Search Results (1,160)

(1) Background: Asymmetry in strength, movement, and neuromuscular control is common in youth sports, yet its role in anterior cruciate ligament (ACL) injury risk in pediatric athletes remains underexamined. (2) Methods: This narrative review synthesized studies that examined lower-limb asymmetry, biomechanics, ACL injury or reconstruction (ACLR), and rehabilitation in participants younger than 18 years, supplemented by key mechanistic and methodological work. (3) Results: Evidence indicates that asymmetry is multifactorial and sometimes functional, arising from limb dominance, sport-specific loading, growth-related morphological change, and neuromuscular variability. However, asymmetry becomes concerning when it coincides with high-risk landing or cutting mechanics, growth-related coordination deficits, or incomplete recovery after ACL reconstruction. Persistent strength and loading asymmetries are linked to secondary ACL injury and early structural joint changes, whereas neuromuscular training and technique-modification programs can improve symmetry and reduce high-risk mechanics. Major gaps include the absence of pediatric-specific asymmetry norms, limited longitudinal and sex-specific data, and heterogeneous measurement approaches. (4) Conclusions: Clarifying when asymmetry is adaptive versus maladaptive, and integrating this knowledge into screening, rehabilitation, and return-to-sport decision-making, will be essential for optimizing performance and promoting lifelong knee health in pediatric athletes. Full article

Pre-elite female field hockey players have a high incidence of lower extremity injury, highlighting the need for practical and reliable screening approaches. A dual assessment combining Functional Performance Tests (FPTs) with movement quality scoring (QASLS) may provide a more comprehensive evaluation; however, its reliability in this population is unclear. Fifteen pre-elite female field hockey players (16.7 ± 0.7 years) completed an FPT battery (anterior reach (AR), single leg drop vertical jump–land (DVJL), single hop for distance (SHFD), side hop (SH)) on two occasions, 28 days apart. Movement quality was assessed by three raters using QASLS. Reliability was evaluated using ICC with 95% confidence intervals (CI), alongside standard error of measurement (SEM), smallest detectable difference (SDD), and percentage exact agreement (PEA). Test–retest reliability varied across tasks (ICC₂,₁ 0.33–0.90), with wide confidence intervals indicating uncertainty in several estimates. AR demonstrated the most consistent reliability, supporting its use for monitoring over time. In contrast, the DVJL and SH showed the greatest variability, likely reflecting higher task complexity, while the SHFD required relatively large performance changes to exceed measurement error. Intra-rater reliability for QASLS was consistent across the FPT battery (ICC₂,k 0.79–0.90), whereas inter-rater reliability was more variable (0.38–0.82), indicating rater-dependent differences. PEA demonstrated generally high agreement (60–100%), although lower agreement was observed for pelvic alignment components. These findings support the use of a dual assessment approach as a practicable profiling approach in pre-elite female field hockey, enabling practitioners to identify movement deficits not captured by performance metrics alone. However, variability in complex tasks and between raters highlights the need to consider measurement error and implement standardised rater training when profiling or monitoring performance. Full article

Background/Objectives: Multiple impacted teeth are defined as the sequential impaction of more than two teeth in the alveolar bone, whether unilateral or multilateral. Multiple impactions are an uncommon and rare phenomenon demanding thorough treatment planning and careful execution, but data on the prevalence of multiple impactions is scarce in the literature. In cases of multiple impactions, clinicians generally perform a 3D assessment using CBCT to determine tooth positions, establish a sequence of surgical exposures, implement suitable traction, and utilise appropriate biomechanics. A multidisciplinary approach between orthodontists and oral surgeons is essential to achieve optimal results. Methods: This case report presents non-syndromic multiple impactions of three upper left permanent anterior teeth—21, 22, and 23—along with a retained supernumerary tooth preventing their eruption and a fused primary tooth. The primary teeth and the impacted supernumerary tooth were surgically removed. A digitally designed transpalatal arch was used to preserve the space and to act as anchorage for the orthodontic traction. After an 8-month observational period without spontaneous eruption, surgical exposure was carried out using the closed exposure technique. Subsequently, elastic traction was performed, guiding the impacted teeth into the dental arch. Results: The multiple impacted teeth were successfully aligned in the dental arch, achieving symmetry in the frontal segment while preserving periodontal health. In order to ensure stability during the retention period, thermoformed retainers were used. Conclusions: Each complex and rare clinical case poses a challenge to orthodontists and is important for the scientific literature as it provides valuable clinical experience. Full article

