bluuebunny/crossref_metadata_2025 huggingface dataset:
Can People Judge the Veracity of Their Intuitions?
Authors: Leach Stefan , Weick Mario
Published: July 2017

People differ in the belief that their intuitions produce good decision outcomes. In the present research, we sought to test the validity of these beliefs by comparing individuals’ self-reports with measures of actual intuition performance in a standard implicit learning task, exposing participants to seemingly random letter strings (Studies 1a–b) and social media profile pictures (Study 2) that conformed to an underlying rule or grammar. A meta-analysis synthesizing the present data ( N = 400) and secondary data by Pretz, Totz, and Kaufman found that people’s enduring beliefs in their intuitions were not reflective of actual performance in the implicit learning task. Meanwhile, task-specific confidence in intuition bore no sizable relation with implicit learning performance, but the observed data favoured neither the null hypothesis nor the alternative hypothesis. Together, the present findings suggest that people’s ability to judge the veracity of their intuitions may be limited.
The Dark Side of a Smiley
Authors: Glikson Ella , Cheshin Arik , Kleef Gerben A. van
Published: July 2017

First impressions are heavily influenced by emotional expressions such as smiles. In face-to-face contact, smiling individuals are perceived as warmer and as more competent than nonsmiling individuals. In computer-mediated communication, which is primarily text-based, the “smiley” (☺) constitutes the digital representation of a smile. But is a smiley a suitable replacement for a smile? We conducted three experiments to examine the impact of smiley use on virtual first impressions in work-related contexts. Our findings provide first-time evidence that, contrary to actual smiles, smileys do not increase perceptions of warmth and actually decrease perceptions of competence. Perceptions of low competence in turn undermined information sharing. The adverse effects of smiley use are moderated by the formality of the social context and mediated by perceptions of message appropriateness. These results indicate that a smiley is not a smile. The findings have implications for theorizing on the social functionality of virtual emotional expressions.
Ureteric stents: The past, present and future
Authors: Williams Kevin G , Blacker Anthony JR , Kumar Priyadarshi
Published: July 2017

Ureteric stents are fundamental to modern-day urological practice. This article aims to chronicle their development over the last century and the key individuals whose efforts have made their development possible. Early stents were ureteric catheters that were exteriorised outside the body and were associated with complications including migration, infection and encrustation.

The use of polyethylene stents in humans was first reported by Tulloch in 1952. Polyethylene was thought to be a promising material due to its durability and water-repellent nature. It would, however, suffer the problems that would become associated with stents over the following decades mentioned above.

The first silicone ureteric stents were developed in the 1960s by Zimskind and provided prolonged, efficient drainage but were complicated with stent migration. Collars, wings, flanges and barbs were developed to help prevent migration. Finney developed a double ‘pig-tail’ stent in the 1970s which helped to prevent both proximal and distal migration and the modern-day ureteric stent was born.

Modern polymers have been developed such as polyurethane or styrene ethylene-butylene (C-flex®). Metal stents have also been used over the last three decades including the Wallstent™, Resonance® and Memokath™ stents. They have shown promising results particularly when long-term relief of ureteric obstruction is needed.

Various strategies are available for removal including cystoscopically, stents with a metallic end that can be removed by using a catheter with a magnet at the proximal end, tethered stents that can be removed noninvasively either by the urologist, nurse or even by the patient and dissolvable stents which are in development.
“Enjoy your feeling”: A media archaeology of material publics
Authors: Bassett Nathanael Edward , Archer Jason Edward
Published: July 2017

Ubiquitous technology depends upon imposing standards. Choices in function and form reflect the homogenization of artifacts, necessitated by the intentions of experts to satisfy a plurality of users. In material publics, users with expert knowledge can develop customized artifacts satisfying desired affordances or aesthetics. This project involves a media archaeology of computer keyboard design to explore the relationship between experts, publics, and the creation of these artifacts. Participation in these communities and study of enthusiast records result in a public-expert knowledge. The importance granted to minutia of design, from the choice of plastics to spring tensioning, parallels new form factors that reflect highly personalized choices. These reassert user control over the materiality of an otherwise ubiquitous and mundane mediating artifact. Publics then create a new political materiality by recomposing artifacts beyond what commercial expertise prescribes.
Resistance to dasatinib is associated with the activation of Akt in oral squamous cell carcinoma
Authors: Yee Pei San , Gan Chai Phei , Zainal Nur Syafinaz , Chiang Ivy KN , Dionne Kalen R , Fadlullah Muhammad ZH , Lee Bernard KB , Tiong Kai Hung , Mun Kein Seong , Abraham Mannil T , Ismail Siti M , Rahman Zainal A Abdul , Patel Vyomesh , Cheong Sok Ching
Published: July 2017

Objectives:

Overexpression and aberrant activation of Src promote the development of oral squamous cell carcinoma (OSCC), thus therapies targeting Src-related kinases may afford an improvement in patient survival. However, limited clinical activity of the Src-targeted drug, dasatinib, in cancer patients warrants further investigation to better understand the underlying basis of resistance to dasatinib in OSCC.

