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Background: This study investigated the effects of decreased energy availability (EA) and carbohydrate availability (CA) on reproductive and metabolic hormones in male endurance-trained athletes., Methods: Thirteen athletes (age: 26.08 ± 4.3 years; weight: 70.9 ± 6.5 kg; height: 179.9 ± 4.2 cm) participated in two training weeks with varying training volumes (low [LV] and high [HV]). The participants logged their diet and exercise for seven days and provided blood samples to measure hormone levels (Testosterone [T], insulin, leptin, cortisol, and interleukin-6 [IL-6])., Results: Results showed that 46.2% (HV) and 38.5% (LV) of participants were at risk for low EA (≤25 kcal/kg FFM·d-1), while 53.8% (HV) and 69.2% (LV) had low CA (<6 g/kg). Strong positive correlations were found between leptin and body fat percentage (DXABFP) in both weeks (HV: r(11) = 0.88, p < 0.001; LV: r(11) = 0.93, p < 0.001). Moderate correlations were observed between T and DXABFP (r(11) = 0.56, p = 0.05) and negative correlations between leptin and fat intake (r(11) = -0.60, p = 0.03). Regression analyses indicated significant relationships between DXABFP and T (F(1,11) = 4.91, p = 0.049), leptin (HV: F(1,11) = 40.56, p < 0.001; LV: F(1,11) = 74.67, p < 0.001), and cortisol (F(1,11) = 6.69, p = 0.025)., Conclusions: These findings suggest that monitoring body composition and macronutrients can be clinically useful for male athletes, especially those without access to blood testing. Ultimately, a greater understanding of health and performance outcomes for male athletes is needed.

Hallux rigidus is a common degenerative condition of the hallux metatarsophalangeal joint (MTPJ) characterized by pain, swelling, stiffness, and limited range of motion with characteristic corresponding clinical, physical examination, and radiographic findings. Many historical risks factors including trauma and family history and patient factors including hallux valgus interphalangeus and inflammatory arthropathies have a well-substantiated etiologic role in the disease process. The purpose of this section is to review the normal and pathologic anatomy and biomechanics of the hallux MTPJ while providing an overview of the current understanding and remain debate regarding the disease process., Competing Interests: Disclosure The authors have no pertinent financial or funding disclosures related to the content of this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To assess the relation between tendon migration, as measured by radiostereometric analysis, and patient-reported outcome measures (PROMs) after biceps tenodesis (BT); to determine the likelihood of achieving clinically significant outcomes (CSOs) after BT; and to identify factors that impact CSO achievement., Methods: Patients undergoing arthroscopic suprapectoral or open subpectoral BT at a single, high-volume academic medical center were prospectively enrolled. A tantalum bead sutured to the tenodesis construct was used as a radiopaque marker. Biceps tendon migration was measured on calibrated radiographs at 12 weeks postoperatively. PROMs (Constant-Murley, Single Assessment Numeric Evaluation [SANE], and Patient-Reported Outcomes Measurement Information System-Upper Extremity [PROMIS-UE] scores) were collected preoperatively and at minimum 2-year follow-up., Results: Of 115 patients enrolled, 94 (82%) were included (median age, 52 years; median body mass index, 31.4). At a mean follow-up of 2.9 years, the median Constant-Murley, SANE, and PROMIS-UE scores were 33 (interquartile range [IQR], 26-35), 90 (IQR, 80-99), and 47 (IQR, 42-58), respectively. Median tantalum bead migration was 6.5 mm (IQR, 1.8-13.8 mm). There were significant correlations between migration and Constant-Murley score (r 2  = 0.222; β = -0.554 [95% confidence interval (CI), -1.027 to -0.081]; P = .022), SANE score (r 2  = 0.238; β = -0.198 [95% CI, -0.337 to -0.058]; P = .006), and PROMIS-UE score (r 2  = 0.233; β = -0.406 [95% CI, -0.707 to -0.104]; P = .009). On univariable analysis, higher body mass index was associated with achievement of substantial clinical benefit (unadjusted odds ratio [OR], 1.078 [95% CI, 1.007 to 1.161]; P = .038). Greater bead migration was negatively associated with achievement of the minimal clinically important difference (unadjusted OR, 0.969 [95% CI, 0.943 to 0.993]; P = .014) and patient acceptable symptomatic state (unadjusted OR, 0.965 [95% CI, 0.937 to 0.989]; P = .008) on all 3 instruments., Conclusions: A 1-cm increase in post-tenodesis biceps tendon migration was associated with a decrease in the Constant-Murley, SANE, and PROMIS-UE scores of 6, 2, and 4 points, respectively, at a mean of 2.9 years after surgery. Most patients achieved CSOs for these PROMs by latest follow-up, and greater biceps tendon construct migration was negatively associated with the likelihood of CSO achievement., Level of Evidence: Level IV, retrospective case series., Competing Interests: Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: B.F. reports board membership with American Orthopaedic Society for Sports Medicine and Video Journal of Sports Medicine; receives funding grants from Arthrex, Smith & Nephew, and Stryker Orthopaedics; receives speaking and lecture fees from Elsevier; owns equity or stocks in iBrainTech, Jace Medical, and Sparta Biopharma; and reports a consulting or advisory relationship with Smith & Nephew and Stryker Orthopaedics. E.J.B. owns equity or stocks in Amgen and Pfizer. K.R.O. reports a consulting or advisory relationship with Arthrex and Smith & Nephew. A.B.Y. reports a consulting or advisory relationship with AlloSource and JRF Ortho; receives funding grants from Arthrex; receives funding grants from Organogenesis; reports a consulting or advisory relationship with Patient IQ, Sparta Biopharma, and Stryker Orthopaedics; owns equity or stocks in Patient IQ and Sparta Biopharma; and receives speaking and lecture fees from Stryker Orthopaedics. B.J.C. receives funding grants from Aesculap Implant Systems, Arthrex, and National Institutes of Health; reports board membership with American Journal of Sports Medicine, Arthroscopy Association of North America, and Journal of the American Academy of Orthopaedic Surgeons; reports a consulting or advisory relationship with Arthrex, JRF Ortho, and Operative Techniques in Sports Medicine; owns equity or stocks in Bandgrip and OSSIO; receives speaking and lecture fees from Elsevier and Operative Techniques in Sports Medicine; and is a board member of Arthroscopy Association of North America. N.N.V. reports board membership with American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Arthroscopy Association of North America, and Slack; receives funding grants from Arthrex, Breg, Ossur, Smith & Nephew, and Stryker Orthopaedics; receives speaking and lecture fees from Smith & Nephew and Stryker Orthopaedics; and reports a consulting or advisory relationship with Stryker Orthopaedics. All other authors (D.K-S., H.H.P., E.M.F., B.T.W.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: The interaural time difference (ITD) is a primary horizontal-plane sound localization cue computed in the auditory brainstem. ITDs are accessible in the temporal fine structure of pure tones with a frequency of no higher than about 1400 Hz. How listeners' ITD sensitivity transitions from very best sensitivity near 700 Hz to impossible to detect within 1 octave currently lacks a fully compelling physiological explanation. Here, it was hypothesized that the rapid decline in ITD sensitivity is dictated not by a central neural limitation but by initial peripheral sound encoding, specifically, the low-frequency (apical) portion of the cochlear excitation pattern produced by a pure tone., Methods: ITD sensitivity was measured in 16 normal-hearing listeners as a joint function of frequency (900-1500 Hz) and level (10-50 dB sensation level)., Results: Performance decreased with increasing frequency and decreasing sound level. The slope of performance decline was 90 dB/octave, consistent with the low-frequency slope of the cochlear excitation pattern., Conclusion: Fine-structure ITD sensitivity near 1400 Hz may be conveyed primarily by "off-frequency" activation of neurons tuned to lower frequencies near 700 Hz. Physiologically, this could be realized by having neurons sensitive to fine-structure ITD up to only about 700 Hz. A more extreme model would have only a single narrow channel near 700 Hz that conveys fine-structure ITDs. Such a model is a major simplification and departure from the classic formulation of the binaural display, which consists of a matrix of neurons tuned to a wide range of relevant frequencies and ITDs., (© 2024. The Author(s) under exclusive licence to Association for Research in Otolaryngology.)

