Indications for Medial Patellofemoral Ligament Reconstruction: A Systematic Review.

The medial patellofemoral ligament (MPFL) plays a key role in lateral patellofemoral stability, and there has been significant clinical and research interest in MPFL reconstruction (MPFLR) in recent years. The primary objective of this systematic review of clinical studies is to investigate the reported indications for an isolated MPFLR and secondarily to examine some of the reasons reported for not performing an isolated MPFLR. A comprehensive search of the MEDLINE, EMBASE, PUBMED, and Cochrane databases was conducted to identify surgical studies investigating MPFLR. Study information including author, publication date, sample size, patient age, follow-up period, procedure performed, surgical indications and contraindications, and study design were extracted. The most common indication for isolated MPFLR was recurrent patellofemoral instability (82.1%). Common reasons given for not performing an isolated MPFLR included bony malalignment (51.8%), trochlear dysplasia (30.4%), and patella alta (23.2%). This systematic review identified recurrent patellofemoral instability as the primary indication for an isolated MPFLR; however, a large number of the studies did not provide clear criteria for when an isolated MPFLR should be performed. Similarly, there was significant variability in the reasons given for not performing an isolated MPFLR.

Posterior tibial translation resulting from the posterior drawer manoeuver in cadaveric knee specimens: a systematic review.

PURPOSE: The purpose of this systematic review of cadaver-based biomechanical studies is to accurately quantify how much posterior tibial translation occurs during posterior drawer testing in normal and PCL-deficient knees. METHODS: A search of the electronic databases, MEDLINE and EMBASE, was performed to identify relevant cadaveric studies that reported posterior tibial translation during posterior drawer testing. Studies were combined to determine overall increase in posterior tibial translation after PCL sectioning at 90° of flexion. Methodological quality of included studies was assessed by two reviewers using a novel clinometric tool. An intraclass correlation coefficient with 95 % confidence intervals (CIs) was used to determine agreement between reviewers on quality scores. RESULTS: Combined analysis of 244 cadaveric specimens from 23 studies in which the PCL was sectioned yielded a mean net increase in tibial translation of 10.7 mm (95 % CI 9.68-11.8) with posterior drawer testing. Posterior tibial translation among cadaveric specimens with no disruption to any ligamentous structures was found to be 5.4 mm (95 % CI 4.3-6.6). CONCLUSIONS: Cadaveric data support previous study findings of >8 mm of posterior tibial translation on stress radiographs being indicative of isolated PCL insufficiency. Use of fixed reference points and strict control of tibial rotation are imperative to ensure accurate results in cadaveric studies and in the clinical setting when performing the posterior drawer examination. LEVEL OF EVIDENCE: III.

Diagnostic accuracy of physical examination for anterior knee instability: a systematic review.

PURPOSE: Determining diagnostic accuracy of Lachman, pivot shift and anterior drawer tests versus gold standard diagnosis (magnetic resonance imaging or arthroscopy) for anterior cruciate ligament (ACL) insufficiency cases. Secondarily, evaluating effects of: chronicity, partial rupture, awake versus anaesthetized evaluation. METHODS: Searching MEDLINE, EMBASE and PubMed identified studies on diagnostic accuracy for ACL insufficiency. Studies identification and data extraction were performed in duplicate. Quality assessment used QUADAS tool, and statistical analyses were completed for pooled sensitivity and specificity. RESULTS: Eight studies were included. Given insufficient data, pooled analysis was only possible for sensitivity on Lachman and pivot shift test. During awake evaluation, sensitivity for the Lachman test was 89 % (95 % CI 0.76, 0.98) for all rupture types, 96 % (95 % CI 0.90, 1.00) for complete ruptures and 68 % (95 % CI 0.25, 0.98) for partial ruptures. For pivot shift in awake evaluation, results were 79 % (95 % CI 0.63, 0.91) for all rupture types, 86 % (95 % CI 0.68, 0.99) for complete ruptures and 67 % (95 % CI 0.47, 0.83) for partial ruptures. CONCLUSION: Decreased sensitivity of Lachman and pivot shift tests for partial rupture cases and for awake patients raised suspicions regarding the accuracy of these tests for diagnosis of ACL insufficiency. This may lead to further research aiming to improve the understanding of the true accuracy of these physical diagnostic tests and increase the reliability of clinical investigation for this pathology. LEVEL OF EVIDENCE: IV.

Aquatic therapies in patients with compromised left ventricular function and heart failure.

With water immersion, gravity is partly eliminated, and the water exerts a pressure on the body surface. Consequently there is a blood volume shift from the periphery to the central circulation, resulting in marked volume loading of the thorax and heart. This paper presents a selection of published literature on water immersion, balneotherapy, aqua exercises, and swimming, in patients with left ventricular dysfunction (LVD) and/or stable chronic heart failure (CHF). Based on exploratory studies, central hemodynamic and neurohumoral responses of aquatic therapies will be illustrated. Major findings are: 1. In LVD and CHF, a positive effect of therapeutic warm-water tub bathing has been observed, which is assumed to be from afterload reduction due to peripheral vasodilatation caused by the warm water. 2. In coronary patients with LVD, at low-level water cycling the heart is working more efficiently than at lowlevel cycling outside of water. 3. In patients with previous extensive myocardial infarction, upright immersion to the neck resulted in temporary pathological increases in mean pulmonary artery pressure (mPAP) and mean pulmonary capillary pressures (mPCP). 4. Additionally, during slow swimming (20-25m/min) the mPAP and/or PCP were higher than during supine cycling outside water at a 100W load. 5. In CHF patients, neck- deep immersion resulted in a decrease or no change in stroke volume. 6. Although patients are hemodynamically compromised, they usually maintain a feeling of well-being during aquatic therapy. Based on these findings, clinical indications for aquatic therapies are proposed and ideas are presented to provoke further research.

Implementation and outcomes of a comprehensive worksite health promotion program.

BACKGROUND: This paper reports on the implementation and results of a three-year comprehensive worksite health promotion program called Take care of your health!, delivered at a single branch of a large financial organization with 656 employees at the beginning of the implementation period and 905 at the end. The program included six educational modules delivered over a three-year period. A global health profile was part of the first and last modules. The decision to implement the program coincided with an overall program of organizational renewal. METHODS: The data for this evaluation come from four sources: analysis of changes in employee health profiles between the first and last program sessions (n=270); questionnaires completed by participating employees at the end of the program (n=169); organizational data on employee absenteeism and turnover; and qualitative interviews with company managers (n=9). RESULTS: Employee participation rates in the six modules varied between 39% and 76%. The assessment of health profile changes showed a significant increase in the Global Health Score. Participants were significantly more likely to report more frequent physical activity and better nutritional practices. The proportion of smokers among participants was significantly reduced (p = 0.0147). Also reduced significantly between the two measurements were self-assessment of high stress inside and outside the workplace, stress signs, and feelings of depression. Employees were highly satisfied with the program and felt that it had impacts on their knowledge and capacities to manage their health behaviour. During the same period, absenteeism in the organization declined by 28% and turnover by 54%. From the organization's perspective, program implementation was very successful. CONCLUSIONS: This study's results are in line with previous findings of significant benefits to organizations and employees from worksite health promotion. The close relationship between the program outcomes and the overall process of organizational renewal that it accompanied supports previous arguments that worksite health promotion will be most effective when it promotes overall organizational health.