Methods:

Response to dasatinib was evaluated in a panel of oral cancer cell lines by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, DNA synthesis, cell cycle and apoptosis analysis. The underlying mechanism of drug response was investigated using immunoblotting. Xenograft models were used to test efficacy.

Results:

All cell lines were sensitive to dasatinib (IC50 < 250 nM), but this was not associated with CDKN2a/p14ARF mutations. Dasatinib-induced cell cycle arrest and apoptosis, while inhibiting Src, Akt and FAK activity in all lines tested. However, dasatinib failed to inhibit tumour growth in xenograft models and treated tissues showed Akt activity despite the loss of Src activity.

Conclusions:

Our data revealed that reactivation of Akt (Ser473) could be a compensatory mechanism that bypasses Src inhibition by dasatinib, providing important clues that could improve treatment strategies to overcome dasatinib resistance.
Painless Aortic Dissection—Diagnostic Dilemma With Fatal Outcomes: What Do We Learn?
Authors: Fatima Saeeda , Sharma Konika
Published: July 2017

Aortic dissection is the most catastrophic clinical condition that involves the aorta. It has a high mortality as well as high rate of misdiagnosis due to frequent unusual presentation. Typically, it presents with acute chest, back, and tearing abdominal pain. However, it can present atypically with minimal or no pain, making diagnosis difficult. Physicians should always suspect acute aortic dissection in patients with certain clinical conditions like difficult-to-control hypertension, giant cell arteritis, bicuspid aortic valve, intracranial aneurysms, simple renal cysts, family history of aortic disease, and Marfan syndrome, especially when a patient presents with ischemic symptoms involving multiple organ without an obvious cause.
Ultra-long-toss vs Straight-line Throwing for Glenohumeral Range of Motion Recovery in Collegiate Baseball Pitchers
Authors: Luo Tianyi D. , Naugher Gregory Lane , Stone Austin , Mannava Sandeep , Strahm Jeff , Freehill Michael T.
Published: July 2017

Objectives:

Repetitive throwing in baseball pitchers can lead to pathologic changes in shoulder anatomy with potential subsequent injury. There have been few studies on throwing regimens and the types of throwing most efficacious for both maintenance and recovery during the baseball season. Limited-distance straight-line throwing (SLT) mimics more normal pitching mechanics, whereas ultra-long-toss (ULT) at greater than physiological throwing distances changes shoulder kinematics, but theoretically offers the advantage of stretching the posterior capsule. Debate exists as to whether ULT or SLT is superior for glenohumeral range of motion (ROM) recovery after baseball pitching. We hypothesize that ULT, via a potential mechanism of posterior shoulder capsular stretching, will be more effective in returning a pitcher’s baseline external rotation (ER), internal rotation (IR), and total range of motion (TROM) when compared to SLT in a cohort of collegiate pitchers.

Methods:

Sixteen Division-I collegiate baseball pitchers were randomized to ULT (n=8, mean age 20.1 ± 1.4 years) or SLT group (n=8, mean age 20.0 ± 1.1 years). Measurements (dominant and non-dominant ER, IR, and TROM) were taken at five time-points across three days: before and immediately after a standardized bullpen (BP) session on day 1; before and immediately after a standardized ULT or SLT session on day 2; and before practice on day 3. Data were analyzed using mix design ANOVA. Post hoc analysis was used to detect differences between time-points.

Results:

In the ULT group (Table 1), dominant ER significantly increased from baseline to final measurements (129° to 136°, p=0.006). Significant increase in ER was observed between pre- and post-long-toss throwing (+6.2°, p=0.004). Dominant IR significantly decreased from baseline to final measurements (57° to 50°, p=0.002). TROM did not significantly change across time-points. In the SLT group, dominant ER increased from baseline to final measurements (139° to 142°), but failed to reach statistical significance. Dominant IR did not vary significantly across time-points, nor did TROM.

Conclusion:

Our results do not support our initial hypothesis. ULT yielded greater increases in ER and decreases in IR in comparison to SLT. Total range of motion did not change over time in either throwing group; however, the overall arc of motion changed more significantly in ULT pitchers, secondary to the greater ER and less IR. We had anticipated an increase in IR with ULT due to the theoretical advantage of posterior capsule stretching. The observed IR decrease suggests ULT may cause additive microtrauma resulting in capsular tightness rather than recovering shoulder ROM. Ultra-long-toss throwing should be further evaluated in the context of training, rehabilitation, and injury-prevention. [Table: see text]
Autologous Conditioned Plasma (ACP) versus Corticosteroid Injections for Plantar Fasciitis: A Randomized Trial
Authors: Willits Kevin , Kaniki Nicole , Bryant Dianne , O’Brecht Lyndsay , Remtulla Alliya
Published: July 2017

Objectives:

Plantar fasciitis is a chronic, degenerative breakdown of the plantar fascia that spans the bottom surface of the foot. The injury is associated with point tenderness at the medial side of the heel and pain and tightness with weight bearing. Corticosteroid (CS) injections are a fairly common treatment option after exhausting all other non-operative treatments. Autologous conditioned plasma (ACP) injections may optimize the healing environment for tissue regeneration and repair which may provide greater improvements in pain and function compared to corticosteroid injections. Thus, the purpose of this study was to compare the pain, function and quality of life in patients who have received an ACP injection versus a corticosteroid injection for the treatment of plantar fasciitis.

