bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Follow-Up of Arthroscopic Treatment of Discoid Lateral Meniscus in Children
Authors: Haskel Jonathan D. , Uppstrom Tyler J. , Dare David , Rodeo Scott A. , Green Daniel W.
Published: August 2015

Objectives:

The discoid meniscus, occurring almost exclusively on the lateral side, can lead to pain, popping, snapping, and decreased knee extension. The purpose of this study was to examine the long-term clinical outcomes of arthroscopic partial meniscectomy for the treatment of discoid lateral meniscus in children.

Methods:

A previous study at our institution identified 27 consecutive patients who underwent arthroscopic meniscal saucerization by one of two surgeons between 1997 and 2002. These patients were included in this study if they were willing and able to complete the five outcomes questionnaires (IKDC Subjective Knee Evaluation, Kujala Scoring Questionnaire, Lysholm Knee Scoring Scale, Marx Activity Rating Scale and Tegner Activity Scale). Seven additional patients that were treated consecutively at least 10 years ago were also included in the study. Patients were also given the opportunity to receive a knee exam performed by one of the two treating surgeons. The exam was documented as per the IKDC knee examination protocol. Associations between outcome scores and discoid type, meniscal stability, location of instability, and age at time of surgery were identified.

Results:

Of the 34 eligible patients (23 female, 11 male), 22 patients were contacted, and 21 agreed to participate. The average length of follow-up was 13.7 years, ranging from 10.3 years to 16.6 years. Average age at the time of surgery was 9.3 years. Long-term follow-up revealed average IKDC, Kujala, and Lysholm scores of 82.87, 86.63 and 83.73, respectively. Additionally, average Marx and Tegner scores were 5.36 and 5.63, respectively. Stratifying the Lysholm scores revealed outcomes that were 45.4% excellent, 18.2% good, 27.3% fair, and 9.1% poor. The average IKDC Knee Examination score was A (normal). In total, 20.6% (7 of 34) of eligible patients underwent a subsequent surgical procedure on the affected knee.

Conclusion:

Numerous studies have demonstrated good to excellent short-term outcomes after arthroscopic treatment of discoid meniscus. At an average follow-up of nearly 14 years, our data suggests that clinical outcome scores decline over time. Compared to our previous study with 2-year follow-up, there is an increased rate of knee pain, mechanical symptoms, and functional limitations. Despite excellent post-operative IKDC examination scores, approximately 40% of our patient cohort demonstrated relatively low Lysholm scores (fair and poor).
Biomechanical Evaluation of Capsulotomy and Capsular Repair in the Hip
Authors: Wuerz Thomas H. , Song Sang Hoon , Grzybowski Jeffrey S. , Greenberg Mitchell , Espinoza Alejandro , Nho Shane Jay
Published: August 2015

Objectives:

The use of hip arthroscopy has increased over recent years to treat various forms of hip pathologies including femoroacetabular impingement. While a capsulotomy facilitates adequate visualization and access for diagnostic and interventional purposes, the current literature remains divided over the use of routine capsular closure to address the iatrogenic instability that may be induced by an excessive or unclosed capsulotomy. The purpose of this biomechanical study was to determine if hip capsulotomy creates significant alterations in rotational range of motion and stability measures. Additionally, does a capsular repair return these variables to normal?

Methods:

Eight fresh-frozen cadaveric hip specimens consisting of the hemipelvis, femur, and overlying soft tissues were used for this study. All specimens were screened by computed tomography (CT) to assess for the absence of significant bony pathology. Each hip was then tested under torsional loads of 6 N·m applied via a pulley system in conjunction with a vertical force exerted by a servohydraulic frame. Conditions tested were as follows: 1) neutral flexion with the capsule intact 2) neutral flexion with a 4 cm inter-portal capsulotomy 3) neutral flexion with a 6 cm inter-portal capsulotomy 4) neutral flexion with capsulotomy repair. Soft tissue was retained during all interventions. Range of motion (from external to internal rotation), hysteresis area, and neutral zones were the outcome measures for stability obtained in each condition.

Results:

While the data demonstrated a positive and statistically significant correlation between the sizes of the capsulotomy and measures of joint instability (range of motion (ROM), hysteresis area, and neutral zone), no significant differences were seen between the intact and repaired hips with regards to such measures (Table). Larger size capsulotomies were accompanied by significant increases in all three measures of joint instability while the repair effectively restored the capsule to conditions similar to its intact state.

Conclusion:

To the best of the authors’ knowledge, this study is the first to demonstrate the biomechanical consequences of sequentially increasing capsulotomy incisions and their repair on a hip joint that still contains its surrounding soft tissue. The results of this study not only confirm the notion of introducing iatrogenic joint instability with larger sized capsulotomies, but also propose the complete capsular closure as an appropriate solution.
Outcomes for Hip Arthroscopy Based on Sex and Age
Authors: Frank Rachel M. , Lee Simon , Grzybowski Jeffrey S. , Cvetanovich Gregory , Mather Richard C. , Bush-Joseph Charles A. , Salata Michael Jonathan , Nho Shane Jay
Published: August 2015

Objectives:

The purpose of this study was to compare the clinical outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) based on sex and age.

