Sensorimotor Features and Daily Living Skills in Autistic Children With and Without ADHD.

Attention-deficit/hyperactivity disorder (ADHD) commonly co-occurs in autistic children. However, additional research is needed to explore the differences in motor skills and sensory features in autistic children with and without ADHD, as well as the impacts of these factors on daily living skills (DLS). This observational study sought to fill this gap with 67 autistic children (6.14-10.84 years-old), 43 of whom had ADHD. Autistic children with ADHD demonstrated higher sensory features and lower motor skills than autistic children without ADHD. In examining autism and ADHD features dimensionally, we found that overall sensory features, seeking, and hyporesponsiveness were driven by both autism and ADHD features, whereas motor skills, enhanced perception, and hyperresponsiveness were driven by only autism features. Additionally, in using these dimensional variables of autism and ADHD features, we found that differences in motor skills, sensory and autism features, but not ADHD features, impact DLS of autistic children, with autism features and motor skills being the strongest individual predictors of DLS. Together, these results demonstrate the uniqueness of motor skills and sensory features in autistic children with and without ADHD, as well as how autism features, sensory features, and motor skills contribute to DLS, emphasizing the importance of a comprehensive understanding of each individual and complexities of human development when supporting autistic children.

The Adductor Sling Technique for Pediatric Medial Patellofemoral Ligament Reconstruction Better Resists Dislocation Loads When Compared With Adductor Transfer at Time Zero in a Cadaveric Model.

Purpose: To characterize the ability of the intact medial patellofemoral ligament (MPFL) and the adductor transfer and adductor sling MPFL reconstruction techniques to resist subluxation and dislocation in a cadaveric model. Methods: Nine fresh-frozen cadaveric knees were placed on a custom testing fixture with the femur fixed parallel to the floor, the tibia placed in 20° of flexion, and the patella attached to a load cell. The patella was displaced laterally, and subluxation load (in newtons), dislocation load (in newtons), maximum failure load (in newtons), patellar displacement at failure, and mode of failure were recorded. Testing was conducted with the MPFL intact and after the adductor sling and adductor transfer reconstruction techniques. Statistical analysis was completed using 1-way repeated-measures analysis of variance with the Holm-Sidák post hoc test. Results: The subluxation load was not significantly different between groups. The native MPFL dislocation load was significantly higher than the dislocation loads of both reconstruction techniques, but no significant difference between the dislocation loads of the 2 reconstruction techniques occurred. The native MPFL failure load was significantly higher than the failure loads of both reconstruction techniques. The adductor sling failure load was significantly higher than the adductor transfer failure load. The mode of failure varied across groups. The native MPFL failed by femoral avulsion, patellar avulsion, and midsubstance tear. The main mode of failure for adductor transfer was pullout, whereas failure for the adductor sling technique most often occurred at the sutures. Most of the native MPFLs and all adductor sling reconstructions failed after dislocation. The adductor transfer reconstructions were much more variable, with failures spanning from before subluxation through dislocation. Conclusions: Our cadaveric model showed that neither the adductor transfer technique nor the adductor sling technique restored failure load to that of the native condition. There was no significant difference in the subluxation or dislocation loads between the 2 MPFL reconstructions, but the adductor sling technique resulted in a higher load to failure. The adductor transfer technique frequently failed before subluxation or dislocation when compared with the adductor sling technique and the native MPFL. Clinical Relevance: The best technique for MPFL reconstruction in patients with open physes is a topic of debate. Given the long-term consequences of MPFL injury and potential for growth plate disturbance, it is important to study MPFL reconstruction techniques thoroughly, including in the laboratory setting.

Ultrasound-Guided Glenohumeral Corticosteroid Injection for the Treatment of Adhesive Capsulitis of the Shoulder: The Role of Clinical Stage in Response to Treatment.

