bluuebunny/crossref_metadata_2025 huggingface dataset:
Is MRI Subchondral Acetabular Edema or Cystic Change a Contraindication for Hip Arthroscopy in Patients with FAI?
Authors: Krych Aaron John , King Alexander Harrison , Berardelli Rebecca L. , Sousa Paul L. , Levy Bruce A.
Published: August 2015

Objectives:

Arthroscopic treatment for femoroacetabular impingement (FAI) generally has good results, but the outcome can worsen with increasing arthritis, largely defined as joint space narrowing. There remains a subset of hips with maintained joint space but with subchondral edema and cystic change of the acetabulum on MRI, with unknown outcome. Therefore, the purpose of this study was (1) to determine if postoperative outcome was worse for patients with subchondral edema on preoperative MRI compared to a matched control group and (2) to identify risk factors on MRI leading to inferior outcome.

Methods:

A review of patients who underwent arthroscopic hip surgery for FAI between 2007 and 2013 identified 530 patients. Of these, 39 patients had evidence of subchondral edema or subchondral cyst on the preoperative MRI with maintained joint space on preoperative radiographs. Lesions were characterized by grade, location and type using an established radiographic MRI classification system. A matched cohort of patients without evidence of subchondral edema or cyst was identified, and 2:1 matching was based on patient age, surgeon, surgery year within one year, surgical procedure, Tegner activity score, and Tonnis grade osteoarthritis changes on preoperative x-ray. Outcome was compared using the Hip Outcome Score and Modified Harris Hip Score between the two groups. Risk factors were then analyzed for type of lesion, grade and location of bone marrow lesion.

Results:

Thirty-nine patients (20 males, 19 females) showed preoperative MRI evidence of subchondral edema, and were followed for a mean of 23 months postoperatively (range, 12 - 60 months). Patients had an average age of 41 years (range, 19 - 67) and a preoperative Tegner score of 3.8 (range, 1 - 9). 87% of patients with subchondral cystic change had evidence of a grade IV full thickness cartilage lesion at the time of hip arthroscopy. Average Modified Harris Hip Scores were inferior for the subchondral group (79.9 ± 18.7) compared to the control group (86.6 ± 12.5; p = 0.027). In addition, Sport sub-scales of the Hip Outcome Score showed significantly lower scores for the subchondral group for both score (69.1 ± 27.0 vs. 79.5 ± 21.4, p = 0.018) and rating (66.7 ± 27.5 vs. 78.0 ± 20.8, p = 0.044). No radiographic risk factors, including type, location, or size of lesion were significant predictors of outcome. Two patients in the subchondral group were later converted to a total hip replacement.

Conclusion:

The presence of a subchondral acetabular cyst on MRI is indicative of a full thickness cartilage lesion at the time of arthroscopy. These patients have inferior outcomes for arthroscopic treatment of FAI compared to patients with similar age and activity level without MRI subchondral changes. Therefore, we recommend caution with consideration of hip arthroscopy in this patient subset.
Open-Access Video-Based Orthopaedic Instructional Content is Inaccurate
Authors: Urch Ekaterina Y. , Taylor Samuel A. , Cody Elizabeth , Fabricant Peter D. , Burket Jayme , O’Brien Stephen J. , Dines David M. , Dines Joshua S.
Published: August 2015

Objectives:

The internet has an increasing role in both patient and physician education. While several recent studies critically appraised the quality and accuracy of web-based written information available to patients, no studies have evaluated such parameters for open access video content designed for provider use. The present study sought to determine utilization of video resources by orthopaedic residents and assess the quality and accuracy of their content

Methods:

Surveys were distributed to orthopaedic surgery residents to to determine their use of open access instructional video content. An assessment of quality and accuracy of said video content was performed using the basic shoulder examination as a suragate for the “best-case scenario” due to its widely accepted components that are stable over time. Three search terms (“shoulder”, “examination” and “shoulder exam”) were entered into the four online video resources most commonly accessed by orthopaedic surgery residents (VuMedi, G9MD, Orthobullets, and YouTube). Videos were captured and independently reviewed by three orthopedic surgeons. Quality and accuracy were assessed in accordance with previously published standards.

Results:

Of the 72 orthopaedic residents surveyed, 70% use open-access videos as a resource monthly and 25% weekly. Over 70% or respondents perceived the video content to be accurate and informative. We reviewed 39 unique video tutorials on physical examination. Of the 39 videos, 61% rated poor (<25% accurate) or fair (<50% accurate). Specific shoulder tests such as Hawkins, O’Brien Sign, and Neer Impingement were accurately demonstrated in only 50%, 36%, and 27% of videos respectively. Inter-rater reliability was excellent (mean Kappa 0.80, range 0.79-0.81).