Methods:

We conducted a randomized controlled trial in patients with plantar fasciitis who were referred to our clinic from local primary care physicians. Patients were stratified by symptom duration (less than and greater than three months) and received either an ACP or CS injection. We measured outcomes at two weeks, six weeks, three months, six months, and one year. Our primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale; secondary outcomes included the SF-12v2 Health Survey and the Plantar Fasciitis Pain and Disability scale. We used an analysis of covariance to analyze all outcomes. We calculated the adjusted between-group mean difference with 95% confidence interval and associated probability values.

Results:

A total of 126 patients were included in the analysis (ACP = 64, CS = 62). For our primary outcome, at six months, the mean and standard deviation of the AOFAS Ankle-hindfoot scale was 67.1±18.3 for the ACP group and 70.8±17.6 for the CS group (mean difference -1.7, CI -7.6 to 4.2, p = 0.6). At one year, the mean and standard deviation was 72.3±19.1 for the ACP group and 75.6±17.0 for the CS group (mean difference -1.3 CI -7.3 to 4.6, p = 0.7). There was no statistically significant differences between treatment groups for any of the secondary outcome measures.

Conclusion:

ACP does not provide greater self-reported pain relief or function than CS injections in patients with plantar fasciitis. Given the know complications of repeated CA injections, ACP is a reasonable first line treatment option.
The Epidemiology of Lisfranc Injuries at the National Football League Combine and its Impact on an Athlete’s National Football League Career
Authors: McHale Kevin Jude , Vopat Bryan George , Sanchez George , Rossy William H. , Logan Catherine , Provencher Matthew T.
Published: July 2017

Objectives:

Lisfranc injuries may have a detrimental effect on athletic performance and an athlete’s career. Understanding the epidemiology of these injuries in collegiate football players and their impact on future performance may assist team physicians in counseling injured athletes and determining optimal treatment. The purposes of this study are to 1) determine the epidemiology of navicular fractures in players participating in the NFL Combine, 2) define positions and demographics that might be at higher risk for sustaining this injury, and 3) evaluate the radiographic healing and eventual impact the injury and radiographic findings has on Lisfranc injuries on NFL draft position and NFL game play compared to matched controls.

Methods:

All players who sustained a Lisfranc injury prior to Combine evaluation between 2009 and 2015 were evaluated. The prevalence, positions affected, treatment methods, and number of missed collegiate games were recorded. Radiographic outcomes were analyzed via Combine radiograph findings, while NFL performance outcomes were assessed for all Lisfranc injuries (2009-13) compared to matched controls in first two years of play.

Results:

A total of 41/2162 (1.8%) Combine participants were identified with Lisfranc injuries, of which 26/41 (63.4%) were managed operatively. When compared to players managed nonoperatively, those who underwent surgery were more likely to go undrafted (38.5% vs. 13.3%, p=0.04) and featured a worse NFL draft pick position (155.6 vs. 109, p=0.03). Lisfranc-injured players were noted to have a worse NFL draft position (142 vs. 111.3, p=0.04), NFL career length ≥2 years (62.5% vs. 69.6%, p=0.23) and fewer games played (16.9 vs. 23.3, p=0.001) and started (6.8 vs. 10.5, p=0.08) within the first two years of NFL career versus controls. Radiographs demonstrated 17/41 (41.5%) athletes with residual Lisfranc joint displacement >2mm compared to the contralateral foot. Lisfranc-injured athletes with >2mm residual displacement had lower draft position (111.2 vs. 156.9, p=0.009), and fewer games played (23.3 vs. 14.4, p=0.001) and started (10.5 vs. 3,1, p=0.03) versus matched controls. Moreover, athletes with >2mm residual displacement featured worse outcomes across all assessed NFL variables versus athletes with ≤2mm residual displacement.

Conclusion:

Lisfranc injuries identified at the NFL Combine have an adverse effect on an NFL athlete’s draft status, draft position and overall play during initial NFL seasons. In particular, residual displacement of the Lisfranc joint has a detrimental impact on the first two seasons of NFL play and may lead to long lasting negative effects on career.
Radiographic Risk Factors and Signs of Abductor Tears in the Hip
Authors: Hartigan David Edward , Perets Itay , Walsh John P. , Chaharbakhshi Edwin , Close Mary , Domb Benjamin G.
Published: July 2017

Objectives:

There is a known increased prevalence of abductor tears in patients with increased age and female gender. This study’s purpose is to identify radiographic risk factors (RRF) and radiographic signs of abductor tendon tears.

Methods:

Patients with intraoperative diagnoses of abductor tear were included in this study and were matched by age ±5 years, gender, and BMI ±5 with patients who had no abductor pathology by clinical exam and MRI. An AP pelvis radiograph was performed on all patients. The radiographs were evaluated for RRF (pelvic width, body weight moment arm, abductor moment arm, abductor angle, pelvic height) and signs of abductor tendon pathology (greater trochanteric excrescence). Femoral version was measured on MRI when images were available.

