bluuebunny/crossref_metadata_2025 huggingface dataset:
Osteochondral Allograft Transplantation: Identifying the Biomechanical Impact of Using Shorter Grafts and Pulsatile Lavage on Graft Stability
Authors: Babu Jacob , Hodax Jonathan D. , Fadale Paul D. , Owens Brett D.
Published: July 2019

Objectives:

This study seeks to identify the ability of shorter Osteochondral Allografts (OCAs) to resist displacement/failure. Additionally, this study seeks to evaluate the effect of pulsatile lavage on the biomechanical stability of the OCA graft.

Methods:

Fifteen millimeter diameter, human cadaveric, osteochondral allografts of 4 mm, 7 mm, and 10 mm in depth were harvested for comparison of resistance to compressive and tensile loads. For each group 7 specimens were subjected to tensile loads and 3 specimens subjected to compressive loads until failure (pull-out or subsidence). An additional study group of 10 pulsatile lavaged (PL) osteochondral allografts of 15 mm in diameter and 7 mm in depth were introduced for comparison to the original 7 mm depth OCA group.

Results:

The average tensile forces for failure for the 4 mm, 7 mm, and 10 mm plugs were 23.74 N, 199.57 N and 197.69 N respectively (p=1.5x10-5). After post-hoc analysis of the tensile groups, significant differences in the mean tensile force to failure were appreciated between the 4 mm and 7 mm groups (p=4.12 x10-5) and the 4 mm and 10 mm groups (p=1.78x10-5), but not between the 7 mm and 10 mm groups (p=.9601). There were no significant differences between the average tensile forces resulting in failure for the 7 mm and 7mm-PL groups (199.57 N and 205.2 N, p=.90) or compressive forces to failure respectively (733.6 N and 656 N, p=.7062).

Conclusion:

For OCAs of 15 mm in diameter, a commonly used size in practice, we recommend that plugs of 7 mm in depth be utilized. Pulsatile lavage of allografts prior to insertion does not appear to take away from the structural integrity and stability of the plug, however an adequately powered study should confirm this. With many described theoretical benefits of decreased immunogenicity and better long term graft incorporation after lavage, we recommend that this practice continue. [Table: see text]
Reoperation and Failure Rate at Six Years Following Revision ACL Reconstruction: A MARS Cohort Study
Authors:   MARS Group
Published: July 2019

Objectives:

Revision anterior cruciate ligament (ACL) reconstruction remains a challenge for orthopaedic surgeons, as results are persistently inferior to those of primary reconstructions. There is very limited data regarding outcomes at 6 years following revision ACL surgery. The purpose of this study was to report the rate of reoperation, further revision, and conversion to total knee arthroplasty (TKA) in a large cohort of revision ACL reconstructions

Methods:

Patients undergoing revision ACL reconstructions were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, intraoperative surgical technique, and a series of validated patient-reported outcome instruments. Patients were followed up by questionnaire and telephone at 6 years following index revision surgery and asked if they had undergone any further surgical procedures to either knee. If a patient reported having undergone subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized.

Results:

Six-year follow-up subsequent surgical data was available for 951/1234 patients (77%). In this available cohort, 556 (58%) were male, mean age was 28 years (range 12-61 years) and mean BMI was 26.1 (range 17.1-47.5). Allograft was used in 510 (54%) cases, BTB autograft in 234 (25%), soft tissue autograft in 174 (18%) and other grafts were used in the remaining 33 (3%). Their index surgery was their first revision ACL reconstruction in 822 (86.4%), in 108 (11.4%) it was their second, and in 21 (2.2%) it was their third or greater. This revision procedure was a mean of 5.7 years (range 0.1-26 years) from their prior ACL reconstruction. At six years following the index revision procedure, 16.2% of the cohort underwent at least 1 subsequent surgical procedure on their index knee. Of the reoperations, 29% were meniscal procedures (71% meniscectomy, 18% repair), 21% were articular cartilage procedures (79% chondroplasty, 15% microfracture, 3% OATS, 3% ACI), 11% were for arthrofibrosis, 9% for hardware removal, and 6% were for a subsequent revision ACL reconstruction. Surprisingly, only 5% reported having undergone a subsequent TKA on their ipsilateral knee. During this same 6-year follow-up period, 6% of the cohort (n=53 patients) underwent a subsequent surgery on their contralateral knee, of which 36 were ACL reconstructions.

Conclusion:

Our data shows that there is a reoperation rate of greater than 15% following ACL revision, which is an important point of discussion between surgeons and their patients. Of particular interest is that there was a 6% rate of recurrent ACL failure and 5% rate of subsequent TKA in this young cohort 6 years following a revision ACL reconstruction.
Quadriceps Tendon Autografts Have A Lower Early Graft Failure Rate Than Hamstring Tendon Autografts When Performing Transphyseal ACL Reconstructions
Authors: Pennock Andrew T. , Johnson Kristina Parvanta , Chambers Henry G. , Bastrom Tracey P. , Badrinath Raghav , Turk Robby , Dennis M. Morgan , Edmonds Eric W.
Published: July 2019

Objectives:

It is unclear what the optimal graft choice is for performing a transphyseal ACL reconstruction in a skeletally immature patient. The purpose of the current study was to evaluate outcomes and complications of skeletally immature patients undergoing an ACL reconstruction with hamstring tendon autograft versus quadriceps tendon autograft.