BACKGROUND: Treatment for idiopathic adhesive capsulitis of the shoulder remains controversial. Stages 1 to 2 reflect an inflammatory process supporting a rationale for intra-articular glenohumeral joint corticosteroid injection to treat synovial inflammation and prevent progression to capsular fibrosis. HYPOTHESIS: We hypothesize that an intra-articular ultrasound-guided glenohumeral injection (USGI) of corticosteroid in patients diagnosed with Stage 1 or 2 idiopathic adhesive capsulitis will result in timely functional recovery and resolution of pain and stiffness. STUDY DESIGN: Case series. LEVEL OF EVIDENCE: Level 4. METHODS: Patients with Stage 1 or 2 idiopathic adhesive capsulitis treated with an intra-articular corticosteroid injection were included. Patients were seen by a single physician and diagnosed using history and physical examination with careful attention to measurement of glenohumeral range of motion (ROM). A total of 61 patients met inclusion criteria. ROM measurements documented in the patient charts were recorded in forward flexion, abduction, internal rotation, and external rotation in neutral abduction. All ROM measurements were performed pre- and postinjection. All patients were treated with an USGI of local anesthetic and depomedrol. Recovery criteria were defined as forward flexion, abduction, and external rotation within 15° of the contralateral side and internal rotation within 3 spinous process levels of the contralateral side. RESULTS: A total of 11 patients with Stage 1 and 50 patients with Stage 2 adhesive capsulitis comprised the final study cohort. Within the Stage 1 cohort, all 11 patients met recovery criteria for forward flexion and internal rotation (100%), 10 met recovery criteria for abduction (91%), and 8 met recovery criteria for external rotation (73%). Within the Stage 2 cohort, 31 patients met recovery criteria for forward flexion (62%), 30 met recovery criteria for abduction (60%), 36 met recovery criteria for internal rotation (72%), and 25 met recovery criteria for external rotation (50%). The difference in time to recovery in days was statistically significant in all ROM planes and was within 2 to 6 weeks for patients in Stage 1 and 7 to 10 weeks for Stage 2. CONCLUSION: USGI for early adhesive capsulitis allows patients to recover ROM more rapidly if performed early after onset of pain and stiffness. CLINICAL RELEVANCE: These results stress the importance of recognition of idiopathic adhesive capsulitis in its early stages and subsequent intervention with an intra-articular glenohumeral corticosteroid injection.

Characterization of FLOWERING LOCUS C 5 in Brassica rapa L.

Brassica rapa L., which includes Chinese cabbage, turnip, and pak choi, has more complex flowering time regulation than does Arabidopsis thaliana due to the presence of multiple paralogous flowering time genes. FLOWERING LOCUS C (FLC) is one of the key genes regulating the flowering time, and B. rapa has four FLC paralogs. BrFLC5 on the reference genome is deemed a pseudogene because of a mutation (from G to A) in the splice site of the third intron, but there are some accessions with a G nucleotide in the splice site. In this study, we genotyped 310 B. rapa accessions and found that 19 had homozygous and 81 had heterozygous putative functional BrFLC5 alleles. Accessions of turnip showed the highest proportion with a functional BrFLC5 allele. BrFLC5 acts as a floral repressor when overexpressed in A. thaliana. The BrFLC5 expression level varied in pre-vernalized plants, and this transcriptional variation was not associated with the G/A polymorphism in the third intron. Three accessions having a higher BrFLC5 expression in pre-vernalized plants had a 584-bp insertion in the promoter region. Many regions homologous to this 584-bp sequence are present in the B. rapa genome, and this 584-bp inserted region has tandem duplications of an AT-rich sequence in its central region. The possibility that a high expression of a functional BrFLC5 could contribute to producing premature bolting-resistant lines in B. rapa vegetables is discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s11032-023-01405-0.

Differences in the transcriptional immune response to Albugo candida between white rust resistant and susceptible cultivars in Brassica rapa L.

Albugo candida causing white rust disease decreases the yield of Brassica rapa vegetables greatly. Resistant and susceptible cultivars in B. rapa vegetables have different immune responses against A. candida inoculation, however, the mechanism of how host plants respond to A. candida is still unknown. Using RNA-sequencing, we identified differentially expressed genes (DEGs) between A. candida inoculated [48 and 72 h after inoculation (HAI)] and non-inoculated samples in resistant and susceptible cultivars of komatsuna (B. rapa var. perviridis). Functional DEGs differed between the resistant and susceptible cultivars in A. candida inoculated samples. Salicylic acid (SA) responsive genes tended to be changed in their expression levels by A. candida inoculation in both resistant and susceptible cultivars, but different genes were identified in the two cultivars. SA-dependent systemic acquired resistance (SAR) involving genes were upregulated following A. candida inoculation in the resistant cultivar. Particular genes categorized as SAR that changed expression levels overlapped between A. candida and Fusarium oxysporum f. sp. conglutinans inoculated samples in resistant cultivar, suggesting a role for SAR in defense response to both pathogens particularly in the effector-triggered immunity downstream pathway. These findings will be useful for understanding white rust resistance mechanisms in B. rapa.

