bluuebunny/crossref_metadata_2025 huggingface dataset:
Misusing the Neighbours: Performing Andhra Child Marriages in Hyderabad State, 1930–1938
Authors: Basha Shaik Mahaboob
Published: October 2021

The British Government passed the Child Marriage Restraint Act in 1929. The Act is popularly known as the Sarda Act. The Act fixed the minimum age of marriage of girls and boys at 14 and 18 years, respectively. The jurisdiction of the Act was confined to British India alone. However, much before the British Government restrained child marriage, few Princely States had already banned child marriages. However, Hyderabad State could not ban child marriages. This article describes how the British-Andhra subjects performed child marriages in the territories of Hyderabad State to escape punishment for violating the Sarda Act. The subjects of the Hyderabad State clearly felt that the Andhra people were ‘defiling’ their ‘sacred territories’ by performing child marriages. This also intensified the demand for a ban on child marriage in the Hyderabad State. Women intellectuals, both Hindu and Muslim, were in the forefront in making the demand. The paper is based exclusively on primary sources. Newspapers and women’s journals in the Telugu vernacular such as the Golakonda Patrika, Andhra Patrika and Grihalakshmi, and autobiographies of Telangana intellectuals like Konda Venkata Ranga Reddy are used.
Land Governance in Fifth Schedule Areas: A Critical Analysis of Chhattisgarh State
Authors: Veeresha Nayakara
Published: October 2021

The governance of land is central to the political economy of development. In India, The schedule areas are demarcated primarily for the development of adivasis who are officially classified as Scheduled Tribes (STs)/and protection of culture through special legal and administrative provisions in the form of fifth and sixth schedule. The article aims to understand and analyse the land governance in the areas of Fifth Schedule with specific reference to the Chhattisgarh State. It explores the role of Governor in preventing the land alienation. The main data sources include the agriculture census, diversion of forest land for the development projects including the mining along with cases of PESA and FRA using a process tracing methodology. The gradual decline in the size of average land holdings indicates the failure of land governance. There is a need to clear the legal ambiguity between the provisions of Fifth Schedule with particular reference to the role of Governor to establish peace and good governance.
The Appearance of an Underrecognized Congenital Heart Disease in a Patient With COVID-19 Pneumonia
Authors: Lakhdar Sofia , Buttar Chandan , Hassan Sameen , Munira Most Sirajum , Trandafirescu Theo
Published: October 2021

A 60-year-old woman presented to the emergency department with worsening shortness of breath and non-productive cough for 1 week, which was preceding a recent COVID-19 infection. At the time the patient thought this was part of the constellation of symptoms of COVID-19, so she stayed home until her symptoms worsened to the point of needing hospitalization. The patient was found to have a rare and complex congenital heart disease that led her to develop acute heart failure precipitated by COVID-19 pneumonia. Medical management and surgical repair were essential in this patient given the late presentation.
Individual and Team Sports-related Hospitalizations for Traumatic Brain Injuries in Pediatric Patients (104)
Authors: Siegel Matthew , Patetta Michael , Orland Mark , Deshpande Abhishek , Hutchinson Mark
Published: October 2021

Objectives:

Pediatric sport participation continues to increase in the United States with a corresponding increase in sports related concussions or traumatic brain injuries (TBIs). Based on this impact, it is important to recognize which sports are at elevated risk, identify patient and hospital-associated risk factors for hospital admission and length of stay, as well as understand billing costs for both individual and team sport participants. Improved awareness may help avoid disproportionate treatments, reduce economic burdens, and allow physicians to more effectively manage these injuries.

Methods:

Pediatric patients (ages 5-18) from 2008 to 2014 were identified from the Healthcare Cost and Utilization Project (HCUP) National (Nationwide) Inpatient Sample (NIS). ICD-9 CM codes were used to include 894 patients who were hospitalized with a concussion resulting from either participating in an individual (N = 451) or team sport (N = 443) (Figure 1). An adjusted odds ratio was calculated using demographic and hospital information. Welch ANOVA was performed to evaluate differences in length of hospital stay and total charges between cohorts. This was repeated for a loss of consciousness subgroup analysis within each cohort.

Results:

Younger athletes in individual sports were more likely to have associated loss of consciousness, be self-pay, experience a greater number of procedures, and require an operating room procedure. (Table 1). When compared to team sports, TBI patients in individual sports had significantly longer (p < 0.001) and costlier (p < 0.001) hospital stays (Table 2). The only significant finding that was worse in team sports was that loss of consciousness led to greater total charges (p < 0.001) (Table 2). For team sports, American tackle football, (43.6%) and for individual sports, bike riding, (28.2%) were the most frequent sports associated with TBIs in their respective cohorts (Table 3).

Conclusions:

Individual sport TBIs may be associated with longer and more expensive hospitalizations. The explanation is likely multifactorial but may be complicated by reduced awareness and reduced compliance with strict return to play protocols in individual sports. Safety education information at a young age, clear discharge instructions, and baseline health assessments when possible may help mitigate these findings.
Predicting Reparability of Meniscal Tears Pre-Operatively Using 3-Tesla MRI (111)
Authors: Kremen Thomas , Garcia-Mansilla Ignacio , Strawbridge Jason , Schroeder Grant , Motamedi Kambiz , Jones Kristofer , Levine Benjamin
Published: October 2021

Objectives:

The ability to predict meniscus tear reparability based on pre-operative MRI is desirable for pre-operative patient counseling. However, the accuracy of MRI-based predictive methods varies widely within the orthopedic and radiology literature. We hypothesized that modern higher resolution 3-Tesla (T) MRI improves the accuracy of predicting reparability compared to prior investigations using 1.5T MRI assessments.