Background and Clinical Significance: Dental trauma presents a considerable challenge for clinicians due to the diverse and complex effects on teeth. Effective management often requires the collaboration of multiple specialists, including endodontists and orthodontists. Case Presentation: This case report presents the interdisciplinary management of a complex dental trauma case involving three permanent maxillary anterior teeth. Unlike most reports of dental trauma, this case includes complete pre-trauma diagnostic records, providing valuable baseline information for treatment planning and outcome assessment. A 15-year-old female patient was examined in the orthodontic clinic, with comprehensive diagnostic records being obtained at the initial visit. Before the commencement of active orthodontic therapy, the patient experienced an extraoral traumatic incident. Clinical and radiographic assessment revealed concussion and traumatic mobility of the upper right canine, intrusive luxation of the upper right lateral incisor and extrusive luxation with increased mobility of the upper right central incisor. Taking into consideration treatment alternatives, an orthodontic–endodontic approach was preferred. Conclusions: The successful management of complex dental trauma affecting multiple permanent teeth requires interdisciplinary collaboration. The clinical significance lies in the potential long-term consequences on both tooth function and aesthetics, which can impact patient well-being. Full article

Background/Objectives: Delivering consistent preclinical instruction for implant attachment procedures can be challenging in large dental cohorts. This report describes the development and implementation of institutionally produced training tools designed to support Locator housing pick-up exercises for second-year predoctoral dental students. Methods: Modified typodont-based simulation tools were integrated into the preclinical curriculum. Clear dentures and gypsum models were fabricated to allow visualization of seating relationships and identification of common interferences. Complete seating of the denture was verified using inspection windows, flange evaluation, and polyvinylsiloxane disclosing materials before housings were incorporated with autopolymerizing acrylic resin. After each session, components were collected, inspected, and prepared for reuse in subsequent cycles. Learner perceptions were obtained through an anonymous voluntary survey. Results: The configuration enabled visualization of seating conditions and identification of misalignment during the exercise. Removal of anterior teeth reduced material use and emphasized posterior stabilization during the pick-up procedure. Of 83 learners, 28 completed the survey (34% response rate), with responses tending toward agreement across items (mean range: 4.5–4.9/5), indicating favorable learner perceptions of the exercise and its organization within the scheduled laboratory period. Across three academic cycles, six dentures required replacement, whereas all gypsum models remained serviceable and no additional fabrication was necessary. Conclusions: This structured simulation approach provided an alternative method for delivering Locator housing pick-up training in a high-volume preclinical environment. The model allowed repeated implementation of the exercise across academic cycles. Full article

Background: Skeletal deep bite malocclusion (Angle Class II division 2) represents a common vertical skeletal discrepancy characterized by excessive anterior overbite and a hypodivergent craniofacial growth pattern. The contribution of cranial base morphology to mandibular growth direction during early development remains incompletely understood. Objective: To evaluate the relationship between cranial base morphology and maxillofacial growth patterns in children with skeletal deep bite, using a longitudinal cephalometric approach. Materials and Methods: This retrospective longitudinal cohort study included 96 prepubertal patients aged 7–10 years (54 with skeletal deep bite, 42 Angle Class I dentoalveolar controls). Skeletal deep bite was defined by overbite > 4 mm and mandibular plane angle (FMA) < 22°. A total of 298 standardized lateral cephalometric radiographs (2–4 per subject; mean follow-up 24 ± 4 months) were analyzed. Twenty-two cephalometric parameters were assessed. Longitudinal changes were evaluated using repeated-measures analysis, and predictors of deep bite severity were identified using multiple linear regression. Results: Compared with controls, the deep bite group exhibited significantly reduced mandibular plane angle (18.5° vs. 24.0°), smaller gonial angle (104.3° vs. 111.0°), and decreased lower anterior facial height (86.3 mm vs. 92.0 mm; all p < 0.001). Differences in cranial base morphology were modest, including reduced anterior cranial base length (58.6 mm vs. 60.0 mm; p = 0.031). Regression analysis identified gonial angle and lower anterior facial height as significant predictors (R² = 0.58). Longitudinal analysis suggested early tendencies toward forward mandibular rotation and reduced vertical growth rate over the observation period. Conclusions: In prepubertal children, skeletal deep bite is associated with early tendencies toward reduced vertical facial development and forward mandibular rotation. Cranial base morphology appears to be associated with mandibular growth direction as a secondary modulatory factor rather than a primary determinant. Early identification of hypodivergent growth indicators may facilitate timely interceptive orthodontic strategies. Full article