Corrigendum: Will epigenetics be a key player in crop breeding?

[This corrects the article DOI: 10.3389/fpls.2022.958350.].

The Relationship Between Maximum Shoulder Horizontal Abduction and Adduction on Peak Shoulder Kinetics in Professional Pitchers.

BACKGROUND: Repetitive horizontal shoulder abduction during pitching can cause increased contact between the posterosuperior aspect of the glenoid and the greater tuberosity of the humeral head, theoretically putting baseball pitchers at increased risk of shoulder internal impingement and other shoulder pathologies. HYPOTHESIS: Increased shoulder horizontal abduction is associated with increased shoulder anterior force, while increased horizontal adduction is associated with increased shoulder distraction force. STUDY DESIGN: Descriptive laboratory study. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 339 professional baseball pitchers threw 8 to 10 fastball pitches using 3D motion capture (480 Hz). Pitchers were divided into 2 sets of quartiles based on maximum shoulder horizontal abduction and adduction. Elbow flexion, shoulder external rotation, and peak shoulder kinetics were compared between quartiles with post hoc linear regressions conducted for the entire cohort. RESULTS: At maximum shoulder horizontal abduction, there was no difference in ball velocity between quartiles (P = 0.76). For every 10º increase in maximum shoulder horizontal abduction, shoulder anterior force decreased by 2.2% body weight (BW) (P < 0.01, B = -0.22, ß = -0.38), shoulder adduction torque decreased by 0.5%BW × body height (BH) (P < 0.01, B = -0.05, ß = -0.19), and shoulder horizontal adduction torque decreased by 0.4%BW × BH (P < 0.01, B = -0.04, ß = -0.48). For every 10º increase in maximum shoulder horizontal adduction, shoulder anterior force increased by 2%BW and ball velocity decreased by 1.2 m/s (2.7 MPH). CONCLUSION: Professional pitchers with the least amount of maximum horizontal adduction had faster ball velocity and decreased shoulder anterior force. Pitchers with greater maximum shoulder horizontal abduction had decreased shoulder anterior force, shoulder adduction torque, and shoulder horizontal adduction torque. To maximize ball velocity as a performance metric while minimizing shoulder anterior force, pitchers can consider decreasing maximum shoulder adduction angles at later stages of the pitch. CLINICAL RELEVANCE: Identifying risk factors for increased throwing shoulder kinetics (ie, shoulder anterior force, shoulder adduction torque) has potential implications in injury prevention. Specifically, mitigating shoulder anterior forces may be beneficial in reducing risk of injury.

Will epigenetics be a key player in crop breeding?

If food and feed production are to keep up with world demand in the face of climate change, continued progress in understanding and utilizing both genetic and epigenetic sources of crop variation is necessary. Progress in plant breeding has traditionally been thought to be due to selection for spontaneous DNA sequence mutations that impart desirable phenotypes. These spontaneous mutations can expand phenotypic diversity, from which breeders can select agronomically useful traits. However, it has become clear that phenotypic diversity can be generated even when the genome sequence is unaltered. Epigenetic gene regulation is a mechanism by which genome expression is regulated without altering the DNA sequence. With the development of high throughput DNA sequencers, it has become possible to analyze the epigenetic state of the whole genome, which is termed the epigenome. These techniques enable us to identify spontaneous epigenetic mutations (epimutations) with high throughput and identify the epimutations that lead to increased phenotypic diversity. These epimutations can create new phenotypes and the causative epimutations can be inherited over generations. There is evidence of selected agronomic traits being conditioned by heritable epimutations, and breeders may have historically selected for epiallele-conditioned agronomic traits. These results imply that not only DNA sequence diversity, but the diversity of epigenetic states can contribute to increased phenotypic diversity. However, since the modes of induction and transmission of epialleles and their stability differ from that of genetic alleles, the importance of inheritance as classically defined also differs. For example, there may be a difference between the types of epigenetic inheritance important to crop breeding and crop production. The former may depend more on longer-term inheritance whereas the latter may simply take advantage of shorter-term phenomena. With the advances in our understanding of epigenetics, epigenetics may bring new perspectives for crop improvement, such as the use of epigenetic variation or epigenome editing in breeding. In this review, we will introduce the role of epigenetic variation in plant breeding, largely focusing on DNA methylation, and conclude by asking to what extent new knowledge of epigenetics in crop breeding has led to documented cases of its successful use.