Methods:

We identified 44 patients (age 16 to 40 years) who were known to have undergone arthroscopic meniscal repair at our institution between the dates of January 1, 2013 and June 1, 2019. The MRI characteristics of this meniscus repair group were then compared to 43 age- and sex-matched patients who underwent arthroscopic partial meniscectomy during the same time period. 3T MRI images from the repair (Figure 1A) and the partial meniscectomy (Figure 1B) groups were all obtained pre-operatively at the author’s institution. Images from all 87 patients were independently reviewed by two fellowship-trained musculoskeletal radiologists and one orthopedic surgery fellow specializing in sports medicine. Each examiner was blinded with regard to meniscus tear treatment (repair versus partial meniscectomy). Meniscal tear MRI characteristics were evaluated based on established arthroscopic criteria including tear length greater than 10 mm, tear location within 3 mm of the menisco-synovial junction, tear greater than 50% thickness, and the presence of an intact inner meniscal fragment. We then analyzed the predictive accuracy and interrater reliability of this method.

Results:

With regards to accurately predicting meniscal reparability using the established criteria, the three MRI examiners accurately predicted repair 58% (orthopedist), 60% (radiologist 1), and 63% (radiologist 2) of the time, with respective positive predictive values of 60%, 62%, and 70%. The three examiners agreed upon tear reparability (i.e., a score of 4 versus not 4) only 41% of the time (κ = 0.173, p = .005). For 2 of the examiners (orthopedist and radiologist), none of the individual criteria were significantly predictive of tear reparability. For the 3rd examiner (radiologist), tear location within 3mm of the meniscosynovial junction was the most predictive individual criterion and the only criteria that reached statistical significance (OR = 9.83, p = .04).

Conclusions:

Although 3T MRI is higher resolution than 1.5T MRI, 3T MR imaging assessments performed by experienced examiners demonstrated a poor ability to predict the reparability of meniscus tears based on the application of previously established arthroscopic criteria. In addition, inter-observer reliability in this setting was also poor. Arthroscopic inspection remains the gold standard for the determination of meniscus tear reparability.
Baseball Players Exhibit Symptoms of Posttraumatic Stress Disorder After Ulnar Collateral Ligament Rupture (124)
Authors: Alexander Frank , Anderson Forrest , Anderson Matthew , Spataro Michelle , Skaggs Kira , Swindell Hasani , Ahmad Christopher
Published: October 2021

Objectives:

The significant psychological impact and prevalence of posttraumatic stress disorder (PTSD) have been thoroughly documented in multiple investigations of patients after anterior cruciate ligament ruptures, but this has not yet been assessed in patients after ulnar collateral ligament (UCL) rupture. Our hypothesis is that symptoms of PTSD are present among baseball players after UCL injury.

Methods:

Baseball players, from the high school to minor league baseball level who had suffered an acute UCL rupture were recruited at a tertiary care center. Patients completed the Horowitz Impact of Event Scale - Revised (IES-R) to analyze for PTSD symptomatology.

Results:

A total of 24 patients were enrolled. The mean patient age was 19.2 years (range 15-24 years). Twenty patients (83.3%) were pitchers; 12 pitched exclusively. Six patients surveyed played at the high school level (25%), 15 in college (62.5%), and 3 at the minor league level (12.5%). 100% of patients were male. Over 91% of patients experienced symptoms of intrusion, 87.5% displayed avoidance symptoms, and 79.2% had symptoms of hyperarousal. Twelve patients (50%) scored >24 on the IES-R (PTSD is a clinical concern). 6 patients (25%) reached the threshold for a probable diagnosis of PTSD (³33 on the IES-R).

Conclusions:

Following UCL rupture, athletes experience substantial emotional trauma, and a significant proportion of patients experience symptoms severe enough to warrant a diagnosis of PTSD.
Is Workload Associated with Ulnar Collateral Ligament Tears in Professional Baseball Players? An Analysis of Days of Rest, Innings Pitched and Batters Faced (126)
Authors: Chalmers Peter , Mcelheny Kathryn , Dangelo John , Ma Kevin , Rowe Dana , Erickson Brandon
Published: October 2021

Objectives:

To determine if workload; as measured by number of days rest between outings, innings pitched, batters faced, and being a starting pitcher; associates with risk for sustaining a subsequent UCL tear in professional baseball players.

Methods:

All professional baseball pitchers who sustained a UCL tear between 2011-2017 were identified using the major league baseball (MLB) Health and Injury Tracking System (HITS). A separate player usage was used to determine workload . We then compared these variables between player-games 2, 6, 12, and >12 weeks prior to a documented UCL tear and player games from a non-UCL tear control group. In a paired analysis, we compared the acute workload (2, 6, 12 weeks) prior to injury and the injured player’s workload >12 weeks prior to injury.

Results:

There were 2,204 elbow injuries within MLB, 369 of which were unique UCL tears in pitchers. In all time periods, player-games with more days rest, more innings pitched, and more batters faced associated with a subsequent UCL tear. Players who pitched 4 of more innings per outing had a 1.78-fold increase in percent of players with a subsequent UCL tear as compared to players with one inning pitched. Being a starting pitcher carried a relative risk of 1.51 (p<0.001) of subsequent UCL injury. In a paired analysis there were significantly more innings pitched and batters faced in the player-games 2 weeks prior to UCL injury than in the player-games >12 weeks prior to UCL injury (p=0.028 and p=0.017).

