Accuracy of soft tissue balancing in total knee arthroplasty using surgeon-defined assessment versus a gap-balancer or electronic sensor

Background Soft tissue balancing is essential for the success of total knee arthroplasty (TKA) and is mainly dependent on surgeon-defined assessment (SDA) or a gap-balancer (GB). However, an electronic sensor has been developed to objectively measure the gap pressure. This study aimed to evaluate the accuracy of soft tissue balancing using SDA and GB compared with a sensor. Methods Forty-eight patients undergoing TKA (60 knees) were prospectively enrolled. Soft tissue balancing was sequentially performed using SDA, a GB, and an electronic sensor. We compared the SDA, GB, and sensor data to calculate the sensitivity, specificity, and accuracy at 0°, 45°, 90°, and 120° flexion. Cumulative summation (CUSUM) analysis was performed to assess the surgeon’s performance during the sensor introductory phase. Results The sensitivity of SDA was 63.3%, 68.3%, 80.0%, and 80.0% at 0°, 45°, 90°, and 120°, respectively. The accuracy of the GB compared with sensor data was 76.7% and 71.7% at 0° and 90°, respectively. Cohen’s kappa coefficient for the accuracy of the GB was 0.406 at 0° (moderate agreement) and 0.227 at 90° (fair agreement). The CUSUM 0° line achieved good prior performance at case 45, CUSUM 90° and 120° showed a trend toward good prior performance, while CUSUM 45° reached poor prior performance at case 8. Conclusion SDA was a poor predictor of knee balance. GB improved the accuracy of soft tissue balancing, but was still less accurate than the sensor, particularly for unbalanced knees. SDA improved with ongoing use of the sensor, except at 45° flexion.

Ulnar Collateral Ligament Reconstruction in Adolescents: A Systematic Review

Background: Ulnar collateral ligament (UCL) reconstruction is an established surgical technique to restore UCL deficiency, especially in the overhead throwing athlete. Over the past decade, the number of patients requiring UCL reconstruction has increased significantly, particularly in the adolescent patient population. Return-to-play rates after UCL reconstruction reported in the literature have ranged from 33% to 92%, and a recent systematic review noted a return-to-play rate of 89.40% in all high school athletes. Purpose: To evaluate the outcomes, particularly return-to-play rates and subjective outcome scores, of UCL reconstruction of the elbow in adolescent throwing athletes. Study Design: Systematic review. Methods: A systematic review of the literature was conducted via the electronic databases Embase, PubMed, and Cochrane. Studies that reported on outcomes, particularly return-to-play rates, in adolescent throwing athletes met the inclusion criteria and were included in our analysis. Studies that did not report on adolescent throwing athletes and studies that reported on adolescent throwing athletes but did not specify the return-to-play outcomes for these athletes were excluded from our analysis. Results: Nine studies met the inclusion criteria and were included in this review. There were 404 baseball players and 10 javelin throwers included in our analysis. A total of 349 of the 414 patients (84.30%) were successfully able to return to play at the same level of competition or higher. Successful rates of return to prior performance ranged from 66.67% to 91.49% in our analysis. Javelin throwers had a mean 80.00% rate of return to prior performance, while baseball players had a mean return-to-play rate of 84.40%. Complications were evaluated for 8 (88.9%) studies and 283 (68.4%) patients. There were 11 (3.9%) reported complications and 5 (1.8%) reoperations. Conclusion: The findings of this systematic review revealed that adolescent patients are generally able to return to their preinjury level of performance or higher with limited complications. Further investigation is necessary to determine long-term outcomes for return to play after UCL reconstruction of the elbow in adolescent throwing athletes.

The AFL Pick Trading Market as a Coasian Utopia

Sporting leagues have various competitive balance measures including player drafts, where teams are awarded picks based on prior performance. Teams, however, have the option to either exercise this pick or trade it as they see fit. An analysis of this trading market in the NFL stated that players obtained through traded picks contributed more to their recruiters in comparison to their counterparts. This paper retested this within the AFL and disproved this fact, establishing the Coasian notion of the efficient allocation of resources, based on some differences between the list management systems between the two leagues.

Team Decision Making: The Dynamic Effects of Team Decision Style Composition and Performance via Decision Strategy

As teams continue to become more prevalent in modern-day organizations, researchers and organizations alike can benefit from a more nuanced understanding of teams’ decision-making process, which can ultimately impact organizational effectiveness. Although team processes are conceptualized as dynamic phenomena, they have largely been treated as static in research. In this study, we draw on the input-mediator-output-input and episodic team performance frameworks to advance a theoretical model of the dynamic, reciprocal effects of team rational decision strategy and team performance as well as the role of team composition of individual rational decision style. We sampled 320 participants in 85 teams competing in a 10-week business strategy simulation where teams made weekly strategic decisions that contributed to team performance. Teams composed of individuals with rational decision styles were more likely to adopt rational decision strategies, which led to better team performance. Additionally, results revealed a positive reciprocal effect between rational decision strategy and team performance such that teams with positive prior performance were more likely to engage in subsequent rational decision strategy. As hypothesized, team composition of members’ rational decision style was the primary determinant of team rational strategy during initial stages of team development, but the valence of outcome feedback (i.e., prior performance) took over as the stronger predictor of team rational strategy during later stages of team development. We contribute to the team and decision-making literatures by examining the dynamic process of team decision making and team performance.