Background: The indirect head of the rectus femoris (IHRF) tendon has been used as an autograft for segmental labral reconstruction. However, the biomechanical properties and anatomic characteristics of the IHRF, as they relate to surgical applications, have yet to be investigated., Purpose: To (1) quantitatively and qualitatively describe the anatomy of IHRF and its relationship with surrounding arthroscopically relevant landmarks; (2) detail radiographic findings pertinent to IHRF; (3) biomechanically assess segmental labral reconstruction with IHRF, including restoration of the suction seal and contact pressures in comparison with iliotibial band (ITB) reconstruction; and (4) assess potential donor-site morbidity caused by graft harvesting., Study Design: Descriptive laboratory study., Methods: A cadaveric study was performed using 8 fresh-frozen human cadaveric full pelvises and 7 hemipelvises. Three-dimensional anatomic measurements were collected using a 3-dimensional coordinate digitizer. Radiographic analysis was accomplished by securing radiopaque markers of different sizes to the evaluated anatomic structures of the assigned hip.Suction seal and contact pressure testing were performed over 3 trials on 6 pelvises under 4 different testing conditions for each specimen: intact, labral tear, segmental labral reconstruction with ITB, and segmental labral reconstruction with IHRF. After IHRF tendon harvest, each full pelvis had both the intact and contralateral hip tested under tension along its anatomic direction to assess potential site morbidity, such as tendon failure or bony avulsion., Results: The centroid and posterior apex of the indirect rectus femoris attachment are respectively located 10.3 ± 2.6 mm and 21.0 ± 6.5 mm posteriorly, 2.5 ± 7.8 mm and 0.7 ± 8.0 mm superiorly, and 5.0 ± 2.8 mm and 22.2 ± 4.4 mm laterally to the 12:30 labral position. Radiographically, the mean distance of the IHRF to the following landmarks was determined as follows: anterior inferior iliac spine (8.8 ± 2.5 mm), direct head of the rectus femoris (8.0 ± 3.9 mm), 12-o'clock labral position (14.1 ± 2.8 mm), and 3-o'clock labral position (36.5 ± 4.4 mm). During suction seal testing, both the ITB and the IHRF reconstruction groups had significantly lower peak loads and lower energy to peak loads compared with both intact and tear groups ( P = .01 to .02 for all comparisons). There were no significant differences between the reconstruction groups for peak loads, energy, and displacement at peak load. In 60° of flexion, there were no differences in normalized contact pressure and contact area between ITB or IHRF reconstruction groups ( P > .99). There were no significant differences between intact and harvested specimen groups in donor-site morbidity testing., Conclusion: The IHRF tendon is within close anatomic proximity to arthroscopic acetabular landmarks. In the cadaveric model, harvesting of the IHRF tendon as an autograft does not lead to significant donor-site morbidity in the remaining tendon. Segmental labral reconstruction performed with the IHRF tendon exhibits similar biomechanical outcomes compared with that performed with ITB., Clinical Relevance: This study demonstrates the viability of segmental labral reconstruction with an IHRF tendon and provides a detailed anatomic description of the tendon in the context of an arthroscopic labral reconstruction. Clinicians can use this information during the selection of a graft and as a guide during an arthroscopic graft harvest., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Stryker donated the suture anchors used in the study. S.J.N. has received research support from AlloSource, Arthrex, Athletico, DJ Orthopedics, Linvatec, Miomed, Smith & Nephew, and Stryker; consulting fees from Stryker; and royalties from Ossur and Stryker. J.C. has received consulting fees from Arthrex, CONMED Linvatec, Ossur, Smith & Nephew, DePuy Synthes Products, and Vericel; support for education from Medwest Associates; and hospitality payments from Medical Device Business Services and Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Tibial spine avulsion injuries, including fractures, are a variant of anterior cruciate ligament injuries. Treatment historically consisted of open reduction and internal fixation of the avulsion fracture, with anterior cruciate ligament reconstruction considered in cases of failed open reduction and internal fixation or residual laxity. However, improved instrumentation has led to the advancement of various arthroscopic techniques for addressing these injuries. The emergence of newer implants designed for all-suture fixation has also overcome the limitations associated with screw fixation, such as hardware-related complications, challenges in treating comminuted fractures, and potential physeal injury. The purpose of this article is to describe a technique consisting of arthroscopic-assisted reduction and internal fixation of a tibial spine avulsion fracture with a re-tensionable all-suture-based construct using multiple looped cinch stitches and a cortical suspensory suture button device., Competing Interests: The authors report the following potential conflicts of interest or sources of funding: G.S.D. receives intellectual property royalties from 10.13039/100007307Arthrex, outside the submitted work; receives consultant fees from 10.13039/100007307Arthrex, outside the submitted work; receives research support from 10.13039/100007307Arthrex, outside the submitted work; and receives stock or stock options from Embody, outside the submitted work. R.M.F. receives consultant fees from Allosource, 10.13039/100007307Arthrex, and 10.13039/501100013673JRF Ortho, outside the submitted work; receives speaking fees from Allosource, 10.13039/100007307Arthrex, 10.13039/501100013673JRF Ortho, and Ossur, outside the submitted work; receives research support from 10.13039/100007307Arthrex and Aesculap Biologics, outside the submitted work; and receives publishing royalties from Elsevier, outside the submitted work. All other authors (R.A.S., D.J.S., B.T.W, A.K.S., K.K.S.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (© 2024 The Authors.)

The cavus foot represents a complex spectrum of deformity ranging from the subtle idiopathic to the severe sensorimotor neuropathy and other neuromuscular deformities. The successful surgical treatment of the cavus foot depends on a fundamental understanding of the underlying multiplanar deformity, inherent muscle balance, and the rigidity of the hindfoot. The location of the deformity is described and understood according to its multiple apices. These deformities are addressed with osteotomies or arthrodesis directed at the apices of deformity. Simultaneously, correction of muscular imbalances with appropriate tendon transfers must also be performed to prevent recurrent deformity. With these principles in mind, the surgical correction of the cavus foot becomes simplified and algorithmically driven.

Background: Studies suggest that similar clinical results are achieved via arthroscopic and open biceps tenodesis (BT) techniques., Purpose: To quantify the postoperative migration of the BT construct between arthroscopic suprapectoral BT (ASPBT) and open subpectoral BT (OSPBT) techniques via interference screw (IS) or single-suture suture anchor (SSSA) fixation using radiostereometric analysis., Study Design: Cohort study; Level of evidence, 2., Methods: Distal migration of the biceps tendon after OSPBT with a polyetheretherketone IS, OSPBT with 1 SSSA, ASPBT with polyetheretherketone IS, and ASPBT with 2 SSSAs was measured prospectively. Patients with symptomatic biceps tendinopathy and preoperative patient-reported outcome measures (PROMs) including Constant-Murley subjective, Single Assessment Numeric Evaluation, or Patient-Reported Outcomes Measurement Information System-Upper Extremity scores were included. A tantalum bead was sutured on the proximal end of the long head of the biceps tendon before fixation of tendon tissue. Anteroposterior radiographs were performed immediately postoperatively, at 1 week, and at 3 months. Bead migration was measured, and preoperative PROMs were compared with those at latest follow-up., Results: Of 115 patients, 94 (82%) were available for final follow-up. IS fixation yielded the least tendon migration with no difference between the open and arthroscopic approaches (4.31 vs 5.04 mm; P = .70). Fixation with 1 suture anchor demonstrated significantly greater migration than that achieved with an IS at both 1 week (6.47 vs 0.1 mm, 6.47 vs 1.75 mm, P < .001;) and 3 months (14.76 vs 4.31 mm, 14.76 vs 5.04 mm, P < .001) postoperatively. Two-suture anchor fixation yielded significantly greater migration than IS fixation at 1 week (7.02 vs 0.1 mm, P < .001; 7.02 vs 1.75 mm, P = .003) but not 3 months postoperatively (8.06 vs 4.31 mm, P = .10; 8.06 vs 5.04 mm, P = .07). Four patients with suture anchor fixation (3 patients in the OSPBT 1 SSSA group, 9.4%, and 1 patient in the ASPBT 2 SSSAs group, 3.8%) developed a Popeye deformity, whereas no Popeye deformities occurred in the IS groups. Mean 3-month bead migration in patients with and without a Popeye deformity was 60.8 and 11.2 mm, respectively ( P < .0001). PROMs did not differ among groups at final follow-up., Conclusion: Interference screw fixation yielded the least tendon migration whether achieved arthroscopically or open. The available data indicated that fixation with 1 SSSA but not 2 SSSAs resulted in significantly greater migration than that achieved with an IS. Despite variations in tendon migration, PROMs were similar among all groups. When SSSAs are used, tendon migration may be minimized by using ≥2 anchors.