Conclusion:

We demonstrated that orthopaedic surgery residents often turn to open-access video tutorials as a supplemental education tool. While the majority residents believed the content is accurate, our results suggest an alarming inaccuracy of these video tutorials. Trainee exposure to inaccurate information has far reaching implications on the education process. As such, training programs should help guide their residents to pre-screened or peer-reviewed video resources.
Validation Of A Dry Model For The Assessment Of Resident Performance Of Anterior Cruciate Ligament Reconstruction (ACLR)
Authors: Dwyer Tim , Shantz Jesse Alan Slade , Chahal Jaskarndip , Wasserstein David , Schachar Rachel , Devitt Brian M. , Theodoropoulos John S. , Ogilvie-Harris Darrell
Published: August 2015

Objectives:

As the demand increases for demonstration of competence in surgical skill, the need for validated assessment tools also increases. The purpose of this study was to validate the use of a sawbones model for the assessment of performance of anterior cruciate reconstruction (ACLR) by residents. We hypothesized that the combination of a checklist and a previously validated global rating scale be a valid and reliable means of assessing ACLR when performed by residents in a dry model.

Methods:

All residents, sports medicine staff and fellows were invited to perform an ACLR on an ACL Sawbones model. Demographics regarding previous exposure to knee arthroscopy and ACLR were collected. All participants were asked to perform a hamstring ACLR using an anteromedial portal with Endobutton fixation on the femur - a detailed surgical manuscript and technique video was sent to all residents prior to the study. Residents were evaluated by faculty using a task-specific checklist created using a modified Delphi procedure, and the Arthroscopic Surgical Skill Evaluation Tool (ASSET) global rating scale. Each procedure was recorded, with videotaping of the hand movements and arthroscopic video recordings of the intra-articular procedure. These videos were scored by a fellow blinded to the year of training of each resident.

Results:

A total of 29 residents, six staff and five faculty performed an ACLR on the sawbones model (40 total). The overall reliability (Cronbach's Alpha) of the test using the total ASSET score was very high (>0.9). The reliability for the femoral checklist was 0.75, for the tibial checklist was 0.78, and 0.68 for the graft passage and fixation. One-way analysis of variance for the total ASSET score and the total checklist score demonstrated a difference between residents based upon year of training (p<0.001). Post hoc analysis demonstrated a significant difference in global ratings and checklist scores between junior residents (PGY1-3) and senior residents (PGY4&5), seniors and fellows, and fellows and staff (p<0.05). A good correlation was seen between the total ASSET score and prior exposure to knee arthroscopy (0.73) and ACLR (0.65). The inter-rater reliability (ICC) between faculty rating and blinded assessor for the total ASSET score was very high (>0.8).

Conclusion:

The use of a sawbones models to assess resident performance of ACLR using the ASSET global rating scale is valid and reliable. These models may be used to ensure a minimal level of competence prior to resident performance of ACLR in the operating room.
Outcomes after Anterior Cruciate Ligament Reconstruction using the Norwegian Knee Ligament Registry of 14,142 Patients
Authors: LaPrade Christopher M. , Dornan Grant , Granan Lars-Petter , LaPrade Robert F. , Engebretsen Lars
Published: August 2015

Objectives:

While the effects of concurrent meniscal resection and anterior cruciate ligament reconstruction (ACLR) are known to decrease patient outcomes and increase the rate of osteoarthritis over the long-term, overall short-term patient functional outcomes in a large cohort of patients are not well known. Therefore, the purpose of this study is to compare the preoperative and two-year postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale scores after ACLR with and without meniscal injury. In comparison to an isolated ACLR, we hypothesized that patients with a medial meniscal (MM) or lateral meniscal (LM) resection with an ACLR would have significantly decreased two-year postoperative KOOS outcomes, while those with an ACLR with a MM or LM repair would be indistinguishable to isolated ACLR.

Methods:

The Norwegian Knee Ligament Registry (NKLR) was used to evaluate outcomes for a total of 14,142 patients with primary ACLR. The KOOS scoring system was used to evaluate patients on 5 subscales (Pain, Other Symptoms, Activities of Daily Life (ADL), Sport and Recreation Function (Sport/Rec), and Quality of Life (QoL) at time of surgery and at two-year postoperative follow-up. Patients with isolated ACLR and ACLR with LM repair, LM resection, MM repair or MM resection were compared using multiple linear regression modeling.

Results:

Preoperatively, in comparison to isolated ACLR, patients that had an ACLR with either a MM repair or MM resection had significantly lower scores for all KOOS subscores and LM repair had significantly decreased scores on the Other Symptoms, Pain, and ADL subscales. Postoperatively, in comparison to isolated ACLR, two-year KOOS outcomes were not significantly different between patients with ACLR and either LM repair, MM resection, or LM resection; however, those with MM repair had significantly lower scores on the Other Symptoms and QoL subscales.

Conclusion:

For the majority of study groups, patients with meniscal repairs or resections with concomitant ACLR had postoperative KOOS scores that were not significantly different from an isolated ACLR. Patients with ACLR with meniscal resections do not exhibit decreased clinical outcomes at two years postoperatively. It is recommended that clinicians follow patients with ACLR and concurrent meniscal treatment for longer than two years postoperatively.
Inter- and Intra-Rater Reliability of Predictive Models for the Non-Operative Healing Potential of Stable Juvenile Osteochondritis Dissecans (JOCD) Knee Lesions
Authors: Haskel Jonathan D. , Uppstrom Tyler J. , Gausden Elizabeth Bishop , Meyer Russell , Shin Yong-Woon , Nguyen Joseph , Green Daniel W.
Published: August 2015

Objectives:

While juvenile osteochondritis dissecans (JOCD) lesions have greater healing potential than equivalent lesions in adults, only 50% of JOCD lesions demonstrate radiographic healing after 6 months of non-operative treatment. Krause et al. (2013) and Wall et al. (2008) have described models to predict a patient's probability of healing with non-operative treatment based on patient and lesion characteristics. The Wall et al. nomogram incorporates normalized lesion length, normalized lesion width, and pain type, while the Krause et al. model includes normalized lesion width, patient age, and the size of concurrent cyst-like lesions. The purpose of this study was to determine inter- and intra-observer reliability of the predictive nomograms.

