Characterisation of polycyclic aromatic hydrocarbons associated with indoor PM0.1 and PM2.5 in Hanoi and implications for health risks.

Polycyclic aromatic hydrocarbons (PAHs) associated with indoor PM pose a high risk to human health because of their toxicity. A total of 160 daily samples of indoor PM2.5 and PM0.1 were collected in Hanoi and analysed for 15 PAHs. In general, the concentrations of carcinogenic PAHs (car-PAHs) accounted for 21% ± 2%, 19.1% ± 2%, and 26% ± 3% of the concentrations of 15 PAHs in PM2.5, PM0.1-2.5, and PM0.1, respectively. Higher percentages of car-PAHs were found in smaller fractions (PM0.1), which can be easily deposited deep in the pulmonary regions of the human respiratory tract. The concentrations of 15 PAHs were higher in winter than in summer. The most abundant PAH species were naphthalene and phenanthrene, accounting for 11%-21% and 19%-23%, respectively. The PAH content in PM0.1 was almost twice as high as those in PM2.5 and PM0.1-2.5. Principal component analysis found that vehicle emissions and the combustion of biomass and coal were the main outdoor sources of PAHs, whereas indoor sources included cooking activities, the combustion of incense, scented candles, and domestic uses in houses. According to the results, 60%-90% of the PM0.1-bound BaP(eq) was deposited in the alveoli region, whereas 63%-75% of the PM2.5-bound BaP(eq) was deposited in head airways (HA), implying that most of the particles deposited in the HA region were PM0.1-2.5. The contributions of dibenz[a,h]anthracene and benzo[a]pyrene were dominant and contributed from 36% to 51% and 31%-50%, respectively, to the carcinogenic potential, whereas benzo[a]pyrene contributed from 30% to 49% to the mutagenic potential for both size fractions. The incremental lifetime cancer risk, simulated by Monte Carlo simulation, was within the limits set by the US EPA, indicating an acceptable risk for the occupants. These results provide an additional scientific basis for protecting human health from exposure to indoor PAHs.

PFAS, bisphenol, and paraben in Malaysian food and estimated dietary intake.

Endocrine disrupting chemicals (EDCs) such as per- and polyfluoroalkyl substances (PFAS), bisphenols, and parabens are used in food packaging or as preservatives and their unintended consumption has been associated with cancer and other diseases. Food EDCs data are scarce in Malaysia. Thus, liquid chromatography mass tandem spectrometry (LC-MS/MS) was utilised to analyse 18 EDCs from different food categories. Bisphenol was the most abundant EDC found, followed by PFAS and paraben. Bisphenol levels in canned foods, dairy products, canned drinks, fruits, and vegetables ranged from 1.16 to 183 ng/g. PFAS was found in almost every food category, with canned foods having the highest concentrations (0.18-34.5 ng/g). Only canned foods, fruits, and vegetables contained parabens, with mean concentrations ranging from 0.27 to 26.7 ng/g. PFOS, PFBA, PFHQA and bisphenol A all had hazard quotients (HQ) above 1, indicating that they can pose a risk to human health.

Is preoperative glenoid defect size a reliable indicator of postoperative recurrence after arthroscopic Bankart repair in teenage competitive athletes?