Methods:

Between 2012 and 2016, 104 skeletally immature patients from a single institution underwent a primary transphyseal ACL reconstruction with either quadriceps tendon autograft or hamstring tendon autograft based on surgeon preference. Patient demographic, injury, radiographic, and surgical variables were documented. Outcome measures included Lysholm score, SANE score, pain score, satisfaction, return to sport, and complications such as graft tears and physeal abnormalities.

Results:

Ninety patients (87%) including 62 hamstring tendon reconstructions and 28 quadriceps tendon reconstructions were available for a minimum follow-up of 2 years. The mean age of the patients was 14.8±1.3 years. No differences in chronologic age, bone age, gender, patient size, or mechanism of injury were noted between patient groups. There were no differences in surgical variables except the quadriceps tendon grafts were larger than the hamstring tendon grafts (9.6 mm vs 7.8 mm; p<0.001). Patient outcomes at a mean follow-up of 2.8 years revealed no differences based graft type with a mean Lysholm score, SANE score, pain score, satisfaction, and Tegner score were 95, 91, 0.8, 9.3, and 6.9 respectively. While there were no physeal complications in either group, patients undergoing a hamstring tendon autograft reconstruction were more likely to tear their graft (19% vs 0%; p= 0.01).

Conclusion:

Skeletally immature patients undergoing an ACL reconstruction can be successfully managed with either a quadriceps tendon autograft or a hamstring tendon autograft with good short-term outcomes, relatively high rates of return to sport, and low rates of physeal abnormalities. The primary differences between grafts were that the quadriceps tendon grafts were larger and were associated with a lower retear rate. Although a relatively new graft source for skeletally immature ACL reconstructions, the quadriceps tendon is not only a viable graft option, but it may be superior to the hamstrings tendon when it comes to early graft failures.
Failure and Reoperation Rates Following Arthroscopic Primary Repair Versus Reconstruction of the Anterior Cruciate Ligament
Authors: van der List Jelle P. , Jonkergouw Anne , DiFelice Gregory S.
Published: July 2019

Objectives:

To compare the failure and reoperation rates of arthroscopic primary repair versus reconstruction of the anterior cruciate ligament (ACL).

Methods:

This study retrospectively reviewed all patients with ACL injury operatively treated between April 2008 and May 2016 by one surgeon. All patients with proximal tears were treated with primary repair using suture anchors, or otherwise underwent standard reconstruction. Patients were included if minimum two-year follow-up was present, and were excluded for multiligamentous injuries. Charts were reviewed and patients were contacted to assess failure (instability, graft rupture or revision), reoperation (other than revision), complications and contralateral failure.

Results:

154 patients were included of which 56 underwent primary repair (36.4%). Mean age was 30 years (range 14-57), 70% was male and mean follow-up was 3 years (range 2-9). Patients undergoing ACL reconstruction were younger (28 vs. 33, p=0.002) and were more often male (77% vs. 59%, p=0.02). Failure rates were lower following primary repair (10.7%) than ACL reconstruction (12.2%) but this was not statistically significant (p=0.776). Also, no clinical relevant or statistical significant differences were found between repair and reconstruction in reoperations (7.1% each group), complications (1.8% vs. 3.1%, respectively) and contralateral failures (3.6% vs. 4.1%, respectively) (all p>0.99). With revision surgery, no complications were noted following primary repair revision (primary reconstruction; 0%) but 25% of revision reconstructions failed and 1 needed reoperation (8%).

Conclusion:

This study is the first study to compare the failure and reoperation rates following arthroscopic primary repair versus reconstruction in a large cohort of patients. With the treatment algorithm of primary repair for proximal avulsion tears and reconstruction of midsubstance tears, equivalent outcomes were noted between both treatments. Arthroscopic primary repair is a safe and good treatment for ACL injuries and has similar failure and reoperation rates when compared to the gold standard of ACL reconstruction.
Distalization Of Tibial Tubercle For Patella Stabilization: Does Length Of Distalization Or Residual Patella Alta Effect Outcome?
Authors: Schmiesing Andrew , Engelking Marta , Agel Julie , Arendt Elizabeth A.
Published: July 2019

Objectives:

Distalization of the tibial tubercle (DTT) is a surgical procedure to help stabilize the patella when patella alta is present. The purpose of this study is to: evaluate the accuracy of our operative intervention (i.e. how often is patella height normalization achieved). correlate post-operative (residual) patella alta with recurrent patellar instability correlate the mm of distal displacement with negative outcomes

Methods:

Data was collected retrospectively on consecutive patients who underwent DTT as part of their surgical procedure for recurrent lateral patella dislocation. All patients had concurrent medial patella ligament reconstruction (MPFLR), performed by a single surgeon between 2009-2015. Data collected included demographics, pre-and post-operative imaging measurements related to patella alta and trochlear dysplasia on MRI and plain radiographs, recurrent lateral patella dislocations, and complications including fracture and knee arthrofibrosis. Surgical planning including the assessment of the Caton-Deschamps index (CD) on sagittal radiographic imaging. The surgical goal was to have a final CD between 1.0 -1.2, or a maximum distance moved of 15 mm in cases of severe patella alta. When CD was within normal limits due to patellar anatomy, we used as a proxy the patellar-trochlear index (PTI), aiming for a PTI of 25% judged intra-operatively.