Results:

There were 152 patients with abductor tears identified intraoperatively. All were treated with surgical repair. These patients were matched as described previously. The RRF found were an increased tear drop to tear drop distance (14.8 for abductor tears vs. 14.3 for control; p<0.001), body weight moment arm (11.1 vs. 10.9; p<0.001), abductor moment arm (7.8 vs. 7.6; p<0.001), decreased femoral anteversion (7.6 vs. 10.6; p=0.045), and excrescence presence (41% vs. 3%; p<0.001). An excrescence of the greater trochanter had a specificity of 97%, PPV of 94% and a positive likelihood ratio of 12.8 for abductor tears.

Conclusion:

Patients with abductor tears have a wider pelvis, longer abductor moment arm, longer body weight moment arm, less femoral anteversion, and have greater trochanteric excrescence noted on nearly half of patients with an abductor tear. Presence of an excrescence was noted to have a positive predictive value of 94%, specificity of 97%, and positive likelihood ratio of 12.75, suggesting that if noted on radiograph, the care provider should have a very high index of suspicion for abductor tendon tear.
Operative Management of Osteochondritis Dissecans: Progression to Osteoarthritis and Arthroplasty in a Population Based Cohort
Authors: Sanders Thomas L. , Pareek Ayoosh , Johnson Nick R. , Mohan Rohith , Carey James L. , Stuart Michael J. , Krych Aaron John
Published: July 2017

Objectives:

Osteochondritis dissecans (OCD) is a disorder of subchondral bone that causes adverse effects on the overlying cartilage and commonly affects the knee. The purpose of this study is to (1) evaluate the rate of arthritis and knee arthroplasty in a population-based cohort of patients with OCD lesions treated operatively and (2) evaluate factors that may predispose patients to knee osteoarthritis and arthroplasty.

Methods:

221 patients (mean age 26.1 ± 13.6 years) with OCD lesions treated operatively were identified between 1976 and 2014 and followed for a mean of 16.3 (±11.4) years from diagnosis. Information related to the diagnosis, laterality of lesion, details of treatment, and progression to arthritis was obtained from the medical record. Surgical treatment was classified as palliative (fragment excision) or restorative (lesion drilling, fragment fixation, osteochondral allograft or autograft). Factors predictive of arthritis and arthroplasty were examined.

Results:

In the palliative group, the cumulative incidence of arthritis was 12.0% at 5 years, 17.0% at 10 years, 26.0% at 15 years, 39.0% at 20 years, and 70% at 30 years. The cumulative incidence of arthroplasty was 2.0% at 5 years, 4.0% at 10 years, 4.0% at 15 years, 10.0% at 20 years, and 32.0% at 30 years. In the restorative group, the cumulative incidence of arthritis was 3.0% at 5 years, 7.0% at 10 years, 16.0% at 15 years, 25.0% at 20 years, and 51% at 30 years. The cumulative incidence of arthroplasty was 0.0% at 5 years, 0.0% at 10 years, 3.0% at 15 years, 6.0% at 20 years, and 11.0% at 30 years. BMI greater than 25 kg/m2 (HR 3.3, 95% CI: 1.6, 7.0), older age at diagnosis (HR 4.9, 95% CI: 1.8, 17.3) and fragment excision (HR 2.3, 95% CI: 1.2, 4.6) were predictive of arthritis.

Conclusion:

OCD patients treated with fragment excision have a high rate of arthritis and knee arthroplasty at long-term follow-up. In contrast, patients treated with fragment repair or osteochondral restoration have lower rates of arthritis and arthroplasty. BMI greater than 25 kg/m2, older age at diagnosis, and fragment excision were predictive of arthritis.
OCA Transplantation Outcomes for Replacing Large Bipolar Defects in the Knee using Novel Techniques
Authors: Cook James L. , Stannard James P. , Kfuri Mauricio , Crist Brett D. , Smith Matthew Jared
Published: July 2017

Objectives:

Osteochondral allograft (OCA) transplantation can functionally restore large articular cartilage defects in the knee, shoulder, hip and ankle. Studies have reported 10-year survivorship between 71% and 85% and up to 74% survivorship at 15 years. Outcomes after OCA treatment have been good to excellent, even in the athletic population in which 88% of patients returned to sport, including 79% returning to preinjury level of sport. However, OCA transplantations for bipolar defects in the knee have traditionally had less favorable results. With the advent of improved allograft preservation methods and refined surgical techniques, OCA transplantations for bipolar defects in the knee have shown a trend toward better outcomes. Therefore, the objective of this study was to report early functional outcomes associated with OCA transplantations to replace large (>4 cm2) bipolar articular cartilage defects in the knee using novel techniques for graft preservation, enhancing bone ingrowth, and implantation.

Methods:

With IRB approval, patients were enrolled in a dedicated registry for prospective assessment of outcomes after OCA surgery. Demographic and operative data were collected. Outcomes assessments including VAS pain, VAS level of function, IKDC, SANE and PROMIS Mobility are prospectively collected at 6 months and yearly after surgery. All complications and re-operations are recorded. OCA survival is determined based on maintenance of acceptable levels of pain and function and/or need for revision surgery. Data are compared to pre-operative and/or pre-injury levels using repeated measures analyses with significance set at p<0.05.

