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Primary ACL reconstruction using the LARS device is associated with a high failure rate at minimum of 6-year follow-up
Purpose
The Ligament Augmentation and Reconstruction System (LARS
®
) is a synthetic ligament consisting of fibres made of polyethylene terephthalate. Despite the LARS being used as an anterior cruciate ligament (ACL) device for nearly 30 years and the well-documented complications from earlier synthetic ligament designs, there is a paucity of published medium- to long-term results. The aim of this study is to report the clinical and functional outcomes after ACL reconstruction using the LARS at a minimum follow-up of 6 years.
Methods
Results of a single surgeon’s entire cohort of 55 patients who underwent primary LARS ACL surgery were reviewed at a median of 7.8 years (6.0–9.4). Patient-reported outcome measures including the International Knee Documentation Committee (IKDC) score and 36-Item Short Form Health Survey (SF-36) were collected and clinical assessment consisted of range of motion (ROM) and the KT-1000 arthrometer to assess the side–side difference in the operative and non-operative knee. Mechanical failures of the graft were confirmed at revision surgery and a survivorship analysis was performed using the Kaplan–Meier method.
Results
The overall mechanical failure rate was 17/51 (33.3%) with ruptures occurring at a median 3.9 years (0.6–8.8 years) following primary LARS ACL surgery. Secondary operative procedures were performed in 39.2% of patients. For intact grafts, there was no statistically significant difference is side-to-side ROM or anterior knee laxity and subjective scores revealed a median IKDC subjective score of 85.1 (26.4–100) and SF-36 physical component score of 94.1.
Conclusion
The rates of LARS ACL construct failure (33.3%) in this cohort are high and based on these results the LARS should not be considered as a graft option for primary ACL reconstruction.
Level of evidence
III, cohort study.
Journal Article
The Role of Lateral Extra-articular Tenodesis in Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review With Meta-analysis and Best-Evidence Synthesis
Background:
The role of lateral extra-articular tenodesis (LEAT) to augment primary anterior cruciate ligament reconstruction (ACLR) remains controversial.
Purpose:
To determine whether the addition of LEAT to primary ACLR provides greater control of rotational laxity and improves clinical outcomes compared with ACLR alone and to assess the impact of early versus delayed ACLR.
Study Design:
Systematic review; Level of evidence, 3.
Methods:
Two reviewers independently searched 7 databases for randomized and nonrandomized clinical studies comparing ACLR plus LEAT versus ACLR alone. Animal, cadaveric, and biomechanical studies; revision or repair procedures; and studies using synthetic ligaments and multiligamentous-injured knees were excluded. Risk of bias was assessed with a modified Downs and Black checklist. The primary outcome was postoperative pivot shift. These data were pooled by use of a fixed-effects meta-analysis model. The studies were divided into delayed (>12 months) and early (≤12 months) reconstruction groups for meta-analysis. A best-evidence synthesis was performed on the remaining outcome measures.
Results:
Of 387 titles identified, 11 articles were included (5 of high quality). Meta-analysis of postoperative pivot shift in 3 studies of delayed primary ACLR showed a statistically significant difference for the pivot-shift test in favor of ACLR with LEAT (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.24-0.81; P = .008; I
2 = 0). Meta-analysis of 5 studies of early primary ACLR found no statistically significant difference with the addition of LEAT (OR, 0.60; 95% CI, 0.33-1.09; P = .10; I
2 = 33%). Insufficient evidence was available to determine whether the addition of LEAT had any effect on clinical, objective, subjective, and functional outcomes.
Conclusion:
In primary ACLR, no evidence is available showing additional benefit of LEAT in reducing the postoperative pivot shift in early reconstructions (≤12 months); however, LEAT may have a role in delayed ACLR. Strong evidence exists that a combined ACLR and LEAT reduces lateral femoral translation, but there is insufficient evidence to identify any benefit for other clinical outcomes.
Journal Article
Single-Leg Squat After Anterior Cruciate Ligament Reconstruction: An Analysis of the Knee Valgus Angle at 6 and 12 Months
Background:
Deficits in neuromuscular control are common after anterior cruciate ligament (ACL) reconstruction and may be associated with further knee injury. The knee valgus angle during a single-leg squat (SLS) is one measure of neuromuscular performance.
Purpose:
To determine whether the knee valgus angle during SLS changes between 6 and 12 months after ACL reconstruction and to assess how the operative knee valgus angle compares with that of the contralateral side.
Study Design:
Case series; Level of evidence, 4.
