Development of a Soft Tissue Knee Clinical Decision-Making Tool for Patients Presenting to Primary Point-of-Care Providers in Alberta, Canada.

Several barriers exist in Alberta, Canada to providing accurate and accessible diagnoses for patients presenting with acute knee injuries and chronic knee problems. In efforts to improve quality of care for these patients, an evidence-informed clinical decision-making tool was developed. Forty-five expert panelists were purposively chosen to represent stakeholder groups, various expertise, and each of Alberta Health Services' 5 geographical health regions.

A Convergent Tibial Tunnel Technique for Concomitant Anterior Cruciate Ligament Reconstruction and Meniscal Root Repair.

Modern arthroscopic knee-reconstruction techniques involve the use of multiple bone tunnels and fixation devices to restore the anatomy and stability of the knee after traumatic injury. In these injuries, however, tunnel collision can be problematic, especially when combining anterior cruciate ligament reconstruction with meniscal root repairs or multiligament reconstructions. We describe a multiple tibial tunnel technique to allow fixation of both anterior cruciate ligament graft and meniscal roots through convergence to a single tibial cortical aperture.

The use of slice encoding for metal artifact correction (SEMAC) sequencing improves the diagnostic evaluation of graft integrity following anterior cruciate ligament reconstruction.

Objectives: To determine whether magnetic resonance imaging (MRI) with metal artifact reduction sequencing is superior to conventional knee MRI in the evaluation of an injured anterior cruciate ligament (ACL) graft, where visualisation on conventional MRI can be limited by the metal artifact from fixation devices.

Methods: Eighteen patients underwent conventional MRI sequence (proton density fat saturated [PDFS]) and two types of metal artifact reduction sequencing MRI (WARP, slice encoding for metal artifact correction (SEMAC); Siemens) following a secondary injury to their ACL reconstructed knee. Six raters with experience in knee MRI evaluation reviewed sagittal PDFS, WARP, and SEMAC sequences, providing semi-quantitative grades for visualisation and diagnostic confidence assessing the ACL, posterior cruciate ligament , menisci, tibial and femoral tunnel margins, and articular cartilage.

Biomechanical Strength of All-Inside ACL Reconstruction Grafts Using Side-to-Side and Backup Fixation.

Background: The all-inside anterior cruciate ligament reconstruction (ACLR) procedure uses a single hamstring tendon folded twice and secured to itself to form a 4-stranded graft. There are several possible configurations for preparing the graft.

Purpose: To investigate the biomechanical properties of a new graft preparation technique in comparison with 2 commonly used configurations.

Biomechanical Comparison of Graft Preparation Techniques for All-Inside Anterior Cruciate Ligament Reconstruction.

Background: All-inside anterior cruciate ligament reconstruction (ACLR) is an emerging technique used to treat ACL injuries. The all-inside technique uses a 4-stranded graft made from a single tendon that is looped on itself. The 4 strands of the graft must be secured to each other to become a closed-loop structure.

Towards improving the identification of anterior cruciate ligament tears in primary point-of-care settings.

Background: Only a small proportion of anterior cruciate ligament (ACL) tears are diagnosed on initial healthcare consultation. Current clinical guidelines do not acknowledge that primary point-of-care practitioners rely more heavily on a clinical history than special clinical tests for diagnosis of an ACL tear. This research will assess the accuracy of combinations of patient-reported variables alone, and in combination with clinician-generated variables to identify an ACL tear as a preliminary step to designing a primary point-of-care clinical decision support tool.

An unusual case of Erysipelothrix rhusiopathiae prosthetic joint infection from the Canadian Arctic: whole genome sequencing unable to identify a zoonotic source.

Background: Erysipelothrix rhusiopathiae is a zoonotic pathogen that causes erysipeloid and is most frequently associated with exposure to domestic swine. Infection of native and prosthetic joints is a rarely reported manifestation.

Case Presentation: We describe a case of E.

Recurrent Instability Episodes and Meniscal or Cartilage Damage After Anterior Cruciate Ligament Injury: A Systematic Review.

Background: Delayed anterior cruciate ligament (ACL) reconstruction may be associated with increased risk of subsequent knee joint damage and osteoarthritis (OA). The relationship between recurrent instability episodes and meniscal or cartilage damage after first-time ACL injury is unknown.

