Minimal clinically important difference (MCID) and substantial clinical benefit (SCB) of upper extremity PROMIS scores following arthroscopic rotator cuff repairs.

PURPOSE: To calculate and determine what factors are associated with achieving the Minimal Clinically Important Difference (MCID) and the Substantial Clinical Benefit (SCB) of Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Testing v2.0 (UE), Pain Interference (P-Interference), and Pain Intensity (P-Intensity) in patients undergoing arthroscopic rotator cuff repair (aRCR). METHODS: The change in PROMIS scores representing the optimal cutoff for a ROC curve with an area under the curve analysis was used to calculate the anchor-based MCID and SCB. To assess the responsiveness of each PROM, effect sizes and standardized response means (SRM) were calculated. To identify factors associated with attaining the MCID and SCB, univariate and multivariate logistic regression analyses were performed. RESULTS: A total of 323 patients with an average age of 59.9 ± 9.5 were enrolled in this study, of which, 187/323 [57.9%] were male and 136/323 [42.1%] were female. The anchor-based MCID for PROMIS UE, P-Interference, and P-Intensity was: 9.0, 7.5, and 11.2, respectively. The respective SCB was 10.9, 9.3, and 12.7. Effect size and SRM were: PROMIS UE (1.4, 1.3), P-Interference (1.8, 1.5), and P-Intensity (2.3, 2.0). Lower preoperative P-Intensity scores (p = 0.02), dominant arm involvement (p = 0.03), and concomitant biceps tenodesis (p = 0.03) were associated with patients achieving the SCB for PROMIS UE. CONCLUSION: A large responsiveness for each of the PROMIS instruments due to the majority of patients reporting great improvement after aRCR and a small standard deviation across all outcome measures was shown in our study. Lower preoperative P-Intensity scores and concomitant biceps tenodesis were associated with higher odds of achieving the SCB for PROMIS UE. The knowledge of MCID and SCB values for PROMIS instruments will allow the surgeon to determine whether the improvements in the PROMIS scores after aRCR are clinically meaningful. LEVEL OF EVIDENCE: Level III.

Intra- and Inter-Day Reliability of the NIRS Portamon Device after Three Induced Muscle Ischemias.

(1) Background: Near-infrared spectroscopy (NIRS) is an innovative and non-invasive technology used to investigate muscular oxygenation. The aim of this study is to assess the within- and between-session reliability of the NIRS Portamon (Artinis, Elst, Netherlands) device following three sets of induced muscle ischemia. (2) Methods: Depending on the experimental group (G1, G2 or G3), a cuff was inflated three times on the left upper arm to 50 mmHg (G1), systolic blood pressure (SBP) + 50 mmHg (G2) or 250 mmHg (G3). Maximum, minimum and reoxygenation rate values were assessed after each occlusion phase, using a Portamon device placed on the left brachioradialis. Reliability was assessed with intraclass correlation coefficient (ICC) value and ICC 95% confidence interval (CI-95%), coefficient of variation (CV) and standard error of measurement (SEM) (3) Results: Our results showed a good to excellent reliability for maximums and minimums within-session. However, the reoxygenation rate within sessions as well as measurements between sessions cannot predominantly show good reliability. (4) Conclusions: Multiple measurements of maximums and minimums within a single session appeared to be reliable which shows that only one measurement is necessary to assess these parameters. However, it is necessary to be cautious with a comparison of maximum, minimum and reoxygenation rate values between sessions.

COVID-19: Social Distancing and Physical Activity in United Kingdom Residents With Visual Impairments.

