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Implantation is an essential issue in orthopedic surgery. Bulk metallic glasses (BMGs), as a kind of novel materials, attract lots of attentions in biological field owing to their comprehensive excellent properties. Here, we show that a Zr61Ti2Cu25Al12 (at. %) BMG (Zr-based BMG) displays the best cytocompatibility, pronounced positive effects on cellular migration, and tube formation from in-vitro tests as compared to those of commercial-pure titanium and poly-ether-ether-ketone. The in-vivo micro-CT and histological evaluation demonstrate the Zr-based BMG can significantly promote a bone formation. Immunofluorescence tests and digital reconstructed radiographs manifest a stimulated effect on early blood vessel formation from the Zr-based BMG. Accordingly, the intimate connection and coupling effect between angiogenesis and osteogenesis must be effective during bone regeneration after implanting Zr-based BMG. Dynamic gait analysis in rats after implanting Zr-based BMG demonstrates a tendency to decrease the pain level during recovery, simultaneously, without abnormal ionic accumulation and inflammatory reactions. Considering suitable mechanical properties, we provide a realistic candidate of the Zr61Ti2Cu25Al12 BMG for biomedical applications.

Dense and crack-free specimens of the shape memory alloy Cu71.6Al17Mn11.4 (at.%) were produced via laser powder bed fusion across a wide range of process parameters. The microstructure, viz. grain size, can be directly tailored within the process and with it the transformation temperatures (TTs) shifted to higher values by raising the energy input. The microstructure, and the superelastic behavior of additively manufactured samples were assessed by a detailed comparison with induction melted material. The precipitation of the α phase, which inhibit the martensitic transformation, were not observed in the additively manufactured samples owing to the high intrinsic cooling rates during the fabrication process. Fine columnar grains with a strong [001]-texture along the building direction lead to an enhanced yield strength compared to the coarse-grained cast samples. A maximum recoverable strain of 2.86% was observed after 5% compressive loading. The first results of our approach imply that laser powder bed fusion is a promising technique to directly produce individually designed Cu-Al-Mn shape memory parts with a pronounced superelasticity at room temperature.

Nearly fully dense, glassy Zr52.5Cu17.9Ni14.6Al10Ti5 bulk specimens were fabricated by selective laser melting (SLM) and their behaviour during compressive loading, during wear testing and in a corrosive medium was investigated. Their performance was compared with as-cast material of the same composition. The additively manufactured samples exhibit a yield strength around 1700 MPa combined with a plastic strain of about 0.5% after yielding despite the residual porosity of 1.3%, which is distributed uniformly in the samples. The propagation of shear bands in the bulk metallic glass prepared by SLM was studied. The specific wear rate and the worn surfaces demonstrated that similar wear mechanisms are active in the SLM and the as-cast samples. Hence, manufacturing the glass in layers does not adversely affect the wear properties. The same holds for the corrosion tests, which were carried out in 0.01 M Na2SO4 and 0.1 M NaCl electrolyte. The anodic polarization curves of SLM samples and as-cast samples revealed a similar corrosion behaviour. However, the SLM samples have a slightly reduced susceptibility to pitting corrosion and exhibit an improved surface healing ability, which might be attributed to an improved homogeneity of the additively manufactured glass. Keywords: Selective laser melting, Zr-based alloy, Microhardness, Compression tests, Wear resistance, Corrosion resistance

Abstract We developed a temperature-controlled inductive flash-annealing device, which heats bulk metallic glasses (BMGs) at defined rates of up to 200 K/s to a given temperature. Subsequent instantaneous quenching in water allows preserving the microstructures obtained at various stages of crystallization. One Zr-based and two CuZr-based BMGs were flash-annealed at the onset of crystallization with different heating rates in order to prepare advanced BMG-matrix composites. The highly reproducible composite microstructures contain uniformly dispersed crystals and a narrow crystal size distribution. In order to assess the limitations of the present process, which mainly originate from non-uniform inductive heating, the skin depth was calculated. It is determined to be about 2.3 mm, which enables flash-annealing of rather bulky samples. The cooling rate was estimated from the interlamellar spacing of eutectic Al-Cu alloys to be on the order of 103 K/s. This ensures that decomposition of the microstructure during quenching is prevented. The present flash-annealing procedure is applicable to a wide variety of glass-forming liquids and has a large potential for tailoring the microstructure and, consequently, the mechanical properties of BMG-matrix composites.