Purpose: To assess the association between recurrent knee instability episodes and prevalence of meniscal lesions, cartilage damage, and OA after first-time ACL injury.

A Validation Study of a Novel 3-Dimensional MRI Modeling Technique to Identify the Anatomic Insertions of the Anterior Cruciate Ligament.

Background: Anatomic single bundle anterior cruciate ligament (ACL) reconstruction is the current gold standard in ACL reconstructive surgery. However, placement of femoral and tibial tunnels at the anatomic center of the ACL insertion sites can be difficult intraoperatively. We developed a "virtual arthroscopy" program that allows users to identify ACL insertions on preoperative knee magnetic resonance images (MRIs) and generates a 3-dimensional (3D) bone model that matches the arthroscopic view to help guide intraoperative tunnel placement.

Five-year changes in gait biomechanics after concomitant high tibial osteotomy and ACL reconstruction in patients with medial knee osteoarthritis.

Background: Concomitant high tibial osteotomy (HTO) and anterior cruciate ligament (ACL) reconstruction is a combined surgical procedure intended to improve kinematics and kinetics in the unstable ACL-deficient knee with varus malalignment and medial compartment knee osteoarthritis (OA).

Purpose: To investigate 5-year changes in gait biomechanics as well as radiographic and patient-reported outcomes bilaterally after unilateral, concomitant medial opening wedge HTO and ACL reconstruction.

Study Design: Controlled laboratory study.

Comparison of cast materials for the treatment of congenital idiopathic clubfoot using the Ponseti method: a prospective randomized controlled trial.

Background: The Ponseti method of congenital idiopathic clubfoot correction has traditionally specified plaster of Paris (POP) as the cast material of choice; however, there are negative aspects to using POP. We sought to determine the influence of cast material (POP v. semirigid fibreglass [SRF]) on clubfoot correction using the Ponseti method.

MRI Anatomy of the Tibial ACL Attachment and Proximal Epiphysis in a Large Population of Skeletally Immature Knees: Reference Parameters for Planning Anatomic Physeal-Sparing ACL Reconstruction.

Background: To aid in performing anatomic physeal-sparing anterior cruciate ligament (ACL) reconstruction, it is important for surgeons to have reference data for the native ACL attachment positions and epiphyseal anatomy in skeletally immature knees.

Purpose: To characterize anatomic parameters of the ACL tibial insertion and proximal tibial epiphysis at magnetic resonance imaging (MRI) in a large population of skeletally immature knees.

Study Design: Cross-sectional study; Level of evidence, 3.

Reliability of 3D localisation of ACL attachments on MRI: comparison using multi-planar 2D versus high-resolution 3D base sequences.

Purpose: Anatomic placement of anterior cruciate ligament (ACL) grafts at arthroscopic reconstruction can be challenging. Localising ACL attachments on magnetic resonance imaging (MRI) sequences pre-operatively could aid with planning for anatomic graft placement. Though ACL attachments can be identified on two-dimensional (2D) MRI, slice thickness theoretically limits out-of-plane accuracy and a 3D MRI base sequence with smaller isotropic voxels may improve observer reliability in localising ACL attachment locations.

Three-dimensional intercondylar notch volumes in a skeletally immature pediatric population: a magnetic resonance imaging-based anatomic comparison of knees with torn and intact anterior cruciate ligaments.

Purpose: To determine whether 3-dimensional notch volume, measured with magnetic resonance imaging (MRI), differs significantly between knees with torn and intact anterior cruciate ligaments (ACLs) after sports injury in a skeletally immature pediatric population.

Methods: MRI studies of 50 pediatric patients (age range, 10 to 17 years) with ACL tears were compared with 50 age- and sex-matched intact-ACL control patients. All patients had open physes and underwent MRI after a sports injury.

Reliability of estimates of ACL attachment locations in 3-dimensional knee reconstruction based on routine clinical MRI in pediatric patients.

Background: Current techniques of anterior cruciate ligament (ACL) reconstruction focus on the placement of femoral and tibial tunnels at anatomic ACL attachments, which can be difficult to identify intraoperatively.

Purpose: To determine whether the 3-dimensional (3D) center of ACL attachments can be reliably detected from routine magnetic resonance imaging (MRI) in patients with intact ACLs and whether the reliability of this technique changes if the ACL is torn.