Introduction: The introduction of the COVID-19 lockdown and social distancing policy has the potential to restrict access to physical activity, change exercise behavior, and to increase sedentary behavior. This study was conducted with the support of British Blind Sport and evaluates the effect of the lockdown policy on adults with visual impairments in the United Kingdom (UK). Methods: An online survey based on the World Health Organization's Global Physical Activity Questionnaire was completed by 73 participants (median age 35-44 years, 59% female) to gain information on how the implementation of the lockdown policy by the UK government has affected physical activity and sedentary behavior in adults that are visually impaired. Paired sample t-tests and Wilcoxon signed rank tests were used to analyze continuous and Likert scale data, respectively. Results: The majority of participants continued to exercise during lockdown, but the nature of this activity altered with a significant change to exercising in a private indoor space (+190% (always), z = -3.871, p < 0.001), and those exercising alone (+118% (always), z = -2.595, p = 0.009). The volume of activity reduced in all cases, between -11% and -52%, with significant changes in duration of vigorous day-to-day activity, moderate day-to-day activity, travel by foot or cycle, and vigorous recreational activity. Sedentary behavior increased on average by 21% (t(59) = -2.050, p = 0.045), with a greater effect seen in females (+36%, t(35) = -2.525, p = 0.016). Discussion: Reductions in physical activity volume and increases in sedentary behavior are consequences of the UK lockdown for those with visual impairments. The health and well-being implications of these data to this specific population are of particular concern. Implications for Practitioners: Lockdown measures should be designed with consideration of the needs of people with disabilities. Innovative ways to engage these populations in physical activity are strongly encouraged.

Radiographic and clinical characterization of coracoid fractures: a retrospective cohort analysis.

PURPOSE: Coracoid fracture is a rare injury. The aim of this study is to present the demographics, clinical and radiologic characteristics, and outcomes of coracoid fracture in a cohort of 32 patients. METHODS: We queried our institutional electronic medical record database (years 2012-2020) to identify patients with coracoid fractures using specific International Classification of Disease-10 codes. Demographic data, injury details including mechanism of injury and associated injuries, imaging performed, and treatment outcomes were obtained from retrospective chart review. A radiologist reviewed all available imaging studies (radiographs/CT/MRI) and classified the fractures according to Ogawa and Eyres classifications. Missed diagnoses were determined by comparing initial imaging reports with the follow-up imaging obtained in the office. RESULTS: Thirty-two patients with coracoid fractures were identified during the study period. Sixteen fractures (50%) occurred in the setting of low-energy trauma. Twelve fractures were missed on initial radiographs, and diagnosis with three-view radiographs (AP, scapular-Y and axillary) was 88% compared to 33% (p < 0.03) with two views (AP, scapular-Y). The majority of fractures were non-displaced (94%), and 56% were Ogawa Type-II fractures. Associated injuries were seen in 81% of patients. Most fractures (94%) were treated without surgery with excellent outcomes. CONCLUSION: Coracoid fractures continue to be a rare injury. In contrast to previous studies, in this case series of 32 patients, half of the fractures were associated with low-energy trauma, which correlated with higher percentage of non-displaced fractures and Ogawa Type-II fractures. Addition of the axillary view in the trauma radiographic series significantly improved the initial fracture detection rate. LEVEL IV: Retrospective study.

Fluctuating asymmetry, a marker of poor growth quality, is associated with adult male metabolic rate.

OBJECTIVES: Life history theory, a branch of evolutionary theory, predicts the existence of trade-offs in energetic allocation between competing physiological functions. The core metabolic cost of self-maintenance, measured by resting metabolic rate (RMR), represents a large component of human daily energy expenditure. Despite strong selective pressures for energetic frugality and high observed interindividual variation in RMR, the link between RMR and energetic allocation to life-history traits remains understudied in humans. MATERIALS: In a sample of 105 (m = 57, f = 48), we investigated the relationship between adult RMR and investment in growth quality, as measured by fluctuating asymmetry (FA). RESULTS: Measurement of RMR and FA in university rowers revealed a significant positive correlation amongst males (n = 57, r = 0.344, p = 0.005, 1-tailed; standardized 95% CI, 0.090 to 0.598). Convincing evidence for a correlation among females was not found (n = 48, r = 0.142, p = 0.169, 1-tailed, standardized 95% CI, -0.152 to 0.435). DISCUSSION: The data suggest that low-quality asymmetrical growth is associated with later-life metabolic inefficiencies in males. Energetic investment in processes (likely concerning the stress-response) unrelated to growth during childhood may thereby trade-off against adult metabolic efficiency. We suggest that the presence of a relationship between RMR and FA in males but not females may be explained by the additional metabolic strain associated with larger body size and increased male muscularity, which may amplify the inefficiencies arising from low-quality growth.

