Anatomy of the Lateral Antebrachial Cutaneous Nerve: Landmarks for Procedures in the Cubital Fossa.

PURPOSE: The research outlines anatomical landmarks that may help surgeons in identifying the lateral antebrachial cutaneous nerve (LABCN) to minimize nerve damage during procedures in the cubital fossa. METHODS: Twenty-eight fresh cadaveric upper extremities were dissected. The course of the LABCN was followed from the emerging point at the biceps brachii tendon (BT) to the mid-forearm. The nerve's relationships with the BT, lateral epicondyle (LE), antebrachial vein, and brachioradialis (BR) muscle were measured and documented. RESULTS: The LABCN emerged lateral to the BT in all specimens and crossed medially at the top of the BT in 50% of the cadavers. It was deep to the forearm superficial fascia in all cadavers. At the level of the LE, the nerve was located at a mean of 6.3 ± 3.1 mm medial to the BR. The LABCN aligns with the medial border of the BR at a mean of 68 mm distal to the interepicondylar line. The mean distance from the LE to the LABCN at the interepicondylar line was 24.5 ± 7.2 mm. The LABCN and antebrachial vein are in the same deep fascia plane, on average 47.6 ± 5 mm (37-55) from the LE. At the elbow joint level, 82.1% of the specimens have two branches for the LABCN, whereas 17.9% demonstrated only a single branch. CONCLUSIONS: Lateral antebrachial cutaneous nerve was situated approximately 6.8 cm distal to the interepicondyle line, positioned at the ulnar edge of the BR, and runs parallel with the antebrachial vein deep to the forearm fascia plane. The nerve crossed over the biceps tendon in 50% of the specimens. These findings suggest that the nerve should be identified 6-7 cm distal to the LE, followed by a proximal dissection. CLINICAL RELEVANCE: This study may help surgeons in identifying LABCN, and reducing the potential risk of LABCN injury.

Conjoint tendon lengthening improves internal rotation following reverse total shoulder arthroplasty: a cadaveric study.

BACKGROUND: Reverse shoulder arthroplasty (RSA) is a common procedure for treating a variety of shoulder pathologies. However, many patients struggle with postoperative internal rotation (IR) deficits, which often hinder their activities of daily living. The conjoint tendon provides an anatomic barrier that can impede the postoperative IR of the shoulder, and this study aims to evaluate the effect of a conjoint tendon lengthening on the glenohumeral range of motion (ROM) following RSA. METHODS: This study used ten fresh-frozen cadaver specimens of the upper extremity. An RSA was implanted using a standard deltopectoral approach, and the ROM was assessed postimplantation. Following this, the conjoint tendon was identified and lengthened using a tendon sheath z-plasty, and the ROM was rerecorded. Statistical significance for the ROM gains after conjoint tendon lengthening was determined with a significance level of P < .05. RESULTS: Following the lengthening of the conjoint tendon, there were statistically significant improvements in all ROMs (P < .05). Subjects demonstrated a notable gain in IR to the back by 10.3 cm (P < .01), and all ROMs increased by at least 10°, except for forward flexion, which increased by 6° (P < .001). CONCLUSIONS: This study suggests that lengthening the conjoint tendon improves postoperative ROM of the glenohumeral joint after RSA, offering a potential solution to considerable IR deficits that are commonly encountered post-RSA. Subsequent clinical and biomechanical studies should assess the stability of the shoulder joint following conjoint tendon lengthening.

Eighteen-year outcome of anterior cruciate ligament reconstruction with patellar tendon or hamstring autograft.