Background: Minimally invasive aortic valve replacement (MIAVR) via transaxillary access, right anterior thoracotomy (RAT), and ministernotomy has matured from niche innovation to guideline-endorsed standard, yet comparative data remain heterogeneous and fragmented. Objectives: This state-of-the-art review synthesizes contemporary evidence to define the role of each approach within modern valve care pathways. Methods: A PRISMA 2020 systematic review with PROSPERO registration identified studies reporting outcomes of isolated AVR performed through transaxillary, RAT, or ministernotomy access. Primary endpoints were 30-day mortality, operative times, and length of stay; secondary endpoints included complications, long-term survival, learning curves, and patient-reported outcomes. Results: Forty-two studies encompassing 15,328 patients were included: transaxillary (n = 2156), RAT (n = 4892), and ministernotomy (n = 8280). All approaches achieved excellent perioperative safety (mortality 0.4–2.5%) and long-term survival comparable to full sternotomy, while consistently reducing blood loss, transfusion, ventilation time, and hospital stay. Ministernotomy offered the broadest anatomical applicability and the shortest learning curve (20–30 cases). RAT combined complete sternal preservation, the lowest bleeding rates, and superior cosmetic and functional recovery in anatomically suitable patients. Transaxillary access provided hidden scarring and attractive options in redo or sternum-avoidance scenarios, but higher reported stroke rates (2.0–6.3%) and greater technical demands limited its use to high-volume centers. Conclusions: MIAVR via ministernotomy, RAT, and transaxillary access now represents a mature, durable alternative to full sternotomy. A structured, anatomy- and center experience-driven selection strategy is essential to fully realize its benefits across diverse patient populations. Full article

Background/Objectives: This cross-sectional study aimed to estimate the Locally Estimated Scatterplot Smoothing (LOESS)-smoothed percentiles for growth trajectories and evaluate age-related tendencies across groups using visual cross-sectional graphs. Methods: A total of 1147 patient records were analyzed, including 648 females and 469 males aged 5–20 years, with a mean age of 11.9 (SD ± 3.8) years. Twenty-seven cephalometric variables were organized into six measurement domains: cranial base, maxillary complex, mandibular complex, occlusal plane, vertical relationship, and sagittal relationship. Percentile curves were generated using LOESS regression across an age range of 5–20 years. Results: The LOESS-smoothed curves showed age-related trends across age groups. An upward trend in the curves was observed for the anterior and posterior cranial bases between 5 and 12 years of age, a plateau indicating reduced age-related change across groups during mid-adolescence. Maxillary measurements showed a similar pattern, with a clear upward tendency during childhood and reduced age-related change after approximately 12 years. Mandibular length and projection showed increasing trends during childhood, followed by a plateau or reduced slope across later age groups. The occlusal plane and vertical dimensions showed consistent patterns that approached a plateau around 12 years, indicating minimal age-related differences between groups. Changes in the ANB angle and Wits appraisal reflected a progressive forward tendency of the mandible across childhood age groups, followed by reduced age-related change during adolescence. Conclusions: These findings suggest that many craniofacial measurements show an upward trend during childhood followed by a plateau or reduced age-related change across age groups between approximately 12 and 14 years. The percentile-based growth curves presented here offer a practical reference for clinicians to evaluate craniofacial growth trajectories as population-level approximations derived from cross-sectional data in the pediatric population. Full article

