bluuebunny/crossref_metadata_2025 huggingface dataset:
Arthroscopic Treatment of Posterior Impingement of the Hindfoot
Authors: Carreira Dominic S. , Vora Anand Mahesh , Kozy John
Published: August 2015

Objectives:

Open and arthroscopic techniques have been utilized in the treatment of posterior impingement of the ankle and hindfoot. Because posterior impingement occurs more frequently in patients who repetitively plantarflex the ankle, this population may especially benefit from a procedure that reduces pain and results in maximal range of motion (ROM). The purpose of this study was to assess the outcome of hindfoot endoscopy in patients with posterior ankle impingement through higher level of function outcome measures and physical examination parameters, focused on analysis of ROM.

Methods:

20 ankles (19 patients) were followed prospectively at a minimum 1 year follow-up (mean 38.2 months). 19 of 20 patients were competitive athletes. Patients completed a minimum of 3 months of nonoperative treatment. Diagnoses included os trigonum, tibial exostosis, talar exostosis, loose body or fracture nonunion, and ganglion cyst removal. Patients underwent arthroscopic treatment utilizing a posterior approach; all relevant pathology was addressed. Post-surgery, patients were placed in a splint for 3 to 7 days then placed in a CAM boot for 2 to 3 weeks, weight bearing as tolerated. Physical therapy was initiated within 7-10 days; strengthening exercises were initiated postoperatively at 1 month.

Results:

At most recent follow-up, VAS Pain and AOFAS Hindfoot scores showed significant improvement (p<0.01) pre to post-operatively; Tegner score remained unchanged (p=0.888). 3 patients were professional athletes; all returned to their previous level of professional activity. ROM variables between affected and unaffected sides reached statistical similarity at most recent follow-up. 15% of patients reported post-operative neuritis. No other complications were reported.

Conclusion:

Posterior ankle arthroscopy allows for maintenance or restoration of anatomic ROM of the ankle and hindfoot, ability to return to at least previous level of activity, and improvement in objective assessment of pain relief and higher level of function parameters. Complications associated with this procedure are minimal.
Treatment And Results Of Combined Mild Bone Loss Instability With The Modified Laterjet
Authors: Yang Justin Shu , Mazzocca Augustus D. , Arciero Robert A.
Published: August 2015

Objectives:

Recurrent anterior glenohumeral dislocation in the setting of an engaging Hill-Sachs lesion is high. The Latarjet procedure has been well-described for restoring glenohumeral stability in patients with over 25% glenoid bone loss. However, the treatment for patients with combined humeral head and mild (<25%) glenoid bone loss remains unclear. We report on the outcomes of the modified Latarjet for this population.

Methods:

Modified Latarjet was performed in twenty three patients with recurrent anterior shoulder instability, engaging Hill-Sachs by exam confirmed with arthroscopy, and less than 25% anterior glenoid bone loss. The mean follow-up was 3.5 years. All patients were assessed for their risk of recurrence using the Instability Severity Index Score (ISIS), had pre-operative 3D imaging to assess humeral and glenoid bone loss. Single Assessment Numeric Evaluation (SANE), Western Ontario Shoulder Instability Index (WOSI), recurrence rate, radiographs, range of motion and dynamometer strength were used to assess outcomes.

Results:

Average pre-operative instability severity index score was 6.2 (range 4-9). Pre-operative glenoid bone loss averaged 15.1% (range 5-25%). The humeral defect averaged 40.4% in width and 13.7% in depth on axial computed tomography scan, with an average Hill-Sachs angle of 28°. The mean WOSI index was 457 of 2100 (range 0-1398). The mean SANE score was 81.2 (range 60-100). Five out of ten competitive athletes returned to play for at least one season. There were no recurrent dislocation and three patients had a single episode of recurrent subluxation. Loss of external rotation at the side averaged 8°, and there was no significant loss of abduction. Subscapularis, abduction and external rotation strength averaged greater than 85% of the contralateral shoulder. Fourteen patients on average had 1.4 (range 1-4) previous open or arthroscopic stabilization procedures prior to the Latarjet, nine others had Latarjet done primarily. WOSI scores correlated directly with number of previous surgery (r=0.81, p=0.02). Average WOSI score was 239 (range 0-510) in primary Latarjet, 495 (range 42-1024) in patients with one previous stabilization procedure, and 674 (range 192-1398) in patients with two or more previous stabilization procedures (ANOVA p<0.001). There were three deep infections, two graft fractures, two painful hardware, one broken screw with graft malunion, and one radiographic graft nonunion. All infections, malunion and nonunion occurred in patients with failed previous stabilization procedures. No long-term nerve palsies were found. Resorption of the graft at the superior screw was seen in 28% of patients.

Conclusion:

The modified Latarjet is a reasonable choice for the treatment of an engaging Hill-Sachs lesion with concomitant mild anterior glenoid bone loss in this very demanding group of patients. However, the complication rate is significant.
Arthroscopic Treatment of FAI in Adolescent Athletes
Authors: Byrd J. W. Thomas , Jones Kay S.
Published: August 2015

Objectives:

Athletic activities are implicated in the development of symptomatic FAI in adolescents as reflected by a high prevalence of sports participation among young individuals who present with this problem. The purpose of this study is to report the outcomes of arthroscopic treatment.

Methods:

All patients undergoing arthroscopy are prospectively assessed with a modified Harris hip score. 104 athletes (117 hips) were identified among 108 consecutive adolescents (122 hips) less than 18 years of age who had undergone arthroscopic surgery for FAI and had achieved minimum one-year follow-up. This cohort of athletes represents the substance of this report.

Results:

Follow-up averaged 28 months (range 12-60 months). Average age was 16 years (range 12-17 years). There were 47 males and 57 females. The average improvement was 22 points (preop 73; postop 95) with 113 hips (97 %) improved with 112 (96%) good & excellent results. Eighty-eight athletes (84%) returned to their sport. Among the 16 that did not return to sports, 5 were unable, 6 chose not, and 5 had completed their high school athletic careers. Most common sports were football 15, soccer 13, basketball 13, dance 11, volleyball 7, cross-country 7, swim 7, gymnastics 5, baseball 4, softball 4, and lacrosse 4. FAI correction was performed for 33 cam, 17 pincer, and 67 combined lesions. 107 labral tears underwent 82 refixations and 24 debridements. There were 99 acetabular chondral lesions (42 Grade I, 18 Grade II, 34 Grade III, 5 Grade IV) with four microfractures. There were 3 femoral chondral lesions (1 Grade II, 2 Grade III). Seven loose bodies were removed and 19 lesions of the ligamentum teres were debrided. Concomitant extra-articular procedures included 13 iliopsoas tendon releases, two iliotibial band tendoplasties, and one trochanteric bursectomy. There were two complications, transient pudendal neurapraxias, that resolved within two weeks. Four patients underwent repeat arthroscopy and one a PAO.

Conclusion:

Athletic activities are implicated in the development of symptomatic FAI at a young age, and this study reports favorable outcomes of arthroscopic treatment of FAI among adolescent athletes. A high portion was improved, although only 84% actually returned to their sport. Return to sport may be influenced by factors other than just the success of the procedure.
Association Of Meniscal Status And Lower Extremity Alignment With Chondrosis At The Time Of Revision Acl Reconstruction
Authors: Brophy Robert H. , Haas Amanda , Huston Laura J. , Nwosu Samuel K. ,   Mars Group, Wright Rick W.
Published: August 2015

Objectives:

Knees undergoing revision ACL reconstruction (rACLR) have a high prevalence of articular cartilage lesions. The purpose of this study was to test the hypothesis that the prevalence of chondrosis at the time of rACLR is associated with meniscus status and lower extremity alignment.