Decreased blood-tissue oxygenation at high altitude (HA) increases mitochondrial oxidant production and reduces exercise capacity. 5-Hydroxymethylfurfural (5-HMF) is an antioxidant that increases hemoglobin's binding affinity for oxygen. For these reasons, we hypothesized that 5-HMF would improve muscle performance in rats exposed to a simulated HA of ~5500 m. A secondary objective was to measure mitochondrial activity and dynamic regulation of fission and fusion because they are linked processes impacted by HA. Fisher 344 rats received 5-HMF (40 mg/kg/day) or vehicle during exposure to sea level or HA for 72 h. Right ankle plantarflexor muscle function was measured pre- and post-exposure. Post-exposure measurements included arterial blood gas and complete blood count, flexor digitorum brevis myofiber superoxide production and mitochondrial membrane potential (ΔΨm), and mitochondrial dynamic regulation in the soleus muscle. HA reduced blood oxygenation, increased superoxide levels and lowered ΔΨm, responses that were accompanied by decreased peak isometric torque and force production at frequencies >75 Hz. 5-HMF increased isometric force production and lowered oxidant production at sea level. In HA exposed animals, 5-HMF prevented a decline in isometric force production at 75-125 Hz, prevented an increase in superoxide levels, further decreased ΔΨm, and increased mitochondrial fusion 2 protein expression. These results suggest that 5-HMF may prevent a decrease in hypoxic force production during submaximal isometric contractions by an antioxidant mechanism., (Published 2023. This article is a U.S. Government work and is in the public domain in the USA. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

Focal chondral defects (FCDs) of the knee can be a debilitating condition that can clinically translate into pain and dysfunction in young patients with high activity demands. Both the understanding of the etiology of FCDs and the surgical management of these chondral defects has exponentially grown in recent years. This is reflected by the number of surgical procedures performed for FCDs, which is now approximately 200,000 annually. This fact is also apparent in the wide variety of available surgical approaches to FCDs. Although simple arthroscopic debridement or microfracture are usually the first line of treatment for smaller lesions, chondral lesions that involve a larger area or depth require restorative procedures such as osteochondral allograft transplantation or other cell-based techniques. Given the prevalence of FCDs and the increased attention on treating these lesions, a comprehensive understanding of management from diagnosis to rehabilitation is imperative for the treating surgeon. This narrative review aims to describe current concepts in the treatment of large FCDs through providing an algorithmic approach to selecting interventions to address these lesions as well as the reported outcomes in the literature., Competing Interests: J.C. is a board or committee member of the American Orthopaedic Society for Sports Medicine (AOSSM), Arthroscopy Association of North America (AANA), and the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine (ISAKOS); and is a paid consultant for Arthrex, Inc, CONMED Linvatec, Ossur, and Smith & Nephew. A.B.Y. receives research support from Arthrex, Inc, Organogenesis, and Vericel; is an unpaid consultant for Patient IQ, Smith & Nephew, and Sparta Biomedical; is a paid consultant for CONMED Linvatec, JRF Ortho, and Olympus; and receives stock or stock options from Patient IQ. J.F. receives research support from Active Implants, Arthrex, Inc, Episurf, Fidia, JRF Ortho, Moximed, Novartis, Organogenesis, Samumed, Inc, Vericel, and ZimmerBiomet; is a paid consultant for Aesculap/B.Braun, Cartiheal, Cook Biotech, Exactech, Moximed, Inc, Organogenesis, Regentis, Samumed, Inc, and ZKR orthopedics; is on the editorial or governing board of the American Journal of Orthopedics, and Cartialge; is a paid presenter or speaker for Arthrex, Inc, Moximed, Inc, Organogenesis, and Vericel; receives IP royalties from Arthrex, Inc, Biopoly, LLC, and Organogenesis; receives stock or stock options from MedShape, Inc, and Ortho Regenerative Tech; and receives publishing royalties, financial or material support from Springer, and Thieme Medical Publishers, Inc., (Thieme. All rights reserved.)

To determine whether photobiomodulation (PBM) therapy can retard ocular axial length (AL) in children with myopia. A randomized controlled clinical trial was conducted on two consecutive cohorts of 50 eligible children aged 8-12 years with ≤ - 0.75 Diopter (D) of spherical equivalent refraction (SER). Participants were randomly assigned to the intervention group (n = 25) and treated with PBM therapy or the control group (n = 25) and treated with single vision spectacles only. At the 12-month follow-up, the changes in AL and cycloplegic SER from baseline were both compared between the two groups. In addition, the subfoveal choroidal thickness (SFChT), anterior chamber depth (ACD), and central corneal refractive power (CCP) were analysed at the 3-, 6-, 9-, and 12-month follow-ups, respectively. Among the 50 children, 78% were included at the final follow-up, with a mean age of 9.7 ± 1.5 years and a mean SER of - 2.56 ± 1.70. The mean difference in AL growth between the two groups at 12 months was 0.50 mm (PBM vs. Control, - 0.02 mm ± 0.11 vs. 0.48 mm ± 0.16, P < 0.001), and the mean difference in cycloplegic SER at 12 months was + 1.25 D (PBM vs. Control, + 0.28 D ± 0.26 vs. - 0.97 D ± 0.25, P < 0.001). There were no significant differences in any of the other parameters (including SFChT, ACD, and CCP) between the two groups at any time point. PBM therapy is an effective intervention for slightly decreasing the AL to control myopia in children.Trial registration: Chinese Clinical Trial Registration Number: ChiCTR2100043619. Registered on 23/02/2021; prospectively registered. http://www.chictr.org.cn/showproj.aspx?proj=121302 ., (© 2023. The Author(s).)

Dimethylsulfoniopropionate (DMSP) is one of the Earth's most abundant organosulfur compounds because many marine algae, bacteria, corals and some plants produce it to high mM intracellular concentrations. In these organisms, DMSP acts an anti-stress molecule with purported roles to protect against salinity, temperature, oxidative stress and hydrostatic pressure, amongst many other reported functions. However, DMSP is best known for being a major precursor of the climate-active gases and signalling molecules dimethylsulfide (DMS), methanethiol (MeSH) and, potentially, methane, through microbial DMSP catabolism. DMSP catabolism has been extensively studied and the microbes, pathways and enzymes involved have largely been elucidated through the application of molecular research over the last 17 years. In contrast, the molecular biology of DMSP synthesis is a much newer field, with the first DMSP synthesis enzymes only being identified in the last 5 years. In this review, we discuss how the elucidation of key DMSP synthesis enzymes has greatly expanded our knowledge of the diversity of DMSP-producing organisms, the pathways used, and what environmental factors regulate production, as well as to inform on the physiological roles of DMSP. Importantly, the identification of key DMSP synthesis enzymes in the major groups of DMSP producers has allowed scientists to study the distribution and predict the importance of different DMSP-producing organisms to global DMSP production in diverse marine and sediment environments. Finally, we highlight key challenges for future molecular research into DMSP synthesis that need addressing to better understand the cycling of this important marine organosulfur compound, and its magnitude in the environment., (Copyright © 2023. Published by Elsevier Inc.)

Listeners often experience challenges understanding a person (target) in the presence of competing talkers (maskers). This difficulty reduces with the availability of visual speech information (VSI; lip movements, degree of mouth opening) and during linguistic release from masking (LRM; masking decreases with dissimilar language maskers). We investigate whether and how LRM occurs with VSI. We presented English targets with either Dutch or English maskers in audio-only and audiovisual conditions to 62 American English participants. The signal-to-noise ratio (SNR) was easy at 0 audio-only and -8 dB audiovisual in Experiment 1 and hard at -8 and -16 dB in Experiment 2 to assess the effects of modality on LRM across the same and different SNRs. We found LRM in the audiovisual condition for all SNRs and in audio-only for -8 dB, demonstrating reliable LRM for audiovisual conditions. Results also revealed that LRM is modulated by modality with larger LRM in audio-only indicating that introducing VSI weakens LRM. Furthermore, participants showed higher performance for Dutch maskers compared to English maskers with and without VSI. This establishes that listeners use both VSI and dissimilar language maskers to overcome masking. Our study shows that LRM persists in the audiovisual modality and its strength depends on the modality.

Background: Significant reductions in ambient pressure subject an individual to risk of decompression illness (DCI); with incidence up to 35 per 10,000 dives. In severe cases, the central nervous system is often compromised (>80%), making DCI among the most morbid of diving related injuries. While hyperbaric specialists suggest initiating recompression therapy with either a Treatment Table 6 (TT6) or 6A (TT6A), the optimal initial recompression treatment for severe DCI is unknown., Methods: Swine were exposed to an insult dive breathing air at 7.06 ATA (715.35 kPa) for 24 min followed by rapid decompression at a rate of 1.82 ATA/min (184.41 kPa/min). Swine that developed neurologic DCI within 1 hour of surfacing were block randomized to one of four United States Navy Treatment Tables (USN TT): TT6, TT6A-air (21% oxygen, 79% nitrogen), TT6A-nitrox (50% oxygen, 50% nitrogen), and TT6A-heliox (50% oxygen, 50% helium). The primary outcome was the mean number of spinal cord lesions, which was analyzed following cord harvest 24 hours after successful recompression treatment. Secondary outcomes included spinal cord lesion incidence and gross neurologic outcomes based on a pre- and post- modified Tarlov assessment. We compared outcomes among these four groups and between the two treatment profiles (i.e. TT6 and TT6A)., Results: One-hundred and forty-one swine underwent the insult dive, with 61 swine meeting inclusion criteria (43%). We found no differences in baseline characteristics among the groups. We found no significant differences in functional neurologic outcomes (p = 0.77 and 0.33), spinal cord lesion incidence (p = 0.09 and 0.07), or spinal cord lesion area (p = 0.51 and 0.17) among the four treatment groups or between the two treatment profiles, respectively. While the trends were not statistically significant, animals treated with TT6 had the lowest rates of functional deficits and the fewest spinal cord lesions. Moreover, across all animals, functional neurologic deficit had strong correlation with lesion area pathology (Logistic Regression, p < 0.01, Somers' D = 0.74)., Conclusions: TT6 performed as well as the other treatment tables and is the least resource intensive. TT6 is the most appropriate initial treatment for neurologic DCI in swine, among the tables that we compared., Competing Interests: The authors have declared that no competing interests exist.