Methods:

We retrospectively evaluated a consecutive series of children with open physes, who underwent non-operative treatment for stable JOCD lesions. Thirty-four patients (40 knees) were included in the study. At two time points at least one week apart, two medical students, two orthopaedic surgeons, and a radiologist made measurements of the JOCD lesions as described by Wall and Krause. These measurements, along with patient ages and pain type, were used to generate a point value for each lesion based on both the Krause and Wall models. Intra-class correlations (ICC) were calculated using the point value data obtained from the nomograms to determine inter- and intra-rater reliability.

Results:

Based on the Landis & Koch (1977) threshold, we found near perfect intra-rater correlation for all raters in terms of individual OCD measurements, as well as total point score as calculated by both Krause and Wall methods (Table 1). Additionally, amongst the five raters there was near perfect inter-rater reliabilities in total scores, as well as substantial to near perfect reliability in measuring the individual components of the scores (Table 2).

Conclusion:

There is high inter- and intra-rater reliability for both the Krause and Wall point systems for predicting healing of JOCD lesions. These models appear to be important tools for helping doctors and patients reliably predict the healing potential of non-operative management of JOCD lesions.
Decellularized Osteochondral Allograft for the Treatment of Cartilage Lesions in the Knee
Authors: Farr Jack , Gracitelli Guilherme , Gomoll Andreas H.
Published: August 2015

Objectives:

Chondrofix® is a pre-shaped cylindrical, decellularized and sterilized osteochondral allograft (OCA). The purpose of this study was to evaluate functional outcomes and graft survivorship among patients treated with this implant for cartilage injuries in the knee.

Methods:

An IRB-approved database was used to identify a prospective series of 32 patients who had been treated with the Chondrofix implant. The surgeries were performed in two centers by two surgeons. The mean age ± Standard Deviation (SD) of the patients was 35.1 ± 10.6 years; 59% were male. Twenty-four (75%) knees had previous surgery. The mean defect area ± SD was 2.9 ± 2.0 cm² . The mean allograft size ± SD was 13.18 ± 2.3 mm (6 grafts ≤ 9 mm and 59 grafts ≥11mm). The number and type of reoperations were assessed. Failure was defined as structural damage of the graft diagnosed by arthroscopy or magnetic resonance imaging and any reoperation resulting in removal of the allograft. Patients were evaluated pre- and postoperatively using the Knee Injury and Osteoarthritis Outcome Score (KOOS) scale and Marx Sports Activity Scale.

Results:

Twenty-three of the 32 knees (72%) were considered failures, and 14 of the 32 knees (43%) had further surgery following the index procedure. Implant survivorship was 19.6% at 2 years(Graphic). The mean follow-up duration was 1.29 years (range 0.11- 2.8 years). KOOS Pain, ADL, Sports and Knee-related Quality of Life (QOL) improved significantly from the preoperative visit to latest follow-up (Table). Age was significantly predictive of failure with hazard ratio of 1.68 per 1SD older (95% CI, 1.05 to 2.68, p = 0.030).

Conclusion:

The decellularized and sterile osteochondral allograft implant demonstrated a 72% failure rate within the first 2 years of implantation in these two institutions.
Variation in Surgical Treatment of Knee Osteochondritis Dissecans (OCD) Among High-Volume OCD Surgeons
Authors: Heyworth Benton E. , Edmonds Eric W. , Kocher Mininder S. , Shea Kevin G. , Nissen Carl W. , Ganley Theodore J. , Murnaghan Michael Lucas
Published: August 2015

Objectives:

Clinical practice guidelines (CPG) for osteochondritis dissecans (OCD) of the knee have demonstrated lower levels of evidence for treatment of this condition. Elucidating variation in treatment is a national priority within healthcare, due to evidence demonstrating that reduction of unnecessary variation can improve outcomes, lower costs, and increase value. The purpose of this study was to assess surgical treatment variation for OCD amongst 20 surgeon-investigator members of an international multi-center OCD study group.

Methods:

Using a validated arthroscopy classification system, surgeons were queried as to which, amongst 5 different surgical treatment ‘principles’ should be applied for each of 6 different arthroscopic OCD presentations in both skeletally immature and mature patients. The process was repeated with an expanded set of 12 different surgical ‘techniques’ for each of the arthroscopy categories. Intra-class correlation coefficients (ICC) were calculated across all surgeons amongst 5 ‘principles’ and amongst 12 ‘techniques’, as well as for each individual arthroscopic presentation.