Computational methods of studying the binding of toxins from venomous animals to biological ion channels: theory and applications.

The discovery of new drugs that selectively block or modulate ion channels has great potential to provide new treatments for a host of conditions. One promising avenue revolves around modifying or mimicking certain naturally occurring ion channel modulator toxins. This strategy appears to offer the prospect of designing drugs that are both potent and specific. The use of computational modeling is crucial to this endeavor, as it has the potential to provide lower cost alternatives for exploring the effects of new compounds on ion channels. In addition, computational modeling can provide structural information and theoretical understanding that is not easily derivable from experimental results. In this review, we look at the theory and computational methods that are applicable to the study of ion channel modulators. The first section provides an introduction to various theoretical concepts, including force-fields and the statistical mechanics of binding. We then look at various computational techniques available to the researcher, including molecular dynamics, brownian dynamics, and molecular docking systems. The latter section of the review explores applications of these techniques, concentrating on pore blocker and gating modifier toxins of potassium and sodium channels. After first discussing the structural features of these channels, and their modes of block, we provide an in-depth review of past computational work that has been carried out. Finally, we discuss prospects for future developments in the field.

Effect of an acute blood donation on oxygen uptake kinetics in moderate and heavy domains over a period of 96 hours.

BACKGROUND: Studies determining the effects of blood donation (BD) on oxygen uptake kinetics are limited. This study aims to ascertain the effects of BD (~470 mL) over a period of 96 hours on oxygen uptake kinetics in moderate and heavy exercise domains. STUDY DESIGN AND METHODS: Twelve participants (nine males and three females; 31.1 ± 11.7 years, mass 79.9 ± 12.8 kg, height 175.5 ± 7.5 cm) completed four consecutive days (24-96 hours) of moderate and heavy V˙O2 on-kinetics trials pre BD and post BD. Visit one (0 hour), pre BD established hematological levels, V˙O2max and Gas Exchange Threshold (GET). Subsequent visits comprised two 6-minute moderate (∆ 50% rest-GET) and 1 heavy (∆ 20% GET-V˙O2max ) trial. Post BD 0 hour the participants donated blood post hematological testing only. RESULTS: Despite non-significances for V˙O2 amplitude, time constant-2 (tau2 ) for V˙O2 showed significant decreases at 24 and 48 hours, and tau3 showed significant increases at 72 and 96 hours pre to post BD (P < .05). Hemoglobin (Hb) values reduced (P < .05) pre (14.48 ± 0.16 g·dL-1 ) to post BD (13.47 ± 0.66 g·dL- 1). Hb significantly decreased at 24, 48, 72, and 96 hours compared to 0 hour post BD (P < .05). CONCLUSION: BD has no effect on V˙O2 amplitude, but time-based components show sensitivity to reduced circulating O2 ; with a decreased PO2 a slower O2 exchange across the blood myocyte barrier could result in altering O2 kinetics.

Leisure-Time Sedentary Behavior, Alcohol Consumption, and Sexual Intercourse Among Adolescents Aged 12-15 Years in 19 Countries From Africa, the Americas, and Asia.