Methods:
A cohort of 100 patients with uninjured contralateral knees were assessed at 6 and 12 months after primary hamstring autograft ACL reconstruction. Participants performed the SLS on each leg, and the knee valgus angle was measured via frame-by-frame video analysis at 30° of flexion and at each patient’s maximum knee flexion angle.
Results:
For the operative limb at 30° of flexion, a small but statistically significant reduction was noted in the valgus angle between 6 and 12 months (5.46° vs 4.44°; P = .002; effect size = 0.24). At 6 months, a slightly higher valgus angle was seen in the operative limb compared with the nonoperative limb (5.46° vs 4.29°; P = .008; effect size = 0.27). At maximum flexion, no difference was seen between limbs in the valgus angle at either 6 or 12 months, and no change was seen in the operative limb between 6 and 12 months. At 6 months and 30° of knee flexion, 13 patients had a valgus angle greater than 10°. This group also had a higher mean valgus angle in the contralateral limb compared with the contralateral limb in the other 87 patients (8.5° vs 3.65°; P < .001).
Conclusion:
During a controlled SLS, the knee valgus angle remained essentially constant, and minimal limb asymmetries were present over the 6- to 12-month postoperative period, a time when athletes typically increase their activity levels. Whether changes or asymmetries will be seen with more dynamically challenging tasks remains to be determined. When present, high valgus angles were commonly bilateral.
Journal Article
Comparison of the Source and Quality of Information on the Internet Between Anterolateral Ligament Reconstruction and Anterior Cruciate Ligament Reconstruction: An Australian Experience
Background:
The internet is a valuable tool, but concerns exist regarding the quality and accuracy of medical information available online.
Purpose:
To evaluate the source and quality of information on the internet relating to anterolateral ligament reconstruction (ALLR) compared with anterior cruciate ligament reconstruction (ACLR).
Study Design:
Cross-sectional study.
Methods:
A questionnaire was administered to 50 ACLR patients in Australia to determine their use of the internet to research their operation and their familiarity with the anterolateral ligament (ALL) of the knee. The most common search terms were determined, and the first 70 websites returned by the 5 most popular search engines were used to assess the quality of information about ACLR and ALLR. Each site was categorized by type and was assessed for quality and validity using the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria, and a novel specific content score for each procedure. The presence of the Health on the Net Code (HONcode) seal was also recorded.
Results:
The majority (84%) of ACLR patients used the internet to research their operation. The quality of information available for ALLR was significantly inferior to that for ACLR according to the DISCERN score (37.3 ± 3.4 vs 54.4 ± 4.6; P < .0001) and specific content score (5.3 ± 1.3 vs 11.0 ± 1.5; P < .0001). ACLR websites were predominantly physician produced, while the majority of ALLR websites were academic. In contrast to ACLR websites, the majority of ALLR websites did not provide information on the indication for treatment or potential complications. ALLR websites scored better on the JAMA benchmark criteria due to the predominance of academic websites. A greater proportion of ACLR websites (14.6%) versus ALLR websites (2.5%) provided an HONcode seal. Correlation was demonstrated between the DISCERN score and specific content scores for both ACLR and ALLR but not with JAMA benchmark criteria. The specific content score had high reliability for both ACLR and ALLR.
Conclusion:
The majority of patients undergoing ACLR in Australia used the internet to research the procedure. The quality of information on the internet relating to ALLR was significantly inferior to information about ACLR. Most ALLR websites failed to include crucial information about the indication or options for treatment, prognosis, and potential complications. Surgeons should be aware of the information to which their patients are exposed through the internet and should be proactive in directing patients to appropriate websites.