Case: This report describes a histoplasma capsulatum total knee prosthetic joint infection (PJI) in an immunosuppressed patient treated with a 2-stage revision. The diagnosis of PJI was made based on minor criteria, and the causative organism was identified from cultures obtained at the time of explantation. The patient underwent induction with amphotericin B, followed by oral antifungal therapy and a successful 2-stage revision with a hinged prosthesis with an interval of ∼7 months between stage 1 and stage 2. At the most recent follow-up (18 months), she remained clear from infection with planned lifetime antifungal suppression., Conclusion: This case report highlights the importance of consideration of atypical organisms when treating immunocompromised patients. Furthermore, this case report documents one of the few cases of histoplasma PJI and provides a successful treatment algorithm to potentially be applied to future cases., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B921)., (Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.)

Objectives: To determine if patients with preoperative symptom durations greater than two-years' experience inferior patient-reported and clinical outcomes at a minimum of two years after high tibial osteotomy., Methods: An institutional registry was retrospectively queried for patients treated with high tibial osteotomy for symptomatic medial knee overload/arthritis and varus malalignment between February 2006 and March 2018. Demographic characteristics, clinical outcomes, patient-reported outcomes (PROs), including the International Knee Documentation Committee ​score, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement ​and Patient-Reported Outcome Measurement Information System Pain Interference ​and Physical Function ​scores, were assessed at a minimum of two-years postoperatively. Patients were compared based on preoperative symptom duration greater than or less than two years. Correlation coefficients were used to analyse the association between patient demographics and postoperative outcomes for the overall patient sample., Results: A total of 41 patients were included in the analysis with a mean age (± standard deviation) of 37.0 ​± ​8.2 years and body mass index of 27.6 ​± ​4.2 ​kg/m 2 . The median (interquartile range) follow-up time for the entire study sample was 48.5 (24-100.5) months. There were no significant differences in delta (pre-to-post improvement) or postoperative PRO scores, number or time-to-reoperation ​or conversion to TKA (all P ​> ​0.05) based on the preoperative duration of symptoms. A statistically significant but weak correlation was observed between greater age (r ​= ​0.344, P ​= ​0.027) and BMI (r ​= ​0.320, P ​= ​0.044) with conversion to TKA., Conclusion: Patients with a preoperative duration of symptomatic medial knee overload/arthritis of two years or greater do not experience inferior PRO or clinical outcomes than patients with a symptom duration of less than 2 years at mid-term follow-up. Greater age and BMI were weakly correlated with conversion to TKA. Greater age was negatively correlated with undergoing at least one reoperation., Level of Evidence: IV; Retrospective case series., Competing Interests: Declaration of competing interest One or more of the authors has declared the following potential conflict of interest or source of funding: A.B.Y. reports personal fees from CONMED Linvatec, personal fees from JRF Ortho, personal fees from Olympus, grants from Organogenesis, non-financial support and other from Patient IQ, non-financial support from Smith & Nephew, non-financial support from Sparta Biomedical, grants from Vericel, and grants from Arthrex, Inc., outside the submitted work; B.F. reports personal fees from Elsevier, personal fees from Arthrex, Inc., personal fees from Jace Medical, grants from Smith and Nephew, personal fees from Stryker, and grants from Ossur, outside the submitted work; B.J.C. reports other from Aesculap/B.Braun, other from the American Journal of Orthopaedics, other from the American Journal of Sports Medicine, grants, personal fees, non-financial support and other from Arthrex, Inc., other from the Arthroscopy Association of North America, other from Athletico, other from Cartilage, other from Elsevier Publishing, other from the International Cartilage Repair Society, other from the Journal of Shoulder and Elbow Surgery, other from the Journal of the American Academy of Orthopaedic Surgeons, other from JRF Ortho, other from the National Institutes of Health (NIAMS & NICHD), other from Operative Techniques in Sports Medicine, other from Ossio, personal fees and other from Regentis, other from Smith & Nephew, personal fees and other from Zimmer, outside the submitted work; J.C. reports personal fees and other from Arthrex, Inc., personal fees and other from Smith & Nephew, and personal fees from CONMED Linvatec, outside the submitted work., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Marine algae and bacteria produce approximately eight billion tonnes of the organosulfur molecule dimethylsulfoniopropionate (DMSP) in Earth's surface oceans annually. DMSP is an antistress compound and, once released into the environment, a major nutrient, signaling molecule, and source of climate-active gases. The methionine transamination pathway for DMSP synthesis is used by most known DMSP-producing algae and bacteria. The S -directed S -adenosylmethionine (SAM)-dependent 4-methylthio-2-hydroxybutyrate (MTHB) S -methyltransferase, encoded by the dsyB/DSYB gene, is the key enzyme of this pathway, generating S -adenosylhomocysteine (SAH) and 4-dimethylsulfonio-2-hydroxybutyrate (DMSHB). DsyB / DSYB , present in most haptophyte and dinoflagellate algae with the highest known intracellular DMSP concentrations, is shown to be far more abundant and transcribed in marine environments than any other known S -methyltransferase gene in DMSP synthesis pathways. Furthermore, we demonstrate in vitro activity of the bacterial DsyB enzyme from Nisaea denitrificans and provide its crystal structure in complex with SAM and SAH-MTHB, which together provide the first important mechanistic insights into a DMSP synthesis enzyme. Structural and mutational analyses imply that DsyB adopts a proximity and desolvation mechanism for the methyl transfer reaction. Sequence analysis suggests that this mechanism may be common to all bacterial DsyB enzymes and also, importantly, eukaryotic DSYB enzymes from e.g., algae that are the major DMSP producers in Earth's surface oceans., Competing Interests: The authors declare no conflict of interests., (© 2022 The Authors. mLife published by John Wiley & Sons Australia, Ltd. on behalf of Institute of Microbiology, Chinese Academy of Sciences.)

Background: It is unclear if native glenohumeral anatomic features predispose young patients to instability and if such anatomic risk factors differ between males and females. The purpose of this study was to compare glenoid and humeral head dimensions between patients with a documented instability event without bone loss to matched controls and to evaluate for sex-based differences across measurements. The authors hypothesized that a smaller glenoid width and glenoid surface area would be significant risk factors for instability, whereas humeral head width would not., Methods: A prospectively maintained database was queried for patients aged <21 years who underwent magnetic resonance imaging (MRI) for shoulder instability. Patients with prior shoulder surgery, bony Bankart, or glenoid or humeral bone loss were excluded. Patients were matched by sex and age to control patients who had no history of shoulder instability. Two blinded independent raters measured glenoid height, glenoid width, and humeral head width on sagittal MRI. Glenoid surface area, glenoid index (ratio of glenoid height to width), and glenohumeral mismatch ratio (ratio of humeral head width to glenoid width) were calculated., Results: A total of 107 instability patients and 107 controls were included (150 males and 64 females). Among the entire cohort, there were no differences in glenoid height, glenoid width, glenoid surface area, humeral head width, or glenoid index between patients with instability and controls. Overall, those with instability had a greater glenohumeral mismatch ratio (P = .029) compared with controls. When stratified by sex, female controls and instability patients showed no differences in any of the glenoid or humerus dimensions. However, males with instability had a smaller glenoid width by 3.5% (P = .017), smaller glenoid surface area by 5.2% (P = .015), and a greater glenohumeral mismatch ratio (P = .027) compared with controls., Conclusion: Compared with controls, males with instability were found to have smaller glenoid width and surface area, and a glenoid width that was proportionally smaller relative to humeral width. In contrast, bony glenohumeral morphology did not appear to be a significant risk factor for instability among females. These sex-based differences suggest that anatomic factors may influence risk of instability for male and female patients differently., (Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Dimethylsulfoniopropionate (DMSP) is an important marine anti-stress compound, with key roles in global nutrient cycling, chemotaxis and, potentially, climate regulation. Recently, diverse marine Actinobacteria, α- and γ-proteobacteria were shown to initiate DMSP synthesis via the methionine (Met) S-methyltransferase enzyme (MmtN), generating S-methyl-Met (SMM). Here we characterize a roseobacterial MmtN, providing structural and mechanistic insights into this DMSP synthesis enzyme. We propose that MmtN uses the proximity and desolvation mechanism for Met S-methylation with two adjacent MmtN monomers comprising the Met binding site. We also identify diverse functional MmtN enzymes in potentially symbiotic archaeal Candidatus Woesearchaeota and Candidate Phyla Radiation (CPR) bacteria, and the animalcule Adineta steineri, not anticipated to produce SMM and/or DMSP. These diverse MmtN enzymes, alongside the larger plant MMT enzyme with an N-terminus homologous to MmtN, likely utilize the same proximity and desolvation mechanism. This study provides important insights into the catalytic mechanism of SMM and/or DMSP production, and proposes roles for these compounds in secondary metabolite production, and SMM cycling in diverse organisms and environments., (© 2022. The Author(s).)