BACKGROUND: The association between sedentary behavior and sexual behavior has not been investigated among adolescents. AIM: The aim of this study was to: (i) investigate the association between leisure-time sedentary behavior and sexual intercourse, and (ii) test for mediation by alcohol consumption, drug use, physical activity, bullying victimization, parental support/monitoring, loneliness, and depressive symptoms in a large global sample of young adolescents. METHODS: Data were analyzed from 34,674 adolescents aged 12-15 years participating in the Global School-based Student Health Survey. Participants reported the number of hours spent in leisure-time sedentary behavior on a typical day (<1, 1-2, 3-4, 5-8, and >8 hours). Data on alcohol consumption, drug use, physical activity, bullying victimization, parental support/monitoring, loneliness, and depressive symptoms were considered as potential mediators. OUTCOME: Participants reported whether or not they had sexual intercourse in the past 12 months (yes/no). RESULTS: The prevalence of past 12-month sexual intercourse was 11.9%, whereas the prevalence of <1, 1-2, 3-4, 5-8, and >8 hours per day of leisure-time sedentary behavior were 26.7%, 35.6%, 21.4%, 11.5%, and 4.9%, respectively. There was a dose-dependent relationship between sedentary behavior and odds of reporting sexual intercourse: compared with <1 hour/day of sedentary behavior, the odds ratio (95% CI) of sexual intercourse associated with 1-2, 3-4, 5-8, and >8 hours/day of sedentary behavior were 1.12 (0.94-1.33), 1.22 (1.01-1.48), 1.34 (1.08-1.66), and 1.76 (1.37-2.27), respectively. There was no significant interaction by sex. The largest proportion of the association between sedentary behavior and sexual intercourse was explained by alcohol use (% mediated 21.2%), with other factors explaining an additional 11.2%. CLINICAL TRANSLATION: Interventions to reduce leisure-time sedentary and/or alcohol consumption may contribute to a reduction in the proportion of adolescents engaging in sexual intercourse at a young age. The strengths and limitations of this study are the large, representative sample of adolescents from 19 countries. However, the cross-sectional design means causality or temporal associations could not be established. CONCLUSIONS: In young adolescents, leisure-time sedentary behavior is positively associated with odds of having sexual intercourse in both boys and girls, in a dose-dependent manner. Alcohol consumption seems to be a key mediator of this relationship. Smith L, Jackson SE, Jacob L, et al. Leisure-Time Sedentary Behavior, Alcohol Consumption, and Sexual Intercourse Among Adolescents Aged 12-15 Years in 19 Countries From Africa, the Americas, and Asia. J Sex Med 2019;16:1355-1363.

Confirming Maximal Oxygen Uptake: Is Heart Rate the Answer?

This study investigates heart rate (HR), in 11 young adults (22.4±3.21yr), at V̇O2max, to ascertain whether measured maximal heart rate (HRmax), as determined by a plateau in HR (HRplat), can reliably confirm V̇O2max. V̇O2max and HRplat were determined, using the parameters of a V̇O2≤50 ml•min-1 and a ∆HR≤2b•min-1, respectively, over the final 60 s of sampling. V̇O2 was also independently determined using a verification phase protocol. A HRplat was achieved by 91% of participants (∆HR=1.3±1b•min-1) and critically the time at which HRmax was reached coincided with that at which V̇O2max was achieved. Moreover RER and ΔRER criteria were reached significantly earlier (p<0.05) than V̇O2max, whilst age-related heart rate maximums (HRage), were not achieved by many participants. The results suggest that a HRplat ≤2 b•min-1 is a more accurate method, within the group tested, to determine whether a 'true' V̇O2max has been achieved, than other secondary criteria and potentially avoids the requirement for an additional verification phase.

The Effects of Non-Contingent Feedback on the Incidence of Plateau at V̇O2max.

The purpose of this study was to examine the effects of non-contingent feedback in the form of heart rate (HR) on the incidence of plateau at V̇O2max. Ten physically active males (age 24.8 yrs ± 4.2; mass 81.4 ± 9.0 kg; stature 1.80 ± 0.11 m, V̇O2max 53.2 ± 5.8 ml·kg-1.min-1) who were V̇O2max testing naïve but were cognisant as to the heart rate responses to exercise completed four incremental tests to volitional exhaustion, separated by ~72 h for the determination of V̇O2max and gas exchange threshold. The first trial served as a familiarisation with the remaining three being experimental conditions where HR was presented in a screen projection as either the actual response (HR-A) or 10 b·min-1 higher than recorded (HR-H) or 10 b·min-1 lower (HR-L). Throughout all trials V̇O2 was recorded on a breath-by-breath basis with plateau criteria of ≤ 50 ml·min-1. RESULTS: A significant difference was observed for Δ V̇O2 over the final two consecutive 30s sampling periods between HR-A, both HR-L and HR-H (p = 0.049) and for the incidence of plateau response between condition (p = 0.021). An additional significant difference was observed for sub-maximal Δ V̇O2 responses between HR-A and HR-H (p = 0.049) and HR-A and HR-L (p = 0.006). Non-significant differences were observed for all other criteria. These data indicate that when presented with non-contingent feedback in the form of HR, that the perceptually orientated pacing schema becomes disrupted promoting a sparing of the finite anaerobic capacity to compensate for the imbalance between the afferent signal and perception of effort.

