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Background: It is unknown if total joint arthroplasty (TJA) patients admitted to the intensive care unit (ICU) benefit from the surgery. This impedes clinical decision-making, resource allocation and patient informed consent. This study aims to identify whether admission to ICU post-TJA surgery is associated with poorer quality of life, pain and function, compared to those not requiring ICU admission., Methods: Data on patients who underwent elective total hip or knee arthroplasty between 2006 and 2019 were extracted from a single-institution registry in Melbourne, Australia. Adjusted mixed-linear regression models were used to estimate the mean difference at 12 months in quality of life (VR-12), and pain and function (WOMAC) between patients admitted postoperatively to ICU and those not admitted., Results: Of the 8444 patients that met the study inclusion criteria, 128 (1.5%) patients were admitted to ICU peri- or postoperatively. The median length of stay in ICU was 1 day (IQR = 1). Patients in both groups reported similar clinically meaningful improvements in quality of life, pain and function 12-months after surgery., Conclusion: Clinicians weighing up risks versus benefits of TJA in patients with a higher risk of ICU admission should not overlook the significant improvements in quality of life, pain and function likely to be seen., (© 2024 Royal Australasian College of Surgeons.)

The musculotendon mechanics of the hamstrings during high-speed running are thought to relate to injury but have rarely been examined in the context of prospectively occurring injury. This prospective study describes the hamstring musculotendon mechanics of two elite rugby players who sustained hamstring injuries during on-field running. Athletes undertook biomechanical analyses of high-speed running during a Super Rugby pre-season, prior to sustaining hamstring injuries during the subsequent competition season. The biceps femoris long head muscle experienced the greatest strain of all hamstring muscles during the late swing phase. When expressed relative to force capacity, biceps femoris long head also experienced the greatest musculotendon forces of all hamstring muscles. Musculotendon strain and force may both be key mechanisms for hamstring injury during the late swing phase of running.

Objective: Psychiatric comorbidities such as depression, anxiety, and personality disorders are common in patients with functional limb weakness/paresis (FND-par). The impact of these conditions on the prognosis of FND-par has not been systematically reviewed. The aim of this study was to identify a potential prognostic effect of comorbid depression, anxiety, and/or personality disorder on prognosis in patients with FND-par., Methods: A systematic review was performed to identify studies that reported measures of baseline depression, anxiety, and/or personality disorder, and physical disability. An individual patient data meta-analysis was subsequently performed., Results: Eight studies comprising 348 individuals were included (7 prospective cohorts; 1 case-control study). There was heterogeneity in sample size, follow-up duration, and treatment modality. Depression and anxiety were present in 51.4% and 53.0% of FND-par patients, respectively. In individuals whose FND-par improved, there was no significant difference between those with versus without depression (52.6% vs 47.4%, p = 0.69) or those with versus without anxiety (50.3% vs 49.7%, p = 0.38). Meta-analysis showed no clear impact of baseline depression or anxiety per se [pooled OR for depression 0.85 (95%CI 0.50-1.45; p = 0.40) and anxiety 0.84 (95%CI 0.51-1.38; p = 0.91)]; and of depression or anxiety severity [pooled OR for depression 1.23 (95%CI 0.63-2.39; p = 0.91) and anxiety 1.40 (95%CI 0.70-2.78; p = 0.58)] on FND-par outcome. Insufficient data were available to assess the impact of personality disorders., Conclusion: We found no evidence that depression or anxiety influenced outcome in FND-par. Large-scale, prospective studies in FND-par, and other FND subtypes, are needed to fully contextualize the impact of concurrent mental health concerns on outcomes., Competing Interests: Declaration of Competing Interest David L. Perez has received honoraria for continuing medical education lectures on functional neurological disorder, royalties from Springer Nature for a functional movement disorder textbook, is a paid senior editor at Brain and Behavior, and has received funding from the NIH and the Sidney R. Baer Jr. Foundation unrelated to this work. Jon Stone reports honoraria from UptoDate, personal fees from expert witness work, grants from National Research Scotland and runs a self-help website for patients with Functional Neurological Disorder. He is medical advisor to FND Hope, FND Hope UK and FND Action, and secretary of the FND society. All other authors do not report any relevant conflicts of interest / disclosures., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective The coronavirus disease 2019 (COVID-19) pandemic precipitated a major shift in the use of telehealth in Australia. The changes highlighted gaps in our knowledge regarding the efficacy of, and clinician attitudes to, the use of telehealth. The current study expands and deepens the available evidence as a result of being collected in unique circumstances that removed one of the major barriers (lack of Medicare rebates) and also one major enablers (willingness) of telehealth uptake. Methods Using a semi-structured interview, we invited clinicians (N  = 39) to share their perspectives, attitudes and experiences of using telehealth. Topics covered included perceptions of the strengths and challenges of telehealth, and how experience of using telehealth during the COVID-19 pandemic had influenced clinicians' views and intentions regarding their future practice. Participants included clinicians from five disciplines across public and private practice: paediatrics, neurology, immunology, rural general practice, and orthopaedics. Results We found three key dimensions for consideration when assessing the suitability of telehealth for ongoing practice: the attributes of the patient population, the attributes of the clinical context and environment, and the risks and benefits of a telehealth approach. These findings map to the existing literature and allow us to infer that the experiences of clinicians who previously would have chosen telehealth did not differ significantly from those of our 'pandemic-conscripted' clinicians. Conclusions Our findings map clearly to the existing literature and allow us to infer that the experiences of the clinicians who have chosen telehealth (and are already represented in the literature) did not differ significantly from those trying out telehealth under the unique circumstances of the removal of the Medicare Benefits Scheme barrier and external pressure that over-rides the 'willingness' enabling factor in uptake decisions.

