| 1. |
- Santangelo, James S., et al.
(författare)
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Global urban environmental change drives adaptation in white clover
- 2022
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 375
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Tidskriftsartikel (refereegranskat)abstract
- Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural dines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale.
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| 2. |
- Greiner, Justin J., et al.
(författare)
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Factors Associated With Knee Extension Strength Symmetry After Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft
- 2024
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Ingår i: ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE. - 2325-9671. ; 12:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Diminished postoperative knee extension strength may occur after anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon (QT) autograft. Factors influencing the restoration of knee extensor strength after ACLR with QT autograft remain undefined. Purpose: To identify factors that influence knee extensor strength after ACLR with QT autograft. Study Design: Case-control study; Level of evidence, 3. Methods: The authors performed a retrospective review of patients who underwent primary ACLR with QT autograft at a single institution between 2010 and 2021. Patients were included if they completed electromechanical dynamometer testing at least 6 months after surgery. Exclusion criteria consisted of revision ACLR, <6 months of follow-up, concomitant procedure (osteotomy, cartilage restoration), and concomitant ligamentous injury requiring surgery. Knee extension limb symmetry index (LSI) was obtained by comparing the peak torque of the operated and nonoperated extremities. Univariable and multivariable analyses were performed to identify factors associated with knee extension LSI in the patient, injury, rehabilitation, and preoperative patient-reported outcomes score domains. Results: A total of 107 patients (58 male; mean age, 22.8 years) were included. Mean knee extension LSI of the overall cohort was 0.82 +/- 0.18 at 7.5 +/- 2.0 months; 35 patients (33%) had a value of >= 0.90. Multivariable analysis demonstrated significant negative associations between knee extension LSI and female sex (-0.12; P < .001), increased age at the time of surgery (-0.01; P = .018), and larger QT graft width (-0.049; P = .053). Conclusion: Factors influencing knee extensor LSI after ACLR with QT autograft in this study population spanned patient and surgical factors, including female sex, older age at the time of surgery, and wider graft harvest. Surgeons should consider the association between these factors and lower postoperative knee extensor LSI to optimize patient outcomes.
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| 3. |
- Herman, Zachary J., et al.
(författare)
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'Real world' clinical implementation of blood flow restriction therapy does not increase quadriceps strength after quadriceps tendon autograft ACL reconstruction
- 2024
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Ingår i: KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY. - 0942-2056 .- 1433-7347. ; 32:8, s. 1953-1960
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Tidskriftsartikel (refereegranskat)abstract
- PurposeTo retrospectively compare strength outcomes of individuals undergoing postoperative rehabilitation following quadriceps tendon (QT) autograft anterior cruciate ligament reconstruction (ACLR) with and without blood flow restriction therapy.MethodsA retrospective review of consecutive patients undergoing ACLR with QT autograft with a minimum of two quantitative postoperative isometric strength assessments via an electromechanical dynamometer (Biodex) was included. Demographics, surgical variables and strength measurement outcomes were compared between patients undergoing blood flow restriction therapy as part of postoperative rehabilitation versus those who did not.ResultsEighty-one (81) patients met the inclusion criteria. No differences were found in demographic and surgical characteristics between those who received blood flow restriction compared with those who did not. While both groups had improvements in quadriceps peak torque and limb symmetry index (LSI; defined as peak torque of the operative limb divided by the peak torque of the nonoperative limb) over the study period, the blood flow restriction group had significantly lower mean peak torque of the operative limb at first Biodex strength measurement (95.6 vs. 111.2 Nm; p = 0.03). Additionally, the blood flow restriction group had a significantly lower mean LSI than those with no blood flow restriction at the second Biodex measurement timepoint (81% vs. 90%; p = 0.02). No other significant differences were found between the strength outcomes measured.ConclusionsResults of this study show that the 'real world' clinical implementation of blood flow restriction therapy to the postoperative rehabilitation protocol following QT autograft ACLR did not result in an increase in absolute or longitudinal changes in quadriceps strength measurements. A better understanding and standardisation of the use of blood flow restriction therapy in the rehabilitation setting is necessary to delineate the true effects of this modality on strength recovery after QT autograft ACLR.Level of EvidenceLevel III.
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| 4. |
- Herman, Zachary J, et al.
