Unfavorable Results of Partial Meniscectomy for Complete Posterior Medial Meniscus Root Tear With Early Osteoarthritis: A 5- to 8-Year Follow-Up Study
Purpose The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of arthroscopic partial meniscectomy for complete posterior medial meniscus root tear (PMMRT) in patients with early radiographic evidence of knee osteoarthritis at a minimum follow-up of 5 years. Meth...
Gespeichert in:
Veröffentlicht in: | Arthroscopy 2010-10, Vol.26 (10), p.1326-1332 |
---|---|
Hauptverfasser: | , , , , , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 1332 |
---|---|
container_issue | 10 |
container_start_page | 1326 |
container_title | Arthroscopy |
container_volume | 26 |
creator | Han, Seung Beom, M.D Shetty, Gautam M., M.S.Orth Lee, Dae Hee, M.D Chae, Dong Ju, M.D Seo, Seung Suk, M.D Wang, Kook Hyun, M.D Yoo, Si Hoon, M.D Nha, Kyung Wook, M.D |
description | Purpose The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of arthroscopic partial meniscectomy for complete posterior medial meniscus root tear (PMMRT) in patients with early radiographic evidence of knee osteoarthritis at a minimum follow-up of 5 years. Methods Forty-six cases had complete PMMRT with follow-up of at least 5 years and were treated with arthroscopic partial meniscectomy. On the basis of medical records, we reviewed the arthroscopic findings of joint degeneration (Outerbridge grading), clinical results using the modified Lysholm (ML) knee score and a patient questionnaire, and radiographic evaluation of degeneration using Kellgren-Lawrence (KL) grading. Results The incidence of complete PMMRT in the study population was 15%. At a mean follow-up of 78 months (range, 60 to 103 months), the mean ML score significantly improved from 72 (range, 62 to 78) preoperatively to 77 (range, 70 to 98) at final follow-up ( P < .01), 16 patients (35%) showed progression of degeneration from KL grade 0 to 2 preoperatively to KL grade 2 to 4, 56% of patients indicated improvement in pain, 67% of patients were satisfied with the results of the procedure, and 19% of patients underwent reoperation. There was a significant negative correlation between chondral wear during arthroscopy (ρ = −0.516, P = .002) and preoperative KL grade (ρ = −0.429, P = .004) with ML score at final follow-up. Conclusions Although arthroscopic partial meniscectomy for complete PMMRT significantly improved ML scores postoperatively, only 56% of patients had improvement in pain, 67% were satisfied with the outcome of the procedure, and 35% showed radiographic progression of osteoarthritis at a mean follow-up of 77 months. Level of Evidence Level IV, therapeutic study. |
doi_str_mv | 10.1016/j.arthro.2010.01.032 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_756663179</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0749806310001453</els_id><sourcerecordid>756663179</sourcerecordid><originalsourceid>FETCH-LOGICAL-c446t-d3fa0eff70c238faa563356fa08a7aba464f3e4cc88cb47d083330389839adba3</originalsourceid><addsrcrecordid>eNqFks9uEzEQxi0EoiHwBgj5gjhtsHf2j8MBqYragtSqVdsIcbIc71h1cNbB9hblRfq8eJtAJS6cLI1-8834-4aQt5zNOOPNx_VMhXQX_KxkucT4jEH5jEx4XTYFlMCfkwlrq3khWANH5FWMa8YYgICX5KhkQrRz4BPysOyNuvdBrRzSa4yDS5F6Q6-yuFWOXmBvo0ad_GZHjQ904TdbhwnplY8Jg82lC-ye0CHSa-8TvUUV6Deb7uiJCm5HLzPtHze2ycZP9JjWBU2eiuL7SJ565_yvYrmlN2nodq_JC6NcxDeHd0qWpye3iy_F-eXZ18XxeaGrqklFB0YxNKZlugRhlKobgLrJRaFatVJVUxnASmsh9KpqOyYAgIGYC5irbqVgSj7sdbfB_xwwJrkZv-uc6tEPUbZ10zTAs1dTUu1JHXyMAY3cBrtRYSc5k2Mgci33gcgxEMm4zIHktneHAcNqg93fpj8JZOD9AVBRK2eC6rWNTxxAxfmj0Oc9h9mOe4tBRm2x19n7kOORnbf_2-RfAe1sb_PMH7jDuPZD6LPVkstYSiZvxuMZb4fns-FVDfAbuqDBfQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>756663179</pqid></control><display><type>article</type><title>Unfavorable