Publications by authors named "Martin S Davey"

78 Publications

Paediatric ankle cartilage lesions: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle.

J ISAKOS 2022 Apr 13. Epub 2022 Apr 13.

Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Pediatric Ankle Cartilage Lesions" developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle.

Methods: Forty-three international experts in cartilage repair of the ankle representing 20 countries convened to participate in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within four working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterised as follows: consensus: 51-74%; strong consensus: 75-99%; unanimous: 100%.

Results: A total of 12 statements on paediatric ankle cartilage lesions reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. Five achieved unanimous support, and seven reached strong consensus (>75% agreement). All statements reached at least 84% agreement.

Conclusions: This international consensus derived from leaders in the field will assist clinicians with the management of paediatric ankle cartilage lesions.
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http://dx.doi.org/10.1016/j.jisako.2022.04.001DOI Listing
April 2022

Transcriptional profiling of human Vδ1 T cells reveals a pathogen-driven adaptive differentiation program.

Cell Rep 2022 May;39(8):110858

Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK. Electronic address:

γδ T cells are generally considered innate-like lymphocytes, however, an "adaptive-like" γδ compartment has now emerged. To understand transcriptional regulation of adaptive γδ T cell immunobiology, we combined single-cell transcriptomics, T cell receptor (TCR)-clonotype assignment, ATAC-seq, and immunophenotyping. We show that adult Vδ1 T cells segregate into TCF7LEF1Granzyme B (T) or T-betEomesBLIMP-1Granzyme B (T) transcriptional subtypes, with clonotypically expanded TCRs detected exclusively in T cells. Transcriptional reprogramming mirrors changes within CD8 αβ T cells following antigen-specific maturation and involves chromatin remodeling, enhancing cytokine production and cytotoxicity. Consistent with this, in vitro TCR engagement induces comparable BLIMP-1, Eomes, and T-bet expression in naive Vδ1 and CD8 T cells. Finally, both human cytomegalovirus and Plasmodium falciparum infection in vivo drive adaptive Vδ1 T cell differentiation from T to T transcriptional status, alongside clonotypic expansion. Contrastingly, semi-invariant Vγ9Vδ2 T cells exhibit a distinct "innate-effector" transcriptional program established by early childhood. In summary, adaptive-like γδ subsets undergo a pathogen-driven differentiation process analogous to conventional CD8 T cells.
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http://dx.doi.org/10.1016/j.celrep.2022.110858DOI Listing
May 2022

Terminology for osteochondral lesions of the ankle: proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle.

J ISAKOS 2022 04 14;7(2):62-66. Epub 2022 Jan 14.

Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden.

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle is based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "terminology for osteochondral lesions of the ankle" developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle.

Methods: Forty-three international experts in cartilage repair of the ankle representing 20 countries were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within four working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed, and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed on in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterised as follows: consensus, 51%-74%; strong consensus, 75%-99%; unanimous, 100%.

Results: A total of 11 statements on terminology and classification reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. Definitions are provided for osseous, chondral and osteochondral lesions, as well as bone marrow stimulation and injury chronicity, among others. An osteochondral lesion of the talus can be abbreviated as OLT.

Conclusions: This international consensus derived from leaders in the field will assist clinicians with the appropriate terminology for osteochondral lesions of the ankle.
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http://dx.doi.org/10.1016/j.jisako.2021.12.001DOI Listing
April 2022

Subscapularis Management during Open Latarjet Procedure- Does Subscapularis Split versus Tenotomy Matter? A Systematic Review & Meta-Analysis.

J Shoulder Elbow Surg 2022 Apr 21. Epub 2022 Apr 21.

Department of Orthopaedics, Sports Surgery Clinic, Dublin, Ireland.

Background: The purpose of this study was to systematically review the literature to ascertain the clinical outcomes of open Latarjet (OL) procedure using either a Subscapularis Split (SS) or Tenotomy (ST) via a Deltopectoral (DP) approach.

Methods: Two independent reviewers performed a literature search using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using Pubmed, Embase and Scopus databases. Only studies reporting on outcomes of OL procedure via a DP approach comparing both SS and ST via a DP approach were considered for inclusion. Meta-analysis was performed on clinical outcomes compared using RevMan.

Results: Our search found 5 studies including 615 shoulders (80.8% males), with average age of 27.8 ± 12.6 years (15-79) and mean follow-up of 50.1 ± 29.4 months (12-180) met our inclusion criteria. There were a total of 410 and 205 shoulders who underwent OL procedure via a DP approach using ST and SS techniques respectively, with both techniques resulting in significant increases in the Rowe scores postoperatively (both p < 0.0001). Additionally, there were significantly higher postoperative Constant scores in those who underwent OL using a SS technique, versus those in the ST groups (91.8 ± 7.2 vs 79.6 ± 16.1, p < 0.0001 respectively). However, meta-analysis demonstrated that there were non-significantly higher postoperative Rowe and American Shoulder and Elbow Surgeons (ASES) scores respectively in those who underwent OL using a SS technique, versus those in the ST groups (96.1 ± 2.6 vs 86.4 ± 7.6, p=0.57; 91.6 ± 1.3 vs 80.6 ± 25.5, p = 0.47 respectively). Furthermore, meta-analysis demonstrated that there were significantly more patients in the ST group who were lift-off test positive when compared to the SS group at final follow-up (2.7% versus 10.0%, p = 0.01). However, meta-analysis demonstrated that the rate of recurrent instability was trending towards significance in favour of the SS group (0% vs 11.7%, p=0.07).

Conclusion: Our systematic review established that in cases of open Latarjet procedures being carried out via a DP approach, the SS technique results in significantly better functional outcome measures and significantly lower rates of subscapularis insufficiency when compared to an L-shaped ST technique at medium-term follow-up. Furthermore, there were lower rates of recurrent instability that were trending towards significance in favour of the SS technique.
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http://dx.doi.org/10.1016/j.jse.2022.03.008DOI Listing
April 2022

The Fragility Index of Statistically Significant Findings From Randomized Controlled Trials Comparing the Management Strategies of Anterior Shoulder Instability.

Am J Sports Med 2022 Apr 13:3635465221077268. Epub 2022 Apr 13.

Sports Surgery Clinic, Dublin, Ireland.

Background: Debate centering on the management of anterior shoulder instability (ASI) in recent years has led to many randomized controlled trials (RCTs) being published on the topic. The fragility index (FI) has subsequently emerged as a novel method of assessing significant findings reported in RCTs, particularly those with small sample sizes.

Purpose: To evaluate the FI of statistically significant findings in RCTs that reported the outcomes of management strategies of patients with ASI.

Study Design: Systematic review; Level of evidence, 1.

Methods: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent reviewers performed a systematic review of RCTs focusing on the outcomes of management strategies of patients with ASI. There were 3 main categories of RCTs included: (1) nonoperative management in internal rotation (IR) versus external rotation (ER), (2) nonoperative management versus a surgical intervention, and (3) surgical management with arthroscopic Bankart repair versus open Bankart repair. The Fisher exact test was utilized to calculate the FI for the reversal of statistical significance in all statistically significant dichotomous outcomes.

