Maxillomandibular advancement (MMA) surgeries for obstructive sleep apnea (OSA) and orthognathic surgeries for dentofacial deformities (DFDs) are both complex procedures with distinct indications. This meta-analysis and systematic review aimed to compare complications and recovery metrics between these surgeries. CINAHL, Cochrane Library, PubMed, and SCOPUS. Included studies focused on MMA for OSA or orthognathic surgeries for DFDs. Included were 18 bimaxillary studies (n = 1734), 10 single-jaw (n = 3847), and 17 MMA studies (n = 601). Outcomes analyzed included operative time, hospital stay, and complications such as neurosensory disturbance, infection, and hardware removal. MMA demonstrated a surgical success rate of 79.6% and a cure rate of 39%. Compared to bimaxillary surgery, MMA was associated with longer operative time (343.87 vs 326.95 min; P = .021) and postoperative hospital stay (4.22 vs 3.25 days; P < .0001). Neurosensory disturbance was comparable between MMA (40.44%) and bimaxillary surgeries (44.91%; P = .2189), but highest in single-jaw procedures (55.18%; P < .001). MMA had higher postoperative infection (16.34%) and hardware removal rates (21.99%) than bimaxillary surgery (3.55% and 4.21%, respectively; P < .0001). Postoperative OSA developed in 12.25% of bimaxillary cases for DFDs. Our findings underscore the need for tailored preoperative counseling and risk stratification when selecting orthognathic surgical interventions. MMA offers a high surgical success rate but is associated with longer operative time, increased hospital stay, and higher rates of infection and hardware removal compared to bimaxillary and single-jaw surgeries. These findings highlight the need to balance efficacy with complication risk when selecting surgical approaches for OSA or DFDs.
Tannery wastewater (TWW) presents a complex and toxic mixture of pollutants, including heavy metals such as chromium, cadmium, lead, and nickel, as well as organic compounds, surfactants, sulfides, chlorides, and dyes. Conventional treatment methods often lead to high operational costs, sludge generation, and disposal issues. This review critically examines the integration of microalgae-based systems with physical, chemical, and biological methods for advanced TWW remediation, emphasising mechanistic insights and consortia-driven treatment. Microalgae facilitate pollutant removal through biosorption, bioaccumulation, enzymatic transformation, and the mitigation of oxidative stress. Specific enzymatic mechanisms, such as chromate reductase-mediated Cr(vi) reduction and peroxidase-driven degradation of phenolics, enable precise detoxification at the cellular level. In multi-species consortia, synergistic interactions optimise nutrient uptake, broaden substrate specificity, and enhance EPS-mediated heavy metal immobilisation. This review delineates how microalgae-bacteria, microalgae-fungi, and microalgae-microalgae systems contribute distinct advantages via mutualistic nutrient exchange, quorum sensing regulation, and biofilm resilience under high pollutant stress.
Minimally invasive spine surgery continues to evolve, with the single-position prone transpsoas lateral approach offering simultaneous lateral and posterior access without repositioning. This technique minimizes tissue disruption while enabling efficient single-position surgery. The authors present the case of a 57-year-old male with left-sided back pain and radiculopathy recalcitrant to conservative treatment. MRI revealed multilevel degeneration, with single photon emission CT (SPECT) highlighting L2-3 pathology. After exhausting conservative measures, he underwent a minimally invasive prone lateral lumbar interbody fusion at L2-3 with the use of navigation. This video highlights the technical steps and advantages of this approach and navigated technique. The video can be found here: https://stream.cadmore.media/r10.3171/2026.4.FOCVID2639.