Accelerometery and Heart Rate Responses of Professional Fast-Medium Bowlers in One-Day and Multi-Day Cricket.

The physical demands of fast-medium bowling are increasingly being recognised, yet comparative exploration of the differing demands between competitive formats (i.e. one-day [OD] versus multi-day [MD] matches) remain minimal. The aim of this study was to describe in-match physiological profiles of professional fast-medium bowlers from England across different versions of competitive matches using a multivariable wearable monitoring device. Seven professional cricket fast-medium bowlers wore the BioharnessTM monitoring device during matches, over three seasons (>80 hours in-match). Heart Rate (HR) and Acceleromety (ACC) was compared across match types (OD, MD) and different in-match activity states (Bowling, Between over bowling, Fielding). Peak acceleration during OD bowling was significantly higher in comparison to MD cricket ([OD vs. MD] 234.1 ± 57.9 vs 226.6 ± 32.9 ct·episode-1, p < 0.05, ES = 0.11-0.30). Data for ACC were also higher during OD than MD fielding activities (p < 0.01, ES = 0.11-.30). OD bowling stimulated higher mean HR responses (143 ± 14 vs 137 ± 16 beats·min-1, p < 0.05, ES = 0.21) when compared to MD matches. This increase in OD cricket was evident for both between over (129 ± 9 vs 120 ± 13 beats·min-1,p < 0.01, ES = 0.11-0.50) and during fielding (115 ± 12 vs 106 ± 12 beats·min-1, p < 0.01, ES = 0.36) activity. The increased HR and ACC evident in OD matches suggest greater acute physical loads than MD formats. Therefore, use of wearable technology and the findings provided give a valuable appreciation of the differences in match loads, and thus required physiological preparation and recovery in fast-medium bowlers.

Prior Knowledge of Trial Number Influences the Incidence of Plateau at VO2max.

UNLABELLED: The purpose of this study was to assess the VO2max plateau response at VO2max during a series of pre-determined trials. METHODS: Ten male well-trained athletes (age, 23.0 ± 3.2; height, 183.3 ± 5.5 cm; mass 77.5 ± 11.1 Kg; VO2max 66.5 ± 5.0 ml(.)kg(-1,)min(-1)), but who were VO2max testing naïve and with prior-knowledge of trial number completed four incremental tests to volitional exhaustion, separated by ~72-h for the determination of VO2max and gas exchange threshold. Throughout all trials VO2max was recorded on a breath-by-breath basis using a pre-calibrated metabolic cart, using a plateau criterion of Δ VO2 ≤1.5 ml(.)kg(-1.)min(-1) over the final 2 consecutive 30 s sampling periods. A significant difference was observed between trial-1 and trial-4 for plateau incidence (p = 0.0285) rising from 20% in trial-1 to a 70% response rate in trial-4. Furthermore a significant difference was observed for VO2dif (difference between criterion value and Δ VO2) in trial-1, 1.02 ± 1.69 ml(.)kg(-1.)min(-1) (p = 0.038), with non-significant differences observed for all other trials, despite a non-significant difference for VO2max across all trials (p > 0.05). Finally, a significant difference was observed for effort perception (RPE) at volitional exhaustion between trial-1 (17.7 ± 1.3) and trial-4 (19.0 ± 1.4) (p = 0.0052). These data indicate that prior-knowledge of trial number can influence the manifestation of the VO2 plateau in a group of well-trained male athletes, thereby suggesting that a form of effort control is established in order to preserve the finite anaerobic capacity. Key pointsIn well-trained athletes the incidence of plateau at VO2max increases in conjunction with an increase in trial number and the associated sensations of pain and fatigue.By informing the participant of the number of trials to be completed a closed-loop condition is developed whereby effort in all trials is compared to a perceptually developed template.Closed-loop condition leads to a sparing of the finite anaerobic capacity during incremental tests when the number of trials to be completed is known.