PURPOSE: To evaluate patient reported outcomes and radiographic arthritic changes of transtibial anterior cruciate ligament reconstruction (ACLR) with either bone-patellar tendon-bone (BPTB) or hamstrings (HS) auto-grafts at a minimum of 15-year follow-up. METHODS: Ninety-four patients (51 of the HS group, 43 of BPTB group) who were operated between the years 2000 to 2005 in two tertiary referral hospitals were contacted and invited to a retrospective evaluation. The interview included subjective outcomes using the Lysholm knee scoring questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Tegner activity level scale, Visual Analogue Scale (VAS) for pain and patients' satisfaction scale. Knee examination included measurements of motion and stability. Knee radiographs were evaluated for osteoarthritic changes according to the Kellgren-Lawrence (KL) score. RESULTS: The average evaluation time from surgery was 18.6 years. Subjectively, there was no significant difference between groups except for a better post-operative level of activity and satisfaction in the HS group. Objectively, there was no significant difference between groups in knee stability and range of motion. Most patients had grade KL ≤ 1 radiographic osteoarthritits changes and there was no significant difference between groups. Recurrent complete tear of the reconstructed graft occurred in 3 patients of each group. In both groups 84% had no further surgery while the indications for further surgery were mostly a meniscal tear or tibial hardware removal. CONCLUSIONS: Very long-term outcomes and clinical stability of transtibial HS or BPTB graft ACL reconstruction are good with low rate of graft failure and radiographic osteoarthritis.

Foot Surgery Using Resorbable Magnesium Screws.

The use of bioabsorbable magnesium (Mg) screws is new in foot surgery. Their relative merit over conventional titanium screws has not yet been proven. This prospective case series study was conducted to compare the clinical and radiological outcomes of bioabsorbable Mg screws and titanium screws. A consecutive series of patients (n = 60; 11 men and 49 women) underwent corrective hallux valgus surgery. The minimum follow-up period was 1 year. The assessment was based on a patient questionnaire, including the American Orthopedic Foot and Ankle Society (AOFAS) hallux valgus score, visual analog scale, patient's global impression of change (PGIC), and fifth metatarsus circumference (IF5C). The radiographic assessment included the intermetatarsal and hallux valgus angles, as well as time to osteotomy union and hardware failure. At 1 year, similar results were obtained radiographically. The healing of the osteotomies was significantly faster in the Mg group. Hardware failure was common in the Mg group (5/26) than in the TI group (0/34) but hardware removal was more common in the TI group (6/34) versus the MG group (0/26). IF5C increased by 8 ± 2 mm in the Mg group. The AOFAS and PGIC scores at 6 months were similar. Validated foot scores and radiographic analysis indicated that there was no detectable difference between the groups. The fast achievement of osteotomy union compensates for a high rate of hardware failure, resulting in patient satisfaction and avoiding reoperation for hardware removal.

Epidemiology of Primary Shoulder Dislocations. A Cohort Study from a Large Health Maintenance Organization: 2004 to 2019.

BACKGROUND: Previous epidemiological studies on shoulder instability evaluated specific and relatively small subgroups of patients. OBJECTIVES: To determine the incidence rate of primary shoulder dislocations. METHODS: Cohort analysis of electronic health records from 2004 to 2019 was conducted in a urban district of a major health maintenance organization (HMO) in Israel. Patients presented with primary shoulder dislocation that was treated with closed reduction in any medical facility within the district. Overall incidence density rates (IDR) of primary shoulder dislocations and stabilization surgeries were determined. RESULTS: Over a period of 16 years 13,158 patients underwent closed reduction of primary shoulder dislocation. Of those, 712 shoulder stabilization surgeries were performed (5%). The IDR of primary shoulder dislocations were 124 per 100,000 person-years. The IDR of primary shoulder stabilizations were 7 per 100,000 person-years. The peak in the number of dislocations was observed in those 20-29 years old and ≥ 60 years of. In patients under 59 years old, dislocations were more common in men. In those ≥ 60 years of age, dislocations were more common in women. Most shoulder stabilization surgeries were performed on young patients. The annual mean time from the first dislocation to stabilization surgery linearly declined to 6 months in 2019. CONCLUSIONS: The IDR of primary shoulder dislocations calculated from the largest HMO in Israel were 124 per 100,000 person-years. Shoulder dislocations had bimodal age distribution. Overall, 5% of the patients (mainly young) with shoulder dislocations underwent shoulder stabilization surgery during the study period.