Results:

89 patients underwent DTT over a 7-year period. There were 21 (24%) males/68 (76%) females. Mean (range): age 21 (13-45), BMI 25.8 (17-44.6). Pre-op imaging measurements were: IS ratio 1.5 (1.18-2.06), CD ratio 1.4 (1.05 -1.93), lateral patella tilt 24.7º (1º-53º), TT-TG 18.6 mm (8-28), sulcus angle 158º (123-180), PTI 29% (5-70). Post-operative mean CD was 1.09 (0.92 -1.67). The amount of distalization averaged 9.8 (range 4 to 15). 13 patients had residual patella alta (CD>1.2). One patient with residual patella alta re-dislocated (CD=1.25). The most extreme residual patella alta (1.67) had a pre-op CD of 1.97 and was distalized 15 mm. There was no patellar baja. 6 patients (6%) had frank recurrent patellar dislocation; postoperative patella height in this group averaged 1.11 (1.02 -1.25), indicating that re-dislocation was not due to residual patella alta. Tibia fracture (4%) was not related to mm of distalization; mean (10) /range 8-15 mm. Arthrofibrosis requiring manipulation was needed in 11 patients (13%) whose mean distalization was 11.8 mm (9-15 mm). This distance was significantly different (p=0.009) from those not requiring manipulation.

Conclusion:

Distalization of TT leads to a high rate of normalization of patellar height measurements, with 94% patella stabilization. Residual patella alta was not associated with an increased risk of recurrence (p=0.57). Distalizing the tibial tubercle up to 15 mm did not increase fracture risk, however there was an increase in arthrofibrosis requiring manipulation.
Risk Factors and Outcomes of Revision Arthroscopic Posterior Shoulder Capsulolabral Repair in Contact Athletes
Authors: Arner Justin W. , Jayakumar Sachidhanand , Vyas Dharmesh , Bradley James P.
Published: July 2019

Objectives:

Risk factors and outcomes of revision arthroscopic posterior capsulolabral repairare currently not well defined in contact athletes.Evaluation of risk factors for contact athletes who require revision arthroscopic posterior unidirectional capsulolabral repair is needed.

Methods:

A total of 186 contact athletes’ shoulders that underwent arthroscopic posterior capsulolabral repair at minimum 2 year follow-up were reviewed. Those who required revision surgery were compared with those who did not. Parameters assessed included age, gender, labral and/or capsular injury, level of sport, and return to sport. Glenoid bone width, bone version, labral width, and labral version were also compared.

Results:

Eleven shoulders required revision surgery (5.9%) at mean 12.0 year follow-up. The only significant risk factor was glenoid bone width (revision=26.4 mm vs. non-revision=29.1 mm, p=0.005). Cartilage version (p=0.676), labral version (p=0.539), and bone version (p=0.791) were not significantly different between groups, nor was labral width (p=0.751). Gender (p=0.326), labral injury (p=0.349), capsule injury (p=0.683), and level of sport (p=0.381) were not significant factors for requiring revision surgery. Both return to sport at the same level (revision=16.7% vs. non-revision=72.1%, p<0.001) and overall return to sport (revision=50% vs. non-revision=93.7%, p<0.001) was significantly worse in the revision group. Of those who had revision surgery, 33.3% stated their original surgery was not worthwhile, which was significantly higher than the 4.5% in the non-revision group (p=0.041).

Conclusion:

Contact athletes underwent revision arthroscopic posterior capsulolabral repair at an incidence of 5.9% at 12 year follow-up. The only significant risk factor for requiring revision surgery was smaller glenoid bone width. Return to play was significantly worse in those who required revision surgery. This data is essential for patient selection, optimal treatment techniques, and patient education as posterior shoulder capsulolabral repair in contact athletes that require revision has not previously been evaluated.
Best Practice Guidelines for Hip Arthroscopy in Femoroacetabular Impingement: Results of a Delphi Process
Authors: Lynch Thomas Sean , Minkara Anas , Aoki Stephen Kenji , Bedi Asheesh , Bharam Srino , Clohisy John C. , Harris Joshua David , Larson Christopher M. , Nepple Jeffrey J. , Nho Shane Jay , Philippon Marc J. , Rosneck James T. , Safran Marc R. , Stubbs Allston J. , Westermann Robert W. , Byrd J. W. Thomas
Published: July 2019

Objectives:

Treatment algorithms for the arthroscopic management of femoroacetabular impingement syndrome (FAI) remain controversial due to a paucity of evidence-based guidance. Consequently, significant variability in clinical practice exists between different practitioners, necessitating expert consensus. The purpose of this study is to establish Best Practice Guidelines (BPG) using formal techniques of consensus building among a group of experienced hip arthroscopists driven by the results of a systematic review and meta-analysis. The scope of these guidelines includes preoperative recommendations, intraoperative practices, and postoperative protocols.

Methods:

The validated Delphi process and nominal group technique (NGT), utilized by the Centers for Disease Control and peer-reviewed orthopedic literature, were used to formally derive consensus among 15 surgeons in North America. Participants were surveyed for current practices, presented with the results of a meta-analysis and systematic literature review, and asked to vote for or against inclusion of non-leading, impartially-phrased items during three iterative rounds while preserving the anonymity of participants’ opinions. Agreement greater than 80% was considered consensus, and items near consensus (70%-80% agreement) were further queried using the NGT in a moderated group session at the American Orthopaedic Society for Sports Medicine (AOSSM) annual meeting.

Results:

Participants had a mean of 12.3 years of practice (range: 1-29 years) and performed an annual mean of 249 (range 100 to 500+) hip arthroscopies, with a combined total of approximately 52,580 procedures. Consensus was reached for the creation of BPG consisting of 27 preoperative recommendations, 15 intraoperative practices, and 10 postoperative protocols. The final checklist was supported by 100% of participants.