Results:

When assessing the most prevalent treatment ‘principles’ overall, agreement between surgeons was excellent (ICC = 0.79, 95% CI 0.58-0.96) for skeletally immature knees and good (ICC = 0.74, 0.51-0.95) for skeletally mature knees. Agreement of selected treatment ‘principles’ for each individual arthroscopic presentation ranged from excellent to poor, with more advanced-stage lesion presentations yielding poorer agreement. For selection of specific surgical ‘techniques’, agreement was poor for both for skeletally immature knees (ICC = 0.27, 0.09-0.71) and skeletally mature knees (ICC = 0.0, 0.0-0.95), and fair to poor for the individual arthroscopic presentations.

Conclusion:

High volume OCD surgeons demonstrated good to excellent agreement on the optimal treatment ‘principles’ to apply for the various arthroscopic presentations of knee OCD, but agreement worsens as lesion stage becomes more advanced. Agreement on application of specific surgical ‘techniques’ is consistently poor, suggesting high variation in surgical approaches, even amongst high volume surgeons.Substantiating agreement for surgical ‘principles’ of knee OCD with higher levels of evidence is important, given what the CPG has revealed about literature on OCD. More importantly, the lack of agreement regarding surgical techniques makes multi-center investigations into outcomes following different techniques a critical research initiative in the future. Higher quality prospective research may reduce variation and improve outcomes in surgical techniques for OCD.
Outcomes of Operatively Treated Non-unions and Symptomatic Mal-unions of Adolescent Diaphyseal Clavicle Fractures
Authors: Carsen Sasha , Bae Donald S. , Kocher Mininder S. , Waters Peter M. , Donohue Kyna , Heyworth Benton E.
Published: August 2015

Objectives:

The purpose of the study was to review the clinical characteristics and outcomes of adolescent diaphyseal clavicle fractures treated surgically for non-union, impending non-union, or symptomatic mal-union, which are rare complications of primary non-operative treatment.

Methods:

Records of all patients 10-18 years-old who underwent surgery at a tertiary-care children's hospital between 2003-2013 for a symptomatic mal-union, non-union (no bony bridging >6 mo post-fx), or impending non-union (no callus 1-6 mo post-fx) of a clavicle shaft fracture were reviewed. Demographic data, radiographic features, operative details, and post-operative course were analyzed and compared to an age-matched, sex-matched, and fracture pattern-matched control group of adolescents who underwent plate fixation as primary fracture treatment.

Results:

Sixteen patients (56% male; mean age 15.4 years, range 12.4-17.7 years) met inclusion/exclusion criteria, most of whom (87.5%) were initially treated at an outside hospital. Plate fixation, with or without osteotomy, was performed in 14 cases (87.5%), with bone grafting in 13 cases (81.3%), including iliac crest autograft (n=4), local bone graft (n=4), cancellous allograft (n=1), or local graft + cancellous allograft (n=4). Two mal-union cases (12.5%) underwent ostectomy only. Comparisons of mean time between injury and surgery, time to healing, duration between surgery and return to sports, and rate of removal of hardware (excluding the two ostectomy patients) are detailed in Table 1.

Conclusion:

Adolescents who underwent surgery for diaphyseal clavicle fracture non-union, impending non-union or symptomatic mal-union demonstrated bony healing and returned to sports within 2-4 months, with a comparable post-operative course and rate of subsequent hardware removal to patients treated with plate fixation for their primary clavicle fracture. To address the rare instance of slow, failed, or painful healing following non-operative management of diaphyseal clavicle fracture in adolescents, surgical treatment, which may be more technically challenging and often requires bone grafting, has clinical and radiographic results that are comparable to primary fracture fixation.
Return to Sports in a General Hip Arthroscopy Cohort: Minimum Two-Year Follow-Up
Authors: Domb Benjamin G. , Dunne Kevin F. , Martin Tim , Gui Chengcheng , Finch Nathan , Stake Christine E.
Published: August 2015

Objectives:

Previous studies have assessed elite athletes’ level of return to sport, but few have investigated a general hip arthroscopy cohort. The study purpose was to compare patient-reported outcomes (PRO) scores and ability to perform sports-related movements between a group of patients that returned to sport (RTS) and a group that did not return to sports (NRTS).

Methods:

Between September 2008 and April 2012, 1343 patients underwent hip arthroscopy, of which, 157 patients (168 hips) reported playing a sport before surgery and also indicated their postoperative involvement in sports. Of these, 148 patients (158 hips, 94%) had two-year follow-up. Four PROs were used. The Hip Outcome Score - Sports Specific Subscale (HOS-SSS) was the primary measure to assess return to sports and ability to perform sport-related movements.

Results:

In the overall cohort of 148 amateur and professional athletes (158 hips) who underwent hip arthroscopies, 25 (17%) did not return to sports due to hip-related issues. An additional 32 patients (22%) did not return to sports due to non-hip-related issues, while three patients did not return sports for unidentified reasons. These 60 patients (65 hips) were considered the NRTS group. The remaining 88 patients (93 hips) were defined as the RTS group. Average ages for the RTS and NRTS groups were 30.7 and 30.4 years, respectively. Both groups demonstrated significant improvements from preoperative to postoperative scores based on all PRO measures. While there was no significant difference between groups for HOS-SSS scores preoperatively, the RTS group had significantly higher HOS-SSS scores at one year and two years post-surgery. Postoperatively, patients in the RTS group had significantly better ability to: run one mile, jump, land from a jump, stop quickly and perform cutting/lateral movements (p<0.05). Patients with HOS-SSS>20 at two years post-surgery were 2.3 times as likely to return to sport as those with HOS-SSS < 20.