Results:

Large bipolar OCA transplantations were performed in 23 knees: femorotibial (n=19), patellofemoral (n=4). Mean age of patients was 34.6 years. Mean pre-operative pain, function, IKDC, SANE and PROMIS Mobility scores were 4.7, 4.1, 40.8, 40.1 and 42.1, respectively. At 6 months postop (n=17), mean scores improved to 1.3, 6, 56.2, 71.8 and 46.1, respectively. At 1 year (n=11), mean scores further improved to 0.4, 8.4, 76.7, 80.6 and 58.4, respectively (Table). Two (8.7%) meniscotibial grafts failed in the first 6 months after surgery and were successfully revised by a second OCA transplantation, making initial survival 91.3%. Five (21.7%) other patients required minor reoperations for lysis of adhesions to restore range of motion and/or screw removal. All subjects are enrolled in the registry and outcomes assessments are ongoing and will be updated for presentation.

Conclusion:

Bipolar osteochondral allograft transplantation surgeries for treatment of large (>4 cm2) femorotibial or patellofemoral articular cartilage defects in the knee using novel techniques are associated with significant improvements in levels of pain and function at 1 year after surgery. [Table: see text]
Anatomic Anterior Cruciate Ligament Reconstruction - A Prospective Evaluation Using Three-Dimensional Magnetic Resonance Imaging
Authors: Hart Adam , Sivakumaran Thiru , Burman Mark , Powell Thomas , Martineau Paul A.
Published: July 2017

Objectives:

The recent emphasis on anatomic reconstruction of the anterior cruciate ligament (ACL) is well supported by clinical and biomechanical research. Unfortunately, the location of the native femoral footprint can be difficult or even impossible to see at the time of surgery. Most surgeons therefore rely on anatomic landmarks, custom drill guides, or general rules-of-thumb to guide femoral tunnel placement; however, the accuracy of these techniques to reconstruct each patient’s native anatomy is poorly understood. The objective of this study was to use a previously described isotropic magnetic resonance sequence (3D MRI) to image patients with torn ACLs before and after reconstruction and thereby assess the accuracy of graft position on the femoral condyle in comparison to each patient’s native ACL footprint.

Methods:

Forty-one patients with unilateral ACL tears were prospectively recruited into our study. Each patient underwent a 3D MRI of both the injured and uninjured knees before surgery. The contralateral (uninjured) knee scan was used to define the patient’s native footprint. Patients then underwent ACL reconstruction with hamstring autograft by one of four experienced fellowship-trained sports orthopedic surgeons. The injured knee was reimaged after surgery. The location and percent overlap of the reconstructed femoral footprint was compared to the patient’s native footprint.

Results:

The center of the native ACL femoral footprint was a mean of 16.4 +/- 4.6 mm distal and 5.3 +/- 2.9 mm anterior to the apex of the deep cartilage. The position of the reconstructed graft was significantly different, with mean distance of 10.4 +/- 2.7 mm distal (P < 0.0001) and 7.7 +/- 3.1 mm anterior (P = 0.001). The mean distance between the center of the graft and the center of the native ACL femoral footprint (error distance) was 5.7 +/- 3.6 mm. Comparing error distances amongst the four surgeons demonstrated no significant difference using the Kruskal-Wallis one-way ANOVA (P = 0.78). On average, 21% of the graft was within the native ACL femoral footprint. Of the 41 patients, 16 (39%) had the graft placed entirely outside the native ACL footprint.

Conclusion:

Despite contemporary techniques and a concerted effort to perform anatomic ACL reconstructions by four experienced sports orthopedic surgeons, the position of the femoral footprint was significantly different between the native and reconstructed ligaments. Furthermore, each of the four surgeons uses a different technique but all had comparable errors in their tunnel placements. In order to achieve a truly anatomic reconstruction, surgeons may consider using a pre-operative 3D MRI, which enables excellent visualization of the ACL’s native anatomy and could potentially be used as a roadmap to guide anatomic tunnel placement.
Concussion Symptoms and Symptom Resolution Time in US High School Athletes, 2007/08-2014/15
Authors: Kraeutler Matthew John , Currie Dustin , Schrock John Bradley , McCarty Eric C. , Comstock Dawn
Published: July 2017

Objectives:

There has been increased interest in sports-related concussions from the professional level down to youth leagues in recent years. Symptom types and resolution time are the metrics most often used to monitor concussions. The purpose of this study is to investigate how concussion symptoms, symptom resolution time, and use of diagnostic imaging have changed among US high school athletes from the 2007/08 through 2014/15 academic years.

Methods:

This study analyzed concussions occurring in all sports available in the High School Reporting Information Online (RIO) database from 2007/08 through 2014/15. Chi-square tests for trend were used to calculate symptom and diagnostic imaging trends over time. Statistical significance was determined at p<0.05.