Conclusions:

Being a starting pitcher, pitching more innings per game, and facing more batters per game increased the risk of a UCL tear. An increase in workload in the 2 weeks prior to injury over that player’s baseline also significantly increased the risk for injury.
Performance Analytics and Pitch Metrics as Predictors of Ulnar Collateral Ligament Injury in Major League Baseball Pitchers (128)
Authors: Fury Matthew , Scarborough Donna , Oh Luke , Wright-Chisem Joshua , Fury Jacob , Berkson Eric
Published: October 2021

Objectives:

Ulnar collateral ligament (UCL) injury is a significant concern in elite throwers, and it is associated with prolonged time away from competition in Major League Baseball (MLB) pitchers. Identifying athletes at higher risk of injury, with the subsequent goal of injury prevention, may positively impact pitcher health while mitigating the significant economic impact of this injury on professional organizations. As technology continues to advance, more granular assessments of performance are becoming possible. In 2015, Major League Baseball introduced StatCast, a spatiotemporal data tracking system that uses a standardized camera system and radar technology, to optically track player and ball movement to measure and quantify game events. This technology allows for further investigation of the science of pitching and provides new frontiers for injury research. Understanding UCL injuries in MLB pitchers may also provide insight into youth pitching injuries. To date, there is a paucity of evidence regarding risk factors of UCL injury in MLB pitchers.

Methods:

All MLB pitchers who underwent primary UCLR between 2015 and 2019 were identified from publicly available reports. This date range was selected to capture the seasons in which Statcast data was available. Advanced analytics and pitch metrics from the injury season—including velocity, spin rates, and pitch movement from MLB StatCast data—were collected as well as the seasonal data of an uninjured control group. Binomial logistic regression analysis was performed to determine risk factors for UCL injury.

Results:

Seventy-six MLB pitchers undergoing primary UCL reconstruction were included, and a control group of 95 uninjured pitchers was identified. There was no significant difference in age, height, weight, or BMI between the two cohorts. A logistic regression model was created using the following variables: 4-seam fastball velocity, 4-seam fastball spin rate, slider spin rate, curveball spin rate, strikeout percentage, and wins above replacement (WAR). The model explained 18.4% of the variance and predicted 70.4% of UCL injuries. Increasing WAR was associated with increasing likelihood of subsequent UCL injury (odds ratio [OR] 2.34; 95% CI, 1.08–5.07; p = 0.031).

Conclusions:

When controlling for fastball velocity and pitch spin rates, MLB pitchers who are more valuable, as indicated by WAR, may be at an elevated risk of UCL injury. While velocity is a known risk factor for UCL injury, this model indicates that other factors, including performance or pitch metrics, may influence single-season injury risk and warrant future investigation in multi-year studies.
Outcomes after Elbow Ulnar Collateral Ligament Reconstruction with the Docking Plus Technique in 162 Athletes (129)
Authors: Lubitz Marc , Molla Vadim , Kremchek Timothy
Published: October 2021

Objectives:

This retrospective case series examined 162 athletes who underwent ulnar collateral ligament (UCL) reconstruction (UCLR) from 2015-2018. All cases were by a single surgeon at a high volume center using the Docking Plus Technique. We previously reported outcomes in 324 athletes from 2005-2014 with 88% of patients reporting a Conway score of good or excellent. The purpose of this study was to determine if patients undergoing UCLR with the docking plus technique are able to return to sport and to better characterize the athletes needing this procedure. Our hypothesis was that our cohort would largely be able to return to their previous level of play and be mostly college level pitchers.

Methods:

Patients who underwent UCLR at our institution from 2015-2018 were identified and surveyed. We were able to reach a total of 162 patients by telephone for a survey. They were surveyed for subjective and objective outcomes and for background demographic information including information about their athletic careers before and after UCLR.

Results:

Of our 162 respondents, 150 (93%) returned to the same level of play or higher (excellent on Conway classification). 9 did not return to competitive play (6%) while 3 returned to a lower level of play. 5 of those who did not return to competitive play had their surgery senior year of college. Most athletes were in college at the time of surgery (61%), followed by high school (32%). 2 athletes were in middle school, the rest were playing professionally. Baseball pitchers compromised the majority of our respondents (75%). Catchers were 9% of respondents and infielders/outfielders were 3% each. Other athletes participated in cheerleading, lacrosse, track, volleyball, gymnastics, wrestling, and football, though these were far less common. The mean and median ages of survey respondents was 19 (12-31). 61% described an acute “pop” leading to their elbow pain while 39% endorses no acute event but chronic elbow pain leading to presentation. Of the 61% presenting with an acute rupture, 40% endorsed an “acute on chronic,” presentation. 58% of baseball players played more than just baseball in high school while 41% had specialized in just baseball. The average return to competitive play was 12 months, with a range of 4-24. The range for pitchers was 9-24 with an average of around.