Objective: With advances in techniques, arthroscopic repair of isolated subscapularis tendon tears has become increasingly popular in recent years. The aim of this study was to analyze the clinical and structural results of arthroscopic repair versus the gold standard of open repair. It is a prospective cohort study with a control group; evidence level III. Methods: In a prospective study performed at two centers, 18 patients with an isolated subscapularis tear were treated with arthroscopic repair (ARG) and 16 patients with open repair (ORG) using a uniform single-row suture anchor repair technique in both groups. The subscapularis function was assessed using specific clinical tests (belly-press and lift-off tests), strength testing and shoulder function with the use of the Constant-Murley score (CMS). Standardized magnetic resonance imaging (MRI) was used to evaluate the postoperative subscapularis muscle-tendon status. Results: At a minimum follow-up of 48 months, the CMS increased from a mean of 54 points preoperatively to a mean of 86 points postoperatively in the ARG ( p < 0.01) and from 50 points to 85 points postoperatively in the ORG ( p < 0.01). Specific subscapularis tests (belly-press test and lift-off test) were significantly improved from the preoperative to the postoperative status in both repair groups ( p < 0.05). Despite a subscapularis tendon healing rate of over 90% on MRI scans in both repair groups, the incomplete correction of specific muscle tests was a frequent postoperative finding. Conclusions: Arthroscopic repair of isolated subscapularis tears achieved equivalent clinical and structural results compared to the gold standard of open repair.

A major challenge for tuberculosis (TB) drug development is to prioritize promising combination regimens from a large and growing number of possibilities. This includes demonstrating individual drug contributions to the activity of higher-order combinations. A BALB/c mouse TB infection model was used to evaluate the contributions of each drug and pairwise combination in the clinically relevant Nix-TB regimen [bedaquiline-pretomanid-linezolid (BPaL)] during the first 3 weeks of treatment at human equivalent doses. The rRNA synthesis (RS) ratio, an exploratory pharmacodynamic (PD) marker of ongoing Mycobacterium tuberculosis rRNA synthesis, together with solid culture CFU counts and liquid culture time to positivity (TTP) were used as PD markers of treatment response in lung tissue; and their time-course profiles were mathematically modeled using rate equations with pharmacologically interpretable parameters. Antimicrobial interactions were quantified using Bliss independence and Isserlis formulas. Subadditive (or antagonistic) and additive effects on bacillary load, assessed by CFU and TTP, were found for bedaquiline-pretomanid and linezolid-containing pairs, respectively. In contrast, subadditive and additive effects on rRNA synthesis were found for pretomanid-linezolid and bedaquiline-containing pairs, respectively. Additionally, accurate predictions of the response to BPaL for all three PD markers were made using only the single-drug and pairwise effects together with an assumption of negligible three-way drug interactions. The results represent an experimental and PD modeling approach aimed at reducing combinatorial complexity and improving the cost-effectiveness of in vivo systems for preclinical TB regimen development., Competing Interests: N.D.W. and G.T.R. are listed as co-inventors on US patent no. 16/632,310 which pertains to the RS ratio.

