Objectively Measured Adherence in Adolescents With Type 1 Diabetes on Multiple Daily Injections and Insulin Pump Therapy.

Objectives: Type 1 diabetes (T1D) poses unique challenges to adherence-related behavior because of complex treatment regimens that vary by use of specific technologies. This study used objective data to determine (1) prevalence rates of adherence behaviors in adolescents with T1D, and (2) relationships between adherence and glycemic control. Methods: Data were downloaded for the past 30 consecutive days from glucose meters and multiple insulin pump models for 80 youth (11-17 years old; n = 40 on multiple daily injections (MDIs) and n = 40 on continuous subcutaneous insulin infusion [CSII]). Frequency of self-monitoring of blood glucose (SMBG; MDI and CSII users); carbohydrate entry (CSII users); daily insulin bolus delivery (CSII users); episodes of high, very high, and dangerously high hyperglycemia; and correction bolusing for hyperglycemia (CSII users) were calculated. Results: Participants completed SMBG ≥4 times/day on 46.13% of days (MDI users), 48.74% of days (CSII users nonmanual entries only), and 59.07% of days (CSII users; manual plus nonmanual entries). CSII users entered carbohydrates ≥3 times/day on 61.47% of days and bloused insulin ≥3 times/ day on 87.34% of days. Hyperglycemic readings were followed by a correction bolus in <70% of cases. Greater SMBG, carbohydrate entry, bolus insulin delivery, and correction bolusing for high and very high hyperglycemia predicted lower glycated hemoglobin (sample M = 8.74%, SD = 1.75%). Conclusions: Objective data from diabetes technology are helpful to differentiate adherence to specific domains of treatment but are complex in nature. Findings support a need for further research to elucidate predictive factors of suboptimal adherence in adolescents with T1D.

Qualitative and quantitative return-to-sport test battery and second anterior cruciate ligament injury risk factors.

Objective: To determine risk factors for second anterior cruciate ligament (ACL) injury following primary ACL reconstruction (ACLR) using return-to-sport (RTS) tests consisting of qualitative and quantitative measures in young athletes. Methods: A case-control study design was used, and a retrospective review of adolescent athletes after primary ACLR was performed. All athletes completed an RTS test consisting of qualitative and quantitative assessments and psychological assessments with the Tampa Scale of Kinesiophobia. Athlete demographics, surgical characteristics and sports participation were also examined. A binary logistic regression was performed to verify an independent association between risk factors and second ACL injury using adjusted OR (aORs), 95% CI and p<0.05. Results: In 72 eligible athletes, 12 (16.7%) suffered a second ACL injury. The mean Tegner activity level was 8.4+1.1, and the mean time from ACLR to RTS test completion was 10.4+2.9 months. One variable that showed the lowest p-value in the preliminary analysis was entered into the binary logistic regression model, which resulted in that qualitative assessment of knee valgus during the sidestep cut was associated with second ACL injury (aOR=4.64, 95% CI: 1.18 to 18.23, p=0.03). Conclusion: Athletes who demonstrated excessive dynamic knee valgus on the involved limb during the sidestep cut were approximately 4.6 times more likely to suffer a second ACL injury.

Current evidence on mesenchymal stem cells for hip osteoarthritis: a narrative review.

There are limited data on the use of mesenchymal stem cell injections for hip osteoarthritis. The goal of this study was to evaluate the literature by analyzing outcomes and comparing methodologies. Online search of PubMed, SportsDiscus and Case Reports Keywords was completed using the keywords 'stem cells' and 'hip' and 'osteoarthritis'. Six studies met the inclusion and exclusion criteria. Five out the six studies had statistically significant improvement in patient reported outcomes after mesenchymal stem cell injections. Only two studies provided information on radiological changes and findings were positive. None of the studies reported major complications. Small series of non-randomized controlled trials completed to date in the use of mesenchymal stem cells for the treatment of hip osteoarthritis reported the procedures to be safe and provide a positive clinical response. Randomized controlled trials must be performed to further confirm mesenchymal stem cells as a treatment option for hip osteoarthritis.

A Case of Proximal Humerus Fracture Dislocation Presenting With Failed Primary Open Reduction and Internal Fixation Followed by Salvage Reverse Total Shoulder Arthroplasty.

The treatment of proximal humerus fractures is complex. Factors like fracture pattern, patient age, pre-injury activity level, soft tissue status, and comorbidities play a role in decision-making for non-operative versus operative management. Complications of non-operative vs operative management of proximal humerus fractures include but are not limited to arthrofibrosis, fracture nonunion, and avascular necrosis. We report an unusual case of a 64-year-old female presenting with a three-part proximal humerus fracture dislocation. The patient underwent primary open reduction internal fixation. Twenty-four weeks after open reduction and internal fixation, the patient experienced collapse of the humeral head with intraarticular hardware migration, and she underwent hardware removal. Fifty-two weeks after hardware removal, the patient experienced avascular necrosis of the humeral head, and she underwent salvage reverse total shoulder arthroplasty. There is debate in the current literature on the best management of multi-part proximal humerus fracture-dislocations.