Influence of blood donation on the incidence of plateau at VO2max.

PURPOSE: The purpose of this study was to examine the effects of reductions in blood volume and associated oxygen-carrying capacity on the incidence of plateau at VO2max. METHODS: Fifteen well-trained athletes (age 23.3 ± 4.5; mass 77.4 ± 13.1 kg, height 180.1 ± 6.0 cm) completed three incremental cycle tests to volitional exhaustion, of which the first was defined as familiarisation, with the remaining two trials forming the experimental conditions of pre- (UBL) and post-(BLE) blood donation (~ 450 cm(3)). The work rate for the incremental tests commenced at 100 W for 60 s followed by a ramp of 0.42 W s(-1), with cadence being held constant at 80 rpm. Throughout all trials, VO2 was determined on a breath-by-breath basis using a pre-calibrated metabolic cart. The criteria for plateau determination was a ∆VO2 ≤ 50 ml min(-1) over the final two consecutive 30 s sampling periods. RESULTS: Despite a significant (P = 0.0028) 9.4 % reduction in haemoglobin concentration and 10.8 % (P = 0.016) reduction in erythrocyte count between UBL and BLE, there was no change in plateau incidence. However, significant differences were observed for both VO2max (P = 0.0059) 51.3 ± 7.6 (UBL) 48.4 ± 7.9 ml kg(-1) min(-1) (BLE) and gas exchange threshold arrival time 383.4 ± 85.2 s (UBL) 349.2 ± 71.4 s (BLE) (P = 0.0028). CONCLUSION: These data suggest that plateau at VO2max is unaffected by O2 availability lending support to the notion of the plateau being dependent on the anaerobic capacity and the classically orientated concept of VO2max.

The Effects of Prescribed Physical and Cognitive Exercise on Life Satisfaction, Self-Efficacy and Mood States in Adults with Down Syndrome: The MinDSets Study.

Down syndrome (DS) is characterised by a duplication of chromosome-21 and is linked to co-occurring physical and mental health conditions, including low self-efficacy and disturbed mood states. The purpose of this study was to investigate the effects of an eight-week prescribed physical and/or cognitive training intervention on measures of mood disturbance, life satisfaction and self-efficacy in a population of adults with DS. Eighty-three participants (age 27.1 ± 8.0 years) from across five continents volunteered. Participants were assigned using matched groups based upon performance in a modified six-minute walk test to either an exercise (EXE) 3 × 30 min of walking/jogging per week, cognitive training (COG) 6 × 20 min per week, a combined group (COM) or the control (CON) who did not complete any intervention. Profile of Mood States (POMS) were assessed using a five-point scale across 65 categories pre- and post-study as well as upon completion of each week of the intervention. In addition, Satisfaction with Life Scale (SWLS) and self-efficacy using the Generalised Self-Efficacy scale (GSE) were recorded before and after the intervention. GSE increased for all participants by 1.9 ± 5.2 (p = 0.002) from pre- to post-intervention, while POMS showed significant changes for the whole group from pre- to post-intervention for tension (p < 0.001), depression (p < 0.001) and for anger (p < 0.001). In addition, significant correlations were observed between SWLS and ΔTMD, Δtension, Δanger, and Δfatigue (p < 0.05) for EXE. Both COG and EXE provide a framework for empowering enhancements in life satisfaction, self-efficacy and mood states fostering improvements in quality of life.

Acute prophylactic antibiotic nailing of open femoral shaft fractures for prevention of fracture-related infection.