Purpose: Three-dimensional (3D)-two-dimensional (2D) fluoroscopic image registration was used to measure 3D hip kinematics before and after hip arthroscopy in patients with femoroacetabular impingement (FAI)., Methods: In total, 24 subjects diagnosed with FAI (21 unilateral, 3 bilateral) were prospectively recruited. A clinical impingement test was performed on both hips while the patient was awake and then while anaesthetized, and in the operative hip after arthroscopic osteoplasties and labral repair. Fluoroscopy was used to image the hip during the impingement tests. Images were analyzed using 3D-2D image registration to calculate joint kinematics. The examiner's hand was instrumented with a glove to measure internal rotation torque applied to the hip during each test., Results: Internal rotation increased by 3.7° (standard error [SE] 0.95°) after surgery ( P  = .001). Maximum displacement of the femoral head out of the acetabulum was 4.0 mm (SE 0.5 mm) in the operative group before surgery and 1.8 mm (SE 0.3 mm) after surgery ( P < .001). This was due to a decrease in lateral displacement by 1.3 mm (SE 0.4 mm, P = .002) and proximal displacement by 0.8 mm (SE 0.3 mm, P = .013). Internal rotation torque was greater in the operative hips when anaesthetized compared with when awake, by 5 Nm (SE 1.2 Nm, P < .001), and greater in the contralateral hips than the operative hips when awake by 8.4 Nm (SE 1.4 mm, P < .001)., Conclusions: Arthroscopic osteoplasty and labral repair increased hip range of motion and reduced femoral head displacement from the acetabulum during the IR90 provocation test (i.e., hip flexion to 90°, maximum internal rotation) in patients with FAI. This suggests that the impinging acetabular rim acted as a fulcrum before surgery and may have caused edge loading that was reduced after surgery., Level of Evidence: Level IV case series, therapeutic study., (© 2022 Published by Elsevier Inc. on behalf of the Arthroscopy Association of North America.)

