bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Infection Following Arthroplasty – Are Patients Protected?
Authors: Young Simon W , Zhu Mark , Ravi Saiprasad , Luey Chris
Published: July 2016

Objective:

Prophylactic antibiotics significantly reduce prosthetic joint infection (PJI) rates after hip and knee arthroplasty. However, the rise of antibiotic resistance has raised concern over the adequacy of conventional prophylaxis. This study aimed to identify organisms causing early PJI in hip and knee arthroplasties and their sensitivity to current prophylactic antibiotics.

Method:

We performed a multicentre audit of 4009 primary hip and knee arthroplasties (1852 hips and 2157 knees) at three tertiary referral hospitals. PJIs were identified according to the Infectious Diseases Society of America (IDSA) definition and all patients were followed for two years. For patients with confirmed PJIs, causative bacteria and their antibiotic sensitivities were identified.

Results:

Thirty-five PJI cases in total were identified in the follow-up period of two years, consisting of 13 hips and 22 knees. The overall definite prosthetic joint infection rate was 0.87% (0.7% for hips, 1.0% for knees). 51.4% of PJIs occurred within the first 6 weeks, 62.9% within the first 3 months and 82.9% during the first year. Ninety-six percent (96%) of patients were given cefazolin as prophylaxis. Thirty-four percent (34%) of patients were infected with Coagulase-negative staphylococci, which were the most common infective organisms. 91.7% of these organisms were resistant to cefazolin. Twenty-five percent (25%) of patients were infected with Staphylococcus aureus, 9.1% of which were methicillin resistant. Overall, 58% of organisms were resistant to cefazolin. Sixty percent (60%) of patients who were treated with cefazolin and had available sensitivities for infective organism(s) were infected with cefazolin-resistant organisms.

Conclusions:

The majority of bacteria causing early PJI are resistant to the antibiotic prophylaxis given at the time of surgery. Whilst all the organisms cultured were sensitive to vancomycin, concerns regarding antibiotic stewardship remain and there is insufficient evidence to justify its routine use. However, the choice of empiric antibiotic when treating PJI in the early post-operative period should take into account resistance profiles.
Surgical Helmet Systems and Intraoperative Wound Contamination
Authors: Bayan A
Published: July 2016

Objective:

The original Charnley-type negative-pressure body-exhaust suit reduced infection rates in early trials of total joint arthroplasty. However, recent registry data on modern positive-pressure surgical helmet systems (SHS) have not shown this benefit, and have instead suggested a paradoxical increase in infection rates with SHS use. The gown-glove interface has been identified as a potential source of particle contamination. The aim of this study was to compare wound contamination in total knee arthroplasty (TKA) between conventional surgeon attire and SHS with and without protective tape at the gown/glove interface.

Methods:

75 patients undergoing TKA were randomised into three groups: in group one the scrubbed theatre staff wore conventional surgical attire, in group two SHS without tape, and in group three SHS with tape sealing the gown-glove interface. All TKA operations were carried out in a standardised manner by a single surgeon. Bacterial contamination was assessed using both a culture-based tetrazolium stained membrane imprint technique (TSMI) technique (See Figure 1) and detection of bacterial ribosomal DNA using polymerase chain reaction (PCR). For PCR two tissue samples were taken at the beginning of the operation to act as controls and five at the end of the first hour. For culture a tetrazolium stained membrane imprint technique was used with membranes pressed onto the wound at the time of tissue sampling.

Results:

For TSMI culture, with a conventional attire 0/25 of the patients had a positive culture, with SHS and no tape 1/26, and with SHS and tape 4/24. Differences in measured contamination did not differ between groups (chi square test conventional gown (0/25) vs SHS (5/50) p= 0.16, SHS without tape (1/26) to SHS with tape (4/24) p = 0.18 (See Table 1).

Conclusions:

Overall contamination rates were low in all groups. No difference was seen in wound contamination between conventional attire and SHS. The use of tape at the gown glove interface with SHS did not appear to reduce contamination rates.
Success of Debridement and Implant Retention in Periprosthetic Joint Infection – Does the Surgeon Matter?
Authors: Young Simon W , Zhu Mark , Ravi Saiprasad , Luey Chris
Published: July 2016

Objective:

Prosthetic joint infection (PJI) is a devastating complication following total joint arthroplasty (TJA). In acute haematogenous and early post-operative PJI, debridement and implant retention (DAIR) surgery is often the initial treatment and success rates vary. This study aimed to identify factors affecting success rates of DAIR and in particular whether involvement of a lower limb arthroplasty surgeon can affect outcome.

Method:

This retrospective review included one hundred and sixty-two patients undergoing DAIR for first-episode PJI following hip and knee arthroplasty at one of three tertiary hospitals. Treatment success was defined as no relapse within two years of DAIR. Data on patient, hospital, and surgical factors were identified including duration of symptoms, time from primary, previous revisions, age of prosthesis, bacterial subtype, whether modular component exchange was performed and whether an arthroplasty surgeon performed the procedure. Adjusted multivariate analysis was performed to identify factors associated with success of the DAIR procedure.

Results:

Overall success rate of DAIR in both hip and knee arthroplasty was 60%. A specialist arthroplasty surgeon was present in 42% of cases. Arthroplasty surgeons performed modular exchange in 51% of cases compared to 32.5% for other surgeons. Inclusion of modular exchange in the procedure was the only factor associated with DAIR success (OR 3.1, p<0.013). Time to theatre of less than 24 hours (OR 0.59), duration of symptoms less than one week (OR 1.28), age of prosthesis less than 3 months (OR 1.47) and having an arthroplasty surgeon perform DAIR (OR 1.6) did not lead to statistically significant improvements in success rate.