Results: A total of 21 RCTs were included, including 1589 shoulders (mean age, 29.4 years) with a mean follow-up of 26.8 months. There were 10 RCTs (831 shoulders) that reported outcomes after the nonoperative management of ASI in IR versus ER, with a mean FI of 6.8. There were 5 RCTs (324 shoulders) that reported outcomes comparing the nonoperative and operative management of ASI, with a mean FI of 3.5. There were 6 RCTs (434 shoulders) that reported outcomes after the operative management of ASI with either arthroscopic Bankart repair or open Bankart repair, with a mean FI of 9.6.

Conclusion: The overall FI of RCTs reporting the outcomes of management strategies for patients with ASI was high, suggesting a moderate fragility of statistically significant outcomes including recurrence, revision stabilization, and return to play.
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http://dx.doi.org/10.1177/03635465221077268DOI Listing
April 2022

Overview of MicroRNA Expression in Predicting Response to Neoadjuvant Therapies in Human Epidermal Growth Receptor-2 Enriched Breast Cancer - A Systematic Review.

Breast Cancer (Auckl) 2022 22;16:11782234221086684. Epub 2022 Mar 22.

Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland.

Purpose: Increased appreciation of the human epidermal growth factor receptor-2 (HER2/neu) signalling pathway has led to the development of targeted therapeutic agents used in conjunction with chemotherapy to improve outcomes for HER2 overexpressing (HER2+) breast cancer. For neoadjuvant therapy, response rates can be unpredictable - novel biomarkers predicting effectiveness are required to enhance oncological outcomes for these patients, and microRNA may prove effective. Our objective was to identify microRNA (miRNA) expression patterns predictive of response to neoadjuvant chemotherapy (NAC) and/or anti-HER2 targeted therapies in patients being treated for early-stage HER2+ breast cancer.

Methods: A search was performed of the PUBMED, SCOPUS, Web of Science, and EMBASE in accordance to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines.

Results: Overall, 15 studies including 1335 patients were included. These studies highlighted an expression profile of 73 miRNA and their ability to predict tumour response to neoadjuvant therapies was correlated. Results from 11 studies were in relation to circulatory miRNA and 4 studies included data from tumour tissue. Overall, upregulation and downregulation of 41 miRNA and 29 miRNA, respectively, predicted differential response to neoadjuvant therapy. Expression levels of 3 miRNA (miR-21, miR-210, and miR-376c-3p) were inconclusive in predicting therapeutic response, while 'aberrant' expression of circulating miR-199a predicted pathological complete response (pCR) to NAC.

Conclusions: This systematic review outlines expression patterns of a number of miRNA which correlate with response to NAC and/or anti-HER2 therapies. Future translational research evaluating predictive biomarkers of primary response to neoadjuvant therapy in HER2+ breast cancer may consider these results.
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http://dx.doi.org/10.1177/11782234221086684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943461PMC
March 2022

Clinical outcomes of Gaelic Athletic Association athletes after surgical stabilization in the setting of anterior shoulder instability.

JSES Int 2022 Mar 17;6(2):259-263. Epub 2021 Dec 17.

Sports Surgery Clinic, Dublin, Ireland.

Background: Gaelic Athletic Association (GAA) games are collision sports played at an amateur level, which represent the most popular sports played on the island of Ireland. Each year, many GAA players in Ireland require surgical stabilization with either arthroscopic Bankart repair (ABR) or open Latarjet (OL) procedures in the setting of anterior shoulder instability. The purpose of this study was to evaluate the clinical outcomes, recurrence, and return to play (RTP) in athletes who play GAA games having undergone surgical stabilization with either ABR or OL procedures in the setting of anterior shoulder instability.

Methods: A retrospective review of all patients with anterior shoulder instability whom had stabilization with either ABR or OL under a single surgeon between 2012 and 2018 was performed. Patients who were athletes partaking in GAA sports were followed up by chart review and telephone survey to assess their clinical outcomes including satisfaction, pain as measured on the visual analog scale score, the Subjective Shoulder Value, recurrence, complications, and revision surgeries. In addition, RTP rates, time to RTP, level of RTP, and Shoulder Instability-Return to Sport after Injury scores were evaluated.

Results: A total of 200 GAA athletes (194 males) with a mean age of 23.9 ± 6.1 years with mean follow-up of 50.4 ± 24 months were included in this study. A total of 98.1% patients were satisfied with their procedure at the latest follow-up, with an overall recurrence rate of 5%. A total of 6.5% of athletes required revision surgery, of whom 4% required revision stabilization (all of whom had recurrence). The overall rate of RTP was 88% at mean 6.0 ± 1.7 months postoperatively, with 75% of athletes returning at the same or higher levels than their preinjury level. There were no significant differences for all outcome measures analyzed between patients who had ABR or OL procedures.

Conclusion: GAA athletes with anterior shoulder instability treated with either ABR or OL procedures report excellent clinical outcomes at medium-term follow-up, with high satisfaction rates, excellent functional outcomes, and high rates of RTP. Furthermore, this cohort demonstrates low rates of recurrence after stabilization with few requiring revision surgery.
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http://dx.doi.org/10.1016/j.jseint.2021.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8888160PMC
March 2022

Tourniquet Use During Open Reduction and Internal Fixation of Ankle Fractures - A Systematic Review and Meta-Analysis.

J Foot Ankle Surg 2022 Jan 23. Epub 2022 Jan 23.

University Hospitals Galway, Galway, Ireland.

The intra-operative use of tourniquet in open reduction and internal fixation (ORIF) of ankle fractures remains a topic of debate. The purpose of this study was to perform a systematic review and meta-analysis of randomized control trials (RCTs) comparing clinical outcomes of patients undergoing ankle ORIF with tourniquet use versus a control group where no tourniquet was used. A systematic review was performed with reference to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines of the Pubmed, Scopus, Embase, and Cochrane Library databases. Studies were included if they were an RCT comparing tourniquet and no-tourniquet in ankle ORIF. Meta-analysis was performed using RevMan, and p-value <.05 was considered to be statistically significant. On completion of the literature search, a total of 4 RCTs including 350 ankles (52.6% males), with a mean age of 47.1 ± 5.7 years were included. There were 173 patients in the tourniquet group (T), versus 177 patients in the no tourniquet control group (NT), with nonsignificant differences between the groups for age, gender and body mass index demographics (all p > .05). There were significantly shorter duration of surgery, with significantly higher patient-reported rates of pain levels at day 2 postoperatively (both p < .001) in the T group. Additionally, there were significantly greater ranges of ankle motion at 6 weeks postoperatively (p = .03), with nonsignificant differences reported incidence of wound infections and deep vein thrombosis (p = .056 and p = .130 respectively) between the groups. In conclusion, current evidence suggests that although intraoperative tourniquet usage in cases of ankle ORIF results in significant reductions in duration of surgery, this may be at the expense of higher patient-reported pain scores and reduced range of motion postoperatively.
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http://dx.doi.org/10.1053/j.jfas.2022.01.019DOI Listing
January 2022

Analysis of Athletes Who Did Not Return to Play After Open Latarjet.

