Dietary quality and dietary greenhouse gas emissions in the USA: a comparison of the planetary health diet index, healthy eating index-2015, and dietary approaches to stop hypertension.

BACKGROUND: The Planetary Health Diet Index (PHDI) measures adherence to the dietary pattern presented by the EAT-Lancet Commission, which aligns health and sustainability targets. There is a need to understand how PHDI scores correlate with dietary greenhouse gas emissions (GHGE) and how this differs from the carbon footprints of scores on established dietary recommendations. The objectives of this study were to compare how the PHDI, Healthy Eating Index-2015 (HEI-2015) and Dietary Approaches to Stop Hypertension (DASH) relate to (a) dietary GHGE and (b) to examine the influence of PHDI food components on dietary GHGE. METHODS: We used life cycle assessment data from the Database of Food Recall Impacts on the Environment for Nutrition and Dietary Studies to calculate the mean dietary GHGE of 8,128 adult participants in the 2015-2016 and 2017-2018 cycles of the National Health and Nutrition Examination Survey (NHANES). Poisson regression was used to estimate the association of (a) quintiles of diet score and (b) standardized dietary index Z-scores with dietary GHGE for PHDI, HEI-2015, and DASH scores. In secondary analyses, we used Poisson regression to assess the influence of individual PHDI component scores on dietary GHGE. RESULTS: We found that higher dietary quality on all three indices was correlated with lower dietary GHGE. The magnitude of the dietary quality-dietary GHGE relationship was larger for PHDI [-0.4, 95% CI (-0.5, -0.3) kg CO2 equivalents per one standard deviation change] and for DASH [-0.5, (-0.4, -0.6) kg CO2-equivalents] than for HEI-2015 [-0.2, (-0.2, -0.3) kg CO2-equivalents]. When examining PHDI component scores, we found that diet-related GHGE were driven largely by red and processed meat intake. CONCLUSIONS: Improved dietary quality has the potential to lower the emissions impacts of US diets. Future efforts to promote healthy, sustainable diets could apply the recommendations of the established DASH guidelines as well as the new guidance provided by the PHDI to increase their environmental benefits.

Adherence to the Planetary Health Diet Index and correlation with nutrients of public health concern: an analysis of NHANES 2003-2018.

BACKGROUND: The Planetary Health Diet Index (PHDI) is a novel measure adapted to quantify alignment with the dietary evidence presented by the EAT-Lancet Commission on Food, Planet, Health. OBJECTIVES: To examine how population-level health and sustainability of diet as measured by the PHDI changed from 2003 to 2018, and to assess how PHDI correlated with inadequacy for nutrients of public health concern (iron, calcium, potassium, and fiber) in the United States. METHODS: We estimated survey-weighted trends in PHDI scores and median intake of PHDI components in a nationally representative sample of 33,859 adults aged 20+ y from 8 cycles (2003-2018) of the National Health and Nutrition Examination Survey with 2 d of dietary recall data. We used the National Cancer Institute method to examine how PHDI correlated with inadequate intake of iron, calcium, potassium, and fiber. RESULTS: Out of a theoretical range of 0-140, the median PHDI value increased by 4.2 points over the study period, from 62.7 (95% confidence interval [CI]: 62.0, 63.4) points in 2003-2004 to 66.9 (66.2, 67.7) points in 2017-2018 (P-trend < 0.001), although most of this change occurred before 2011-2012 and plateaued thereafter. For adequacy components that are encouraged for consumption, nonstarchy vegetable intake significantly decreased over time, whereas whole grains, nuts and seeds, and unsaturated oils increased. For moderation components with recommended limits for consumption, poultry and egg intake increased, but red and processed meat, added sugars, saturated fats, and starchy vegetables decreased over time. Higher PHDI values were associated with a lower probability of iron, fiber, and potassium inadequacy. CONCLUSIONS: Although there have been positive changes over the past 20 y, there is substantial room for improving the health and sustainability of the United States diet. Shifting diets toward EAT-Lancet recommendations would improve nutrient adequacy for iron, fiber, and potassium. Policy action is needed to support healthier, more sustainable diets in the United States and globally.