Conclusions:

Modular exchange was associated with a significantly higher success rate for both hip and knee PJI, suggesting thorough debridement is important in DAIR. Arthroplasty surgeons were more likely to perform modular exchange, but their presence in theatre alone did not reduce the risk of failure.
Two-Year Outcomes following Arthroscopic Treatment for Snapping Scapula Syndrome
Authors: Menge Travis , Horan Marilee P. , Mitchell Justin , Tahal Dimitri S. , Millett Peter J.
Published: July 2016

Objectives:

Snapping scapula syndrome is a rare cause of shoulder pain that can result in significant dysfunction. The purpose of this study was to report clinical outcomes following arthroscopic treatment for snapping scapula syndrome, as well as identify associated risk factors that affect outcomes.

Methods:

One-hundred patients underwent arthroscopic treatment for snapping scapula syndrome from October 2005 to October 2013. This was an IRB-approved retrospective outcomes study with prospectively collected data. Patients were excluded if they had prior scapula or rib surgeries, or concomitant sternoclavicular or glenohumeral reconstructive procedures. Patients included in this study failed non-operative modalities for mechanical symptoms of snapping scapula and reported symptomatic relief from a local anesthetic injection prior to surgery. Preoperative and postoperative pain and functioning levels were assessed with the American Shoulder and Elbow Surgeons (ASES), QuickDASH (Disabilities of the Arm, Shoulder and Hand), and general health SF-12 including both physical (PCS) and mental (MCS) components. Patient satisfaction was recorded on a 10-point visual analog scale (VAS).

Results:

There were 86 scapulae in 79 patients that met inclusion criteria. Mean age at time of surgery was 33 years old (range 12-65). A partial scapulectomy and bursectomy was performed in 79 scapulae, with 7 having bursectomy alone. Mean duration from onset of symptoms to surgery was 3.8 years (range 90 days-16.6 years). One patient died in the follow-up period from unrelated causes, and 6 patients refused to participate. Of the remaining 72 scapula, 8/72 (11%) failed and underwent a revision procedure at a mean of 309 days (SD+283 days). Of those that met inclusion criteria and did not require revision surgery, 86% (55/64) returned surveys with a mean follow-up of 3.4 years (range 2-7 years). There was a significant improvement following surgery in SF-12 PCS (p<0.001), SF-12 MCS (p=0.043), ASES (p<0.001), and QuickDASH (p=0.001) scores. Overall, median patient satisfaction was 7 out of 10 (range 1 to 10). Increasing age correlated with decreased postoperative SF-12 PCS (r= -.372;p=0.007), ASES (r= .279;p=0.043), and QuickDASH (r=.350;p=0.011) scores, while gender was not found to be associated with outcomes. A lower preoperative SF-12 MCS score was found to correlate with lower postoperative ASES scores (r=.395;p=0.011), while longer duration of symptoms prior to surgery also correlated with lower postoperative ASES (rho=-.296; p=0.027) and QuickDASH (rho=.315;p=0.019) scores.

Conclusion:

Arthroscopic surgery is an effective treatment for individuals that have failed conservative management for snapping scapula syndrome, demonstrating significant improvements in all postoperative outcome scores at a mean of 3.4 years. Lower preoperative mental status score, greater age, and longer duration of symptoms prior to surgery were associated with poorer outcomes.
Arthroscopic Treatment for Shoulder Instability with Glenoid Bone Loss Using Distal Tibia Allograft Augmentation - Short Term Results
Authors: Wong Ivan , Amar Eyal , Coady Catherine M. , Dilman Daryl B. , Smith Ben
Published: July 2016

Objectives:

Background: The results of arthroscopic anterior labral (Bankart) repair have been shown to have high failure rate in patients with significant glenoid bone loss. Several reconstruction procedures using bone graft have been described to overcome the bone loss, including autogenous coracoid transfer to the anterior glenoid (Latarjet procedure) as well as iliac crest autograft and tibial allografts. In recent years, trends toward minimally invasive shoulder surgery along with improvements in technology and technique have led surgeons to expand the application of arthroscopic treatment.

Purpose:

This study aims to perform a retrospective analysis of prospectively collected data to evaluate the clinical and radiological follow up of patient who underwent anatomic glenoid reconstruction using distal tibia allograft for the treatment of shoulder instability with glenoid bone loss at 1-year post operation time point.

Methods:

Between December 2011 and January 2015, 55 patients underwent arthroscopic stabilization of the shoulder by means of capsule-labral reattachment to glenoid ream and bony augmentation of glenoid bone loss with distal tibial allograft for recurrent instability of the shoulder. Preoperative and postoperative evaluation included general assessment by the western Ontario shoulder instability index (WOSI) questionnaire, preoperative and postoperative radiographs and CT scans.

Results:

Fifty-five patients have been evaluated with mean age of 29.73 years at time of the index operation. There were 40 males (mean age of 29.66) and 15 female (mean age of 29.93). Minimum follow up time was 12 months. The following adverse effects were recorded: none suffered from recurrent dislocation, 2 patients suffered from bone resorption but without overt instability, 1 patient had malunion due to screw fracture, none of the patients had nonunion. The mean pre-operative WOSI score was 36.54 and the mean postoperative WOSI score was 61.0.

