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Compared with the Latarjet procedure, the Bristow procedure has a lower screw-related complication rate but poor bone healing. A modified Inlay Bristow procedure has been reported to significantly improve the bone healing rate, but the biomechanical mechanism is unclear. The aim of this study was to evaluate the biomechanical stability of the bone graft between a modified Inlay Bristow procedure and the classic Bristow procedure. Sixteen left scapula models (Sawbones, Composite Scapula, and fourth generation) were randomly divided into 2 groups (8:8). The bone graft in the first group was fixed with a 3.5 mm screw using the Inlay structure. The bone graft in the second group was fixed with a 3.5 mm screw via the traditional method. The maximum cyclic displacement, ultimate failure load and stiffness were evaluated biomechanically. The failure type was recorded for each model. Cyclic loading tests demonstrated that the maximum cyclic displacement of the Inlay procedure was significantly smaller (P =.001) than that of the classic procedure. The Inlay Bristow technique resulted in a significantly higher (P =.024) ultimate failure load than the classic Bristow technique. The stiffness of the classic group was 19.17 ± 4.01 N/mm and that of the inlay group was 22.34 ± 5.35 N/mm (P =.232). Failure was mainly due to bone graft fractures through the drill hole or glenoid bone fractures. Inlay Bristow fixation of the bone graft in a Sawbones model provides significantly stronger fixation and better time point zero stability than classic Bristow fixation, suggesting a higher likelihood of graft union. [ABSTRACT FROM AUTHOR]

To compare clinical and computed tomography outcomes between the arthroscopic Latarjet procedure and the arthroscopic Bristow procedure. Patients who underwent arthroscopic Latarjet or Bristow procedures with at least 2 years of follow-up were retrospectively reviewed. Thirty-eight shoulders were included in the Latarjet group, and 34 were included in the Bristow group. Recurrence of dislocation, clinical scores, rate of return to sports (RTS), and computed tomography assessment findings (position of transferred coracoid, graft healing, graft absorption, and glenohumeral degenerative osteoarthritis [OA]) were obtained at final follow-up. No recurrent dislocation occurred in either group, and no significant differences in clinical scores were found between the 2 procedures, with a mean follow-up period of 3.4 years. The operative time in the Bristow group was significantly shorter than that in the Latarjet group (P <.001). The transferred coracoid had healed in 94.7% of the patients in the Latarjet group and 85.3% in the Bristow group at final follow-up (P =.01). No significant difference in graft absorption or the degree of glenohumeral OA was detected between the 2 groups. However, moderate to severe OA only occurred in the Latarjet group at final follow-up (4 of 38 shoulders, 10.5%). The postoperative external rotation angle and level of RTS favored the Latarjet procedure (P =.030 and P =.034, respectively). Both the arthroscopic Latarjet and arthroscopic Bristow procedures led to good clinical scores with no new dislocation episodes. The Bristow group showed significantly less graft healing than the Latarjet group. However, the arthroscopic Bristow procedure took less operative time and showed a lower rate of early moderate to severe glenohumeral OA, better range of motion, and a higher rate of RTS. Level III, retrospective comparative therapeutic trial. [ABSTRACT FROM AUTHOR]

Bristow-Latarjet procedure has been widely regarded as a reliable and satisfactory operation for recurrent anterior glenohumeral instability, especially for patients with significant glenoid bone loss or high sports demand. Once failed, however, the subsequent revision surgery could be challenging. Eden-Hybinette procedure is the most common operation for revision of failed Bristow-Latarjet. It can perfectly restore the bone defect of the failed Bristow-Latarjet by harvesting a proper size of iliac bone block. Furthermore, several studies have shown the advantages of using suture button fixation in the revision surgery for failed Bristow-Latarjet procedure. However, the potential inferior biomechanical strength of suture button fixation is still a concern. This Technical Note introduced an arthroscopic "double-inlay" Eden-Hybinette procedure with modified suture button fixation for the revision of failed Bristow-Latarjet. With its "quadruple" reinforcement effect, this procedure can achieve an excellent biomechanical strength of fixation. [Display omitted] [ABSTRACT FROM AUTHOR]