Breast implant-associated Mycobacterium fortuitum infections with presumed rib osteomyelitis are exceedingly rare, with fewer than 7 cases reported globally. We report the first documented case from Latin America, identified through systematic review of PubMed and SciELO databases. A 25-year-old woman with no predisposing comorbidities underwent mastopexy and breast augmentation with a retropectoral silicone implant. She developed a persistent left breast wound unresponsive to conventional treatment at an outside institution and was referred to our center ∼14 months postoperatively with a chronic fistula and rib exposure. A multidisciplinary approach (plastic surgery, orthopedic surgery, and infectious disease) was employed. Serial surgical debridement with vacuum-assisted closure therapy was performed. Cultures confirmed M. fortuitum sensitive to clarithromycin and doxycycline; combination therapy with clarithromycin and moxifloxacin was administered for 6 months. Wound closure was achieved with epigastric and thoracoabdominal pedicle flaps, followed by bilateral autologous fat grafting for breast reconstruction. At 8-year follow-up, the patient reported satisfaction with the aesthetic result. This case emphasizes the importance of maintaining clinical suspicion for nontuberculous mycobacterial infection in chronic nonhealing wounds following breast implant surgery, even in immunocompetent patients without identifiable risk factors. Level of Evidence: 5 (Therapeutic) For image description, please refer to the figure legend and surrounding text.
Pain beliefs play an important role in how people understand and cope with pain, and they are especially relevant for military personnel and Veterans who bear a disproportionately high burden of chronic pain. However, limited research has examined which pain beliefs are central to military training and the broader military culture from the perspective of active basic training instructors. The current study aims to explore what beliefs about pain are emphasized in basic military training and the broader military culture from the perspective of active basic training instructors within the Canadian Armed Forces. We used a qualitative descriptive study design involving two semi-structured focus groups with instructors. The transcripts were analyzed using inductive content analysis. Three themes were generated. Theme 1 describes how instructors aim to teach recruits to prioritize mission and team success by pushing through pain and distinguishing it from injury. Theme 2 outlines the culture around pain in training and the broader military. Injuries are often experienced as personal failures and threaten one's identity. Thus, there is pressure to endure painful injuries and stigma for seeking care. Theme 3 describes instructors' critical reflections on how pain is addressed within the military, emphasizing that the military's relationship with pain is a double-edged sword with both helpful and harmful aspects. There is a tension between the military's operational goals and the effective management of pain and injuries. Implications for military training and future research are discussed. Contexte : Les croyances relatives à la douleur jouent un rôle important dans la façon dont les personnes comprennent la douleur et y font face. Elles sont particulièrement pertinentes pour le personnel militaire et les anciens combattants, chez qui le fardeau associé à la douleur chronique est disproportionnellement élevé. Toutefois, peu d’études ont examiné les croyances relatives à la douleur qui occupent une place centrale dans la formation militaire et, plus largement, dans la culture militaire, du point de vue des instructeurs en service actif responsables de la formation de base.Objectif : La présente étude vise à explorer les croyances relatives à la douleur mises de l’avant dans la formation militaire de base et, plus largement, dans la culture militaire, du point de vue d’instructeurs en service actif responsables de cette formation au sein des Forces armées canadiennes.Méthodes : Nous avons utilisé un devis descriptif qualitatif comprenant deux groupes de discussion semi-structurés avec des instructeurs. Les transcriptions ont été analysées au moyen d’une analyse de contenu inductive.Résultats : Trois thèmes ont été dégagés. Le thème 1 décrit comment les instructeurs cherchent à enseigner aux recrues à donner la priorité à la réussite de la mission et de l’équipe en surmontant la douleur et en la distinguant d’une blessure. Le thème 2 présente la culture entourant la douleur dans le cadre de la formation et, plus largement, au sein de l’armée. Les blessures sont souvent vécues comme des échecs personnels et menacent l’identité de l’individu. Il en résulte une pression qui pousse à endurer des blessures douloureuses ainsi qu’une stigmatisation associée au fait de demander des soins. Le thème 3 décrit les réflexions critiques des instructeurs sur la façon dont la douleur est abordée au sein de l’armée, en soulignant que le rapport de l’armée à la douleur constitue une arme à double tranchant, comportant à la fois des aspects bénéfiques et néfastes.Conclusions : Il existe une tension entre les objectifs opérationnels de l’armée et la prise en charge efficace de la douleur et des blessures. Les implications pour la formation militaire et les recherches futures sont abordées.