Journal Article
Vitamin D, Folate, Vitamin B 12 , and Iron Status in Pregnant/Postpartum Old Order Anabaptist Women in Southwestern Ontario
Purpose: To assess vitamin D, folate, vitamin B 12 , and iron status in Old Order Anabaptist (OOA) pregnant/postpartum women. Methods: Blood was analyzed for plasma 25 hydroxy vitamin D (25(OH)D), red blood cell (RBC) folate, serum vitamin B 12 , and iron status indicators. Dietary intakes (food and supplements) from 3-day estimated records were compared to Dietary Reference Intakes and Canada’s Food Guide (2007). Results: Fifty women participated in this descriptive cross-sectional study. Concentrations of 25(OH)D were low (<50 nmol/L for 20% and < 75 nmol/L for 63%); 42% had total vitamin D intakes < estimated average requirement (EAR). All women had RBC folate above the 1360 mmol/L cut-off. Nineteen percent had folate intakes upper limit. One woman had low serum vitamin B 12 (<148 pmol/L); serum vitamin B 12 was high (>652 pmol/L) for 24%. None had vitamin B 12 intakes
Journal Article
Vitamin D, Folate, Vitamin B.sub.12, and Iron Status in Pregnant/Postpartum Old Order Anabaptist Women in Southwestern Ontario
Purpose: To assess vitamin D, folate, vitamin [B.sub.12], and iron status in Old Order Anabaptist (OOA) pregnant/postpartum women. Methods: Blood was analyzed for plasma 25 hydroxy vitamin D (25(OH)D), red blood cell (RBC) folate, serum vitamin [B.sub.12], and iron status indicators. Dietary intakes (food and supplements) from 3-day estimated records were compared to Dietary Reference Intakes and Canada's Food Guide (2007). Results: Fifty women participated in this descriptive cross-sectional study. Concentrations of 25(OH)D were low (<50 nmol/L for 20% and <75 nmol/L for 63%); 42% had total vitamin D intakes < estimated average requirement (EAR). All women had RBC folate above the 1360 mmol/L cut-off. Nineteen percent had folate intakes upper limit. One woman had low serum vitamin [B.sub.12] (<148 pmol/L); serum vitamin [B.sub.12] was high (>652 pmol/L) for 24%. None had vitamin [B.sub.12] intakes 652 pmol/l) pour 24 % des femmes. Aucune n'avait un apport en vitamine [B.sub.12] inferieur au BME; les apports etaient eleves comparativement a l'apport alimentaire recommande. Une femme presentait un taux d'hemoglobine faible; 13 % avaient un taux de ferritine inferieur a 15 [micro]g/l. Treize pour cent avaient un apport total en fer inferieur au BME. Conclusions. Dans l'ensemble, l'apport alimentaire et l'etat nutritionnel en micronutriments seriques des femmes AAO enceintes et en post-partum de notre etude etaient similaires a ceux rapportes dans des etudes anterieures menees chez des femmes canadiennes. Si certaines femmes avaient un faible apport en vitamine D et en fer, la plupart avaient un apport eleve en folate et en vitamine [B.sub.12]. Ces resultats fournissent une indication pour assurer des apports alimentaires et en supplements appropries dans cette population potentiellement vulnerable et rarement etudiee. Mots-cles : anabaptiste, femmes enceintes post-partum, folate, vitamine [B.sub.12], vitamine D, fer. (Rev can prat rech dietet. 2024;85:149-156) (DOI: 10.3148/cjdpr-2024-003) Publie au dcjournal.ca le 12 aout 2024
Journal Article
Vitamin D, Folate, Vitamin B12, and Iron Status in Pregnant/Postpartum Old Order Anabaptist Women in Southwestern Ontario
Objectif. Évaluer le bilan en vitamine D, en folate, en vitamine B12 et en fer de femmes anabaptistes de l'Ancien Ordre (AAO) enceintes ou en post-partum. Méthodes. Des analyses sanguines ont été effectuées afin d'évaluer les taux de 25-hydroxyvitamine D (25(OH)D) plasmatique, de folate des globules rouges, de vitamine B12 sérique et de fer. Les apports alimentaires (aliments et suppléments) issus d'estimations sur 3 jours ont été comparés aux apports nutritionnels de référence et au Guide alimentaire canadien (2007). Résultats. Cinquante femmes ont participé à cette étude transversale descriptive. Les concentrations de 25(OH)D étaient faibles (<50 nmol/l pour 20 % et <75 nmol/l pour 63 %); 42 % avaient des apports totaux en vitamine D inférieurs au besoin moyen estimatif (BME). Toutes les femmes avaient un taux de folate dans les globules rouges supérieur au seuil de 1360 mmol/l. Dix-neuf pour cent avaient un apport en folate inférieur au BME; 80 % avaient un apport en suppléments d'acide folique supérieur à la limite supérieure. Une femme avait un taux de vitamine B12 sérique faible (<148 pmol/l); mais le taux de vitamine B12 sérique était élevé (>652 pmol/l) pour 24 % des femmes. Aucune n'avait un apport en vitamine B12 inférieur au BME; les apports étaient élevés comparativement à l'apport alimentaire recommandé. Une femme présentait un taux d'hémoglobine faible; 13 % avaient un taux de ferritine inférieur à 15 µg/l. Treize pour cent avaient un apport total en fer inférieur au BME. Conclusions. Dans l'ensemble, l'apport alimentaire et l'état nutritionnel en micronutriments sériques des femmes AAO enceintes et en post-partum de notre étude étaient similaires à ceux rapportés dans des études antérieures menées chez des femmes canadiennes. Si certaines femmes avaient un faible apport en vitamine D et en fer, la plupart avaient un apport élevé en folate et en vitamine B12. Ces résultats fournissent une indication pour assurer des apports alimentaires et en suppléments appropriés dans cette population potentiellement vulnérable et rarement étudiée.