Mild radiographic osteoarthritis is associated with increased pain and dissatisfaction following total knee arthroplasty when compared with severe osteoarthritis: a systematic review and meta-analysis.

PURPOSE: The association between severity of radiographic osteoarthritis with patient pain, function, and satisfaction following total knee arthroplasty has been disputed. The discrepancies in current literature prompt us to further examine this association in a systematic review and meta-analysis. METHODS: The OVID-Medline, Embase, and Web of Science databases were searched from their inception up to Mar 2020. The main independent variable was osteoarthritis severity as defined by preoperative radiographs. The outcomes measured were pain, function and satisfaction following total knee arthroplasty. A minimum of three studies assessing the same patient-reported outcome measures were included in the meta-analysis, as well as those separating patients by chronic pain or dissatisfaction. RESULTS: 29 studies were included in this study. Significant heterogeneity was seen between radiographic evaluation and reported outcomes. Patients with only mild radiographic osteoarthritis were more likely to suffer from chronic pain (odds ratio = 2.45, 95% CI = 1.80-3.34, p < 0.001) and dissatisfaction (odds ratio = 2.43, 95% CI = 1.79-3.31, p < 0.001) compared to patients with severe osteoarthritis. A significant association was found between mild radiographic severity and lower total Western Ontario and McMaster Universities Osteoarthritis scores (95% CI = - 0.37-0.06, p = 0.006) as well as Knee Society Scores (CI: - 0.54-0.16, p < 0.001). CONCLUSION: Patients with mild radiographic osteoarthritis are anticipated to gain less from total knee arthroplasty compared to those with severe osteoarthritis. They are also at risk for chronic pain and dissatisfaction and should be consulted about this risk prior to surgery. LEVEL OF EVIDENCE: III.

Preoperative pain sensitivity questionnaire helps customize pain management after arthroscopic partial meniscectomy.

PURPOSE: To evaluate correlations between preoperative pain sensitivity and postoperative analgesic consumption together with pain perception shortly after arthroscopic partial meniscectomy in non-arthritic knees. METHODS: Ninety-nine patients who underwent primary arthroscopic meniscectomy were prospectively divided into three postoperative treatment groups that were prescribed with betamethasone injection (at the end of surgery), oral celecoxib or rescue analgesia (control). Preoperative pain sensitivity was evaluated by pain sensitivity questionnaires (PSQ). Patients were followed for the first three postoperative weeks to evaluate knee injury and osteoarthritis outcome score (KOOS) pain scores and analgesics consumption. Statistical analysis included correlations among preoperative pain sensitivity, postoperative pain levels and analgesics consumption. A receiver operating characteristic curve was plotted to investigate the cutoff values of the PSQ score to predict insufficient postoperative pain reduction. RESULTS: There were no differences at baseline among all study groups in age, sex, BMI, level of activity, comorbidities and surgical findings. At the final follow-up, KOOS pain scores improved in all groups (p < 0.001). Mean final KOOS pain scores were 76.1 ± 15.2 for the betamethasone group, 70.8 ± 12.6 for the celecoxib group and 78.7 ± 11.6 for the control group. No differences in scores were observed among groups (n.s.). In the control group, a negative correlation was observed between PSQ score and KOOS-pain scores at the end of the follow-up in addition to a positive correlation between PSQ score and rescue analgesia consumption at the first postoperative week. The optimal cutoff value for PSQ score to predict insufficient improvement in KOOS-pain subscale was 5.0 points. CONCLUSIONS: A cutoff value of pain sensitivity questionnaire score above 5.0 points was determined to identify patients with higher sensitivity to pain who underwent arthroscopic partial meniscectomy. These patients reported relatively increased pain and consumed more rescue analgesics postoperatively unless treated with a single intraoperative corticosteroids injection or oral non-steroidal anti-inflammatories. Therefore, surgeons can use pain sensitivity questionnaire score as a preoperative tool to identify patients with high sensitivity to pain and customize their postoperative analgesics protocol to better fit their pain levels. LEVEL OF EVIDENCE: II.