Chronic cardiopulmonary diseases, including chronic obstructive pulmonary disease, interstitial lung disease, and coronary artery disease, represent a major global health burden. Low-dose computed tomography (LDCT) combined with artificial intelligence (AI) quantitative imaging enables the identification of cardiopulmonary imaging abnormalities in asymptomatic individuals. To evaluate early risk factors for cardiopulmonary imaging abnormalities in asymptomatic middle-aged and elderly population using single-inspiratory phase LDCT combined with AI-based whole-lung quantitative analysis. A retrospective collection was conducted on 1035 asymptomatic individuals aged ≥ 40 years who underwent routine single-inspiratory-phase LDCT screening at Zhuzhou 331 Hospital in 2025. An AI platform was utilized to automatically extract airway wall area percentage, low-attenuation area percentage, interstitial lung abnormality, and coronary artery calcification score. Based on risk stratification criteria, the population was divided into a high-risk group (n = 689) and a low-risk group (n = 346) and randomly stratified into a training set (n = 724) and a validation set (n = 311) at a 7:3 ratio. Independent sample t-test or χ 2 test was applied to analyze between-group differences. Binary logistic regression was used to screen independently associated factors, and a multivariate logistic regression model was constructed after excluding collinear variables using variance inflation factor (VIF < 5), followed by the establishment of a nomogram prediction model. The receiver operating characteristic curve and DeLong test were employed to evaluate model discrimination. The Hosmer-Lemeshow test and calibration curves were used to assess goodness of fit. Decision curve analysis (DCA) was applied to evaluate clinical net benefit, and internal validation was performed using the bootstrap method (1000 resamplings). Univariate analysis showed that smoking history, abnormal metabolic status, body mass index (BMI), age, and gender were significantly associated with cardiopulmonary imaging-defined high-risk status (P < 0.05), while work style showed a marginal association in univariate analysis (P = 0.043) but did not retain statistical significance in the multivariate model (P = 0.851). After VIF collinearity screening (all VIF < 5) and multivariate logistic regression analysis with forced entry of six candidate variables, smoking history [odds ratio (OR) = 1.968 per level, 95% confidence interval (CI): 1.665-2.325, P < 0.001], abnormal metabolic status (OR = 3.266, 95%CI: 2.259-4.723, P < 0.001), BMI (OR = 1.150 per unit, 95%CI: 1.079-1.226, P < 0.001), and age (OR = 1.028 per year, 95%CI: 1.005-1.052, P = 0.018) were identified as independently associated factors for cardiopulmonary imaging-defined high-risk status, while male gender demonstrated an (inverse) association (OR = 0.427, 95%CI: 0.276-0.660, P < 0.001) after adjustment for smoking and other covariates. The nomogram-based risk stratification model integrating the above five independently associated factors achieved an area under the curve (AUC) of 0.833 (95%CI: 0.787-0.879) in the validation set, significantly outperforming the baseline model containing only age and gender (AUC = 0.647, 95%CI: 0.582-0.712; DeLong test: Delta AUC = 0.186, z = 5.256, P < 0.001). The Hosmer-Lemeshow goodness-of-fit test confirmed satisfactory calibration (training set: χ 2 = 10.40, P = 0.238; validation set: χ 2 = 6.50, P = 0.591). Calibration curves and DCA demonstrated good agreement and positive clinical net benefit. Bootstrap internal validation (1000 resamples) confirmed model robustness (mean AUC = 0.792, 95%CI: 0.760-0.824). The LDCT-based nomogram model combined with AI quantitative imaging analysis may assist in identifying individuals with cardiopulmonary imaging abnormalities in asymptomatic screening populations, potentially guiding further diagnostic evaluation. Prospective studies are warranted to establish its role in improving clinical outcomes.