Alternating pressure support surface (APSS) is a common support surface for treating pressure injury in individuals with spinal cord injury (SCI). However, conflicting results on the effectiveness of APSS have been reported and may be associated with inappropriate configurations of APSS. The objectives of this study were to compare the different pressure amplitudes (75/5 mmHg [alternating between 75 and 5 mmHg] vs. 65/15 mmHg) and cycle periods (5 min [4 cycles] vs. 2.5 min [8 cycles]) of alternating pressure on sacral skin blood flow responses in 10 individuals with SCI. Sacral skin blood flow during and after loading of four alternating pressure protocols was assessed using laser Doppler flowmetry and was normalised to the value before loading (10-min baseline, 20-min loading and 10-min recovery). The results demonstrated that during the high-pressure phase, there was a significant difference between the 75/5 and 65/15 mmHg protocols (0.3658 ± 0.0688 for 75/5 mmHg and 0.1702 ± 0.0389 for 65/15 mmHg, p < 0.05); and during the low-pressure phase, there was a significant difference between the 75/5 and 65/15 mmHg protocols (1.7184 ± 0.262 for 75/5 mmHg and 0.5916 ± 0.1378 for 65/15 mmHg, p < 0.05). There were no differences between cycle periods in skin blood flow responses. No adverse events were reported. Our finding indicates that the pressure amplitude of alternating pressure is a significant factor affecting sacral skin blood flow responses. An appropriate configuration of alternating pressure is needed to effectively increase skin blood flow and tissue viability in individuals with SCI., (© 2024 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Mechanistic probing of surface potential changes arising from dynamic charge transport is the key to understanding and engineering increasingly complex nanoscale materials and devices. Spatiotemporal averaging in conventional heterodyne detection-based Kelvin probe force microscopy (KPFM) inherently limits its time resolution, causing an irretrievable loss of transient response and higher-order harmonics. Addressing this, we report a wavelet transform (WT)-based methodology capable of quantifying the sub-ms charge dynamics and probing the elusive transient response. The feedback-free, open-loop wavelet transform KPFM (OL-WT-KPFM) technique harnesses the WT's ability to simultaneously extract spatial and temporal information from the photodetector signal to provide a dynamic mapping of surface potential, capacitance gradient, and dielectric constant at a temporal resolution 3 orders of magnitude higher than the lock-in time constant. We further demonstrate the method's applicability to explore the surface-photovoltage-induced sub-ms hole-diffusion transient in bismuth oxyiodide semiconductor. The OL-WT-KPFM concept is readily applicable to commercial systems and can provide the underlying basis for the real-time analysis of transient electronic and electrochemical properties.

A major challenge for tuberculosis (TB) drug development is to prioritize promising combination regimens from a large and growing number of possibilities. This includes demonstrating individual drug contributions to the activity of higher-order combinations. A BALB/c mouse TB infection model was used to evaluate the contributions of each drug and pairwise combination in the clinically relevant Nix-TB regimen (bedaquiline-pretomanid-linezolid [BPaL]) during the first three weeks of treatment at human equivalent doses. RS ratio, an exploratory pharmacodynamic (PD) marker of ongoing Mycobacterium tuberculosis rRNA synthesis, to-gether with solid culture CFU and liquid culture time to positivity (TTP) were used as PD markers of treatment response in lung tissue; and their time course profiles were mathematically modeled using rate equations with pharmacologically interpretable parameters. Antimicrobial interactions were quantified using Bliss independence and Isserlis formulas. Subadditive (or antagonistic) and additive effects on bacillary load, assessed by CFU and TTP, were found for bedaquiline-pretomanid and linezolid-containing pairs, respectively. In contrast, subadditive and additive effects on rRNA synthesis were found for pretomanid-linezolid and bedaquiline-containing pairs, respectively. Additionally, accurate predictions of the response to BPaL for all three PD markers were made using only the single-drug and pairwise effects together with an assumption of negligible three-way drug interactions. The results represent an experimental and PD modeling approach aimed at reducing combinatorial complexity and improving the cost-effectiveness of in vivo systems for preclinical TB regimen development.

The study aimed to analyze the stress/strain distribution of new designs of mini-implants manufactured by machining and additive manufacturing. Four designs were evaluated (Ø2.0 mm × 10 mm): Intra-lock, helical, threaded machined (MN threaded) and threaded by additive manufacturing (AM threaded). Analysis of stress was performed through photoelastic analysis (100 N axial/oblique loads) and analysis of strain by digital image correlation (DIC) (250 N axial/100 N oblique load). Data distribution was verified using the Shapiro-Wilk test and a significance level of 5% was adopted. Quantitative data were analyzed using the non-parametric Kruskal-Wallis test. In photoelastic analysis, the Intra-lock mini-implant showed the highest stresses in the cervical (104 kPa), middle (108 kPa), and apical (212 kPa) thirds. Higher stresses were observed in the oblique loading situation for all designs. For DIC analysis, axial loading, a significant difference was observed for the AM Threaded mini-implants about the other designs in the cervical third (p = .04), with the highest strain value 47 με [10; 76]. In oblique loading, a significant difference between the mini-implants was observed in the middle and apical thirds, with higher strains for the AM threaded design -185 με [-173; 162] (p = .009) and 242 με [87; 372] (p = .013), respectively. In general, the influence of different mini-implant designs and the additive manufacturing method on the stress/strain was observed, in the photoelastic and DIC analysis. The evaluated designs demonstrated a lower concentration of stress/strain in the cervical region compared to the apical region, and higher stress/strain in situations of oblique load compared with axial load., (© 2023 Wiley Periodicals LLC.)