Morphological and Histological Changes in the Human Anterior Cruciate Ligament after Rupture.

BACKGROUND: Injuries to the anterior cruciate ligament (ACL) are common and complete tears often fail to heal. ACL reconstruction is considered the surgical gold standard of care for ACL injuries in young active patients. OBJECTIVES: To determine the corresponding morphological and histological features of the torn ACL in different time periods after injury. METHODS: The study included 28 remnant specimens of torn ACLs from patients who had ACL reconstruction surgery of the knee. The remnant pathology was evaluated by its morphology during arthroscopy and by histopathologic measurements. RESULTS: At surgery there were three progressive and distinct morphological tear patterns. The first pattern was noticed within the first 3 months from injury and showed no scar tissue. The second pattern appeared later and was characterized by the appearance of scar tissue with adhesion to the femoral wall. The third pattern was characterized by adhesion of the ACL remnant to the posterior cruciate ligament. The histological changes of the first morphological pattern showed abundance of blood vessels and lymphocytes at the torn femoral end with few irregular collagen fibers. The second and third tear patterns showed decrement in the number of blood vessels and lymphocytes with longitudinally oriented collagen fibers. CONCLUSIONS: The morphological features of the ACL remnant in the first 3 months after injury showed no scar tissue and its histological features had the characteristics of a reparative phase. This phase was followed by a prolonged remodeling phase that ended with attachment of the remnant to the posterior cruciate ligament.

Percutaneous surgery of the forefoot compared with open technique - Functional results, complications and patient satisfaction.

BACKGROUND: The use of percutaneous surgery is currently very common in foot and ankle surgery. The following prospective open-label patient-preference based study compares the traditional open technique versus the percutaneous surgery technique. METHODS: The current study describes the results of 287 patients operated due to forefoot deformities either by open surgery or percutaneously. 96 of them underwent hallux valgus corrective surgery. The rest had lesser toe deformities. They were followed for a period of up to 24 months, to assess the surgery related pain, complications, and patient satisfaction. 112 patients were operated using a conventional open technique were compared to 175 patients treated using a percutaneous technique. Technique choice was left to the patient preference, though older patients with disturbed blood flow, were advised to undergo percutaneous surgery. RESULTS: There is less pain using the percutaneous techniques relative to the open technique during the first 6 post-operative weeks. The 6, and 24 months FAOS score is similar in both groups. Complications are rare in any of the groups, with a significantly higher ASEPSIS score in the open surgery group. CONDCLUSIONS: Percutaneous forefoot surgery appears safe and efficacious, demonstrating equal radiographic (in a 96 strong cohort of hallux valgus patients) and clinical results at six and 24 months. Due to less post-operative pain, and less infection risk it appears that percutaneous techniques are superior to open technique in some respects of treatment and indeed the PGIC of patients was significantly higher in this group.

Effect of adding medical cannabis to analgesic treatment in patients with low back pain related to fibromyalgia: an observational cross-over single centre study.