Orthop J Sports Med 2022 Feb 15;10(2):23259671211071082. Epub 2022 Feb 15.

Sports Surgery Clinic, Dublin, Ireland.

Background: The Latarjet procedure is indicated in patients with risk factors for postoperative recurrence, including collision and competitive athletes. However, the factors that prevent athletes from being able return to play (RTP) after the open Latarjet procedure are still unclear and have not been fully elucidated in the literature.

Purpose: To evaluate patient-reported outcomes and psychological and psychosocial factors associated with athletes who did not RTP after the open Latarjet procedure compared with patients who did RTP.

Study Design: Cohort study; Level of evidence, 3.

Methods: We conducted a retrospective review of athletes who underwent the open Latarjet procedure and subsequently did not RTP after a minimum of 12 months. These patients were pair matched in a 2:1 ratio for age, sex, sport, and level of preoperative play with a control group who returned to play. Patients were evaluated for their psychological readiness to return to sport using the Shoulder Instability-Return to Sport after Injury (SIRSI); other measures included the visual analog scale (VAS) for pain and Subjective Shoulder Value (SSV). Multivariate regression models were used to evaluate factors affecting RTP.

Results: Included were 35 patients in the no-RTP group and 70 patients in the RTP group. In the no-RTP group, 7 patients (20%) passed the SIRSI benchmark of 56, with a mean overall score of 41.5 ± 21.9; in the RTP group, 57 patients (81.4%) passed the SIRSI benchmark, with a mean overall score of 74.5 ± 19.8 ( < .0001 for both). Patients in the RTP group had better SSV (88.0 vs 75.7; <.0001) and VAS pain (1.7 vs 2.9; = .0046) scores. Of the athletes who did not return, 18 felt persistent pain/apprehension and 17 felt that it was a natural end to their career or that their lifestyle had changed. Multiple logistic regression revealed that thoughts of having to go through surgery and rehabilitation again was significantly associated with lower RTP ( < .05).

Conclusion: Patients who did not RTP after open Latarjet exhibited poor psychological readiness to RTP and worse pain VAS and SSV scores compared with patients who did RTP.
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http://dx.doi.org/10.1177/23259671211071082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8851950PMC
February 2022

Clinical Outcomes in Patients With Humeral Avulsion Glenohumeral Ligament Lesions in the Setting of Anterior Shoulder Instability: A Retrospective Comparative Study.

Am J Sports Med 2022 Feb;50(2):327-333

Sports Surgery Clinic, Dublin, Ireland.

Background: Humeral avulsion glenohumeral ligament (HAGL) lesions are often underreported but have been shown to occur in up to 10% of cases of anterior shoulder instability.

Purpose: To compare clinical outcomes and recurrence rates of patients with HAGL lesions undergoing open stabilization for anterior shoulder instability versus a pair-matched control.

Study Design: Cohort study; Level of evidence, 3.

Methods: A retrospective review of all patients who underwent both arthroscopic and open stabilization procedures with a minimum 24-month follow-up was performed. Patients with HAGL lesions were pair-matched in a 1:6 ratio for age, sex, sport, level of preoperative play, and follow-up length with those without HAGL lesions who underwent arthroscopic Bankart repair alone. Return to play (RTP), the level of return, and the timing of return were assessed. In addition, recurrence, visual analog scale for pain (VAS), Subjective Shoulder Value (SSV), Rowe score, satisfaction, and whether they would undergo the same surgery again were compared.

Results: A total of 15 patients with HAGL lesions who underwent shoulder stabilization procedures were included, with a mean age of 21.5 ± 4.1 years and mean follow-up of 53.5 ± 17.4 months, and were pair-matched to 90 patients without HAGL lesions. Overall, there was no significant difference in any of the clinical outcome scores (VAS, Rowe, SSV, satisfaction) used between the 2 groups (1.6 vs 1.7, = .86; 83.4 vs 88.0, = .06; 85.7 vs 87.2, = .76; and 86.7% vs 94.5%, = .26, respectively). In addition, there were no significant differences in terms of overall rates, levels, and timing of RTP between the 2 groups (93.3% vs 90.0%, > .99; 80.0% vs 78.9%, > .99; and 5.3 ± 2.2 vs 5.9 ± 2.9 months, = .45, respectively). There was no significant difference in the rates of apprehension, subluxation, and recurrent instability between the HAGL and pair-matched control groups (26.7% vs 26.7%, > .99; 6.7% vs 3.3%, = .47; and 13.3% vs 6.7% months, = .32, respectively).

Conclusion: Patients with anterior shoulder instability undergoing surgical stabilization with open HAGL repair demonstrate excellent functional outcomes and high rates of RTP, with low rates of recurrence in the medium term compared with a control group without HAGL lesions who underwent arthroscopic Bankart repair alone.
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http://dx.doi.org/10.1177/03635465211063917DOI Listing
February 2022

Platelet-rich plasma in non-operative management of mild to moderate carpal tunnel syndrome - A systematic review & meta-analysis of short-term outcomes.

J Orthop 2021 May-Jun;25:155-161. Epub 2021 May 7.

Department of Trauma & Orthopaedics, Galway University Hospital, Galway, Ireland.

Background: To perform an updated systematic review with meta-analysis on trials focusing on patient-reported outcome measures (PROMs), nerve conduction studies (NCS) result and cross sectional area (CSA) measurements of those who underwent PRP injection for mild to moderate CTS, versus a control.

Conclusion: This study indicates that there may be a potential role for the use of PRP in the non-operative management of mild to moderate CTS results in improvements in pain scores, functional outcomes as well as CSA measurements of the MN at short-term follow-up. However, PRP does not result in improvements in NCS.

Level Of Evidence: II; Systematic Review & Meta-Analysis of Prospective Trials.
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http://dx.doi.org/10.1016/j.jor.2021.05.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8758911PMC
May 2021

Osteochondral Lesions of the Tibial Plafond and Ankle Instability With Ankle Cartilage Lesions: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle.

Foot Ankle Int 2022 03 5;43(3):448-452. Epub 2022 Jan 5.

Background: An international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to present the consensus statements on osteochondral lesions of the tibial plafond (OLTP) and on ankle instability with ankle cartilage lesions developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle.

Methods: Forty-three experts in cartilage repair of the ankle were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 4 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed on in unanimous fashion within the working groups. A final vote was then held.

Results: A total of 11 statements on OLTP reached consensus. Four achieved unanimous support and 7 reached strong consensus (greater than 75% agreement). A total of 8 statements on ankle instability with ankle cartilage lesions reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support, and seven reached strong consensus (greater than 75% agreement).

Conclusion: These consensus statements may assist clinicians in the management of these difficult clinical pathologies.