Importance: Distal radius fractures are common and are managed with or without surgery. Current evidence indicates surgical treatment is not superior to nonsurgical treatment at 12 months., Objective: Does surgical treatment for displaced distal radius fractures in patients 60 years or older provide better patient-reported wrist pain and function outcomes than nonsurgical treatment at 24 months?, Design, Setting, and Participants: In this secondary analysis of a combined multicenter randomized clinical trial (RCT) and a parallel observational study, 300 patients were screened from 19 centers in Australia and New Zealand. Of these, 166 participants were randomized to surgical or nonsurgical treatment. Participants who declined randomization (n = 134) were included in the parallel observational group with the same treatment options and follow-up. Participants were followed up at 3, 12, and 24 months by a blinded assessor. The 24-month outcomes are reported herein. Data were collected from December 1, 2016, to December 31, 2020, and analyzed from February 4 to October 21, 2021., Interventions: Surgical treatment consisting of open reduction and internal fixation using a volar-locking plate (VLP group) and nonsurgical treatment consisting of closed reduction and cast immobilization (CR group)., Main Outcomes and Measures: The primary outcome was patient-reported function using the Patient-Rated Wrist Evaluation (PRWE) questionnaire. Secondary outcomes included health-related quality of life, wrist pain, patient-reported treatment success, patient-rated bother with appearance, and posttreatment complications., Results: Among the 166 randomized and 134 observational participants (300 participants; mean [SD] age, 71.2 [7.5] years; 269 women [89.7%]), 151 (91.0%) randomized and 118 (88.1%) observational participants were followed up at 24 months. In the RCT, no clinically important difference occurred in mean PRWE scores at 24 months (13.6 [95% CI, 9.1-18.1] points for VLP fixation vs 15.8 [95% CI, 11.3-20.2] points for CR; mean difference, 2.1 [95% CI, -4.2 to 8.5]; P = .50). There were no between-group differences in all other outcomes except for patient-reported treatment success, which favored VLP fixation (33 of 74 [44.6%] in the CR group vs 54 of 72 [75.0%] in the VLP fixation group reported very successful treatment; P = .002). Rates of posttreatment complications were generally low and similar between treatment groups, including deep infection (1 of 76 [1.3%] in the CR group vs 0 of 75 in the VLP fixation group) and complex regional pain syndrome (2 of 76 [2.6%] in the CR group vs 1 of 75 [1.3%] in the VLP fixation group). The 24-month trial outcomes were consistent with 12-month outcomes and with outcomes from the observational group., Conclusions and Relevance: Consistent with previous reports, these findings suggest that VLP fixation may not be superior to CR for displaced distal radius fractures for patient-rated wrist function in persons 60 years or older during a 2-year period. Significantly higher patient-reported treatment success at 2 years in the VLP group may be attributable to other treatment outcomes not captured in this study., Trial Registration: ANZCTR.org Identifier: ACTRN12616000969460.

Purpose: The purpose of this paper is to present a method for registration of 3D computed tomography to 2D single-plane fluoroscopy knee images to provide 3D motion information for knee joints. This 3D kinematic information has unique utility for examining joint kinematics in conditions such as ligament injury, osteoarthritis and after joint replacement., Methods: We proposed a non-invasive rigid body image registration method which is based on two different multimodal similarity measures. This hybrid registration method helps to achieve a trade-off among different challenges including, time complexity and accuracy., Results: We performed a number of experiments to evaluate the performance of the proposed method. The experimental results show that the proposed method is as accurate as one of the most recent registration methods while it is several times faster than that method., Conclusion: The proposed method is a non-invasive, fast and accurate registration method, which can provide 3D information for knee joint kinematic measurements. This information can be very helpful in improving the accuracy of diagnosis and providing targeted treatment., (© 2022. The Author(s).)