Methods:

A total of 150 patients undergoing hip arthroscopy for FAI by a single fellowship-trained surgeon were prospectively analyzed, with 25 patients categorized in each of the following groups: A) females ≤30 years,B) females 31-45 years, C) females >45 years, D) males ≤30 years, E) males 31-45 years and F) males >45 years. Primary clinical outcomes included the Hip Outcome Score Activity of Daily Living (HOS-ADL) and Sport-Specific Subscales (HOS-SS), the modified Harris Hip Score (mHHS), and clinical improvement at final follow-up. Statistical analysis was performed utilizing ANOVA with post-hoc Tukey HSD tests, with P<0.05 considered significant.

Results:

One-hundred forty of 150 patients (93%) were available for follow-up at an average 2.72±0.43 years (minimum, 2 years), with no differences in follow-up rates between the 6 groups (P<0.05). All groups demonstrated significant improvements in HOS-ADL, HOS-SS, and mHHS outcomes at final follow-up (P<0.001). Females >45 scored significantly worse on the HOS-ADL, HOS-SS, and mHHS compared to females ≤30 (P<0.0001, P=0.001, P<0.0001 respectively) and females 30-45 (P=0.015, P<0.0001, P=0.001 respectively). Similarly, males >45 scored significantly worse on the HOS-ADL, HOS-SS, and mHHS compared to males ≤30 (P=0.012, P=0.015, P=0.022 respectively) (Figure 1). Males >45 scored significantly better than females >45 on the HOS-SS (P=0.013) and the mHHS(P=0.024). Incorporating both sexes, patients >45 scored significantly worse on the HOS-ADL, HOS-SS, and mHHS compared to patients ≤30 (P<0.0001, P<0.0001, P<0.0001, respectively) and patients 30-45 (P=0.005, P<0.0001, P=0.008, respectively).

Conclusion:

While all patients had significant improvements in all outcomes following hip arthroscopy for FAI, patients >45 years performed worse compared to patients in younger age groups, with females >45 years demonstrating the poorest outcome scores. This data can be used to counsel patients preoperatively and to individualize care to optimize outcomes following hip arthroscopy for FAI.
Age-related Trends in Hip arthroscopy
Authors: Zhang Alan L. , Sing David C. , Feeley Brian T.
Published: August 2015

Objectives:

The rate of hip arthroscopy has increased dramatically in the past 5 years but there is a lack of information regarding patient demographics in a large cross-sectional population. The purpose of this study was to evaluate recent trends in hip arthroscopy from a large private payer population in the United States.

Methods:

We performed a retrospective analysis using the Pearldiver private insurance patient record database from 2007 through 2011. A search was performed for hip arthroscopy procedures including newly introduced codes such as osteochondroplasty of Cam and Pincer lesions and labral repair. Hip arthroscopy incidence, growth over time, and conversion rates to total hip arthroplasty (THA) were stratified by age. Chi-square analysis was used for statistical comparison. Conversion to THA was evaluated using Kaplan-Meier analysis with logrank and Wilcoxon tests.

Results:

From 2007 through 2011, 15,532,426 outpatient procedure records were analyzed. Hip arthroscopy was performed in 8,237 patients with females comprising 63% of cases. The number of hip arthroscopies increased over 250% from 981 cases in 2007 to 2,507 cases in 2011 (p<0.0001). Patients in age group 40-49 underwent the most number of hip arthroscopies, comprising 28% of cases followed by 30-39 (22%), 50-59 (19%), 20-29 (14%), 10-19 (12%) and 60-69 (5%). Patients under 30 years of age showed the greatest increase in incidence from 2007 to 2011 (335%) but patients over 60 still had over a 200% increase. Chondroplasty/labral debridement was the most common procedure, present in 6,031 cases and approximately 1.6 procedural codes were billed for every case performed. Older patients were more likely to receive labral debridement instead of repair. Within 24 months of hip arthroscopy, 17% of patients older than 50 years old required conversion to THA compared to less than 1% of patients under 30 years old (p<0.0001).

Conclusion:

Hip arthroscopy procedures are increasing in popularity across all age groups with patients aged 40-49 having the highest incidence in this population. A high rate of conversion to THA within 2 years of hip arthroscopy in patients over 50 suggests a need to better specify appropriate indications.
Revision Hip Arthroscopy in the Youth Athlete
Authors: Newman Justin T. , Philippon Marc J. , Saroki Adriana , Briggs Karen K.
Published: August 2015

Objectives:

Despite a dramatic increase in the numbers of primary and revision hip arthroscopy cases that are performed, there is limited literature focusing on the younger population of patients who undergo revision hip arthroscopy. Pathophysiology and post-procedural outcomes of pediatric patients has been demonstrated to differ from adults in many common sports related injuries, including those to the shoulder and knee. The purpose of this study was to describe the indications for and outcomes following revision hip arthroscopy in patients 18 years and younger. Our hypothesis was that these patients would present to revision surgery with different pathology and demonstrate significant improvement in outcomes and return to activity.

Methods:

A prospective data registry was queried for all patients 18 years and younger who underwent revision hip arthroscopy with a minimum of 2-year follow-up. Data included detailed surgical data and outcome scores (modified Harris hip (mHHS), Tegner activity scale, and patient satisfaction with outcome) at minimum 2 year follow-up. This study was IRB approved.