Do diets with higher carbon footprints increase the risk of mortality? A population-based simulation study using self-selected diets from the USA.

OBJECTIVE: Are diets with a greater environmental impact less healthy? This is a key question for nutrition policy, but previous research does not provide a clear answer. To address this, our objective here was to test whether American diets with the highest carbon footprints predicted greater population-level mortality from diet-related chronic disease than those with the lowest. DESIGN: Baseline dietary recall data were combined with a database of greenhouse gases emitted in the production of foods to estimate a carbon footprint for each diet. Diets were ranked on their carbon footprints and those in the highest and lowest quintiles were studied here. Preventable Risk Integrated Model (PRIME), an epidemiological modelling software, was used to assess CVD and cancer mortality for a simulated dietary change from the highest to the lowest impact diets. The diet-mortality relationships used by PRIME came from published meta-analyses of randomised controlled trials and prospective cohort studies. SETTING: USA. PARTICIPANTS: Baseline diets came from adults (n 12 865) in the nationally representative 2005-2010 National Health and Nutrition Examination Survey. RESULTS: A simulated change at the population level from the highest to the lowest carbon footprint diets resulted in 23 739 (95 % CI 20 349, 27 065) fewer annual deaths from CVD and cancer. This represents a 1·83 % (95 % CI 1·57 %, 2·08 %) decrease in total deaths. About 95 % of deaths averted were from CVD. CONCLUSIONS: Diets with the highest carbon footprints were associated with a greater risk of mortality than the lowest, suggesting that dietary guidance could incorporate sustainability information to reinforce health messaging.

Flexor Hallucis Longus Tenolysis and Tenosynovectomy in Dancers.

The purpose of this study was to report on a series of dancers who had undergone flexor hallucis longus (FHL) tenolysis/tenosynovectomy after having failed conservative management. Institutional human subjects committee approval was obtained prior to initiating this study. This study is a retrospective case series of 58 dancers and 63 ankles who underwent FHL tenolysis/tenosynovectomy via an open posteromedial approach by a single surgeon between 1993 and 2017. All patients were interviewed and charts reviewed. Collected variables included: preoperative and postoperative pain levels, time to return to dance, and subjective satisfaction with the procedure. Age, primary dance form, and level of dance were determined. Mean preoperative pain level decreased significantly postoperatively. Mean time to return to dance was 7.1 weeks. There was a 98% (62/63) return to dance at some level while 97% (61/63) of patients returned to dance symptom-free. There were no neurovascular or other major complications. Minor complications included stiffness at follow-up (6.3%, 4/63), superficial wound infection (3.1%, 2/63), and hypertrophic scar (4.8%, 3/63). Over 97% (61/63) of dancers considered the procedure a success and 98% (62/63) of dancers would repeat the procedure. This is one of the largest series reported of isolated FHL tenolysis/tenosynovectomy in dancers who have failed nonoperative management. Satisfactory pain relief and return to dance with a low complication rate may be expected from this surgical procedure. The results of this study can be used to help dancers and their providers make informed decisions about treatment in isolated FHL tendinitis.

Apoiando a educação em pesquisa dos graduandos de enfermagem / Apoyando la educación para la investigación de los estudiantes de enfermería de pregrado / Sustaining undergraduate nursing students' research education

