bluuebunny/crossref_metadata_2025 huggingface dataset:
Poor Static Balance is a Novel Risk Factor for Non-contact Anterior Cruciate Ligament Injury
Authors: Oshima Takeshi , Nakase Junsuke , Takata Yasushi , Numata Hitoaki , Tsuchiya Hiroyuki
Published: August 2015

Objectives:

The anterior cruciate ligament (ACL) injury is common and affects young individuals, particularly female, who are active in sports that involve jumping, pivoting, as well as change of direction. ACL injury is associated with potential long-term complications including reduction in activity levels and osteoarthritis. In recent years, the focus on the ACL injury prevention has increased and many studies exploring risk factors for ACL injury have been published. However, the influence of the static balance on ACL injuries is poorly documented. The purpose of this study was to investigate the relationship between the static balance and incidence of ACL injury among high school female athletes.

Methods:

A 3-year prospective cohort study was conducted with 287 high school female handball or basketball players. All subjects were 15 years old and included 111 handball players and 176 basketball players. At baseline, using gravicorder, postural sway was measured for 30 seconds during two-leg standing with eye open. The measured parameters of postural sway were locus length per time (LG), which indicates postural control function by proprioceptive reflexes, and environmental area (AR), which indicates the degree of equilibrium impairment. After the baseline examination was performed at high school entry, all players were followed for 36 months to register any subsequent incidence of ACL injury. We compared the differences in the static balance between injured and uninjured players using an unpaired t-test. Values of p < 0.05 were considered statistically significant.

Results:

In the present study, 28 of the 287 players (9.6%) suffered an ACL injury during the 3-year observation period. Two players suffered both knees. Twenty five injured players sustained a non-contact injury and three injured players sustained a contact injury. Sixteen players were injured during the game and other players were injured during the practice. In this study three contact injury players were excluded. There were not significantly different between the ACL injured group and uninjured group in the stature characteristics such as age, height and weight. The mean values for LG and AR for the two-leg standing of the eye-open test were 1.30 ± 0.36 cm/s and 2.44 ± 1.34cm2 (ACL injured group), 1.15 ± 0.26 cm/s and 1.98 ± 1.02 cm2 (uninjured group). There was significantly difference between the injured group and uninjured group in LG (p = 0.045). However there was no significant difference two groups in AR (P = 0.107). (Table1)

Conclusion:

In the present study, locus length per time was significantly longer in injured players compared with uninjured players. This result showed that the postural control function by proprioceptive reflexes is the one of the risk factors for non-contact ACL injury. The proprioceptive training may be effective in ACL prevention with clinical relevance.
Biomechanical Consequences of Lateral Meniscal Posterior Root Avulsions
Authors: Geeslin Andrew G. , Civitarese David Marc , Turnbull Travis L. , Dornan Grant , Fuso Fernando , LaPrade Robert F.
Published: August 2015

Objectives:

Lateral meniscal posterior root avulsions are commonly found with anterior cruciate ligament (ACL) tears. The purpose of this study was to investigate the biomechanical effects of lateral meniscal posterior root avulsions with and without intact meniscofemoral ligaments (MFLs), and with concurrent ACL tears, on lateral compartment contact mechanics.

Methods:

A controlled laboratory study was performed using ten nonpaired fresh-frozen cadaveric knees. Tekscan sensors were used to simultaneously measure contact area and pressure (Figure) in the lateral and medial compartments. Specimens were tested with 6 conditions (1: Intact; 2: Lateral meniscal posterior root avulsion; 3: Root avulsion and torn MFL; 4: Condition 3 with ACL tear; 5: Condition 4 with ACL reconstruction; 6: ACL reconstruction with root repair) at 5 flexion angles (0, 30, 45, 60, and 90 degrees), under a 1000 N axial load.

Results:

Compared to the intact state, condition 2 did not significantly alter lateral compartment contact area or pressure (p < 0.05). A significant decrease in contact area and increase in mean contact pressure occurred in condition 3. Conditions 4 and 5 (ACL tear and reconstruction of the ACL, respectively, both with deficient MFLs and lateral meniscal posterior root avulsion) also produced significantly lower contact areas than the intact condition (p < 0.05), and were not substantially different than Condition 3 (Figure). Changes in contact mechanics tended to be greater at increased flexion angles; for condition 3 at 0 and 90 degrees, contact area decreased 37% and 52% (95% CI [21,53] and [39,66], respectively) and mean contact pressure increased 55% and 87% (95% CI [33,76] and [59,114], respectively). Condition 6 (root repair with ACL reconstruction) was not significantly different from the intact state (p < 0.05).

Conclusion:

The meniscofemoral ligaments protect the lateral compartment from changes in contact mechanics in the setting of a lateral meniscal posterior root avulsion, whereas combined lateral meniscal root avulsion and deficient meniscofemoral ligaments leads to substantial changes. Concurrent ACL reconstruction and root repair restores contact area and mean contact pressure to the intact state.
Evaluation Of Three-Dimensional Motion During Side-step Cutting After Anterior Cruciate Ligament Reconstruction in Pediatric Athletes
Authors: Pace James Lee , Mueske Nicole , Katzel Mia , Zaslow Tracy , Chua Matthew , Wren Tishya , Zaslow Tracy
Published: August 2015

Objectives:

This study assessed three-dimensional kinematic and kinetic data during side-step cutting in young athletes following anterior cruciate ligament (ACL) reconstruction.