Background: Endoscopic sacrocolpopexy (ESC) is a widely performed procedure for pelvic organ prolapse, with laparoscopic sacrocolpopexy (LSC) and robotic-assisted sacrocolpopexy (RSC) approaches. However, suturing to the anterior longitudinal ligament at the sacral promontory carries a risk of massive hemorrhage due to presacral vascular injury. This study aimed to determine the frequency of presacral venous variations considered clinically relevant during suturing at the promontory and to explore their association with perioperative outcomes using contrast-enhanced three-dimensional computed tomography (3D-CT). Methods: Among 319 consecutive ESC cases performed between 2014 and 2025, 265 patients who underwent preoperative contrast-enhanced CT were retrospectively analyzed in this single-center cohort study. Two vascular findings were defined as clinically significant: (1) anomalous drainage of the internal iliac vein into the contralateral common iliac vein and (2) a clearly visualized median sacral vein on 3D reconstruction. The clinical impact of vascular abnormalities was evaluated using surgical time, blood loss, and perioperative complication rates as indicators. Student’s t-test was used for comparing continuous variables, and the chi-squared test was used for comparing categorical variables. The data for this study were retrospectively collected from electronic medical records, anonymized, and then analyzed. Results: Anomalous internal iliac vein drainage was observed in 11.3% (30/265), and a visible median sacral vein was observed in 10.2% (27/265). Overall, 17.7% (47/265, CI: 13.2–22.2%) of patients had at least one clinically significant variation. There were no significant differences between the groups in terms of age, parity, BMI, operative time, blood loss, or perioperative complication rates. No cases required transfusion. Conclusions: Clinically significant presacral vein mutations were present in approximately 1 in 6 patients. The main findings of this study are that clinically significant presacral vascular mutations are relatively frequent (17.7%) in ESC and that there was no significant difference in perioperative outcomes between patients with and without vascular mutations. Clinically relevant presacral vascular variations are relatively common in ESC. Preoperative contrast-enhanced 3D-CT may support risk assessment and surgical planning. Full article

Background and Objectives: Previous comparisons between right anterior mini-thoracotomy (RAT) and partial upper sternotomy (PS) for aortic valve replacement (AVR) have shown similar clinical outcomes. This study aims to assess the potential in-hospital cost differences in one technique over the other. Materials and Methods: Between 2018 and 2023, 303 patients at our institution underwent minimally invasive isolated AVR (241 PS vs. 62 RAT). Endocarditis, emergencies, and reinterventions were excluded. A 1:1 nearest neighbor propensity-matched analysis without replacement was performed. Perioperative clinical outcomes and hospital costs were analyzed, comparing total and average (per patient) direct, indirect, and total hospital costs between the two groups. Multivariable linear regression identified significant predictors of hospital costs. Results: Sixty-two well-matched pairs were analyzed. Significant differences were found in intraoperative (PS: 27/62, 43.5% vs. RAT: 10/62, 16.1%, p = 0.002) and postoperative transfusions (PS: 33/62, 53.2% vs. RAT: 16/62, 25.8%, p = 0.003), and median intensive care unit (ICU) hours (PS: 52.2 vs. RAT: 45.7, p = 0.007). Average direct, indirect, and total hospital costs were significantly higher for PS (p = 0.038, p = 0.040, and p = 0.035, respectively), with significant blood bank cost differences favoring RAT (p = 0.010). Multivariable linear regression showed that intraoperative and postoperative transfusions, ICU, and hospital length of stay were significantly associated with hospital costs, but not the surgical approach. Conclusions: PS and RAT have comparable perioperative clinical outcomes, with differences observed only in the number of transfusions and ICU stay, both favoring RAT. Given the significant perioperative differences and regression analysis results, the cost advantage of RAT is likely mediated through its impact on these perioperative outcomes. Full article