Conclusions:

Overall, our results mirror those of previous studies. 93% of our patients returned to the same level of competition or higher after undergoing UCLR with the docking plus technique. Most of those who did not return were college seniors who graduated. Our typical patient was a college baseball pitcher around 19 years old. Return to play with our set rehab protocol was around 1 year, though faster for non-pitchers. The docking plus technique provides reliable treatment for chronic or acute UCL tears in athletes.
Return to Play in Adolescent Baseball Players after SLAP Repair (131)
Authors: Rao Somnath , Jeyamohan Hareindra , D’Amore Taylor , Jack Robert , Acharya Pankti , Cohen Steven , Dodson Christopher , Ciccotti Michael
Published: October 2021

Objectives:

Superior labrum from anterior to posterior (SLAP) tears are increasingly common shoulder injuries in adolescent athletes who participate in repetitive overhead throwing. The purpose of this study is to evaluate adolescent baseball athletes who undergo SLAP repair in order to determine their long-term progression of play, surgical outcomes, and overall satisfaction with surgery.

Methods:

Patients between the ages of 10-19 who underwent a SLAP repair over a 10-year period from 2008-2018 with minimum two year follow-up were identified by a database query in the medical records of a single institution. From this cohort, non-baseball athletes and injuries to non-throwing shoulders were excluded. After identifying the cohort, patients were contacted via phone to complete functional outcome scores including Conway Score, Western Ontario Shoulder Instability (WOSI) Index, Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Score, Short Form 12 Mental (MCS)/Physical (PCS) survey and a custom return to play questionnaire.

Results:

During this time period, 59 baseball players met the inclusion criteria for this study and 76.3% (45/59) of patients were available to be contacted to complete final follow-up surveys at a minimum of 2 years. All patients were male with a mean age of 17.4 +/- 1.5 (14-19) years. The mean follow-up of this cohort was 5.3 +/- 2.6 (2.1-12.1) years. The overall return to play rate was 75.6% (34/45). The average time from surgery to initiation of throwing was 5.9 +/- 2.0 (2-12) months and the average time to return to full competition was 11.3 +/- 3.5 (6-22) months after the surgery. After the SLAP repair, those who returned to play continuing playing baseball competitively for 3.0 +/- 1.9 (0.5-8.0) years after surgery. At the time of final follow-up, 71.1% (32/45) of players had stopped playing baseball. Of those who had stopped playing competitive baseball, 12 (37.5%) reported it was because they were not recruited to the next level, 10 (31.3%) reported they lost the desire to play and 10 (31.3%) reported their shoulder prevented them from playing. The overall mean KOJC, WOSI, SF-12 MCS and SF-12 PCS scores were 60.0 +/- 27.4 (range, 0-100), 21.0+/-20.6% (0-73.8%), 55.2+/-3.9 (37.4-59.8) and 55.2+/-5.6 (range, 37.9-65.7) respectively. The overall satisfaction score was 83.2% with 86.7% (39/45) saying they given the opportunity they would undergo surgery again.

Conclusions:

The results of this study demonstrated a low return to play rate and low patient reported outcomes on baseball specific surveys among adolescent baseball players who underwent a SLAP repair. Mean functional outcome scores between pitchers and position players were not found to be significantly different. Based on these findings, orthopedic surgeons can better counsel their adolescent baseball players on expectations for future return to play and functional outcomes after SLAP repair.
Capsular Complications and Subsequent Instability on the Rise as Indications for Revision Hip Arthroscopy (140)
Authors: Selley Ryan , Lawton Cort , Dooley Matthew , Swensen Stephanie , Marom Niv , Kelly Bryan , Ranawat Anil , Nawabi Danyal
Published: October 2021

Objectives:

Femoroacetabular impingement (FAI) has become an increasingly recognized diagnosis contributing to morbidity in the adolescent and young adult population over the past decade. Our ability to treat such pathology with hip arthroscopy has grown in parallel. As the number of hip arthroscopy cases performed annually continues to rise, so will the number of patients be requiring revision surgery. Continuing to reassess trends in the indications for revision hip arthroscopy is critical to improve primary surgery techniques and accurately address pathology at the time of revision surgery. As such, the purpose of this study is to determine the trends in indications for revision hip arthroscopy.

Methods:

A single-center hip preservation registry was reviewed to identify patients who underwent revision hip arthroscopy for the treatment of femoroacetabular impingement between 2012 and 2019. Patient demographics and primary indications for revision hip arthroscopy were determined. Trends in the indications for revision hip arthroscopy were compared.

Results:

A total of 229 patients met inclusion criteria for this study. Residual FAI in our cohort was the primary indication for revision with 68.1% of cases and remained the primary indication for revision in all years of the study (Figure 1). The second most common indication for revision was instability at 14.8%, third heterotopic ossification (HO) at 4.8% and fourth was adhesions at 3.9% (Table 1). In cases in which instability was present, 39.4% were secondary to traumatic capsular deficiency, 34.2% were attributed to atraumatic capsular deficiency and 26.3% were attributed to borderline dysplasia, Numerous other findings were noted at the time of revision arthroscopy, 100% of patients were noted to have synovitis, in 97.8% loose osteochondral fragments were noted, 90.8% had labral tears, 47.6% had adhesions and 24.5% had heterotopic ossification (Table 2).

Conclusions:

The most common indication for revision hip arthroscopy in the treatment of FAI remains residual impingement. However, capsular complications are increasingly recognized as an indication for revision hip arthroscopy highlighting the need for careful attention to capsular management, post-operative protection during the healing period, and preoperative recognition of hip instability. Lastly, heterotopic ossification is third most common reason for revision hip arthroscopy underlining the importance of postoperative prophylaxis.
Nonoperative Management of Femoroacetabular Impingement: Clinical Outcomes at 5-Years--A Prospective Study (143)
Authors: Zogby Andrew , Bomar James , Johnson Kristina , Randich Kelly , Upasani Vidyadhar , Pennock Andrew
Published: October 2021

Objectives:

Mid-term and long-term outcomes data on non-operative management of femoroacetabular impingement (FAI) syndrome remains sparse despite expanding research on the topic. Our purpose is to present 5-year outcomes data utilizing a non-operative protocol on a consecutive series of patients with FAI syndrome.