Conclusion:

Arthroscopic stabilization of the shoulder with distal tibia allograft augmentation demonstrates promising result at 1year follow up.
Hemiarthroplasty versus Total Shoulder Arthroplasty For Shoulder Osteoarthritis
Authors: Sinatro Alec , Liu Joseph N. , Mahony Gregory Thomas , Wu Hao-Hua , Warren Russell F. , Dines David M. , Craig Edward V. , Gulotta Lawrence Vincent , Garcia Grant
Published: July 2016

Objectives:

Return to activity is a commonly used indication for shoulder hemiarthroplasty (HA) in comparison to total shoulder arthroplasty (TSA). Despite clinical studies demonstrating better functional outcomes after TSA, the literature has failed to show a difference in return to sport. The purpose of this study was to compare rates of return to sports in a matched cohort of TSA and HA patients with a preoperative diagnosis of glenohumeral osteoarthritis (OA).

Methods:

A prospectively collected registry was queried retrospectively for consecutive patients who underwent HA. Inclusion criteria were preoperative diagnosis of OA and > 2 years of follow up. After inclusion criteria, all HA were statistically matched to a TSA patient by preoperative diagnosis, age (+/- 5 yrs), sex, and follow up period (+/- 6 months). At final follow up both cohorts completed a questionnaire regarding physical fitness and sporting activities.

Results:

40 HA and 40 TSA were available at final follow up. Average age at surgery was 65.7 years for HA and 66.2 year for TSA (p=0.06). Average follow up was 62.0 months for HA and 61.1 months for TSA (p=0.52). Average ASES scores improved for HA from 36.3 to 70.2 (p<0.001) and for TSA they improved from 34.0 to 78.5 (p<0.001). Final ASES scores were not significantly different between groups (p=0.21). Average VAS scores improved for HA from 6.3 to 2.2 (p<0.001), while TSA improved from 6.1 to 0.6 (p<0.001). HA patients had significantly worse final VAS scores compared to the TSA group (p=0.002). 70% (28) of HA patients compared to 15% (6) of TSA patients complained of postoperative problems with their shoulder (p<0.001). Significantly more TSA were satisfied with their surgery (p=0.01). 65.5% (19/29) of HA patients returned to at least one sport postoperatively compared to 97.3% (36/37) of TSA patients (p<0.001). Average timing for return to full sports was 5.5±4.2 months for HA and 5.4±3.1 months for TSA (p=0.92). Significantly more TSA patients returned to higher upper extremity use sports (p=0.01).

Conclusion:

In patients with OA, rate of return to sports was significantly better after TSA compared to HA. HA patients had significantly more pain, worse surgical satisfaction and decreased ability to return to high upper extremity use sports. For OA patients wishing to return to sporting activities, these result help manage expectations.
Risk of Fragments in Ulnar Collateral Ligament Injuries Of Baseball Players
Authors: Furushima Kozo , Itoh Yoshiyasu , Mitsui Yasuhiro , Kusano Hiroshi
Published: July 2016

Objectives:

Many baseball players with UCL injuries have avulsed persistent fragments by throwing disorder in the youth. The presence of fragments results in discontinuity of the medial elbow joint support structures; therefore, a ligament with fragments is considered more fragile than the normal ligament. This study compared three types (fragment, malunion, and normal) of throwing-related UCL injuries and prospectively examined the risk of surgical treatment.

Methods:

The total subjects were 439 baseball players (age 14-30 years; mean age, 17.5 years) diagnosed with UCL injuries at our hospital between November 2009 and June 2013. At the time of the initial examination, the medial epicondyle was assessed on plain frontal radiographs with the elbow flexed at 45°. Based on this assessment, subjects were divided into three groups: group with persistent fragments (fragment [F] group), group with complete union following avulsion fracture (malunion [M] group), and a group with no history of avulsion fracture (normal [N] group). Each patient’s ability to return to playing baseball was assessed after at least 3 months of systematic rehabilitation. Subjects who failed to comply with rehabilitation, played only recreationally, or with pain in sites other than the elbow were excluded. In this series, 220 cases were left for investigation. The Conway-Jobe scale was used as a standard to assess the return to playing after conservative therapy; subjects with excellent or good ratings were deemed able to return to playing baseball, whereas those with fair or poor ratings were deemed unable to return to playing baseball. The return rates were calculated for the F, M, and N groups respectively. The Magnetic resonance (MR) images consisted of three slices along the long axis of the anterior oblique ligament; these images were used to classify injuries as severe or mild, which were then compared with each other. SPSS 20.0 was used to perform the statistical analysis.

Results:

A total of 107 subjects were able to resume playing competitive baseball game, whereas 113 subjects were unable to resume playing and underwent surgical treatment (Table.1). The F group demonstrated a significantly lower return rate (p < 0.01) (Table.2). The F group demonstrated a significantly higher percentage of severe injuries (p < 0.01) (Table.2).Return rates in the mild and severe injury groups were 79.1% and 29.1%, respectively, demonstrating a significant difference (p < 0.01) (Table.3). Not surprisingly, the return rate among subjects with severe injuries in the F group was a mere 14.3% (7/49).

Conclusion:

The results of the present study demonstrated that the presence of fragments in UCL injuries tended to increase the severity of UCL injuries and significantly reduced patient the return rates of competitive game after conservative therapy. Therefore, this exacerbation of UCL injuries is considered a result of persistent medial epicondylar fragments in young baseball players.
Systematic Review and Meta-analysis of Osteochondral Autograft Transplantation versus Debridement in the Treatment of Osteochondritis Dessicans of the Capitellum
Authors: Bowman Seth , Braunstein Jacob , Rabinowitz Justin , Barfield William R. , Chhabra Bobby , Haro Marc Scott
Published: July 2016

Objectives:

The purpose of this systematic review and meta- analysis is to compare clinical results and functional outcomes in patients with osteochondritis dessicans (OCD) lesions of the capitellum treated with either osteochondral autograft transplantation (OATS) or debridement with or without microfracture.