Results of Partial Meniscectomy for Complete Posterior Medial Meniscus Root Tear With Early Osteoarthritis: A 5- to 8-Year Follow-Up Study</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Han, Seung Beom, M.D ; Shetty, Gautam M., M.S.Orth ; Lee, Dae Hee, M.D ; Chae, Dong Ju, M.D ; Seo, Seung Suk, M.D ; Wang, Kook Hyun, M.D ; Yoo, Si Hoon, M.D ; Nha, Kyung Wook, M.D</creator><creatorcontrib>Han, Seung Beom, M.D ; Shetty, Gautam M., M.S.Orth ; Lee, Dae Hee, M.D ; Chae, Dong Ju, M.D ; Seo, Seung Suk, M.D ; Wang, Kook Hyun, M.D ; Yoo, Si Hoon, M.D ; Nha, Kyung Wook, M.D</creatorcontrib><description>Purpose The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of arthroscopic partial meniscectomy for complete posterior medial meniscus root tear (PMMRT) in patients with early radiographic evidence of knee osteoarthritis at a minimum follow-up of 5 years. Methods Forty-six cases had complete PMMRT with follow-up of at least 5 years and were treated with arthroscopic partial meniscectomy. On the basis of medical records, we reviewed the arthroscopic findings of joint degeneration (Outerbridge grading), clinical results using the modified Lysholm (ML) knee score and a patient questionnaire, and radiographic evaluation of degeneration using Kellgren-Lawrence (KL) grading. Results The incidence of complete PMMRT in the study population was 15%. At a mean follow-up of 78 months (range, 60 to 103 months), the mean ML score significantly improved from 72 (range, 62 to 78) preoperatively to 77 (range, 70 to 98) at final follow-up ( P < .01), 16 patients (35%) showed progression of degeneration from KL grade 0 to 2 preoperatively to KL grade 2 to 4, 56% of patients indicated improvement in pain, 67% of patients were satisfied with the results of the procedure, and 19% of patients underwent reoperation. There was a significant negative correlation between chondral wear during arthroscopy (ρ = −0.516, P = .002) and preoperative KL grade (ρ = −0.429, P = .004) with ML score at final follow-up. Conclusions Although arthroscopic partial meniscectomy for complete PMMRT significantly improved ML scores postoperatively, only 56% of patients had improvement in pain, 67% were satisfied with the outcome of the procedure, and 35% showed radiographic progression of osteoarthritis at a mean follow-up of 77 months. Level of Evidence Level IV, therapeutic study.</description><identifier>ISSN: 0749-8063</identifier><identifier>EISSN: 1526-3231</identifier><identifier>DOI: 10.1016/j.arthro.2010.01.032</identifier><identifier>PMID: 20887931</identifier><identifier>CODEN: ARTHE3</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Arthroscopy ; Biological and medical sciences ; Cartilage, Articular - anatomy & histology ; Cartilage, Articular - injuries ; Diseases of the osteoarticular system ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Magnetic Resonance Imaging - methods ; Male ; Medical sciences ; Menisci, Tibial - surgery ; Middle Aged ; Orthopedic surgery ; Orthopedics ; Osteoarthritis ; Osteoarthritis - complications ; Osteoarthritis - surgery ; Patient Satisfaction ; Reoperation - statistics & numerical data ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surveys and Questionnaires ; Tibial Meniscus Injuries ; Time Factors ; Treatment Failure</subject><ispartof>Arthroscopy, 2010-10, Vol.26 (10), p.1326-1332</ispartof><rights>2010</rights><rights>2015 INIST-CNRS</rights><rights>Crown Copyright © 2010. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c446t-d3fa0eff70c238faa563356fa08a7aba464f3e4cc88cb47d083330389839adba3</citedby><cites>FETCH-LOGICAL-c446t-d3fa0eff70c238faa563356fa08a7aba464f3e4cc88cb47d083330389839adba3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.arthro.2010.01.032$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23341132$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20887931$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Han, Seung Beom, M.D</creatorcontrib><creatorcontrib>Shetty, Gautam M., M.S.Orth</creatorcontrib><creatorcontrib>Lee, Dae Hee, M.D</creatorcontrib><creatorcontrib>Chae, Dong Ju, M.D</creatorcontrib><creatorcontrib>Seo, Seung Suk, M.D</creatorcontrib><creatorcontrib>Wang, Kook Hyun, M.D</creatorcontrib><creatorcontrib>Yoo, Si Hoon, M.D</creatorcontrib><creatorcontrib>Nha, Kyung Wook, M.D</creatorcontrib><title>Unfavorable Results of Partial Meniscectomy for Complete Posterior Medial Meniscus Root Tear With Early Osteoarthritis: A 5- to 8-Year Follow-Up Study</title><title>Arthroscopy</title><addtitle>Arthroscopy</addtitle><description>Purpose The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of arthroscopic partial meniscectomy for complete posterior medial meniscus root tear (PMMRT) in patients with early radiographic evidence of knee osteoarthritis at a minimum follow-up of 5 years. Methods Forty-six cases had complete PMMRT with follow-up of at least 5 years and were treated with arthroscopic partial meniscectomy. On the basis of medical records, we reviewed the arthroscopic findings of joint degeneration (Outerbridge grading), clinical results using the modified Lysholm (ML) knee score and a patient questionnaire, and radiographic evaluation of degeneration using Kellgren-Lawrence (KL) grading. Results The incidence of complete PMMRT in the study population was 15%. At a mean follow-up of 78 months (range, 60 to 103 months), the mean ML score significantly improved from 72 (range, 62 to 78) preoperatively to 77 (range, 70 to 98) at final follow-up ( P < .01), 16 patients (35%) showed progression of degeneration from KL grade 0 to 2 preoperatively to KL grade 2 to 4, 56% of patients indicated improvement in pain, 67% of patients were satisfied with the results of the procedure, and 19% of patients underwent reoperation. There was a significant negative correlation between chondral wear during arthroscopy (ρ = −0.516, P = .002) and preoperative KL grade (ρ = −0.429, P = .004) with ML score at final follow-up. Conclusions Although arthroscopic partial meniscectomy for complete PMMRT significantly improved ML scores postoperatively, only 56% of patients had improvement in pain, 67% were satisfied with the outcome of the procedure, and 35% showed radiographic progression of osteoarthritis at a mean follow-up of 77 months. Level of Evidence Level IV, therapeutic study.</description><subject>Arthroscopy</subject><subject>Biological and medical sciences</subject><subject>Cartilage, Articular - anatomy & histology</subject><subject>Cartilage, Articular - injuries</subject><subject>Diseases of the osteoarticular system</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Menisci, Tibial - surgery</subject><subject>Middle Aged</subject><subject>Orthopedic surgery</subject><subject>Orthopedics</subject><subject>Osteoarthritis</subject><subject>Osteoarthritis - complications</subject><subject>Osteoarthritis - surgery</subject><subject>Patient Satisfaction</subject><subject>Reoperation - statistics & numerical data</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surveys and Questionnaires</subject><subject>Tibial Meniscus Injuries</subject><subject>Time Factors</subject><subject>Treatment