Conclusion:

In a mixed group of hip arthroscopy athletes, 84% returned to sport or discontinued participation due to non-hip related issues. Patients who returned to sport demonstrated significantly higher HOS-SSS scores and abilities to perform several sport-related movements. movements.
Magnetic Resonance Arthrography and the Prevalence of Acetabular Labral Tears in Patients 50 Years of Age and Older: Is It Really Indicated?
Authors: Jayakar Rohit , Merz Alexa , Plotkin Benjamin , Wang Dean , Seeger Leanne L. , Hame Sharon L.
Published: August 2015

Objectives:

Arthroscopy for acetabular labral tears has minimal impact on pain and function in patients older than 50 years of age in the setting of concomitant osteoarthritis. Despite this, many physicians continue to seek diagnoses of labral tears in older arthritic patients with magnetic resonance arthrography. The inefficacy of surgical management and the suggested high prevalence of this condition in both symptomatic and asymptomatic patients call into question the utility of diagnosis through an invasive and expensive imaging modality. The purpose of this study is to assess the frequency of acetabular labral tears in patients aged 50 years and older with hip pain and to correlate the likelihood of a labral tear with the severity of osteoarthritis as visualized on conventional radiograph.

Methods:

From 2004-2013, 208 patients aged 50 years and older who underwent hip MR arthrogram and hip radiographs within a 12-month period were identified. Age, gender, grade and location of labral tear, hip alpha angle, hip Tönnis grade, and hip joint space width were documented for each patient. Labral tears and alpha angle were identified and measured on MR arthrogram. Tönnis grade and joint space width were measured on hip radiographs by a musculoskeletal radiologist.

Results:

On MR arthrography, labral pathology was identified in 93% of patients (73.1% labral tearing, 20.2% labral fraying or degeneration). In patients with moderate to severe osteoarthritis (Tönnis grade 2-3), 100% had labral pathology (73.1% labral tearing, 26.9% labral fraying or degeneration). Similarly, in patients with joint space width ≤ 2mm, 100% had labral pathology (81.2% labral tearing, 18.8% labral fraying or degeneration). There were no statistically significant correlations between labral tear grade and Tönnis grade or joint space width.

Conclusion:

Given the high frequency of tears, as well as the questionable efficacy of arthroscopic surgical intervention in these patients, only good surgical candidates with chronic hip pain and minimal evidence of osteoarthritis (joint space width > 2mm, Tönnis grade 0-1) on initial radiographic evaluation should be considered for magnetic resonance arthrography.
Labral Reconstruction with Iliotibial Band Autograft and Semitendinosus Allograft Improves Hip Joint Contact Area and Contact Pressure: An In-Vitro Analysis
Authors: Lee Simon , Wuerz Thomas H. , Shewman Elizabeth , McCormick Francis , Salata Michael Jonathan , Philippon Marc J. , Nho Shane Jay
Published: August 2015

Objectives:

Labral reconstruction using iliotibial band (ITB) autograft and semitendinosus (Semi-T) allograft have recently been described in cases of labral deficiency. The current study seeks to understand the biomechanical effects of an intact labrum, segmental labral resection, and labral reconstruction on joint contact area, contact pressure, and peak force.

Methods:

Ten fresh-frozen human cadaver hips were analyzed utilizing thin-film piezoresistive load sensors to measure contact area, contact pressure, and peak force 1) with the native intact labrum, 2) after segmental labral resection and 3) after graft labral reconstruction with either ITB autograft or Semi-T allograft. Each specimen was examined at 20° extension and 60° flexion. Statistical analysis was conducted through one-way ANOVA with post-hoc Games-Howell tests.

Results:

For the ITB group, labral resection significantly decreased contact area (20°: 73.2%±5.38, P=0.0010; 60°: 78.5%±6.93, P=0.0063) and increased contact pressures (20°: 106.7%±4.15, P=0.0387; 60°: 103.9%±1.15, P=0.0428). ITB reconstruction improved contact area (20°: 87.2%±12.3, P=0.0130; 60°: 90.5%±8.81, P=0.0079) and contact pressures (20°: 98.5%±5.71, P=0.0476; 60°: 96.6%±1.13, P=0.0056) from the resected state. Contact pressure at 60° flexion was significantly lower compared to the native labrum ( P = 0.0420). For the Semi-T group, labral resection significantly decreased contact area (20°: 68.1±12.57, P=0.0002; 60°: 67.5%±6.70, P=0.0002) and increased contact pressures (20°: 105.3%±3.73, P=0.0304; 60°: 106.8%±4.04, P=0.0231). Semi-T reconstruction improved contact area (20°: 87.9%±7.95, P=0.0087; 60°: 92.9%±13.2, P=0.0014) and contact pressures (20°: 97.1%±3.18, P=0.0017; 60°: 97.4%±4.39, P=0.0027) from the resected state. Comparative analysis demonstrated no statistically significant differences between either graft reconstruction in relation to contact area, contact pressure, or peak forces. (Figure 1).