Tuberculosis lung lesions are complex and harbor heterogeneous microenvironments that influence antibiotic effectiveness. Major strides have been made recently in understanding drug pharmacokinetics in pulmonary lesions, but the bacterial phenotypes that arise under these conditions and their contribution to drug tolerance are poorly understood. A pharmacodynamic marker called the RS ratio ® quantifies ongoing rRNA synthesis based on the abundance of newly synthesized precursor rRNA relative to mature structural rRNA. Application of the RS ratio in the C3HeB/FeJ mouse model demonstrated that Mycobacterium tuberculosis populations residing in different tissue microenvironments are phenotypically distinct and respond differently to drug treatment with rifampin, isoniazid, or bedaquiline. This work provides a foundational basis required to address how anatomic and pathologic microenvironmental niches may contribute to long treatment duration and drug tolerance during the treatment of human tuberculosis., Competing Interests: N.W.D., M.I.V., and G.T.R. are listed as co-inventors on US patent No. 16/632,310 that pertains to the RS ratio. The remaining authors have no conflicts of interest to declare.

Cupping therapy has been widely used to manage musculoskeletal impairment. However, the effects of pressure and duration of cupping therapy on the hemodynamic activity of the muscle have not been investigated. A 2 × 2 repeated measures factorial design was used to examine the main effect and interaction of pressure (-225 and -300 mmHg) and duration (5 and 10 min) on biceps muscle blood flow using near-infrared spectroscopy in 18 participants. The results showed that a significant interaction is between pressure and duration on deoxy-hemoglobin (p = 0.045). A significant main effect of pressure is on oxyhemoglobin (p = 0.005) and a significant main effect of duration is on oxyhemoglobin (p = 0.005). Cupping therapy at -300 mmHg for 10 min results in a higher oxyhemoglobin (6.75 ± 2.08 μM) and deoxy-hemoglobin (1.71 ± 0.78 μM) compared to other three combinations. Our study provides first evidence that the pressure and duration factors of cupping therapy can significantly affect muscle blood volume and oxygenation., (© 2023 The Authors. Journal of Biophotonics published by Wiley-VCH GmbH.)

The management of proximal tibial fractures has evolved significantly in recent years. While the main goals of treatment - stability, restoration of the mechanical axis, and smooth articular surfaces - remain the same, methods have advanced substantially. In diagnostics, technical progress in CT and MR imaging has led to a better three-dimensional understanding of the injury. Newly developed classification systems such as the three-column concept of Luo et al. and the 10-segment concept of Krause et al. take this into account. Accordingly, there is a trend towards tailored approaches for particular fracture localizations. Parallel to this development, there is increasing evidence of the advantages of arthroscopically assisted surgical procedures. This Current Concepts article reviews classifications, diagnostics, treatment options as well as complications in fractures of the proximal tibia., Competing Interests: SK is member of the speaker’s bureau of Smith & Nephew, Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Gahr, Kopf and Pauly.)

Localized surface plasmon resonance (LSPR) of metallic nanostructures is a unique phenomenon that controls the light in sub-wavelength volumes and enhances the light-matter interactions. Traditionally, the excitation and measurement of LSPR require bulky external light sources, and efforts to scale down to nano-plasmonic devices have predominantly relied on the system's miniaturization and associated accessories. Addressing this, here we show the generation and detection of LSPR wavelength (λ LSPR ) shifts in large-area nanostructured Au surfaces using frictional charges generated by triboelectric surfaces. We observe a complex interplay of the localized surface plasmons with frictional charges via concurrent spectroscopic and triboelectric measurements undertaken for the detection of bioconjugation in the streptavidin-biotin complex. When subjected to multivariate principal component analysis, a strong correlation between the triboelectric peak-to-peak voltage output response and the λ LSPR shift is observed. Furthermore, we reveal a landscape of the interfacial events involved in the electrical generation/detection of the LSPR by using theoretical models and surface characterization. The demonstrated concept of electrification of plasmon resonance thus provides the underlying basis for the subsequent development of self-powered nano-plasmonic sensors and opens new horizons for advanced nanophotonic applications.