OBJECTIVES: Low back pain (LBP) occurs in many patients with fibromyalgia (FM). The current study aimed to assess the possible pain and function amelioration associated with medical cannabis therapy (MCT) in this setting. METHODS: 31 patients were involved in an observational cross-over study. The patients were screened, treated with 3 months of standardised analgesic therapy (SAT): 5 mg of oxycodone hydrochloride equivalent to 4.5 mg oxycodone and 2.5 mg naloxone hydrochloride twice a day and duloxetine 30 mg once a day. Following 3 months of this therapy, the patients could opt for MCT and were treated for a minimum of 6 months. Patient reported outcomes (PRO's) included: FIQR, VAS, ODI and SF-12 and lumbar range of motion (ROM) was recorded using the modified Schober test. RESULTS: While SAT led to minor improvement as compared with baseline status, the addition of MCT allowed a significantly higher improvement in all PRO's at 3 months after initiation of MCT and the improvement was maintained at 6 months. ROM improved after 3 months of MCT and continued to improve at 6 months. CONCLUSIONS: This observational cross-over study demonstrates an advantage of MCT in FM patients with LBP as compared with SAT. Further randomised clinical trial studies should assess whether these results can be generalised to the FM population at large.

The detached stump of the torn anterior cruciate ligament adheres to the femoral notch wall and then to the posterior cruciate ligament within 6 months from injury.

PURPOSE: To evaluate the progressive changes in the morphology of traumatic ruptures of the anterior cruciate ligament (ACL) over time. A secondary objective was evaluating their correlation with meniscal tears or chondral lesions. METHODS: The study included one hundred and one patients who underwent ACL reconstruction surgery of the knee after a definite date of injury. The torn ACL remnant morphological pattern was assessed and classified during arthroscopy. A correlation analysis was performed between the pathological features of the remnant and the time length from injury. In addition, correlation between ACL remnant subtypes and meniscal tears or chondral lesions was evaluated. RESULTS: At surgery there were four distinct ACL tear morphological patterns that were correlated to the time span from injury (r = 0.61, p < 0.001) and ended with scarring of the femoral remnant to the posterior cruciate ligament. The early pattern was noticed within median time of 2.6 months from injury and appeared as a separate stump with no scar tissue. The following two patterns appeared within 6 months from injury and were characterized by adhesion of scar tissue to different locations in the femoral notch. The last morphological pattern appeared as adherence of the ACL stump to the posterior cruciate ligament. This pattern was seen in some patients within 6 months from injury but was the dominant pattern later on and was also correlated with meniscal tears. CONCLUSIONS: During the first 3 months from injury the gross morphological features of the torn ACL remnant showed no scar. This phase was followed by scarring of the femoral remnant at first to the femoral notch, and eventually to the posterior cruciate ligament within 6 months from injury and later on. Therefore, further research on the healing potential of the human ACL stump and its biological environment should be focused on the first 3 months from injury. STUDY DESIGN: Case series; Level of evidence, 4.

Arthroscopic rotator cuff surgery following shoulder trauma improves outcome despite additional pathologies and slow recovery.

PURPOSE: To compare the outcome, recovery and surgical findings after shoulder arthroscopy of clinically defined traumatic and non-traumatic rotator cuff pathology in middle-aged patients. METHODS: Of the patients who underwent rotator cuff surgery, 37 patients who reported a preceding shoulder injury related to their shoulder symptoms (traumatic group) were compared to a control group of 58 patients without a preceding injury (non-traumatic group), matched by age, body mass index and comorbidities. Data included demographic details, patient history, surgical findings, the Oxford Shoulder Score questionnaires and overall satisfaction from surgery. RESULTS: The mean follow-up time was 33.2 ± 14.4 months. More concomitant pathologies were found in the study group. The proportion of large and massive supraspinatus tears was double in the study group (43%) compared to the control group (22%). The Oxford Shoulder Score (OSS) improved significantly after surgery in both groups (p < 0.001) with no differences between groups in OSS and overall satisfaction from surgery. Patients in the study group felt recovered at an average time of 6.1 ± 4.6 months from surgery, while patients in the control group felt recovered at 4.2 ± 2.6 months (p = 0.02). Patients who were operated at the first 6 months after the injury had better improvement in OSS than patients who were operated later. CONCLUSION: Surgical arthroscopy for rotator pathology of the shoulder in middle-aged patients improved pain and function regardless of a traumatic onset; however, earlier repair after trauma resulted in better outcome scores. Larger full-thickness tears and concomitant pathologies were more common after injury. STUDY DESIGN: Level III.