Objectives: The aim of this study was to identify patient, hospital and transitional factors associated with unplanned 30-day readmissions in patients who had a total hip arthroplasty (THA)., Design: A cross-sectional survey was performed. All patients attending a 6-week follow-up after a THA in the Australian Capital Territory (ACT) at four public and private clinics in the ACT from 1 February 2018 to 31 January 2019, were invited to complete an ACT Transition from Hospital to Home Orthopaedic Survey ., Participants: Within the ACT, 431 patients over the age of 16 attending their 6-week post-surgery consultation following a THA entered and completed the survey (response rate 77%)., Primary Outcome Measure: The primary outcome measure was self-reported readmissions for any reason within 30 days of discharge after a THA. Multiple logistic regression was used to estimate ORs of factors associated with unplanned 30-day readmissions., Results: Of the 431 participants (representing 40% of all THAs conducted in the ACT during the study period), 27 (6%) were readmitted within 30 days of discharge. After controlling for age and sex, patients who did not feel rested on discharge were more likely to be readmitted within 30 days than those who felt rested on discharge (OR=5.75, 95% CI: (2.13 to 15.55), p=0.001). There was no association between post-hospital syndrome (ie, in-hospital experiences of pain, sleep and diet) overall and readmission. Patients who suffered peripheral vascular disease (PVD) were significantly more likely to have an unplanned 30-day readmission (OR=16.9, 95% CI: (3.06 to 93.53), p=0.001). There was no significant difference between private and public patient readmissions CONCLUSIONS: Hospitals should develop strategies that maximise rest and sleep during patients' hospital stay. Diagnosis and optimum treatment of pre-existing PVD prior to THA should also be a priority to minimise the odds of subsequent unplanned readmissions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The aim of this study was to investigate factors associated with unplanned 30-day readmissions following a total knee arthroplasty (TKA), including association with post-hospital syndrome, patient enablement and transition from hospital to home., Design, Setting and Participants: A cross-sectional written survey of public and private patients attending a 6-week follow-up appointment after TKA at one of four clinical services in the Australian Capital Territory (ACT) between 1 February 2018 and 31 January 2019. Multiple logistic regression analyses were used to measure associations between patient, hospital and transitional care factors with unplanned 30-day readmissions, while controlling for known confounders., Results: Of the 380 participants who completed the survey (n=380, 54% of TKAs undertaken over the study period), 3.4% (n=13; 95% CI: 1.8 to 5.8) were subsequently readmitted within 30 days of discharge after a primary hospitalisation. Public patients were significantly more likely to be readmitted within 30 days compared with private patients (adjusted OR=6.31, 95% CI: 1.59 to 25.14, p=0.009), and patients who attended rehabilitation were significantly less likely to be readmitted within 30 days of discharge than those who did not (adjusted OR=0.16, 95% CI: 0.04 to 0.57, p=0.005). There were no associations between post-hospital syndrome or patient enablement and 30-day readmissions in this study., Conclusion: Reasons underlying the difference in unplanned readmission rates for public versus private patients need to be explored, including differences in surgical waiting times and the consequences for impairment and disease complexity. Strategies to foster increased participation post-surgical rehabilitation programmes need to be developed as an avenue to mitigate the burden of unplanned 30-day readmissions on individuals and health systems., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Abstract: Exercise and pain neuroscience education (PNE) have both been used as standalone treatments for chronic musculoskeletal pain. The evidence supporting PNE as an adjunct to exercise therapy is growing but remains unclear. The aim of this systematic review and meta-analysis was to evaluate the effect of combining PNE and exercise for patients with chronic musculoskeletal pain, when compared with exercise alone. A systematic search of electronic databases was conducted from inception to November 6, 2020. A quality effects model was used to meta-analyze outcomes where possible. Five high-quality randomized controlled studies (n = 460) were included in this review. The PEDro scale was used to assess the quality of individual studies, and Grading of Recommendations, Assessment, Development, and Evaluation analysis was conducted to determine the quality of evidence for each outcome. Meta-analyses were performed for pain intensity, disability, kinesiophobia, and pain catastrophizing using data reported between 0 and 12 weeks postintervention. Long-term outcomes (>12 weeks) were only available for 2 studies and therefore were not suitable for meta-analysis. Meta-analysis revealed a significant difference in pain (weighted mean differences, -2.09/10; 95% confidence interval [CI], -3.38 to -0.80; low certainty), disability (standardized mean difference, -0.68; 95% CI, -1.17 to -0.20; low certainty), kinesiophobia (standardized mean difference, -1.20; CI, -1.84 to -0.57; moderate certainty), and pain catastrophizing (weighted mean differences, -7.72; 95% CI, -12.26 to -3.18; very low certainty) that favoured the combination of PNE and exercise. These findings suggest that combining PNE and exercise in the management of chronic musculoskeletal pain results in greater short-term improvements in pain, disability, kinesiophobia, and pain catastrophizing relative to exercise alone., (Copyright © 2021 International Association for the Study of Pain.)