BACKGROUND: Being younger than 20 years of age at the time of arthroscopic Bankart repair (ABR) is known to be one of the most important risk factors for postoperative recurrence of instability. When deciding on the appropriate surgical approach, surgeons generally consider only the size of a critical glenoid defect, and most of them do not take into account factors such as the size of bone fragments and possible bone union after arthroscopic bony Bankart repair (ABBR). Therefore, this retrospective study aimed to clarify the risk factors for postoperative recurrence after ABR in teenage competitive athletes by focusing on glenoid rim morphologies and bone union. METHODS: Participants were 115 teenage competitive athletes without a capsular injury who underwent primary ABR for chronic traumatic anterior instability and were followed up for a minimum of 2 years. Possible risk factors for postoperative recurrence were investigated by univariate and multivariate analysis. In shoulders with a glenoid defect and bone fragment, the influence of glenoid defect size and bone fragment size on bone union after ABBR was also investigated. RESULTS: Postoperative recurrence was seen in 16 patients (13.9%). Regarding glenoid defect size, recurrence was seen in 1 (3.2%) of 31 shoulders with a glenoid defect smaller than 5% (including those with a normal glenoid), 15 (22.1%) of 68 shoulders with a glenoid defect of 5%-20%, and 0 (0%) of 16 shoulders with a glenoid defect of 20% or larger (P = .009). Regarding bone union, recurrence was seen in 4 (6.9%) of 58 shoulders with complete or partial bone union after ABBR and 8 (40%) of 20 shoulders with nonunion or disappearance of the bone fragment (P = .001). Regarding bone fragment size, recurrence was seen in 12 (20.7%) of 58 shoulders with a small or no bone fragment (<7.5%) and in 3 (8.6%) of 35 shoulders with a large bone fragment (≥7.5%; P = .154). Multivariate analysis identified non-union or disappearance of the bone fragment after ABBR as a significant risk factor for recurrence. Complete or partial bone union was seen in 25 (58.1%) of 43 shoulders with a small bone fragment (<7.5%) and 33 (94.3%) of 35 shoulders with a large bone fragment (≥7.5%; P < .001). CONCLUSIONS: In teenage competitive athletes, bone union after ABBR affects postoperative recurrence after ABR, regardless of the preoperative glenoid defect size, and bone union rate after ABBR is significantly influenced by bone fragment size.

Penetration factor and indoor deposition rate of elementary and particulate iodine in a Japanese house for assessing the effectiveness of sheltering for radiation exposures.

Sheltering is one of the countermeasures for protection against radiation exposures in nuclear accidents. The effectiveness of sheltering is often expressed by the reduction factor, that is the ratio of the indoor to the outdoor cumulative radioactivity concentrations or doses. The indoor concentration is mainly controlled by the air exchange rate, penetration factor, and indoor deposition rate. The penetration factor and indoor deposition rate depend on the surface and the materials and structure of windows and doors as it is these openings in the building envelope that control penetration. We investigated experimentally these parameters of I2and particles. The experiment was performed in two apartment houses, three single-family houses, and chambers. The obtained penetration factor ranged from 0.3 to 1 for particles of 0.3-1µm and 0.15-0.7 for I2depending on the air exchange rate. The indoor deposition rate for a house room ranged from 0.007 to 0.2 h-1for particles of 0.3-1µm and 0.2-1.5 h-1for I2.

Epigenetic effects of insecticides on early differentiation of mouse embryonic stem cells.

Increasing evidence indicates that many insecticides produce significant epigenetic changes during embryogenesis, leading to developmental toxicities. However, the effects of insecticides on DNA methylation status during early development have not been well studied. We developed a novel nuclear phenotypic approach using mouse embryonic stem cells harboring enhanced green fluorescent protein fused with methyl CpG-binding protein to evaluate global DNA methylation changes via high-content imaging analysis. Exposure to imidacloprid, carbaryl, and o,p'-DDT increased the fluorescent intensity of granules in the nuclei, indicating global DNA methylating effects. However, DNA methylation profiling in cell-cycle-related genes, such as Cdkn2a, Dapk1, Cdh1, Mlh1, Timp3, and Rarb, decreased in imidacloprid treatments, suggesting the potential influence of DNA methylation patterns on cell differentiation. We developed a rapid method for evaluating global DNA methylation and used this approach to show that insecticides pose risks of developmental toxicity through DNA methylation.

Nerve Block for Pain Relief During Arthroscopic Rotator Cuff Repair.

BACKGROUND: Although arthroscopic rotator cuff repair (ARCR) often results in good outcomes, some patients have severe pain postoperatively. This study investigated the efficacy of nerve block for ARCR. METHODS: This study was retrospective, and consent was obtained from all patients. We divided 50 patients who had undergone ARCR into 4 groups: continuous interscalene nerve block was performed for 11 patients (continuous-injection group), single interscalene nerve block for 10 (single-injection group), suprascapular nerve block for 8 (suprascapular group), and intravenous analgesic administration for 10 (intravenous group). Eleven patients received no nerve block (control group). We evaluated diclofenac sodium and pentazocine dosing, visual analog scale (VAS) scores, and perioperative complications in each group. VAS scoring was done immediately after surgery and 1 and 6 hours and 1, 2, 3, 7, and 14 days postoperatively. RESULTS: The doses of diclofenac sodium and pentazocine did not differ between groups. VAS scores immediately after surgery and at 1 and 6 hours after surgery were significantly lower in the single-injection and continuous-injection groups than in the suprascapular, intravenous, and control groups. VAS score at 1 day postoperatively was significantly lower in the continuous-injection group than in the other groups. One patient in the continuous group reported temporary paralysis of the fingers and drug solution leakage. CONCLUSION: Interscalene nerve blocks yielded good pain relief for ARCR. Although continuous interscalene nerve block produced continuous pain relief, complications are a concern.

