Evaluating the role of graft integrity on outcomes: clinical and imaging results following superior capsular reconstruction.

BACKGROUND: Superior capsular reconstruction (SCR) addresses massive, irreparable rotator cuff tears in young patients. The purpose of this study was to retrospectively evaluate clinical outcomes and graft integrity in patients following SCR. METHODS: Thirty-four consecutive patients undergoing SCR by 2 surgeons with minimum 2-year follow-up were identified. Functional outcomes were obtained, including Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), visual analog scale (VAS), and Single Assessment Numeric Evaluation (SANE) scores. Graft integrity was evaluated on magnetic resonance images (MRIs). RESULTS: Thirty-five shoulders in 34 patients were identified. Four patients underwent subsequent surgery. The mean preoperative scores were SST 21.6 ± 17.6, ASES 28.3 ± 10.1, SANE 50.6 ± 22.1, and VAS 6.6 ± 1.7. The mean postoperative outcomes were SST 79.1 ± 19.6, ASES 79.9 ± 17.4, SANE 74.3 ± 18.7, and VAS 1.5 ± 2.2. There was statistically significant improvement in SST, ASES, and VAS following SCR. MRI revealed graft failure in 62% (n = 13 of 21) of shoulders. Radiographic evidence of graft healing did not have any effect on SST, ASES, SANE, or VAS scores. CONCLUSION: Given the high rate of graft failure without a significant difference in clinical outcomes, graft healing after SCR might not be an independent predictor of success. The improved clinical improvement in patients undergoing SCR may be due to other known beneficial aspects of the procedure, including partial rotator cuff repair, débridement, and biceps management.

RNA drug discovery: Conformational restriction enhances specific modulation of the T-box riboswitch function.

Antibacterial drug resistance is a global health concern that requires multiple solution approaches including development of new antibacterial compounds acting at novel targets. Targeting regulatory RNA is an emerging area of drug discovery. The T-box riboswitch is a regulatory RNA mechanism that controls gene expression in Gram-positive bacteria and is an exceptional, novel target for antibacterial drug design. We report the design, synthesis and activity of a series of conformationally restricted oxazolidinone-triazole compounds targeting the highly conserved antiterminator RNA element of the T-box riboswitch. Computational binding energies correlated with experimentally-derived Kd values indicating the predictive capabilities for docking studies within this series of compounds. The conformationally restricted compounds specifically inhibited T-box riboswitch function and not overall transcription. Complex disruption, computational docking and RNA binding specificity data indicate that inhibition may result from ligand binding to an allosteric site. These results highlight the importance of both ligand affinity and RNA conformational outcome for targeted RNA drug design.

Who Needs What? Perceptions of Patients and Caregivers in Oncology Phase 1 Trials.

BACKGROUND: The study design and nature of oncology phase 1 clinical trials create a uniquely vulnerable patient population yet little research has been conducted to identify the added burden these trials create for both cancer patients and their caregiver(s). OBJECTIVE: Examining the perceptions and needs of patients and their caregivers participating in phase 1 oncology clinical trials, the investigators tested the hypothesis that the caregiver will exhibit a higher level of burden and/or distress than the patient. METHOD: A mixed-methods exploratory process utilizing patient and caregiver interviews and quality-of-life questionnaires was used to assess the psychosocial burdens associated with oncology clinical trial participation. A qualitative and quantitative analysis of the responses were 8 performed. RESULT: Both patients and caregivers reported similar themes identifying the burdens and benefits related to phase 1 clinical trial participation. However, the caregivers' expressed burden exceeded that of the patients' validating the study's hypothesis. CONCLUSION: The need for ongoing additional support services for not only the patient but also the caregiver was identified.

In vivo degradation characteristics of bioabsorbable cross-pins in anterior cruciate ligament reconstruction.

BACKGROUND: We evaluated degradation of bioabsorbable femoral cross-pins following anterior cruciate ligament (ACL) reconstruction. METHODS: Four patients underwent ACL reconstruction using hamstring autograft with femoral fixation provided by a polylactic acid/polyglycolic acid copolymer (LactoSorb L15) cross-pin. Serial computed tomography (CT) scans were performed of the reconstructed knees at approximately 6 weeks, 4 months, 1 year and 2 years, postoperatively. A radiologist evaluated the scans for density of pins and surrounding bone and pin morphology. RESULTS: The cross-pins demonstrated a relative reduction in density of 7.7%, 49.1%, and 75.0% at 4 months, 1 year and 2 years, respectively. Bone density values adjacent to the pin decreased by an mean of 8.6% between 6 weeks and 4 months. At one year an additional 14.2% reduction in bone density was seen but at 2 years the relative reduction in bone density had decreased to 7.4%. Evaluation of pin morphology revealed that minimal change had occurred after 6 weeks. At 4 months all of the pins were showing some morphologic changes on the surface, but none had fractured. After 1 year, two of the pins had fractured. By 2 years all of the pins had fractured. None of the pins had completely reabsorbed at 2 years postoperatively. CONCLUSIONS: LactoSorb L15 cross-pins for femoral fixation in ACL reconstruction remain largely unchanged 4 months postoperatively, suggesting that this device maintains the necessary structural integrity to allow early integration of soft tissue grafts within bone tunnels. LEVEL OF EVIDENCE: IV, case series.

A new technique for establishing and maintaining an anteromedial knee portal.

Precise placement of the anteromedial portal is critical to the safety and efficacy of knee arthroscopy. Our described technique establishes and maintains a properly placed portal with minimal capsular violation using a needle arthrotomy and the outer shaver barrel as a cannula. This technique has the dual benefit of optimizing instrument access to the knee without large portal arthrotomies and reducing postoperative pain and swelling by minimizing fluid extravasation.

Comparative flexion after rotating-platform vs fixed-bearing total knee arthroplasty.

A retrospective review of rotating-platform (n = 113) and fixed-bearing (n = 100) total knee arthroplasties at a minimum 2-year follow-up was performed. All patients in both groups in this study had osteoarthritis and underwent surgery by 1 of the 2 senior authors at 1 of 2 institutions. A cruciate-retaining total knee arthroplasty was implanted with patellar resurfacing in all cases. The only difference between the 2 groups was the design of the tibial bearing and its tibial tray. Through minimization of confounding variables relating to pathology, surgeon, institution, soft-tissue balancing, and type of prosthesis, this study isolates articular design as a variable. We could not demonstrate any significant difference in knee flexion after either fixed-bearing or rotating-platform cruciate-retaining total knee arthroplasty.