Purpose: Little is known about how others evaluate applicants to master's programs in speech-language pathology along criteria used during holistic review despite more programs adopting holistic review. This knowledge gap limits our understanding of whether holistic admissions may offer a more equitable pathway to entering speech-language pathology. This study investigated how faculty and PhD students evaluated applicants to master's speech-language pathology programs along criteria used during holistic review., Method: We administered a survey online through a Qualtrics platform. Respondents ( N = 66) were faculty and PhD candidates in U.S. speech-language-hearing departments. Survey blocks included demographics, professional background, and vignettes. Vignettes featured profiles of applicants to master's programs in speech-language pathology. Vignettes systematically varied in the indicators of applicant criteria, which were specified at low, moderate, or high levels or not specified. After reading each vignette, respondents rated the applicant and indicated their admissions decision. Analysis included descriptives., Results: Relative to an applicant who was at a high level for all indicators except cultural and linguistic diversity, respondents ranked applicants who varied in their indicators of criteria levels lower. Respondents were also less likely to make an explicit "accept" decision (vs. "waitlist" or "reject") for this latter group of applicants., Conclusions: Even when implementing criteria used during holistic review, applicants who vary from a "high-achieving" stereotype may still face barriers to entry. Future work is needed to understand the precise nature of how holistic admissions review may play out in actual practice and help increase diversity in the profession.

Background: The lateral patellofemoral complex (LPFC) is an important stabilizer of the patella composed of the lateral retinacular structures including the lateral patellofemoral ligament (LPFL), the lateral patellomeniscal ligament (LPML), and the lateral patellotibial ligament (LPTL). While the isolated anatomy of the LPFL has been previously described, no previous study has investigated the entirety of the LPFC structure, length changes, and radiographic landmarks. An understanding of LPFC anatomy is important in the setting of LPFL injury or previous lateral release resulting in iatrogenic medial instability requiring LPFC reconstruction., Purpose: To both qualitatively and quantitatively describe the anatomy and length changes of the LPFC on gross anatomic dissections and standard radiographic views., Study Design: Descriptive laboratory study., Methods: Ten nonpaired cadaveric specimens were utilized in this study. Specimens were dissected to identify distinct attachments of the LPFL, LPML, and LPTL. Ligament lengths, footprints, and centers of each attachment were described with respect to osseous landmarks using a 3-dimensional coordinate measuring device. Ligament length changes were also assessed from 0° to 90° of flexion. Radiopaque markers were subsequently utilized to describe attachments on standard anteroposterior and lateral radiographic views., Results: The individual elements of the LPFC were identified in all specimens. The LPFL patellar attachment had an average total length of 22.5 mm (range, 18.3-27.5 mm), involving a mean of 59% (range, 50%-75%) of the sagittal patella. Based on the average patellar size, a mean of 63% of the LPFL attached to the patella, and the remainder (11.1 ± 1.4 mm) inserted into the patellar tendon. The femoral attachment of the LPFL had a mean maximum length of 24.4 ± 4.3 mm. The center of the LPFL femoral attachment was a mean distance of 13.5 ± 3.2 mm anterior and distal to the lateral epicondyle. The LPFL demonstrated significant shortening, especially in the first 45° of flexion (7.5 ± 5.1 mm). In contrast, the LPTL (5.5 ± 3.0 mm) and LPML (10.0 ± 3.3 mm) demonstrated significant shortening from 45° to 90°. On lateral radiographs, the center of the femoral attachment of the LPFL was a mean total distance of 19.2 ± 7.2 mm from the lateral epicondyle., Conclusion: The most important findings of this study were the correlative anatomy of 3 distinct lateral patellar ligaments (LPFL, LPML, and LPTL) and their anisometry through flexion. All 3 components demonstrated significant shortening during flexion. The quantitative and radiographic measurements detailed the LPFL osseous attachment on the patella; soft tissue attachment on the patellar tendon; and finally, the osseous insertion on the femur distal and anterior to the lateral epicondyle. Similarly, the authors documented the meniscal insertion of the LPML and defined a patellar insertion of the LPTL and LPML as a single attachment. These data allow for reproducible landmarks to aid in the understanding and reconstruction of the lateral patellar restraints., Clinical Relevance: The data produced from this investigation provide a comprehensive description of these 3 lateral patellar stabilizers (LPFL, LPML, LPTL). These data can be used intraoperatively to facilitate anatomic reconstructions of the lateral patellar stabilizers.

Background: Despite the existence of many clinical studies on platelet-rich plasma (PRP) interventions for ligamentous pathology, basic science consensus regarding the indications, mechanisms, and optimal composition of PRP for treating ligament injuries is lacking., Purpose: To (1) compare the efficacy of PRP in animal models of ligament injury with placebo and (2) describe the potential variability in PRP preparation using accepted classification systems., Study Design: Systematic review., Methods: The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed, Embase, and Ovid MEDLINE were queried in April 2020 for in vivo and in vitro basic science studies regarding PRP use for ligament injury. Study design, results, PRP composition, and analyzed cellular and molecular markers were extracted, and outcomes relative to control models were documented. Bias was assessed using the SYRCLE risk-of-bias tool., Results: Included were 43 articles (31 in vivo and 12 in vitro studies) investigating the anterior cruciate ligament/cranial cruciate ligament (n = 32), medial collateral ligament (n = 6), suspensory ligament (n = 3), patellar ligament (n = 1), and Hock ligament (n = 1). Platelet concentration was reported in 34 studies (77.3%); leukocyte composition, in 12 (27.3%); and red blood cell counts, in 7 (15.9%). With PRP treatment, 5 of 12 in vitro studies demonstrated significant increases in cell viability, 6 of 12 in gene expression, 14 of 32 in vivo studies reported superior ligament repair via histological evaluation, and 13 in vivo studies reported superior mechanical properties. Variability in PRP preparation methods was observed across all articles, and only 1 study reported all necessary information to be classified by the 4 schemes we used to evaluate reporting. Among the in vivo studies, detection and performance bias were consistently high, whereas selection, attrition, reporting, and other biases were consistently low., Conclusion: Conflicting data on the cellular and molecular effects of PRP for ligament injuries were observed secondary to the finding that included studies were heterogeneous, limiting interpretation across studies and the ability to draw meaningful conclusions. Clinical trials and any causal relationship between PRP use in ligament injuries and its potential for regeneration and healing should be pursued with caution if based solely on basic science data., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: K.C.P. has received grant support from Acumed and Arthrex, education payments from Smith & Nephew, and hospitality payments from Stryker. J.C. has received grant support from Arthrex; education payments from Arthrex and Smith & Nephew; consulting fees from Arthrex, ConMed Linvatec, DePuy, Ossur, and Smith & Nephew; nonconsulting fees from Arthrex, Linvatec, and Smith & Nephew; and hospitality payments from Medwest and Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