Level and determinants of serum perfluoroalkyl acids (PFAAs) in a population in Klang Valley, Malaysia.

For decades, perfluoroalkyl acids (PFAAs) have been commonly used for industrial and commercial purposes due to their water- and stain-resistant properties. Persistent pollutants that contain PFAAs have been associated with adverse health effects in humans, and many studies have documented dietary intake, indoor air inhalation, and dermal contact as the potential routes for human exposure to PFAAs. The aim of this study was to assess the level of PFAAs in the serum samples of a general population in a specific region in Malaysia. Using 219 serum samples collected from residents of Klang Valley, Malaysia, the levels of nine PFAAs were analyzed using liquid chromatography-tandem mass spectrometry. In addition, questionnaire surveys on the dietary habits and lifestyles of the subjects were conducted. The results showed that PFAA concentrations of up to 32.57 ng/mL were detected in all serum samples. In 82.6% of the participants, at least seven PFAAs were detected in the serum samples, with perfluorooctanesulfonic acid being the predominant PFAA (median = 8.79 ng/mL). In the adjusted regression model, the concentrations of most PFAAs were higher in men than in women and positively correlated with age, although body mass index and smoking were not significantly associated with the serum PFAA concentrations. Taking into consideration the lifestyle variables, significant associations were found between nonstick cookware and perfluorononanoic acid, between dental floss and cosmetics and perfluorodecanoic acid (PFDA), and between leather sofa and perfluoroundecanoic acid (PFUnDA). Besides, consumption of beef was significantly associated with increased levels of serum PFUnDA, whereas consumption of lamb and chicken eggs was negatively associated with the serum levels of PFUnDA and PFDA, respectively.

Benefits of bone graft augmentation to arthroscopic Bankart repair for recurrent anterior shoulder instability with glenoid bone loss.

PURPOSE: Glenoid bone loss contributes to recurrent instability after arthroscopic Bankart repair alone. With significant glenoid bone loss, better results have been reported after arthroscopic Bankart repair with glenoid arc reconstruction. However, no reports compare augmentation using bone graft with non-augmentation for glenoid bone loss. The purpose of this study was to assess clinical results of an arthroscopic Bankart repair with or without arthroscopic bone graft augmentation. It was hypothesized that such bone graft augmentation would restore shoulder stability, and lead to excellent outcomes. METHODS: Of 552 patients treated for anterior glenohumeral instability with arthroscopic Bankart repair, 68 met this study's inclusion criteria of glenoid bone loss over 20% and follow-up of at least 2 years. Patients were divided into 2 groups based on whether with bone graft augmentation for glenoid bone loss [Group A: n = 35, median age; 21 years (range 13-72 years)], or not (Group B: n = 33, median age; 21 years (range 13-50 years)]. For grafting, either autologous iliac bone or artificial bone made of hydroxyapatite was used. Rowe score, recurrence rate, and return to sport were used to assess the results. RESULTS: Mean Rowe score was 95.0 (SD 10.6) in Group A and 69.7 (SD 27.2) in Group B (p < 0.05). The recurrence rate was 2.9% (1/36) in Group A and 48.5% (16/33) in Group B (p < 0.05). Regarding contact/collision athletes, 24 were contained in Group A and 22 in Group B. Of the patients with recurrence in Group B, 13 (59.1%) were contact/collision athletes. Finally, 50% of the contact/collision sports athletes for both groups returned to their sports at the same as pre-injury level. Of the 11 patients who returned to the same level of contact/collision sports in Group B, seven returned with residual instability. Nine athletes in Group A and 3 in Group B quit their sports for personal or social reasons. CONCLUSIONS: Bone graft augmentation was beneficial when used with Arthroscopic Bankart repair for recurrent anterior shoulder instability with glenoid bone loss. Especially, for recurrent anterior shoulder instability with glenoid bone loss in contact/collision sports athletes, bone graft augmentation should be strongly considered as beneficial. LEVEL OF EVIDENCE: Level IV.