Methods:

Systematic review of multiple medical databases was performed after PROSPERO registration and using PRISMA guidelines. A literature search was performed using the multiple medical databases and the methodological quality of the individual studies was assessed by two review authors using the Cochrane Collaboration’s “Risk of Bias” tool. Case reports were excluded and only case series of more than five patients and higher level of evidence were included. All study, subject, and surgery parameters were collected. Data was analyzed using statistical software. Odds ratios (OR) were calculated when possible. Data were compared using Pearson Chi-Square and independent sample T tests when applicable.

Results:

Fifteen studies were included involving 368 patients (326 males and 42 females). There were a total of 197 patients in the debridement group and 171 patients in the OATS group. The mean age was 16.9 +/-4.1 for the debridement group and 14.6 +/-1.2 for the OATS group. Mean follow up was 29.0 +/-24.3 and 38.0 +/-12.8 for the debridement and OATS groups, respectively. Patients that underwent an OATS procedure had a statistically significant improvement in overall arc range of motion compared to patients that had a debridement (P≤0.001). When compared to patients with debridement, patients with OATS were 5.6 times more likely to return to at least their pre-injury level of sports participation (p≤0.002).

Conclusion:

Post-operative range of motion was significantly improved in patients undergoing an OATS procedure versus a debridement for OCD lesions of the capitellum. Patients with an OATS were 5.7 times more likely to return to at least the pre-injury level of sports participation compared to patients undergoing a debridement. Further studies are necessary in order to directly compare functional outcomes in patients undergoing a debridement procedures versus and OATS procedure.
Survivorship after Arthroscopic Management of Glenohumeral Osteoarthritis with a Minimum 5 year Follow-up
Authors: Mitchell Justin , Horan Marilee P. , Greenspoon Joshua A. , Menge Travis , Tahal Dimitri S. , Millett Peter J.
Published: July 2016

Objectives:

We previously reported clinical improvement and pain relief following arthroscopic management of glenohumeral osteoarthritis (GHOA) at 2 years. The purpose of this study was to determine 5 year survivorship for the comprehensive arthroscopic management (CAM) procedure for the treatment of GHOA.

Methods:

This study had prior IRB approval. The CAM procedure was performed on a consecutive series of 42 young patients (44 shoulders) with GHOA who otherwise met criteria for shoulder arthroplasty but instead opted for joint preservation. The procedure included glenohumeral chondroplasty, capsular release, and synovectomy, humeral osteoplasty, axillary nerve neurolysis, subacromial decompression, loose body removal, microfracture and biceps tenodesis. Only patients who were a minimum of 5 years out from surgery were included in the study. Patients completed a subjective questionnaire, and further surgical intervention of the index shoulder was noted for survivorship analysis. Failure was defined as progression to TSA. Kaplan Meier survivorship analysis was performed.

Results:

Forty-two patients (with 44 shoulders) underwent a CAM procedure between 1/2006-12/2009 and were included. All patients were self-described recreational athletes. Seven patients were former collegiate or professional athletes. Mean follow-up was 5.9 years (range, 5 years to 8.1 years). Mean age at surgery was 52 (range 27- 68) years old in 13 women and 29 men. Eleven shoulders (26%) failed and progressed to TSA at a mean of 2.9 years (1.0-5.4 years). Shoulder status (progression to TSA or not) at minimum 5 years (range 5.3 - 9.4 years) was known for 95% (42/44). One patient progressed to another surgery for stiffness at a mean of 5.6 months and another patient underwent a revision CAM procedure at 7.9 years. From this cohort, Kaplan Meier survivorship was 92% at 1 year, 85.7% at 3 years, and 75.3% survivorship at 5 years.

Conclusion:

The long term durability of arthroscopic management for symptomatic GHOA is not well studied. Glenohumeral debridement and capsular release may not be enough to address all the pain generating pathology in the osteoarthritic shoulder. After the CAM procedure we found an 84% survivorship at 3 years and 72% survivorship at 5 years. Predictors of success were not known in the early years for this patient cohort. We have since found that factors such as joint space > 2 mm, glenoid morphology (A1, A2, B1) and CSA > 30o are associated with better outcomes. The 72% survivorship at 5 years demonstrated in this study can serve as a benchmark. Hopefully, with better patient selection, excluding those with negative predictive factors, outcomes and survivorship after the CAM procedure for GHOA can be improved.
Minimum 2-Year Outcomes after Resection Arthroplasty of the Sternoclavicular Joint
Authors: Katthagen Jan Christoph , Tahal Dimitri S. , Menge Travis , Horan Marilee P. , Millett Peter J.
Published: July 2016

Objectives:

Injuries of the sternoclavicular (SC) joint are rare and are usually caused by high energy mechanisms, such as collision sports or motor vehicle accidents. The aims of this study were to assess functional outcomes and return to sport following resection arthroplasty for osteoarthritis of the sternoclavicular joint.

Methods:

20 SC joints (18 patients) had undergone resection arthroplasty of up to a maximum of 10 mm of the medial end of the clavicle for painful osteoarthritis, without instability, between November 2006 and November 2013. Patients at least two years out from surgery and living in the U.S. were included in the study. This was an IRB-approved retrospective outcomes study with prospectively collected data. Preoperative and postoperative function and pain levels were assessed with the ASES, SF-12 PCS, QuickDASH and SANE scores. Additionally, the level of sport intensity and the pain levels during activities of daily living, work and recreation were assessed pre- and postoperatively. The results of the functional outcome scores were normally distributed and were compared with the paired sample t-test. The results of pain level assessment were not normally distributed and were compared with the paired Wilcoxon signed-rank test.