Level Of Evidence: Level V, mechanism-based reasoning.
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http://dx.doi.org/10.1177/10711007211049169DOI Listing
March 2022

Management options for proximal humerus fractures - A systematic review & network meta-analysis of randomized control trials.

Injury 2022 Feb 15;53(2):244-249. Epub 2021 Dec 15.

Sports Surgery Clinic, Dublin, Ireland.

Aims: The purpose of this study is to systematically review the randomized controlled trials on the various treatment options that can be utilized in the management of displaced proximal humerus fractures.

Materials & Methods: Based on the PRISMA guidelines, three independent reviewers performed a systematic review of the literature. Randomized control trials (RCTs) focusing on the outcomes of the following interventions in the management of PHFs were considered for inclusion; (1) non-operative or conservative (NOC) management, (2) open reduction and internal fixation (ORIF), (3) intra-medullary nailing (IMN), (4) shoulder hemi-arthroplasty (HA), and (5) reverse shoulder arthroplasty (RSA). Network meta-analyses were performed using R and studies were ranked according to their P-score.

Results: Our study included 13 RCTs. RSA had improvements in abduction, constant score, flexion, as well as lowest rates of malunion and osteonecrosis when compared to other management modalities (P-Score = 0.9786, P-Score = 0.9998, P-Score = 0.9909, P-Score = 0.9590 and P-Score = 0.8042 respectively). HA was found to have improvements in health-related quality of life scores when compared to other management modalities (P-Score = 0.9672). ORIF had the highest improvement in quick disability of arm, shoulder and hand scores and visual analogue scale scores (P-Score = 0.8209 and P-Score = 0.7155 respectively). NOC was found to have the lowest rate of conversion to surgical intervention, with RSA having the lowest rate of surgical interventions (P-Score = 0.9186 and P-Score = 0.7497 respectively).

Discussion & Conclusion: RSA offers satisfactory improvements in clinical and functional outcomes when compared to other non-operative and operative treatment options in the management of carefully selected proximal humerus fractures, with a minimal revision rate when compared to other surgical management modalities.

Level Of Evidence: I - Systematic Review & Meta-Analysis of Randomized Control Trials.
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http://dx.doi.org/10.1016/j.injury.2021.12.022DOI Listing
February 2022

Age as a predictor of additional surgeries following initial closed reduction for children with developmental dysplasia of the hip: the 10-year experience of a national paediatric orthopaedic unit.

Hip Int 2021 Dec 23:11207000211062081. Epub 2021 Dec 23.

Department of Trauma and Orthopaedics, Our Lady's Children Hospital, Crumlin, Dublin, Ireland.

Background And Purpose: Dislocated and unstable hip joints which do not stabilize in an orthosis in the neonatal period require operative intervention to achieve a stable concentric joint. The aim of this study is to assess the requirement for further operative intervention in patients who have undergone successful closed reduction to treat developmental dysplasia of the hip (DDH).

Methods: We identified all patients who had undergone closed reduction of an unstable hip joint at our institution within 10 years, with further identification of patients who underwent a second procedure. We used logistic regression to evaluate correlation between age at closed reduction and the probability of secondary procedures.

Results: A total of 694 patients (84.5% females) who underwent a closed reduction in the study period were identified. 235 were excluded (patients with underlying genetic conditions, neuromuscular disorders, syndromic disorders). 250 patients had closed reductions only. 209 patients (45.5%) had at least 1 secondary procedure after their initial closed reduction. In multivariable analysis, female gender (OR 0.310; 95% CI, 0.108-0.885;  = 0.029) and patients aged ⩽12 months at the time of first surgery (OR 0.055; 95% CI, 0.007-0.423;  = 0.005) independently predicted being less likely to require a second surgery for their DDH.

Discussion: In conclusion, we found that a significant proportion of children (45.5%) who underwent closed reduction of a dislocated hip required additional surgical intervention in early childhood. Our data show that those children who undergo later closed reduction of a dislocated hip in DDH after 12 months of age, and male infants, have a significantly higher incidence of additional surgical intervention.
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http://dx.doi.org/10.1177/11207000211062081DOI Listing
December 2021

Informed Written Consent for Orthopaedic Trauma in the Emergency Setting at a Tertiary Referral Centre: A Closed-Loop Audit.

Cureus 2021 Nov 11;13(11):e19460. Epub 2021 Nov 11.

Trauma and Orthopaedics, Galway University Hospitals, Galway, IRL.

Introduction The purpose of this investigation was to perform an audit of the standards of consent forms in which patients sign prior to operative intervention for orthopaedic trauma in an emergency setting in our institution, with comparison to the standards, as set by the . If required, the investigator aimed to close the loop in this audit by educating orthopaedic surgeons on the necessary standards of obtaining written consent for orthopaedic trauma. Methods Following being granted approval by our institutional audit committee, a pre-intervention cycle was performed to assess the quality of consent obtained in written format using electronic patient records in consecutive patients over a four-week period. Following the analysis of this data, an education session was provided for all orthopaedic doctors responsible for obtaining informed written consent from patients who are planned to undergo operative management of a soft tissue or bony injury by the trauma and orthopaedic service in the emergency setting. Thereafter, a post-intervention cycle was performed with subsequent descriptive analysis using the GraphPad software. Results In the pre-intervention audit cycle, all included (n = 107) consent forms (100%) correctly included the patient's name, date of birth (DOB) and institutional board number (BN). However, only 79 consent forms (74.5%) were completed without using abbreviations or acronyms of any kind, whilst 81 consent forms (76.4%) were completed without correctly stating the side or site of the planned intervention. In the post-intervention cycle, all included (n = 40) consent forms (100%) correctly included the patient's name, DOB and institutional BN. Additionally, a total of 37 consent forms (92.5%) were correctly completed without using abbreviations or acronyms of any kind (74.5% versus 92.5%, p = 0.02). Furthermore, a total of 39 consent forms (97.5%) were completed correctly stating the side or site of the planned intervention (76.4% versus 97.5%, p = 0.0015). Conclusion This closed-loop audit found that the quality of informed consent obtained by orthopaedic surgeons in the emergency setting might potentially be significantly improved with at least one virtual education session. Such simple education sessions may potentially improve the documentation of the planned potential operative intervention by orthopaedic surgeons for cases of orthopaedic trauma to ensure patient safety is optimised. As the turnover of non-consultant hospital doctors is high in university teaching hospitals, regular education sessions on such topics may introduce a cultural shift in maintaining high standards when marking and consenting patients in the emergency setting.
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http://dx.doi.org/10.7759/cureus.19460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8654130PMC
November 2021

Guidelines for the use of flow cytometry and cell sorting in immunological studies (third edition).

Eur J Immunol 2021 12 7;51(12):2708-3145. Epub 2021 Dec 7.

Department of Viral Immunology, Helmholtz Centre for Infection Research, Braunschweig, Germany.