Is Pregabalin Effective Against Acute Lumbar Radicular Pain ?

INTRODUCTION: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for acute lumbar radicular pain accompanying lumbar disc herniation (LDH), but their effects are minimal. The purpose of this study was to evaluate the efficacy and safety of pregabalin (PGB) as an alternative therapy for this condition. METHODS: Patients with acute lumbar radicular pain accompanying LDH were randomly administered either NSAIDs plus PGB (30 patients) or NSAIDs alone (30 patients) for up to 4 weeks. The primary outcome was leg pain at 2 and 4 weeks. Secondary outcomes were reduction in sleep disturbances and patient global impressions of change (PGIC) at 2 and 4 weeks. RESULTS: Four patients in the NSAIDs plus PGB group were deemed ineligible and excluded from the study. Fewer sleep disturbances were reported by patients administered NSAIDs plus PGB compared with the NSAID monotherapy group at both 2 and 4 weeks. Additionally, the NSAIDs plus PGB group showed greater improvement in pain than the NSAID monotherapy group at 4 weeks, although this difference was not significant. PGIC was also significantly better in the NSAIDs plus PGB group than in the NSAID monotherapy group at 4 weeks. The incidence of adverse events was significantly greater in the NSAIDs plus PGB group than in the NSAID monotherapy group. CONCLUSIONS: The combination of NSAIDs plus PGB is more effective against sleep disturbance than NSAIDs alone in patients with acute LDH, although the control of sciatic pain is minimal. Patients reported satisfactory recoveries could also be obtained, and thus, this combination therapy could be a good option for the conservative treatment of acute lumbar radicular pain, including LDH.

Arthroscopic Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Dislocation.

BACKGROUND: The purpose of this study was to evaluate mid- and long-term clinical and radiologic outcomes of arthroscopic coracoclavicular ligament reconstruction (ACCLR) with an artificial ligament for acute dislocation of the acromioclavicular joint (ACJ). METHODS: Twelve male patients (average age at the time of surgery: 40.8 years, range: 21-64 years) underwent ACCLR with an artificial ligament for acute dislocation of the ACJ type III or type V according to the Rockwood classification. Arthroscopic surgery was performed with the patient under general anesthesia and interscalene brachial plexus block in the beach-chair position. Reduction of the ACJ was performed manually or using an elevator under control of an imaging intensifier. The ACJ was fixed temporarily with a Kirschner wire. Bone tunnels of the coracoid process and clavicle were made with a cannulated drill. An artificial ligament was pulled out through the bone tunnels and fixed on the upper surface of the clavicle with a staple and interference screw, and on the undersurface of the coracoid process with an Endobutton. The shoulder was immobilized with a shoulder brace for 4 weeks postoperatively, and rehabilitation was started in the first postoperative week. The Japan Shoulder Society Acromioclavicular Joint Function Assessment (JSS-ACJ) score was used for evaluation of clinical outcomes, and plain radiographs were performed after a minimum follow-up period of 5 years postoperatively. RESULTS: The average follow-up period after surgery was 106.3 months (range: 62-128 months). The average postoperative JSS-ACJ score was 97.2 points (range: 92-100). The seven patients who had been playing sports before injury all returned to their pre-injury level. No patients complained of pain or shoulder dysfunction in daily activities, work, or sports. There were no complications such as neurovascular injuries during surgery, infection, or foreign body reaction from the artificial ligament. Radiographs at the final follow-up showed subluxation of the ACJ and non-symptomatic osteoarthritic changes of the ACJ in two patients, respectively. CONCLUSION: ACCLR for acute dislocation of the ACJ is a useful surgical procedure that gives satisfactory clinical and radiologic outcomes on mid- and long-term follow-up. ACCLR can stabilize vertical instability of the ACJ. If instability in the horizontal direction remains, repair or reconstruction of the acromioclavicular ligament should be added to prevent osteoarthritic changes of the ACJ.

Multiparameter Phenotypic Profiling in MCF-7 Cells for Assessing the Toxicity and Estrogenic Activity of Whole Environmental Water.