Methods:

Between 2013 and 2016, patients were prospectively recruited in a non-operative FAI study. The protocol consisted of an initial trial of rest, physical therapy, and activity modification. Patients who remained symptomatic were offered an intra-articular steroid injection. Patients with recurrent symptoms were offered arthroscopic treatment. Patient-reported outcomes including the modified Harris Hip Score (mHHS) and Non-arthritic Hip Score (NAHS) were collected 1-, 2-, and 5-years after enrollment. We present the 5-year data. Statistical analysis was performed to determine outcomes based on FAI type and treatment.

Results:

133 hips in 100 patients were enrolled. Sixty-seven hips in 50 patients were available for 5-year follow up. At enrollment, the mean mHHS and NAHS were 69.6±13.1 and 76.3±14.7 respectively. In total, 73% of the cohort was managed non-operatively. Of the 11 patients requiring surgery, six (55%) converted to surgery within one year of enrollment, 4 (36%) converted to surgery between one and 2 years, and one patient converted to surgery between 2 and 5 years. At final follow up, the mean mHHS and NAHS were 89.6±10.7 and 88.0±12.1 respectively. At 1-year follow up, only the activity modification group made a significant increase in mHHS and NAHS (p<0.03), by two year follow up, all three treatment groups had made statistically significant improvements in mHHS and NAHS (p<0.05), by 5-years follow up, the activity modification group and the scope group had maintained their statistically significant improvement in mHHS and NAHS (p<0.03). There was no significant difference in mHHS or NAHS between treatment groups at 5-year follow-up (p>0.4)(Table 1), and no difference in proportion of hips meeting the MCID for mHHS based on treatment course (p=0.961). There was no difference in mHHS or NAHS between FAI types at any time point (p>0.06)(Table 2), or in the proportion of hips that met MCID among FAI types (p=0.511). 72% of patients returned to the same or similar sport/activity level, and there was no difference in the proportion of patients that returned to sports/activities among treatment type (p=0.095) or FAI type (p=0.273).

Conclusions:

Non-operative management of FAI syndrome is effective in a majority of adolescent patients, with robust improvements in patient-reported-outcomes persisting at 5-year follow-up.
Articular Cartilage and Meniscus Risk Factors of Patient-Reported Outcomes 10 Years after ACL Reconstruction: A Multicenter Cohort Study (160)
Authors: Brophy Robert , Huston Laura , Briskin Isaac ,   MOON Knee Group, Spindler Kurt
Published: October 2021

Objectives:

Articular cartilage and meniscal damage are commonly encountered and often treated at the time of anterior cruciate ligament reconstruction (ACLR). Our understanding of how these injuries and their treatment relate to outcomes of ACLR is still evolving. The purpose of this study was to assess whether articular cartilage and meniscal variables are predictive of 10-year outcomes after ACLR. We hypothesized that articular cartilage lesions and meniscus tears/treatment would be predictors of the IKDC, KOOS (all 5 subscales), and Marx activity level at 10-year follow-up after ACLR.

Methods:

Between 2002 and 2008, 3273 ACLR subjects were prospectively enrolled and followed longitudinally with the IKDC, KOOS, and Marx activity score completed at entry, 2, 6, and 10 years. A logistic regression model was built incorporating variables from patient demographics, surgical technique, articular cartilage injuries, and meniscus tears/treatment to determine the risk factors of IKDC, KOOS, and Marx at 10 years.

Results:

We completed a minimum follow-up on 77% (2530/3273) of our cohort at 10 years. The cohort was 56% male with a median age of 23 years at the time of enrollment. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC]-22%, lateral femoral condyle [LFC]-15%, medial tibial plateau [MTP]-4%, lateral tibial plateau [LTP]-11%, patella-18%, trochlear-8%) and meniscal (medial-37%, lateral-46%). Variables that were predictive of 10-year outcomes included articular cartilage damage in the patellofemoral and medial compartments and previous medial meniscus surgery (6% of knees) (Table). Medial and lateral meniscus tears and treatment at the time of ACLR were not associated with 10-year outcomes. Other variables that significantly influenced 10-year outcomes included sex, race, BMI, type of reconstruction (primary vs. revision), baseline outcome scores, and MCL pathology (5.5% of knees).

Conclusions:

Articular cartilage injury in the patellofemoral and medial compartments at the time of ACLR and a history of medial meniscus surgery prior to ACLR are associated with 10-year ACLR outcomes. However, meniscal tears/treatment at the time of ACLR did not predict 10-year outcomes.
The Incidence of Post-Traumatic Osteoarthritis on Clinical Radiographs at 10 Years after Anterior Cruciate Ligament Reconstruction: Data from the MOON Nested Cohort (168)
Authors: Everhart Joshua , Jones Morgan , Yalcin Sercan , Reinke Emily , Huston Laura ,   MOON Knee Group, Winalski Carl , Spindler Kurt
Published: October 2021

Objectives:

1) To prospectively determine the incidence of post-traumatic osteoarthritis (PTOA) at 10 years after anterior cruciate ligament reconstruction (ACLR) in young athletic patients on clinical radiographs: and 2) to determine the average difference in clinical radiographic osteoarthritis changes (joint space narrowing [JSN] and osteophyte formation) between the ACLR and contralateral ACL-intact knees.