Journal Article
Estimation of the radiation budget during MOSAiC based on ground-based and satellite remote sensing observations
An accurate representation of the radiation budget is essential for investigating the impact of clouds on the climate system, especially in the Arctic, an environment highly sensitive to complex and rapid environmental changes. In this study, we analyse a unique dataset of observations from the central Arctic made during the MOSAiC (Multidisciplinary drifting Observatory for the Study of Arctic Climate) expedition in conjunction with state-of-the-art satellite products from CERES (Clouds and the Earth's Radiant Energy System) to investigate the radiative effect of clouds and radiative closure at the surface and the top of the atmosphere (TOA). We perform a series of radiative transfer simulations using derived cloud macro- and microphysical properties as inputs to the simulations for the entire MOSAiC period, comparing our results to collocated satellite products and ice-floe observations. The radiative closure biases were generally within the instrumental uncertainty, indicating that the simulations are sufficiently accurate to reproduce the radiation budget during MOSAiC. Comparisons of the simulated radiation budget relative to CERES show similar values in the terrestrial flux but relatively large differences in the solar flux, which are attributed to a lower surface albedo and a possible underestimation of atmospheric opacity by CERES. While the simulation results were consistent with the observations, more detailed analyses reveal an overestimation of simulated cloud opacity for cases involving geometrically thick ice clouds. In the annual mean, we found that, during the MOSAiC expedition, the presence of clouds leads to a loss of 5.2 W m−2 of the atmosphere–surface system to space, while the surface gains 25.0 W m−2 and the atmosphere is cooled by 30.2 W m−2.
Journal Article
Deep generative AI models analyzing circulating orphan non-coding RNAs enable detection of early-stage lung cancer
Liquid biopsies have the potential to revolutionize cancer care through non-invasive early detection of tumors. Developing a robust liquid biopsy test requires collecting high-dimensional data from a large number of blood samples across heterogeneous groups of patients. We propose that the generative capability of variational auto-encoders enables learning a robust and generalizable signature of blood-based biomarkers. In this study, we analyze orphan non-coding RNAs (oncRNAs) from serum samples of 1050 individuals diagnosed with non-small cell lung cancer (NSCLC) at various stages, as well as sex-, age-, and BMI-matched controls. We demonstrate that our multi-task generative AI model, Orion, surpasses commonly used methods in both overall performance and generalizability to held-out datasets. Orion achieves an overall sensitivity of 94% (95% CI: 87%–98%) at 87% (95% CI: 81%–93%) specificity for cancer detection across all stages, outperforming the sensitivity of other methods on held-out validation datasets by more than ~ 30%.
A generative AI model, Orion, learns a robust and generalizable pattern of non-small cell lung cancer from cancer-specific circulating non-coding RNAs. Orion enhances the performance of liquid biopsy for early cancer detection and tumor subtyping.
Journal Article
Estimation of the radiation budget during MOSAiC based on ground-based and satellite remote sensing observations
An accurate representation of the radiation budget is essential for investigating the impact of clouds on the climate system, especially in the Arctic, an environment highly sensitive to complex and rapid environmental changes. In this study, we analyse a unique dataset of observations from the central Arctic made during the MOSAiC (Multidisciplinary drifting Observatory for the Study of Arctic Climate) expedition in conjunction with state-of-the-art satellite products from CERES (Clouds and the Earth's Radiant Energy System) to investigate the radiative effect of clouds and radiative closure at the surface and the top of the atmosphere (TOA). We perform a series of radiative transfer simulations using derived cloud macro- and microphysical properties as inputs to the simulations for the entire MOSAiC period, comparing our results to collocated satellite products and ice-floe observations. The radiative closure biases were generally within the instrumental uncertainty, indicating that the simulations are sufficiently accurate to reproduce the radiation budget during MOSAiC. Comparisons of the simulated radiation budget relative to CERES show similar values in the terrestrial flux but relatively large differences in the solar flux, which are attributed to a lower surface albedo and a possible underestimation of atmospheric opacity by CERES. While the simulation results were consistent with the observations, more detailed analyses reveal an overestimation of simulated cloud opacity for cases involving geometrically thick ice clouds. In the annual mean, we found that, during the MOSAiC expedition, the presence of clouds leads to a loss of 5.2 W m−2 of the atmosphere–surface system to space, while the surface gains 25.0 W m−2 and the atmosphere is cooled by 30.2 W m−2.
Journal Article