Conclusion:

We developed the first national consensus-based Best Practice Guidelines for the surgical and nonsurgical management of FAI. The resulting consensus items can serve as a tool to reduce the variability in pre-, intra-, and postoperative practices and guide further research for arthroscopic management of FAI.
Can Combined Trans-physeal and Lateral Extra-Articular Pediatric ACL Reconstruction Techniques Be Employed to Reduce ACL Re-Injury While Allowing for Growth?
Authors: Ellis Henry B. , Boes Nathan , Mitchell Parker , Wyatt Charles , Wilson Philip L.
Published: July 2019

Objectives:

To describe outcomes, including failure rates, following a pediatric ACL reconstruction (ACLR) employing combined trans-physeal technique with hamstring autograft (TPH) and a hybrid extra-articular technique using iliotibial band autograft (ITB).

Methods:

Consecutive skeletally immature patients undergoing combined TPH/ITB ACLR from 1/2012 to 4/2017 were reviewed. With the goal of decreasing ACL graft re-injury in this high-risk group; this technique employed anterior-medial portal drilling for TPH, with an extra-osseous femoral ITB technique and intra-articular combined TPH/ITB grafts fixed within the tibial bone tunnel (Figure 1). Inclusion required a minimum 12 months follow up; exclusions were prior knee surgery and multi-ligamentous injury. Demographics, bone-age (hand), standing alignment XR for growth and mechanical axis grade, and PROs were documented. T-tests, Mann-Whitney tests, and Spearman’s correlation coefficients were employed.

Results:

60 knees in 59 adolescents underwent the combined TPH/ITB ACLR, with 49 knees meeting inclusion criteria with a mean follow up = 23 months (r = 12-48 m). Only 1/49 knees (2%) sustained ACL re-injury. Mean age was 12.9y (11-16y) with 29 males (mean bone-age = 14.1) and 19 females (mean bone-age =13.3). There was a high level return to pre-operative sport. No families reported cosmetic, functional alignment or length concerns, and no clinical deformity was diagnosed. Outcome measures at final follow up indicated a high functional level with a mean Pedi-IKDC = 90.39 and mean Pedi-Fabs = 22.66. To critically assess growth, a cohort of 22 knees (mean age = 12.8y) with > 18 months of growth remaining at surgery were evaluated at maturity. No difference was seen in mean operative and non-operative leg growth (54.1 mm and 53.0 mm). One patient, 1/22 (4.5%), had a final LLD > 10 mm (12 mm), and peri-operative alignment difference [0-GII (central compartment) valgus]. Growth and alignment were not significantly associated with age, bone age, height, weight, demonstrated growth, or pre-operative alignment.

Conclusion:

Combined TPH/ITB ACLR in adolescent patients resulted in return to high activity levels (Pedi-Fabs = 22.66), and a low (2%) re-injury rate at an average of 23 months. A novel pediatric ACLR employing combined trans-physeal hamstring and extra-osseous iliotibial band grafts merits further study as a technique for reducing re-injury in high-risk, growing adolescents by maximizing articular graft size while adding anterior-lateral rotational knee control. [Figure: see text]
Long-term Results after Repair of Isolated Meniscus Tears in Patients 18 Years and Younger: An 18-Year Follow-up Study
Authors: Hagmeijer Michella , Kennedy Nicholas I. , Tagliero Adam J. , Levy Bruce A. , Stuart Michael J. , Saris Daniël B. , Dahm Diane L. , Krych Aaron John
Published: July 2019

Objectives:

Meniscus repair is desirable over resection to prevent post-meniscectomy arthritis, especially in young and active patients. However, long-term data is currently lacking following isolated meniscus repair, particularly in the pediatric population. The purpose of this study was to report long-term follow-up of isolated meniscus tears treated by meniscus repair in a pediatric population, and to compare those results to previous mid-term follow-up data reported. We hypothesized that these patients would have satisfactory function and reoperation rates at long-term follow-up.

Methods:

Patients less than 18 undergoing repair of an isolated (without concomitant ACL injury) meniscus tear performed between 1990 and 2005 were included. At the time of final followup, recurrent tear, reoperations, and IKDC and Tegner scores were determined. With logistic regression, the overall failure between different tear types was calculated. Wilcoxon signed ranks tests were performed to calculate the differences in clinical outcome for different time-points, and Spearman coefficients were calculated for Tegner and IKDC with different variables.

Results:

At an average followup of 17.6 years (13.1 - 26.0 years), 32 patients with 33 isolated meniscus repairs (29 M: 3F) with an average age of 16.1 (9.9 - 18.7) were included in this study. At early follow-up, complex tears (80%) had a higher overall failure rate compared to simple tears (18.2%). However, no further failures occurred since mid-term follow-up with any tear type. At final follow-up, the average IKDC score was 92.3, which was significantly increased when compared to both preoperative 65.3 (p< 0.0001) and mid-term scores, 90.2 (p= 0.01). However, the average Tegner score (6.5) was significantly lower than both pre-operative 8.3 (p< 0.0001) and mid-term 8.4 (p< 0.0001) scores. There was no correlation for Tegner or IKDC values with any risk factors.