Methods:

The first 146 patients in an ongoing prospective nested cohort study within the Multicenter Orthopaedic Outcomes Network (MOON) cohort returned onsite for minimum 10-year follow-up. Inclusion criteria were that patients had a sports-related ACL injury, no prior history of knee surgery, no contralateral ACL injury, and were less than 33 years of age at the time of their ACLR. Bilateral knee standing metatarsophalangeal (MTP) view radiographs were obtained and graded by International Knee Documentation Committee (IKDC), Osteoarthritis Research Society International (OARSI), and modified Kellgren-Lawrence (KL) criteria by two blinded reviewers. Inter-rater reliability was determined for all clinical radiographic OA grading criteria. The incidence and severity of ipsilateral and contralateral knee osteoarthritis were determined among patients without a contralateral ACL injury before 10-year follow-up (n=133).

Results:

Inter-rater reliability was substantial for IKDC (Gwet’s AC1 = 0.71), moderate for KL (0.48) and almost perfect for OARSI (0.84) grading systems. The 10-year incidence of PTOA on clinical radiographs in the ACLR knee was 43% as defined by osteophytes and 27% as defined by JSN (Table 1). In the contralateral ACL-intact knee, the incidence of osteophyte-defined OA was 10% and JSN-defined OA was 5%. The maximum side-to side difference in medial or lateral compartment OARSI osteophyte grade was 0 in 65% of patients, 1 in 20%, and 2+ in 15% (Figure 1) (Table 2). The maximum difference in OARSI JSN grade was 0 in 77% of patients, 1 in 19%, and 2+ in 4% (Figure 2) (Table 2).

Conclusions:

In young active patients, the 10-year incidence on clinical radiographs of osteophyte-defined PTOA after ACLR is 43% and JSN-defined PTOA is 27%. The average difference in degree of osteophyte formation (≤1 grade in 85%) and JSN (≤1 grade in 96%) between the ACLR knee and contralateral ACL-intact knee is small.
Tranexamic Acid has no Effect on Post-Operative Hemarthrosis or Pain Control Following ACL Reconstruction Using Bone Patella Tendon Bone Autograft: A Double-Blind Randomized Controlled Double-Blind Trial (169)
Authors: Fried Jordan , Bloom David , Baron Samuel , Hurley Eoghan , Popovic Jovan , Campbell Kirk , Strauss Eric , Jazrawi Laith , Alaia Michael
Published: October 2021

Objectives:

Tranexamic acid (TXA) is a commonly used medication in orthopaedic procedures, reducing perioperative bleeding and need for transfusion. The purpose of this double-blind randomized controlled study was to evaluate if IV TXA for primary anterior cruciate ligament (ACL) reconstruction with bone-patella tendon-bone (BTB) could reduce perioperative blood loss or postoperative intra-articular hemarthrosis without postoperative drains.

Methods:

A controlled, randomized, double-blinded trial was conducted in 110 patients who underwent ACLR with BTB autograft. Patients were equally randomized to the control and experimental groups. The experimental group received two 1-gram boluses of IV TXA, one prior to tourniquet inflation and one prior to wound closure; the control group did not receive TXA. If a clinically significant hemarthrosis was evident, the knee was aspirated, and the volume of blood (ml) was recorded. Additionally, perioperative blood loss (ml); Visual Analog Scale (VAS) on postoperative days (POD) 1-7 and post-operative weeks (POW) 1, 6 and 12; postoperative opioid consumption POD 1-7; range of motion (ROM) and ability to straight leg raise (SLR) at POW 1, 6, 12; and pre and postoperative thigh circumference ratio (TCR).

Results:

There was no significant difference in perioperative blood loss between the experimental and control groups (32.5ml v. 35.6ml, p=0.47). The experimental group had 23 knees aspirated; control group had 26 knees aspirated (p=0.56). No significant difference seen in postoperative hemarthrosis volume with IV TXA (26.7ml v. 37.3ml, p=0.12). There was no significant difference in VAS score between the two groups (p=0.15), additionally, there was no difference in postoperative opioid consumption (p=0.33). There was no significant difference in ROM or ability to SLR, or pre- nor post-operative TCR (p > 0.05 for all).

Conclusions:

IV TXA in patients who undergo ACLR with BTB autograft does not significantly impact perioperative blood loss, postoperative hemarthrosis, or postoperative pain levels. Additionally, no significant differences were seen in early post-operative recovery regarding ROM or quadriceps reactivation.
Allograft Bone Dowel Incorporation to Tibial and Femoral Tunnels in Two–Stage Revision Anterior Cruciate Ligament Reconstruction (173)
Authors: Kew Michelle , Buyukdogan Kadir , Laidlaw Michael , Miller Mark
Published: October 2021

Objectives:

The purpose of this study was to quantitatively evaluate the radiographic outcomes of allograft dowels used as bone grafts in two-stage revision anterior cruciate ligament reconstruction (ACLR).