Conclusion:

Segmental anterosuperior labral resection results in significantly decreased contact area and increased contact pressures, while labral reconstruction partially restores time-zero acetabular contact areas and pressures as compared to the resected state. Although labral reconstruction improved the measured biomechanical properties as compared to the resected state, some of these properties remained significantly different compared to the native intact labrum.
Effect on Patient-Reported Outcome of Debridement or Microfracture of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament-Reconstructed Knees
Authors: Røtterud Jan Harald , Sivertsen Einar , Forssblad Magnus L. , Engebretsen Lars , Aroen Asbjorn
Published: August 2015

Objectives:

To evaluate the effect of debridement or microfracture compared with no treatment of concomitant full-thickness (International Cartilage Repair Society [ICRS] grades 3-4) cartilage lesions on patient-reported outcome after ACL reconstruction in a large population-based cohort study.

Methods:

644 patients with a primary unilateral ACL reconstruction and a concomitant full-thickness cartilage lesion treated simultaneously by debridement (n=78) or microfracture (n=88), or receiving no treatment (n=191) of the cartilage lesion, registered in the Norwegian and the Swedish National Knee Ligament Registry during 2005-2008 were included. Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to measure patient-reported outcome. At a mean follow-up of 2.1 years (SD, 0.2) after surgery, 357 (55%) patients completed the KOOS. Linear regression analyses were used to evaluate the effect of debridement or microfracture on KOOS. The multiple regression analyses were adjusted for gender, age, previous knee surgery, time from injury to surgery, concomitant ligament injury, concomitant meniscal lesion(s), type of ACL graft, area of cartilage lesion, ICRS grade of cartilage lesion, location of cartilage lesion and preoperative KOOS scores.

Results:

No significant effects of debridement were detected in the unadjusted or adjusted regression analyses on any of the KOOS subscales at 2-year follow-up. Microfracture treatment of the cartilage lesions had significant negative effects at 2 year follow-up on the KOOS subscales Sport/Recreation (regression coefficient [β] = -8.9; 95% CI, -15.1 to -1.5) and Knee-Related Quality of Life (QoL) (β = -8.1; 95% CI, -14.1 to -2.1) in the unadjusted analyses. When adjusting for confounders, microfracture had significant negative effects on the same KOOS subscales, Sport/Recreation (β = -9.1; 95% CI, -16.9 to -1.2), and QoL (β = -7.3; 95% CI, -13.7 to -0.9). For the remaining KOOS subscales Pain, Symptoms and Activity of Daily Living (ADL) there were no significant unadjusted or adjusted effects of microfracture.

Conclusion:

Microfracture of concomitant full-thickness cartilage lesions showed adverse effects on patient-reported outcome at 2-year follow-up after ACL reconstruction. Debridement of concomitant full-thickness cartilage lesions showed neither positive nor negative effects on patient-reported outcome at 2-year follow-up after ACL reconstruction.
Driving Reaction Time after Right Knee Anterior Cruciate Ligament Reconstruction
Authors: Singh Brian , Weinberg Maxwell , Sherman Orrin H. , Strauss Eric Jason , Jazrawi Laith M.
Published: August 2015

Objectives:

The purpose of the present study was to determine when patients recover the ability to safely operate the brakes of an automobile following a right knee anterior cruciate ligament reconstruction (ACLR).

Methods:

A prospective case series of 27 patients who underwent a right knee ACLR, nine with a bone patellar tendon-bone (BPTB) autograft, nine patients who had hamstring (HS) tendon autograft and nine patients who had tibialis anterior (TA) tendon allograft for their reconstructions were tested in a validated computerized driving simulator. At 7-10 days, three weeks, and six weeks post operatively, patients were evaluated with respect to their brake reaction time (BRT), brake travel time (BTT), and total braking time (TBT). Each cohort was then compared with thirty healthy volunteers with similar demographics to establish normative mean values.

Results:

At 7-10 days post-operatively, all patients had statistically significant differences compared to controls for BRT, BTT, and TBT, regardless of the graft used for the reconstruction. By three weeks post-operatively, those reconstructed with TA allografts demonstrated a return to normal braking parameters with no statistically significant differences compared to controls between BRT, BTT, and TBT, whereas those with BPTB and HS autografts continued to have significant delays in their BTT and TBT with BPTB (p = 0.007, p = 0.009) and HS (p = 0.016, p = 0.015), respectively. By six weeks post-operatively, braking parameters for patients receiving an ACL reconstruction with a hamstring autograft returned to normal values while those treated with a BPTB autograft continued to demonstrate impairment in brake travel time and total braking time compared to controls; however, their brake reaction time had recovered to normative values.

Conclusion:

Patients who underwent a right knee ACL reconstruction with a TA allograft regained normal braking times by three weeks post-operatively and continued to improve through the six week post-operative time point. In contrast, those treated with a BPTB or HS autograft demonstrated impaired ability to operate motor vehicle brakes three weeks following surgery. While at six weeks, the braking ability of patients treated with hamstring autografts normalized, those receiving a BPTB autograft continued to demonstrate limitations in their brake travel time and total braking time. Patients should be counseled appropriately when discussing reconstruction options and when it is safe to resume driving.
Patient Factors Associated with Osteochondral Allograft Success in Knees with or without Co-morbidities
Authors: Nuelle Clayton William , Nuelle Julia , Cook James L. , Stannard James P.
Published: August 2015

Objectives:

To determine preoperative variables that may influence outcomes after osteochondral allograft transplantation for treatment of large cartilage defects in the knee.

