Intra- and interdisciplinary agreement in the rating of acromioclavicular joint dislocations.

BACKGROUND: Acromioclavicular (AC) joint dislocation is a common injury observed and treated by physicians from several disciplines; proper classification and communication of the diagnosis between physicians is essential to manage injuries properly. This study assessed inter- and intradepartmental agreement in the rating of AC joint dislocations and compared departments of orthopedic surgery, musculoskeletal (MSK) radiology, and emergency medicine (EM). METHODS: Fifty radiographs indicating a random distribution of AC dislocations (Rockwood types I, II, III, and V) were sent to 25 resident, fellow, and attending physicians; the study group consisted of orthopedic surgeons (n = 9), MSK radiologists (n = 7), and EM physicians (n = 9). Dislocations were rated by physicians using the Rockwood classification (excluding type IV) and rating agreement was derived using the multirater κ statistic. RESULTS: Moderate rating agreement was found among orthopedic surgeons (κ = 0.5147), which was higher than among radiologists (κ = 0.3628) or EM physicians (κ = 0.1894). Interdisciplinary rating agreement was highest between orthopedic surgeons and MSK radiologists and lowest between MSK radiologists and EM physicians. Attending orthopedic surgeons showed the highest rating agreement (κ = 0.5167) compared with attending MSK radiologists (κ = 0.3585) and attending EM physicians (κ = 0.2612). In-training orthopedic surgeons had higher rating agreement (κ = 0.4918) than in-training MSK radiologists (κ = 0.4218) and in-training EM physicians (κ = 0.1410). DISCUSSION: Orthopedic surgeons exhibited the highest intradepartmental rating agreement in assessing AC joint injuries, but interdepartmental rating agreement was low. It is unclear if low interdepartmental rating agreement reflects classification or training weaknesses; recognition of these differences may help develop a more standardized education for physicians to improve the management of AC joint injuries. CONCLUSIONS: Interdisciplinary rating agreement of AC joint injuries is low. Further study may help improve education and communication about AC joint injuries among physicians.

In vitro response of human chondrocytes to a combination of growth factors and a proteinase inhibitor.

Degenerative disk disease is an accelerating cascade of tissue degeneration in the intervertebral disk. A harsh catabolic environment perpetuates the degeneration of the intervertebral disk. Tissue engineering-based techniques offer effective treatment to slow the progression of degenerative disk disease and regenerate intervertebral disk tissue. The purpose of this study was to assess the efficacy of a regenerative therapy for degenerative disk disease by treating human chondrocytes with anabolic growth factors and a proteinase inhibitor. The use of both proved effective in upregulating important extracellular matrix markers of human chondrocytes. These successful in vitro results have implications for the regeneration of the intervertebral disk.

Methylene ATP analogs as modulators of extracellular ATP metabolism and accumulation.

1 Transient accumulation of extracellular ATP reflects both release of ATP from intracellular stores and altered rates of ATP metabolism by ecto-enzymes. Ecto-nucleoside triphosphate diphosphohydrolases (eNTPDases) and ecto-nucleotide pyrophosphatases (eNPPs) degrade ATP, while ecto-nucleotide diphosphokinases (eNDPKs) synthesize ATP from ambient ADP. 2 Although the methylene ATP analogs betagamma-meATP and alphabeta-meATP are widely used as metabolically stable tools for the analysis of purinergic signaling, their specific effects on eNTPDase, eNPP, and eNDPK activities have not been defined. This study compared the actions of these analogs on extracellular ATP metabolism by human 1321N1 astrocytes, rat PC12 pheochomocytoma cells, and rat C6 glioma cells. 3 Both analogs significantly reduced clearance of extracellular ATP by 1321N1 cells that express both eNTPDases and eNPPs, as well as by C6 cells that exclusively express eNPPs. In contrast, both analogs were much less efficacious in inhibiting ATP clearance by PC12 cells that predominantly express eNTPDases. Betagamma-meATP, but not alphabeta-meATP, was effectively hydrolyzed by the 1321N1 and C6 cells; PC12 cells did not significantly degrade this analog. 4 Alphabeta-meATP, but not betagamma-meATP, acted as a substrate for purified yeast NDPK to generate ATP via trans-phosphorylation of ADP. alphabeta-meATP also acted as substrate for the eNDPK activities expressed by 1321N1, PC12, and C6 cells and thereby induced extracellular ATP accumulation in the presence of ambient or exogenously added ADP. 5 These results indicate that methylene ATP analogs exert complex and cell-specific effects on extracellular ATP metabolism that can significantly modify interpretation of studies that use these reagents as probes of purinergic signal transduction in intact tissues.

Prehabilitation in preparation for orthopaedic surgery.

By improving an individual's functional capacity through increased physical activity before an anticipated orthopaedic procedure, it seems reasonable to assume that the individual will maintain a higher level of functional ability and rebound more rapidly in the rehabilitation process. Prehabilitation is the process of enhancing functional capacity of the individual to enable him or her to withstand the stressor of inactivity associated with an orthopaedic procedure. A generic prehabilitation program incorporates the components of warm-up, a cardiovascular component, resistance training, flexibility training, and practicing functional tasks.