Results:

Thirty hips were included in 29 patients. 24 of the patients were female. Average age at revision was 16.6 (range 15-18). 21 of the patients had one prior surgery, 6 had 2 prior surgeries and 2 had 3 prior surgeries. Mean time from most recent surgery to revision surgery was 18.7 months (range 4.7 to 74 months). Surgeries prior to presentation included 13 with labral debridement, 11 with labral repair, 7 had both cam and pincer addressed, 4 had cam only, 1 had pincer only. 18 patients did not have femoroacetabular impingement (FAI) addressed. 5 patients had iliopsoas releases. At revision, lysis of adhesions was performed on all patients. 12 had labral reconstruction, including 9 of the initial labral debridement patients. 18 underwent cam and pincer resection, including 13 of those without FAI addressed initially. 8 patients had labral repair. 3 patients had iliopsoas release and 1 had iliotibial band release. One patient underwent a periacetabular osteotomy without further arthroscopy. At an average follow-up of 37 months (range 24 to 52 months), the mHHS improved from 57 (25 to 96) to 82 (45 to 96). Mean improvement was 22 points (p<0.001). The median satisfaction was 7 (1 to 10), median Tegner was 5 (1 to 9), SF12 PCS was 50.8 (37.2 to 58.3) and the SF12 MCS was 52.8 (45. to 63.6)

Conclusion:

Revision hip arthroscopy in patients under the age of 18 resulted in good outcomes scores. The majority of these patients were satisfied and all returned to activity. Failure to address FAI and the failure of labral debridement were the most common pathologies precipitating revision hip arthroscopy. This challenging population should be further studied to prevent revision surgery and possible additional irreparable damage.
Arthroscopic Management of Dysplastic Hip Morphologies
Authors: Larson Christopher M. , Ross James R. , Stone Rebecca M. , Samuelson Kathryn M. , Giveans Russell , Bedi Asheesh
Published: August 2015

Objectives:

Previous reports regarding arthroscopic management of dysplastic hip morphologies have conflicting results. Arthroscopy alone in the setting of dysplastic morphologies is controversial.

Methods:

We retrospectively reviewed 88 hips (77 patients, 71% female, mean age 33.9 years) with radiographic findings consistent with hip dysplasia and a mean 26.0 months follow-up (range 12-80 months) after hip arthroscopy. Procedures performed included 67 labral repairs (76%), 20 selective labral debridements (23%), 72 capsular repair /plications (82%), and management of associated cam-type morphology in 63 hips (72%). All radiographs were evaluated for parameters consistent with dysplasia including the LCE, Neck Shaft angle, Tonnis angle, Extrusion index, femoral head lateralization, and break in Shenton's line. Preoperative and post-operative function were evaluated prospectively using the Modified Harris Hip Score (MHHS), SF-12 scoring, and pain on a visual analog score (VAS). Patient demographics, procedures performed, and radiographic parameters were evaluated with regards to functional outcomes. In addition, the results of the dysplastic cohort were compared to an aged matched cohort of 231 hips (215 patients, 52% female, mean age 32 years) performed during the study period with a mean follow-up 22.7 months (12-60 months) that underwent arthroscopic FAI correction without the diagnosis of dysplasia.

Results:

The mean LCE was 20.8 degrees (range, 8.7 - 24.5), and mean Tonnis angle was 11.0 (range, 0 - 22.2 degrees). The dysplastic cohort had a mean latest MHHS of 81.3 (range, 34-100) and mean 15.6 point (range, -28 - 60) improvement in MHHS compared to 88.4 points and 24.4 points, respectively, in the FAI cohort (p<0.01). The dysplastic cohort had 60.9% good to excellent results and 32.2% failures, compared to 81.2% good/excellent results and 10.5% failures for the FAI cohort (p<0.01). Decreased head neck offset (cam-type morphology) trended towards being predictive of better scores in the dysplastic cohort (p=0.079). In addition, dysplastic hips that underwent capsular plications and labral repairs had greater good / excellent results and lower failure rates (p<0.05). Grade 4 chondral defects were predictive of lower scores (p=0.02). There were no statistically significant differences for functional outcomes regarding gender or age for either cohort (p>0.05). There were no iatrogenic subluxations / dislocations in either group.

Conclusion:

Although functional scores were improved post-arthroscopy in hips with mild to borderline dysplastic morphologies, Good/Excellent results were inferior and Failure rates were higher compared to an FAI cohort. These results were independent of gender. Associated cam-type FAI, and labral repair / capsular plications were predictive of better clinical outcomes in the dysplastic cohort. Outcomes after pelvic osteotomy in this borderline population are required to determine the optimal treatment.
Are Lesser Trochanteric Tenotomies More Effective than Labral-Level Releases for the Treatment of Iliopsoas Snapping and Impingement?
Authors: Steiner Samuel R. h. , Keene James S.
Published: August 2015

Objectives:

Currently arthroscopic iliopsoas tenotomies (AIT's) are performed at the level of the labrum to treat both painful snapping and labral injuries to impingement of the tendon. However, two recent studies found that although this labral-level procedure relieved painful labral impingement, recurrent snapping of the tendon occurred in 18 to 60% of the cases (1-2). The objective of this study was to determine if arthroscopic tenotomies done at the lesser trochanter would more effectively treat both central labral impingement and snapping of the tendon.