Anatomic posterolateral corner (PLC) reconstruction is utilized for ligamentous knee instability associated with PLC injury in patients who desire a return to active lifestyles 1,2 . The fibular collateral ligament (FCL) and popliteal tendon (PLT) are reconstructed in anatomic fashion according to techniques described by LaPrade et al. 3-7 ., Description: Various PLC reconstruction techniques have been described; however, the preferred reconstruction technique of the senior author is the method developed by LaPrade et al. that restores the anatomy of the 3 primary stabilizers of the PLC, including the FCL, PLT, and popliteofibular ligament 3,5,6 ., Alternatives: Alternative nonoperative treatments include knee immobilization for 4 weeks and physical therapy. Surgical alternatives include PLC repair, which involves repair of the lateral collateral ligament, PLT, and/or popliteofibular ligament if structures can be anatomically reduced to their attachment site. However, repair of acute grade-III PLC injuries with staged treatment of concurrent cruciate injuries is associated with a substantially higher postoperative PLC failure rate 8-10 ., Rationale: Clinical outcomes have demonstrated that primary repairs have significantly higher rates of reoperation compared with reconstruction; therefore, reconstruction is recommended. Treatment of grade-III PLC injuries with reconstruction of midsubstance tears and any associated cruciate ligament tears results in significantly improved objective stability 11 . In addition, anatomic PLC reconstruction has demonstrated improved subjective and objective patient outcomes compared with nonsurgical treatment or repair 5,11,12 ., Expected Outcomes: Reconstruction of the PLC offers excellent outcomes after surgery. Studies have shown that the fibular-based technique for treatment of a chronic isolated PLC injury showed good results in terms of clinical outcome, restoring knee varus and rotational stability 13 ., Important Tips: Patients with associated proximal tibiofibular joint instability will benefit from this reconstruction because this technique will add stability to the joint.This surgical approach is technically demanding, requiring proficiency with surgical dissection.Damage to the common peroneal nerve can potentially occur. Careful dissection and placement of retractors should be observed.Risks include surgical failure due to unrecognized malalignment; especially in chronic cases, the patient should have a complete evaluation of the standing alignment and tibial slope 12 ., Acronyms and Abbreviations: FCL = fibular collateral ligamentPFL = popliteofibular ligamentPLC = posterolateral cornerIT = iliotibialIKDC = International Knee Documentation CommitteeACL = anterior cruciate ligamentPCL = posterior cruciate ligamentPEEK = polyetheretherketonePROM = passive range of motion., (Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: Anteromedial (AM) femoral tunnel positioning in anterior cruciate ligament reconstruction (ACLR) has been reported by some authors to yield superior clinical and functional outcomes compared with the transtibial (TT) approach; however, differences in the subsequent rates of posttraumatic osteoarthritis (PTOA) are not clear., Purpose: To perform a systematic review and meta-analysis of the literature to evaluate the influence of femoral tunnel positioning during primary ACLR on the development of radiographic PTOA., Study Design: Systematic review and Meta-analysis., Methods: The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2019), and MEDLINE (1980-2019) were queried for all studies describing the development of PTOA after TT or AM ACLR. Data pertaining to patient demographics, ACLR technique, and radiographic PTOA were extracted. A meta-analysis utilizing the DerSimonian-Laird method for random effects was used to compare the weighted proportion of PTOA after ACLR between the TT and AM approaches., Results: There were 16 studies identified for inclusion with a total of 1546 patients. The mean follow-up across all studies was 10.9 years (range, 5.4-17.8 years). The mean follow-up in the AM and TT groups was 10.8 years (range, 5.4-17 years) and 11.4 years (range, 6-17.8 years), respectively. A total of 783 (50.6%) patients underwent TT ACLR. Of these patients, 401 (weighted mean, 49.3%) developed radiographic PTOA. A total of 763 (49.4%) patients underwent AM ACLR. Of these patients, 166 (mean, 21.8%) went on to develop radiographic PTOA. The meta-analysis demonstrated a significantly greater rate of PTOA after ACLR using a TT technique compared with an AM technique overall (49.3% vs 25.4%, respectively; P < .001) and when studies were stratified by 5- to 10-year (53.7% vs 14.2%, respectively; P < .001) and greater than 10-year (45.6% vs 31.2%, respectively; P < .0001) follow-up., Conclusion: TT ACLR was associated with higher overall rates of radiographic PTOA compared with the AM ACLR approach. The rates of radiographic PTOA after ACLR with a TT approach were also significantly higher than using an AM approach when stratified by length of follow-up (5- to 10-year and >10-year follow-up).

Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed orthopaedic sports procedures. Two main techniques are used for accomplishing an ACL reconstruction: transtibial and anteromedial portal techniques. The transtibial technique has been criticized for its inability to create an anatomic femoral tunnel given the intrinsic constraint of the tibial tunnel during drilling. However, technical modifications of the transtibial technique can result in anatomic tunnel entrance positioning and a properly oriented graft. This Technical Note presents our technique for anatomic transtibial ACL reconstruction., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier.)

Background: Studies examining the physiological consequences associated with deficits in energy availability (EA) for male athletes are sparse. Purpose: To examine male athlete triad components; low energy availability (LEA) with or without an eating disorder risk (ED), reproductive hormone [testosterone (T)], and bone mineral density (BMD) in endurance-trained male athletes during different training periods. Methods: A cross-sectional design with 14 participants (age: 26.4 ± 4.2 years; weight: 70.6 ± 6.4 kg; height: 179.5 ± 4.3 cm; BMI: 21.9 ± 1.8 kg/m2) were recruited from the local community. Two separate training weeks [low (LV) and high (HV) training volumes] were used to collect the following: 7-day dietary and exercise logs, and blood concentration of T. Anthropometric measurements was taken prior to data collection. A one-time BMD measure (after the training weeks) and VO 2max -HR regressions were utilized to calculate EEE. Results: Overall, EA presented as 27.6 ± 10.7 kcal/kgFFM·d-1 with 35% ( n = 5) of participants demonstrating increased risk for ED. Examining male triad components, 64.3% presented with LEA (≤ 30 kcal/kgFFM·d-1) while participants presented with T (1780.6 ± 1672.6 ng/dl) and BMD (1.31 ±.09 g/cm 2 ) within normal reference ranges. No differences were found across the 2 training weeks for EI, with slight differences for EA and EEE. Twenty-five participants (89.3%) under-ingested CHO across both weeks, with no differences between weeks. Conclusion: Majority of endurance-trained male athletes presented with one compromised component of the triad (LEA with or without ED risk); however, long-term negative effects on T and BMD were not demonstrated. Over 60% of the participants presented with an EA ≤ 30 kcal/kgFFM·d-1, along with almost 90% not meeting CHO needs. These results suggest male endurance-trained athletes may be at risk to negative health outcomes similar to mechanistic behaviors related to EA with or without ED in female athletes., Competing Interests: The 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., (Copyright © 2021 Moore, Drenowatz, Stodden, Pritchett, Brodrick, Williams, Goins and Torres-McGehee.)

Background: Posterolateral corner (PLC) injuries of the knee are being increasingly recognized and treated in current orthopaedic practice. While there are numerous systematic reviews evaluating the management and outcomes after PLC injuries, there are limited data investigating complications after PLC reconstruction or repair., Purpose: To systematically review the literature to determine the incidence of postoperative complications after the surgical treatment of PLC injury., Study Design: Systematic review; Level of evidence, 4., Methods: The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008-2019), Embase (2008-2019), and MEDLINE (2008-2019) were queried for literature reporting on PLC reconstruction or repair, with or without concomitant ligamentous or meniscal surgery. Data including type of surgery performed, concomitant procedures, and follow-up time were extracted. Complications recorded included intra- and postoperative complications., Results: After the intra- and postoperative complication data of 60 studies (1747 cases) were combined, surgical management of PLC injuries was associated with an intraoperative complication rate of 0.34% (range, 0%-2.8%) and a postoperative complication rate of 20% (range, 0%-51.2%). The most common postoperative complication was arthrofibrosis (range, 0%-20%). The overall infection rate was 1.3% (range, 0%-10%). Four cases of postoperative common peroneal nerve palsy were reported. Failure of reconstruction or repair was reported in 164 (9.4%) of all cases examined (range, 0%-37.1%)., Conclusion: Although the intraoperative rate of complications during PLC reconstructions is low, postoperative complications rates of 20% can be expected, including arthrofibrosis, infection, and neurovascular injury. PLC structures repaired or reconstructed failed in 9.4% of the cases.

Dimethylsulfoniopropionate (DMSP) is one of Earth's most abundant organosulfur molecules. Recently, many marine heterotrophic bacteria were shown to produce DMSP, but few studies have combined culture-dependent and independent techniques to study their abundance, distribution, diversity and activity in seawater or sediment environments. Here we investigate bacterial DMSP production potential in East China Sea (ECS) samples. Total DMSP (DMSPt) concentration in ECS seawater was highest in surface waters (SW) where phytoplankton were most abundant, and it decreased with depth to near bottom waters. However, the percentage of DMSPt mainly apportioned to bacteria increased from the surface to the near bottom water. The highest DMSP concentration was detected in ECS oxic surface sediment (OSS) where phytoplankton were not abundant. Bacteria with the genetic potential to produce DMSP and relevant biosynthesis gene transcripts were prominent in all ECS seawater and sediment samples. Their abundance also increased with depth and was highest in the OSS samples. Microbial enrichments for DMSP-producing bacteria from sediment and seawater identified many novel taxonomic groups of DMSP-producing bacteria. Different profiles of DMSP-producing bacteria existed between seawater and sediment samples and there are still novel DMSP-producing bacterial groups to be discovered in these environments. This study shows that heterotrophic bacteria significantly contribute to the marine DMSP pool and that their contribution increases with water depth and is highest in seabed surface sediment where DMSP catabolic potential is lowest. Furthermore, distinct bacterial groups likely produce DMSP in seawater and sediment samples, and many novel producing taxa exist, especially in the sediment.