Importance: The burden of injury and costs of wrist fractures are substantial. Surgical treatment became popular without strong supporting evidence., Objective: To assess whether current surgical treatment for displaced distal radius fractures provided better patient-reported wrist pain and function than nonsurgical treatment in patients 60 years and older., Design, Setting, and Participants: In this multicenter randomized clinical trial and parallel observational study, 300 eligible patients were screened from 19 centers in Australia and New Zealand from December 1, 2016, until December 31, 2018. A total of 166 participants were randomized to surgical or nonsurgical treatment and followed up at 3 and 12 months by blinded assessors. Those 134 individuals who declined randomization were included in a parallel observational cohort with the same treatment options and follow-up. The primary analysis was intention to treat; sensitivity analyses included as-treated and per-protocol analyses., Intervention: Surgical treatment was open reduction and internal fixation using a volar-locking plate (VLP). Nonsurgical treatment was closed reduction and cast immobilization (CR)., Main Outcomes and Measures: The primary outcome was the Patient-Rated Wrist Evaluation score at 12 months. Secondary outcomes were Disabilities of Arm, Shoulder, and Hand questionnaire score, health-related quality of life, pain, major complications, patient-reported treatment success, bother with appearance, and therapy use., Results: In the 300 study participants (mean [SD] age, 71.2 [7.5] years; 269 [90%] female; 166 [81 VLP and 85 CR] in the randomized clinical trial sample and 134 [32 VLP and 102 CR] in the observational sample), no clinically important between-group difference in 12-month Patient-Rated Wrist Evaluation scores (mean [SD] score of 19.8 [21.1] for VLP and 21.5 [24.3] for CR; mean difference, 1.7 points; 95% CI -5.4 to 8.8) was observed. No clinically important differences were found in quality of life, wrist pain, or bother at 3 and 12 months. No significant difference was found in total complications between groups (12 of 84 [14%] for the CR group vs 6 of 80 [8%] for the VLP group; risk ratio [RR], 0.53; 95% CI, 0.21-1.33). Patient-reported treatment success favored the VLP group at 12 months (very successful or successful: 70 [89%] vs 57 [70%]; RR, 1.26; 95% CI, 1.07-1.48; P = .005). There was greater use of postoperative physical therapy in the VLP group (56 [72%] vs 44 [54%]; RR, 1.32; 95% CI, 1.04-1.69; P = 0.02)., Conclusions and Relevance: This randomized clinical trial found no between-group differences in improvement in wrist pain or function at 12 months from VLP fixation over CR for displaced distal radius fractures in older people., Trial Registration: http://anzctr.org.au identifier: ACTRN12616000969460.

Introduction: A kinematic measurement method combining dynamic motion and imaging, which captures the behaviour of the hip at terminal motion, may offer improved diagnostic accuracy and enhance our understanding of the mechanics of femoroacetabular impingement (FAI)., Methods: 3 embalmed cadaveric hip/pelvis specimens with implanted Roentgen Stereophotogrammetric Analysis (RSA) beads were mounted on a custom rig and imaged with a fluoroscope in four poses to simulate a clinical impingement examination: in hip extension and in three positions: near impingement, early impingement and late impingement while simulating a flexion/adduction/internal rotation manoeuvre. Hip joint kinematics were measured using 2 methods and compared: RSA (gold standard) and a custom 3-dimensional to 2-dimensional (3D-2D) image registration method which matches 3D models developed from CT to 2D fluoroscopic images., Results: Using RSA as the gold standard, bias and precision of hip joint rotations measured using 3D-2D registration demonstrated maximums of 1.64° and 3.96°, respectively. However, if the single outlier was removed, bias and precision were 0.55° and 1.38°. Bias and precision of translations had maximums of 0.51 mm and 0.77 mm, respectively., Conclusions: This 3D to 2D registration method may offer a clinically useful solution for dynamic assessment of hip impingement. If 5-mm translation and 10° of rotation represent a clinically significant difference in hip kinematics, the method's accuracy of approximately 1 mm displacement and 1° rotation should enable detection of significant clinical differences.

Purpose: There is a paucity of evidence regarding mid- to long-term clinical outcomes of arthroscopic repair of humeral avulsion of the glenohumeral ligament (HAGL). This study investigated clinical outcomes, return to sport and the frequency of associated shoulder lesions., Methods: Eighteen patients underwent arthroscopic repair of a HAGL lesion between 2008 and 2015. Clinical outcome was evaluated using the Rowe Score, the Quick DASH Score (Q-DASH), the Oxford Shoulder Instability Score (OSIS), the ASES Score and Range of Motion (ROM). Return to sports and associated shoulder lesions were documented., Results: Sixteen patients agreed to complete the shoulder scores and nine patients were available for clinical examination. Median time to follow-up was 59 months (range 16-104). The median Rowe Score and Q-DASH Score improved significantly from 33 to 85 points and 61 to 7 points, respectively (p = 0.001, p = 0.001). The median OSIS and ASES Score were 20 and 91 points. External rotation was significantly reduced compared to the contralateral side (p = 0.011). One recurrent dislocation was reported. No neurologic or vascular complications after surgery were reported. Five out of the nine patients did not return to sports at the same level. Associated shoulder lesions were found in 89% of the cases., Conclusion: Arthroscopic repair of a HAGL lesion is a reliable method to restore shoulder stability with good clinical results. However, limitations in external rotation and a reduction in sporting ability may persist at 59 months follow-up. Concomitant lesions are common., Level of Evidence: Case series, level IV.