Methods:

The study included 28 pediatric athletes (mean age 15.6 ± 2.2 years) who underwent ACL reconstruction due to a non-contact injury. Lower extremity and trunk three-dimensional kinematic and kinetic data was collected during a side-step cut. Testing occurred within 12 months (mean time since surgery 5.3 ± 2.1 months) post-surgery. Outcomes were evaluated at initial foot contact and between initial foot contact and maximum knee flexion of the cutting limb. Differences between the operative limb and non-operative (contralateral) limb were investigated using paired t-tests.

Results:

The operative limb had higher peak adduction (-0.14° ± 7.3 vs. -6.1° ± 5.0, p=0.001) and higher peak pelvic obliquity (14.0° ±6.2 vs. 10.5° ±5.7, p=0.01) compared to the non-operative limb. While there was no significant difference in peak ground reaction force (23.2 N/kg ± 4.7 vs. 24.5 N/kg ± 4.5, p=0.15), the operative limb had lower peak knee flexion (53.3° ± 13.5 vs. 59.6° ±10.0, p=0.004), ankle dorsiflexion (14.5° ± 7.5 vs. 18.6° ± 6.5, p=0.007), and external knee flexor moment (1.4 Nm/kg ± 0.61 vs. 1.9 Nm/kg ± 0.62, p=0.002) leading to the operative limb having less power absorption at the knee (0.38 Ws/kg ± 0.31 vs. 0.58 Ws/kg ± 0.28, p=0.005). At initial contact the operative limb was more adducted (-5.0° ± 7.6 vs. -8.6° ± 3.9; p=0.02) and flexed (56.3° ± 11.4 vs. 52.5° ± 12.7; 0.06) at the hip and more flexed at the knee (21.5° ± 17.1 vs. 17.2° ± 13.6; p=0.06). The operative limb also had more pelvic elevation (8.1° ± 7.0 vs. 5.5° ± 3.8; p=0.04) and had more trunk rotation (rotation relative to the lab; -11.4° ±7.2 vs. -5.3° ±8.6; p=0.004). Eight of the 28 operative limbs had an asymmetry greater than 10% of the non-operative limb on one of the kinematic or kinetic variables; though all eight limb asymmetries occurred on different movement variables.

Conclusion:

Following ACL reconstruction pediatric athletes exhibit asymmetry several months post-surgery. The operative limb displayed deficits and asymmetry in hip control and shock absorption strategies after initial contact until maximum knee flexion which could increase the risk of future re-injury based on prior biomechanical studies. The contralateral limb also demonstrated deficits and asymmetries at initial contact. These asymmetrical movement patterns and deficits potentially put the non-operative limbs at an increased risk for injury and potentially lend insight into why patients who tear one ACL are at increased risk of contralateral ACL injury. If asymmetry is indicative of future injury risk, this should be considered during treatment, rehabilitation and return to sport decision-making.
Trends in Articular Cartilage Treatments of the Knee
Authors: Westermann Robert W. , Duchman Kyle R. , Amendola Annunziato
Published: August 2015

Objectives:

Full-thickness articular cartilage defects of the knee are often encountered during arthroscopy. Management likely varies between surgeons and may include chondroplasty, microfracture, or osteochondral grafting procedures. The purpose of this study is to evaluate the trends in treatment of articular cartilage lesions over the past decade using data obtained from the ABOS database.

Methods:

The American Board of Orthopaedic Surgery part II database was queried from 2004 through 2013. Cases involving Common Procedural Terminology (CPT) codes representing chondroplasty (29877), microfracture (29879), and osteochondral grafting procedures (27415, 27416, 29866, 29867) were selected. Surgical cases were categorized by year and by surgeon and patient variables provided by the database. Surgeon-specific variables of interest will include determination of fellowship training status. Patient-specific variables of interest will include age. Univariate analysis including chi-square test for categorical variables and Student's t-test for continuous variables will be performed to determine any significant changes in practice patterns based on the location and year of the procedure as well as previously noted surgeon- and patient-specific variables. The level of significance will be set to p < 0.05.

Results:

Between 2004-2013, 27,707 procedures addressing articular cartilage lesions were identified in the ABOS database. Overall, the reported surgical volume for treatment of articular cartilage lesions of the knee has decreased from 3126 cases/year in 2004 to 1690 cases/year in 2013. The most common procedure performed overall was chondroplasty (76.0%) followed by microfracture (19.9%) and Osteochondral grafting procedures (4%). The mean age of patients undergoing chondroplasty was 46.9; this was significantly higher than microfracture (mean age 40.5) or Osteochondral grafting procedures (mean age 31.6), p<0.0005. The age of patients undergoing chondroplasty, microfracture and Osteochondral grafting procedures significantly decreased between 2004-2013 (p<0.0001). The volume of microfracture has gradually decreased over time. A sharp decrease in reported chondroplasty procedures was observed between 2011 and 2012, and that trend has continued. A sharp increase in the utilization of Osteochondral grafting was observed beginning in 2011 by fellowship trained sports medicine surgeons.