Background: Open, grossly contaminated femoral shaft fractures pose a significant threat for fracture-related infection. Traditional treatment for these injuries consists of irrigation and debridement with temporizing external fixation placement and staged conversion to definitive fixation. Methods: We describe a protocol for acute antibiotic cement nailing of open femoral shaft fractures as an infection prophylaxis modality in fractures with a high risk of infection and present three cases. Results: Three patients presented with open femoral shaft fractures with large soft tissue defects and gross contamination and were successfully treated with acute retrograde antibiotic nailing and external fixation with later conversion to definitive metallic nailing. They did not develop infection and had acceptable postoperative function and fracture alignment. Conclusion: This technique of early infection prophylaxis after open femoral shaft fracture is reproducible, pragmatic, and cost-effective.

Does Artificial Intelligence Outperform Humans Using Fluoroscopic-Assisted Computer Navigation for Total Hip Arthroplasty?

Background: Successful total hip arthroplasty (THA) relies on the correct implant position. THA accuracy can be improved with the use of intraoperative fluoroscopic-assisted computer navigation. Artificial intelligence (AI) software may enhance fluoroscopic navigation; however, the accuracy of the AI compared to human-controlled software in assessing acetabular component position and leg length discrepancy (LLD) has not been studied. Methods: We analyzed 420 consecutive primary THAs performed by a single surgeon using fluoroscopic-assisted computer navigation software. The first cohort of 211 patients required inputs from a human technician (manual), while the second cohort of 209 patients used an automated version of the software controlled by AI. The intraoperative acetabular component placement (inclination and anteversion) and LLD were recorded and compared to the 2-week postoperative standing anterior-posterior pelvis radiograph. Results: Ninety-four percent (199/211) of cups in the manual cohort and 95% (198/209) of cups in the AI cohort were within the Lewinnek "safe-zone" (P = 1.0). In the manual cohort, 69% (146/211) of THAs had a final LLD within ±2 mm of the intraoperatively navigated LLD (ie, ΔLLD ≤2 mm). In the AI cohort, 66% (137/209) of THAs had a final LLD within ±2 mm of the intraoperatively navigated LLD (P = .47). Ninety-nine percent (209/211) of hips in the manual cohort and 98% (205/209) of hips in the AI cohort had a final LLD within ±5 mm of the intraoperatively navigated LLD (P = .45). Conclusions: Both AI and human-controlled versions of the same navigation platform were similarly accurate for navigating cup position within the Lewinnek "safe zone" and LLD accuracy.

Subscapularis Management in Anatomic Total Shoulder Arthroplasty A Review.

Surgical management of the subscapularis tendon is critical to a successful outcome following anatomic total shoulder arthroplasty. However, the optimal surgical technique for adequate exposure of the glenohumeral joint while mini-mizing complications resulting from subscapularis tendon dysfunction continues to be controversial. Common surgical techniques for the management of the subscapularis tendon include tenotomy, peeling, sparing, and lesser tuberosity oste-otomy. Despite a number of published studies comparing these techniques, no consensus has been reached regarding optimal management. This article reviews the extensive literature on the biomechanical, radiologic, and clinical outcomes of each technique, including recently published comparison studies.

The effects of lower limb ischaemic preconditioning: a systematic review.

Ischaemic preconditioning (IPC) involves the use of repeated occlusions and reperfusions of the peripheral muscle blood supply at a limb. This systematic literature review examines the typical responses in response to the method of application during an IPC applied at the lower limb. This review focuses on the physiological responses for VO2max, haemoglobin, metabolic and genetic responses to various IPC interventions. The literature search was performed using four databases and assessed using the PRISMA search strategy and COSMIN to assess the quality of the articles. Seventeen articles were included in the review, with a total of 237 participants. While there is variation in the method of application, the average occlusion pressure was 222 ± 34 mmHg, ranging from 170 to 300 mmHg typically for 3 or 4 occlusion cycles. The distribution of this pressure is influenced by cuff width, although 8 studies failed to report cuff width. The majority of studies applies IPC at the proximal thigh with 16/17 studies applying an occlusion below this location. The results highlighted the disparities and conflicting findings in response to various IPC methods. While there is some agreement in certain aspects of the IPC manoeuvre such as the location of the occlusion during lower limb IPC, there is a lack of consensus in the optimal protocol to elicit the desired responses. This offers the opportunity for future research to refine the protocols, associated responses, and mechanisms responsible for these changes during the application of IPC.