Background/Objectives: Quality of life (QoL) and functional recovery are essential outcomes in patients undergoing rectal cancer surgery. In addition to oncological results, bowel dysfunction and stoma-related issues may significantly affect postoperative well-being. We aimed to evaluate QoL changes at 1 and 6 months postoperatively and functional outcomes in rectal cancer patients who underwent curative surgical treatment, sphincter-preserving surgeries (SPS) or abdominoperineal resection (APR). Owing to its impact on QoL, several functions were assessed using the Low Anterior Resection Syndrome (LARS) score. Methods: This retrospective observational study consisted of 99 patients who underwent curative rectal cancer surgery, of which 38 patients had colostomy, and 61 no colostomy. To assess patient-reported outcomes related to QoL, the EORTC QLQ-C30 questionnaire, QLQ-CR29 questionnaire, and LARS instrument were sent to the patients at 1 and 6 months postoperatively. Changes over time were analyzed using paired statistical tests, and subgroup analyses were performed according to colostomy status and surgical approach. Results: Significant improvements were observed in the global health status and all major functional domains between 1 and 6 months postoperatively. The global health status increased from 74.9% to 86.5% (p < 0.001). Symptom burden decreased significantly, particularly for fatigue (−18.31), pain (−14.48), diarrhea (−12.46), and insomnia (−11.45), representing clinically meaningful improvements. Patients who underwent abdominoperineal resection or resection with colostomy had lower QoL scores at 1 month but showed substantial improvement at 6 months, becoming comparable to those who underwent SPS. LARS outcomes demonstrated progressive functional recovery, with the proportion of patients without LARS increasing from 39 to 46, while major LARS decreased from 7 to 3 patients. However, approximately 40% of patients in the SPS group continued to report moderate-to-severe LARS symptoms. Conclusions: In this study, QoL and bowel function improved significantly during the first 6 months after colorectal cancer surgery. Although most patients demonstrated recovery, persistent bowel dysfunction and stoma-related challenges remain important issues. These findings highlight the need for comprehensive postoperative care and routine assessment of both QoL and functional outcomes. Full article

Emergency responders face a high risk of musculoskeletal disorders (MSDs), particularly lower back injuries, due to frequent patient-handling tasks performed in awkward and dynamic postures. This aim of study is to utilize dual motion capture systems integrated with a digital human modeling (DHM) ergonomics tool to evaluate the biomechanical effects of two common two-person carrying techniques: facing forward and facing each other. Twenty-two participants lifted a 25 kg mannequin while wearing Xsens motion sensors, and lumbar forces and joint angles were analyzed using Siemens Jack software (v9.0). Peak compressive and anterior–posterior (AP) shear forces, along with trunk, hip, and knee joint angles, were examined. Compressive forces ranged from approximately 948.6 to 2955.6 N, and AP shear forces ranged from 286.0 to 827.0 N. Mean compressive and AP shear forces were higher during the facing-each-other task (1977.3 N and 595.0 N) than during the facing-forward task (1596.0 N and 462.0 N). Males experienced higher spinal loads than females across both tasks. The facing-each-other technique was associated with greater hip flexion, lower knee flexion, and reduced trunk flexion, whereas the facing-forward technique resulted in less hip flexion, greater knee flexion, and greater trunk flexion. Overall, under the conditions of the present study, the facing-forward technique was associated with lower lumbar loading indicators. Integrating motion capture with DHM offers a valuable approach for evaluating realistic rescue tasks and can inform ergonomic training strategies for emergency responders. Full article

Ventricular repolarization abnormalities are among the most frequent electrocardiographic findings in pediatric athletes undergoing cardiovascular screening, yet their clinical significance remains a major source of diagnostic uncertainty. While most of them represent benign expressions of training-induced cardiac remodeling and developmental maturation, selected patterns may constitute the earliest phenotypic manifestation of cardiomyopathies or primary electrical disease. Distinguishing physiological adaptation from early pathology is therefore essential to prevent both sudden cardiac events and unnecessary restrictions on sports participation. This review integrates contemporary international electrocardiographic interpretation criteria with emerging pediatric evidence to provide a clinically oriented framework for evaluation and risk stratification of ventricular repolarization abnormalities in pediatric athletes. Early repolarization and anterior T-wave inversion are commonly benign when occurring within recognized age- and ethnicity-specific patterns and in the absence of symptoms, concerning family history, or structural abnormalities. Conversely, lateral or inferolateral T-wave inversion, atypical ST-segment morphology, complex ventricular arrhythmias, and abnormal imaging findings represent red flags requiring comprehensive investigation, including multimodality imaging when indicated. Due to the dynamic electrophysiological evolution during adolescence, longitudinal reassessment is crucial. A structured, risk-based approach integrating electrocardiographic features, demographic/familial context, clinical evaluation, imaging findings, and follow-up provides a pragmatic strategy to optimize risk detection while safeguarding appropriate athletic participation in young athletes. Full article