Rotator cuff tear can be divided into 4 main patterns on the basis of the geometric characteristics: crescent, longitudinal (U- or L-shaped), massive contracted, and arthropathy tears. For L-shaped rotator cuff tear, the surgical procedure often refers to the identification of the apex of the "L" and the side-to-side suturing of the longitudinal split. This technique note introduced an "M"-shaped suturing with 2 aasuture anchors, 3 sutures, and 4 knotting procedures, especially efficient for L-shaped rotator cuff tear. [Display omitted] [ABSTRACT FROM AUTHOR]

A variety of semi-volatile banned pesticides (SVBPs) are ubiquitous in soils of mid-latitude regions. SVBPs undertake complicated soil-gas exchange processes in mid-latitude regions, challenging the understanding of source or sink roles of soils for the semi-volatile contaminants. Herein, we develop structural equation models (SEMs) to unveil source or sink roles of mid-latitude soils (Liaoning, China) in winter and summer for 12 SVBPs (7 organochlorine and 5 organophosphorus pesticides). The 12 SVBPs exhibit different distribution patterns in soils, dependent of sampling seasons, soil characteristics, topographic/climate conditions of soil sites and chemical properties of compounds. SEM Model I (winter) and Model II (summer) reveal the distribution patterns of SVBPs in soils over season changes, indicating sink-source switches of soils for SVBPS from winter to summer. In winter, soil is a sink of 12 SVBPs in the study area, associated with the inputs of SVBPs in soils by air-particulate partition and dry depositions. However, in summer, soil is mainly a source of the same contaminants, mainly through the volatilization and leaching of SVBPs in soils. The sink-source switches of soils for SVBPs are usually dependent of chemical properties of compounds to higher extents than soil characteristics and topographic/climate conditions of soil sites, though these parameters pose different influences in winter and summer. It has been revealed that soil acts as a sink of SVBPs in winter, associated with the inputs of SVBPs in soils by air-particulate partition and dry depositions, whereas soil acts as a source of SVBPs in summer, mainly through the volatilization and leaching of SVBPs in soils. This finding may provide new insights into the unique distribution patterns of SVBPs in soils in mid-latitude regions. [Display omitted] • SVBPs exhibit different distribution patterns in mid-latitude soils over season changes. • SEM models unveil the source-sink switches of mid-latitude soils for SVBPs over season changes. • The source-sink switches of mid-latitude soils for SVBPs are season, compound and site specific. • Mid-latitude soils act as a sink of SVBPs in winter through particulate adsorption and depositions. • Mid-latitude soils act as a source in summer through SVBPs' volatilization and leaching. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical outcomes and radiologic evaluation of an all-arthroscopic Latarjet procedure with modified button fixation.Methods: Patients who received all-arthroscopic Latarjet procedure with modified suture button fixation between September 2015 to September 2016 were retrospectively reviewed. Indications for surgery were recurrent anterior shoulder dislocation with any 1 of these 3 conditions: glenoid defect >15%, contact-sport athlete, or failure after Bankart repair. Inclusion criteria included cases who received this surgery. Clinical outcomes were evaluated by University of California Los Angeles, ASES and Rowe score with a minimal follow-up of 3 years. Radiologic assessment on 3D computed tomography scan was performed preoperatively and postoperatively at different time points. Complications were also recorded.Results: A total of 30 patients were eventually included in this study. The mean follow-up time was 38.0 ± 2.5 months. There were 25 patients who performed contact sports. Of them, 10 patients were without glenoid defect >15% or failed Bankart repair. The remaining 20 patients had glenoid defect >15%, including 2 failed Bankart cases. Ten patients had glenoid defect < 13.5%, and the rest 20 patients had > 13.5%. UCLA, American Shoulder and Elbow Surgeons, and Rowe score significantly improved during follow-up, and the improvement exceeded MCID for all patients. No severe complications were noted. In total, 86.7% of the graft positioning was measured as flush and 13.3% as medial. The bone union rate was 96.7% at 3 months postoperatively and at final follow-up. The remodeling process for the restoration of the normal anatomy of the lower part of glenoid was noted.Conclusions: All-arthroscopic Latarjet with modified suture button fixation can achieve stable fixation of the coracoid, good clinical outcomes (all patients with improvement exceeding MCID), low complications rate. Furthermore, the bone remodeling process contributes to the recovery of the normal anatomy of anteroinferior glenoid.Study Design: Case series; Level of evidence, 4. [ABSTRACT FROM AUTHOR]