Murine tuberculosis drug efficacy studies have historically monitored bacterial burden based on CFU of Mycobacterium tuberculosis in lung homogenate. In an alternative approach, a recently described molecular pharmacodynamic marker called the RS ratio quantifies drug effect on a fundamental cellular process, ongoing rRNA synthesis. Here, we evaluated the ability of different pharmacodynamic markers to distinguish between treatments in three BALB/c mouse experiments at two institutions. We confirmed that different pharmacodynamic markers measure distinct biological responses. We found that a combination of pharmacodynamic markers distinguishes between treatments better than any single marker. The combination of the RS ratio with CFU showed the greatest ability to recapitulate the rank order of regimen treatment-shortening activity, providing proof of concept that simultaneous assessment of pharmacodynamic markers measuring different properties will enhance insight gained from animal models and accelerate development of new combination regimens. These results suggest potential for a new era in which antimicrobial therapies are evaluated not only on culture-based measures of bacterial burden but also on molecular assays that indicate how drugs impact the physiological state of the pathogen.

Aims: Fungal periprosthetic joint infections (fPJIs) are rare complications, constituting only 1% of all PJIs. Neither a uniform definition for fPJI has been established, nor a standardized treatment regimen. Compared to bacterial PJI, there is little evidence for fPJI in the literature with divergent results. Hence, we implemented a novel treatment algorithm based on three-stage revision arthroplasty, with local and systemic antifungal therapy to optimize treatment for fPJI., Methods: From 2015 to 2018, a total of 18 patients with fPJI were included in a prospective, single-centre study (DKRS-ID 00020409). The diagnosis of PJI is based on the European Bone and Joint Infection Society definition of periprosthetic joint infections. The baseline parameters (age, sex, and BMI) and additional data (previous surgeries, pathogen spectrum, and Charlson Comorbidity Index) were recorded. A therapy protocol with three-stage revision, including a scheduled spacer exchange, was implemented. Systemic antifungal medication was administered throughout the entire treatment period and continued for six months after reimplantation. A minimum follow-up of 24 months was defined., Results: Eradication of infection was achieved in 16 out of 18 patients (88.8%), with a mean follow-up of 35 months (25 to 54). Mixed bacterial and fungal infections were present in seven cases (39%). The interval period, defined as the period of time from explantation to reimplantation, was 119 days (55 to 202). In five patients, a salvage procedure was performed (three cementless modular knee arthrodesis, and two Girdlestone procedures)., Conclusion: Therapy for fPJI is complex, with low cure rates according to the literature. No uniform treatment recommendations presently exist for fPJI. Three-stage revision arthroplasty with prolonged systemic antifungal therapy showed promising results. Cite this article: Bone Jt Open  2021;2(8):671-678.

The surface properties of titanium and its alloys are commonly modified by different techniques, including additive manufacturing (AM), to improve the osseointegration of dental implants. The aim of this study was to evaluate and compare the wettability, topography, chemistry, and structure of titanium-aluminum-vanadium (Ti-6Al-4 V) discs fabricated by selective laser melting (SLM) and subtractive manufacturing (conventional machining). Three different groups were evaluated: selective laser melting (SLM); conventional machining with H 3 PO 4  + NaOH surface treatment (CM + ST); and conventional machining without surface treatment (CM), including analysis of wettability and roughness, morphological and chemical analyses by scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX), and structural characterization analysis by computed tomography (micro-CT), and X-ray diffraction (XRD). The results showed that SLM surface had higher roughness (9.09 ± 1.94 Ra; 51.93 ± 11.59 Rz; 11.03 ± 1.95 Sa) and lower wettability (103.23° ± 13) than CM (0.06 ± 0.01 Ra; 0.42 ± 0.078 Rz; 0.07 ± 0.01 Sa) (76.95° ± 4.18) and CM + ST (0.17 ± 0.38 Ra; 0.88 ± 0.15 Rz; 0.18 ± 0.04 Sa) (18.55° ± 6.47) (p < 0.05). SEM images also proved the higher roughness of SLM surface, and CM + ST discs showed a topography resembling a sponge, characteristic of the nanometric treatment applied. EDX and XRD found no differences between the different surfaces, and micro-CT demonstrated the solid characteristic of the SLM disc. Compared with conventional machining, the SLM technique resulted in higher roughness and lower wettability. Meanwhile, the chemical properties and structure of the titanium alloy was not altered by the technique., (© 2020 Wiley Periodicals LLC.)