Conclusion:

In conclusion, this study demonstrates overall good to excellent long-term clinical outcomes following isolated meniscus repair in a pediatric population. Early failure and reoperation rates were variable depending on tear type, with complex multiplanar tears having more failures at short-term follow-up. However, at long-term follow-up, IKDC and Tegner scores were not significantly different for those with complex tears compared to other tear types.
Return-to-Play after Concussion in American versus European Professional Soccer Players: A Comparative Short-Term Analysis of Performance and Longevity
Authors: Ramkumar Prem N. , Navarro Sergio M. , Haeberle Heather S. , Jang Albert S. , Frangiamore Salvatore Joseph , Farrow Lutul D. , Schickendantz Mark S. , Williams Riley J.
Published: July 2019

Objectives:

Many studies have focused on the long-term impact of concussions in professional sports, but few have investigated short-term effects. This study examines concussion effects on individual players in the Major League Soccer (MLS) and English Premier League (EPL) by assessing 1) return-to-play (RTP) time, 2) career length, and 3) performance.

Methods:

Contracts, transactions, injury reports, and performance statistics from 2008-17 were obtained from the official MLS and EPL online publications. Players who sustained a concussion were compared with the 2008-17 non-concussed player pool. Career length was analyzed using Kaplan-Meier survival curves and athletes were stratified by player age, experience, and longevity. Player performance changes were evaluated between the years before versus after concussion. RTP and games missed were analyzed and compared.

Results:

Of the 1,784 eligible MLS and 2,001 eligible EPL players evaluated over the 10-year period, 102 MLS players sustained 165 concussions and 124 EPL players sustained 142 concussions resulting in injury protocol initiation. MLS players on average missed 7.5 games after a concussion, with 33.5 days missed, whereas EPL players on average missed 0.5 games after a concussion with 9.5 days missed, which was statistically different (p<0.001, p<0.0001). Performance was reduced at all non-goalie positions for goals and assists post-concussion for players in the MLS and in the EPL (p < 0.01). Concussed MLS players playing non-goalie positions scored 2.5 points/year less following a concussion and played in 20 fewer games/year on average. Concussed EPL players playing non-goalie positions scored 3.1 points/year less following a concussion and started in 5.8 fewer games/year on average. Concussed MLS and EPL goalies saw no significant change in performance, although EPL goalies played 3.2 additional games/year on average (p <0.05). The probability of playing a full season post-concussion was not significantly decreased compared with the non-concussed pool (p > 0.05) in both leagues

Conclusion:

This study investigating the short-term effects of concussion on professional soccer players demonstrates that performance is reduced for non-goalie players, without a significant difference in career longevity between concussed and non-concussed controls.
The Effectiveness of Mandated Headgear Use in High School Women’s Lacrosse at Reducing the Rate of Head and Face Injuries
Authors: Baron Samuel L. , Veasley Shayla J. , Kingery Matthew T. , Alaia Michael J. , Cardone Dennis A.
Published: July 2019

Objectives:

There has been continued controversy regarding whether or not headgear use in women’s lacrosse will increase or decrease the rate of head injuries. In 2017, the Public Schools Athletic of New York City became the first high school organization in the country to mandate ASTM standard F3137 headgear for all women’s lacrosse players. The purpose of this study is to investigate the effect of mandated headgear use on the rate of head and face injuries in high school women’s lacrosse.

Methods:

This was a prospective cohort study. The study group included eight varsity and junior varsity women’s lacrosse teams, as well as their game opponents, who were mandated to wear F3137 headgear for all practice and game events over the course of the 2017 and 2018 seasons. Certified athletic trainers assessed and documented all injuries that occurred as a result of participation on the lacrosse teams and athlete exposures were estimated based on the number of team practice and game events. Injury rates were compared with those from the High School RIO (Reporting Information Online) injury data reports from the 2009 to 2016 seasons.

Results:

Over the study period, 17 total injuries were reported during 22,397 exposures for an injury rate of 0.76 injuries per 1,000 athlete-exposures. Two head/face injuries, both of which were classified as concussions, were reported during the study for a head/face injury rate and concussion rate of 0.09 per 1,000 athlete-exposures. The headgear cohort demonstrated significant decreases in rates of in-game head/face injury (RR 0.141, 95% CI [0.004, 0.798]), in-game concussion (RR 0.152, 95% CI [0.004, 0.860) and practice non-head/face injury (RR 0.239, 95% CI [0.049, 0.703]) when compared to the control cohort.

Conclusion:

Mandated use of F3137 headgear was shown to be effective at lowering the rate of head or face injury and concussions in women’s lacrosse. Additionally, mandated headgear use was also shown to lower the rate of injury to body locations other than the head or face during practice. [Table: see text]
Shoulder Surgery in Professional Baseball Players
Authors: Chalmers Peter Nissen , Erickson Brandon J. , D’Angelo John , Romeo Anthony A.
Published: July 2019

Objectives:

Injury rates are increasing in professional baseball players. There is little information regarding shoulder surgeries in these athletes. The purpose of this study is to report the incidence, procedure type, demographics, and return to sport (RTS) rate of shoulder surgeries in MLB players

Methods:

All MLB players who underwent surgery between 2012-2016 were identified from a database prospectively maintained by the MLB. Demographic information as well as details regarding the procedure were recorded. RTS rates were determined. Only those players with a minimum of six month follow-up were included.

Results:

There were 581 shoulder surgeries (542 players) performed, and thus the incidence of shoulder surgery among professional baseball players is 1.48%. Pitchers accounted for the majority of players who had shoulder surgery (60%). Overall, 19% surgeries were performed on players in the majors and most players were between 20-25 years old. The majority of procedures were performed on the posterior and anterior labrum. Of these, 67% involved labral repair. Within surgeries that addressed the rotator cuff, 84% involved debridement, most tears were articular sided (87%), and 75% involved the supraspinatus. Overall, 11% of players had a history of prior shoulder surgery and 76% had spent time on the disabled list prior to surgery. The overall rate of RTS was 63%, with 86% of those who returned returning to at least the same level of play as prior to surgery or higher. Of those who returned to their prior level of play, 73% later ascended to a higher level of play or were not able because they were in the major leagues pre-operatively.