Conclusion:

The overall decrease in surgical volume for articular cartilage treatments of the knee appears to be driven by a sharp decline in the use of chondroplasty since 2011. The average age of patients undergoing procedures addressing articular cartilage defects is decreasing. The volume of osteochondral grafting procedures has remained steady, and may be increasing; this is most pronounced in surgeons with sports medicine fellowship training.
Hyaluronic Acid versus Platelet-Rich Plasma
Authors: Cole Brian J. , Fortier Lisa A. , Karas Vasili , Hussey Kristen Elizabeth , Tilton Annemarie K. , Merkow David B. , Verma Nikhil N. , Bach Bernard R. , Forsythe Brian
Published: August 2015

Objectives:

Osteoarthritis (OA) is a debilitating disease that, in some form, affects up to 47 million Americans each year and is estimated to affect 67 million by 2030. Hyaluronic acid (HA) is currently utilized as an intra-articular injection for treatment of patients with knee OA. A movement in biochemical research has emerged that focuses on analysis of catabolic and anabolic growth factors of the joint. It is proposed that platelet-rich plasma (PRP) is a biologic alternative to HA that may alter the intra-articular biologic milieu to mitigate the symptoms of OA. The purpose of this double-blind prospective randomized clinical trial is to compare the effects of PRP to HA for the treatment of OA in the knee using validated clinical outcome measures and biologic correlates associated with OA.

Methods:

Patients with a minimum of 3 months of symptomatic unilateral knee OA and Kellgren-Lawrence Grade 1-3 OA were randomized into two cohorts. One cohort received three weekly ultrasound-guided injections of HA and the other received three weekly injections of PRP. Patients in both cohorts were seen again at 6-, 12-, and 24-weeks following their index treatment. At each visit, including the treatment and index visits, patients completed a survey that included Lysholm, IKDC, WOMAC, and VAS pain, and underwent a clinical examination. Patients also underwent an ultrasound-guided aspiration of the knee for synovial fluid analysis during each of the treatment visits and at 3-month and 6-month follow up. Synovial fluid was grouped and analyzed via ELISA assay.

Results:

111 patients (mean age 56.2 +/- 10.2 years; 53 male, 58 female) met inclusion criteria and were randomized into either the HA or PRP cohort. Eleven (9.9 %) patients were lost to follow-up or unwilling to complete the study. In all of the scales measured, outcomes improved significantly from the index visit at 6 months post treatment (p<.01). PRP had a higher IKDC (p<.02) at 6-month follow up when compared to HA. Patients in the PRP group also reported lower VAS pain scores at 6-month follow up as well (p<.01). The remainder of the outcome measures (Lysholm, WOMAC) demonstrated trends toward greater improvement in the PRP group but did not demonstrate statistical significance. Synovial fluid aspirated was analyzed using ELISA assay for catabolic factors TNF-α, IL-1B/IL-F2, IL-1ra/IL-1F3, IL-6, and CXCL8/IL-8. The PRP cohort had significantly higher IL-6 concentration than the HA cohort at 6-month follow up (p=.02). The PRP and HA groups were not found to have significant differences in concentrations of the other catabolic factors analyzed.

Conclusion:

The findings of this study support a significant improvement of pain and function at 6 months with the use of intra-articular PRP as well as HA for the treatment of OA. Findings further suggest that PRP may be a superior treatment for the active patient with OA.
Outcomes of 1038 Hip Arthroscopies
Authors: Lodhia Parth , Martin Tim , Gui Chengcheng , Stake Christine E. , Vemula S Pavan , Suarez-Ahedo Carlos , Chandrasekaran Sivashankar , Domb Benjamin G.
Published: August 2015

Objectives:

The purpose of this study was to evaluate clinical outcomes, pain, and patient satisfaction following all hip arthroscopies performed by a single surgeon at a high volume referral center with a mean 2-year follow-up.

Methods:

During the study period, February 2008 to June 2012, data were collected on all patients undergoing hip arthroscopy. All patients were assessed pre- and post-operatively with 4 patient-reported outcome (PRO) measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sport Specific Subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS). Patient satisfaction was measured on a scale from 0 to 10. The number of patients who underwent revision arthroscopy, total hip arthroplasty, or a resurfacing procedure during the study period is also reported for primary and revision hip arthroscopies.

Results:

One thousand and thirty eight patients underwent hip arthroscopy during the study period. The score improvement from preoperative to 2-year follow-up was 60.9 to 77.6 for mHHS, 62.8 to 78.9 for HOS-ADL, 40.0 to 63.43 for HOS-SSS, 57.4 to 76.2 for NAHS. VAS decreased from 5.86 preoperatively to 3.15 postoperatively. All scores demonstrated statistically significant improvement (p<0.001). Overall patient satisfaction was 7.57. One hundred and seven (10.3%) patients underwent revision hip arthroscopy during the study period. Sixty-three (6.07%) patients underwent either total hip arthroplasty (THA) or hip resurfacing (HR) procedures during the study period. Of these, 51 (5.48%) were after primary hip arthroscopies and 12 (11.2%) were after revision hip arthroscopies suggesting a relative risk of 2.05 for a THA/HR after revision procedures. Figure 1 shows a Kaplan-Meier survivorship curve for patients who underwent primary and revision hip arthroscopies with THA/HR. The overall complication rate was 5.5%.