An Analysis of Extensor Carpi Ulnaris Groove Morphology and Tendon Instability.

BACKGROUND: The extensor carpi ulnaris (ECU) tendon has a distinct subsheath at the distal ulna. Symptomatic tears of this subsheath and subluxation of the ECU tendon often require reconstruction. We sought to determine the anatomical constraints of the ECU subsheath. METHODS: The ECU subsheath was exposed on 12 fresh-frozen upper extremities. The tip of the ulnar styloid, the distal ulnar joint surface, and the proximal extent of the distal radio-ulnar joint were identified and dimensions measured. Subluxation of the tendon was then assessed with and without an intact subsheath in 9 specimens. The travel of the tendon was measured in pronation through supination and flexion before and after sectioning of the subsheath. RESULTS: The ECU subsheath is 8.9 mm (standard deviation [SD] = 0.8 mm) wide proximally and 9.0 mm (SD = 1.2 mm) distally. The distal ulnar insertion is 0.5 mm (SD = 0.8 mm) proximal to the tip of the styloid, and stretches 10.2 mm (SD = 2.7 mm) proximally. From maximum pronation to maximum supination and flexion, the ECU tendon traveled 3.32 mm (SD = 4.24) medially when the subsheath was intact and 5.42 mm (SD = 5.0 mm) after sectioning. The maximum depth of the ulnar groove was 2.5 mm (1.59-3.56 mm). There was no significant association between changes in ECU subluxation and the depth of the ECU groove (Spearman's rho = 0.25). CONCLUSION: The ECU subsheath is roughly 1 cm square stretching proximally from the ulnar styloid. ECU groove depth is not a significant independent predictor of tendon subluxation.

The Transcription Factors TaTDRL and TaMYB103 Synergistically Activate the Expression of TAA1a in Wheat, Which Positively Regulates the Development of Microspore in Arabidopsis.

Pollen fertility plays an important role in the application of heterosis in wheat (Triticum aestivum L.). However, the key genes and mechanisms underlying pollen abortion in K-type male sterility remain unclear. TAA1a is an essential gene for pollen development in wheat. Here, we explored the mechanism involved in its transcriptional regulation during pollen development, focusing on a 1315-bp promoter region. Several cis-acting elements were identified in the TAA1a promoter, including binding motifs for Arabidopsis thaliana AtAMS and AtMYB103 (CANNTG and CCAACC, respectively). Evolutionary analysis indicated that TaTDRL and TaMYB103 were the T. aestivum homologs of AtAMS and AtMYB103, respectively, and encoded nucleus-localized transcription factors containing 557 and 352 amino acids, respectively. TaTDRL and TaMYB103 were specifically expressed in wheat anthers, and their expression levels were highest in the early uninucleate stage; this expression pattern was consistent with that of TAA1a. Meanwhile, we found that TaTDRL and TaMYB03 directly interacted, as evidenced by yeast two-hybrid and bimolecular fluorescence complementation assays, while yeast one-hybrid and dual-luciferase assays revealed that both TaTDRL and TaMYB103 could bind the TAA1a promoter and synergistically increase its transcriptional activity. Furthermore, TaTDRL-EAR and TaMYB103-EAR transgenic Arabidopsis plants displayed abnormal microspore morphology, reduced pollen viability, and lowered seed setting rates. Additionally, the expression of AtMS2, a TAA1a homolog, was significantly lower in the two repressor lines than in the corresponding overexpression lines or WT plants. In summary, we identified a potential transcriptional regulatory mechanism associated with wheat pollen development.

Does Ligamentous Laxity Protect Against Chondral and Osteochondral Injuries in Patients With Patellofemoral Instability?