Results:

19 SC joints in 17 patients (9 female, 8 male; mean age at time of surgery 39.5±17.1 years) met inclusion criteria. One patient refused participation in the study. Two patients (10.5%) were considered failures as they required additional SC joint surgery (one patient with revision resection of the medial clavicle for persistent symptoms and one patient with secondary figure-of-eight graft stabilization for instability). Minimum 2-year outcomes data were available for 14 of the remaining 16 SC joints (88%). The mean time to follow-up was 3.1 years (range, 2.0-8.8 years). The ASES score, QuickDASH, and pain levels demonstrated significant improvement postoperatively (p<0.05; Table 1). No significant differences were observed between the pre- and postoperative SANE and SF-12 PCS scores (p>0.05; Table 1). All patients (100%, n=11) that answered the question were able to return to sport, with 64% of these patients (n=7) returning to their pre-injury level or slightly below.

Conclusion:

Resection arthroplasty of up to a maximum of 10 mm of the medial end of the clavicle in patients with osteoarthritis of the SC joint results in significant functional improvement, pain reduction, and a high rate of return to sport at mid-term follow-up.
Rotator Cuff Tear Shape Characterization
Authors: Goodwin David Steven , Kaplan Daniel James , Fralinger David , Gyftopoulos Soterios , Meislin Robert J. , Jazrawi Laith M.
Published: July 2016

Objectives:

Proper surgical planning requires accurate and reliable pre-operative patient information. The more comprehensive the data, the more the surgeon can tailor a general surgical technique to an individual patient’s unique anatomy. A previous retrospective study demonstrated that three-dimensional magnetic resonance imaging more accurately characterized rotator cuff tears compared to two-dimensional images when checked against intra-operative pictures. The purpose of this study was to determine if three-dimensional MRI imaging would continue to be more accurate than two-dimensional imaging in a prospective study.

Methods:

Patients were prospectively included if they had a full-thickness primary rotator cuff tear on pre-operative MRI. Intra-op videos were taken from the posterior and lateral portals, with a grasper fully mobilizing the torn tendon in each view. 7 surgeons then reviewed the videos and independently characterized the shape of the tears into crescent, U-shaped tears, L-shaped tears, or massive tears. This was considered the gold-standard. Two musculoskeletal radiologists reviewed the corresponding MRI studies independently and blind to the arthroscopic findings and characterized the shape on the basis of the tear’s retraction and size 2D MRI. The 3D reconstructions of each cuff tear were reviewed by each radiologist to characterize the shape. Statistical analysis included 95% confidence intervals and fleiss’s kappa.

Results:

37 patients were enrolled in the study. Among the 7 surgeons, agreement on cuff tear was 93% ( =.87). The accuracy for differentiating between crescent-shaped, longitudinal, and massive tears using measurements on 2D MRI was 73.4% for reader 1 and 71.2% for reader 2. The accuracy for tear shape characterization into crescent and longitudinal U- or L-shaped using 3D MRI was 92% for reader 1 and 94% for reader 2. When further characterizing the longitudinal tears as massive or not using 3D MRI, both readers had an accuracy of 83%. The overall accuracy of 3D MRI was 91%, significantly different (P=.07) from 2D MRI accuracy (70.4).

Conclusion:

Our study has demonstrated that 3D MR reconstructions of the rotator cuff improve the accuracy of characterizing rotator cuff tear shapes compared with current 2D MRI-based techniques.
Characterization of Posterior Glenoid Bone Loss
Authors: Yanke Adam Blair , Frank Rachel M. , Shin Jason J. , Van Thiel Geoffrey S. , Verma Nikhil N. , Cole Brian J. , Romeo Anthony A. , Provencher Matthew T.
Published: July 2016

Objectives:

The purpose of this study was to characterize the morphology and location of posterior glenoid bone loss in pat ients with posterior instability instability utilizing computed tomography (CT).

Methods:

Clinical data was selected for patients with posterior shoulder instability that had undergone posterior stabilization (open or arthroscopic) or posterior osseous augmentation (distal tibia or iliac crest). Three fellowship-trained surgeons from two institutions contributed patients. Pre-operative CT data was collected for all patients. The axial cuts were segmented and reformatted in three-dimensions for glenoid analysis using Osirix. From this three-dimensional model, the following was calculated: percent bone loss (Nobuhara), total arc of the defect (degrees), and a clock-face description (start point, stop point, and average or direction). Pearson correlation coefficients were performed using significance of p<0.05.

Results:

Fifty shoulders from 50 patients were reviewed. Fourteen patients (average age 30 years; 93% male) had evidence of posterior glenoid bone loss and were included for evaluation. Defects on average involved 13.7±8.6% of the glenoid (range, 2-35%). The average start time (assuming all right shoulders) on the clock face was 10 o’clock ± 40 minutes and stopped at 6:30 ± 25 minutes. The average direction of the defect pointed toward 8:15 ± 25 minutes. The percent bone loss correlated with the total arc of the defect (Pearson: 0.93, p<0.05, R2: 0.86) and the direction of the bone loss (Pearson: 0.64, p<0.05, R2: 0.40). The direction of bone loss significantly moved more posterosuperior the larger the defect became (Pearson: 0.63, p<0.05, R2: 0.40).