Methods:

From a review of the senior author's data base of 1150 hip arthroscopies, 30 patients that had AIT's at the lesser trochanter to treat both painful snapping of the tendon and labral injuries due to impingement of the tendon were identified (Figure 1). The location of the labral injuries was recorded on each patient's “hip sheet” at the time of their hip arthroscopy and the diagnosis of iliopsoas impingement was confirmed from a review of each patient's operative note and intra-operative photographs. All hips were examined and assessed with Byrd's 100-point modified Harris hip scoring system prior to the release and at 3, 6, 12, and 24 months after surgery.

Results:

Average age of the 30 patients (14 of which were competitive athletes) was 28 years, and their preoperative scores averaged 44 points. After surgery, the patients had hip flexor weakness, used crutches for 2 to 4 weeks and had six-week scores that averaged 77 points. Their scores continued to improve and at 6, 12, and 24 months after surgery, the scores averaged 88, 90, and 91 points, respectively. After an average follow-up of 30 months (range 24-42 months), none of the patients had recurrence of the painful snapping of their tendon, and all 14 competitive athletes returned to full participation in their sport which included Division 1-A crew and soccer (she played 90 mins/game), and high school basketball and softball (she played catcher), at an average of 8.8 months (range 4-12 months) after surgery.

Conclusion:

Arthroscopic iliopsoas tenotomies performed at the level of the lesser trochanter appear to be more effective than labral-level tenotomies for the treatment of patients that have both intra-articular labral impingement and a painful snapping of the tendon.
A Matched-Pair Controlled Study of Arthroscopic Psoas Tenotomy with Minimum 2-Year Follow-Up
Authors: Redmond John M. , Schwartz Aaron R. , Gupta Asheesh , Stake Christine E. , Finch Nathan , Domb Benjamin G.
Published: August 2015

Objectives:

It is unknown whether pateints undergoing tenotomy for painful internal snapping at the time of hip arthroscopy can expect equivalent functional outcome to patients undergoing hip arthroscopy without tenotomy. The contribution of the psoas tendon and hip capsule to hip stability is also currently debated. The purpose of this matched study is to (1) compare two-year outcome scores in a study group who underwent psoas tenotomy to a matched control group who did not have a psoas tenotomy, and (2) perform a subgroup analysis of the study group comparing capsular repair to capsular release.

Methods:

Between April of 2008 and December of 2012, we prospectively collected data and reviewed 694 hip arthroscopies with a minimum 2 year follow up. A total of 243 patients had undergone psoas tenotomy and comprised the study group available for matching. After a power analysis was performed we matched 50 patients in the control group to 50 patients in the study group. A subgroup analysis of the study group was then performed based on the capsular treatment performed. Twenty five patients who underwent capsular release were compared to 25 patients who underwent capsular repair. The protocol included pre- and post-operative administration of four hip-specific patient-reported outcome (PRO) tools, the visual analog scale (VAS), and patient satisfaction scores.

Results:

Both the study group (n=50) and control group (n=50) demonstrated a statistically significant improvement in patient-reported outcome (PRO) scores and pain scores at 2-year follow up (p<0.05). No statistical differences in PRO scores, pain scores, or patient satisfaction was observed at 2-years between the study group and the control group as well as between the capsular repair and capsular release subgroups.

Conclusion:

In patients with painful internal snapping and psoas impingement lesions arthroscopic psoas tenotomy appears to result in similar two-year outcomes to patients not undergoing psoas tenotomy at the time of labral treatment. We were unable to detect a significant role for capsular closure at the time of psoas tenotomy; however, this requires further study.
Operative vs. Non-Operative Treatment of Achilles Tendon Ruptures
Authors: Erickson Brandon J. , Mascarenhas Randhir , Saltzman Bryan Michael , Walton David , Lee Simon , Cole Brian J. , Bach Bernard R.
Published: August 2015

Objectives:

Background: Multiple meta-analyses have been published to in efforts to determine whether operative or non-operative treatment of Achilles tendon ruptures affords superior outcomes. The results, however, remain varied and inconsistent.

Purpose:

To perform a systematic review of overlapping meta-analyses comparing operative and non-operative treatment of Achilles tendon ruptures in order to determine which meta-analyses provide the highest level of evidence for treatment recommendations.

Methods:

Methods: A systematic review of the literature was performed to identify meta-analyses that fit our inclusion criteria. Data was extracted from these meta-analyses regarding patient outcomes and re-ruptures. Meta-analysis quality was assessed using the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) systems. The Jadad algorithm was applied to determine the meta-analyses with the highest level of evidence.

Results:

Results: Nine meta-analyses met the eligibility criteria, with all but one study including level I evidence. A total of 5,842 patients were included. Seven studies found a higher rate of rerupture in the non-operative group but a higher rate of complications in the operative group. One study found no differences in rerupture or complication rates, and one study found surgery decreased rerupture rates only when compared to non-operative treatment without a functional brace. Three studies also identified an earlier return to work in the operative group. Almost all (8 out of 9) of the meta-analyses had Oxman-Guyatt scores (>3) indicating no major flaws.