To identify and characterize active national illicit drug use sentinel surveillance systems worldwide. We conducted a scoping review to identify and characterize active sentinel surveillance systems for illicit drug use worldwide. Inclusion criteria: 1) articles describing or analyzing data from sentinel networks with an established national scope, 2) supported by public agencies, and 3) data accessible via online repositories. We excluded articles on networks which did not have drug surveillance as their main designated objective. Ten sentinel surveillance systems targeting recreational drug use at the national level were identified. Even though each has its own structure and functionality, they are often integrated in larger surveillance programs. Although health professionals in emergency departments are the main informants, some systems also include information directly from people who use drugs or from community stakeholders. Systems also varied in their operational characteristics, including reporting frequency and methods used to disseminate findings. Having similarities, awareness of these different characteristics makes it possible to improve the design of surveillance systems directed towards illicit drug use monitoring and surveillance.
Achieving the goal of tuberculosis (TB) elimination in India requires innovative approaches. The TB-Free Haryana Mission is a decade-long public-private partnership (PPP) between the government of Haryana state and Medanta - The Medicity, a tertiary corporate hospital designed to strengthen TB case detection and care, particularly among underserved populations. Launched in 2014 as a pilot in Rewari district, the initiative scaled statewide by 2019 using a mobile diagnostic model that integrated digital chest X-ray screening, sputum microscopy and rapid molecular testing. Over time, point-of-care molecular diagnostics and AI-assisted chest X-ray interpretation were incorporated to enable same-day diagnosis and treatment initiation. Over 10 years, the Mission performed >62 000 chest X-rays, achieving an overall high diagnostic yield (5.3%) and extending access to quality diagnostics in remote rural settings. The approach improved detection of smear-negative TB, reduced delays between diagnosis and treatment and remained operationally effective even during the COVID-19 pandemic. Long-term sustainability was supported through shared funding, continuous technological upgrades, strong monitoring systems, community engagement and alignment with national TB policies. This experience demonstrates that a technology-enabled, domestically funded PPP model can effectively bridge diagnostic gaps and is scalable for replication to accelerate TB elimination efforts in India.
Internal hernias are particularly difficult to diagnosis and should be considered in patients presenting with sudden, severe abdominal pain and symptoms of intestinal obstruction. Internal hernias carry a high risk of morbidity and mortality. Here, we present an unusual case of internal hernia through the foramen of Winslow of an ileoileal anastomosis created 25 years prior that was successfully diagnosed and operatively reduced via single-port laparoscopy with an optimal clinical outcome. Uniquely, the defect was closed using a ligamentum teres buttress to avoid undue tension at the foramen.
Meat adulteration is a significant global food safety challenge, creating a pressing need for rapid and on-site detection technologies. Herein, we present an intelligent one-pot biosensing platform termed one-pot TLAMP-PfAgo assay (OTPA) that integrates the rapid amplification of turn-back loop primer-accelerated loop-mediated isothermal amplification (LAMP) (TLAMP) with the sequence-specific detection of Pyrococcus furiosus Argonaute (PfAgo). This system features a clever heat-activatable design using microcrystalline wax to spatially separate reactions within a single tube, enabling contamination-free and streamlined operation. The OTPA assay achieves sensitive and specific detection, with limits of detection as low as 3×10-4 ng/μL for pork DNA and 2×10-4 ng/μL for beef DNA within 30 min. It successfully enables duplex target identification and has been validated with commercial meat products, showing perfect concordance with standard polymerase chain reaction (PCR)-based qualitative detection. Notably, the result can be directly visualized under blue light, underscoring the substantial potential of this cost-effective and simple platform for point-of-care testing (POCT) and intelligent biosensing in food safety surveillance. 肉类掺假是全球食品安全面临的一项重大挑战，因而迫切需要开发快速的现场检测技术。在此，本研究提出了一种名为OTPA（一锅法TLAMP-PfAgo分析）的智能一锅法生物传感平台。该平台将基于折返环引物加速的环介导等温扩增技术（LAMP）（TLAMP）与激烈火球菌（Pyrococcus furiosus）的Argonaute蛋白（PfAgo）的序列特异性检测功能完美融合，采用一种巧妙的热激活设计，利用微晶蜡在单管内实现反应的空间隔离，从而确保了操作的无污染与流程的简化。OTPA分析法具备极高的灵敏度与特异性，在30分钟内对猪肉DNA和牛肉DNA的检测限分别低至3×10-4 ng/μL和2×10-4 ng/μL。此外，它成功实现了双靶标鉴定，并在市售肉制品中得到了验证，其结果与标准的PCR定性检测高度一致。值得注意的是，检测结果可在蓝光下直接通过肉眼可视化，这充分凸显了这种经济高效且简便的平台在食品安全监测的即时检测（POCT）与智能生物传感领域中所具备的巨大潜力。.