Hamstring injuries are highly prevalent in many running-based sports, and predominantly affect the long head of biceps femoris. Re-injury rates are also high and together lead to considerable time lost from sport. However, the mechanisms for hamstring injury during high-speed running are still not fully understood. Therefore, the aim of this review was to summarize the current literature describing hamstring musculotendon mechanics and electromyography activity during high-speed running, and how they may relate to injury risk. The large eccentric contraction, characterized by peak musculotendon strain and negative work during late swing phase is widely suggested to be potentially injurious. However, it is also argued that high hamstring loads resulting from large joint torques and ground reaction forces during early stance may cause injury. While direct evidence is still lacking, the majority of the literature suggests that the most likely timing of injury is the late swing phase. Future research should aim to prospectively examine the relationship between hamstring musculotendon dynamics and hamstring injury., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Hamstring injuries are one of the most prevalent injuries in rugby union and many other running-based sports, such as track sprinting and soccer. The majority of these injuries occur during running; however, the relationship between running mechanics and hamstring injury is unclear. Obtaining large samples of prospective injury data to examine this relationship is difficult, and therefore exploratory analysis frameworks may assist in deriving valuable information from studies with small but novel samples. The aim of this study was to undertake a prospective exploratory analysis of the relationship between running mechanics and hamstring injury. Kinematic and kinetic data of the trunk, pelvis and lower limbs were collected during maximal overground running efforts for ten elite rugby union athletes. Subsequently, hamstring injury occurrence was recorded for the following Super Rugby season, during which three athletes sustained a running-based hamstring injury. Functional principal component analysis was used to visualise patterns of variability in running mechanics during the late swing phase between athletes. Results indicated that subsequently injured athletes demonstrated a tendency for greater thoracic lateral flexion, greater hip extension moments and greater knee power absorption, compared to uninjured athletes. All variables demonstrated an ability to descriptively differentiate between injured and uninjured athletes at approximately 60% of the late swing phase. Therefore, we hypothesize that greater thoracic lateral flexion, a greater hip extension moment and greater knee power absorption between peak hip flexion and peak knee extension during the late swing phase may put rugby athletes at greater risk of running-based hamstring injury., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: To describe the most common hamstring injury scenarios and outcomes in elite rugby union., Design: Retrospective investigation., Setting: Hamstring injury data from an elite rugby union team was collected over five seasons and retrospectively analysed., Participants: 74 professional rugby players., Main Outcome Measures: Injuries were classified as new or recurrent. Injury severity, activity, player position, and whether the injury occurred during a match or training was determined for each injury. Injury location and grade were determined for more clinically severe injuries where Magnetic Resonance Imaging (MRI) data was available (15 injuries)., Results: Thirty hamstring injuries were sustained over the five seasons. The majority of injuries were new (93%), moderate in severity (60%) and occurred during running (77%). For more clinically severe injuries, the biceps femoris long head (BFlh) was the most commonly injured muscle (73%) and the distal myofascial junction (DMFJ) was the most common injury site (58% of BFlh injuries)., Conclusions: Hamstring injuries most commonly occurred while running and in the BFlh muscle, which is similar to other sports. However, the most common intramuscular injury site was the DMFJ, which contrasts with reports from other cohorts. Future studies should ensure to include the myofascial junction when classifying injury location., (Copyright © 2019. Published by Elsevier Ltd.)