Conclusion:

Conclusions: Operative treatment of Achilles tendon ruptures decreases rerupture rates but increases the risk for minor complications when compared to non-operative treatment. Additionally, surgical treatment may allow earlier return to work.
Clinical Assessment of the Dynamic Shear Test for SLAP Lesions
Authors: Sodha Sonal , Joseph Jacob , Borade Amrut , McFarland Edward G.
Published: August 2015

Objectives:

Making the diagnosis of superior labrum anterior posterior (SLAP) lesions with physical examination remains challenging. The dynamic shear test is a recently described physical examination test which has been shown in two previous studies to have a likelihood ratio of 31.6 and 1.1 for making the diagnosis of a SLAP tear. The goal of this study was to determine the clinical utility of the dynamic shear test for making the diagnosis of SLAP lesions.

Methods:

This is a consecutive case series of patients who were studied prospectively who had a diagnostic arthroscopy by the senior author between 2007 and 2013 (N=674). All had a thorough physical examination preoperatively which included a dynamic shear test. Only Type II through V SLAP lesions were considered positive for a SLAP tears. A type I tear was considered a degenerative lesion and included in the control group. For statistical analysis, the patients were divided into three groups: a control group (n = 528) consisting of patients with no SLAP lesion but with other pathologies, an Isolated SLAP lesion group (n = 7), and a Concomitant SLAP group (n=139) who had a SLAP tear and some other shoulder pathology such as a rotator cuff tear or instability of the shoulder. Statistical analysis included determining sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR), and diagnostic accuracy (DA) of the dynamic shear test with and without other tests for SLAP tears.

Results:

The dynamic shear test was positive for 242 (45.8%) control patients, 6 (85.7%) patients with isolated SLAP lesions, and 79 (56.8%) of the concomitant SLAP patients. For isolated SLAP tears the dynamic shear test had a sensitivity of 85.7, specificity of 51.9, PPV of 1.8, NPV of 99.7, LR of 6.4, and DA of 54.4. In comparison, the LR for the active compression test was 0.7 and for the relocation test was 1.5. For patients with combined SLAP lesions with other pathologies, the dynamic shear test had a sensitivity of 58.2, specificity of 54.2, PPV of 35.99, NPV of 82.4, LR of 1.5, and DA of 55.0. Combining all three tests did not improve the LR for either isolated SLAP lesions or lesions with concomitant pathology.

Conclusion:

This study demonstrates that the dynamic shear test is sensitive but not specific for isolated SLAP lesions. With a likelihood ratio of over 6, it is one of the better tests for diagnosing isolated SLAP tears. However, in patients who have concomitant pathologies it is not as useful for making the diagnosis of a SLAP lesion.
Predictive Risk of Ulnar Collateral Ligament Injury Based on Ligament Morphology and Dynamic Abnormalities in Professional Baseball Pitchers Using Stress Ultrasonography
Authors: Mayer Braden K. , Shanley Ellen , Bailey Lane Brooks , Thigpen Charles A. , Wyland Douglas J. , Hawkins Richard J. , Kissenberth Michael J. , Noonan Thomas J.
Published: August 2015

Objectives:

Ulnar collateral ligament (UCL) injury of the elbow is a common and debilitating problem seen frequently in elite baseball pitchers. Ultrasound has been shown to be a useful diagnostic tool in evaluating UCL injuries. We hypothesized that the evaluation using stress ultrasound (US) of the elbow to measure both the morphology of the UCL and the ulnohumeral joint space gapping as a surrogate for UCL incompetence will be helpful to predict UCL injury in professional baseball pitchers.

Methods:

Ultrasound imaging was used to assess the medial joint laxity of both arms of 70 asymptomatic professional baseball pitchers during spring training. Medial joint laxity and UCL morphology was assessed using OsiriX Imaging Software under 2 conditions: (1) gravity valgus load and (2) 10 lbs of valgus load using a handheld dynamometer with the shoulder in the maximal cocking position and the elbow in 90° of flexion. Two trials of resting position, elbow gapping, and UCL thickness were collected, measured and averaged for data analysis. Intra and inter rater reliability was established and maintained with ICC's in the acceptable range for all measures (.84-.99). One-way ANOVA (α=0.05) was used to compare pitchers’ dominant variables between those with a prospective UCL injury to those who never had a UCL injury. Receiver Operating Curve (ROC) was used to identify pitchers who, based on elbow gapping measures (by cut score), were at high-risk versus those at low risk for UCL injury. (AUC > .70; α=0.05).

Results:

Players with a prospective UCL injury (n=7) presented with a trend toward wider (mm) D arm resting joint opening (4.9± 1.2 vs. 4.0±1.1; p=0.07), significantly wider gapped opening (6.5± 1.2 vs. 5.3 ± 1.2; p=0.01) and greater peak stiffness (nm) (.17±.09 vs. 10 ±.07; p=0.03) when compared to pitchers without UCL injury history (n=63). Figure 1 displays larger values of dynamic elbow gapping differentiated between UCL injured (>5.5 mm) and uninjured pitchers (AUC=0.77; p=0.02).