Background: Treatment of first-time shoulder dislocation (FSD) is a topic of debate. After high rates of recurrent instability after nonoperative management were reported in the literature, primary repair of FSD significantly increased. At the same time, new concepts were proposed that had promising results for immobilization in external rotation (ER) and abduction (ABD)., Purpose: The aim of this study was to evaluate the recurrence rates (primary outcome) and clinical outcomes (secondary outcome parameters) of immobilization in ER+ABD versus arthroscopic primary stabilization after FSD., Study Design: Randomized controlled trial; Level of evidence, 1., Methods: In a multicenter randomized controlled trial, patients with FSD were randomized to either treatment with immobilization in 60° of ER plus 30° of ABD (group 1) or surgical treatment with arthroscopic Bankart repair (group 2). Clinical evaluation was performed 1, 3, and 6 weeks as well as 6, 12, and 24 months postoperatively or after reduction, including range of motion, instability testing, subjective shoulder value, Constant-Murley score, Rowe score, and Western Ontario Shoulder Instability Index. Recurrent instability events were prospectively recorded., Results: Between 2011 and 2017, a total of 112 patients were included in this study. Of these, 60 patients were allocated to group 1 and 52 to group 2. At the 24-month follow-up, 91 patients (81.3%) were available for clinical examination. The recurrence rate was 19.1% in group 1 and 2.3% in group 2 ( P = .016). No significant differences were found between groups regarding clinical shoulder scores ( P > .05). Due to noncompliance with the immobilization treatment protocol, 4 patients (6.7%) were excluded., Conclusion: Immobilization in ER+ABD versus primary arthroscopic shoulder stabilization for the treatment of FSD showed no differences in clinical shoulder scores. However, recurrent instability was significantly higher after nonoperative treatment.

Panel data covering the French population before and after the outbreak of the Covid-19 epidemic reveal that self-reported health and well-being have improved during the lockdown in comparison to previous years. We name this counterintuitive phenomenon the "eye of the hurricane" paradox: the large majority of individuals who are not infected by the virus may be seeing their current condition in a more positive light than they normally would. There are, however, divergences across social groups that reflect socioeconomic inequalities. In particular, blue-collar workers deviate from the prevailing trend as their level of self-reported health declines over the lockdown period, Parisian residents experience a sudden drop in their subjective well-being, and people working long hours at home exhibit higher levels of stress during the quarantine., (© 2020 Elsevier Ltd. All rights reserved.)

Although several studies revealed a multifactorial pathogenesis of degenerative rotator cuff disorders, the impact and interaction of extrinsic variables is still poorly understood. Thus, this study aimed at uncovering the effect of patient- and pathology-specific risk factors that may contribute to degeneration of the rotator cuff tendons. Between 2015 and 2018, 54 patients who underwent arthroscopic shoulder surgery at three specialized shoulder clinics were prospectively included. Using tendon samples harvested from the macroscopically intact subscapularis (SSC) tendon, targeted messenger RNA expression profile analysis was performed in the first cohort (n = 38). Furthermore, histological analyses were conducted on tendon tissue samples obtained from a second cohort (n = 16). Overall, both study cohorts were comparable concerning patient demographics. Results were then analyzed with respect to specific extrinsic factors, such as patient age, body mass index, current as well as previous professions and sport activities, smoking habit, and systemic metabolic diseases. While patient age, sports-activity level, and preexisting rotator cuff lesions were considered to contribute most strongly to tendinopathogenesis, no further coherences were found. With regards to gene expression analysis, change in expression correlated most strongly with patient age and severity of the rotator cuff pathology. Further, chronic disorders increased overall gene expression variation. Taken together, our study provides further evidence that tendon degeneration is the consequence of a multifactorial process and pathological changes of the supraspinatus tendon affect the quality of SSC tendon and most likely vice versa. Therefore, the rotator cuff tendons need to be considered as a unit when managing rotator cuff pathologies. © 2019 The Authors. Journal of Orthopaedic Research ® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society J Orthop Res 38:182-191, 2020., (© 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society.)