[PERCUTANEOUS CORRECTION OF FOREFOOT DEFORMITIES IN DIABETIC PATIENTS IN ORDER TO PREVENT PRESSURE SORES - TECHNIQUE AND RESULTS IN 20 CONSECUTIVE PATIENTS].

INTRODUCTION: Diabetes mellitus is a 21st century pandemic. Due to life-span prolongation combined with the increased rate of diabetes, a growing population of patients is afflicted with neuropathic foot deformities. Traditional operative repair of these deformities is associated with a high complication rate and relatively common infection incidence. In recent years, in order to prevent these complications, percutaneous deformity correction methods were developed. OBJECTIVES: Description of experience accumulated in treating 20 consecutive patients with diabetic neuropathic foot deformities treated in a percutaneous fashion. METHODS: A consecutive series of patients treated at our institute for neuropathic foot deformity was assessed according to a standard protocol using the AOFAS forefoot score and the LUMT score performed at baseline as well as at 6 months and 12 months. Treatment related complications were monitored. RESULTS: All procedures were performed in an ambulatory setting using local anesthesia. A total of 12 patients had soft tissue corrections, and 8 had a combined soft tissue and bone correction. Baseline AOFAS score was 48±7 and improved to 73±9 at six months and 75±7 at one year. LUMT score in 11 patients with a chronic wound decreased from 22±4 to 2±1 at one year post-op. One patient required hospitalization due to post-op bleeding. CONCLUSIONS: Percutaneous techniques allow deformity correction of diabetic feet, including those with open wounds in an ambulatory setting with a low complication rate.

All-polyethylene tibial components are not inferior to metal-backed tibial components in long-term follow-up of knee arthroplasties.

BACKGROUND: All-polyethylene tibias (APT) are under-utilized in most of the Western countries, due to a shift from the original all-polyethylene design to metal-backed tibia (MBT) components. Only few total knee prostheses allow direct comparison between APT and MBT components, due to different geometric designs in many systems. The Depuy PFC Sigma prostheses have a similar geometric design in both the MBT and the APT, and with the same corresponding femoral component, thus allowing an assessment and comparison between APT and MBT components. METHODS: This is a retrospective analysis of a consecutive series of osteoarthritic patients who underwent total knee arthroplasties with at least 10-year follow-up comparing a modern congruent APT component to a modular MBT component of the same design. RESULTS: Seventy-three patients (81 knees, mean age 73 years) were available for assessment. Among the cohort, three patients had revision surgery (one from the APT group). In total, 73 patients were available for follow-up (59 MBT prostheses and 22 APT prostheses). There were no differences in knee function (Knee Society score, range of motion, stability) or radiographic parameters between the groups. Of the three revisions due to tibial tray loosening, only one was performed in the APT group and two were performed in the MBT group; another revision in the MBT group was due to loosening of both components; none of the revisions were due to septic complications. Ten-year survivorship of both designs was 92 %. CONCLUSIONS: While function of both designs appears similar, the APT design shows a trend toward requiring fewer revisions and is more cost-effective.

Assessment of the normal and pathological alignment of the elbow in children using the trochleocapitellar index.