Purpose: To determine the relation between tunnel placement and tunnel enlargement after single-bundle anterior cruciate ligament (ACL) reconstruction. Methods: Seventy-two subjects (mean age, 30.1 years; 17.5 months'' follow-up) who underwent single-bundle ACL reconstruction with hamstring autograft were studied. EndoButton fixation (Ethicon, Somerville, NJ) was used on the femoral side, whereas staples were used on the tibial side. A transtibial femoral tunnel position technique was used in 53 subjects, whereas positioning through the medial portal was used in the other 19 cases. Tunnel enlargement was determined by comparing the diameter of the tunnel on the radiograph obtained after 12 months and the radiograph obtained instantly after the operation. The centers of the femoral and tibial tunnels and the angles between the graft and tibial plateau were also measured on standard radiographs. Clinical outcomes including KT-1000 assessment (MEDmetric, San Diego, CA) and International Knee Documentation Committee (IKDC) score were also collected in all patients. The relations between tunnel enlargement/tunnel position and knee joint laxity and IKDC score were analyzed. Results: The mean KT-1000 side-to-side difference significantly decreased, from 6.07 ± 2.75 mm to 1.57 ± 2.14 mm, after ACL reconstruction; the IKDC subjective score increased from 52.8 to 87.5. On lateral radiographs, the tunnel enlargement rates were 41% on the femoral side and 35% on the tibial side; on plain anteroposterior radiographs, the tunnel enlargement rates were 39% on the femoral side and 32% on the tibial side. Subjects with a higher femoral tunnel had a greater enlargement rate (P < .001). Subjects with a more vertical graft also had a larger femoral enlargement (P < .05). More anterior placement of the femoral tunnel was associated with larger tibial tunnel enlargement on anteroposterior plain radiographs (P < .05). A more vertical graft was also associated with larger tibial tunnel enlargement. Subjects in whom the transtibial femoral position technique was used had more femoral tunnel enlargements (P < .01). Conclusions: Drilling the femoral tunnel through the medial portal created a lower, more posterior, and less vertical tunnel than drilling through the tibial tunnel. Femoral and tibial tunnel enlargements were greater with more anterior, more proximal, and more vertical femoral tunnels. Whereas no clinical differences were seen in the 2 groups, drilling the femoral tunnel from the medial portal will result in smaller postoperative tunnel enlargements. Level of Evidence: Level III, retrospective comparative study. [Copyright &y& Elsevier]

Purpose: The purpose of this report is to summarize our experience in the diagnosis and management of septic arthritis after anterior cruciate ligament (ACL) reconstruction. Methods: A retrospective review was conducted of all the arthroscopic ACL reconstructions performed at our institution between 1997 and 2007. Postoperative septic arthritis occurred in 21 of 4,068 patients. The incidence, cause, presentation, laboratory results, and treatment of all infected patients were analyzed. Results: The incidence of septic arthritis after ACL reconstruction was 0.52%. The most common symptoms of the infected patients were fever, swelling, severe pain, tenderness, and restricted motion. The erythrocyte sedimentation rate, C-reactive protein level, and fibrinogen level were markedly elevated. Microbiology showed that coagulase-negative Staphylococcus was the most common bacterium. Both conservative and operative treatments were effective, and no patient had the ACL graft removed. However, the conservative group had a longer recovery time and duration of intravenous antibiotic therapy. Conclusions: Septic arthritis after arthroscopic ACL reconstruction is a rare but potentially devastating complication. The correct diagnosis relies on clinical evaluation, laboratory tests, synovial fluid analysis, and bacterial culture. With early diagnosis and prompt treatment, the infection can be successfully eradicated. Our proposed treatment protocol is arthroscopic debridement and irrigation as quickly as possible, with retention of the ACL graft when it is still functional. Level of Evidence: Level IV, therapeutic case series. [Copyright &y& Elsevier]