Conclusion:

Our data suggests that changes present in the UCL and detectable on ultrasound may help distinguish elbows at risk for later clinical UCL insufficiency. Screening using ultrasound of UCL thickness, loaded joint gapping, and stiffness may help predict the likelihood of elbow injury in professional baseball pitchers.
Patient Activity Levels After Reverse Total Shoulder Arthroplasty
Authors: Garcia Grant , Taylor Samuel A. , Mahony Gregory Thomas , Grawe Brian , Dines Joshua S. , Warren Russell F. , Craig Edward V. , Gulotta Lawrence Vincent
Published: August 2015

Objectives:

Indications for reverse total shoulder arthroplasty (RTSA) are expanding, resulting in younger patients who wish to remain active following the procedure. Little information, however, is available to help manage expectations of both physicians and patients for return to sporting activities. The purpose of this study was to determine the rate of return of sports activities, assess average time to return to sports for patients having undergone RTSA.

Methods:

A prospectively collected registry was queried for consecutive patients who underwent RTSA at our institution between 2007 and 2013. Patients with a minimum of 1-year follow-up were included. Patients without preoperative sporting activity were excluded. All patients were asked to complete a questionnaire regarding their physical fitness, sporting activities. The questionnaire was designed in accordance with previously published activity assessments for total joint arthroplasty. Each patient also completed an ASES and VAS assessment.

Results:

76 patients played a sport preoperatively and met inclusion/exclusion criteria. The average follow-up was 31.6 months (12-65 mons) and average age was 74.84 years (49.9 - 92.6 yrs). Preoperative diagnoses were cuff tear arthropathy (55.2%), osteoarthritis (30.9%), proximal humerus fracture (17.1%), and rheumatoid arthritis (5.2%). 73% of the cohort had undergone prior ipsilateral shoulder surgery. Average VAS pain scores improved from 6.57 to 0.63 (p<0.001). Average ASES scores improved from 34.30 to 81.45 (p<0.001). 85.5% of patients who participated in sports preoperatively returned to at least one sport following RTSA. Average time to full return to sport was 5.3 months. Walking had the highest direct rate of return (85.7%), followed by fitness sports (81.5%), swimming (66.7%), running (57.1%), cycling (50.0%) and golf (50%). Age less than 70 years had significant improvement in rate of return to sports (p<0.002). 41.1% reported improved physical fitness following RTSA. 88.2% felt their sports outcome was good to excellent and 93.4% felt their surgical outcome was good to excellent. The two most commonly reported reasons for not returning to a sport were pain (13.1%) and lack of interest (9.2%). For all types of sports and rates of return see fig 1.

Conclusion:

Patients undergoing RTSA had an 85% rate of return to one or more sporting activities at an average of 5.3 months following surgery. Non-contact high demand activities (swimming, skiing, golf, and tennis) had lower return rates than lower demand activities. Age greater than 70 years old was a significant predictor of decreased return to activities. This is the only study to document both preoperative and postoperative sports and activities of daily living following RTSA. The present study offers valuable information to help manage patient and surgeon expectations.
Does Prior Shoulder Surgery Negatively Impact Shoulder Arthroplasty Outcomes?
Authors: Frank Rachel M. , Aiyash Sal , Kupfer Noam , Tilton Annemarie K. , Cole Brian J. , Verma Nikhil N. , Nicholson Gregory P. , Romeo Anthony A.
Published: August 2015

Objectives:

Several studies have shown a negative correlation between prior knee arthroscopy and ultimate knee arthroplasty outcomes compared to patients without prior arthroscopy. The purpose of this study was to determine the effects of prior shoulder surgery on patients undergoing total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (rTSA) compared to patients without prior shoulder surgery.

Methods:

A retrospective review of prospectively collected data was performed on 107 patients undergoing TSA or rTSA. All medical records were analyzed for demographic variables, type of prior shoulder surgery, and type of arthroplasty. All patients underwent a clinical follow-up evaluation, and were evaluated with the American Shoulder and Elbow Society (ASES), Simple Shoulder Test (SST), and Visual Analog Scale (VAS) outcomes scores. Complications, failures, and reoperations were also recorded an analyzed.

Results:

A total of 107 patients (47 males, 60 females) were included with an average follow-up of 24 months (minimum 12 months). Seventy-one patients (underwent arthroplasty without prior surgery (30 rTSA, 41 TSA) while 50 patients underwent arthroplasty with a history of at least one prior shoulder surgery (27 rTSA, 9 TSA). Prior surgeries included a mix of both open and arthroscopic procedures, including open and arthroscopic rotator cuff repair, open and arthroscopic stabilization (with and without bone augmentation), arthroscopic capsular release, and arthroscopic debridement. Following arthroplasty, both groups experienced significant improvements in ASES, SST, and VAS scores compared to preoperative scores (P<0.05 for all). There was a statistically significant difference in postoperative ASES scores in the no-surgery group compared to the prior-surgery group (84.49 versus 71.67, P=0.0003) as well as in the SST scores (8.97 versus 5.47, P<0.0001); there were no differences in the VAS score (0.83 vs 1.40, P=0.104).