BACKGROUND: The current research is a retrospective study that involves the description of a new trochleocapitellar index (TCI), on basis of anteroposterior (AP) radiographs of normal and fractured paediatric elbows. This index may be useful in assessing the alignment of the elbow with a supracondylar fracture. METHODS: The index was evaluated to define its normal and pathological range in children between the ages of 1-13 years. A total of 212 elbows in 141 children were radiographically evaluated. 70 children without fracture elbows were evaluated by radiographs taken at the time of trauma. 35 children with unilateral fractures that healed in a normal alignment were compared to 33 patients that had a mal-union and three patients with bilateral elbow fractures. The patients were radiographically assessed at the time of fracture as well as after fracture healing as part of a routine clinical assessment. Treatment included observation, cast or internal fixation as needed. RESULTS: The current study establishes that the normal range of the TCI was 0.25-0.8. The average TCI is 0.45. The lower range correlates with a valgus alignment of the elbow while the higher range indicates a neutral alignment. The TCI in fractured elbows that have healed in a clinically normal alignment is different than the contra-lateral elbow's TCI. This might indicate a sub-clinical remaining deformity. CONCLUSIONS: In current practice, paediatric patients with elbow trauma, often undergo bilateral radiographs during emergency room visits. The TCI has high negative and positive predictive values and might be superior to direct angle measurement that is currently in use. The use of the TCI measurement is expected to reduce exposure to irradiation in elbow trauma patients as bilateral comparative films appear to be superfluous when this measurement is used.

Predictive Refined Computational Modeling of ACL Tear Injury Patterns.

Anterior cruciate ligament (ACL) ruptures are prevalent knee injuries, with approximately 200,000 ruptures annually, and treatment costs exceed USD two billion in the United States alone. Typically, the initial detection of ACL tears and anterior tibial laxity (ATL) involves manual assessments like the Lachman test, which examines anterior knee laxity. Partial ACL tears can go unnoticed if they minimally affect knee laxity; however, they will progress to a complete ACL tear requiring surgical treatment. In this study, a computational finite element model (FEM) of the knee joint was generated to investigate the effect of partial ACL tears under the Lachman test (GNRB® testing system) boundary conditions. The ACL was modeled as a hyperelastic composite structure with a refined representation of collagen bundles. Five different tear types (I-V), classified by location and size, were modeled to predict the relationship between tear size, location, and anterior tibial translation (ATT). The results demonstrated different levels of ATT that could not be manually detected. Type I tears demonstrated an almost linear increase in ATT, with the growth in tear size ranging from 3.7 mm to 4.2 mm, from 25% to 85%, respectively. Type II partial tears showed a less linear incline in ATT (3.85, 4.1, and 4.75 mm for 25%, 55%, and 85% partial tears, respectively). Types III, IV, and V maintained a nonlinear trend, with ATTs of 3.85 mm, 4.2 mm, and 4.95 mm for Type III, 3.85 mm, 4.25 mm, and 5.1 mm for Type IV, and 3.6 mm, 4.25 mm, and 5.3 mm for Type V, for 25%, 55%, and 85% partial tears, respectively. Therefore, for small tears (25%), knee stability was most affected when the tears were located around the center of the ligament. For moderate tears (55%), the effect on knee stability was the greatest for tears at the proximal half of the ACL. However, severe tears (85%) demonstrated considerable growth in knee instability from the distal to the proximal ends of the tissue, with a substantial increase in knee instability around the insertion sites. The proposed model can enhance the characterization of partial ACL tears, leading to more accurate preliminary diagnoses. It can aid in developing new techniques for repairing partially torn ACLs, potentially preventing more severe injuries.

Segmentation of polyps based on pyramid vision transformers and residual block for real-time endoscopy imaging.

Polyp segmentation is an important task in early identification of colon polyps for prevention of colorectal cancer. Numerous methods of machine learning have been utilized in an attempt to solve this task with varying levels of success. A successful polyp segmentation method which is both accurate and fast could make a huge impact on colonoscopy exams, aiding in real-time detection, as well as enabling faster and cheaper offline analysis. Thus, recent studies have worked to produce networks that are more accurate and faster than the previous generation of networks (e.g., NanoNet). Here, we propose ResPVT architecture for polyp segmentation. This platform uses transformers as a backbone and far surpasses all previous networks not only in accuracy but also with a much higher frame rate which may drastically reduce costs in both real time and offline analysis and enable the widespread application of this technology.

The detrimental danger of Water-Pipe (Hookah) transcends the hazardous consequences of general health to the driving behavior.