Multi-parameter phenotypic profiling of small molecules is a powerful approach to their toxicity assessment and identifying potential mechanisms of actions. The present study demonstrates the application of image-based multi-parameter phenotypic profiling in MCF-7 cells to assess the overall toxicity and estrogenic activity of whole environmental water. Phenotypic profiling of 30 reference compounds and their complex mixtures was evaluated to investigate the cellular morphological outcomes to targeted biological pathways. Overall toxicity and estrogenic activity of environmental water samples were then evaluated by phenotypic analysis comparing with conventional bioassays and chemical analysis by multivariate analysis. The phenotypic analysis for reference compounds demonstrated that size and structure of cells related to biological processes like cell growth, death, and communication. The phenotypic alteration and nuclei intensity were selected as potential biomarkers to evaluate overall toxicity and estrogenic activities, respectively. The phenotypic profiles were associated with the chemical structure profiles in environmental water samples. Since the phenotypic parameters revealed multiple toxicity endpoints, it could provide more information that is relevant to assessing the toxicity of environmental water samples in compare with conventional bioassays. In conclusion, the image-based multi-parameters phenotypic analysis with MCF-7 cells provides a rapid and information-rich tool for toxicity evaluation and identification in whole water samples.

Characteristics of the patients with delaminated rotator cuff tear.

PURPOSE: The purpose of this study was to analyze factors relating to delamination in full-thickness rotator cuff tears. METHODS: 126 patients with full-thickness rotator cuff tears treated by arthroscopic rotator cuff repair were the subjects of this study. There were 52 females and 74 males whose average age was 64.2 years. Fifty-three patients had history of trauma. The average duration of disorder was 29.5 weeks. Nineteen patients were diagnosed with diabetes. On types of the tears, small tear was observed in 59 patients, medium tear in 47 patients, large tear in 6 patients, and massive tear in 14 patients. The average size of tear was 1.98 cm. Delamination of the torn cuff was observed in 45 patients. Factors compared between the patients without delamination and those with delamination were as follows: gender and age of the patients, history of trauma, duration of disorder, diabetes, smoking, size and number of rotator cuff tears. RESULTS: The delamination rate of the smoking patients was significantly higher than non-smoking patients. The delamination rate of patients with more than two tendon tears was significantly higher than those with only one tendon tear. The average size of tear with delamination was significantly larger than that of tear without delamination. The other factors were not related to delamination. CONCLUSIONS: This study suggests that smoking, size of tear and number of torn cuffs are associated with delamination. The progression of torn cuff, anatomical features and nicotine of smoking affect the causes of delaminated tear of rotator cuff.

Bioaccessibility of Fukushima-Accident-Derived Cs in Soils and the Contribution of Soil Ingestion to Radiation Doses in Children.

Ingestion of contaminated soil is one potential internal exposure pathway in areas contaminated by the Fukushima Daiichi Nuclear Power Plant accident. Doses from this pathway can be overestimated if the availability of radioactive nuclides in soils for the gastrointestinal tract is not considered. The concept of bioaccessibility has been adopted to evaluate this availability based on in vitro tests. This study evaluated the bioaccessibility of radioactive cesium from soils via the physiologically-based extraction test (PBET) and the extractability of those via an extraction test with 1 mol/L of hydrochloric acid (HCl). The bioaccessibility obtained in the PBET was 5.3% ± 1%, and the extractability in the tests with HCl was 16% ± 3%. The bioaccessibility was strongly correlated with the extractability. This result indicates the possibility that the extractability in HCl can be used as a good predictor of the bioaccessibility with PBET. In addition, we assessed the doses to children from the ingestion of soil via hand-to-mouth activity based on our PBET results using a probabilistic approach considering the spatial distribution of radioactive cesium in Date City in Fukushima Prefecture and the interindividual differences in the surveyed amounts of soil ingestion in Japan. The results of this assessment indicate that even if children were to routinely ingest a large amount of soil with relatively high contamination, the radiation doses from this pathway are negligible compared with doses from external exposure owing to deposited radionuclides in Fukushima Prefecture.

Shoulder manual muscle resistance test cannot fully detect muscle weakness.