Purpose: To identify demographic, clinical, and radiographic factors associated with failure after superior capsular reconstruction (SCR)., Methods: Prospectively collected data were analyzed from patients who underwent SCR using a decellularized dermal allograft for an irreparable rotator cuff tear. Demographic characteristics, radiographic findings, concomitant procedures, and patient-reported outcomes (PROs) were recorded. Failure was defined by ≥1 of the following criteria: (1) conversion to reverse total shoulder arthroplasty (RTSA), (2) a decrease in 1-year postoperative shoulder-specific PROs compared with preoperative scores, or (3) patient reports at final follow-up that the shoulder was in a worse condition than before surgery. Preoperative variables were compared between patients meeting the criteria for clinical failure and those who did not., Results: Fifty-four patients (mean age 56.3 ± 5.8 years, range 45 to 70) who underwent SCR, with minimum 1-year follow-up, were included in the analysis. Mean follow-up after surgery was 24 months (range 12 to 53). Eleven patients (20.4%) met criteria for clinical failure. Of the 11, 8 reported decreased American Shoulder and Elbow Surgeons (ASES) or Constant scores or indicated that the operative shoulder was in a worse condition than before surgery. Three patients underwent RTSA in the 6 to 12 months after SCR. Female sex and the presence of a subscapularis tear were associated with failure (P = .023 and P = .029, respectively). A trend toward greater body mass index (BMI), lower preoperative forward flexion, and lower preoperative acromiohumeral distance (AHD) was found in patients with clinical failure (P = .075, P = .088, and P = .081, respectively). No other variable included in the analysis was significantly associated with failure., Conclusion: The proportions of female patients and those with subscapularis tear were greater among patients with clinical failure after SCR. Greater BMI, lower preoperative forward flexion, and lower preoperative AHD trended toward association with clinical failure of SCR., Level of Evidence: 4, case series., (Copyright © 2020 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To (1) determine the diagnostic efficacy of artificial intelligence (AI) methods for detecting anterior cruciate ligament (ACL) and meniscus tears and to (2) compare the efficacy to human clinical experts., Methods: PubMed, OVID/Medline, and Cochrane libraries were queried in November 2019 for research articles pertaining to AI use for detection of ACL and meniscus tears. Information regarding AI model, prediction accuracy/area under the curve (AUC), sample sizes of testing/training sets, and imaging modalities were recorded., Results: A total of 11 AI studies were identified: 5 investigated ACL tears, 5 investigated meniscal tears, and 1 investigated both. The AUC of AI models for detecting ACL tears ranged from 0.895 to 0.980, and the prediction accuracy ranged from 86.7% to 100%. Of these studies, 3 compared AI models to clinical experts. Two found no significant differences in diagnostic capability, whereas one found that radiologists had a significantly greater sensitivity for detecting ACL tears (P = .002) and statistically similar specificity and accuracy. Of the 5 studies investigating the meniscus, the AUC for AI models ranged from 0.847 to 0.910 and prediction accuracy ranged from 75.0% to 90.0%. Of these studies, 2 compared AI models with clinical experts. One found no significant differences in diagnostic accuracy, whereas one found that the AI model had a significantly lower specificity (P = .003) and accuracy (P = .015) than radiologists. Two studies reported that the addition of AI models significantly increased the diagnostic performance of clinicians compared to their efforts without these models., Conclusions: AI prediction capabilities were excellent and may enhance the diagnosis of ACL and meniscal pathology; however, AI did not outperform clinical experts., Clinical Relevance: AI models promise to improve diagnosing certain pathologies as well as or better than human experts, are excellent for detecting ACL and meniscus tears, and may enhance the diagnostic capabilities of human experts; however, when compared with these experts, they may not offer any significant advantage., (Copyright © 2020 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: As the number of total shoulder arthroplasties (TSAs) performed annually increases, some surgeons have begun to shift toward performing TSAs in the outpatient setting. However, it is imperative to establish the safety of outpatient TSA. The purpose of this systematic review was to define complication, readmission, and reoperation rates and patient-reported outcomes after outpatient TSA., Methods: A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using three databases (PubMed, Ovid, and Embase). English-language publications describing results on complication rates in patients who underwent TSA in an outpatient or ambulatory setting were included. All nonclinical and deidentified database studies were excluded. Bias assessment was conducted with the methodologic index for nonrandomized studies criteria., Results: Seven studies describing outcomes in outpatient TSA were identified for inclusion. The included studies used varying criteria for selecting patients for an outpatient procedure. The total outpatient 90-day complication rate (commonly including hematomas, wound issues, and nerve palsies) ranged from 7.1%-11.5%. Readmission rates ranged from 0%-3.7%, and emergency and urgent care visits ranged from 2.4%-16.1%. Patient-reported outcomes improved significantly after outpatient TSA in all studies. Two studies found a higher complication rate in the comparative inpatient cohort ( P  = .023-.027). Methodologic index for nonrandomized studies scores ranged from 9 to 11 (of 16) for noncomparative studies (n = 3), while all comparative studies received a score of a 16 (of 24)., Conclusion: Outpatient TSA in properly selected patients results in a similar complication rate to inpatient TSA. Further studies are needed to aid in determining proper risk stratification to direct patients to inpatient or outpatient shoulder arthroplasty., (© 2021 The Authors.)

Purpose: To perform a systematic review and meta-analysis evaluating the effects of mesenchymal stem cells (MSCs) on cartilage regeneration and patient-reported pain and function., Methods: A systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using a PRISMA checklist. The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008-2019), EMBASE (2008-2019), and MEDLINE (2008-2019) were queried in July 2019 for literature reporting use of stem cells to treat knee osteoarthritis or chondral defects. Data describing administered treatment, subject population, injection type, duration of follow-up, pain and functional outcomes, and radiographic and magnetic resonance imaging findings were extracted. Risk of bias was assessed using the Downs and Black scale. Meta-analyses adjusted for random effects were performed, calculating pooled effect sizes in terms of patient-reported pain and function, cartilage quality, and cartilage volume., Results: Twenty-five studies with 439 subjects were identified. There was no significant difference in pain improvement between MSC treatment and controls (pooled standardized mean difference [SMD] = 0.23, P = .30). However, MSC treatment was significantly favored for functional improvement (SMD = 0.66, P < .001). There was improvement in cartilage volume after MSC treatment (SMD = 0.84, P < .001). Regarding cartilage quality, meta-analysis resulted in a small, nonsignificant effect size of 0.37 (95%, -0.03 to 0.77, P = .07). There was risk for potential bias among included studies, with 17 (68%) receiving either a grade of "poor" or "fair.", Conclusions: The pooled SMD from meta-analyses showed statistically significant effects of MSC on self-reported physical function but not self-reported pain. MSCs provided functional benefit only in patients who underwent concomitant surgery. However, this must be interpreted with caution, as there was substantial variability in MSC composition and mode of delivery. MSC treatment provided significant improvement in cartilage volume but not cartilage quality. Preliminary data regarding therapeutic properties of MSC treatment suggest significant heterogeneity in the current literature, and risk of bias is not negligible., Level of Evidence: II, Systematic Review and Meta-analysis., (Copyright © 2020 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Several post-operative pain control methods have been described for hip arthroscopy including systemic medications, intra-articular or peri-portal injection of local anesthetics and peripheral nerve blocks. The diversity of modalities used may reflect a lack of consensus regarding an optimal approach. The purpose of this investigation was to conduct an international survey to assess pain management patterns after hip arthroscopy. It was hypothesized that a lack of agreement would be present in the majority of the surgeons' responses. A 25-question multiple-choice survey was designed and distributed to members of multiple orthopedic professional organizations related to sports medicine and hip arthroscopy. Clinical agreement was defined as > 80% of respondents selecting a single answer choice, while general agreement was defined as >60% of a given answer choice. Two hundred and fifteen surgeons completed the survey. Clinical agreement was only evident in the use of oral non-steroidal anti-inflammatory drugs (NSAIDs) for pain management after hip arthroscopy. A significant number of respondents (15.8%) had to readmit a patient to the hospital for pain control in the first 30 days after hip arthroscopy in the past year. There is significant variability in pain management practice after hip arthroscopy. The use of oral NSAIDs in the post-operative period was the only practice that reached a clinical agreement. As the field of hip preservation surgery continues to evolve and expand rapidly, further research on pain management after hip arthroscopy is clearly needed to establish evidence-based guidelines and improve clinical practice., (© The Author(s) 2020. Published by Oxford University Press.)

Introduction: The purpose of this study was to perform a systematic review and meta-analysis of the effects of training simulators on surgical skill measures across randomized controlled trials. The authors hypothesized that simulated training would (1) result in objective improvements in skill acquisition and (2) be heterogeneous regarding the outcomes and types of validity assessed., Methods: The Cochrane Database of Systematic Reviews, the Central Register of Controlled Trials, PubMed, EMBASE, and MEDLINE databases were queried for Level I studies on training simulators between 2007 and 2019 in accordance with the 2009 Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Exclusion criteria were studies without discrete assessment of skills acquisition after surgical simulator training and level of evidence II to V. The Jadad scale was used to assess the methodological quality of all included articles. Data pertaining to patient demographics, validity measures, simulator types, and study-specific outcome measures were extracted. Meta-analyses adjusted for random effects and heterogeneity analyses (I) were used to compare pooled time-to-completion and performance outcomes among included studies., Results: A total of 24 studies with 494 participants were identified. The most common simulator type involved knee arthroscopy (11 studies, 45.8%). Eight studies reporting time-to-task completion and performance scores were included in the meta-analysis. Virtual reality training was favored in time-to-task completion (mean difference = -82.25 seconds, P = 0.002) and improvement in objective performance scores (mean difference = 1.24, P = 0.02) relative to traditional training. Sensitivity analysis of time-to-task completion based on the length of training interval revealed a mean difference of -45.24 (P = 0.07) and -137.74 (P < 0.001) seconds for the short-term and immediate posttesting subgroups, respectively., Conclusion: Overall, improved task efficiency and performance were observed with the use of orthopaedic simulators. However, simulator type, training protocols, and outcome measures were heterogeneous. Future studies are warranted to evaluate financial cost and longitudinal training programs and to standardize outcomes regarding the use of simulators in orthopaedic education., Level of Evidence: Level I.