OBJECTIVE: To determine whether the consumption of tobacco used in Water-Pipe by drivers increases the risk of a motor vehicle collision as a consequence of hypoxia. DESIGN: Analytical case-control study. DATA SOURCES: Seventy exclusive Water-Pipe smokers (Experimental Group--EG)--mean age ± SD: 29.47 ± 10.45 years; mean number of weekly WPS, (6.9 ± 3.7); mean duration of WPS (WPS) is (7.5 ± 2.1 years)--and thirty non-smoker (Control Group--CG; mean age ± SD: 36.33 ± 13.92 years) were recruited during 2011 from two Arab villages located in the Galilee, northern Israel. METHODS: We performed a case-control study exclusively among Water-Pipe smokers with an appropriate non smokers control group. Demographic questionnaire, Pulse Oxymeter for blood oxygenation measure and a driver simulator for measuring various participants driving behaviors were utilized. Statistical analysis for analyzing the different variables, Pearson's x2 analysis for the comparison of categorical variables, continuous variable is compared using Student's t-test and for testing the correlation between the different variables and bivariate correlation analysis were applied. RESULTS: In the (EG) following WPS, we observed increase in the pulse rate--from 80 to 95 (t = 11.84, p < 0.05) and decrease in saturation level from 97.9 to 97.32, the decrease is statistically significant (t = 3.01, p < 0.05) versus no change in (CG). An increased number of accidents among EG (OR is 1.333 with CI of 1.008-1.776), while in CG, an insignificantly decrease (t = 3.08, p < 0.05). In EG an increase in centerline crossings (OR is 1.306 with CI of 1.016-1.679), also the total time not being within the lane was increased and the estimated (OR: 1.329; CI: 1.025-1.722). WPS increases the number of accidents by 33% and Hypoxia can cause driving behavioral turbulences. CONCLUSION: The results show that WPS has a significant impact on driving behavior and on the risk of being involved in road accidents and causing driving to become riskier and less careful and stable. To the best of our knowledge, this is the first time such relationships have been tested. After WPS the total number of traffic accidents and driving violations increase. The results show a significant increase in the pulse rate immediately after WPS with a decrease in the saturation rate (the level of blood oxygenation); these changes continue half an hour after WPS.

Comparing Sublingual and Inhaled Cannabis Therapies for Low Back Pain: An Observational Open-Label Study.

BACKGROUND AND OBJECTIVE: Medical cannabis is becoming an acceptable treatment modality in medicine, especially for pain relief. Concurrently, cannabis use is becoming more prevalent worldwide, a public demand-driven trend despite the lack of established scientific basis. This observational open-label study sought to investigate the effectiveness of cannabis therapy for alleviating low back pain symptoms. METHODS: Two types of cannabis treatment modalities were sequentially administered to chronic low back pain patients. After an initial 1-month washout period (WO1), the first modality was cannabidiol (CBD)-rich sublingual extract treatment administered for 10 months. Following another washout period, the second modality, Δ9-tetrahydrocannabinol (THC)-rich smoked inflorescence (whole dried cannabis flowers) was administered for 12 months. RESULTS: Enrolled in the study were 24 patients whose advanced imaging studies (i.e. computerized tomography or magnetic resonance imaging of the lumbar spine) revealed disc herniation or spinal stenosis. Three patients dropped out of extract therapy treatment but resumed study participation to receive THC-rich smoking therapy. After a minimum of 2 years, cannabis therapy had reduced lower back pain symptoms, as assessed by Oswestry Disability Index, the SF-12 patient-reported outcome questionnaire, and the visual analogue scale. Pain reduction was not significant during the extract treatment part of the study; however, pain reduction was significant during the inhaled therapy part of the study. CONCLUSIONS: Our findings indicate that inhaled THC-rich therapy is more effective than CBD-rich sublingual extract therapy for treating low back pain and that cannabis therapy is safe and effective for chronic low back pain.