Conclusion:

Shoulder arthroplasty after undergoing prior shoulder surgery results in overall clinically improved outcomes, however these results are inferior compared to patients without a history of prior shoulder surgery. Further research examining this correlation is needed.
Walking a Fine Line
Authors: McInerney Paul-Brian
Published: August 2015

As they assemble organizations from different economic sectors, intersectoral collaborations are co-constituted by institutional pluralism. However, the intimacy and inequality of these arrangements also constrain an organization’s ability to respond strategically to the concomitant institutional pluralism. Members of the organization experience pluralism as a tension I call moral ambivalence, that is, they simultaneously hold opposing judgments about their actions or the situations in which they find themselves. Moral ambivalence leads actors to engage in institutional work, pragmatic compromises directed toward coping with the competing institutional rules they face. This institutional work produces hybrid actions that, in turn, help the organization maintain internal cohesion and prevent negative outcomes. The article traces the sources of institutional pluralism to organizational imprinting from for-profit partners and institutional pressures from other members of the field. Data come from an ethnography of a single nonprofit organization that collaborates with several large for-profit organizations.
“Leave a Bowl of Fruit on the Kitchen Table”
Authors: Koch Shelley L.
Published: August 2015

Food and nutrition policy in the United States relies heavily on convincing individual household food provisioners to make healthy choices to improve their eating behavior. This policy strategy has not only been unsuccessful in encouraging healthy eating but also ignores the labor involved in this work of provisioning the household. This focus on individual behavior change meshes well with the ideology of consumer sovereignty, which is the belief in the power of the individual consumer to influence the food system by what they purchase. Using the Let’s Move! Program, initiated by Michelle Obama, as an example of mainstream nutrition policy, this article highlights the problems with our current food and nutrition policy, especially with regard to the gendered work involved in provisioning, and offers examples of more effective policies for promoting health through public provisioning policies and programs.
Reconceptualizing Exploitation
Authors: Avent-Holt Dustin
Published: August 2015

Rent theory has taken off in stratification research, and a conceptualization of exploitation derived from rent theory has become popular in models of economic inequality. Some have argued that rent theory provides a more appropriate foundation for scientifically studying exploitation and economic inequality than neo-Marxian conceptualizations rooted in the labor theory of value. This article develops a critique of the rent-based conceptualization of exploitation, and two possible directions for reformulating the concept. I argue that rent-based exploitation fails to identify either a normatively or empirically defensible baseline condition that identifies when exploitation is absent and how much exists when it is present. To develop a more useful baseline, social scientists can either ground the concept in the normative worldviews of economic actors (positive approach) or in the normative commitments of the analyst himself or herself (normative approach). I use the social scientific literatures on distributive justice and fairness norms and the philosophical literature on exploitation and distributive justice to develop these alternatives, and conclude by discussing the strengths and weaknesses of each approach.
Cracks in the “Regulatory State”
Authors: Perrow Charles
Published: August 2015

Over the last 30 years, the U.S. states has retreated from its regulatory responsibility over private-sector economic activities. Over the same period, a celebratory literature, mostly in political science, has developed, characterizing the current period as the rise of the regulatory state or regulatory capitalism. The notion of regulation in this literature, however, is a perverse one—one in which regulators mostly advise rather than direct, and industry and firm self-regulation is the norm. As a result, new and potentially dangerous technologies such as fracking or mortgage backed derivatives are left unregulated, and older necessary regulations such as prohibitions are weakened. This article provides a joint criticism of the celebratory literature and the deregulation reality, and strongly advocates for a new sociology of regulation that both recognizes and documents these failures.
Association Between Remoteness to a Health Care Facility and Incidence of Ambulance Calls in Rural Areas of Japan
Authors: Kashima Saori , Inoue Kazuo , Matsumoto Masatoshi , Eboshida Akira , Takeuchi Keisuke
Published: August 2015

Objectives:

Whether traffic remoteness from health care service in rural areas influences usage of ambulance service has not been well investigated. This study aimed to evaluate the relation between remoteness to health care facilities and incidence of ambulance calls in rural areas of Japan.

Methods:

We analyzed 155 rural communities of Hiroshima. Data were obtained on all ambulance dispatches from 2010 to 2012. Driving time was calculated from each community to the closest primary/secondary and tertiary health care facility (equivalent to tertiary emergency care centers). We estimated the incidence rate and the incidence rate ratio (IRR) of ambulance calls for each 10-minute increase in the driving time, using generalized log-linear regression models, and evaluated the effect among each specific subgroup of emergency level and season.

Results:

During the study period, the median incidence rate was 436 per 10 000 people in targeted communities. When driving time to the closest primary/secondary facility increased by an increment of 10 minutes, there was a significant increase in the IRR of ambulance calls, especially during colder seasons (IRR: 1.29 [95% confidence interval: 1.11-1.49]), and this relation was also obtained for most emergency levels. In comparison, there was no such increase in IRRs observed for driving time to a tertiary facility.