 Mechanical power (MP) integrates multiple ventilatory variables and reflects the total energy transferred to the lungs during mechanical ventilation, potentially contributing to ventilator-induced lung injury (VILI) in acute respiratory distress syndrome (ARDS). This study evaluated the association between MP, ventilatory variables, and mortality in patients with ARDS.  In this prospective cohort study conducted between May 2025 and May 2026, 50 mechanically ventilated patients with ARDS were enrolled and categorized into survivors (n=25) and non-survivors (n=25). Ventilatory parameters, arterial blood gas (ABG) variables, and MP components were serially recorded. Chest computed tomography (CT) was performed for quantitative lung aeration analysis. Mechanical power was calculated using static, dynamic, and resistive components.  Non-survivors had significantly higher Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores (p<0.0001). They demonstrated worse oxygenation, higher partial pressure of carbon dioxide (PaCO₂) and lactate levels, lower compliance, and significantly elevated ventilatory pressures and MP indices. Day 1 total MP, dynamic MP, and resistive MP were significantly greater among non-survivors (p<0.0001). Average ventilatory parameters during ICU stay showed persistent elevation of respiratory rate (RR), plateau pressure (PP), driving pressure (DP), and total MP in non-survivors. CT-derived aeration parameters did not differ significantly between groups. Multivariate regression identified average pressure of arterial oxygen (PaO₂), PaO₂/fraction of inspired oxygen (FiO₂) (P/F) ratio, day 1 static compliance (SC), plateau pressure, static MP, average peak inspiratory pressure (PIP), and average total MP as independent predictors of mortality.  Increased mechanical power and adverse ventilatory mechanics were strongly associated with mortality in ARDS. Continuous optimization of ventilatory parameters and reduction of cumulative mechanical energy delivery may improve outcomes in mechanically ventilated patients with ARDS.
Excessive gingival display, or gummy smile, caused by upper lip elevator muscle hyperactivity presents a significant esthetic challenge. This case report details the successful management of a 28-year-old female patient with an objectively measured dynamic gingival exposure of 4 mm. Preoperative evaluations confirmed normal clinical crown dimensions and healthy periodontal tissues, definitively ruling out altered passive eruption. The patient underwent conventional lip repositioning surgery (LRS) featuring a partial-thickness mucosal excision and meticulous wound closure with 6-0 polytetrafluoroethylene (PTFE) sutures to mechanically restrict upper lip mobility. The dynamic gingival display decreased from 4.0 mm preoperatively to 1.0 mm at 2 weeks and was stably maintained at 1.5 mm at the 1-year follow-up, meeting the treatment success criteria (≤ 2 mm). The procedure established a harmonious dentolabial relationship with high patient satisfaction and no complications, such as severe scarring, labial paresthesia, or relapse. These findings demonstrate that, based on accurate differential diagnosis and strict case selection, LRS serves as a safe, minimally invasive, and highly predictable intervention yielding excellent short-to-medium-term esthetic outcomes for muscular hyperactive gummy smiles.
Metastasis of oropharyngeal squamous cell carcinoma (OPSCC) to the thyroid gland is rare, and p16-positive cases form an even smaller subset. We present a case of p16-positive thyroid metastasis from OPSCC identified after complete treatment response. Nine months after completing chemoradiotherapy, the patient developed throat pain and hoarseness. Computed tomography demonstrated an enlarged heterogeneous right thyroid gland and fine needle aspiration confirmed p16-positive metastatic OPSCC in the absence of locoregional recurrence. The patient underwent extended total thyroidectomy and right selective neck dissection; formal pathology confirmed metastatic OPSCC with involved margins and 13/22 positive lymph nodes. To our knowledge, this is the first reported intrathyroidal metastasis from p16-positive OPSCC after complete treatment response and in the absence of local recurrence. Further cases are required to better understand the epidemiology, optimal management, and prognosis of this presentation.