PURPOSE: The shoulder manual resistance test is one of the common clinical assessments for patients with muscle weakness. However, there have been no studies investigating the threshold for muscle weakness. The purpose of this study was to clarify the threshold for muscle weakness in the shoulder manual muscle resistance test. METHODS: Fifty-three patients (37.9 ± 20.6 years old) with either rotator cuff tear (21 patients), superior labrum anterior-to-posterior (SLAP) lesion (7 patients), or Bankart lesion (25 patients) of one shoulder were administered three manual muscle resistance tests (abduction strength, external rotation, and belly press tests). Positive results in these tests were defined as a subjective weakness in the involved shoulder compared to the opposite shoulder. Based on this result, the patients were divided into positive and negative groups. Another observer measured isometric strength using a hand-held dynamometer and calculated the side-to-side ratio. Comparing instrument measurement with manual measurement, the cut-off point, at which we can recognise that there is a side-to-side difference, was calculated by receiver operating characteristic analysis. RESULTS: The cases with less than 60% of the muscle strength in the contralateral shoulder were judged as positive in all examinations, whereas among the cases with 60-90% of muscle strength, there was a mixture of negative and positive determinations. The cut-off point was 78.9% in the abduction strength test, 73.8% in the external rotation test, and 84.0% in the belly press test. CONCLUSION: The side-to-side difference could be manually detected, when muscle strength was less than 75-85% of that on the contralateral side. This finding suggests that it is necessary to understand the limitation of these manual tests in the case of clinical examinations. Therefore, care must be taken for the shoulder manual muscle resistance test as muscle weakness cannot be fully detected by manual measurement. LEVEL OF EVIDENCE: Case-control study, Level IV.

The pathology of the anterior capsule in patients over forty years of age with recurrent shoulder dislocation.

PURPOSE: We evaluated the pathologies of anterior capsular mechanism in older patients with recurrent anterior shoulder dislocation in the absence of full-thickness rotator cuff tears. METHODS: Three hundred and ninety-five shoulders with recurrent anterior shoulder dislocation were assessed. The patients were divided into three groups by the age at the first dislocation and the surgical treatment: group A (onset and treatment were at an age over 40 years), group B (onset was at an age under 40 years and treatment was at an age over 40 years) and group C (onset and treatment were at an age under 40 years). Groups A, B and C involved nine, 31 and 355 shoulders, respectively. RESULTS: The prevalence of an isolated Bankart lesion was 81.7 % in group C, 33.3 % in group A and 64.5 % in group B, and each of A and B was significantly lower than group C. The prevalence of an isolated capsular tear was 3.1 % in group C, while it was 33.3 % in group A, which was significantly higher. CONCLUSIONS: The prevalence of an isolated Bankart lesion was low and the prevalence of a capsular tear was high in older patients. We should keep in mind the existence of a capsular tear in older patients and examine the whole anterior capsular mechanism meticulously.

Hill-sachs lesions in shoulders with traumatic anterior instability: evaluation using computed tomography with 3-dimensional reconstruction.

BACKGROUND: In patients with traumatic anterior shoulder instability, a large Hill-Sachs lesion is a risk factor for postoperative recurrence. However, there is no consensus regarding the occurrence and enlargement of Hill-Sachs lesions. PURPOSE: To investigate the influence of the number of dislocations and subluxations on the prevalence and size of Hill-Sachs lesions evaluated by computed tomography (CT) with 3-dimensional reconstruction. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: The prevalence and size of Hill-Sachs lesions were evaluated preoperatively by CT in 142 shoulders (30 with primary instability and 112 with recurrent instability) before arthroscopic Bankart repair. First, the prevalence of Hill-Sachs lesions was compared with the arthroscopic findings. Then, the size of Hill-Sachs lesions confirmed by arthroscopy was remeasured using the previous CT data. In addition, the relationship of Hill-Sachs lesions with the number of dislocations and subluxations was investigated. RESULTS: Hill-Sachs lesions were detected in 90 shoulders by initial CT evaluation and were found in 118 shoulders at arthroscopy. The Hill-Sachs lesions missed by initial CT were 15 chondral lesions and 13 osseous lesions. However, all 103 osseous Hill-Sachs lesions were detected by reviewing the CT data. In patients with primary subluxation, the prevalence of Hill-Sachs lesions was 26.7%, and the mean length, width, and depth of the lesions (calculated as a percentage of the diameter of the humeral head) were 9.0%, 5.3%, and 2.1%, respectively, while the corresponding numbers for primary dislocation were 73.3%, 27.7%, 14.8%, and 7.0%, all showing statistically significant differences. Among all 142 shoulders, the corresponding numbers were, respectively, 56.3%, 20.7%, 11.2%, and 4.8% in patients who had subluxations but never a dislocation; 83.3%, 33.4%, 19.1%, and 7.6% in patients with 1 episode of dislocation; and 87.5%, 46.8%, 22.2%, and 10.2% in patients with ≥2 episodes, all showing statistically significant differences. There were no differences in lesion measurements in relation to the number of subluxations. CONCLUSION: Computed tomography is a useful imaging modality for evaluating Hill-Sachs lesions except for purely cartilaginous lesions. Hill-Sachs lesions were more frequent and larger when the primary episode was dislocation than when it was subluxation. Among patients with recurrent episodes of complete dislocation, the prevalence of Hill-Sachs lesions is increased, and the lesions are larger.