Conclusion:

Hip arthroscopy for all indications results in improved clinical outcomes, decreased pain, and high satisfaction at a mean 2-year follow-up. Patients should be counseled regarding the potential progression of degenerative change leading to arthroplasty, and the potential for revision surgery.
Does Revision Hip Arthroscopy Result in Improved Clinical Outcomes? - A 2-Year Clinical Follow-up On All Revision Hip Arthroscopies Performed at a High Volume Referral Center
Authors: Gupta Asheesh , Redmond John M. , Dunne Kevin F. , Stake Christine E. , Domb Benjamin G.
Published: August 2015

Objectives:

The purpose of this study was to evaluate clinical outcomes, pain, and patient satisfaction following revision hip arthroscopy at a high volume referral center with a minimum 2-year follow-up.

Methods:

During the study period, April 2008 to October 2011, data was prospectively collected on all patients undergoing revision hip arthroscopy. All patients were assessed pre- and post-operatively with 4 patient-reported outcome (PRO) measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sport Specific Subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS). Patient satisfaction was measured on a scale from 0 to 10.

Results:

Eighty-seven patients underwent revision hip arthroscopy during the study period. Seventy (80.5%) patients were included in our study. In terms of residual FAI morphology, 45.7% of patients had preoperative alpha angles ≥55 degrees and 7.14% of patients had a LCEA ≥40 degrees. The score improvement from preoperative to 2-year follow-up was 57.84 to 73.65 for mHHS, 62.79 to 83.04 for HOS-ADL, 37.33 to 54.93 for HOS-SSS, 55.65 to 70.79 for NAHS. VAS decreased from 6.72 preoperatively to 4.08 postoperatively. All scores demonstrated statistically significant improvement (P<.001). Overall patient satisfaction was 7.67. Our success rate was 74.58% for primary revision hip arthroscopy and 100% for secondary revision hip arthroscopy. Ten (14.29%) patients underwent total hip arthroplasty during the study period. Our hip survivorship was 85.7%. Five (7.14%) patients underwent secondary revision hip arthroscopy during the study period. We found an overall minor complication rate of 10%.

Conclusion:

Revision hip arthroscopy for all procedures performed on aggregate has excellent clinical outcomes for all PROs and patient satisfaction scores at short-term follow-up. Patients should be counseled regarding the potential progression of degenerative change leading to arthroplasty, and the potential for revision surgery.
Foot Progression Angle Walking Test- An Effective Dynamic Test for the Diagnosis of Femoroacetabular Impingement and Hip Instability
Authors: Ranawat Anil S. , Park Caroline , Licatesi Thomas , Rebolledo Brian J. , Satalich James
Published: August 2015

Objectives:

Clinical diagnosis of femoroacetabular impingement (FAI) and hip instability is determined by accurate history, physical examination, and imaging assessment. Currently, there is no ideal physical examination maneuver and certainly no dynamic method of testing. In this prospective study, we evaluate the Foot Progression Angle Walking (FPAW) test as a novel diagnostic tool that is sensitive and specific for the detection of FAI and hip instability.

Methods:

A prospective cohort of patients who presented with hip pain underwent FPAW testing in addition to the gold standard assessments for impingement and instability, the Flexion Adduction and Internal Rotation (FADIR) test and the Abduction and External Rotation (ABER) test, respectively. Baseline foot progression angles were initially recorded. Patients were then instructed to walk with foot progression angles: 1) internally rotated (-15º) and 2) externally rotated (+15º). A positive FPAW test was defined by an increase in hip pain with either internal or external rotation. Radiographs and/or magnetic resonance imaging were then used to evaluate for abnormal hip morphology and confirm diagnosis.

Results:

80 patients (53 Female) with hip pain were evaluated by FPAW testing. Imaging used to assess for hip pathology exhibited FAI (n=48), instability (n=26) and normal anatomic morphology (n=13). Baseline measurements showed a neutral foot progression (64%), out-toeing gait (35%), and in-toeing gait (1%). Analysis of FPAW testing showed a sensitivity of 75% and specificity of 66% for FAI; sensitivity 54% and specificity 61% for instability. A positive predictive value (FAI: 77%; Instability 40%) and negative predictive value (FAI 64%; Instability 73%) were also determined. In comparison, the FADIR test showed a sensitivity and specificity of 96% and 13% for FAI, respectively. Its positive predictive value was 62% while its negative predictive value was 67%. Abduction and external rotation testing showed a sensitivity and specificity of 42% and 96%, respectively for diagnosing instability. Its positive predictive value was 85% and negative predictive value was 78%.

Conclusion:

FPAW testing was found to be more sensitive and specific for detecting FAI than instability. The higher specificity and positive predictive value of FPAW in comparison to the FADIR test makes it a reliable tool to identify patients with impingement. The FPAW test appears to be an effective tool to reproduce hip pathology in FAI patients during weight-bearing activity and could be a useful adjunct to give further clinical prospective in FAI and hip instability.
Risk Factors for Early Conversion to Total Hip Arthroplasty following Hip Arthroscopy
Authors: Redmond John M. , Gupta Asheesh , Dunne Kevin Fanning , Stake Christine E. , Domb Benjamin G.
Published: August 2015

Objectives:

The most common reason for reoperation following arthroscopic hip surgery is conversion to total hip arthroplasty (THA). The purpose of this study was to identify clinical and radiographic risk factors for early conversion to THA.