The third edition of Flow Cytometry Guidelines provides the key aspects to consider when performing flow cytometry experiments and includes comprehensive sections describing phenotypes and functional assays of all major human and murine immune cell subsets. Notably, the Guidelines contain helpful tables highlighting phenotypes and key differences between human and murine cells. Another useful feature of this edition is the flow cytometry analysis of clinical samples with examples of flow cytometry applications in the context of autoimmune diseases, cancers as well as acute and chronic infectious diseases. Furthermore, there are sections detailing tips, tricks and pitfalls to avoid. All sections are written and peer-reviewed by leading flow cytometry experts and immunologists, making this edition an essential and state-of-the-art handbook for basic and clinical researchers.
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http://dx.doi.org/10.1002/eji.202170126DOI Listing
December 2021

Return to play following open Bankart repair in collision athletes aged 18 years or less.

J Shoulder Elbow Surg 2022 Jun 11;31(6S):S8-S12. Epub 2021 Dec 11.

Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland.

Hypothesis: The purpose of this study was to evaluate clinical outcomes, return to play (RTP), and recurrence rates in patients aged 18 years or less who underwent open Bankart repair (OBR) for anterior shoulder instability.

Methods: A retrospective review of collision athletes under 18 years old who underwent OBR by 2 surgeons between the years 2010 and 2019 was carried out. An OBR using a subscapularis split was performed in all patients. Recurrent instability, rate of RTP, and time to RTP were recorded. The Shoulder Instability Return to Sport after Injury score, Subjective Shoulder Value score, and visual analog scale scores were also evaluated.

Results: The study included 34 male collision athletes with a mean age of 16.5 ± 1.3 years (range, 15-18 years). The mean follow-up for patients was 49.5 ± 30.7 months. A total of 30 patients (88.2%) returned to full sport at a mean time of 5.8 ± 2.2 months, with 27 (90%) managing to return at their preinjury level of participation. The mean Subjective Shoulder Value score for patients at the final follow-up was 86.8 ± 17.5, the mean Shoulder Instability Return to Sport after Injury score was 86.3 ± 22.6, and the mean visual analog scale score was 1.6 ± 1.8. Eight patients (23.5%) re-dislocated their shoulder, with 4 of them requiring a further surgery. Two patients (5.8%) reported having incidents of subluxation that did not require reduction.

Conclusion: This study found high rates of patient-reported satisfaction, excellent functional outcomes, and high rates of RTP in the medium term among young collision athletes aged 18 years or less who underwent OBR for anterior shoulder instability. However, there were high rates of recurrence with moderate rates of revision surgical stabilization in the medium term.
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http://dx.doi.org/10.1016/j.jse.2021.11.001DOI Listing
June 2022

Repeated infection in humans drives the clonal expansion of an adaptive γδ T cell repertoire.

Sci Transl Med 2021 12 1;13(622):eabe7430. Epub 2021 Dec 1.

Infection and Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia.

Repeated infections drive the development of clinical immunity to malaria in humans; however, the immunological mechanisms that underpin this response are only partially understood. We investigated the impact of repeated infections on human γδ T cells in the context of natural infection in Malian children and adults, as well as serial controlled human malaria infection (CHMI) of U.S. adults, some of whom became clinically immune to malaria. In contrast to the predominant Vδ2 T cell population in malaria-naïve Australian individuals, clonally expanded cytotoxic Vδ1 T cells were enriched in the γδ T cell compartment of Malian subjects. Malaria-naïve U.S. adults exposed to four sequential CHMIs defined the precise impact of on the γδ T cell repertoire. Specifically, innate-like Vδ2 T cells exhibited an initial robust polyclonal response to infection that was not sustained with repeated infections, whereas Vδ1 T cells increased in frequency with repeated infections. Moreover, repeated infection drove waves of clonal selection in the Vδ1 T cell receptor repertoire that coincided with the differentiation of Vδ1 T cells into cytotoxic Vδ1 T cells. Vδ1 T cells of malaria-exposed Malian and U.S. individuals were licensed for reactivity to parasites in vitro. Together, our study indicates that repeated infection drives the clonal expansion of an adaptive γδ T cell repertoire and establishes a role for Vδ1 T cells in the human immune response to malaria.
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http://dx.doi.org/10.1126/scitranslmed.abe7430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9291638PMC
December 2021

Recognition of the antigen-presenting molecule MR1 by a Vδ3 γδ T cell receptor.

Proc Natl Acad Sci U S A 2021 12;118(49)

Infection and Immunity Program, Biomedicine Discovery Institute, Monash University, Clayton, VIC 3800, Australia;

Unlike conventional αβ T cells, γδ T cells typically recognize nonpeptide ligands independently of major histocompatibility complex (MHC) restriction. Accordingly, the γδ T cell receptor (TCR) can potentially recognize a wide array of ligands; however, few ligands have been described to date. While there is a growing appreciation of the molecular bases underpinning variable (V)δ1 and Vδ2 γδ TCR-mediated ligand recognition, the mode of Vδ3 TCR ligand engagement is unknown. MHC class I-related protein, MR1, presents vitamin B metabolites to αβ T cells known as mucosal-associated invariant T cells, diverse MR1-restricted T cells, and a subset of human γδ T cells. Here, we identify Vδ1/2 γδ T cells in the blood and duodenal biopsy specimens of children that showed metabolite-independent binding of MR1 tetramers. Characterization of one Vδ3Vγ8 TCR clone showed MR1 reactivity was independent of the presented antigen. Determination of two Vδ3Vγ8 TCR-MR1-antigen complex structures revealed a recognition mechanism by the Vδ3 TCR chain that mediated specific contacts to the side of the MR1 antigen-binding groove, representing a previously uncharacterized MR1 docking topology. The binding of the Vδ3 TCR to MR1 did not involve contacts with the presented antigen, providing a basis for understanding its inherent MR1 autoreactivity. We provide molecular insight into antigen-independent recognition of MR1 by a Vδ3 γδ TCR that strengthens an emerging paradigm of antibody-like ligand engagement by γδ TCRs.
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http://dx.doi.org/10.1073/pnas.2110288118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8694053PMC
December 2021

Evaluation of factors associated with successful 5-year outcomes following arthroscopic Bankart repair in athletes.

Knee Surg Sports Traumatol Arthrosc 2022 Jun 23;30(6):2092-2098. Epub 2021 Nov 23.

Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland.

Purpose: The purpose of this study was to evaluate the outcomes of athletes 5-years post-operatively following arthroscopic Bankart repair, and to evaluate factors associated with satisfaction and shoulder function, as defined by subjective shoulder value.

Methods: A retrospective review of athletes who underwent arthroscopic Bankart repair, with a minimum of 5-year follow-up was performed. Recurrence, Visual Analogue Scale (VAS) score, Subjective Shoulder Value (SSV), satisfaction, and whether they would undergo the same surgery again, and rate, level and timing of return to play, and Shoulder Instability-Return to Sport after Injury (SIRSI) score were evaluated. Multi-linear regression models were used to evaluate factors affecting postoperative Satisfaction, and SSV level.