Anorectal malignant melanoma is a rare, notably aggressive malignancy, comprising fewer than 1% of all melanoma cases. Its early symptoms frequently resemble benign anorectal conditions, which may lead to diagnostic delays and poor outcomes. We report a case of a 42-year-old, previously healthy male who presented with a two-month history of progressive constipation, unintentional weight loss, and lower abdominal discomfort associated with melena. Imaging revealed a mass extending from the anal canal into the distal rectum, with hepatic metastases. Histopathological examination confirmed malignant melanoma with positive immunohistochemical staining for HMB-45 and Melan-A, and negative S-100. A diverting functional colostomy was performed for impending obstruction, and first-line nivolumab was initiated, but the patient deteriorated rapidly and died on best supportive care. This case highlights the silent nature of this malignancy and the importance of considering rare yet aggressive tumors when dealing with atypical or unexplained anorectal lesions.
Introduction Gingival hyperpigmentation is a common esthetic concern managed by surgical depigmentation. However, delayed epithelialization and postoperative discomfort remain challenges. Low-level laser therapy (LLLT) has been suggested as an adjunct for enhancing healing and reducing pain. This study aimed to evaluate the effect of adjunctive LLLT on wound healing and postoperative pain following surgical gingival depigmentation. Methods This prospective observational study included 24 systemically healthy participants with physiological gingival pigmentation. Each participant underwent surgical depigmentation, with selected sites receiving adjunctive LLLT and others serving as the comparison sites. Clinical evaluations were performed on postoperative days 3, 7, and 15. Epithelialization was assessed by the residual wound area (mm²), wound healing was evaluated using a Likert scoring, and pain perception was recorded using a visual analog scale (VAS). Non-parametric tests were applied at a significance level of p < 0.05. Results On day 3, the median epithelialization area was significantly lower in the LLLT-treated sites than in the non-LLLT sites (2.78 [2.05-4.50] vs. 4.68 [2.41-6.86]; p = 0.035). This difference was more pronounced on day 7 (0.35 [0.24-0.56] vs. 0.72 [0.41-1.28]; p < 0.001). By day 15, complete epithelialization was observed in both the groups. The wound healing scores were comparable between the groups at all time points (p > 0.05). VAS pain scores were significantly lower in LLLT-treated sites on day 3 (p = 0.001) and day 7 (p < 0.001), with no difference on day 15 (p = 0.083). Conclusion Adjunctive LLLT promoted faster early epithelialization and reduced postoperative pain following gingival depigmentation. Although overall wound healing outcomes were similar between groups, LLLT appears to be a useful adjunct for improving patient comfort and early healing.
The human cochlea is a fragile, spiral-shaped sensory organ for hearing that is deeply embedded within the dense otic capsule bone, making accurate post-mortem anatomical studies difficult when using conventional histological approaches requiring sectioning. X-ray microscopy (XRM) is a non-destructive radiological imaging modality that combines geometric and optical magnification to achieve high-resolution 3D visualization. Here, we evaluated the ability of XRM to resolve the entire inner ear, including delineating soft tissue and bony structures, in trimmed human temporal bones ex vivo following lumen perfusion with a reversible iodine-based contrast-enhancing solution. After optimizing contrast incubation conditions, XRM datasets were acquired, reconstructed, and used to generate 3D volume renderings of the inner ear. XRM enabled visualization of the entire cochlea and vestibular system, from millimeter-scale labyrinthine anatomy to submillimeter and micrometer-scale cochlear structures, including spiral ganglion nerve fiber bundles and sensory cell rows. Quantitative analysis in a representative case demonstrated an increasing width-to-height ratio of the organ of Corti from the basal to the apical cochlear turns, consistent with histology images and prior anatomical studies. These findings demonstrate that XRM provides high-resolution, sectioning-free ex vivo 3D visualization of human cochlear anatomy and may enable quicker and more faithful correlation of cochlear pathology with otologic disorders than traditional histology.