Background: Many patients undergoing medial patellofemoral ligament (MPFL) reconstruction for patellofemoral instability have chondral or osteochondral injuries requiring treatment. Hypothesis: In patients undergoing MPFL reconstruction for patellofemoral instability, those with ligamentous laxity (LAX) would be less likely to have chondral or osteochondral defects requiring surgical intervention compared with those with no laxity (NLX). Study Design: Cohort study; Level of evidence, 2. Methods: Included were 171 patients with patellofemoral instability (32 men, 139 women; mean age, 22 years [range, 11-57 years]) who underwent MPFL reconstruction between 2005 and 2015. Patients with a Beighton-Horan score ≥5 were considered LAX (n = 96), while patients with scores <5 were considered NLX (n = 75). Preoperative magnetic resonance images were evaluated to determine the presence, size, and location of chondral or osteochondral injury as well as the grade according to the Outerbridge classification. Documented anatomic measurements included tibial tubercle-trochlear groove (TT-TG) distance, Caton-Deschamps Index (CDI) for patellar height, and the Dejour classification for trochlear dysplasia. Results: Of the 171 patients, 58 (34%) required a surgical intervention for a chondral or osteochondral defect: chondroplasty (29/58; 50%), particulated juvenile cartilage implantation (18/58; 31%), microfracture (16/58; 28%), osteochondral fracture fixation (2/58; 3.4%), and osteochondral allograft (2/58; 3.4%). While there was no statistical difference in the proportion of patellar chondral or osteochondral injuries between patients with NLX (58%) versus LAX (67%) (P = .271), there was a significantly higher rate of patellar grade 3 or 4 injuries in the NLX (74%) versus LAX (45%) group (P = .004). Similarly, there was no difference in femoral chondral or osteochondral injury rates between groups (P = .132); however, femoral grade 3 or 4 injuries were significantly higher in the NLX (67%) versus the LAX (13%) group (P = .050). After adjusting for age, sex, radiographic parameters (TT-TG distance and CDI), and trochlear morphology, patients with LAX were 75% less likely to have had a grade 3 or 4 patellar cartilage injury compared with patients with NLX (P = .006). Conclusion: For patients who sustained patellar or femoral chondral or osteochondral injuries, compared with their counterparts with NLX, patients with LAX were less likely to have severe (grade 3 or 4) injuries requiring surgical intervention.

Kinematic and kinetic analyses of professional pitchers with history of core or groin injuries: A propensity-score matched analysis.

Background: Core injuries in professional baseball pitchers have been linked to both diminished performance and time missed during the season injury was sustained. It is currently unclear how a history of a core injury may affect the future pitching performance and mechanics of professional baseball pitchers. Purpose: To compare kinetic and kinematic variables between professional baseball pitchers with prior core/groin injuries and those without prior injury. Study design: Descriptive laboratory study. Methods: Professional baseball pitchers with a history of core injury pitched 8-12 fastball pitches while evaluated with 3D-motion capture (480 Hz). Inclusion criteria necessitated that the core injury occurred within one to four-years prior to biomechanical evaluation and that the core injury required time off from professional play for a minimum of 2 weeks and maximum of 3 months. These pitchers were 4:1 propensity-scored matched by age, height, weight, and handedness to pitchers with no prior injury history (control). Twenty kinematic and eleven normalized and non-normalized kinetic parameters were compared between groups using appropriate parametric testing. Sub-analysis of pitchers with distinct core muscle and spinal injuries were also analyzed. Results: The No Prior Injury (NPI) subgroup (n = 76) had significantly less elbow flexion at ball release (31 ± 5° vs. 35 ± 6° respectfully, p = 0.044) compared to the Core Musculature/Soft Tissue subgroup (CM/ST, n = 10), with no significant difference in kinematics for other injury groups (p > 0.05). The General Core/Groin injury group (GCG, n = 19) had significantly greater normalized elbow anterior force (43.9 ± 4.7 vs. 40.0 ± 5.2 %BodyWeight[BW], p = 0.006) and elbow flexion torque (4.3 ± 0.5 vs. 3.8 ± 0.5 %BWxBodyHeight[BH], p = 0.001) than the NPI pitchers. CM/ST had significantly greater normalized elbow anterior force (p = 0.031), elbow flexion torque (p = 0.002), and shoulder adduction torque (p = 0.007) than NPI pitchers. Conclusion: Professional baseball pitchers with prior core/groin injuries demonstrated increased elbow anterior force and elbow flexion torque compared to pitchers with no prior core injuries. One possible explanation for this finding includes inadequate recruitment and utilization of the lower extremities as a component of the kinetic chain leading to compensation at the level of the throwing arm. Whether these kinetic differences arise as a consequence of injury or present a risk for such warrants additional investigation.

Particulated Juvenile Articular Cartilage and Matrix-Induced Autologous Chondrocyte Implantation Are Cost-Effective for Patellar Chondral Lesions.