Methods:

Data were prospectively collected on all hip arthroscopy patients from January 2009 through December 2011. Inclusion criteria for the study group were patients undergoing hip arthroscopy for a labral tear who eventually converted to THA. Patients were then compared to a control group of patients who underwent hip arthroscopy for a labral tear and did not convert to THA during the same period. Exclusion criteria were patients with previous hip conditions such as Legg-Calves-Perthes, slipped capital femoral epiphysis, pigmented villonodular synovitis, and avascular necrosis. A bivariate analysis of 41 preoperative and intraoperative variables was performed.

Results:

A total of 792 patients met inclusion and exclusion criteria. A total of 72 (9%) converted to THA. The control group consisted of 720 patients who did not convert to THA. Bivariate analysis demonstrated that the study group had significantly higher means or frequencies than the control group for the following variables: male gender, age at time of surgery, BMI, back pain, previous back surgery, Tönnis grade above 0, acetabular inclination angle, alpha angle, Seldes combined-type labral tear, labral tear size, chondral injury, traction time, labral debridement (versus repair), number of anchors used repair or reconstruction, and capsular release (versus repair). The study group had significantly lower means or frequencies than the control group for the following variables: preoperative patient reported outcome scores, crossover sign, lateral center edge angle, and psoas release. A statistically significant difference in average joint space was not observed.

Conclusion:

Multiple risk factors are possible preoperative and intraoperative risk factors for conversion to THA following hip arthroscopy. The clinician and patient should be aware of these variables.
Stability of the Glenohumeral Joint with Combined Humeral Head and Glenoid Defects
Authors: Gottschalk Lionel , Walia Piyush , Patel Ronak Maneklal , Kuklis Matthew , Jones Morgan H. , Fening Stephen D. , Miniaci Anthony
Published: August 2015

Objectives:

Shoulders with recurrent anterior shoulder instability often have combined defects of the humeral head and glenoid. The aim of this study is to define the relationship of combined humeral head and glenoid defects on anterior shoulder instability. We hypothesize that combined humeral head and glenoid defects will produce greater instability than either defect found alone, and that the size of humeral head and glenoid defects which are “critical” and need to be repaired in order to restore glenohumeral stability will be smaller when the defects are found together than when either defect is found alone.

Methods:

Eighteen shoulder specimens (mean age 57 years) were tested at 60° of glenohumeral abduction and 80° of glenohumeral external rotation (equivalent to 90° of abduction and 90° of external rotation relative to the trunk). Humeral head defect sizes included 6%, 19%, 31%, and 44% of the humeral head diameter. Glenoid defect sizes included 10%, 20%, and 30% of the glenoid width. Outcome measures included Percent of Intact Stability Ratio (stability ratio for a given trial divided by the stability ratio in the intact state for that specimen) and Percent of Intact Translation (distance to dislocation for a given trial divided by the distance to dislocation in the intact state for that specimen).

Results:

There was a progressive decrease in stability as humeral head defect size increased and as glenoid defect size increased. The decrease in Percent of Intact Stability Ratio reached statistical significance for humeral head defects of 44%, for glenoid defects of 30%, and additionally for a combined 19% humeral head defect with a 20% glenoid defect. The mean Percent of Intact Stability Ratio was 65% for a combined 19% humeral head defect with a 20% glenoid defect. The decrease in Percent of Intact Translation reached statistical significance for humeral head defects of 31% and 44%, for glenoid defects of 20% and 30%, and additionally for a combined 19% humeral head defect with a 10% glenoid defect. The mean Percent of Intact Translation was 69% for a combined 19% humeral head defect with a 10% glenoid defect.

Conclusion:

The humeral head and glenoid defect sizes required to produce instability are smaller when the defects are found together than when either defect is found alone. In patients with combined humeral head and glenoid defects bony reconstruction may be indicated for humeral head defects as small as 19% of the humeral head diameter and glenoid defects as small as 10-20% of the glenoid width.
Arthroscopic Transosseous Rotator Cuff Repair
Authors: Austin Luke , Black Eric M. , Lombardi Nick J. , Pepe Matthew D. , Lazarus Mark
Published: August 2015

Objectives:

Health expenditures in the United States are outpacing national income, and affordability has become a major policy issue. Over 500,000 rotator cuff repairs (RCR) are performed annually in the United States making RCR a potential source of cost savings. Arthroscopic trans-osseous equivalent (TOE) repair using a double row of anchors has shown superior biomechanical strength compared to other techniques, but at a higher cost. The arthroscopic transosseous (TO) repair is a novel technique allowing arthroscopic rotator cuff repair to be performed without suture anchors. Arthroscopic TO repair may be a means to provide similarly excellent patient outcomes while lowering the cost of care. The primary purpose is to compare the price differential and time of surgery for an arthroscopic rotator cuff repair using anchorless TO repair verses an anchor trans-osseous equivalent (TOE) repair. A secondary purpose of the study was to evaluate outcomes at 6 months postoperatively.