Resumo Objetivos Descrever a experiência da implementação de um programa de treinamento de assistente de pesquisa voluntário para graduandos canadenses de Enfermagem, objetivando o desenvolvimento de habilidades de comunicação verbal e escrita, métodos de pesquisa e análise de dados, pensamento crítico e resolução de problemas, assim como o planejamento de suas carreiras e o avanço de seus papéis relacionados à pesquisa e às oportunidades administrativas e de liderança. Método Estudo descritivo com relato de experiência sobre o processo de treinamento para um novo papel profissional relativo ao engajamento dos graduandos em 11 oficinas, cada uma com duração de uma hora e o processo de apoiá-los para assumir papéis profissionais e de liderança. Resultados Os graduandos demonstraram comprometimento em todas as fases do treinamento. Destaca-se, ainda, o interesse por assumirem a liderança em atividades práticas que redefinem seu perfil profissional. Essa experiência contribuiu para construir e nutrir relações intelectuais docentes-graduandos. Os graduandos expandiram suas redes profissionais e a relação com o mentor de carreira, estão desenvolvendo suas habilidades práticas e relataram confiança em se candidatar para cargos de assistentes de pesquisa. Conclusão e implicações para a prática O treinamento pode instrumentalizá-los para escolhas de planos de carreira, ingresso no mercado de trabalho e a construção de plano para desenvolvimento profissional. O desejo genuíno dos docentes de Enfermagem, apoiando uma nova geração de enfermeiros, culminou nessa experiência de empoderamento mútuo.

Resumen Objetivos Informar sobre la experiencia de un equipo de profesionales de enfermería y desarrollo profesional en la implementación de un programa de asistente voluntario de investigación para estudiantes universitarios canadienses de pregrado en enfermería con el objetivo de desarrollar la comunicación escrita y verbal, métodos de investigación, análisis de datos, pensamiento crítico y habilidades de resolución de problemas, así como en su planificación y avance profesional para funciones relacionadas con la investigación y oportunidades de empleo administrativo y de liderazgo. Método Un diseño descriptivo con el informe de la experiencia de los investigadores de enfermería y desarrollo profesional sobre el proceso de apoyo para la formación de los estudiantes para un nuevo rol profesional. La experiencia se refiere a 11 talleres que durarán una hora sobre los temas relacionados con la investigación. Resultados Los estudiantes demostraron compromiso con la capacitación. Relevante es su interés en liderar actividades prácticas para redefinir su perfil profesional. Esta experiencia contribuyó a construir y fomentar relaciones significativas e intelectuales entre los profesores y los estudiantes. Los estudiantes amplían sus redes profesionales y obtienen una relación con un mentor de carrera. Conclusión e implicaciones para la práctica La capacitación puede equipar mejor a los estudiantes para elegir trayectorias profesionales, entrar en el mercado laboral y elaborar un plan para el avance profesional. Fue el deseo genuino de los profesores de enfermería de apoyar a una nueva generación de enfermeras que culminó en esta experiencia de empoderamiento mutuo.

Abstract Objective To describe the experience of implementing a research assistant program for Canadian undergraduate nursing students, which aimed to develop written and verbal communication, critical thinking and problem-solving skills, as well as knowledge of various research methods. Engagement in this program was intended to support students' career planning and advancement in research related roles, including administrative and leadership employment opportunities. Method A descriptive design with the report of experience of nursing researchers and career advisers pertaining to: engagement in an 11 one-hour research focused workshop; and the process of supporting students to assume professional and leadership roles. Results Students demonstrated commitment to the training program throughout its phases. They expressed interest in leading practical activities to redefine their professional profile. This experience contributed to building and nurturing intellectual teacher-student relationships. Students are expanding their professional networks and a relationship with a career mentor, while demystifying the research assistant role. Students are developing practical skills and reporting confidence in applying for research assistant positions. Conclusion and Implications for practice Participating in the training program better equips students for choosing their career path, entering the job market, and building a plan for further career advancement. Nursing faculty's genuine desire for and purposeful actions to support a new generation of nurses informed this mutually empowering experience.

Case Report of a Bifid Distal Biceps Tendon with Traumatic Rupture and Subsequent Repair of Short Head Tendon Limb.

Distal biceps tendon ruptures are a topic of great interest in the orthopedic literature with differentiation between complete and partial tears being difficult to recognize. Recent cadaveric and radiologic studies have shown that the muscle maintains two distinct tendons and tendinous insertions. In this clinical case report, we describe the rare case of a patient with a congenitally bifid distal biceps tendon who selectively ruptured a single bundle of the tendon and subsequently underwent surgical repair.