Conclusion:

Posterior bone loss associated with posterior glenohumeral instability is typically directed posteriorly at 8:15 on the clock. As defect get bigger, this direction moves more posterosuperior. This information will help guide clinicians in understanding the typical location of posterior bone loss aiding in diagnosis, cadaveric models, and treatment.
Should We Limit Innings Pitched Following Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers?
Authors: Erickson Brandon J. , Cvetanovich Gregory , Bach Bernard R. , Bush-Joseph Charles A. , Verma Nikhil N. , Romeo Anthony A.
Published: July 2016

Objectives:

Background: Ulnar collateral ligament reconstruction (UCLR) has become a common procedure amongst major league baseball (MLB) pitchers. It is unclear if a limit on innings pitched following UCLR should be instituted to prevent revision UCLR.

Purpose:

To determine whether the number of innings pitched or number of pitches thrown in the first full season following UCLR, as well as the pitcher’s overall MLB career, correlated with need for a revision UCLR

Hypothesis:

Number of innings pitched and number of pitches thrown following UCLR will not affect whether a pitcher undergoes a revision UCLR.

Methods:

Methods: All MLB pitchers between 1974-2015 who pitched at least one full season following UCLR were included. Pitch counts and innings pitched for the first full season following UCLR as well as total pitch count and total innings pitched following UCLR were recorded. Pitch counts and innings pitched were compared amongst players who required revision UCLR and those who did not.

Results:

Results: Overall, 154 pitchers were included. Of these, 135 pitchers did not require revision UCLR while 19 underwent revision UCLR. No significant difference existed between pitchers who underwent revision UCLR and those who did not in: number of innings pitched in the season following UCLR (p=0.9016), number of pitches thrown in the season following UCLR (p=0.7337), number of innings pitched in the pitcher’s career following UCLR (p=0.6945), and number of pitches thrown in the pitcher’s career following UCLR (p=0.4789). Furthermore, no difference existed in revision rate between pitchers who pitched more or less than 180 innings in the first full season following UCLR (p=0.6678).

Conclusion:

Conclusion: The number of innings pitched and number of pitches thrown in the first full season as well as over a player’s career following UCLR does not appear to increase a player’s risk of revision UCLR.
Analysis of Glenoid Inter-anchor Distance with an All-Suture Anchor System
Authors: Kramer Jonathan , Robinson Sean , Dutton Pascual , Dickinson Ephraim , Rodriguez John Paul , Camisa William , Leasure Jeremi M. , Montgomery William H.
Published: July 2016

Objectives:

Arthroscopic shoulder stabilization using suture anchors are commonly used techniques. More recently developed all-suture systems employ smaller diameter anchors, which increase repair contact area and allow greater placement density on narrow surfaces such as the glenoid. Our goal is investigate the strength characteristics of various inter-anchor distances in a human glenoid model.

Methods:

Twelve fresh-frozen human cadaveric glenoids were potted after the labrum was excised. The glenoids were then implanted with 1.4 mm all-suture anchors (Juggerknot, Biomet, Warsaw, IN) at varying inter-anchor distances. Anchors were implanted adjacent to one another or at 2 mm, 3 mm, or 5 mm distances using a template with pre-drilled holes. The glenoids were then underwent single cycle pullout testing using a test frame (Instron 8521, Instron Inc., Norwood, MA). A 5 N preload was applied to the construct and the actuator was driven away from the shoulder at a rate of 12.5mm/s as seen in Figure 1. Force and displacement were collected from the test frame actuator at a rate of 500 Hz. The primary outcomes were failure strength and stiffness. Stiffness was calculated from the initial linear region of the force displacement curve. Failure strength was defined as the first local maximum inflection point in the force displacement curve.

Results:

During load to fail testing, all but three of the specimens had both anchors pull out of the glenoid. The other mode of failure included one or both of the sutures failing. Stiffness was 13.52 ± 3.8, 17.97 ± 5.02, 17.59 ± 4.65 and 18.95 ± 4.67 N/mm for the adjacent, 2 mm, 3 mm and 5 mm treatment groups as shown Table 1. The adjacent group had a significantly lower stiffness compared to the other treatment groups. Failure strength was 48.68 ± 20.64, 76.16 ± 23.78, 73.19 ± 35.83 and 87.04 ± 34.67 N for the adjacent, 2 mm, 3 mm and 5 mm treatment groups as shown in Table 1. The adjacent group had a significantly lower failure strength compared to the other treatment groups.

Conclusion:

These data provide biomechanical evidence that in the glenoid, small diameter all-suture anchors may be implanted as close as 2 mm to one another without significantly decreasing their strength characteristics.
Use of the Knee Injury and Osteoarthritis Outcomes Survey (KOOS) in a Normal US Population
Authors: Sikka Robby Singh , Williamson Tyler , Tompkins Marc , Nelson Bradley J.
Published: July 2016

Objectives:

Patient-reported outcome instruments are frequently used for assessing clinical outcomes after injury and surgery. Previously reported normative data for the Knee Injury and Osteoarthritis Outcome Survey (KOOS) instrument is limited to a narrow subset of ages and has not accounted for a history of knee injury.

Methods:

The KOOS was administered to 1000 patients or accompanying family members who presented to an outpatient orthopaedic clinic in a suburban metropolitan city for an orthopaedic issue unrelated to their knee in July 2014. Participants were eligible if they self-reported a medical history negative for ankle, knee, or hip surgery. KOOS scale means, standard deviations, medians, ranges, interquartile ranges, and percentiles were calculated by sex, age range, laterality, and history of knee injury in the past year. Non-parametric statistical analysis was used to evaluate differences in KOOS scale scores between five age ranges and between those with or without a history of knee injury.

Results:

There were 402 males and 598 females in the final study cohort. Males scored lower on the Symptoms scale compared to other scales (median score = 96.4 for Symptoms; median score = 100 for all other scales) in all age cohorts except ages 56-64. Females also reported lower scores in the Symptoms scale. Median Symptoms score for females in each of the age groups from 18-55 years old was 96.4, and median score for the 56-64 year old cohort was 92.9. Median scores for Pain and Knee-related Quality of Life scales were lower in the 56-64 year old female cohort (97.2 and 93.8 respectively).