Background/Objectives: The optimal management of anterior cruciate ligament (ACL) rupture remains debated, especially regarding long-term outcomes after early ACL reconstruction (ACLR) versus rehabilitation-first with optional delayed ACLR. The interpretation of randomized evidence is complicated by frequent treatment crossover. This review synthesized evidence from randomized controlled trial (RCT) cohorts comparing surgical versus rehabilitation-first management strategies across available follow-up durations. Methods: A structured review based on a systematic literature search and narrative synthesis was conducted, with study identification and reporting guided by PRISMA 2020. MEDLINE (via PubMed) and Google Scholar were searched in February 2026 for English-language human RCTs (2000–2026) comparing early ACLR plus rehabilitation with rehabilitation-first management allowing delayed ACLR for persistent instability. A linked-report PubMed search using the KANON trial registration number (ISRCTN84752559) was additionally performed to identify cohort-derived follow-up publications. Reports were grouped by underlying RCT cohort. Data were extracted on crossover, follow-up, and clinical outcomes. Risk of bias for primary RCT reports was assessed with Cochrane RoB 2. Results: Twenty-seven reports representing three RCT cohorts (KANON, COMPARE, ACL SNNAP) were included; six index reports were prioritized for synthesis. In acute ACL rupture (KANON, COMPARE), early ACLR did not show a consistent long-term superiority in patient-reported outcomes versus rehabilitation-first with optional delayed ACLR, although COMPARE reported a statistically significant 2-year subjective functional difference favoring early ACLR; early ACLR more consistently improved mechanical stability and reduced instability episodes. Crossover from rehabilitation to delayed ACLR was common. In non-acute ACL injury with persistent symptomatic instability (ACL SNNAP), surgery-first improved 18-month patient-reported outcomes. Meniscal procedure rates and osteoarthritis-related outcomes did not consistently favor early ACLR. Conclusions: In acute ACL rupture, rehabilitation-first with timely access to delayed ACLR appears to provide long-term patient-reported outcomes comparable to an early ACLR strategy in many patients, while early ACLR more consistently improves knee stability. In non-acute symptomatic ACL deficiency, a surgery-first strategy appears more effective in the mid-term. These randomized trials should be interpreted as comparisons of management strategies rather than of “pure” operative versus nonoperative treatment approaches. Full article

Background/Objectives: Accurate quantification of alveolar cleft defects for bone grafting remains difficult due to inconsistent anatomical boundaries. This study established an expert consensus on boundary landmarks for alveolar bone graft (ABG) planning and validated the accuracy and reliability of digital volumetric measurement methods. Methods: Three cleft specialists performed repeated simulated graft procedures in seven patient-specific 3D-printed models, first according to the operator’s clinical judgment, and subsequently according to panel-derived consensus boundaries. Two radiologists independently conducted digital volumetric assessments in 3D X-ray imaging using four measurement approaches (axial tracing, interpolated axial tracing, landmark-based mirroring, and mesh-based mirroring), generating 56 independent digital segmentations to be evaluated against the consensus-based physical reference standard. Volumes of the defects were recorded, intra- and inter-rater reliabilities were calculated using the intraclass correlation coefficient (ICC), and differences among methods were analyzed. Results: Operator-defined plans showed significant inter-operator differences (p < 0.001) with poor-to-excellent reliability (intra-rater ICC 0.060–0.967; inter-rater ICC 0.300–0.635). Consensus established standardized boundaries: tilted plane from base of anterior nasal spine to hard palate, cemento-enamel junctions, incisive canal, and alveolar contour. Consensus-based filling showed non-significant inter-rater differences (p = 0.139) and substantially improved reliability (intra-rater ICC 0.904–0.988; inter-rater ICC 0.622–0.861). Among the four digital methods evaluated, axial tracing demonstrated excellent reliability (intra-rater ICC 0.971–0.99; inter-rater ICC 0.965) and high accuracy (mean difference 0.001–0.026 cm³), with no significant difference (p = 0.999) from the physical reference standard. Conclusions: These proposed consensus-based boundary definitions and validated volumetric measurement methods improved the accuracy and reproducibility of personalized alveolar bone graft planning. Full article