Position of the Society for Nutrition Education and Behavior: The Importance of Including Environmental Sustainability in Dietary Guidance.

It is the position of the Society for Nutrition Education and Behavior that environmental sustainability should be inherent in dietary guidance, whether working with individuals or groups about their dietary choices or in setting national dietary guidance. Improving the nutritional health of a population is a long-term goal that requires ensuring the long-term sustainability of the food system. Current environmental trends, including those related to climate change, biodiversity loss, land degradation, water shortages, and water pollution, threaten long-term food security and are caused in part by current diets and agricultural practices. Addressing these problems while producing more food for a growing population will require changes to current food systems. Dietary choices have a significant role in contributing to environmental impacts, which could be lessened by consuming fewer overconsumed animal products and more plant-based foods while reducing excess energy intake and the amount of food wasted. Discussion of sustainability within governmental dietary guidance is common in many countries, is consistent with previous US guidelines, and is within the scope of authorizing legislation. Dietary choices are a personal matter, but many American consumers are motivated by a concern for the environment and would welcome sound advice from credentialed nutrition professionals. More opportunities are needed for developing such interdisciplinary knowledge among nutritionists.

Greenhouse gas emissions and energy use associated with production of individual self-selected US diets.

Human food systems are a key contributor to climate change and other environmental concerns. While the environmental impacts of diets have been evaluated at the aggregate level, few studies, and none for the US, have focused on individual self-selected diets. Such work is essential for estimating a distribution of impacts, which, in turn, is key to recommending policies for driving consumer demand towards lower environmental impacts. To estimate the impact of US dietary choices on greenhouse gas emissions (GHGE) and energy demand, we built a food impacts database from an exhaustive review of food life cycle assessment (LCA) studies and linked it to over 6000 as-consumed foods and dishes from 1 day dietary recall data on adults (N = 16 800) in the nationally representative 2005-2010 National Health and Nutrition Examination Survey. Food production impacts of US self-selected diets averaged 4.7 kg CO2 eq. person-1 day-1 (95% CI: 4.6-4.8) and 25.2 MJ non-renewable energy demand person-1 day-1 (95% CI: 24.6-25.8). As has been observed previously, meats and dairy contribute the most to GHGE and energy demand of US diets; however, beverages also emerge in this study as a notable contributor. Although linking impacts to diets required the use of many substitutions for foods with no available LCA studies, such proxy substitutions accounted for only 3% of diet-level GHGE. Variability across LCA studies introduced a ±19% range on the mean diet GHGE, but much of this variability is expected to be due to differences in food production locations and practices that can not currently be traced to individual dietary choices. When ranked by GHGE, diets from the top quintile accounted for 7.9 times the GHGE as those from the bottom quintile of diets. Our analyses highlight the importance of utilizing individual dietary behaviors rather than just population means when considering diet shift scenarios.

Os Trigonum Excision in Dancers via an Open Posteromedial Approach.

BACKGROUND: An os trigonum is a potential source of posterior ankle pain in dancers, often associated with flexor hallucis longus (FHL) pathology. Options for operative excision include open excision, subtalar arthroscopy, and posterior endoscopy. The purpose of this paper was to present a series of dancers who underwent excision of a symptomatic os trigonum via an open posteromedial approach. METHODS: This study is a retrospective case series of 40 ankles in 38 dancers who underwent os trigonum excision via an open posteromedial approach with FHL tenolysis between 2000 and 2013. All patients were interviewed and charts retrospectively analyzed. Collected variables included pre- and postoperative pain level, time to return to dance, and subjective satisfaction. The average age was 19.2 years; ballet was the primary dance form in 36 (95%) of patient-cases. Eight (20%) of the patient-cases were professional dancers, and 30 (75%) were students or preprofessional dancers. RESULTS: Average preoperative pain level was 7.7/10, which decreased to 0.6/10 postoperatively. Seventeen (42.5%) experienced concurrent preoperation-associated FHL symptomatology, all of whom experienced relief postoperatively. The average time to return to dance was 7.9 weeks, and time to pain-free dance was 17.7 weeks. Of the 37 patient-cases desiring to return to dance, 35 (94.6%) returned to their preoperative level of dance. There were no neurovascular or other major complications. Four (10%) had minor wound complications that resolved, and 38 cases (95%) considered the procedure a success. CONCLUSION: Open posteromedial excision of an os trigonum in dancers provided satisfactory pain relief, return to dance, and complication rates compared to other approaches, and allowed for identifying and treating any associated FHL pathology. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Cardiovascular risk factors and physical activity behavior among elementary school personnel: baseline results from the ACTION! worksite wellness program.