Background: Pathologic activation pattern of muscles can cause shoulder instability. We propose to call this pathology functional shoulder instability (FSI). The purpose of this prospective study was to provide an in-detail description of the characteristics of FSI., Methods: In the year 2017, a total of 36 consecutive cases of FSI presenting to our outpatient clinic were prospectively collected. Diagnostic investigation included a pathology-specific questionnaire, standardized clinical scores, clinical examination, psychological evaluation, video and dynamic fluoroscopy documentation of the instability mechanism, as well as magnetic resonance imaging (MRI). In a final reviewing process, the material from all collected cases was evaluated and, according to the observed pattern, different subtypes of FSI were determined and compared., Results: Based on the pathomechanism, positional FSI (78%) was distinguished from nonpositional FSI (22%). Controllable positional FSI was observed in 6% of all cases and noncontrollable positional FSI in 72%, whereas controllable and noncontrollable nonpositional FSI were each detected in 11% of the cases. The different subtypes of FSI showed significant differences in all clinical scores (Western Ontario Shoulder Instability Index: P = .002, Rowe Score: P = .001, Subjective Shoulder Value: P = .001) and regarding functional impairment (shoulder stability: P < .001, daily activities: P = .001, sports activities: P < .001). Seventy-eight percent had posterior, 17% anterior, and 6% multidirectional instability. Although several patients showed constitutional glenoid shape alterations or soft tissue hyperlaxity, only few patients with acquired minor structural defects were observed., Conclusion: FSI can be classified into 4 subtypes based on pathomechanism and volitional control. Depending on the subtype, patients show different degrees of functional impairment. The majority of patients suffer from unidirectional posterior FSI., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Reverse shoulder arthroplasty shifts the rotational center of the shoulder joint caudally and medially to restore shoulder function in a rotator cuff deficient shoulder. Despite promising results in early- and mid-term follow-up, long-term loss in shoulder function has been described in the literature. A lack of exercise in elderly patients may be one reason for this loss in function. This study examines the functional benefits of physical therapy in the mid-term to long-term follow-up regarding the subjective and objective shoulder function., Materials and Methods: Twenty patients with a mean age of 73 years were included in this series. The study was performed as a single-center, prospective study. Initial indications for reverse shoulder arthroplasty were cuff tear arthropathy, failed anatomical shoulder arthroplasty, and fracture sequelae. The patients were clinically examined at a mean follow-up of 62 months using the Constant score (CS) and the DASH score for the operated and the non-operated shoulder. They were reevaluated using the same scores following a standardized physical therapy program of 6 weeks' duration., Results: The mean CS as well as the mean age- and gender-adjusted CS of the affected shoulder improved significantly from 53.5 to 59.3 points, and 72.7-80.8%, respectively. The subcategories activities of daily living (ADL) and range of motion (ROM) of the CS improved significantly, whereas no significant improvement was observed for the subcategories pain and strength. Evaluating the contralateral shoulder, no significant change was observed for the age- and gender-adjusted CS and the CS as well as its subcategories. We found no significant difference in the CS comparing the different etiologies prior to physical therapy., Discussion: Physical therapy plays an important role subsequent to reverse shoulder arthroplasty. It also has an effect in the mid-term to long-term follow-up regarding the range of motion as well as activities of daily living. However, physical therapy seems to have limited effect on the strength and the residual pain level., Level of Evidence: Level III.

Background: Platelet rich plasma (PRP) is widely used in rotator cuff repairs but its effect on the healing process is unclear. Several cell culture studies on the effect of allogenic PRP have reported promising results but are not transferable to clinical practice. The aim of the present study is to assess the possible effect of autologous PRP on rotator cuff tendon cells. The amount of growth factors involved with tendon-bone healing (PDGF-AB, IGF-1, TGF-β1, BMP-7 and -12) is quantified., Methods: Rotator cuff tissue samples were obtained from (n = 24) patients grouped by age (>/< 65 years) and sex into four groups and cells were isolated and characterized. Later, autologous PRP preparations were obtained and the effect was analyzed by means of cell proliferation, collagen I synthesis and expression of collagen I and III. Furthermore, the PRPs were quantified for growth factor content by means of platelet-derived growth factor (PDGF-AB), insulin-like growth factor (IGF-1), transforming growth factor (TGF-β1), as well as bone morphogenetic protein (BMP) -7 and - 12., Results: Cell proliferation and absolute synthesis of collagen I were positively affected by PRP exposure compared to controls (p < 0.05), but expression and relative synthesis of collagen I (normalized to cell proliferation) were significantly reduced. PRP contained high amounts of IGF-1 and lower levels of TGF-β1 and PDGF-AB. The amounts of BMP-7 and -12 were below the detection limits., Conclusions: PRP is a source of growth factors such involved with tendon-bone healing. PRP had an anabolic effect on the human rotator cuff tenocytes of the same individual in vitro by means of cell proliferation and absolute, but not relative collagen I synthesis. These results encourage further studies on clinical outcomes with more comparable standards in terms of preparation and application methods., Level of Evidence: Controlled laboratory study.