Conclusion:

Normative values for KOOS scale scores at all age ranges suggest a high level of functioning among participants with no history of knee injury in the past year. Symptoms, Pain, and Knee-related Quality of Life scales showed the greatest variability in KOOS scores for patients, particularly in the youngest and oldest cohorts. This study can aid surgeons in counseling patients and in developing expectations after treatment of injuries.
Deficits in Sagittal and Frontal Plane Mechanics during Drop Jump in Young Athletes with Recent Anterior Cruciate Ligament Reconstruction
Authors: Pace James Lee , Brophy Christopher , Mueske Nicole , Katzel Mia , Healy Bitte S. , Wren Tishya
Published: July 2016

Objectives:

While the vertical drop jump (VDJ) is an established predictor of ACL injury risk, most studies have focused on frontal and transverse plane assessment in young adult athletes. This study assessed sagittal as well as frontal plane biomechanics during VDJ in adolescent athletes following recent anterior cruciate ligament reconstruction (ACLR).

Methods:

29 limbs with unilateral ACLR (69% female, mean age 15.8 ± 1.6 years, 5 to 12 months post-surgery), 29 contralateral non-operative limbs, and 19 control limbs (53% female, mean age of 15.5 ± 1.8 years) were evaluated during VDJ. Lower extremity three-dimensional kinematic and kinetic data from initial contact to peak knee flexion were compared among groups using analysis of variance with Bonferroni post-hoc tests.

Results:

The operative limbs had significantly lower peak ground reaction forces (GRF) than both control and contralateral limbs (ACLR: 1.7 body weights (BW), Contralateral: 2.1 BW, Control: 2.1 BW; p≤0.01) along with lower average external knee flexion moments (ACLR: 0.7Nm/kg, Contralateral: 0.9Nm/kg, Control: 1.1Nm/kg; p≤0.05) and reduced power absorption at the knee (ACLR: 0.9Nm/kg, Contralateral: 1.5Nm/kg, Control: 1.2Nm/kg; p≤0.01). Operative limbs had lower peak knee flexion (ACLR: 96.8°; Contralateral: 100.7°; p=0.001) and knee flexion excursion (ACLR: 75.0°, Contralateral: 82.5°; p=0.003) than contralateral limbs, but did not differ from controls in these measures. Both operative and non-operative limbs had greater peak hip flexion (ACLR: 98.9°, Contralateral: 99.8°, Control: 83.5°; p≤0.006), hip flexion excursion (ACLR: 60.8°, Contralateral: 65.6°, Control: 49.6°; p=), and power absorption at the hip (ACLR: 1.0Nm/kg, Contralateral: 1.2Nm/kg, Control: 0.7Nm/kg; p<0.03) compared with controls. In the coronal plane, both the operative and non-operative limbs demonstrated higher peak knee valgus moments compared to controls (ACLR: 0.5Nm/kg, Contralateral: 0.4Nm/kg, Control: 0.2Nm/kg; p≤0.02) and utilized less hip ab/adduction range (ACLR: 1.7°, Contralateral: 1.9°, Control: 6.1°; p≤0.003) though there were no differences in knee valgus angles (p≥0.31) or excursion (p≥0.52).

Conclusion:

Lower GRF and less energy absorbed at the knee during VDJ suggests a landing strategy that shifts loading from the post-surgical knee to the hip and contralateral limb. The frontal plane knee deficits in both the operative and non-operative limbs may place the limb at an elevated risk for future injury or re-injury. Avoidance of loading the reconstructed knee and residual deficits in frontal plane hip and knee control on either limb may indicate lack of readiness to return to full activity after recent ACLR.
Effect of ACL Graft Type on Side-Step Cutting in Young Athletes
Authors: Pace James Lee , Mueske Nicole , Padilla Ricardo A. , Katzel Mia , Healy Bitte S. , Wren Tishya
Published: July 2016

Objectives:

Due to the slightly higher re-tear rate for ACL reconstruction (ACLR) with hamstring (HT) versus patellar tendon (PT), differences in movement strategies were assessed during side-step cutting in young athletes with recent ACLR to determine if graft type affected post-operative motion.

Methods:

Dominant limbs from 21 athletes without lower extremity injury or previous surgery (age 14.9 ± 2.0 years) and 26 limbs with recent (5.1-8.0 months post-operative) unilateral ACLR were included, 18 with HT grafts (age 16.6 ± 3.7 years) and 8 with PT (age 16.7 ± 1.2 years). Lower extremity 3-dimensional data was recorded during the deceleration phase (initial contact to maximum knee flexion) of a 45° cut. Group differences were assessed using analysis of variance with Bonferroni post-hoc tests.

Results:

The HT group had a slower approach velocity than controls (2.9 vs. 3.5 m/s; p=0.006) with intermediate velocity in the PT group (3.2 m/s). Both the HT and PT groups had lower peak ground reaction force (GRF) compared to controls (HT: 2.0 body weights, PT: 2.2 BW, Control: 2.8 BW; p≤0.02), along with lower peak knee flexion moments (HT: 1.4 Nm/kg, PT: 1.3 Nm/kg, Control: 2.2 Nm/kg; p=0.002). The PT group had less power absorption at the knee than controls (0.3 vs. 0.7 Nm/kg; p=0.07), while the HT group had more at the hip (0.4 vs. 0.1 Nm/kg; p=0.04). The HT group also had higher peak hip flexion (HT: 65.8°, PT: 53.9°, Control: 55.1°; p≤0.06) and hip sagittal plane excursion (HT: 9.4°, PT: 3.6°, Control: 2.8°; p≤0.05) than the PT and control groups. The HT group had lower peak knee valgus moments than controls (0.05 vs. 1.2 Nm/kg; p=0.01) as well as a greater range of frontal plane pelvic (8.2° vs. 3.4°; p=0.03) and hip (7.6° vs. 3.0°; p=0.05) motion. The PT group had intermediate values for valgus moment (0.8 Nm/kg) and pelvic (4.9°) and hip (3.3°) excursion.