BACKGROUND: Although the prevalence of obesity is increasing during adulthood, there have been few assessments of obesity, cardiovascular risk factors, and levels of physical activity among adult elementary school staff. METHODS: Data were collected from 745 African-American and White female school personnel in a suburban school district in southeastern Louisiana as part of the baseline assessment before implementation of a program to improve eating and physical activity behaviors. Anthropometry, blood pressure, serum lipids and lipoproteins, and glucose were measured using established protocols. Physical activity was assessed by accelerometry. RESULTS: For both White and Black females, 30% were overweight (body mass index [BMI]) ≥25 kg/m(2) but <30 kg/m(2) ). Whereas 37% of White females were obese (BMI ≥ 30 kg/m(2) ), 61% of the Black females were obese. There was a positive association between BMI and other cardiovascular risk factors except for high-density lipoprotein cholesterol, where the association was negative. The mean number of minutes of daily moderate-to-vigorous physical activity was <1 minute per day and was lower for overweight and obese women than for normal weight women. CONCLUSIONS: School personnel in the study have adverse cardiovascular risk factors, including high rates of obesity and very low levels of physical activity. Because these individuals are often called upon to promote health for children, they are an important target population for wellness interventions.

Myositis ossificans within the intercondylar notch treated arthroscopically.

We present a case of intraarticular myositis ossificans in the right knee of a child. Myositis ossificans (MO), though relatively rare in childhood and even more uncommon within a joint, should be included in the differential diagnosis of an intra-articular mass when indicated by the typical clinical, radiographic, and histologic findings. An 11-year-old male presented with a history of trauma to his right knee. Four weeks after the initial injury, an MRI demonstrated evidence of an ACL rupture with a "cystic mass" within the intercondylar notch along the anterior surface of the torn ligament. At subsequent arthroscopy, the mass noted on MRI was removed. The histology was consistent with MO. The authors believe this to be the first case of MO in the intercondylar notch detected by MRI, treated by arthroscopy, and confirmed by histology.

MR imaging of complications of anterior cruciate ligament graft reconstruction.

During the past 3 decades, graft reconstruction of the anterior cruciate ligament (ACL) has become an accepted treatment for symptomatic ACL deficiency. The goal of surgery is to prevent joint instability, which may further damage articular cartilage and menisci. Graft failure is defined as pathologic laxity of the reconstructed ACL. The prevalence of recurrent instability after primary ACL reconstruction ranges from 1% to 8%. Early failures, those that occur within the first 6 months, often are secondary to poor surgical technique, failure of graft incorporation, or errors in rehabilitation. Late failures, those that occur more than 1 year after surgery, likely are related to new trauma and graft tearing. Other complications of ACL reconstruction include roof impingement, postoperative stiffness, tunnel widening due to cyst formation, iliotibial band friction syndrome, hardware failure, and infection. Magnetic resonance imaging is the preferred advanced imaging modality for the evaluation of symptomatic ACL graft reconstructions.

Surgical treatment of refractory tibial stress fractures in elite dancers: a case series.