Results: Overall, 144 athletes who underwent arthroscopic Bankart repair were included, with a mean age of 26.9 years (SD: 8.1), 132 (91.7%) were males, and mean follow-up of 75.7 months. At final follow up, 82.6% were satisfied/very satisfied, and the mean SSV was 85.8 (SD: 14.4). Overall, the rate of return to play was 80.5%, with 63.9% returning at the same level at a mean of 6.2 months (SD: 2.7). Overall, there was 18 (12.5%) had recurrent instability, and a further procedure was performed in 15 (10.4%) patients. Linear regression revealed that the SIRSI score (p < 0.0001), SSV (p < 0.0001), VAS (p < 0.0031), no sleep trouble (p = 0.0129) was associated with satisfaction. Logistic regression revealed whether a patient required revision surgery (p = 0.0029), or had re-dislocation (p = 0.0031) was also associated with satisfaction. Linear regression revealed that the SIRSI score (p < 0.0001), VAS score (p < 0.0001), and no sleep trouble (p < 0.0001), were associated with SSV score.

Conclusion: There was a high rate of satisfaction at 5-year follow-up, with excellent patient-reported outcomes and a high rate of return to play among athletes. However, there was a moderate rate of recurrent instability and further revision surgery. This study identified that the SIRSI score, VAS score, no sleep trouble and ability to return to play at the same level were associated with both satisfaction and SSV score.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-021-06803-5DOI Listing
June 2022

Arthroscopic Bankart Repair for Primary Versus Recurrent Anterior Instability in Athletes Results in Excellent Clinical Outcomes, High Rates of Return to Play, and Low Recurrence Rates.

Arthrosc Sports Med Rehabil 2021 Oct 26;3(5):e1499-e1504. Epub 2021 Aug 26.

Sports Surgery Clinic, Dublin, Ireland.

Purpose: To compare the outcomes of athletes who have been treated for either primary or recurrent anterior shoulder instability with arthroscopic Bankart repair (ABR).

Methods: A retrospective review of patients who underwent ABR for anterior shoulder instability, with a minimum of 24 months' follow-up, was performed. Those who underwent ABR for primary instability were matched in a 1:1 ratio for age, sex, sport, and level of preoperative play to those who underwent ABR for recurrent instability. The rate, level, and timing of return to play (RTP), as well as the Shoulder Instability-Return to Sport After Injury score, were evaluated. Additionally, the recurrence rate, visual analog scale score, Subjective Shoulder Value, Rowe score, satisfaction, and whether patients would undergo the same operation again were compared.

Results: After analysis of 467 patients, 100 athletes who underwent ABR for primary instability were identified and subsequently pair matched to 100 patients who underwent ABR for recurrent instability, with a mean age of 27.2 years, 87% male patients, 68% collision athletes, and a mean follow-up period of 61.9 months. There was no significant difference between the groups in the rate of RTP (80% vs 79%,  = .86) or RTP at the preinjury level (65% vs 65%,  >. 999); however, there was a significant difference in time to RTP (6.9 ± 2.9 months vs 5.9 ± 2.5 months,  = .02). There were no significant differences in visual analog scale score, Shoulder Instability-Return to Sport After Injury score, Subjective Shoulder Value, Rowe score, patient satisfaction, and whether patients would undergo the operation again ( > .05 for all). There was no difference in the rate of recurrent instability after ABR (10% vs 16%,  = .29).

Conclusions: ABR results in excellent clinical outcomes, high rates of RTP, and low recurrence rates for both athletes with primary instability and those with recurrent instability.

Level Of Evidence: Level III, retrospective comparative cohort study.
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http://dx.doi.org/10.1016/j.asmr.2021.07.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8551395PMC
October 2021

Athletes with primary glenohumeral instability demonstrate lower rates of bone loss than those with recurrent instability and failed prior stabilization.

J Shoulder Elbow Surg 2022 Apr 20;31(4):813-818. Epub 2021 Oct 20.

Sports Surgery Clinic, Dublin, Ireland.

Background: The purpose of this study was to compare the preoperative magnetic resonance arthrography findings in patients who underwent glenohumeral stabilization with a history of primary instability, recurrent instability, or failed stabilization.

Methods: All patients who presented with glenohumeral instability and underwent stabilization performed by a single surgeon in our institution between 2008 and 2020 were considered for inclusion in this study. The magnetic resonance arthrography findings of all patients were recorded. Imaging findings were compared between patients with primary instability, those with recurrent instability, and those with failed prior stabilization. P < .05 was considered statistically significant.

Results: Overall, 871 patients were included, of whom 814 (93.5%) were male patients; the mean age was 23.1 years (range, 13-57 years). There were 200 patients with primary instability, 571 with recurrent instability, and 100 who required revision stabilization surgery, with no significant differences in demographic characteristics between the groups. A significantly higher amount of glenoid bone loss was noted in patients with recurrent instability (43.4%) and failed prior stabilization (56%) than in those with primary instability (26.5%) (P < .0001). Additionally, a significantly higher number of Hill-Sachs lesions were observed in patients with recurrent instability (70.1%) and failed prior stabilization (89%) than in those with primary instability (67.5%) (P < .0001). We found no significant differences between the groups regarding articular cartilage damage, glenolabral articular disruption, anterior labral periosteal sleeve avulsion, humeral avulsion of the glenohumeral ligaments, or superior labral anterior-posterior tears (P > .05).

Conclusion: Patients presenting for stabilization with recurrent instability or following a failed stabilization procedure have higher rates of glenohumeral bone loss than those with primary instability. Therefore, stabilization of primary instability, particularly in high-functioning athletes with a view to preventing recurrence, may reduce the overall progression of glenohumeral bone loss and potential subsequent inferior clinical outcomes.
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http://dx.doi.org/10.1016/j.jse.2021.10.002DOI Listing
April 2022

Radiomic differentiation of breast cancer molecular subtypes using pre-operative breast imaging - A systematic review and meta-analysis.

Eur J Radiol 2021 Nov 2;144:109996. Epub 2021 Oct 2.

The Lambe Institute for Translational Research, National University of Ireland, Galway H91 YR91, Ireland.

Introduction: Breast cancer has four distinct molecular subtypes which are discriminated using gene expression profiling following biopsy. Radiogenomics is an emerging field which utilises diagnostic imaging to reveal genomic properties of disease. We aimed to perform a systematic review of the current literature to evaluate the value radiomics in differentiating breast cancers into their molecular subtypes using diagnostic imaging.

Methods: A systematic review was performed as per PRISMA guidelines. Studies assessing radiomictumour analysis in differentiatingbreast cancer molecular subtypeswere included. Quality was assessed using the radiomics quality score (RQS). Diagnostic sensitivity and specificity of radiomic analyses were included for meta-analysis; Study specific sensitivity and specificity were retrieved and summary ROC analysis were performed to compile pooled sensitivities and specificities.