Results:

The prevalence of each of the following symptoms was found to significantly decrease over the time period analyzed in athletes diagnosed with a concussion: amnesia (p<0.0001), confusion/disorientation (p<0.0001), dizziness/unsteadiness (p<0.01), loss of consciousness (LOC, p<0.0001), and tinnitus (p<0.0001). Among all athletes diagnosed with a concussion, the prevalence of LOC was 6.6% in 2007/08 and decreased to 2.4% in 2014/15. The prevalence of each of the following symptoms was found to significantly increase over the time period analyzed in athletes diagnosed with a concussion: drowsiness (p<0.01), irritability (p<0.0001), light sensitivity (p<0.0001), and noise sensitivity (p<0.0001). The prevalence of concentration difficulty, headaches, hyper-excitability, and nausea did not change significantly over time. The average concussion symptom resolution time has significantly increased over time (p<0.0001). The use of diagnostic plain radiographs, magnetic resonance imaging (MRI), and computed tomography (CT) scans all significantly decreased over the time period analyzed (p<0.0001 for each diagnostic test).

Conclusion:

From the 2007/08 to 2014/15 academic years, the prevalence of various symptoms changed significantly in US high school athletes diagnosed with a concussion. The decrease in severe symptoms (LOC, amnesia, disorientation) and the increase in less recognizable symptoms (drowsiness, irritability) may point to a lower threshold used by healthcare providers in diagnosing concussions in more recent years. Improved education among healthcare providers has likely led to increased recognition of lingering symptoms in athletes diagnosed with concussions, thereby leading to a longer average symptom resolution time. Furthermore, the significant reduction in use of all forms of diagnostic head imaging demonstrates an increased recognition of concussions as functional disturbances rather than physical abnormalities detectable on imaging.
Does Patient Education Prior to Arthroscopic Rotator Cuff Repair Decrease Narcotic Consumption? A Randomized Prospective Study
Authors: Tjoumakaris Fotios P. , Syed Usman Ali Mohammed , Aleem Alexander William , Wowkanech Charles Dante , Getz Charles , Weekes Danielle , Pepe Matthew D. , Tucker Bradford S. , Abboud Joseph A. , Austin Luke
Published: July 2017

Objectives:

In order to help combat opioid addiction, our objective is to see, through a randomized prospective study design, if patient education on proper use of narcotic medication would decrease narcotic consumption in the post-operative period after arthroscopic rotator cuff repair (ARCR).

Methods:

Patients undergoing primary ARCR at our institution were prospectively enrolled in a randomized fashion to receive either formal education on proper use of narcotics versus no education. The education group received instruction on the proper use of opioids, dosage, side effects, dependence, and addiction while the control group received education regarding the surgery alone. The education program consisted of a 2-minute narrated video in addition to a handout. All the subjects were blind to the randomization and true purpose of the study. Variables such as age, sex, and body mass index (BMI) were recorded. To determine risk of opioid abuse of the patient, the physician d a validated Opioid Risk Tool (ORT). Patients were given the same post-operative medication regimen. Patients filled out questionnaires at their 2- and 6- week follow up querying VAS pain score, refills, and total number of narcotic pills remaining. Standard statistical comparison was performed with t test calculations.

Results:

67 patients d 6-week follow-up with 34 patients in the control group and 33 patients in the study group. There were no statistically significant differences in age, sex, BMI, ORT score, preoperative and postoperatively VAS score between the groups (Table 1). Patients who received pre-operative education on average consumed 26 pills compared to 35 in the control group (Table 1). More than 20 pills were consumed by only 48% of the study group compared to 76% in the control group (p = 0.01).

Conclusion:

Patient education is associated with a significant decrease in the number of patients consuming more than 20 narcotic pills in the acute post-operative period. Although the difference in average amount of narcotics consumed was not statistically significant, the increased frequency of patients in the control group that consumed a high number of narcotics was, suggesting benefit in preoperative education on narcotics. This is the first study to document that preoperative education can help reduce the number of patients consuming high levels of post-operative narcotics. Future recruitment and study analysis will help determine if this effect is long-lasting and can help reduce the incidence of drug dependence and addiction among this patient population. [Table: see text]
Risk Factors for Prolonged Narcotic Use Following Arthroscopic Rotator Cuff Repair
Authors: Cancienne Jourdan M. , Gwathmey Frank Winston , Werner Brian C.
Published: July 2017

Objectives:

Narcotics are commonly prescribed for management of acute pain in the early postoperative period following arthroscopic rotator cuff repair (RCR), but little is known about the frequency and risk factors for persistent use. The goal of this study was to determine risk factors for prolonged narcotic use following arthroscopic RCR.

Methods:

A national insurance database was queried for patients undergoing arthroscopic RCR from 2007-2015 using CPT codes. Prolonged narcotic use was defined as a new prescription for a narcotic pain medication between 3 and 6 months following the procedure. Patients without minimum 6 months’ follow-up were excluded. A multivariate logistic regression analysis was utilized to evaluate risk factors for prolonged narcotic use, including a prescription for narcotics within the 3 months before surgery, age, sex, obesity, tobacco use, alcohol use, depression and inflammatory arthritis. The regression analysis was used to control for demographics and numerous medical comorbidities. Adjusted odds ratios (OR) and 95% confidence intervals (CIs) were calculated for each risk factor, with P < 0.05 considered statistically significant.