Objective: Describe research methods used in priority-setting exercises for musculoskeletal conditions and synthesise the priorities identified., Design: Scoping review., Setting and Population: Studies that elicited the research priorities of patients/consumers, clinicians, researchers, policy-makers and/or funders for any musculoskeletal condition were included., Methods and Analysis: We searched MEDLINE and EMBASE from inception to November 2017 and the James Lind Alliance top 10 priorities, Cochrane Priority Setting Methods Group, and Cochrane Musculoskeletal and Back Groups review priority lists. The reported methods and research topics/questions identified were extracted, and a descriptive synthesis conducted., Results: Forty-nine articles fulfilled our inclusion criteria. Methodologies and stakeholders varied widely (26 included a mix of clinicians, consumers and others, 16 included only clinicians, 6 included only consumers or patients and in 1 participants were unclear). Only two (4%) reported any explicit inclusion criteria for priorities. We identified 294 broad research priorities from 37 articles and 246 specific research questions from 17 articles, although only four (24%) of the latter listed questions in an actionable format. Research priorities for osteoarthritis were identified most often (n=7), followed by rheumatoid arthritis (n=4), osteoporosis (n=4) and back pain (n=4). Nearly half of both broad and specific research priorities were focused on treatment interventions (n=116 and 111, respectively), while few were economic (n=8, 2.7% broad and n=1, 0.4% specific), implementation (n=6, 2% broad and n=4, 1.6% specific) or health services and systems research (n=15, 5.1% broad and n=9, 3.7% specific) priorities., Conclusions: While many research priority-setting studies in the musculoskeletal field have been performed, methodological limitations and lack of actionable research questions limit their usefulness. Future studies should ensure they conform to good priority-setting practice to ensure that the generated priorities are of maximum value., Prospero Registration Number: CRD42017059250., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Novel research surrounding anterior cruciate ligament (ACL) injury is necessary because ACL injury rates have remained unchanged for several decades. An area of ACL risk mitigation which has not been well researched relates to vertical stiffness. The relationship between increased vertical stiffness and increased ground reaction force suggests that vertical stiffness may be related to ACL injury risk. However, given that increased dynamic knee joint stability has been shown to be associated with vertical stiffness, it is possible that modification of vertical stiffness could help to protect against injury. We aimed to determine whether vertical stiffness is related to measures known to load, or which represent loading of, the ACL., Methods: This was a cross-sectional observational study of 11 professional Australian rugby players. Knee kinematics and ACL elongation were measured from a 4-dimensional model of a hopping task which simulated the change of direction manoeuvre typically observed when non-contact ACL injury occurs. The model was generated from a CT scan of the participant's knee registered frame by frame to fluoroscopy images of the hopping task. Vertical stiffness was calculated from force plate data., Results: There was no association found between vertical stiffness and anterior tibial translation (ATT) or ACL elongation (r=-0.05; p=0.89, and r=-0.07; p=0.83, respectively). ATT was related to ACL elongation (r=0.93; p=0.0001)., Conclusions: Vertical stiffness was not associated with ACL loading in this cohort of elite rugby players but a novel method for measuring ACL elongation in vivo was found to have good construct validity., Competing Interests: Conflicts of Interest: None declared.

Background: Many injury prevention and rehabilitation programs aim to train hamstring and quadriceps co-activation to constrain excessive anterior tibial translation and protect the anterior cruciate ligament (ACL) from injury. However, despite strong clinical belief in its efficacy, primary evidence supporting training co-activation of the hamstrings and quadriceps muscles for ACL injury prevention and rehabilitation is quite limited. Therefore, the purpose of the study presented in this paper was to determine if hamstring-quadriceps co-activation alters knee joint kinematics, and also establish if it affects ACL elongation., Methods: A computed tomography (CT) scan from each participant's dominant leg was acquired prior to performing two step-ups under fluoroscopy: one with 'natural' hamstring-quadriceps co-activation, one with deliberate co-activation. Electromyography was used to confirm increased motor unit recruitment. The CT scan was registered to fluoroscopy for 4-D modeling, and knee joint kinematics subsequently measured. Anterior cruciate ligament attachments were mapped to the 4-D models and its length was assumed from the distance between attachments. Anterior cruciate ligament elongation was derived from the change in distance between those points as they moved relative to each other., Results: Reduced ACL elongation as well as knee joint rotation, abduction, translation, and distraction was observed for the step up with increased co-activation. A relationship was shown to exist for change in ACL length with knee abduction (r = 0.91; p ≤ 0.001), with distraction (r = -0.70; p = 0.02 for relationship with compression), and with anterior tibial translation (r = 0.52; p = 0.01). However, ACL elongation was not associated with internal rotation or medial translation. Medial hamstring-quadriceps co-activation was associated with a shorter ACL (r = -0.71; p = 0.01), and lateral hamstring-quadriceps co-activation was related to ACL elongation (r = 0.46; p = 0.05)., Conclusion: Net co-activation of the hamstrings and quadriceps muscles will likely reduce ACL elongation provided that the proportion of medial hamstring-quadriceps co-activation exceeds lateral.