BACKGROUND: Treatment of tibial stress fractures in elite dancers is centered on rest and activity modification. Surgical intervention in refractory cases has important implications affecting the dancers' careers. HYPOTHESIS: Refractory tibial stress fractures in dancers can be treated successfully with drilling and bone grafting or intramedullary nailing. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 1992 and 2006, 1757 dancers were evaluated at a dance medicine clinic; 24 dancers (1.4%) had 31 tibial stress fractures. Of that subset, 7 (29.2%) elite dancers with 8 tibial stress fractures were treated operatively with either intramedullary nailing or drilling and bone grafting. Six of the patients were followed up closely until they were able to return to dance. One patient was available only for follow-up phone interview. Data concerning their preoperative treatment regimens, operative procedures, clinical union, radiographic union, and time until return to dance were recorded and analyzed. RESULTS: The mean age of the surgical patients at the time of stress fracture was 22.6 years. The mean duration of preoperative symptoms before surgical intervention was 25.8 months. Four of the dancers were male and 3 were female. All had failed nonoperative treatment regimens. Five patients (5 tibias) underwent drilling and bone grafting of the lesion, and 2 patients (3 tibias) with completed fractures or multiple refractory stress fractures underwent intramedullary nailing. Clinical union was achieved at a mean of 6 weeks and radiographic union at 5.1 months. Return to full dance activity was at an average of 6.5 months postoperatively. CONCLUSION: Surgical intervention for tibial stress fractures in dancers who have not responded to nonoperative management allowed for resolution of symptoms and return to dancing with minimal morbidity.

Interventions to reduce household food insecurity: a synthesis of current concepts and approaches for Latin America / Intervenções para reduzir a insegurança alimentar: uma síntese dos atuais conceitos e abordagens para a América Latina

Food insecurity has been documented in countries throughout the range of national incomes. Most Latin American countries, including Brazil, fall in the middle of this range. Although responses to problems of food insecurity need to be developed for specific contexts, valuable lessons for successful interventions can be learned from both low- and high-income countries. This article begins by describing a continuum of country-level food security contexts. The basic elements of food security, including food availability, access, and utilization, are reviewed as are more recent developments in the field, including livelihood analysis, vulnerability, and risk management strategies. A selection of public sector food security interventions is described that focus on improving agricultural production, increasing employment and household income, developing human capital, and distributing food. Recent international experiences and insights are used to develop themes for orientation of these types of food security interventions in Latin America. These include: the importance of planning relief efforts to be synergistic with long-run development; the tailoring of interventions to the needs of specific contexts; and the related expansion of information systems to support these activities. The article also describes the need to improve food security without leading to over-consumption, a problem of increasing concern in Latin America and elsewhere. Finally, development of local capacity through community-based participatory actions is suggested as a means for improving program outcomes as well as promoting human rights.

A insegurança alimentar tem sido documentada em países de toda a gama de rendas nacionais, desde os países de mais baixa até os de mais alta renda. A maioria dos países latino-americanos, incluindo o Brasil, está no meio deste espectro. Embora as ações direcionadas aos problemas de insegurança alimentar precisem ser desenvolvidas de acordo com contextos específicos, lições valiosas para o êxito das intervenções podem ser aprendidas das experiências dos países de baixa e de alta renda. Este artigo descreve a segurança alimentar nos diferentes contextos nacionais. Os elementos básicos de segurança alimentar, incluindo a disponibilidade de alimentos, o acesso e a utilização são revisados, assim como os desenvolvimentos mais recentes na área, incluindo análises de subsistência, vulnerabilidade e estratégias de gestão de risco. É apresentada uma seleção das intervenções do sector público de segurança alimentar, que se destinam a melhorar a produção agrícola, a aumentar o nível de emprego e da renda familiar, ao desenvolvimento do capital humano e à distribuição de alimentos. Experiências internacionais recentes são utilizadas com o intuito de desenvolver temas para orientação desses tipos de intervenções de segurança alimentar na América Latina. Dentre as quais, se inclui: a importância de que os projetos de auxílio estejam em sinergia com o desenvolvimento em longo prazo, a adaptação das intervenções às necessidades dos contextos específicos e a expansão dos sistemas de informação para apoiar estas atividades. O artigo também descreve a necessidade de melhorar a segurança alimentar sem levar a um excesso de consumo, um problema cada vez mais preocupante, tanto na América Latina como em outros lugares. Finalmente, o desenvolvimento das capacidades locais a partir de ações comunitárias participativas é sugerido, como um meio para melhorar os resultados dos programas assim como assegurar os direitos humanos.