Influence of posterior capsular tightness on throwing shoulder injury.

PURPOSE: The role of posterior capsular tightness in throwing shoulder injury has not yet been clarified. Accordingly, the influence of posterior capsular tightness on the occurrence of throwing shoulder injury was investigated. METHODS: Sixty-one shoulders with throwing injury were retrospectively reviewed, including 50 tight shoulders and 11 non-tight shoulders. Occurrence of long head of biceps (LHB) lesions, superior glenohumeral ligament (SGHL) and middle glenohumeral ligament (MGHL) injuries, type 2 SLAP lesions, and supraspinatus and subscapularis tendon injuries was compared between the tight and non-tight groups. RESULTS: There were LHB lesions in 8 tight shoulders and 6 non-tight shoulders, SGHL injury in 14 and 8 shoulders, and subscapularis tendon injury in 6 and 5 shoulders, respectively, showing significant differences between tight and non-tight shoulders. In contrast, MGHL injury, type 2 SLAP lesions, and supraspinatus tendon injury showed no significant differences. The SLAP lesion was located anteriorly in 6 tight shoulders, posteriorly in 5, and combined in 4 versus 0, 3, and 0 for the non-tight shoulders, respectively, so anterior SLAP lesions only occurred in tight shoulders. Similarly, anterior supraspinatus tendon injuries had a higher incidence in tight shoulders than in non-tight shoulders (19 vs 3). CONCLUSIONS: Rotator interval lesions were frequent in non-tight shoulders, while anterior SLAP lesions and anterior supraspinatus tendon injuries were predominant in tight shoulders. The significance of posterior capsular tightness should be reconsidered. LEVEL OF EVIDENCE: Retrospective, Level IV.

In vivo graft tension in anatomic double-bundle anterior cruciate ligament reconstruction during active leg-raising motion with the knee splinted.

PURPOSE: The purpose of this study was to measure the in vivo graft tension in anatomic 2-bundle anterior cruciate ligament (ACL) reconstruction during active leg-raising exercise with the knee immobilized. METHODS: Anatomic double-bundle ACL reconstruction was performed with autogenous semitendinosus tendons in 7 patients while under general anesthesia. Two grafts were fixed with 2 EndoButton-CL devices (Smith & Nephew Endoscopy, Andover, MA) on the femur and were temporarily fixed to 2 tension-adjustable force gauges on the anterior tibial cortex. Then, a knee brace in semi-flexion was put around the knee, and 10 N of initial tension was applied to each graft at 20° of flexion. The tension on the anteromedial (AM) and posterolateral (PL) grafts was continuously measured during active leg-raising motion with the knee immobilized after patients had awoken from anesthesia. Then, the tension measurement was repeated during active leg-raising motion with the knee immobilized while a 2-kg weight was fitted around the ankle. RESULTS: In situ graft tension during active leg-raising motion with a knee brace was 10.9 ± 4.0 N for the AM graft and 8.6 ± 5.1 N for the PL graft, whereas the tension with a 2-kg weight around the ankle was 10.9 ± 3.4 N for the AM graft and 9.9 ± 3.6 N for the PL graft. There was no significant difference between each graft in the 2 motions with a paired t test. CONCLUSIONS: Graft tension with the knee immobilized with a semi-flexed knee brace during active leg-raising motion was 19.5 N with no weight and 20.8 N with additional weight, both of which were almost equal to the initial graft tension at the time of fixation at 20°. Thus the leg-raising exercise can be recommended as safe when a semi-flexed knee brace is worn after ACL reconstruction. CLINICAL RELEVANCE: These findings will help to plan postoperative rehabilitation programs with security.

