Academic literature on the topic 'Least laxity first(LLF)'

Category: Bunion Introduction/Purpose: Minimally invasive surgical techniques have challenged objectives in hallux valgus surgery, attempting to obtain good clinical outcomes with the least damage to anatomic structures, low complication rates, short time of surgery, cosmetic advantages and an earlier recovery. However, because patients with generalized ligamentous laxity have a major risk for recurrence, arthrodesis of the first tarsometatarsal (TMT) joint is an established method for the surgical treatment of the patients with generalized ligamentous laxity. This study aims to investigate the clinical and radiographic outcomes of joint-preserving minimally invasive distal metatarsal osteotomy in moderate hallux valgus patients with generalized ligamentous laxity. Methods: Thirty-two feet from 29 patients were involved prospectively with mean follow-up of 16.8 (range, 10 – 26) months. Generalized ligamentous laxity was assessed in all patients and the patients were divided into two groups (16: 16) with the result. Clinical outcomes were assessed using visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score and Foot and Ankle Outcome Score (FAOS). Radiographic parameters were evaluated by preoperative and postoperative weight bearing radiographs. Results: Mean tourniquet time was 30.4 (range, 19 – 44) minute and additional procedures were required in 6 cases in each group. The mean VAS (p<0.001), AOFAS score (p<0.001) and three FAOS subscales (Pain, Symptoms and Quality-of-Life) (p=0.003, p=0.002 and p<0.001) improved significantly at the last follow-up. Significant corrections in the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and sesamoid reduction were obtained at the last follow-up (p<0.001). Relative first metatarsal length was decreased 2.8% from preoperative length (p<0.001). No other radiographic outcomes showed significant difference between the 2 groups but the mean relative first metatarsal length was shorter in the group without generalized ligamentous laxity (p=0.014, respectively) at the last follow-up. Conclusion: Despite the patients without generalized ligamentous laxity tended to have shorter first metatarsal bone postoperatively, minimally invasive distal metatarsal osteotomy yielded substantial clinical and radiological results without any recurrence or fixation failure. This procedure can be a reasonable alternative to first TMT arthrodesis in patients with moderate hallux valgus even with generalized ligamentous laxity.

In an EV charging facility, with multiple vehicles requesting charge simultaneously, scheduling becomes crucial to provide adequate service under vehicle sojourn time constraints. However, these departure times may not be known accurately, and typical policies such as Earliest-Deadline- First or Least-Laxity-First are affected by this uncertainty in information. In this paper, we analyze the performance of these policies under uncertain deadlines, using a meanfield approach. We characterize the deviation in individual attained service as a function of the uncertainty. Since incentives appear to under-report deadlines in order to be prioritized, we analyze a simple modification of the policies to enforce incentive compatibility. Simulation experiments are carried out with a practical data set.

Background. Return to participation in sport is an important outcome when evaluating the success of anterior cruciate ligament (ACL) reconstruction surgery. A review by Arden et al. (2014) demonstrates that just because an athlete has surgery, it does not automatically mean that they will return to sport. So, the purpose of this study was to assess if patients could return to their pre-injury activity level 8 months after ACLR.
 Methods. Patients completed IKDC-2000, ACL-RSI questionnaires, underwent FMS, YBT, HOP test sets and drop jump tests, which were evaluated with the LESS. ACL laxity was measured by using a GNRB® device. Participants were 81 patients. They were divided into two groups based on single leg HOP test results. The first group included 30 persons who all had their four single leg HOP test scores above 90%. The second group consisted of 51 persons for whom at least one of the single leg HOP tests scored lower than 90%.
 Results. IKDC and HOP test results in the first group scored higher than in the second group. Psychological confidence was higher in the first group, who had better HOP test results. For the first group, FMS and LESS results were better than those for the second group. Moderate positive correlation was found between LESS scores and laxity results, FMS, three HOP sub-tests. IKDC had the biggest number of correlations with other tests. Results showed negative and weak correlation with laxity results using 134 N power, as well as positive and moderate correlation with HOP sub-tests, FMS, ACL-RSI. Single HOP for distance, triple HOP for distance, crossover HOP for distance and LESS increased the odds of achieving RTS criteria. No other factors were found to be associated with the accomplishment of reaching RTS criteria after ACLR.
 Conclusions. The main factor which can help decide if a person can return to their pre-injury level of physical activity are the single leg HOP test and LESS. The use of single leg HOP tests and LESS along with psychological and self-reported evaluations is the best test combination for assessment 8 months after ACLR.
 Keywords: ACL reconstruction, function tests, return to play, jump tests, psychological readiness.

Objectives: Ramp lesion is a specific type of injury, located in the posterior horn of the medial meniscus. The purpose of the study was to evaluate the complications for meniscal ramp lesions left in situ during ACL reconstruction, after more than 20 months of follow up. Methods: All patients who underwent arthroscopic ACLR between January 1998 and December 2000 were evaluated retrospectively. Surgery was performed by the same surgeon. In case of a stable vertical tear, i.e. without instability, the lesion was left in situ, without suture or debridement. The following parameters were examined: demographics; history and clinical findings including time between injury and surgery, side-to-side laxity, pivot shift; knee function and activity by Lysholm score, subjective IKDC, KOOS and Tegner activity scale; and progression to bucket handle. We established two groups: the bucket handle group versus the no bucket handle group. Results: A total of 716 patients underwent a primary ACLR during this period. The overall incidence of ramp lesions in the study population was 5.4% (39 ramp lesions in 716 patients). Mean follow-up time was 262.1 (± 10.5) months. Bucket handle tear of the medial meniscus occurs in 21.4% of our population, with an average lead time of 99 (± 50) months, and a concentration of injuries between 96 and 156 months. The postoperative scores significantly improved for the entire population at more than 20 years of follow-up (p <0.0001), except for the Tegner score (p = 0.3424). Functional scores and side-to-side laxity were the same for the two groups. No risk factors were identified. Conclusion: There is a high incidence of bucket-handle injury after ACL surgery with a residual ramp lesion (21.4%). This high rate is only found in series with a long follow-up, since these lesions appear between 8 and 12 years after the first surgery.