Failure</subject><issn>0749-8063</issn><issn>1526-3231</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFks9uEzEQxi0EoiHwBgj5gjhtsHf2j8MBqYragtSqVdsIcbIc71h1cNbB9hblRfq8eJtAJS6cLI1-8834-4aQt5zNOOPNx_VMhXQX_KxkucT4jEH5jEx4XTYFlMCfkwlrq3khWANH5FWMa8YYgICX5KhkQrRz4BPysOyNuvdBrRzSa4yDS5F6Q6-yuFWOXmBvo0ad_GZHjQ904TdbhwnplY8Jg82lC-ye0CHSa-8TvUUV6Deb7uiJCm5HLzPtHze2ycZP9JjWBU2eiuL7SJ565_yvYrmlN2nodq_JC6NcxDeHd0qWpye3iy_F-eXZ18XxeaGrqklFB0YxNKZlugRhlKobgLrJRaFatVJVUxnASmsh9KpqOyYAgIGYC5irbqVgSj7sdbfB_xwwJrkZv-uc6tEPUbZ10zTAs1dTUu1JHXyMAY3cBrtRYSc5k2Mgci33gcgxEMm4zIHktneHAcNqg93fpj8JZOD9AVBRK2eC6rWNTxxAxfmj0Oc9h9mOe4tBRm2x19n7kOORnbf_2-RfAe1sb_PMH7jDuPZD6LPVkstYSiZvxuMZb4fns-FVDfAbuqDBfQ</recordid><startdate>20101001</startdate><enddate>20101001</enddate><creator>Han, Seung Beom, M.D</creator><creator>Shetty, Gautam M., M.S.Orth</creator><creator>Lee, Dae Hee, M.D</creator><creator>Chae, Dong Ju, M.D</creator><creator>Seo, Seung Suk, M.D</creator><creator>Wang, Kook Hyun, M.D</creator><creator>Yoo, Si Hoon, M.D</creator><creator>Nha, Kyung Wook, M.D</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20101001</creationdate><title>Unfavorable Results of Partial Meniscectomy for Complete Posterior Medial Meniscus Root Tear With Early Osteoarthritis: A 5- to 8-Year Follow-Up Study</title><author>Han, Seung Beom, M.D ; Shetty, Gautam M., M.S.Orth ; Lee, Dae Hee, M.D ; Chae, Dong Ju, M.D ; Seo, Seung Suk, M.D ; Wang, Kook Hyun, M.D ; Yoo, Si Hoon, M.D ; Nha, Kyung Wook, M.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c446t-d3fa0eff70c238faa563356fa08a7aba464f3e4cc88cb47d083330389839adba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Arthroscopy</topic><topic>Biological and medical sciences</topic><topic>Cartilage, Articular - anatomy & histology</topic><topic>Cartilage, Articular - injuries</topic><topic>Diseases of the osteoarticular system</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Menisci, Tibial - surgery</topic><topic>Middle Aged</topic><topic>Orthopedic surgery</topic><topic>Orthopedics</topic><topic>Osteoarthritis</topic><topic>Osteoarthritis - complications</topic><topic>Osteoarthritis - surgery</topic><topic>Patient Satisfaction</topic><topic>Reoperation - statistics & numerical data</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surveys and Questionnaires</topic><topic>Tibial Meniscus Injuries</topic><topic>Time Factors</topic><topic>Treatment Failure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Han, Seung Beom, M.D</creatorcontrib><creatorcontrib>Shetty, Gautam M., M.S.Orth</creatorcontrib><creatorcontrib>Lee, Dae Hee, M.D</creatorcontrib><creatorcontrib>Chae, Dong Ju, M.D</creatorcontrib><creatorcontrib>Seo, Seung Suk, M.D</creatorcontrib><creatorcontrib>Wang, Kook Hyun, M.D</creatorcontrib><creatorcontrib>Yoo, Si Hoon, M.D</creatorcontrib><creatorcontrib>Nha, Kyung Wook, M.D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Arthroscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Han, Seung Beom, M.D</au><au>Shetty, Gautam M., M.S.Orth</au><au>Lee, Dae Hee, M.D</au><au>Chae, Dong Ju, M.D</au><au>Seo, Seung Suk, M.D</au><au>Wang, Kook Hyun, M.D</au><au>Yoo, Si Hoon, M.D</au><au>Nha, Kyung Wook, M.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Unfavorable Results of Partial Meniscectomy for Complete Posterior Medial Meniscus Root Tear With Early Osteoarthritis: A 5- to 8-Year Follow-Up Study</atitle><jtitle>Arthroscopy</jtitle><addtitle>Arthroscopy</addtitle><date>2010-10-01</date><risdate>2010</risdate><volume>26</volume><issue>10</issue><spage>1326</spage><epage>1332</epage><pages>1326-1332</pages><issn>0749-8063</issn><eissn>1526-3231</eissn><coden>ARTHE3</coden><abstract>Purpose The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of arthroscopic