Conclusion:

Shoulder surgery is uncommon among MLB players. Of those players who undergo surgery, the majority are pitchers and minor league players. Most procedures involve the labrum. Rotator cuff tears are mostly articular sided supraspinatus tears. Overall RTS rates are 56%, with only 41% able to return to the same level of play as before surgery.
Biomechanical Comparison of Three Novel Repair Techniques for Radial Tears of the Medial Meniscus
Authors: Buckley Patrick S. , Kemler Bryson , Robbins Colin , Aman Zachary S. , Storaci Hunter , Dornan Grant , LaPrade Robert F.
Published: July 2019

Objectives:

Historically, radial meniscal tears were treated with partial or near- total meniscectomy which usually resulted in with poor outcomes. Radial meniscal tears function similar to a total meniscectomy and are challenging to treat. Repair of radial meniscal tears should be performed to prevent joint deterioration and the need for salvage procedures in the future. The purpose of this study was to compare three novel repair techniques for radial tears of the medial meniscus; the two-tunnel, the hybrid, and the hybrid tunnel techniques. We hypothesized that there would be no difference between the three groups in regards to gapping and ultimate failure strength.

Methods:

Thirty human male cadaver knees (ten matched pairs (n=20) and ten unpaired (n=10)) were used to compare the two-tunnel, hybrid, and hybrid tunnel repairs. A complete radial tear was made at the midbody of the medial meniscus. Repairs were performed according to the described techniques. Specimens were potted and mounted on a universal Instron testing machine where each specimen was cyclically loaded for 1000 cycles before experiencing a pull-to-failure. Gap distances at the tear site, ultimate failure load, and failure location were measured and recorded.

Results:

After 1000 cycles of cyclic loading, there was no significant difference in displacement between the two-tunnel repair (3.0 mm ± 1.7 mm), hybrid repair (3.0 mm ± 0.9 mm) or hybrid tunnel repair (2.3 mm ± 1.0 mm) (p=0.4042). On pull-to-failure testing there was also no significant difference in ultimate failure strength when comparing the two-tunnel (259 N ± 103 N), hybrid (349 N ± 149 N), or hybrid tunnel (365 N ± 146 N) repairs (p=0.26). However, the addition of vertical mattress sutures to act as a “rip stop” did significantly reduce the likelihood of the sutures pulling through the meniscus during pull-to-failure testing for the hybrid and hybrid tunnel repairs (4/16=25%) when compared to the two-tunnel repair (7/9=78%) (p=0.017).

Conclusion:

This study biomechanically evaluated two previously described techniques- the two-tunnel and hybrid repair- as well as one novel repair technique- the hybrid tunnel repair. The results showed equivalent biomechanical testing in regard to gap distance and pull to failure strength among each repair. The addition of the vertical mattress sutures to act as a rip stop suture was effective in preventing meniscal cut out through the meniscus. [Table: see text][Table: see text]
Comparison of Clinical Outcomes in the Treatment of Patellofemoral Chondral Defects: Autologous Chondrocyte Implantation versus Fresh Osteochondral Allografts
Authors: Patel Nirav K. , Varzhapetyan Vahe , Chaudhry Zaira , Salem Hytham S. , Tucker Bradford S. , Freedman Kevin B.
Published: July 2019

Objectives:

The complex environment and the extreme stresses of the patellofemoral joint make chondral defects a challenge to treat. Autologous chondrocyte implantation (ACI) and osteochondral allograft transplantation (OCA) have been reported as case series in the patellofemoral joint with mixed results. This study compared the clinical outcomes for ACI and OCA treatments for patellofemoral chondral defects at our institution.

Methods:

We reviewed all consecutive patients undergoing ACI and OCA at a single institution for the treatment of isolated patellofemoral cartilage defects. Treatment type was based on surgeon preference. Medical records were examined for patient demographic, lesion specific data, complications, re-operations and failures (graft delamination requiring surgery, revision cartilage repair or conversion to arthroplasty). Clinical outcomes included International Knee Documentation Committee (IKDC) and Short Form 12 health survey (SF-12) scores. Mean follow up was 5.2 years (range, 3.1-7.5 years).

Results:

There were 30 patients: 19 in the ACI group and 11 in the OCA group with a mean age of 33 (15-48) and 25.5 (16-55) respectively (p=0.12). Etiology in the ACI group was 63%(n=12) patellar instability, 21%(n=4) post-traumatic osteoarthritis, 10%(n=2) primary osteoarthritis and 5%(n=1) osteochondritis dissecans, whereas it was more evenly distributed in the OCA group (27%, 27%, 19% and 27% respectively). Lesions in the ACI group were either Fulkerson type III (84% (n=16), medial patellar facet) or type IV (16%(n=3), pan-patellar). In the OCA group, lesions varied between type 1 (9%(n=1)), type II (27%(n=3)), type III (9%(n=1)) and type IV (54%(n=6)). The mean lesion size was similar between the two groups (OCA 3.1 cm2 ±1.1 vs. ACI 3.4 cm2 ±2.4, p=0.7) with more bipolar lesions in the OCA group (45%(n=5) vs.11%(n=2), p=0.038). Failures (requiring revision or replacement surgery), were significantly more common in OCA at 36% (n=4) compared to 5.3% (n=1) in ACI patients (p=0.04), one of which was bipolar in the former group. Re-operation was performed in 27%(n=3) OCA patients (each for adhesiolysis) and in 21%(n=4) ACI patients (2 manipulation under anesthesia, 1 adhesiolysis and 1 graft debridement for overgrowth) (p=0.3). There were no significant differences between the OCA and ACI groups in IKDC (60.7 vs. 74, p=0.08) and SF-12 scores (43.5 vs 43.7, p=0.43).