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To provide a step-by-step description of canine lip/alveolar cleft repair, describe intra- and postoperative complications, and report mid-term clinical, functional and cosmetic outcomes. Prospective study. A total of 10 client-owned puppies with unilateral or bilateral lip/alveolar clefts. Detailed clinical and historical data were recorded. The lip/alveolar clefts were repaired using a surgical technique adapted from human medicine including: (1) alveolar cleft and labial vestibulum repair, (2) cheilorhinoplasty and (3) palatal cleft repair when indicated. Intra- and postoperative complications, as well as clinical, functional and cosmetic outcomes, were recorded at 7 and 14 days and at a minimum of 3 months postoperatively. Cosmetic outcomes were evaluated using postoperative CT measurements. A total of 10 puppies (4 males, 6 females) were included. Of these, six presented with unilateral lip/alveolar clefts (2 right-sided and 4 left-sided) and four presented with bilateral clefts. A total of 14 lip/alveolar clefts were repaired. Four dogs had a complete secondary palate cleft. No intraoperative surgical complications were reported. Three cases of minor dehiscence of the cheilorhinoplasty suture line were observed, all healed by second intention within 14 days postoperatively. One case of oronasal communication on the hard palate was successfully treated with minor revision surgery. Successful clinical and functional outcomes were reported for all dogs at the 3-month postoperative evaluation. Overall cosmetic outcomes were rated as good to excellent. The described step-by-step surgical technique resulted in good to excellent clinical, functional, and cosmetic outcomes. This technique offers a new surgical treatment with a low complication rate.
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Multiple versions of the Knee Injury and Osteoarthritis Outcome Score (KOOS) are used in anterior cruciate ligament (ACL) populations, but their responsiveness and ceiling effects remain uncertain. This study aimed to evaluate the floor and ceiling effects, responsiveness and minimal important difference (MID) using the United Kingdom's National Ligament Registry (NLR). It was hypothesised that ceiling effects would increase over time, but would vary by KOOS version. A secondary analysis of the NLR (2012-2024) was performed including patients undergoing ACL reconstruction. We quantified floor and ceiling effects for KOOS5, KOOS4, KOOS-ACL, KOOSglobal. Responsiveness was assessed using Cohen's d and standardised response mean comparing pre-operative scores and follow-up scores (6 months, 1 year, 2 years and 5 years). MIDs were estimated using a distribution-based method (half of the baseline standard deviation). 14,660 participants completed baseline scores and were followed up. Large improvements were observed from baseline to 12 months (KOOS5 1.44 [95% confidence interval, CI, 1.40-1.48], KOOS4 1.54 [95% CI 1.50-1.59], KOOS-ACL 1.45 [95% CI 1.42-1.49] and KOOSglobal 1.81 [95% CI 1.74-1.87], followed by increased ceiling effects). At 12 months, ceiling effects (90-100 definition) were present for KOOS5 (30.46%), KOOS4 (24.60%) and KOOS-ACL composite (44.01%), and increased at 24 and 60 months. KOOSglobal demonstrated lower ceiling effects: 5.37% at 12 months and 13.38% at 60 months. Pre-operative floor effects were highest for sport/recreation (20.32%) and KOOS-ACL sport (19.68%). Estimated MIDs were 9.0 for KOOS5, 9.0 for KOOS4, 9.6 for pain, 9.7 for symptoms, 10.3 for activities, 13.6 for sport/recreation, 9.5 for quality of life, 10.1 for KOOS-ACL composite, 10.0 for KOOS-ACL function, 12.5 for KOOS-ACL sport, and 5.1 for KOOSglobal. Ceiling effects were observed for KOOS5, KOOS4 and KOOS-ACL from 12 months, suggesting a limited ability to distinguish between higher-functioning patients. KOOSglobal appears less susceptible to ceiling effects. Level III, cohort study.