Infection caused by pathogenic bacteria carrying antibiotic resistance genes (ARGs) is a serious challenge to human health. Water environment, including water and surface sediments, is an important repository of ARGs, and the activity of aquatic animal can affect the development of ARG pollution in the water environment. Macrobenthic invertebrates are an important component of aquatic ecosystems, and their effects on ARG development in aquatic environments remain unreported. The distribution of ARGs, including tetA gene, sul2 gene, and kan gene, in Chironomidae larvae is demonstrated in this study for the first time. The ARG distribution was related to sampling points, metal elements, and seasons. Animal models demonstrated that Chironomidae larvae enriched ARGs from water and passed them on to downstream predators in the food chain. Conjugative transfer mediated by resistant plasmids was crucial in the spread of ARG in Chironomidae larvae, and upregulated expression of trfAp gene and trbBp gene was the molecular mechanism. Escherichia in Proteobacteria and Flavobacterium in Bacteroidetes, which are gram-negative bacteria in Chironomidae larvae, are the primary host bacteria of ARGs confirmed via resistance screening and DNA sequencing of V4 region of 16S rRNA gene. Feeding experiments further confirmed that ARGs from Chironomidae larvae can be enriched in the fish gut. Research gaps in food chain between sediments and fish are addressed in this study, and Chironomidae larvae is an important enricher of ARGs in the freshwater environment. [Display omitted] • ARGs, including Tet , Sul2 , and Km distribute in Chironomidae larvae. • Chironomidae larvae enrich ARGs from water to fish in the food chain. • Conjugative transfer mediated by resistant plasmids happens in Chironomidae larvae. • Escherichia and Flavobacterium are the primary host bacteria of ARGs. Chironomidae larvae: an enricher of ARG pollution mediated by conjugation resistance plasmids from water and sediments to fish. [ABSTRACT FROM AUTHOR]

Background There have been few studies using magnetic resonance imaging (MRI) to evaluate the clinical outcomes and structural results after arthroscopic repair of bursal-side partial-thickness rotator cuff tears (PTRCTs). Methods From 2009 to 2012, 73 consecutive patients with bursal-side PTRCTs underwent arthroscopic repair. Fifty-nine of them were retrospectively evaluated as Ellman classification grade 2 (group A, n = 11) or grade 3 (group B, n = 48). All repairs were performed with a technique that preserved the intact articular fibers and repaired the avulsed bursal flap. The University of California–Los Angeles (UCLA) score and Constant score were assessed before the operation and at the final follow-up. Postoperative cuff integrity was determined with MRI following Sugaya's classification. Results At the 2-year follow-up, the average UCLA score increased from 17.3 ± 3.7 to 33.3 ± 2.2, and the Constant score increased from 65.3 ± 12.9 to 93.9 ± 5.1 ( P < .001). Forty-nine patients received follow-up MRI examinations at an average of 10.3 months after surgery. Of these 49 patients, 41 patients (83.7%) had a healed tendon and 8 patients had partial tears. Neither the clinical scores nor the retear rates on follow-up MRI were significantly different between the 2 groups. Conclusions Arthroscopic repair of bursal-side PTRCTs achieved good functional and structural outcomes at a minimum of 2 years after surgery. [ABSTRACT FROM AUTHOR]