Objective: Reconstruction of tendon integrity to maintain glenohumeral joint centration and hence to restore shoulder functional range of motion and to reduce pain., Indications: Isolated or combined full-thickness subscapularis tendon tears (≥upper two-thirds of the tendon) without both substantial soft tissue degeneration and cranialization of the humeral head., Contraindications: Chronic tears of the subscapularis tendon with higher grade muscle atrophy, fatty infiltration, and static decentration of the humeral head., Surgical Technique: After arthroscopic three-sided subscapularis tendon release, two double-loaded suture anchors are placed medially to the humeral footprint. Next to the suture passage, the suture limbs are tied and secured laterally with up to two knotless anchors creating a transosseous-equivalent repair., Postoperative Management: The affected arm is placed in a shoulder brace with 20° of abduction and slight internal rotation for 6 weeks postoperatively. Rehabilitation protocol including progressive physical therapy from a maximum protection phase to a minimum protection phase is required. Overhead activities are permitted after 6 months., Results: While previous studies have demonstrated superior biomechanical properties and clinical results after double-row compared to single-row and transosseous fixation techniques, further mid- to long-term clinical investigations are needed to confirm these findings.

ZrCu-based bulk metallic glass composites (BMGCs) are well known for their plastic deformability, superior to traditional metallic glasses (MGs), which is attributed to a unique dual-phases structure, namely, the glassy matrix and unstable B2 phase. In the present study, in-situ tensile testing is used to trace the deformation process of a ZrCu-based BMGC. Three deformation stages of the BMGC, i.e., the elastic-elastic stage, the elastic-plastic stage, and the plastic-plastic stage are identified. In the elastic-elastic and elastic-plastic stages, the yield strength and elastic limit are major influenced by the volume fraction of the B2 crystals. In the plastic-plastic stage, the B2 phase stimulates the formation of multiple shear bands and deflects the direction of shear bands by disturbing the stress field in front of the crack tip. The deformation-induced martensitic transformation of the metastable B2 phase contributes to the plasticity and work hardening of the composite. This study highlights the formation and propagation of multiple shear bands and reveals the interactions of shear bands with structural heterogeneities in situ. Especially, the blocking of shear bands by crystals and the martensitic transformation of the B2 phase are critical for the mechanistic deformation process and illustrate the function of the B2 phase in the present BMGCs.

Martensitic transformations originate from a rigidity instability, which causes a crystal to change its lattice in a displacive manner. Here, we report that the martensitic transformation on cooling in Ti-Zr-Cu-Fe alloys yields an amorphous phase instead. Metastable β-Ti partially transforms into an intragranular amorphous phase due to local lattice shear and distortion. The lenticular amorphous plates, which very much resemble α'/α″ martensite in conventional Ti alloys, have a well-defined orientation relationship with the surrounding β-Ti crystal. The present solid-state amorphization process is reversible, largely cooling rate independent and constitutes a rare case of congruent inverse melting. The observed combination of elastic softening and local lattice shear, thus, is the unifying mechanism underlying both martensitic transformations and catastrophic (inverse) melting. Not only do we reveal an alternative mechanism for solid-state amorphization but also establish an explicit experimental link between martensitic transformations and catastrophic melting.

This present article summarizes established and current developments and aspects of rotator cuff surgery. Achieved milestones as well as current approaches are presented and assessed with respect to their clinical and radiographic impact. Despite biomechanical and technical improvements in modern rotator cuff repair techniques, re-defect and re-tearing rates could not be fully eliminated. Meanwhile, the importance of biological processes around successful tendon-bone reintegration has been increasingly recognized. Hence, this article presents the current scientific standing regarding biological growth factors, platelet-rich plasma and rotator cuff augmentation techniques (with allogenic/autologous grafts). In summary, there are clear biomechanical advantages as well as many promising approaches to biological augmentation; however, the latter have not yet been transferred into regular clinical application.