Conclusion:

Compared to ACI, OCA had significantly more failures for patellofemoral chondral defects at short to mid-term follow-up. This may relate to differences in the etiology and lesion locations between the two groups. Despite these findings, both groups had similar complication rates and functional outcome scores.
Return to Work and Sport After Distal Biceps Repair
Authors: Beletsky Alexander , Manderle Brandon J. , Liu Joseph , Nwachukwu Benedict Uchenna , Cohen Mark S. , Bush-Joseph Charles A. , Cole Brian J. , Nicholson Gregory P. , Wysocki Robert , Verma Nikhil N.
Published: July 2019

Objectives:

Outcomes following distal biceps repair are important to establish in order to properly counsel patients on expected postoperative function. Of particular interest are metrics regarding return to work and return to sport, including when return can be expected and at what intensity level. The purpose of this study is to establish important return to sport and work expectations for patients undergoing distal biceps repair.

Methods:

A prospectively maintained institutional database was retrospectively reviewed for all patients who underwent distal biceps repair since 2005 with minimum 24-month follow-up. A patient survey was conducted over phone with regard to preoperative and postoperative participation in sports, level of intensity, and maximum weight repetitions of barbell and dumbbell biceps curl, bench press, and consecutive push-ups.

Results:

A total of 49 patients (23 male) were contacted for final follow-up information. Average age was 54.38 + 13.49 and average time from initial injury to surgical intervention was 4.05 + 3.85 months. The dominant side was affected in 63.27% of cases. 32.65% of the injuries involve lifting of heavy objects, and 24.49% occurred during sport. Return to work was achieved in 85.71% of patients, occurring at an average of 1.41 months. Moderate and heavy duty status workers significantly differed from light and sedentary duty status patients in regard to average months to return to work (3.68 months vs. 0.53 months, P<0.001). 73.25% patients returned to the same or higher level of work. Return to sport was achieved by 89.80% of patients, and 44.89% returned to the same or higher intensity of sport. One-repetition maximum (ORM) an average of 15 pounds for barbell bench press and 27.5 pounds for dumbbell curls on the affected arm. Maximum consecutive pushups decreased by an average of 11.66. Time from injury to surgical intervention was found to be significantly associated with decreased push-up counts (P=0.019) and decreased days participating in sports per week (P=0.014) postoperatively.

Conclusion:

After surgical repair of distal biceps rupture, the majority of patients are able to return to work and sport. Those that work moderate and heavy duty status jobs tend to return at later dates, and patients with longer times to surgical invention have worse functional outcomes with respect to push-ups and frequency of sporting activities. These expected outcomes should be shared with patients to aid in decision making and communicate postsurgical expectations.
Open Reduction Internal Fixation of Medial Epicondyle Fractures After Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers
Authors: Erickson Brandon J. , Chalmers Peter Nissen , D’Angelo John , Ma Kevin , Romeo Anthony A.
Published: July 2019

Objectives:

Ulnar collateral ligament reconstruction (UCLR) is a common procedure among professional baseball pitchers. Currently, 25% of starting Major league baseball (MLB) pitchers have undergone UCLR. Fracture of the medial epicondyle at the level of the humeral tunnel requiring open reduction internal fixation (ORIF) is an uncommon complication following UCLR. The purpose of this study was to determine the rate of return to sport (RTS) and performance upon RTS in professional baseball pitchers following ORIF of the medial epicondyle, and see if there is a difference in RTS rate and performance between players who underwent ORIF and matched controls. The authors hypothesized that there is a high rate of RTS in professional baseball pitchers following medial epicondyle ORIF with no significant difference in rate of RTS or performance, specifically related to the primary outcome performance variables of win-loss percentage (W-L%), WHIP ((walks +hits)/innings pitched), fielding independent pitching (FIP), and wins above replacement (WAR)) between cases and controls.

Methods:

All professional baseball pitchers who underwent medial epicondyle ORIF between 2010-2016 were included. Demographic and performance data (pre and post surgery) for each player was recorded. Performance metrics were then compared between cases and matched controls (no history of UCLR or ORIF).

Results:

Overall, 15 pitchers (80% starters, 73.3% right-handed) underwent ORIF of a medial epicondyle fracture. All underwent a prior UCLR using either the American Sports Medicine Institute (n=9, 60%) or docking (n=6, 40%) technique. ORIF techniques included fixation with one screw (n=13, 86.7%) and fixation with suture anchors (n=2, 13.3%). Eleven (73.3%) pitchers were able to RTS (which did not differ from controls p=0.537). No significant differences existed in the primary performance outcome variables when comparing pre-operative to post-operative performance. No significant differences in the primary performance outcome measures were seen between cases and controls following surgery although cases pitched fewer innings than controls following surgery (p=0.003)

Conclusion:

Following medial epicondyle ORIF of professional pitchers with a history of UCLR, 73.3% were able to RTS without a significant decline in most performance variables when compared to their pre-operative performance levels, or when compared to matched controls. Number of innings pitched declined following surgery.
The Influence of Laxity on Injury Severity at the Time of Anterior Shoulder Stabilization Surgery
Authors: Baron Jacqueline , Duchman Kyle R. , Hettrich Carolyn M. , Ortiz Shannon F. , Glass Natalie ,   MOON Shoulder Group, Wolf Brian R.
Published: July 2019

Objectives:

To determine whether a greater degree of translation measured under anesthesia during anterior shoulder stabilization surgery was associated with greater injury severity, more dislocations in the previous year, and a greater duration of injury.