The decision to manage first-time shoulder dislocations conservatively or operatively has become increasingly complex because of conflicting literature. Although shoulder dislocations have traditionally been managed with reduction and immobilization, recent evidence has suggested high rates of subsequent recurrence. Surgical intervention is thought to better restore stability and decrease recurrence rates; however, it also has the potential for additional morbidity and financial cost. As such, recent literature has sought to better define patient risk profiles to identify optimal candidates for both conservative and operative management. The purpose of the current review is to provide a comprehensive and evidence-based assessment of the most recent literature to better delineate an appropriate treatment algorithm for this challenging clinical scenario.

Purpose: To to assess whether there are any significant differences in hip joint space width (JSW) between weight-bearing versus supine pelvic radiographs., Methods: Standing and supine anteroposterior pelvic radiographs of 86 patients (146 hips) were included. Sample size was sufficiently powered to assess for equivalence between standing and supine films for JSW measurements made at the medial, lateral, and central aspects of the sourcil line. Measurements were made by 2 independent reviewers blinded to patient positioning. Each reviewer repeated a subset of the measurements to assess intra-rater reproducibility. Mean differences in joint space measurements between standing and supine radiographs were reported for each point of the sourcil. Intraclass correlation coefficients (ICCs) for inter and intra-rater reliability were also calculated., Results: There were no significant differences between JSW measurements made on standing and supine pelvic radiographs (P = .468). Furthermore, equivalence testing demonstrated statistical equivalence between standing and supine JSW measurements made based on an equivalence threshold of ±0.5 mm. Inter-rater reliability demonstrated good agreement with an overall ICC of 0.775 (95% confidence interval [CI] 0.734-0.809). Intra-rater reliability also demonstrated good agreement with ICCs of 0.84 (95% CI 0.758-0.889) and 0.798 (95% CI 0.721-0.851) for the 2 reviewers, respectively., Conclusions: JSW measurements on standing and supine pelvic radiographs were not significantly different, and their inter-rater agreement and intra-rater reproducibility demonstrated good reliability and repeatability. Therefore, either may be used to assess JSW, including measurements that may impact treatment decisions for hip arthroscopy., Level of Evidence: Level III; retrospective comparative study., (Copyright © 2020 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Despite its increasing use in the management of musculoskeletal conditions, questions remain regarding the preparation methods of platelet-rich plasma (PRP) and its clinical applications for intra-articular hip disorders, including femoroacetabular impingement syndrome (FAIS), labral pathology, and osteoarthritis (OA)., Purpose: To systematically review and assess the preparation methods and clinical outcomes from randomized clinical trials (RCTs) on the use of PRP for intra-articular hip disorders., Study Design: Systematic review; Level of evidence, 2., Methods: A systematic review in accordance with the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed in September 2019. The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed, Ovid Medline, and Embase were queried for studies regarding the use of PRP to treat intra-articular hip disorders. Qualifying articles were English-language RCTs describing the use of PRP for intra-articular hip disorders, either as standalone treatment or surgical augmentation. Two authors independently assessed article eligibility. Data pertaining to patient characteristics, indication for treatment, PRP preparation method, follow-up period, and clinical outcomes were extracted. Study results were qualitatively reported and quantitatively compared using meta-analysis when appropriate., Results: Seven RCTs met inclusion criteria. Four studies described the use of PRP for hip OA and 3 utilized PRP at arthroscopy for FAIS and labral tears. Outcomes after PRP for OA demonstrated improvement in validated patient-reported outcome measures for up to 1 year; however, pooled effect sizes found no statistically significant difference between PRP and hyaluronic acid (HA) regarding pain visual analog scale scores at short-term (≤2 months; P = .27), midterm (4-6 months; P = .85), or long-term (1 year; P = .42) follow-up. When injected at arthroscopy, 1 study reported improved outcomes, 1 reported no difference in outcomes, and 1 reported worse outcomes compared with controls. The meta-analysis demonstrated no statistically significant difference on the modified Harris Hip Score (mHHS) between PRP and control cohorts at a minimum 1-year follow-up. There were considerable deficiencies and heterogeneity in the reporting of PRP preparation methods for both indications., Conclusion: Treatment of OA with PRP demonstrated reductions in pain and improved patient-reported outcomes for up to 1 year. However, there was no statistically significant difference between PRP and HA in pain reduction. Likewise, for FAIS and labral surgery there was no statistically significant difference in mHHS outcomes between patients treated with PRP and controls. Given the limited number of studies and variability in PRP preparations, additional high-quality randomized trials are warranted., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: B.U.N. has received educational support from Smith & Nephew and hospitality payments from Stryker, Wright Medical, and Zimmer Biomet. S.J.N. has received research support from Allosource, Arthrex, Athletico, DJO, Linvatec, Miomed, Smith & Nephew, and Stryker; educational support from Elite Orthopedics; consulting fees from Ossur and Stryker; and royalties from Ossur and Springer. J.C. has received educational support from Arthrex and Smith & Nephew and consulting fees from Arthrex, ConMed Linvatec, and Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)

Listeners often experience challenges understanding an interlocutor (target) in the presence of competing talkers (maskers). However, during linguistic release from masking (LRM), this difficulty decreases for native language targets (English) when paired with different language maskers (e.g., Dutch). There is considerable evidence that the linguistic similarity between target-masker pairs determines the size of LRM. This study investigated whether and how LRM is affected when the streams also differed in talker sex. Experiment 1 investigated intelligibility for English targets in sex-matched and mismatched conditions with Dutch or English maskers. While typical LRM effects were obtained when sex was matched, opposite effects were detected when sex was mismatched. In experiment 2, Mandarin maskers were used to increase linguistic dissimilarity and elicit stronger LRM effects. Despite the greater linguistic dissimilarity, the surprising reverse LRM effect in the sex-mismatch condition persisted. In experiment 3, the target stream was held constant and talker sex and language were manipulated in the masker. Here, expected LRM effects were obtained for both the sex-matched and sex-mismatched conditions. This indicated that the locus of the dissimilarities and not just relative properties affect LRM. Broadly, this study suggests that using naturally varying listening situations advances understanding of factors underlying LRM.

Dimethylsulfoniopropionate (DMSP) is an important marine osmolyte. Aphotic environments are only recently being considered as potential contributors to global DMSP production. Here, our Mariana Trench study reveals a typical seawater DMSP/dimethylsulfide (DMS) profile, with highest concentrations in the euphotic zone and decreased but consistent levels below. The genetic potential for bacterial DMSP synthesis via the dsyB gene and its transcription is greater in the deep ocean, and is highest in the sediment.s DMSP catabolic potential is present throughout the trench waters, but is less prominent below 8000 m, perhaps indicating a preference to store DMSP in the deep for stress protection. Deep ocean bacterial isolates show enhanced DMSP production under increased hydrostatic pressure. Furthermore, bacterial dsyB mutants are less tolerant of deep ocean pressures than wild-type strains. Thus, we propose a physiological function for DMSP in hydrostatic pressure protection, and that bacteria are key DMSP producers in deep seawater and sediment.

Purpose: The purpose of this study is to identify and summarize the current utility of intraoperative ultrasound (US) during hip arthroscopy., Methods: A systematic database query of the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, EMBASE, PubMed (1980 to 2019), and Ovid MEDLINE (1980 to 2019) was performed. After article identification, descriptions of the surgical procedure, use of intraoperative US, procedural complications, and conclusions from each article were recorded and summarized., Results: Five studies met inclusion criteria, all of which were surgical techniques or technical notes. Four of the 5 studies described US used for placement of arthroscopic portals, and 1 described the use of an intraarticular US catheter for the assessment of an osteochondritis dissecans (OCD) lesion. Of the 4 studies using US for portal placement, 3 were performed supine and 1 was performed in the lateral decubitus position. All studies recognized the need for additional US training or the required assistance of a radiologist to incorporate US into a surgical practice., Conclusion: Descriptions of intraoperative US during hip arthroscopy are limited in the literature. However, existing technique reports demonstrate the feasibility of US for both portal placement with superficial probes and limited evaluation of cartilage using intraarticular US catheters., Level of Evidence: V, systematic review., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier Inc.)