Methods:

A prospective, case-controlled study evaluating arthroscopic rotator cuff repair using two techniques was performed. The study group consisting of 21 patients undergoing TO repair was compared to a control group consisting of 22 patients undergoing TOE repair. The groups were controlled for size of tear, biceps treatment, acromioplasty, distal clavicle excision, and labral pathology. The primary outcome measures were surgical time as well as total cost of implants and equipment for each surgery, determined by an independent third party, Atlanticare Hospital. Secondary outcomes were changes in the SST, VAS, and SANE scores.

Results:

Mean total surgical implant/equipment cost per procedure for TOE repair was $2348.03 (SD 490.30) and for TO repair was $1204.97 (SD 330.69; p<0.0001). Mean cut to close time for TOE repair was 85 minutes (95% CI is 77-90) verses 74 (95% CI = 71-98) for TO repair. A log rank test revealed no difference in time (p =0.95). A linear regression model was developed to evaluate the change in SST, VAS, and SANE scores from pre-op to 6 months follow-up. Our study was underpowered but no difference in outcome was observed.

Conclusion:

Arthroscopic TO rotator cuff repair is a cost savings and time neutral technique compared to TOE repair. A mean of $1100 can be saved in surgical cost per case. In a country that performs over 500,000 RCRs annually, utilizing a TO repair technique can provide substantial cost savings to the healthcare system.
A Biomechanical and Clinical Comparison of Midshaft Clavicle Fixation Performed With Either Two Or Three Screws On Each Side Of The Plate
Authors: Larsen Christopher , Sleasman Brian , Chudik Steven
Published: August 2015

Objectives:

Plate fixation with six cortices of purchase (three screws) on each side of the fracture has been the standard of care when operatively treating displaced midshaft clavicle fractures. The use of locking plates and screws may afford equivalent biomechanical strength and clinical outcomes with only four cortices of purchase (two screws) on each side of the fracture. The purpose of this study is to compare the biomechanical and clinical performance of three-screw and two-screw constructs for displaced midshaft clavicle fractures.

Methods:

Biomechanical studies employing cantilever bending, deemed most physiologic of midshaft clavicle fracture models, have demonstrated that plate bending and fracture through the end screw hole are the common modes of failure. After simulating midshaft fractures in 10 pairs of embalmed cadaveric clavicles, the biomechanically inferior lateral fragments were randomly assigned to plate fixation with either three non-locking screws or two locking screws. Cyclic tensile loads (10 N to 75 N in a sinusoidal pattern at a rate of 1 Hz) were applied for 5 minutes along the long axis of the clavicle. Then, the constructs were loaded to failure at a rate of 0.5 mm/s with pullout forces applied parallel to the long axis of the screws. Additionally, we retrospectively identified 41 patients who had midshaft clavicle fractures surgically repaired with a minimum follow-up of 6 months: 21 patients were treated with three-screw constructs and 20 patients with two-screw constructs. Patient reported outcomes, radiographic time to union, and complication rates were compared.

Results:

Biomechanically, there were no significant differences in cyclic displacement (p=0.17), stiffness (p=0.94), yield load (p=0.65), or ultimate load (p=0.622) between the two groups. Clinically, there were no significant differences in American Shoulder and Elbow Surgeons score (ASES) (p=0.35), Constant score (p=0.34), Visual Analog Scale (VAS) pain score (p=0.34), Single Assessment Numeric Evaluation (SANE) score (p=0.99), or average time to union (p=0.74). Complication rates (painful hardware, non-union, hardware failure) trended toward being higher in the three-screw group (p=0.20).

Conclusion:

Plate fixation of displaced midshaft clavicle fractures with four cortices of purchase using two locking screws performs biomechanically and clinically equivalent to fixation with six cortices of purchase using three non-locking screws. Potential beneficial clinical implications include decreased surgical exposure, morbidity, time, and cost. Particularly, with regards to midshaft clavicle fractures, the reduction of the required number of points of cortical fixation from six to four allows the surgeon, in most instances, to use shorter and non contoured straight plates, eliminating the extra time and technical difficulty typically required to fit longer contoured plates to the variable and complex anatomy of the clavicle.
Dynamometer Elbow Strength and Endurance Testing After Distal Biceps Reconstruction w/Allograft
Authors: McGee Alan , Strauss Eric Jason , Jazrawi Laith M.
Published: August 2015

Objectives:

The purpose of the current study is to investigate the functional strength outcomes of late distal biceps reconstruction using allograft tissue.

Methods:

Patients who underwent distal biceps reconstruction with allograft tissue between May 2007 and May 2013 were identified. Charts were retrospectively reviewed for post-operative complications, gross flexion and supination strength, and range of motion (ROM). Isokinetic strength and endurance in elbow flexion and forearm supination were measured in both arms. Tests were conducted using a dynamometer at 60o per second for isokinetic strength and 240o per second for endurance. Isometric strength testing was also measured for elbow flexion and forearm supination. Paired t tests were used for statistical analysis.