Methods:

This study evaluated Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group shoulder instability participants who underwent anterior shoulder stabilization surgery between October 2012-September 2016. Surgeons measured shoulder mobility under anesthesia following a standardized protocol and graded translation as 0, 1+, 2+ or 3+. Using this measure, translation was defined as having a grade ≥2+. Labral tear length, duration of injury, and number of times dislocated in the previous year were compared between mobility groups using the Wilcoxon Rank Sum Test while categorical variables were compared between groups using the chi-square or exact test. Logistic regression was also used to model the relationship between mobility grade as an ordered variable and presence of >10% bone loss as well as HSL >20%. Age and BMI were compared between groups using t-tests.

Results:

A total of 679 participants (19% women) with an average age of 24.8±9.5years and BMI of 25.4±4.4 kg/m2were included in analyses. Mobility grade groups <2 had a slightly higher BMI than ≥2 (27.0±5.2 vs 25.0±4.1kg/m2, <0.01) but did not significantly differ in age (26.0±10.7 vs 24.4±9.0yrs, p=0.31) or proportion of women (14% vs 20%, p=0.12), respectively. Labral tear length (median: 126, range: 0-360°) and the proportion with >10% bone loss (5.8% vs 9.8%) did not significantly differ between groups (all p>0.05). However, there was a greater proportion of HSL >20% in the ≥2 (3.2%) vs <2 (0%, p<0.01) groups. In addition, mobility under anesthesia was associated with a larger number of dislocations reported in the previous year (p<0.01), but not a greater duration of injury (p=0.76). A greater proportion of the ≥2 (13.7%) vs <2 (4.7%) mobility groups also had a Beighton score ≥4 (p<0.01). Results were similar looking at EUA grade as an ordinal variable except that an increase in EUA grade was associated with a greater odds of >10% bone loss (OR: 1.51, 95%CI: 1.01-2.27, p=0.046). Labral tear length was significantly greater in individuals who reported at least two dislocations in the previous year (median=144, 0-360°) vs less than two (126, 0-360°, p=0.02).

Conclusion:

Measures of translation during EUA in patients undergoing anterior shoulder stabilization surgery demonstrated higher likelihood of HSL and increased glenoid bone loss>10% as positive predictors of translation ≥2 intra-operatively. Self-reported number of dislocations and Beighton scores≥4 were also found to be correlated with increasing translation under EUA and may serve as a reliable clinical predictor of patients at risk for recurrent instability.
The Rate of Posterior Labral Extension In Operatively Treated Bankart Lesions
Authors: Golan Elan J. , Li Ryan Tianran , Vaswani Ravi Surender , Lesniak Bryson P. , Lin Albert
Published: July 2019

Objectives:

Traumatic avulsion of the antero-inferior glenoid labrum is a well-recognized sequela of shoulder dislocation. Such Bankart lesions are readily identified on pre-operative imaging, and results of arthroscopic management of these lesion are favorable. However, the frequency with which such antero-inferior lesions propagate posteriorly remains unclear. Further, how well pre-operative imaging detects posterior labral extension remains unknown. The purpose of this study was to investigate both the rate of posterior extension in operatively managed Bankart lesions and the ability of MRI to identify such lesions prior to surgery.

Methods:

A retrospective review was conducted of patients undergoing operative management for a diagnosis of Bankart Lesion. All patients had a history of traumatic anterior shoulder dislocation. Patients with a history of known concomitant pathology in the ipsilateral shoulder, multi-directional instability, or prior shoulder surgery were excluded. All patients underwent a pre-operative arthrogram which was read by a trained MSK radiologist and reviewed by an orthopedic practitioner assessing for involvement of the posterior labrum. Operative dictations were then reviewed as a gold standard for posterior labral involvement. Follow up data was also reviewed to determine if posterior extension was a risk factor for post-surgical failure. Calculated rates of posterior involvement, as well as the ability of MRI arthrogram to detect posterior labral pathology were analyzed and compared via chi-squared tests.

Results:

Review yielded 95 shoulders with arthroscopy confirming an antero-inferior labral avulsion. Of these, 20% (19 shoulders) demonstrated involvement of the posterior labrum during arthroscopy. MRI arthrogram findings were equivalent to the arthroscopic findings 82.1% (78/95) of the time when read by a radiologist as compared to 91.6% (87/95) of the time when reviewed by a sports-trained orthopedist (p= .053). Posterior extension was detected in 8/19 (42.1%) of cases when the arthrogram was read by a radiologist alone compared to 16/19 (84.2%) of cases when the arthrogram as read by a sports-trained orthopedist (p= .007). There was no association between Bankart lesions with demonstrated posterior extension and those repairs that eventually went on to failure (p = .29).

Conclusion:

Propagation of a Bankart lesion into the posterior labrum is relatively common following shoulder dislocation, with data from this review demonstrating a rate of 20%. Based on our findings, careful assessment of the posterior labrum on MRI arthrogram may reveal the majority, but not all, of these lesions prior to surgery. Practitioners should maintain a high level of suspicion for posterior labral involvement, both for pre-operative planning and during operative management of traumatic shoulder dislocations.