Methods:

A retrospective review of 75 patients who underwent osteochondral allograft transplantation for large (>1 cm) grade IV cartilage defects in knees was performed. Patient variables evaluated included: smoking, workers compensation, BMI, pre-injury activity level (high level athlete, recreational athlete, active non-athlete, minimal activity, sedentary), number and type of co-morbidities in the operated knee (meniscal, ligament, and/or other cartilage pathology), lesion location (medial femoral condyle, lateral femoral condyle or multiple lesions), number of grafts placed (1, 2 or >2) and patients who underwent revision surgery related to OCA transplantation. Preoperative and postoperative VAS pain scores were used as the primary outcome measure. Success was defined as a VAS pain score of 0 or improvement in score (decrease) of 2 or more at final follow-up. The mean follow-up time was 19.5 months (3-53 months). Statistically significant (p<0.05) effects on successful outcomes were evaluated using Fisher's exact tests and odds ratios.

Results:

The study population was 41 males and 34 females with an average age of 34.2 years (14-61). 53 patients (71%) had successful outcomes. 59 patients (79%) had co-morbidities with the average being 2 comorbidities (1-4) per patient. 68% of patients with co-morbidities achieved a successful outcome versus 81% of patients with no co-morbidities, but this difference in proportions was not statistically significant (p=0.46). Active patients (HLA, REC, ACT) were significantly (p=0.023) and 4.5 times more likely to have a successful outcome than minimally active or sedentary patients. Patients with BMI <30 were 3.7 times more likely to have a successful result and the difference was significant (p=0.011). Smoking, workman's compensation, OCA-related revision surgery, lesion location and number of grafts placed did not have statistically significant effects on outcome.

Conclusion:

Osteochondral allograft transplantation can be a successful treatment option for large cartilage defects in the knee with patients having no intra-articular co-morbidities achieving an 81% success rate. Patients who are more active preoperatively and those with BMI <30 were significantly more likely to have successful outcomes.
Increased Risk of Second Anterior Cruciate Ligament Injury for Female Soccer Players
Authors: King Alexander Harrison , Krych Aaron John , Sousa Paul L. , Stuart Michael J. , Levy Bruce A. , Dahm Diane L.
Published: August 2015

Objectives:

Female athletes are an at-risk population for anterior cruciate ligament (ACL) injury, with rates of injury significantly higher than the general population. Few studies have reported on a second ACL injury for female athletes. The purpose of this study was to (1) report the rate of subsequent ACL injury (ACL graft rupture or contralateral ACL tear) in competitive female soccer players, (2) compare these rates to those of other female athletes of similar competitive level, and (3) determine risk factors for second ACL injury in this athletic population.

Methods:

The medical record at our institution was reviewed for patients treated with primary ACL reconstruction between 1998 and 2013. Female patients injured during a competitive athletic event were included for further review, and followed for an average of 7.1 years postoperatively (range 1.0 - 17.7 years). Chi-square analysis was used to compare rate of graft rupture and contralateral ACL injury based on pre-operative Tegner score, graft type, and injury side for soccer players vs. other female athletes. Wilcoxon rank-sum test was used to compare rate of subsequent ACL injury to patient age.

Results:

337 patients met our inclusion/exclusion criteria (90 soccer players; 247 non-soccer playing athletes) with a mean age of 24.0 years. Of the 337 athletes, 6 were injured during professional competition, 43 were injured during collegiate athletics, 184 during high school play, and 136 during recreational athletics. No patient demographical differences were found at baseline between the soccer group and non-soccer group, including Tegner scores. Overall, 21 soccer players (23.3%) sustained a second ACL injury compared to 21 (8.5%) non-soccer athletes (P < 0.001). Soccer players had significantly more graft ruptures (10.0% vs. 2.0%, P = 0.003) and more contralateral ACL tears (13.3% vs. 6.5%, P = 0.04). Risk factors for ACL graft tear included young age (mean 16.0 vs 24.3 years; P < 0.0001) and higher Tegner Activity Level scores (mean 8.1 vs. 7.4, P = 0.049), but were not risk factors for contralateral ACL injury. Graft selection and injury side showed no statistical significance on graft rupture or contralateral injury.

Conclusion:

Female soccer players treated with ACL reconstruction had an increased rate of second ACL injury, including graft tear and contralateral ACL injury, compared to a similar group of non-soccer female athletes (23.3% vs. 8.5%, P < 0.001). In addition, young age and higher activity level were risk factors for graft rupture in this population.
Percutaneous Partial Medial Collateral Ligament Release (PPMCLR) Does Not Result in Residual Medial Collateral Laxity (MCL)
Authors: Hinton M. Alan
Published: August 2015

Objectives:

The intra-articular posterior medial knee can be difficult to approach during arthroscopy. This is especially true for medial meniscal tears, medial meniscal repairs or medial meniscal transplantation. Various methods and instruments have been proposed to help with this approach. PPMCLR is one of these methods. This study found that this is a safe technique and does not result in measurable laxity of the MCL.