(författare)
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Overhead Athletes Have Comparable Intraoperative Injury Patterns and Clinical Outcomes to Nonoverhead Athletes Following Surgical Stabilization for First-Time Anterior Shoulder Instability at Average 6 Year Follow Up
- 2024
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Ingår i: Journal of shoulder and elbow surgery. - 1532-6500. ; 33:6, s. 1219-1227
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Tidskriftsartikel (refereegranskat)abstract
- Anterior shoulder instability is a common problem affecting young, athletic populations that results in potential career-altering functional limitations. However, little is known regarding the differences in clinical outcomes after operative management of overhead versus nonoverhead athletes presenting with first-time anterior shoulder instability. We hypothesized that overhead athletes would have milder clinical presentations, similar surgical characteristics, and diminished postoperative outcomes when compared to nonoverhead athletes after surgical stabilization following first-time anterior shoulder instability episodes.Patients with first-time anterior shoulder instability events (subluxations and dislocations) undergoing operative management between 2013-2020 were included. Exclusion criteria included multiple dislocations and multidirectional shoulder instability. Baseline demographics, imaging, exam, and intraoperative findings were retrospectively collected. Patients were contacted to collect postoperative patient reported outcomes (PROs) including American Shoulder and Elbow Surgeons (ASES) score, Western Ontario Shoulder Instability (WOSI) score, Brophy activity index, Subjective Shoulder Value (SSV), in addition to return to work/sport rates, recurrent dislocation, and revision rates.A total of 256 patients met inclusion criteria, of which 178 (70%) patients were nonoverhead athletes. Mean age of the entire population was 23.1 years. There was no significant difference in concomitant shoulder pathology nor preoperative range of motion or strength between cohorts. A greater proportion of overhead athletes presented with instability events not requiring manual reduction (defined as subluxations; 64.1% vs. 50.6%; p < 0.001) and underwent arthroscopic surgery (97% vs. 76%, p < 0.001) compared to nonoverhead athletes. A smaller proportion of overhead athletes underwent open soft-tissue stabilization compared to nonoverhead athletes (1% vs. 19%, p < 0.001). Outcome data on 60 patients with average follow-up 6.7 years was available. No significant differences were found between groups with respect to recurrent postoperative instability event rate (13.0% overhead vs. 16.8% nonoverhead) or revision (13.0% overhead vs. 11.1% nonoverhead) rates, ASES, WOSI, BROPHY, SSV, or rates return to work/sport.Overhead athletes who underwent surgery after an initial instability event were more likely to present with subluxations compared to nonoverhead athletes. With limited follow-up subject to biases, this study found no differences in recurrence or revision rates, postoperative PROs, or return to work/sport rates between the overhead and nonoverhead athletes undergoing shoulder stabilization surgery following first-time instability events. While larger prospective studies are necessary to draw firmer conclusions, the findings of this study suggest that overhead athletes can be considered in the same treatment pathway for first-time dislocation as nonoverhead athletes.
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| 5. |
- Fox, Michael A., et al.
(författare)
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Anatomic Anterior Cruciate Ligament Reconstruction
- 2023
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Ingår i: Arthroscopy - Journal of Arthroscopic and Related Surgery. - 0749-8063 .- 1526-3231. ; 39:9, s. 1968-1970
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Tidskriftsartikel (refereegranskat)abstract
- Anterior cruciate ligament reconstruction (ACLR) techniques have substantially evolved over the past several decades, driven by evidence that nonanatomic techniques increase the risk for instability, loss of motion, surgical failure, and posttraumatic osteoarthritis. Early techniques used transtibial femoral tunnel drilling, although improved understanding of the anatomy and biomechanics has led to independent femoral tunnel. Anatomic ACLR requires careful consideration of the native ACL dimensions and orientation. Although there is significant variation between patients, understanding of anatomic patterns allows for reliable identification of the ACL footprints and appropriate tunnel positioning, particularly in chronic injuries where the remanent ACL stump is degraded or absent. The femoral tunnel should be placed low and posterior on the lateral femoral condyle using the lateral intercondylar and bifurcate ridges as landmarks. The center of the tibial footprint can be determined by referencing the medial tibial spine and posterior border of anterior horn of lateral meniscus. Measurement of the dimensions of the native ACL and intercondylar notch is also critical for determining graft size and minimizing the risk of impingement, with a goal of reconstructing 50% to 80% of the tibial footprint area. Clinical outcome studies have demonstrated superior anteroposterior and rotatory knee stability with low surgical revision rates (reported between 3% and 5%). By adhering to the principles of anatomic ACLR, surgeons can produce an appropriately sized and located graft for the individual patient, thereby best restoring native knee kinematics and maximizing function. The aim of this infographic is to highlight essential features of anatomic ACLR techniques, which a focus on the native anatomy and surgical planning to achieve an anatomic ACLR.
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