PURPOSE: To compare the cost-effectiveness of nonoperative management, particulated juvenile allograft cartilage (PJAC), and matrix-induced autologous chondrocyte implantation (MACI) in the management of patellar chondral lesions. METHODS: A Markov model was used to evaluate the cost-effectiveness of three strategies for symptomatic patellar chondral lesions: 1) nonoperative management, 2) PJAC, and 3) MACI. Model inputs (transition probabilities, utilities, and costs) were derived from literature review and an institutional cohort of 67 patients treated with PJAC for patellar chondral defects (mean age 26 years, mean lesion size 2.7 cm2). Societal and payer perspectives over a 15-year time horizon were evaluated. The principal outcome measure was the incremental cost-effectiveness ratio (ICER) using a $100,000/quality-adjusted life year (QALY) willingness-to-pay threshold. Sensitivity analyses were performed to assess the robustness of the model and the relative effects of variable estimates on base case conclusions. RESULTS: From a societal perspective, nonoperative management, PJAC, and MACI cost $4,140, $52,683, and $83,073 and were associated with 5.28, 7.22, and 6.92 QALYs gained, respectively. PJAC and MACI were cost-effective relative to nonoperative management (ICERs $25,010/QALY and $48,344/QALY, respectively). PJAC dominated MACI in the base case analysis by being cheaper and more effective, but this was sensitive to the estimated effectiveness of both strategies. PJAC remained cost-effective if PJAC and MACI were considered equally effective. CONCLUSIONS: In the management of symptomatic patellar cartilage defects, PJAC and MACI were both cost-effective compared to nonoperative management. Because of the need for one surgery instead of two, and less costly graft material, PJAC was cheaper than MACI. Consequently, when PJAC and MACI were considered equally effective, PJAC was more cost-effective than MACI. Sensitivity analyses accounting for the lack of robust long-term data for PJAC or MACI demonstrated that the cost-effectiveness of PJAC versus MACI depended heavily on the relative probabilities of yielding similar clinical results. LEVEL OF EVIDENCE: III, economic and decision analysis.

Elbow varus torque and ball velocity associations in high school and professional pitchers with increased sagittal-plane trunk tilt.

BACKGROUND: Increased sagittal-plane trunk tilt is thought to increase drive in the anterior direction toward home plate, transferring energy from the trunk to the distal upper extremity, ultimately generating greater ball velocity. Increased sagittal trunk tilt has also been implicated in the risk of upper-extremity joint loading in baseball pitchers by way of elbow varus torque (EVT), a metric previously associated with elbow injury in professional pitchers. The purposes of this study were (1) to compare sagittal trunk tilt positioning between high school and professional pitchers throughout the pitch and (2) to identify the potential associations between sagittal-plane trunk tilt, ball velocity, and EVT for both cohorts. METHODS: Professional and high school pitchers were instructed to throw fastballs while being evaluated with 3-dimensional motion capture (480 Hz). Sagittal trunk tilt motion throughout the pitching motion was compared between cohorts from maximum knee height to maximum shoulder internal rotation. To assess the effects of sagittal-plane trunk tilt on ball velocity and EVT, linear mixed-effect models were created. RESULTS: Professional pitchers (n = 100, 882 pitches) achieved greater sagittal trunk tilt than high school pitchers (n = 57, 519 pitches) during early portions of the pitching motion, including maximum positive sagittal trunk tilt (46.6° ± 8.3° vs. 43.6° ± 10.2°, P = .042). Professional pitchers also had greater sagittal trunk tilt excursion throughout the pitch motion (68.0° ± 11.4° vs. 62.5° ± 11.0°, P = .004). For every 10° increase in sagittal trunk tilt at ball release for professional pitchers, ball velocity increased by 0.36 m/s (B = 0.036 and ß = 0.194, P < .001) or 0.9% average ball velocity whereas EVT increased by 0.14% body weight × body height (B = 0.014 and ß = 0.159, P < .001) or 2.9% average normalized EVT. For every 10° increase in sagittal trunk tilt at ball release for high school pitchers, ball velocity increased by 0.34 m/s (B = 0.097 and ß = 0.025, P = .025) or 1.1% average ball velocity whereas EVT increased by 0.07% body weight × body height (B = 0.007 and ß = 0.086, P = .016) or 1.7% average normalized EVT. CONCLUSION: Increased positive sagittal-plane trunk tilt was significantly associated with greater ball velocity and increased EVT for both professional and high school pitchers. Peak EVT estimates were consistently more pronounced than ball velocity benefits for both populations, suggesting that no specific time point may provide a ball velocity benefit while concomitantly minimizing EVT. Both professional and high school pitchers should consider this trade-off, which may influence injury risk, when engaging in higher degrees of positive sagittal-plane trunk tilt.