Spontaneous regression of langerhans cell histiocytosis in a neonate with multiple bony lesions.

We report the case of a newborn with Langerhans cell histiocytosis involving the skin and multiple bones. All lesions resolved without therapy. This case underscores the benefits of a conservative approach in the absence of risk organ involvement.

Arthroscopic treatment of anterior ankle impingement syndrome in dancers.

BACKGROUND: The purpose of this study was to evaluate the results of arthroscopic treatment of anterior bony and soft-tissue impingement of the ankle in elite dancers. METHODS: The study is a case series retrospectively reviewed. In the period between 1990 and 1999, 11 elite dancers (12 ankles) had ankle arthroscopy after a diagnosis of anterior ankle impingement that markedly interfered with their dancing. Initial nonoperative treatment failed in all subjects. Previous ankle trauma was noted in all subjects. There were seven women and four men (average age 28 years). Tibiotalar exostoses were radiographically noted in six ankles. Standard anteromedial and anterolateral arthroscopic portals and instrumentation were used for resection of bone spurs and debridement of impinging soft tissues. Patients were nonweightbearing for 5 days after surgery and had postoperative physiotherapy. RESULTS: Nine dancers returned to full dance activity at an average of 7 weeks after surgery. One patient did not return to dance performance because of concurrent unrelated orthopaedic problems, but he resumed work as a dance teacher; he developed a recurrent anterior tibial spur that was successfully resected at a second arthroscopy 9 years later. Another dancer developed postoperative scar-tissue impingement and stiffness; she had a repeat arthroscopy 4 months after the initial procedure and subsequently returned to dance performance. All patients eventually had marked postoperative improvement in pain relief and dance performance. CONCLUSIONS: Arthroscopic debridement is an effective method for the treatment of bony and soft-tissue anterior ankle impingement syndrome in dancers and has minimal morbidity.

Anterior cruciate ligament radiofrequency thermal shrinkage: a short-term follow-up.

PURPOSE: To review the results of 34 patients who underwent radiofrequency thermal shrinkage (RFTS) for treatment of anterior cruciate ligament (ACL) laxity in the attenuated and partially torn ACL. TYPE OF STUDY: Retrospective cross-sectional survey performed at least 6 months after treatment. METHODS: Patients with recurrent instability after attenuation of ACL autografts and partially torn ACLs were treated with RFTS. Follow-up included subjective questionnaires (International Knee Documentation Committee [IKDC], Tegner, and Lysholm) and objective clinical tests (IKDC, KT-1000, pivot-shift, Lachman, single-leg hop). RESULTS: Mean follow-up was 21.4 months. Based on IKDC and subjective evaluation, 18 of 20 (90%) partially torn ACLs and 10 of 14 reconstructed ACLs (71%) treated with RTFS were judged to have good or excellent knee function (overall 82%). ACL laxity based on KT-1000 was less successful, with 15 of 20 (75%) partially torn ACLs and 8 of 12 (66%) reconstructed ACLs considered successful. CONCLUSIONS: With no major complications in this study, we conclude that RFTS for treatment of ACL laxity is a well-tolerated procedure with success rates around 71% to 90% in selected patients. RFTS may be offered as a less-extensive alternative to patients being considered for ACL reconstruction who have either attenuated or partially torn ligaments, especially in the athletically low-demand population. LEVEL OF EVIDENCE: Level IV, case series.