We characterize the electrical properties of a biocompatible nanocomposite which will be used as a stress sensing material in an instrumented knee implant. The composite is fabricated from multi-walled carbon nanotubes and ultra high molecular weight polyethylene. Experimental cyclic compression loading shows that the composite's resistance exponentially decreases with increasing compression stress, proving its potential for application as a piezoresistive stress sensing material. An analytical model is built to estimate the optimal depth from the tibio-femoral contact surface at which an embedded stress sensor could achieve the highest stress resolution and lowest distortion energy inside the tibial insert.

Whiplash is the colloquial term for neck injuries caused by sudden extension of the cervical spine. Patients with chronic whiplash associated disorder (WAD) can experience neck pain for many years after the original injury. Researchers have found some evidence to suggest that chronic whiplash is related to the amount of intra-muscular fat in the cervical spine muscles. Hence, an important step towards developing a treatment for chronic WAD is a technique to accurately and efficiently measure the amount of intra-muscular fat in the muscles of the cervical spine. Our proposed technique for making this measurement is to automatically segment the cervical spine muscles using a fused volume created from multi-modal MRI volumes of the cervical spine. Multiple modes are required to enhance the boundaries between the different muscles to assist the following automatic segmentation process. However, before these multiple modes can be fused it is first necessary to accurately register these volumes. Hence, in this paper, we have proposed a new non-rigid multi-modal registration algorithm using the sum of conditional variance (SCV) with partial volume interpolation (PVI) similarity measure and Gauss-Newton (GN) optimization for the accurate registration of multi-modal cervical spine MRI volumes. The performance of the proposed approach is compared with the existing SCV based registration algorithm and the sum of the conditional squared deviation from the mode (SCSDM) method. The experimental results demonstrate that the proposed approach provides superior performance than the best existing approaches.

Total hip arthroplasty or THA is a surgical procedure for the relief of significant disabling pain caused by osteoarthritis or hip fracture. Knowledge of the 3D kinematics of the hip during specific functional activities is important for THA component design. In this paper we compare kinematic measurements obtained by a new 2D-3D registration algorithm with measurements provided by the gold standard roentgen stereo analysis (RSA). The study validates a promising method for investigating the kinematics of some pathologies, which involves fitting three dimensional patient specific 3D CT scans to dynamic fluoroscopic images of the hip during functional activities. This is the first study in which single plane fluoroscopy has been used for kinematic measurements of natural hip bones. The main focus of the study is on the out-of-plane translation and rotation movements which are difficult to measure precisely using a single plane approach. From our experimental results we found that the precision of our proposed approach compares favourably with that of the most recent dual plane fluoroscopy approach.

Intramedullary reamed nailing causes elevation in intramedullary pressure and extravazation of intramedullary contents into the venous blood system. This study investigated the effect of an intramedullary suction system, recently developed in our laboratory, on the pressure and fat extravazation in isolated bovine bone and a sheep model. During reaming, the pressure with and without suction was recorded at each step of the procedure. Hemodynamic parameters of mean arterial blood pressure, pulmonary artery pressure, pulmonary arterial CO(2) (PaCO(2)), heart rate, and oxygen saturation were monitored. Blood and lung tissue samples were collected for the examination of medullary fat intravazation. The increases of intramedullary pressure were dramatically reduced in the suction group (p < 0.05) in both in vitro and in vivo experiments. PaCO(2) was significantly lower in the suction group than nonsuction group (32 vs. 40 mmHg, respectively, p = 0.02), while oxygen saturation was higher in the suction group (99 vs. 91 mmHg, respectively, p = 0.009). Histological data revealed a significant higher count of fat emboli in sheep lung tissue in the nonsuction group. Total lipids in lung specimens was lower in the suction group (7.6 mg/g tissue) than in the nonsuction group (13.6 mg/g, p = 0.04). The suction system appears to control the surge in intramedullary pressure and therefore prevent fat embolism., ((c) 2008 Orthopaedic Research Society.)