Combined MPFL Reconstruction with Tibial Tubercle Osteotomy and Repair of Patellar Cartilage Defect with Particulated Juvenile Articular Cartilage.

Medial patellofemoral ligament (MPFL) reconstruction with tibial tubercle osteotomy (TTO) and particulated juvenile articular cartilage (PJAC) grafting can be performed in combination for the treatment of recurrent patellar instability with associated patellar cartilaginous defects. Description: Preoperative planning is an essential component for this procedure. Measurement of the tibial tubercle to trochlear groove (TT-TG) distance and the Caton-Deschamps index (CDI) allows for determination of the degree of medial and anterior translation and helps to identify whether distalization is necessary. The procedure begins with a thorough examination under anesthesia to determine range of motion, patellar tracking, translation, and tilt. A diagnostic arthroscopy is performed, at which time patellar tracking is again assessed and the patellar and trochlear cartilage are evaluated. A medial parapatellar incision is made, and the layer between the capsule and retinaculum is identified. This layer will serve as the location for the MPFL graft passage. The medial patella is decorticated to prepare for graft fixation. The patella is then everted, and the cartilaginous defect is prepared and sized. The PJAC graft is prepared on the back table based on these measurements. The MPFL graft is then anchored to the decorticated medial patella. Attention is then turned to performing the TTO. The patellar tendon is isolated and protected. The osteotomy shingle is created with a combination of sagittal saw and osteotomes, followed by shingle translation and fixation. Attention is then turned to performing the MPFL graft fixation on the femur. An incision is made, the area of the sulcus between the medial epicondyle and adductor tubercle is identified, and a pin is placed. Graft isometry is assessed, pin placement is confirmed, and a socket is created. After thorough irrigation, the patella is then everted and the PJAC graft is implanted and set with fibrin glue. Finally, the MPFL graft is passed through the previously identified layer and docked into the medial femur at its isometric point. Alternatives: Nonoperative treatment of first-time patellar instability can often include physical therapy, bracing, and activity modification. However, recurrence rates can be high, especially in a subset of high-risk patients with characteristics such as age of <25 years, trochlear dysplasia, patella alta, and coronal plane malalignment. For patients with recurrent patellar instability, a well-executed MPFL reconstruction restores stability while the TTO serves to unload the lateral and/or inferior patellar cartilage and correct osseous malalignment. Additional techniques, such as a distal femoral osteotomy and trochleoplasty, have been suggested to address patellar tracking and trochlear dysplasia. For patients who have sustained cartilaginous injury from their previous dislocations, PJAC can be utilized to restore the patellofemoral cartilage. Alternative operative treatments of cartilaginous defects include matrix-induced autologous chondrocyte implantation (MACI), mosaicplasty, osteochondral allograft, microfracture, and-in later stages of disease-patellofemoral arthroplasty. Rationale: The MPFL is an important medial stabilizer in the knee, with high rates of injury in patients who have experienced patellar instability. When an MPFL reconstruction is combined with a TTO, it can stabilize the patella while simultaneously correcting osseous malalignment and unloading the patellofemoral joint. Additionally, use of PJAC is advantageous for patients with patellar chondral defects because it is a single-stage technique, has low technical difficulty, and can be customized to accommodate large lesions. Expected Outcomes: MPFL in combination with TTO and PJAC provides patellar stabilization and overall improvements in pain and function, with low rates of recurrent instability. A recent study by Franciozi et al. showed significant improvement in functional outcome scores at a minimum of 2 years with no recurrent subluxations or dislocations1. Another study by Krych et al. showed an 83% rate of return to sport in patients who underwent MPFL reconstruction combined with TTO2. With respect to PJAC grafts, a study by Grawe et al. assessed the maturation of PJAC implanted into patellar chondral defects, demonstrating that the matured grafts paralleled the characteristics of the surrounding native cartilage. In addition, the authors reported that 73% of patients who completed follow-up magnetic resonance imaging at 2 years postoperatively had good defect fill, defined as >66%3. Important Tips: A lateral release may be necessary if the patella is unable to be everted parallel with the table. Typically, 80% of patients with instability do not need a lateral release, whereas 80% of patients with malalignment and isolated patellar osteoarthritis do need a release.MPFL graft isometry should be assessed by manually placing the patella in the center of the trochlea and flexing the knee to roughly 70°. The graft should slacken in subsequent deeper flexion and should never tighten.When customizing the TTO to obtain the necessary anatomic alignment, the surgeon can achieve additional medialization by dropping their hand to create a flatter cut, while additional anteriorization can be created with a steeper cut.Once the cartilage defect has been prepared and measured, a mold can be created to allow for concomitant PJAC preparation on the back table earlier in the procedure. Acronyms and Abbreviations: TT-TG = tibial tubercle to trochlear groove distanceMPFL = medial patellofemoral ligamentTTO = tibial tubercle osteotomyPJAC = particulated juvenile articular cartilageMACI = matrix-induced autologous chondrocyte implantationOR = operating roomIV = intravenousK-wires = Kirschner wiresCPM = continuous passive motionMRI = magnetic resonance imagingOA = osteoarthritisASA = acetylsalicylic acid (aspirin)DVT = deep vein thrombosisPPX = prophylaxisNWB = non-weight-bearingFWB = full weight-bearingPOD = postoperative day.