Results:

28,331 patients met inclusion and exclusion criteria. 7,543 patients (27%) were characterized as having prolonged narcotic use. Preoperative narcotic use was the most significant risk factor for prolonged postoperative narcotic use (OR 5.4, p < 0.0001). Age < 50 years (OR 1.4), male sex (OR 1.1), obesity (OR 1.1), morbid obesity (OR 1.4), tobacco use (OR 1.8), alcohol use (OR 1.3), inflammatory arthritis (OR 1.5) and depression (OR 2.0) were also all significant risk factors for prolonged postoperative narcotic use [Table 1].

Conclusion:

More than a quarter of patients undergoing arthroscopic RCR continue to receive narcotic prescriptions more than 3 months postoperatively. The most significant risk factor for prolonged narcotic use is the use of preoperative narcotics. Additional risk factors include younger age, male sex, obesity, tobacco and alcohol use, depression and inflammatory arthritis. [Table: see text]
Biomechanical Evaluation of Pediatric Anterior Cruciate Ligament Reconstruction Techniques with and without the Anterolateral Ligament
Authors: Pace James Lee , Trentacosta Natasha E. , Metzger Melodie , nelson trevor , Michalski Max , Polakof Landon S. , Mandelbaum Bert R.
Published: July 2017

Objectives:

Management of anterior cruciate ligament (ACL) injuries in skeletally immature patients is controversial and several surgical procedures have been developed. The two most popular physeal sparing procedures are the iliotibial band (ITB) ACL reconstruction (ACLR) and the all-epiphyseal (AE) ACLR. There has been some concern for over-constraint of the knee with the ITB ACLR while the AE ACLR is technically challenging and can still risk growth disturbance. There has been interest recently into the anterolateral ligament (ALL) and its role in rotational stability, but it has not been assessed in the setting of pediatric ACLR techniques. The ITB ACLR includes a lateral tenodesis of the IT band to the femur that closely approximates the ALL. Our hypothesis is that the ITB ACLR and AE ACLR with ALL reconstruction (ALLR) will best replicate the biomechanics profile of the intact ACL.

Methods:

Eight cadaveric legs were statically loaded with an anterior drawer force and varus, valgus, internal and external rotational moments at 0°, 30°, 60°, and 90° of flexion. Displacement and rotation was recorded in the following conditions: intact ACL/intact ALL, ACL deficient/intact ALL, ITB ACLR/intact ALL, ITB ACLR/ALL deficient, ACL deficient/ALL deficient, AE ACLR/ALL deficient, AE ACLR/ALLR.

Results:

Both ACLR techniques reduced anterior translation from the ACL deficient state but neither restored translation to the intact state (p<0.05) except in full extension. ALL deficiency increased anterior translation in the ACL deficient state (p<0.05). In rotational testing, only the ACL deficient/ALL deficient state had a significant increase in internal rotation (p<0.05). This was significantly restored at all flexion angles with the ITB ACLR. There was no rotational over-constraint in any flexion angle with the ITB ACLR. The AE ACLR/ALL deficient state and AE ACLR/ALLR improved rotational stability at lower flexion angles, but not at 60° and 90°. There were no significant changes in varus/valgus moments.

Conclusion:

In this model, the ITB ACLR best corrected both parameters at all angles without over-constraining the knee and without the need for an ALLR. The AE ACLR and AE ACLR/ALLR improved both parameters but not at all flexion angles. The ITB ACLR appears to be the simpler pediatric ACLR technique to regain translational and rotational stability. ALL deficiency in the knee increased anterior displacement and rotational moments in the ACL deficient state.
Distal Femoral Osteotomy Survivorship: A Population-based Study
Authors: Heidari K Soraya , Heckmann Nathanael , Pannell William C. , Hill J Ryan , McKnight Braden Michael , Vangsness C. Thomas , Hatch George F. Rick
Published: July 2017

Objectives:

Malalignment of the lower extremity can lead to functional impairment and degenerative changes at an early age. Distal femoral osteotomies (DFO) are often performed concurrently with arthroscopic procedures to correct malalignment while addressing intra-articular pathology. The aim of this study was to examine survivorship following distal DFO and to identify risk factors for failure.

Methods:

Data from the California Office of Statewide Health Planning and Development, a mandatory statewide discharge database, was utilized to identify all patients who underwent a DFO from 2000 to 2014. Patients with lower extremity trauma, infectious arthritis, rheumatologic disease, congenital deformities, malignancy, or concurrent arthroplasty were excluded. Patient demographic information was assessed for every patient. Failure was defined as conversion to total or unicompartmental knee arthroplasty. Statistically significant differences between patients who required arthroplasty and those who did not were identified on univariate analysis. A multivariate analysis was performed to account for identified differences and a survivorship curve was constructed to estimate 5 and 10-year survivorship.

Results:

After exclusions were applied, 420 patients were identified and followed for an average of 5.0 years. Of those, 53 were converted to arthroplasty at an average of 5.9 years. 5-year survivorship was 98.3% and 10-year survivorship was 92.3%. Patients converted to arthroplasty tended to be older (43.6 years versus 36.9 years, p<0.001) and had a higher number of comorbidities (47.2% with at least one comorbidity versus 27.5%, p=0.021). A diagnosis of osteoarthritis at the time of surgery was more prevalent amongst patients who went on to arthroplasty (81.1% versus 53.7%, p<0.001). On multivariate analysis, patients were 4% more likely to undergo arthroplasty for each additional year of age (OR 1.04, p=0.013). Patients with osteoarthritis were also at increased risk of conversion to arthroplasty (OR 2.57, p=0.025).