Results: Forty-one studies were included. Overall, there were 10,090 female patients (mean age of 47.6 ± 11.7 years, range: 21-93) and molecular subtypewas reported in 7,693 of cases, with Luminal A (LABC), Luminal B (LBBC), Human Epidermal Growth Factor Receptor-2 overexpressing (HER2+), and Triple Negative (TNBC) breast cancers representing 51.3%, 19.9%, 12.3% and 16.3% of tumour respectively. Seven studies provided radiomic analysis to determine molecular subtypes using mammography to differentiateTNBCvs.others (sensitivity: 0.82,specificity:0.79). Thirty-five studies reported on radiomic analysis of magnetic resonance imaging (MRI); LABC versus others(sensitivity:0.78,specificity:0.83),HER2+versusothers(sensitivity:0.87,specificity:0.88), andLBBCversusTNBC (sensitivity: 0.79,specificity:0.88) respectively.

Conclusion: Radiomic tumour assessment of contemporary breast imaging provide a novel option in determining breast cancer molecular subtypes. However, amelioration of such techniques are required and genetic expression assessment will remain the gold standard.
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http://dx.doi.org/10.1016/j.ejrad.2021.109996DOI Listing
November 2021

Criteria for Return to Play After Hip Arthroscopy in the Treatment of Femoroacetabular Impingement: A Systematic Review.

Am J Sports Med 2021 Sep 30:3635465211038959. Epub 2021 Sep 30.

Sports Surgery Clinic, Dublin, Ireland.

Background: Femoroacetabular impingement (FAI) is a common pathology in athletes that often requires operative management in the form of hip arthroscopy.

Purpose: To systematically review the rates and level of return to play (RTP) and the criteria used for RTP after hip arthroscopy for FAI in athletes.

Study Design: Systematic review; Level of evidence, 4.

Methods: A systematic review of the literature, based on the PRISMA guidelines, was performed using PubMed, Embase, and Scopus databases. Studies reporting outcomes after the use of hip arthroscopy for FAI were included. Outcomes analyzed were RTP rate, RTP level, and criteria used for RTP. Statistical analysis was performed using SPSS software.

Results: Our review found 130 studies, which included 14,069 patients (14,517 hips) and had a mean methodological quality of evidence (MQOE) of 40.4 (range, 5-67). The majority of patients were female (53.7%), the mean patient age was 30.4 years (range, 15-47 years), and the mean follow-up was 29.7 months (range, 6-75 months). A total of 81 studies reported RTP rates, with an overall RTP rate of 85.4% over a mean period of 6.6 months. Additionally, 49 studies reported the rate of RTP at preinjury level as 72.6%. Specific RTP criteria were reported in 97 studies (77.2%), with time being the most commonly reported item, which was reported in 80 studies (69.2%). A total of 45 studies (57.9%) advised RTP at 3 to 6 months after hip arthroscopy.

Conclusion: The overall rate of reported RTP was high after hip arthroscopy for FAI. However, more than one-fourth of athletes who returned to sports did not return at their preinjury level. Development of validated rehabilitation criteria for safe return to sports after hip arthroscopy for FAI could potentially improve clinical outcomes while also increasing rates of RTP at preinjury levels.
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http://dx.doi.org/10.1177/03635465211038959DOI Listing
September 2021

Return to Play Following COVID-19 Infection-A Systematic Review of Current Evidence.

J Sport Rehabil 2022 02 25;31(2):218-223. Epub 2021 Sep 25.

Context: The COVID-19 pandemic has had catastrophic impact on a global scale, affecting people from all walks of life including elite athletes.

Objectives: The purpose of this study was to evaluate the reported rates of return to play (RTP) in conjunction with the expert-derived guidelines previously recommended to enable safe RTP post COVID-19 infection.

Evidence Acquisition: Two independent reviewers searched the literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, utilizing the MEDLINE, Embase, and Scopus databases. Only studies that reported rates of RTP and/or recommended guidelines for safe RTP were included.

Evidence Synthesis: Overall, 17 studies (3 level III and 14 level V) were included. A total of 3 studies reported rates of RTP in a total of 1255 athletes and 623 officials; 72 (30 symptomatic) were infected with COVID-19, 100% of whom were able to RTP post COVID-19 infection. Of the 14 studies recommending guidelines for safe RTP, 3 and 9 studies recommended 7 and 14 days of rest in isolation respectively for asymptomatic patients with COVID-19 infection, prior to safe RTP. In contrast, 7 studies recommended 3 to 6 months of rest (following 14 d isolation) in cases of COVID-19-induced myocarditis as a safe timeframe for safe RTP. Of the 11 studies reporting on whether blanket testing prior to RTP was recommended, only 7 studies recommended a negative test result as mandatory prior to RTP for athletes previously infected with COVID-19.

Conclusions: Although excellent rates of RTP have been reported for elite athletes post COVID-19 infection, discrepancies in recommended rest periods, requirement for mandatory negative test results, and the magnitude of screening investigations required continue to exist in the literature, with a need for further standardized international guidelines required in future.

Level Of Evidence: Level V; systematic review of all forms of evidence.
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http://dx.doi.org/10.1123/jsr.2021-0028DOI Listing
February 2022

The use of radiomic analysis of magnetic resonance imaging in predicting distant metastases of rectal carcinoma following surgical resection: A systematic review and meta-analysis.

Colorectal Dis 2021 12 1;23(12):3065-3072. Epub 2021 Oct 1.

Discipline of Surgery, Galway University Hospitals, Galway, Ireland.

Aim: Estimating prognosis in rectal carcinoma (RC) is challenging, with distant recurrence (DR) occurring in up to 30% of cases. Radiomics is a novel field using diagnostic imaging to investigate the tumour heterogeneity of cancers and may have the potential to predict DR. The aim of the study was to perform a systematic review of the current literature evaluating the use of radiomics in predicting DR in patients with resected RC.

Methods: A systematic review was performed as per PRISMA guidelines to identify studies reporting radiomic analysis of magnetic resonance imaging (MRI) to predict DR in patients diagnosed with RC. Sensitivity and specificity of radiomic analyses were included for meta-analysis.

Results: A total of seven studies including 1497 patients (998 males) were included, seven, five and one of whom reported radiomics, respectively. The overall pooled rate of DR from all included studies was 17.1% (256/1497), with 15.6% (236/1497), 1.3% (19/1497) and 0.2% (3/1497) of patients having hepatic, pulmonary and peritoneal metastases. Meta-analysis demonstrated that radiomics correctly predicted DR with pooled sensitivities and specificities of MRI 0.76 (95% CI: 0.73, 0.78) and 0.85 (95% CI: 0.83, 0.88), respectively.

Conclusion: This systematic review suggests the benefit of radiomic analysis of preoperative MRI in identifying patients with resected RC at an increased risk of DR. Our findings warrant validation in larger prospective studies as modalities to predict DR is a significant unmet need in RC. Radiomics may allow for tailored therapeutic strategies for high-risk groups.
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http://dx.doi.org/10.1111/codi.15919DOI Listing
December 2021

Arthroscopic Bankart Repair Versus Open Latarjet for Recurrent Shoulder Instability in Athletes.