Evaluation and management of patellar instability.

Patellar instability is a common clinical problem that primarily affects the adolescent and young adult population. The demographic and anatomic risk factors that predispose patients to patellar instability are multifactorial and include young age, female sex, trochlear dysplasia, elevated tibial tubercle to trochlear groove distance (TT-TG), patella alta, femoral and tibial malalignment, ligamentous laxity, and lack of neuromuscular control. There have been substantial efforts to predict which patients who sustain a first-time dislocation will go on to incur additional dislocations. This is particularly important because with each dislocation event, there is a significant risk of injury to the patellofemoral joint including both medial patellofemoral ligament (MPFL) stretch or rupture and damage to the cartilage which can range from simple fissures to full-thickness cartilage defects and osteochondral fractures. Prediction models have demonstrated that amongst first time dislocators, young patients with trochlear dysplasia are at the highest risk for redislocation. The current standard of care for treatment of first-time dislocators without a loose body or osteochondral fracture is nonoperative management. However, recently there has been a focus on implementing a risk-stratified approach to the surgical indications for a first-time dislocator as the high-risk population might be better treated with early surgical stabilization to prevent or reduce their risk of recurrent dislocation and its associated morbidity. Likewise, for patients with recurrent dislocations, it remains to be determined whether an isolated MPFL reconstruction is sufficient for high-risk patients with several poor prognostic risk factors or if bony realignment procedures should be implemented concurrently.

Rice hybrid mimics have stable yields equivalent to those of the F1 hybrid and suggest a basis for hybrid vigour.

MAIN CONCLUSION: We have developed long term stable high yielding rice lines, Hybrid Mimics, from commercial hybrids. The vigour of the Mimic and the hybrid are developmental changes. These Mimics could substitute for hybrid seed for planting. We have used two pre-existing high-yielding hybrid systems (FLY1 and DY527) to develop Hybrid Mimics. In the FLY1 hybrid system we selected, under field conditions, F6 lines which have high grain yields and biomass equivalent to the F1 hybrids, stable over subsequent F7, F8 and later generations. We have termed these lines Hybrid Mimics. The mimics are mostly homozygous as a consequence of selfing in each generation. We have repeated this selection procedure in the second independent hybrid system DY527, producing Mimics with similar characteristics to the F1 hybrid. In both hybrid systems the selection criterion, based on the phenotype of the F1 hybrid, results in the Mimics having grain yield and biomass similar to that of the F1 hybrid. In each generation of the breeding program the plant population has increased phenotypic homogeneity. The genomes of the Mimic plants do not contain any common heterozygous segments negating claims that the vigour of hybrids depends upon heterozygosity of particular loci. Both hybrids and Mimics have early germination and commence photosynthesis before the parents, providing enhanced growth which is maintained throughout the life cycle. The biochemical parameters of photosynthesis in the hybrids and Mimics do not differ from those of the parents. Grain quality and resistance to the two major diseases, bacterial blight and rice blast are similar in the Mimics and hybrids. The Mimics overcome the major disadvantage of hybrids where F2 phenotypic segregation prevents their use as a crop beyond the F1 generation.