Study Design: Cohort study (diagnosis); Level of evidence, 3.

Outcome of anatomic transphyseal anterior cruciate ligament reconstruction in Tanner stage 1 and 2 patients with open physes.

Background: Anterior cruciate ligament (ACL) injuries are being seen with increasing frequency in children. Treatment of the ACL-deficient knee in skeletally immature patients is controversial.

Purpose: To determine the outcome of all-arthroscopic transphyseal anatomic single-bundle ACL reconstruction in Tanner stage 1 and 2 patients at a minimum of 2 years after surgery.

Clinical and patient-reported outcomes of patients with four major lower extremity arthroplasties.

Few studies report the outcomes of patients treated with total joint arthroplasty of both hips and both knees. We present the outcomes of 14 patients with total joint arthroplasty of both hips and both knees using validated outcome measures. Eleven patients (79%) were satisfied at final review.

Five-year comparison of oxidized zirconium and cobalt-chromium femoral components in total knee arthroplasty: a randomized controlled trial.

Background: In vitro analysis has shown that oxidized zirconium on ultra-high molecular weight polyethylene has better wear properties than cobalt-chromium on ultra-high molecular weight polyethylene. The purpose of this study was to determine if oxidized zirconium femoral components performed better than cobalt-chromium in vivo and if the use of oxidized zirconium components had clinical adverse effects.

Methods: Forty consecutive patients (eighty knees) underwent simultaneous bilateral cruciate-retaining total knee arthroplasty for primary osteoarthritis from January 2002 to December 2003.

The "coiling-up procedure": a novel technique for extra-articular arthroscopy.

The "coiling-up procedure" is a novel technique for extra-articular arthroscopy. A coil-shaped lifter is used to create the extra-articular working space, and a dry arthroscopy is performed. It can be combined with conventional intra-articular arthroscopy to enable direct vision from both inside and outside the joint.

Fifteen-year outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft for "isolated" anterior cruciate ligament tear.

Background: Few studies report the long-term results of anterior cruciate ligament rupture and single-incision endoscopic reconstructive surgery. Outcomes are often clouded by concomitant meniscal, chondral, or ligament injuries.

Purpose: To determine the 15-year outcomes of anterior cruciate ligament ruptures treated with endoscopic anterior cruciate ligament reconstruction using middle-third patellar tendon autograft.

Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee.

Background: The management of degenerative arthritis of the knee in the younger, active patient presents a challenge to the orthopaedic surgeon. Surgical treatment options include high tibial osteotomy (HTO), unicompartmental knee arthroplasty, and total knee arthroplasty.

Purpose: To examine the long-term survival of closing wedge HTO in a large series of patients up to 19 years after surgery.

Radiation dose from initial trauma assessment and resuscitation: review of the literature.

Background: Trauma care benefits from the use of imaging technologies. Trauma patients and trauma team members are exposed to radiation during the continuum of care. Knowledge of exposure amounts and effects are important for trauma team members.

Femoral fractures in children younger than three years: the role of nonaccidental injury.

Background: Nonaccidental injury (NAI) in children is a major cause of morbidity and mortality, with fractures being the second most common presentation. The presence of a femur fracture has been reported to be suggestive of nonaccidental trauma in 30% to 60% of young children. The purpose of this study was to determine the percentage of NAI in children younger than 3 years presenting with a femur fracture to a single institution within a western Canadian population.

Incidence of intramedullary nail removal after femoral shaft fracture healing.

Introduction: There are limited data on hardware removal after femoral fracture healing. We determined the incidence of intramedullary nail (IMN) removal after midshaft femoral fractures. We also studied demographic factors influencing IMN removal.

Purification and some properties of Saccharomyces cerevisiae meiosis-specific protein kinase Ime2.

Ime2 is the founding member of a family of protein kinases that are required for effective progression through meiotic development. Ime2 is essential for the induction of meiosis-specific genes and for the activation of meiotic DNA replication in the budding yeast Saccharomyces cerevisiae. Aside from the fact that Ime2 is a protein kinase and shares several amino acid motifs with cyclin dependent kinases, virtually nothing is known about its enzymatic properties or substrates.