Methods:

Prospective review of patients who underwent 2-stage revision ACLR with allograft bone dowels. Inclusion criteria were tibial/femoral tunnel diameter of >14 mm on pre-operative computed tomography (CT), overlapping prior tunnels with new tunnels (Figure 1). Allograft dowels were placed during the first stage and arthroscopic assessment of dowels was performed at the second-stage revision (Figure 2). Quantitative analysis of radiographic incorporation rates was performed with the Union Ratio (UR, Figure 3A) and Occupying Ratio (OR, Figure 3B) on post-operative CT scans. Biopsy specimens were obtained to analyze incorporation.

Results:

21 patients were included. Second-stage revision surgeries were performed at 6.5 months (SD, 2.1 months) after first-stage revision. All dowels preserved their integrity without any signs of degradation and complete incorporation at the host bone and graft junction at the second stage procedure. The average diameter of the dowels placed in tibial tunnels were greater than those placed in femoral tunnels (16.1 mm [SD, 2.3 mm] vs 12.4 mm [SD, 1.6 mm]; p = < .05). CT scans were obtained at 121 days (SD, 28 days) after the first-stage. There was no difference between the OR of femoral and tibial tunnels (87.6% [SD, 4.8%] vs 85.7% [SD, 10.1%]; p = .484), however, the UR was significantly higher in femoral tunnels (74% [SD, 10.5%] vs 83%[ SD, 6.2%], p = 0.005). Histological examination revealed osseous incorporation between the host bone and allograft dowel (Figure 4).

Conclusions:

Allograft bone dowels are a safe graft choice to replenish bone stock in the setting of a staged revision ACL reconstruction and dowels placed in femoral tunnels had a higher healing union ratio. Further studies are warranted to evaluate long-term clinical outcomes in this subset of patients.
Uneven Playing Field: Insurance Status Adversely Affects Children with Tibial Spine Fractures (181)
Authors: Patel Neeraj , Leska Tomasina , Ganley Theodore , Aoyama Julien , Cruz Aristides , Ellis Henry , Fabricant Peter , Green Daniel , Jagodzinski Jason , Johnson Benjamin , Kushare Indranil , Lee R , McKay Scott , Rhodes Jason , Sachleben Brant , Sargent Catherine , Schmale Gregory , Yen Yi-Meng , Mistovich Justin
Published: October 2021

Objectives:

Previous studies have reported disparities in medical and surgical care resulting from demographic factors, including insurance status. Tibial spine fractures are uncommon injuries, which may exacerbate potential disparities in care. The purpose of this study is to assess the impact of insurance status on the treatment of tibial spine fractures in children and adolescents.

Methods:

We performed a retrospective cohort study of tibial spine fractures treated at 10 institutions between 2000 and 2019. Polytraumas and patients older than 18 years were excluded. Demographic data was collected as was information regarding pre-operative, intra-operative, and post-operative treatment, with attention to delays in management and differences in care. Both surgical and non-surgical fractures were included, but a separate analysis of operative patients was performed subsequently. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors.

Results:

Data was collected on a total of 434 subjects with a mean age of 11.7±3.0. Of these, 61.1% had commercial insurance and 38.9% had public insurance. Publicly insured children were more likely to be injured in a motor vehicle accident. Among athletes, those with public insurance were injured more frequently during football while commercially insured patients were more likely to be injured while skiing. When analyzing the overall cohort of surgical and non-surgical fractures in multivariate analysis, those with magnetic resonance imaging (MRI) performed 21 or more days after injury were 5.3 times more likely to have public insurance (95% CI 1.3-21.7, p=0.02). Similar results were found with the 365 patients that required surgery. In this cohort, those with MRI delayed ≥21 days from injury were 4.8 times more likely to have public insurance (95% CI 1.2-19.6, p=0.03). Children that underwent surgery ≥21 days after injury were 2.2 times more likely to have public insurance (95% CI 1.1-4.1, p=0.02). Those that were publicly insured had 2.5 times higher odds of undergoing open surgery rather than arthroscopic (95% CI 1.1-6.1, p=0.04). These children also had 4.5 times lower odds of receiving a continuous passive motion machine (CPM) after surgery (95% CI 1.7-11.7, p=0.002) and were 4.0 times more likely to be immobilized in a cast rather than a brace post-operatively (95% CI 2.0-8.2, p<0.001).

Conclusions:

Children with public insurance and a tibial spine fracture were more likely to experience delays with MRI and surgical treatment than those with commercial insurance. Additionally, these patients were more likely to undergo open surgery and post-operative casting and less likely to receive a CPM machine.
Biomechanical Comparison of a Prepared Thick Fresh Frozen Irradiated Fascia Lata Allograft to the Native Superior Capsule (212)
Authors: Debellis Nicholas , Manning John , Tibone James , McGarry Michelle , Adamson Gregory , Lee Thay
Published: October 2021

Objectives:

Superior Capsule Reconstruction (SCR) has been described as treatment option for irreparable tears of the superior rotator cuff. Reported outcomes on the success of the surgery have been variable, with graft choice seeming to be one of the most important factors. Fascia Lata (FL) allograft has been proposed as a potential option as it provides adequate graft thickness while avoiding the morbidity of an autograft harvest. The purpose of this study was to compare the biomechanical characteristics of an SCR with FL allograft (FL-SCR) to a native superior capsule in a cadaveric specimen.

Methods:

Eight cadaver shoulder specimens were used. Each specimen was tested with a custom shoulder system twice. Initial testing was performed after the specimen was dissected of all soft tissue except for the native superior capsule. Subsequent testing was performed after FL-SCR was done. All allografts were fresh frozen and irradiated. Capsule and graft dimensions were recorded before testing. Biomechanical values recorded were cyclic and load to failure for both the native capsule and FL-SCR, and fixation displacement for the SCR-FL construct. A Paired T-test was performed to compare the biomechanical values of the native superior capsule to the FL-SCR.