Results:

Ten patients with a mean age of 48 years (range 42 - 61 years) were included in the study. Distal biceps reconstruction was performed using an Achilles tendon allograft in 9 patients and a combination of tibialis anterior allograft and gracilis allograft in 1 patient. Of the reconstructions, 50% involved the dominant arm. Full ROM was observed in all patients at the time of their final follow up assessment. The mean follow-up for dynamometer strength testing was 34 months (range 13-81 months). No statistical differences were noted between data obtained from operative and contralateral extremities. The average peak torque of the operative limb (38.5± 5.9 Nm) was 91.7% of that of the contralateral limb (41.8±4.9 Nm) in flexion and 93.4% (operative, 5.7±1.3 Nm; contralateral, 6.1± 1.0 Nm) in supination. No significant differences were found in fatigue index between operative or contralateral limbs for flexion (operative, 34.1±17.1%; contralateral, 30.8±17.1%; p = 0.29) or supination (operative, 38.2±16.5%; contralateral, 42.1±11.9%; p = 0.65). . The only complication observed was a transient PIN palsy in one patient which resolved by 3 months post-operatively. All patients reported postoperative cosmetic deformity but found their gross appearance acceptable.

Conclusion:

Late reconstruction for chronic distal biceps rupture using allograft tissue is a safe and effective solution for symptomatic patients with functional demands in forearm supination and elbow flexion. Dynamometer testing shows near normal return of strength and endurance of both elbow flexion and supination following the procedure.
An Examination of Leader-Member Dyadic Politeness of Exchange and Servant Leadership on Group Member Performance
Authors: Abu Bakar Hassan , McCann Robert M.
Published: August 2015

Integrating conversational constraint theory and models of homophily and relational dyadic communication, this study investigates how leader-member politeness exchange and servant leadership influence group member performance in a Malaysian organizational context. Using hierarchical linear modeling with data obtained from a sample of 510 employees, 65 workgroups, and 3 organizations, a politeness of exchange-servant leadership model was tested. Results show that servant leadership was positively and significantly associated with workgroup manager’s ratings of group member’s performance. The positive association between servant leadership and group member performance is more pronounced when managers and members in workgroups are high in politeness of exchange in their interactions. As predicted, leader-member dyadic politeness of exchange within the workgroup manager-group member dyads moderated this positive association.
Why Do Scholars Use PowerPoint the Way They Do?
Authors: Hertz Brigitte , van Woerkum Cees , Kerkhof Peter
Published: August 2015

PowerPoint has received much criticism regarding excessive use of text and the lack of contact with the audience. Why presenters use PowerPoint in this way has not been studied so far. Our study using interviews with beginning and advanced presenters shows that some use the program as a speaking note and as a means to draw the attention away from themselves. Some even think that PowerPoint can replace rhetorical skills. Slides are mainly designed on the basis of commonsense, instead of guidelines based on human information processing. Implications for the teaching of PowerPoint use in business communication are discussed.
Monitoring unfractionated heparin in children: a parallel-cohort randomized controlled trial comparing 2 dose protocols
Authors: Hanslik Andreas , Kitzmüller Erwin , Tran Ulrich S. , Thom Katharina , Karapetian Hratsch , Prutsch Nicole , Voitl Jasmin , Michel-Behnke Ina , Newall Fiona , Male Christoph
Published: August 2015

Key Points

Anti-Xa, aPTT, and ACT discriminate well between different heparin dose protocols but the assays are poorly correlated with each other. The heparin effect was lower in younger children. This influence of age was dose-dependent and more pronounced at low- vs high-dose heparin.
Contralateral breast cancer can represent a metastatic spread of the first primary tumor: determination of clonal relationship between contralateral breast cancers using next-generation whole genome sequencing
Authors: Alkner Sara , Tang Man-Hung Eric , Brueffer Christian , Dahlgren Malin , Chen Yilun , Olsson Eleonor , Winter Christof , Baker Sara , Ehinger Anna , Rydén Lisa , Saal Lao H. , Fernö Mårten , Gruvberger-Saal Sofia K.
Published: August 2015

Introduction

By convention, a contralateral breast cancer (CBC) is treated as a new primary tumor, independent of the first cancer (BC1). Although there have been indications that the second tumor (BC2) sometimes may represent a metastatic spread of BC1, this has never been conclusively shown. We sought to apply next-generation sequencing to determine a “genetic barcode” for each tumor and reveal the clonal relationship of CBCs.

Methods

Ten CBC patients with detailed clinical information and available fresh frozen tumor tissue were studied. Using low-coverage whole genome DNA-sequencing data for each tumor, chromosomal rearrangements were enumerated and copy number profiles were generated. Comparisons between tumors provided an estimate of clonal relatedness for tumor pairs within individual patients.

Results

Between 15–256 rearrangements were detected in each tumor (median 87). For one patient, 76 % (68 out of 90) of the rearrangements were shared between BC1 and BC2, highly consistent with what has been seen for true primary-metastasis pairs (>50 %) and thus confirming a common clonal origin of the two tumors. For most of the remaining cases, BC1 and BC2 had similarly low overlap as unmatched randomized pairs of tumors from different individuals, suggesting the CBC to represent a new independent primary tumor.

