Mechanical assessment of two different methods of tripling hamstring tendons when using suspensory fixation.

PURPOSE: To investigate two different methods of suture fixation and tendon behaviour when using an Endobutton and a tripled tendon. METHODS: Thirty bovine tendons and foam blocks were randomly allocated to three groups: group 1: The tendon was doubled through 40-mm Endobutton; group 2: Tripled tendon--whip-stitched with No. 2 Ultrabraid, passed through an Endobutton and third limb secured to the loop via seven knots; and group 3: Tripled tendon--whip-stitched with No. 2 Fibreloop and fixed as group 2. A tunnel matching the graft diameter was drilled through the block. The graft was passed through the tunnel and fixed with an interference screw. The constructs were cycled at 1 Hz from 10 to 50 N for 10 cycles followed by 50-250 N at 1 Hz for 500 cycles. Load-to-failure test was then carried out at a rate of 20 mm/min. A custom digital image capture technique was used to measure and calculate displacement, strain and stress. Statistical analysis was carried out using Kruskal-Wallis test and paired t test. RESULTS: There was no statistical significant difference between ultimate tensile strength (UTS) (P = 0.35) and yield load (0.41) between the 3 groups. The mean displacement of the third tendon limb in group 2 was 4.8 mm and in group 3, 1.5 mm. Displacement was not statistically significant (P = 0.07). The mean stress in the third limb versus the doubled portion of tendon in group 2 was 0.4 ± 0.02 versus 4.8 ± 0.52 MPa and in group 3, 0.5 ± 0.03 versus 5.2 ± 0.52 MPa. CONCLUSIONS: In this biomechanical study, there was no mechanical difference in the overall properties between a doubled and tripled tendon graft. Significant cyclic elongation occurred in the third limb of the tripled tendon in comparison with the doubled portioned. Further work is needed to determine whether these mechanical findings translate to clinical practice. Caution should be used when tripling hamstring grafts. In particular, tripling small grafts provides no biomechanical advantage immediately and possibly long term, thus potentially increasing the risk of failure.

Objectively characterizing Huntington's disease using a novel upper limb dexterity test.

BACKGROUND: The Clinch Token Transfer Test (C3t) is a bi-manual coin transfer task that incorporates cognitive tasks to add complexity. This study explored the concurrent and convergent validity of the C3t as a simple, objective assessment of impairment that is reflective of disease severity in Huntington's, that is not reliant on clinical expertise for administration. METHODS: One-hundred-and-five participants presenting with pre-manifest (n = 16) or manifest (TFC-Stage-1 n = 39; TFC-Stage-2 n = 43; TFC-Stage-3 n = 7) Huntington's disease completed the Unified Huntington's Disease Rating Scale and the C3t at baseline. Of these, thirty-three were followed up after 12 months. Regression was used to estimate baseline individual and composite clinical scores (including cognitive, motor, and functional ability) using baseline C3t scores. Correlations between C3t and clinical scores were assessed using Spearman's R and visually inspected in relation to disease severity using scatterplots. Effect size over 12 months provided an indication of longitudinal behaviour of the C3t in relation to clinical measures. RESULTS: Baseline C3t scores predicted baseline clinical scores to within 9-13% accuracy, being associated with individual and composite clinical scores. Changes in C3t scores over 12 months were small ([Formula: see text] ≤ 0.15) and mirrored the change in clinical scores. CONCLUSION: The C3t demonstrates promise as a simple, easy to administer, objective outcome measure capable of predicting impairment that is reflective of Huntington's disease severity and offers a viable solution to support remote clinical monitoring. It may also offer utility as a screening tool for recruitment to clinical trials given preliminary indications of association with the prognostic index normed for Huntington's disease.

An application of the Dempster-Shafer theory of evidence to the classification of knee function and detection of improvement due to total knee replacement surgery.

This paper utilises a novel method for the classification of subjects with osteoarthritic and normal knee function. The classification method comprises a number of different components. Firstly, the method exploits the Dempster-Shafer theory of evidence allowing for a degree of ignorance in the subject's classification, i.e., a level of uncertainty as to whether a gait variable indicates osteoarthritis or not. Secondly, the inclusion of simplex plots allows both the classification of a subject, and the contribution of each associated gait variable to that classification, to be represented visually. As a result, the method is further able to highlight periodic changes in a subject's knee function due to total knee replacement surgery and subsequent recovery. The visual representation enables a simple clinical interpretation of the results from the quantitative analysis.

Objective classification of scapular kinematics in participants with movement faults of the scapula on clinical assessment.

The aim of this study was to assess the potential of employing a classification tool to objectively classify participants with clinically assessed movement faults (MFs) of the scapula. Six participants with a history of shoulder pain with MFs of the scapula and 12 healthy participants with no movement faults (NMFs) performed a flexion movement control test of the scapula, while scapular kinematic data were collected. Principal component scores and discrete kinematic variables were used as input into a classifier. Five out of the six participants with a history of pain were successfully classified as having scapular MFs with an accuracy of 72%. Variables related to the upward rotation of the scapula had the most influence on the classification. The results of the study demonstrate the potential of adopting a multivariate approach in objective classification of participants with altered scapular kinematics in pathological groups.

Recovery of crustacean zooplankton communities from acidification in Killarney Park, Ontario, 1971-2000: pH 6 as a recovery goal.

Despite reductions in atmospheric SO4(2-) deposition and resultant decreases in surface water acidity, widespread biological recovery from acidification has not yet been documented. Temporal trends in crustacean zooplankton species richness (number of species) and composition were examined between 1971-2000 in 46 Killarney Park lakes, Ontario, Canada, to assess the degree of biological recovery in lakes with significant water quality improvements, i.e. pH now > 6, compared to 2 other groups: i) lakes which never acidified; and ii) lakes which are still acidified (pH < 6). Time trends in species richness could not be distinguished among the 3 groups of lakes, nor did changes in species richness indicate recovery. In contrast, the zooplankton community composition of lakes in which the pH increased to above 6, as measured by a multivariate index of species abundances, changed from a "damaged" state to one typical of neutral lakes. Some recovery in composition was also documented for the acidic lakes. While still acidic, the pH levels of these lakes have risen. The extent and pace of recovery in Killarney Provincial Park bodes well for the future of other acidified regions in North America and Europe.