Conclusion:

Older age and a diagnosis of osteoarthritis at the time of surgery were associated with conversion to arthroplasty. These factors should be taken into account when performing this procedure. [Table: see text]
Long-Term Clinical Outcomes after Microfracture of the Glenohumeral Joint: Minimum 7-Year Follow-up
Authors: Frank Rachel M. , Meyer Maximilian A. , Poland Sarah Glen , Leroux Timothy Sean , Griffin Justin W. , Hannon Charles Patrick , Verma Nikhil N. , Romeo Anthony A. , Cole Brian J.
Published: July 2017

Objectives:

Microfracture is an effective surgical treatment for isolated, full-thickness cartilage defects with current data focused on applications in the knee. Currently, only early outcomes are available analyzing patients undergoing microfracture in the glenohumeral joint. The purpose of this study is to present long-term clinical outcomes of patients undergoing microfracture of full-thickness articular cartilage defects of the glenohumeral joint.

Methods:

A review of a consecutive series of patients who underwent arthroscopic microfracture of the humeral head and/or glenoid surface with a minimum follow-up of 7 years between 2001 and 2007 was conducted. All patients d surveys containing the Simple Shoulder Test (SST), American Shoulder and Elbow Score (ASES), and visual analog scale (VAS) outcomes scores. Failure was defined by reoperation, including conversion to arthroplasty. Reoperation and failure rates were compared to a previous analysis of these patients at an average follow-up of 28 months.

Results:

A total of 15 patients (16 shoulders) with an average age of 37.0±14.7 years (8 females, 7 males) were available for analysis at an average 9.3 ± 0.7 years following surgery (range, 8.5 to 10.5 years). The average size of humeral and glenoid defects was 5.07 cm2 (range, 1.0-7.8 cm2) and 1.66 cm2 (range, 0.4-3.8 cm2), respectively. Five patients (5 shoulders) underwent at least 1 reoperation, for an overall reoperation rate of 31%. Of these 5 patients, 4 underwent shoulder arthroplasty (2 initially, 2 after additional arthroscopic procedures) and were considered failures, for an overall failure rate of 25%. Of the patients who did not progress onto arthroplasty, there were statistically significant improvements in SST, VAS, and ASES outcomes scores compared to preoperative values. When compared to short-term follow-up at 28 months, in which 3 patients had already been considered failures, 1 additional patient progressed to failure at 9.6 years after the original microfracture.

Conclusion:

The management of full-thickness symptomatic chondral defects of the glenohumeral joint is challenging. For some patients, microfracture can result in improved function and reduced pain, however, in this small series, up to 25% of patients required conversion to arthroplasty less than 10 years following the index microfracture procedure. Additional studies with larger patient cohorts are needed.
Bridge-enhanced ACL Repair: Mid-term Results of the First-in-human Study
Authors: Micheli Lyle J. , Flutie Brett , Fleming Braden C. , Murray Martha M.
Published: July 2017

Objectives:

Bridge-enhanced ACL repair (BEAR) is a new technique for treating midsubstance ACL injuries. The technique involves placing a scaffold loaded with the patient’s own blood between the torn ligament ends prior to using suture to realign the ends of the ligament (Fig. 1). Preclinical studies in large animal models found that the mechanical properties of the bridge-enhanced repaired ligaments were similar to reconstructed grafts, and that animals receiving the repair had less osteoarthritis compared to those receiving traditional ACL reconstruction. In this first-in-human study, our goal was to determine if bridge-enhanced ACL repair would be safe in humans and to compare the early outcomes of this new technique with ACL reconstruction in a small cohort of patients.

Methods:

Nonrandomized controlled trial (Level 2). Both FDA Investigational Device Exemption Approval and IRB approval was obtained prior to starting the study. Twenty patients were enrolled in this study; ten undergoing the bridge-enhanced repair and ten patients having an ACL reconstruction with hamstring autograft. The inclusion criteria were patients ages of 18 to 35, surgery performed within 30 days for the BEAR technique and within 90 days for ACL reconstruction. All surgeries were performed by a single surgeon (LJM).

Results:

At this time, we have six month follow-up data for 10 of the BEAR patients and 5 of the ACL reconstruction control patients. To date, no patients have had any infection or other serious adverse reaction to the implanted scaffold. At three months and six months post-operatively, there was no significant difference in IKDC scores for the two groups, and effusion and range of motion recovered similarly in both groups. The average side-to-side difference in AP laxity at three and six months post-operatively as measured by manual Lachman testing was also similar for the two groups. MRI showed presence of tissue in the region of the torn ACL in all ten BEAR patients at three and six months.

Conclusion:

Bridge-enhanced ACL repair can be performed in patients and early results show a low risk of adverse reactions to the implant. Early results suggest the knees are stable and recover motion after bridge-enhanced ACL repair. Whether these results will hold up in the longer term requires further study and we will plan to present additional data, good or bad, at the meeting in July. [Figure: see text]