Conclusion

Using rearrangement fingerprinting, we show for the first time with certainty that a contralateral BC2 can represent a metastatic spread of BC1. Given the poor prognosis of a generalized disease compared to a new primary tumor, these women need to be identified at diagnosis of CBC for appropriate determination of treatment. Our approach generates a promising new method to assess clonal relationship between tumors. Additional studies are required to confirm the frequency of CBCs representing metastatic events.
Kaleidoscope
Authors: Tracy Derek K. , Joyce Dan W. , Shergill Sukhwinder S.
Published: August 2015

Antidepressant effectiveness is a topic seldom out of the scientific or popular press, with claim and counter-claim about the disclosure, reporting, and interpretation of data. Hieronymus and colleagues1 have thrown their hats into the ring: noting that about half of company-sponsored trials failed to show any superiority over placebo, they challenge that most studies evaluated changes in total scores on the 17-point Hamilton Rating Scale for Depression (HRSD-17), but that this might mask improvement in important subcomponents. Not all items equally correlate with illness burden, so they undertook patient-level post hoc analyses focusing on the four-point depressed mood subcomponent in 18 placebo-controlled industry trials of various selective serotonin reuptake inhibitors (n = 6669). The choice of this question was based on its diagnostic importance and the fact it had the highest baseline severity in the pooled sample. The result was that 91% of comparisons showed superiority of the active drug over placebo, compared with 46% where the summed scale was used (P<0.001). The authors argue that the summed scale is insensitive, and clouds current views on medications. The end of the debate? We think not …
Systematic synthesis of barriers and facilitators to service user-led care planning
Authors: Bee Penny , Price Owen , Baker John , Lovell Karina
Published: August 2015

Background

Service user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice.

Aims

To examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur.

Method

Systematic evidence synthesis.

Results

Synthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes.

Conclusions

Service user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs.
Interventions to improve therapeutic communications between Black and minority ethnic patients and professionals in psychiatric services: Systematic review
Authors: Bhui Kamaldeep S. , Aslam Rabeea'h W. , Palinski Andrea , McCabe Rose , Johnson Mark R. D. , Weich Scott , Singh Swaran P. , Knapp Martin , Ardino Vittoria , Szczepura Ala
Published: August 2015

Background

Communication may be an influential determinant of inequality of access to, engagement with and benefit from psychiatric services.

Aims

To review the evidence on interventions designed to improve therapeutic communications between Black and minority ethnic patients and clinicians who provide care in psychiatric services.

Method

Systematic review and evidence synthesis (PROSPERO registration: CRD42011001661). Data sources included the published and the ‘grey’ literature. A survey of experts and a consultation with patients and carers all contributed to the evidence synthesis, interpretation and recommendations.

Results

Twenty-one studies were included in our analysis. The trials showed benefits mainly for depressive symptoms, experiences of care, knowledge, stigma, adherence to prescribed medication, insight and alliance. The effect sizes were smaller for better-quality trials (range ofd0.18–0.75) than for moderate- or lower-quality studies (range ofd0.18–4.3). The review found only two studies offering weak economic evidence.

Conclusions

Culturally adapted psychotherapies, and ethnographic and motivational assessment leading to psychotherapies were effective and favoured by patients and carers. Further trials are needed from outside of the UK and USA, as are economic evaluations and studies of routine psychiatric care practices.
Prediction of Allogeneic Hematopoietic Stem-Cell Transplantation Mortality 100 Days After Transplantation Using a Machine Learning Algorithm: A European Group for Blood and Marrow Transplantation Acute Leukemia Working Party Retrospective Data Mining Study
Authors: Shouval Roni , Labopin Myriam , Bondi Ori , Mishan-Shamay Hila , Shimoni Avichai , Ciceri Fabio , Esteve Jordi , Giebel Sebastian , Gorin Norbert C. , Schmid Christoph , Polge Emmanuelle , Aljurf Mahmoud , Kroger Nicolaus , Craddock Charles , Bacigalupo Andrea , Cornelissen Jan J. , Baron Frederic , Unger Ron , Nagler Arnon , Mohty Mohamad
Published: August 2015

Purpose

Allogeneic hematopoietic stem-cell transplantation (HSCT) is potentially curative for acute leukemia (AL), but carries considerable risk. Machine learning algorithms, which are part of the data mining (DM) approach, may serve for transplantation-related mortality risk prediction.

Patients and Methods

This work is a retrospective DM study on a cohort of 28,236 adult HSCT recipients from the AL registry of the European Group for Blood and Marrow Transplantation. The primary objective was prediction of overall mortality (OM) at 100 days after HSCT. Secondary objectives were estimation of nonrelapse mortality, leukemia-free survival, and overall survival at 2 years. Donor, recipient, and procedural characteristics were analyzed. The alternating decision tree machine learning algorithm was applied for model development on 70% of the data set and validated on the remaining data.

Results

OM prevalence at day 100 was 13.9% (n = 3,936). Of the 20 variables considered, 10 were selected by the model for OM prediction, and several interactions were discovered. By using a logistic transformation function, the crude score was transformed into individual probabilities for 100-day OM (range, 3% to 68%). The model's discrimination for the primary objective performed better than the European Group for Blood and Marrow Transplantation score (area under the receiver operating characteristics curve, 0.701 v 0.646; P < .001). Calibration was excellent. Scores assigned were also predictive of secondary objectives.

Conclusion

The alternating decision tree model provides a robust tool for risk evaluation of patients with AL before HSCT, and is available online ( http://bioinfo.lnx.biu.ac.il/∼bondi/web1.html ). It is presented as a continuous probabilistic score for the prediction of day 100 OM, extending prediction to 2 years. The DM method has proved useful for clinical prediction in HSCT.