partial meniscectomy for complete posterior medial meniscus root tear (PMMRT) in patients with early radiographic evidence of knee osteoarthritis at a minimum follow-up of 5 years. Methods Forty-six cases had complete PMMRT with follow-up of at least 5 years and were treated with arthroscopic partial meniscectomy. On the basis of medical records, we reviewed the arthroscopic findings of joint degeneration (Outerbridge grading), clinical results using the modified Lysholm (ML) knee score and a patient questionnaire, and radiographic evaluation of degeneration using Kellgren-Lawrence (KL) grading. Results The incidence of complete PMMRT in the study population was 15%. At a mean follow-up of 78 months (range, 60 to 103 months), the mean ML score significantly improved from 72 (range, 62 to 78) preoperatively to 77 (range, 70 to 98) at final follow-up ( P < .01), 16 patients (35%) showed progression of degeneration from KL grade 0 to 2 preoperatively to KL grade 2 to 4, 56% of patients indicated improvement in pain, 67% of patients were satisfied with the results of the procedure, and 19% of patients underwent reoperation. There was a significant negative correlation between chondral wear during arthroscopy (ρ = −0.516, P = .002) and preoperative KL grade (ρ = −0.429, P = .004) with ML score at final follow-up. Conclusions Although arthroscopic partial meniscectomy for complete PMMRT significantly improved ML scores postoperatively, only 56% of patients had improvement in pain, 67% were satisfied with the outcome of the procedure, and 35% showed radiographic progression of osteoarthritis at a mean follow-up of 77 months. Level of Evidence Level IV, therapeutic study.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>20887931</pmid><doi>10.1016/j.arthro.2010.01.032</doi><tpages>7</tpages></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0749-8063 |
ispartof | Arthroscopy, 2010-10, Vol.26 (10), p.1326-1332 |
issn | 0749-8063 1526-3231 |
language | eng |
recordid | cdi_proquest_miscellaneous_756663179 |
source | MEDLINE; Elsevier ScienceDirect Journals Complete |
subjects | Arthroscopy Biological and medical sciences Cartilage, Articular - anatomy & histology Cartilage, Articular - injuries Diseases of the osteoarticular system Endoscopy Female Follow-Up Studies Humans Investigative techniques, diagnostic techniques (general aspects) Magnetic Resonance Imaging - methods Male Medical sciences Menisci, Tibial - surgery Middle Aged Orthopedic surgery Orthopedics Osteoarthritis Osteoarthritis - complications Osteoarthritis - surgery Patient Satisfaction Reoperation - statistics & numerical data Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surveys and Questionnaires Tibial Meniscus Injuries Time Factors Treatment Failure |
title | Unfavorable Results of Partial Meniscectomy for Complete Posterior Medial Meniscus Root Tear With Early Osteoarthritis: A 5- to 8-Year Follow-Up Study |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-02T14%3A42%3A12IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Unfavorable%20Results%20of%20Partial%20Meniscectomy%20for%20Complete%20Posterior%20Medial%20Meniscus%20Root%20Tear%20With%20Early%20Osteoarthritis:%20A%205-%20to%208-Year%20Follow-Up%20Study&rft.jtitle=Arthroscopy&rft.au=Han,%20Seung%20Beom,%20M.D&rft.date=2010-10-01&rft.volume=26&rft.issue=10&rft.spage=1326&rft.epage=1332&rft.pages=1326-1332&rft.issn=0749-8063&rft.eissn=1526-3231&rft.coden=ARTHE3&rft_id=info:doi/10.1016/j.arthro.2010.01.032&rft_dat=%3Cproquest_cross%3E756663179%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=756663179&rft_id=info:pmid/20887931&rft_els_id=S0749806310001453&rfr_iscdi=true |