Migration of EndoButton after anatomic double-bundle anterior cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to (1) assess the migration of EndoButtons (Smith & Nephew Endoscopy, Andover, MA) with or without tissue interposition by comparing the radiographs obtained immediately after anterior cruciate ligament (ACL) reconstruction and those obtained during the follow-up period and (2) investigate the effect of tissue interposition or migration of EndoButtons on the clinical outcomes. METHODS: One hundred one patients underwent anatomic double-bundle ACL reconstruction with EndoButtons for femoral fixation. Anteroposterior and lateral radiographs were taken immediately postoperatively and at 1 week, 1 month, 3 months, and 1 year. The distance between the EndoButton and lateral femoral cortex was measured on the radiograph obtained immediately postoperatively, and more than 1 mm in distance was defined as positive tissue interposition. Moreover, the locations of the EndoButtons on the radiographs obtained at each follow-up visit were compared with those obtained immediately postoperatively, and EndoButton migration was considered to be present when the EndoButton had moved more than 1 mm or had rotated by more than 5°. The relations between clinical outcomes at 1 year and tissue interposition or migration of EndoButtons were also evaluated. RESULTS: Tissue interposition was found for 51 EndoButtons and migration was observed for 71 EndoButtons, and there was a significant difference in the incidence of migration between anteromedial and posterolateral grafts. Of the 51 EndoButtons with tissue interposition, 32 migrated within 1 year, and 39 of 151 EndoButtons without tissue interposition migrated, whereas the EndoButtons with tissue interposition migrated significantly more frequently. On the other hand, there were no significant differences in clinical outcomes between the cases with or without tissue interposition and between the cases with or without EndoButton migration. CONCLUSIONS: Tissue interposition between the EndoButton and femoral lateral cortex was found in 51 EndoButtons (25.2%) on the radiographs obtained immediately after ACL reconstruction, whereas EndoButtons with tissue interposition migrated more frequently than those without it 1 year after ACL reconstruction. However, neither tissue interposition nor migration of the EndoButton affected the clinical outcomes. LEVEL OF EVIDENCE: Level IV, prognostic case series.

Effect of patient age on morphology of anterior cruciate ligament grafts at second-look arthroscopy.

PURPOSE: The purpose of this study was to evaluate the effect of patient age on the morphology of anterior cruciate ligament (ACL) graft after ACL reconstruction, as well as to investigate the relation between morphology and clinical outcomes. METHODS: Anatomic double-bundle ACL reconstruction by use of autogenous semitendinosus tendon graft was performed in 193 patients. Of these, 102 patients (51 male and 51 female patients) had consented to undergo second-look arthroscopy at the time of hardware removal within 2 years of ACL reconstruction. These patients were divided into the following 3 groups according to their age: group A, 29 years or younger (55 cases); group B, 30 to 49 years (36 cases); and group C, 50 years or older (11 cases). At second-look arthroscopy, the grafts were evaluated based on synovial coverage around the grafts, tension, and damage/tear of the grafts themselves. Clinical outcomes were evaluated with a physical examination including the Lachman test and side-to-side difference by KT-2000 knee arthrometer (MEDmetric, San Diego, CA), subjective assessment including International Knee Documentation Committee subjective assessment and Lysholm score, and sports activity level including Tegner activity scale. The Mann-Whitney U test, Kruskal-Wallis test, analysis of variance, and χ² test were used for statistical analysis. RESULTS: Good synovial coverage over the graft was found in 49 cases (89%) in group A, 30 (83%) in group B, and 5 (46%) in group C. Synovial coverage in group C was significantly poorer than that in the other 2 groups. No statistical difference was found in tension of graft among the 3 groups, whereas the incidence of a "partial tear" tended to increase with age. With respect to clinical outcome, there was no significant difference among the 3 groups except for sports activity. CONCLUSIONS: Although clinical outcomes were comparable among the 3 groups, synovial coverage of ACL grafts in elderly patients was significantly poorer than that in younger patients. LEVEL OF EVIDENCE: Level II, prognostic study.