Conclusion:

While both ACLR groups showed reduced GRFs and knee flexion moments compared with controls, the HT group demonstrated greater adaptations proximally with increased hip flexion and frontal plane pelvic and hip excursion. The lower frontal and sagittal plane hip motion in the PT group may be due to anterior knee pain associated with PT grafts. Since the HT group exhibited movement adaptations, but no observable pathologic movement patterns, such as increased knee valgus moment, other factors likely account for the observed higher re-tear rate in HT vs. PT ACLR.
Patient Perception of Reimbursement for Arthroscopic Meniscectomy and ACL Reconstruction
Authors: Okoroha Kelechi , Keller Robert A. , Marshall Nathan E. , Guest John-Michael , Lynch Jonathan , Lock Terrence R. , Rill Brian K.
Published: July 2016

Objectives:

Healthcare policy changes and decreases in Medicare physician reimbursement continue to change the landscape of healthcare. Historically, patient perceptions of surgeon reimbursement have been exaggerated compared to actual reimbursement. Currently there is limited evidence for patient perception for arthroscopic meniscectomy and ACL reconstruction. The purpose of this study was to evaluate patient perception of physician reimbursement for arthroscopic meniscectomy and ACL reconstruction and to compare health care perceptions between urban and suburban clinics.

Methods:

Surveys were given to 231 consecutive patients, 127 in an urban clinic and 104 in a suburban clinic. Patients were asked their estimation of reasonable reimbursement for arthroscopic meniscectomy and ACL reconstruction as well as their perception on actual Medicare reimbursement to physicians. They were also asked how much would they be willing to pay out of pocket for the procedures. After revealing actual reimbursement rates, patients were asked if reimbursement levels were appropriate, whether surgeon subspecialty training was important, and if additional compensation should be associated with subspecialty training. Survey responses were compared with respondents in an urban versus a suburban setting as well as amongst income and education level.

Results:

Patients on average reported surgeons should receive $8,096 for a meniscectomy and $11,794 for an ACL reconstruction, 14 times and 11 times as much as actually reimbursed, respectively. Patients estimated that Medicare paid physicians $5,442 for a meniscectomy and $6,667 for an ACL reconstruction. Patients were willing to pay $2,286 out of pocket for a meniscectomy and $11,793 for an ACL reconstruction. Sixty five percent of patients believed reimbursement for meniscectomy was too low and 57% of patients believe reimbursement for ACL reconstruction was too low. Less than 2% of patients believed physician salaries should be cut, whereas 75% believed physicians should be paid extra for sub-specialty training. There were no differences in payment perception between urban and suburban settings.

Conclusion:

Patients perceived the values of meniscectomy and ACL reconstruction were substantially higher than current Medicare reimbursement. Majority of patients believed that the current reimbursement is too low and patients on average would be willing to pay more out of pocket than is currently reimbursed.
Improved Squat and Gait Biomechanics 6-Months Post-Arthroscopic Surgery for Femoroacetabular Impingement
Authors: Cvetanovich Gregory , Farkas Gary Jordan , Rajan Kumar , Espinoza Alejandro , Nho Shane Jay
Published: July 2016

Objectives:

This study aimed to assess gait and squat biomechanics 6-months following arthroscopic surgery for femoroacetabular impingement.

Methods:

Symptomatic patients with clinical and radiographic diagnosis of FAI who had failed non-operative treatment underwent gait and squat analysis preoperatively and at 6-months postoperatively following arthroscopic surgery for FAI. Age- and BMI-matched controls without radiographic FAI or other lumbar or lower extremity pathology underwent a single analysis for comparison. Comparisons between preoperative and 6-month postoperative gait and squat parameters as well as comparison to the control group were performed using paired and independent sample t-tests. Statistical significance was set at p<0.05.

Results:

Fifteen FAI patients and 9 controls were analyzed. Age for the patients vs. controls was 28.7±9.6 y vs. 27.8±6.5 y (p>0.05), respectively; while BMI was 23.5±5.1 kg/m2 vs. 22.8±3.5 kg/m2 (p>0.05). All gait parameters were unchanged between preoperative and 6-month postoperative testing (p>0.05), with a trend toward significance for hip external rotation moment (p=0.056) (Table 1). Squat testing revealed that FAI arthroscopic surgery increased maximum hip extension (p=0.011), with a trend toward significance for hip adduction moment (p=0.059). All other squat parameters did not differ from preoperative to 6-month follow-up (p>0.05). Compared to the control group, preoperative FAI patients had reduced hip external rotation moment during gait (p=0.024), with a trend toward significance for hip abduction moment (p=0.082). No other gait or squat differences were detected between FAI patients preoperatively or 6-months postoperatively compared to controls (p>0.05).

Conclusion:

Biomechanical gait and squat analysis at 6-month follow-up from arthroscopic FAI surgery revealed a tendency to improve external hip rotation during gait and maximum hip extension and hip adduction during squat. Arthroscopic surgery for FAI may help to restore the reported altered gluteal function by the early 6 months postoperative timepoint.