Results:

The mean thickness of the NSC was 2.4 ± 0.6 mm and 7.4 ± 1.2mm for the FL graft. The native superior capsule had an average linear stiffness of 94.5 ± 20.4 N/mm, yield load of 386.9 ± 63.6 N, ultimate load of 444.9 ± 67.7 N and energy absorbed of 1418.4 ± 248.8 N-mm. The FL-SCR construct had an average linear stiffness of 28.0 ± 1.6 N/mm, yield load of 123.8 ± 54.3 N, ultimate load of 369.0 ± 43.4 N and energy absorbed of 5021.2 ± 755.1 N-mm. Comparing the two groups there was a statistically significant difference for stiffness (P = 0.013), yield load (P = 0.03) and energy absorbed (P = 0.003). There was no statistically significant difference between ultimate load. The total displacement of the FL-SCR fixation was 5.8 ± 0.6 mm after 1 cycle, 8.5 ± 0.7 mm after 30 cycles, 11.4 ± 1.8 mm at the yield load and 29.5 ± 1.8 mm at the ultimate load. For the failure mode, 8/8 NSC specimens failed at the mid-substance. The FL-SCR, 3/8 specimens failed at the suture tendon interface and 4/8 had medial anchor pull out.

Conclusions:

Performing SCR with FL allograft in a cadaver model creates a construct that is sufficiently strong enough to withstand normal physiologic loading of the shoulder, although it does not fully re-create the biomechanical characteristics of a native shoulder superior capsule.
A Three-Dimensional Computed Tomography Radiographic Study -- Can We Predict Glenoid Width Based on Glenoid Height? (216)
Authors: Rayes Johnny , Xu Jian , Sparavalo Sara , Ma Jie , Wong Ivan
Published: October 2021

Objectives:

The purpose of this study was to investigate the relationship between glenoid width and other morphologic parameters using three-dimensional (3D) computed tomography (CT) images of native shoulders in hopes of generating a formula to predict glenoid width which will have utility in planning boney shoulder stabilization surgeries.

Methods:

102 glenoid images were obtained for patients who underwent contralateral shoulder glenoid reconstruction for anterior shoulder instability between 2012 and 2020. Demographic data was obtained including age, gender and BMI. The subjects were excluded if they had a prior history of ipsilateral shoulder instability, shoulder fractures, or bone tumors. The following glenoid parameters were measured: width (W), height (H), ratio (W/H), anteroposterior (AP) depth, superior-inferior (SI) depth and version. The shape of the glenoid was also classified into pear, inverted comma or oval. Data was analyzed based on gender and age. Simple logistic regression, Kruskal Wallis Rank tests and Fisher Exact tests were performed.

Results:

There were 71 male and 25 females with a mean age of 39.74 ± 17.88 years. Pear morphotype accounted for most glenoid shapes (46%). The glenoid width was strongly correlated with the height (coefficient = 0.78) and a regression model equation was obtained: W (mm) = 3.4 + 0.68*H (mm). There was also strong correlation with gender (P<0.0001), age (P=0.0384), BMI (P<0.0001), glenoid shape (P=0.0036), height (P=0.0019), AP and SI depths (P<0.0001). Male gender was associated with higher measurement values for all parameters. Older age was significantly correlated with higher glenoid width values in both male and females group. (P=0.0015 and P=0.0104, respectively).

Conclusions:

The native glenoid width can be easily estimated using solely the glenoid height. This is particularly important for surgical decision making when facing anterior or posterior glenoid defects in patients with shoulder instability.
Is Workload Associated with Internal Impingement in Professional Baseball Players? An Analysis of Days of Rest, Innings Pitched and Batters Faced (221)
Authors: Chalmers Peter , Mcelheny Kathryn , Dangelo John , Ma Kevin , Rowe Dana , Erickson Brandon
Published: October 2021

Objectives:

Determine if workload; as measured by number of days rest between outings, innings pitched, batters faced, and being a starting pitcher; associates with risk for internal impingement in professional baseball pitchers.

Methods:

All professional baseball pitchers who were diagnosed with internal impingement between 2011-2017 were identified using the major league baseball (MLB) Health and Injury Tracking System (HITS). A separate player usage dataset was used to determine workload. We then compared workload variables between pitcher-games 2, 6, 12, and >12 weeks prior to documented internal impingement and pitcher games from a control group who were never diagnosed with internal impingement. In a paired analysis, we compared the acute workload (2, 6, 12 weeks) prior to injury and the injured pitcher’s workload >12 weeks prior to injury.

Results:

There were 624 pitchers who suffered from internal impingement in professional baseball. Across all time points, players with more innings pitched per game, more batters faced per game, and fewer days rest in between games were associated with a subsequent internal impingement compared to controls. Pitchers who threw four or more innings per game had a 1.3-fold increase in percent of players with subsequent internal impingement compared to pitchers who threw only one inning per game. Significantly more starting pitchers were diagnosed with internal impingement over multiple time points compared to controls.

Conclusions:

Greater pitcher workload was associated with increased risk for internal impingement in professional baseball players. Throwing four or more innings per game increase a pitcher’s risk for internal impingement 1.3-fold compared to pitchers who threw one inning per game. Starting pitchers are more likely to sustain a LD/TM tear than control pitchers.