Methods:

50 consecutive patients took part in the study. The patients were then randomized into a control or partial percutaneous release group (25 in each group). Prior to arthroscopy each patient had standardized 30 degree valgus stress radiograph performed. The MCL was stressed with the Telos Stress Device GA/III at 30 degrees of flexion; utilizing 150 Newton's of stress. The stress radiographs were measured independently for the maximal separation at the medial compartment. At six weeks the stress radiographs were repeated and the results again recorded. The postoperative care for each group was the same.

Results:

The results were then statistically evaluated using the, finding no radiographic evidence of residual laxity P<.005. There was also no difference in the control and PPMCLR group p<.0005. No patient complained of residual laxity. Patient follow up will be discussed.

Conclusion:

PPMCLR is an effective and safe method to reach the intra-articular posterior aspect of the knee during arthroscopy. PPMCLR does not result in measurable laxity of the MCL.
Short-Term Outcomes of the Subchondroplasty Procedure for the Treatment of Bone Marrow Edema Lesions in Patients with Knee Osteoarthritis
Authors: Davis Adrian Thomas , Byrd Jennifer Marie , Zenner Justin Angelo , Frank Darren A. , DeMeo Patrick J. , Akhavan Sam
Published: August 2015

Objectives:

To determine the short-term outcomes, effectiveness and perception of the subchondroplasty (SCP) procedure in patients with radiographic evidence of bone marrow edema (BME) in the setting of knee osteoarthritis (OA).

Methods:

A retrospective chart review in conjunction with a follow-up questionnaire was conducted on fifty patients with radiographic evidence of BME lesions who underwent the SCP procedure performed at a single academic medical institution. All patients failed prior conservative measures, including medications, injections, physical therapy, and bracing. The questionnaire focused on symptoms before and after the procedure, the perception of the procedure, any other interventions performed after the procedure, and willingness to undergo SCP again.

Results:

The average patient age was 55 years (range 36-82 years) and 53.2% of patients were male. The average follow-up period was 14.6 months (range 12.9-25.1 months). Preliminary data from 50 patients demonstrated an average 4.7 point improvement in pain on a 10 point visual analog scale (pre-SCP 8.3, post-SCP 3.6). Eighty-eight percent (44 of 50) of patients experienced improvement in their pain and 72% (36 of 50) experienced improvement in pain-free walking distance. Forty-eight percent (24 of 50) of patients required additional interventions: eighteen received cortisone or hyaluronic acid injections, two required serial aspirations, and four went on to total knee arthroplasty. The average satisfaction level was 7.8 on a 10 point scale. Seventy-eight percent (39 of 50) of patients stated they would undergo SCP again and 86% (43 of 50) would recommend the procedure to a friend or family member.

Conclusion:

SCP is an effective treatment modality in the management of patients with knee OA and BME lesions. The goal of the procedure is to provide enduring pain relief caused by BME, hopefully delaying the need for TKA in this select patient population. Future studies are necessary to evaluate the long-term outcomes of SCP.
Incidence Of Delayed Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients With Previous Anterior Tibial Spine Fractures
Authors: Mitchell Justin , Fader Ryan R. , Rhodes Jason , Vidal Armando F.
Published: August 2015

Objectives:

Pediatric avulsion fractures of the anterior tibial spine are injuries similar to anterior cruciate ligament injuries in adults. Sparse data exists on the association between anterior tibial spine fractures (ATSFs) and later ligamentous laxity and need for anterior cruciate ligament (ACL) reconstruction. Understanding that there is a component of stretch injury to the ACL during initial ATSF, and that there is limited ability for the ACL to undergo remodeling of mid substance fibers, it would stand to reason that this injury could cause weakness in the ACL and lead to delayed instability or injury. This research presents a retrospective review of clinical records, operative reports, and patient reporting to characterize the incidence of delayed ACL reconstruction in cases of ATSFs in children. The purpose of this study was to better delineate the incidence of delayed instability or ACL rupture requiring further surgery in the form of ACL reconstruction.

Methods:

We identified 44 patients who sustained an ATSF and met inclusion criteria for this study between 1996 and 2011. The subjects were aged between 5 and 18 at the time of injury and were separated by the Myers and McKeever classification into type I, II, and III fractures. All patients had at least two-year follow-up after initially injury by clinical examination and/or via telephone. Patients were asked if any further surgical intervention was performed on their injured knee, and if so, operative reports were reviewed thereafter.

Results:

Eleven percent of children with an ATSF sustained a delayed ACL rupture requiring ACL reconstruction. No delayed ACL reconstruction with type I fractures (0/6) was found. Fourteen percent of type II injuries (4/21) reported delayed ACL reconstruction after a second injury. Six percent (1/17) type III fractures went onto later reconstruction.

Conclusion:

This data suggests that a small subset of patients with previous ATSF may be at risk for delayed ACL rupture. At this time, it is unclear as to whether these delayed ACL ruptures are related to initial injury or caused only by a secondary event that would have otherwise caused ACL rupture. Further patient follow-up and prospective studies are required. Although ATSF is a rare injury, our cohort of patients suggests that a subset of patients with type II and III fractures will require later ACL reconstruction. There is a need to council patients that delayed ACL rupture is a potential risk after an ATSF.