaging and surgical treatment. The indication for surgery was recurrent (n = 6) or acute (n = 2) central hamstring tendon injury. All patients followed the same postoperative rehabilitation protocol, and return to play was monitored. RESULTS: Magnetic resonance imaging found a central tendon injury in all 3 hamstring muscles (long head of the biceps femoris, semimembranosus, and semitendinosus) with disrupted tendon ends. In acute and recurrent central tendon injuries, full return to play was achieved at 2.5 to 4 months. There were no adverse events during follow-up. CONCLUSION: Central tendon injuries of the hamstrings can be successfully repaired surgically after acute and recurrent ruptures.

Arthroscopic Coracoclavicular Ligament Reconstruction Using a Synthetic Polycaprolactone-Based Polyurethane Urea Tendon Graft: A Report of 5 Cases.

BACKGROUND: Several techniques have been introduced to treat acromioclavicular (AC) separation using the semitendinosus tendon as a graft for coracoclavicular (CC) ligament reconstruction. However, the tendon may have been used previously or the patient may not want it harvested. Hence, synthetic tendon transfers have become increasingly popular. METHODS: Five patients with chronic AC separations were treated. A synthetic polyurethane urea tendon graft (Artelon Tissue Reinforcement [ATR]) was chosen for its ability to partially transform into connective tissue. The patient follow-up period lasted 45 to 60 months. RESULTS: The mean preoperative Constant Score increased from 64.8 to 100 postoperatively. The mean preoperative Simple Shoulder Test increased from 7.2 to 12 postoperatively. The mean postoperative increase of the CC distance was 1.5 mm. The mean expansion of the clavicular drill hole from the original was 2.1 mm. According to the postoperative magnetic resonance imaging, the grafts had healed well and the cross-sections of the grafts were up to 10.5 mm between the coracoid and the clavicle. DISCUSSION: The synthetic ATR tendon strip was a practical method for reconstructing a torn CC ligament complex. The ATR graft appears promising for future CC ligament reconstructions.

First-pass MR imaging in the assessment of perfusion impairment in patients with hypertrophic cardiomyopathy and the Asp175Asn mutation of the alpha-tropomyosin gene.

PURPOSE: To assess first-pass magnetic resonance (MR) imaging in the evaluation of perfusion impairment in a genetically homogeneous population of patients with hypertrophic cardiomyopathy (HCM) and the Asp175Asn mutation of the alpha-tropomyosin gene and to evaluate the association between hypertrophy and perfusion. MATERIALS AND METHODS: Rest-stress first-pass MR imaging with gadopentetate dimeglumine was performed in 17 patients with HCM and the Asp175Asn substitution in the alpha-tropomyosin gene and in five control subjects. Global and segmental first-pass reserve index (FPR) measurements were derived from signal intensity versus time curves. Left ventricular (LV) wall thickness and LV mass index were measured on cine MR images. The Mann-Whitney test was used to evaluate the difference in FPR between the patient group and the control group. The Spearman correlation was used to evaluate the association between LV hypertrophy and FPR. RESULTS: Global FPR was significantly lower in the patients with HCM than in the control subjects (1.12 +/- 0.35 vs 1.80 +/- 0.58, P =.015). In patients with HCM, maximal LV wall thickness and LV mass index correlated negatively with global FPR (r = -0.723, P =.001 and r = -0.598, P =.011, respectively). At the regional level, segmental FPR correlated inversely with LV wall thickness (r = -0.389; P <.001) in patients with HCM. CONCLUSION: First-pass MR imaging facilitates global and regional evaluation of perfusion impairment in patients with HCM. The severity of perfusion impairment is associated with the degree of LV hypertrophy.

Electrophysiological findings in X-linked myopathy with excessive autophagy.

We report electrophysiological features and magnetic resonance imaging muscle findings in 4 patients and 1 female carrier of X-linked myopathy with excessive autophagy. Motor units were polyphasic with high mean amplitude and normal duration. The thigh muscles were most severely involved, but myotonic discharges were abundant in both clinically affected and unaffected muscles. Along with the clinicopathological features, these electrophysiological findings distinguish X-linked myopathy with excessive autophagy from other limb-girdle myopathies.