Orthop J Sports Med 2021 Sep 8;9(9):23259671211023801. Epub 2021 Sep 8.

Sports Surgery Clinic, Dublin, Ireland.

Background: In athletes with recurrent shoulder instability, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are commonly indicated to restore stability and allow them to return to play (RTP).

Purpose: To compare the outcomes of ABR and OL in athletes with recurrent shoulder instability.

Study Design: Cohort study; Level of evidence, 3.

Methods: We performed a retrospective review of patients with recurrent shoulder instability who underwent ABR and OL and had a minimum 24-month follow-up. Indications for OL over ABR in this population were those considered at high risk for recurrence, including patients with glenohumeral bone loss. The patients were pair-matched in a 1:1 ratio (OL and ABR) by age, sex, sport, and level of preoperative play. We evaluated the rate, level, and timing of RTP, and the Shoulder Instability-Return to Sport after Injury (SIRSI) score between procedures. Additionally we compared the recurrence rate, visual analog scale (VAS) pain score, Subjective Shoulder Value (SSV), Rowe score, satisfaction, and whether patients would undergo the same surgery again.

Results: Participants included 62 athletes who underwent ABR and 62 who underwent OL, with a mean follow-up of 47.7 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, SIRSI score, VAS score, SSV, or patient satisfaction. OL resulted in a significantly lower recurrence rate (1.6% vs 16.1% for ABR; = .009) and a significantly higher Rowe score (mean ± SD, 90.5 ± 12.2 vs 82.2 ± 20.8 for ABR; = .008). In collision athletes, there was no significant difference between ABR and OL regarding RTP rate (89.1% vs 94.5%; = .489) or SIRSI score (70.4 ± 24.8 vs 73.8 ± 19.6; = .426), but OL resulted in a lower recurrence rate (14.5% vs 1.8%; = .031).

Conclusion: ABR and OL resulted in excellent clinical outcomes, with high rates of RTP in athletes. However, lower recurrence rates were seen with OL.
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http://dx.doi.org/10.1177/23259671211023801DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436306PMC
September 2021

Our evolving understanding of the role of the γδ T cell receptor in γδ T cell mediated immunity.

Biochem Soc Trans 2021 11;49(5):1985-1995

Infection and Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia.

The γδ T cell immune cell lineage has remained relatively enigmatic and under-characterised since their identification. Conversely, the insights we have, highlight their central importance in diverse immunological roles and homeostasis. Thus, γδ T cells are considered as potentially a new translational tool in the design of new therapeutics for cancer and infectious disease. Here we review our current understanding of γδ T cell biology viewed through a structural lens centred on the how the γδ T cell receptor mediates ligand recognition. We discuss the limited knowledge of antigens, the structural basis of such reactivities and discuss the emerging trends of γδ T cell reactivity and implications for γδ T cell biology.
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http://dx.doi.org/10.1042/BST20200890DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8589442PMC
November 2021

Arthroscopic Bankart Repair Versus Open Latarjet for First-Time Dislocators in Athletes.

Orthop J Sports Med 2021 Aug 31;9(8):23259671211023803. Epub 2021 Aug 31.

Sports Surgery Clinic, Dublin, Ireland.

Background: In athletes with a first-time shoulder dislocation, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are the most commonly utilized surgical procedures to restore stability and allow them to return to play (RTP).

Purpose: To compare the outcomes of ABR and OL in athletes with a first-time shoulder dislocation.

Study Design: Cohort study; Level of evidence, 3.

Methods: We performed a retrospective review of patients with first-time shoulder dislocation who underwent primary ABR and OL and had a minimum 24-month follow-up. Indications for OL over ABR in this population were those considered at high risk for recurrence, including patients with glenohumeral bone loss. Patients who underwent ABR were pair-matched in a 2:1 ratio with patients who underwent OL by age, sex, sport, and level of preoperative play. The rate, level, and timing of RTP, as well as the Shoulder Instability-Return to Sport after Injury (SIRSI) score were evaluated. Additionally, we compared recurrence, visual analog scale pain score, Subjective Shoulder Value, Rowe score, satisfaction, and whether patients would undergo the surgery again.

Results: Overall, 80 athletes who underwent ABR and 40 who underwent OL were included, with a mean follow-up of 50.3 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, or recurrent dislocation rate. There were also no differences between ABR and OL in patient-reported outcome scores or patient satisfaction. When collision athletes were compared between ABR and OL, there were no differences in RTP, SIRSI score, or redislocation rate.

Conclusion: ABR and OL resulted in excellent clinical outcomes, with high rates of RTP and low recurrence rates. Additionally, there were no differences between the procedures in athletes participating in collision sports.
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http://dx.doi.org/10.1177/23259671211023803DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414621PMC
August 2021

Clinical outcomes at medium-term follow-up of sub-acromial balloon spacer insertion in the operative management of massive rotator cuff tears.

Ir J Med Sci 2022 Aug 3;191(4):1687-1691. Epub 2021 Sep 3.

Department of Trauma & Orthopaedics, Galway University Hospitals, Galway, Ireland.

Introduction: The management of massive rotator cuff tears (RCTs) remains a debated topic amongst orthopaedic surgeons, with a wide spectrum of treatment options available. In recent years, the use of sub-acromial balloon spacers has emerged as an option in the management of massive RCTs. The purpose of this study is to evaluate the clinical outcomes of patients with massive RCTs who underwent arthroscopic sub-acromial balloon spacer insertion at medium-term follow-up.

Methods: All consecutive patients in our institution who had undergone sub-acromial balloon spacer insertion under the senior author from 2015 to 2020 were identified and followed up via telephone survey. Patient demographics, patient-reported outcomes, complications and subsequent surgeries were all analysed using the SPSS.

Results: Overall, 45 patients (31 males) including 36 retired (80.0%) patients, with a mean age of 70.3 ± 7.0 (40-83) years, and mean follow-up of 37.1 ± 16.4 (12-62) months were included. At final follow-up, the mean ASES score was 73.4 ± 21.8 (25-100), the mean SSV was 76.4 ± 16.0 (45-100), baseline VAS score was 0.3 ± 1.1 (0.0-6.0) and functional VAS score was 2.6 ± 2.3 (0.0-8.0), with a total of 89.9% of patients (n = 40) being satisfied at final follow-up. This series reported no intra-operative complications (0.0%), with 4 patients (8.9%) required subsequent procedures to the ispilateral shoulder post-sub-acromial balloon insertion.

Conclusion: In selected patient cohorts, the use of sub-acromial balloon spacer insertion represents a minimally invasive, viable surgical option in the management of massive rotator cuff tears, with satisfactory patient-reported outcomes, high rates of satisfaction and a low complication rate reported at medium-term follow-up.

Level Of Evidence: III; Retrospective Cohort Study.
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http://dx.doi.org/10.1007/s11845-021-02760-7DOI Listing
August 2022
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