Conclusion:

This study indicated a positive association between remoteness to primary/secondary medical facilities and the frequency of ambulance calls. The remoteness to a primary/secondary health care may induce an increase in ambulance calls, particularly during cold seasons.
Effectiveness of Advanced Stay Strong, Stay Healthy in Community Settings
Authors: Crowe Emily M. , Ball Stephen D.
Published: August 2015

The goal of this research was to investigate the effectiveness of the 10-week, University of Missouri (MU) Extension strength training program Advanced Stay Strong, Stay Healthy (ASSSH). It was hypothesized that the program can improve strength, balance, agility, and flexibility—all physical measures of falling among seniors. Matched pair t tests were used to compare differences in five physical measures of health, body composition, and percent body fat (%BF). Two-way ANOVA was conducted to examine the age effects on changes in physical health from the start and finish of the exercise program. Following programming, participants significantly improved strength, flexibility, and balance, and significantly reduced %BF ( p < .05). Our data indicate that ASSSH can improve the physical health of senior citizens and can successfully be translated into community practice by MU Extension professionals.
Self-Rated Health Among Very Old People in European Countries
Authors: Harschel Anne K. , Schaap Laura A. , Iwarsson Susanne , Horstmann Vibeke , Tomsone Signe
Published: August 2015

Objectives: To explore and gain insight into factors related to self-rated health (SRH) among very old people in two European countries. Methods: The study was based on Latvian ( n = 301) and Swedish ( n = 397) data from the baseline of the Enabling Autonomy, Participation, and Well-Being in Old Age: The Home Environment as a Determinant for Healthy Ageing Survey Study. Besides descriptive statistics, ordinal regression analysis was used to analyze demographic, physical and mental health-related, functional and environmental factors related to SRH in each sample. Results: In both samples, participants with worse perceived physical mobility and more symptoms were significantly more likely to have worse SRH. There were more diverse results regarding other factors in terms of opposite relations to SRH, comparing the two samples. Discussion: Preventive measures and health care should focus on improving and supporting mobility and physical health among older people. Especially in countries with low scores on indicators of health such as Latvia, to minimize health inequalities. More attention should be paid to factors to improve the general health status of the population.
Influence of electric current on superplastic deformation mechanism of 5083 aluminium alloy
Authors: Liu J. Y. , Zhang K. F.
Published: August 2015

5083 aluminium alloy superplastic forming adopted resistance heating can not only improve efficiency and cut energy but also generate electroplastic/electrosuperplastic effect to make the material deformation possess lower flow stress and higher plasticity. By analysing the influence of current on dislocation slipping, grain boundary migration and dynamic recrystallisation, it is found that the electron wind force can enhance the mobility of dislocations; meanwhile, the current also can reduce the activation heat of dislocation motion by joule heating effect. What is more, the grain size of resistance heating forming sample is significantly smaller than furnace heating, and the cavities in the sample become small and dispersive, so the resistance heating forming specimen possesses better performance.
Activity of ibrutinib in mantle cell lymphoma patients with central nervous system relapse
Authors: Bernard Sophie , Goldwirt Lauriane , Amorim Sandy , Brice Pauline , Brière Josette , de Kerviler Eric , Mourah Samia , Sauvageon Hélène , Thieblemont Catherine
Published: August 2015

Key Points

Ibrutinib induces a rapid, dramatic, and sustained response in MCL patient with symptomatic CNS relapse. Ibrutinib penetration through the blood-brain barrier was confirmed using plasma and cerebrospinal fluid pharmacokinetic analyses.
Theoretical analysis of headache recurrence in patients administered triptans for migraine based on receptor occupancy
Authors: Tokuoka Kentaro , Takayanagi Risa , Toyabe Mioko , Watanabe Masayuki , Kitagawa Yasuhisa , Yamada Yasuhiko
Published: August 2015

Background

In this study, we retrospectively analyzed the relationship between headache recurrence and serotonin 5-HT1B/1D receptor occupancy (Φ1B and Φ1D). Triptans marketed in Japan (sumatriptan, zolmitriptan, eletriptan, rizatriptan, naratriptan) were investigated.

Methods

Receptor occupancies were calculated from both the pharmacokinetic and pharmacodynamic data of triptans. We examined the relationships between recurrence rate and elimination half-lives, and Ф1B and Ф1D, as calculated from the time-course of plasma drug concentration obtained from other studies. The time until Ф1B and Ф1D became 50 % or less, 40 % or less, and 30 % or less was calculated as duration time to examine the relationship with recurrence rate.

Results

For Ф1B, eletriptan remained at a low level. For Ф1D, it was indicated that all triptans obtained an occupancy of 80 % or higher at maximum. For all items, though recurrence tended to be lower along with longer half-life, no significant statistical correlation was found. For both Ф1B and Ф1D, the recurrence rate tended to be lower as the duration became longer. In addition, a significant correlation was observed for Ф1D (p < 0.05). For clarifying the Ф value and time period most closely correlated with recurrence rate, recurrence and Ф1B and Ф1D at 6, 12, and 18 h after administration were calculated. The most significant correlation was observed between recurrence rate and Ф1D at 12 h after administration (p < 0.01).

Conclusions

As an index for evaluating headache recurrence following triptan administration, recurrence rate and Ф1D value at 12 h after administration were found to be most closely correlated and useful for analysis. Our results indicate that headache recurrence inhibition can be evaluated using these values.
Machine learning as a tool for classifying electron tomographic reconstructions
Authors: Staniewicz Lech , Midgley Paul A.
Published: August 2015

Electron tomographic reconstructions often contain artefacts from sources such as noise in the projections and a “missing wedge” of projection angles which can hamper quantitative analysis. We present a machine-learning approach using freely available software for analysing imperfect reconstructions to be used in place of the more traditional thresholding based on grey-level technique and show that a properly trained image classifier can achieve manual levels of accuracy even on heavily artefacted data, though if multiple reconstructions are being processed, a separate classifier will need to be trained on each reconstruction for maximum accuracy.