Methods:

Data from the prospective Multicenter ACL Revision Study (MARS) cohort was reviewed to identify patients with pre-operative lower extremity alignment films. Lower extremity alignment was defined by the weight bearing line (WBL) as a percentage of the tibial plateau width, while the chondral and meniscal status of each weight bearing compartment was recorded at the time of surgery. Multivariable proportional odds models were constructed and adjusted for relevant factors in order to examine which risk factors were independently associated with the degree of medial and lateral compartment chondrosis.

Results:

The cohort included 246 patients with lower extremity alignment films at the time of rACLR. Average (SD) patient age was 26.9 (9.5) years with a BMI of 26.4 (4.6). The medial compartment had more chondrosis (Grade 2/3: 42%, Grade 4: 6.5%) than the lateral compartment (Grade 2/3: 26%, Grade 4: 6.5%). Disruption of the meniscus was noted in 35% of patients on the medial side and 16% in the lateral side. The average (SD) WBL was measured to be 0.43 (0.13). Medial compartment chondrosis was associated with BMI (p=0.025), alignment (p=0.002)(see figure), and medial meniscus status (p=0.001). None of the knees with the WBL lateral to 0.625 had Grade 4 chondrosis in the medial compartment. Lateral compartment chondrosis was significantly associated with age (p=0.013) and lateral meniscus status (p<0.001). Subjects with ‘intact’ menisci were found to decrease their odds of having chondrosis by 64-84%.

Conclusion:

The status of articular cartilage in the tibiofemoral compartments at the time of rACLR is related to meniscal status. Preserving the meniscus at the time of ACL reconstruction has the potential to be chondroprotective, particularly in patients who go on to require rACLR. Lower extremity alignment and BMI are associated with medial compartment chondrosis, suggesting that optimizing alignment and minimizing weight gain may be important in these patients.
Transcriptomic Signatures of Meniscal Tears and Articular Cartilage from Knees Undergoing Arthroscopic Partial Meniscectomy Show Evidence for Early Osteoarthritis
Authors: Brophy Robert H. , Sandell Linda , Wright Rick W. , Rai Muhammad Farooq
Published: August 2015

Objectives:

Despite clinical evidence demonstrating that meniscus tears are early events in the initiation and propagation of knee osteoarthritis (OA), the biology of how meniscus injury leads to changes in the articular cartilage is not well studied. Therefore, we compared the molecular biology of articular and meniscal cartilage within the same knees undergoing partial meniscectomy to advance our understanding of early molecular events in the knee that contribute to the development of OA following a meniscus tear. The purpose of this study was to test the hypothesis that meniscal and articular cartilage from knees undergoing arthroscopic partial meniscectomy will demonstrate molecular signature representative of early OA.

Methods:

Patients (n=12) with a known isolated medial meniscus tear without any knee chondrosis or radiographic OA were consented prior to surgery. During arthroscopic partial meniscectomy, a sample of their injured meniscus and a small fragment of their articular cartilage off the medial femoral condyle were procured. The transcriptome signatures measured through Affymetrix microarray were compared between the two tissues and underlying biological processes were explored computationally.

Results:

3566 gene transcripts, representing several underlying biological processes, including extracellular matrix organization, wound healing, cell adhesion, chemotaxis, blood vessel morphogenesis, and angiogenesis, were differentially expressed between meniscus and articular cartilage.

Conclusion:

Articular cartilage and meniscus exhibit molecular events associated with OA at the time of partial meniscectomy despite no gross evidence of degeneration in the knee. These findings identify early effects of meniscus injury on meniscus and articular cartilage, which likely lead to the development of knee OA.
Revision Meniscus Surgery in Children And Adolescents: the Effect Of Skeletal Immaturity
Authors: Shieh Alvin , Edmonds Eric W. , Pennock Andrew T.
Published: August 2015

Objectives:

The purpose of this study was to investigate the incidence and risk factors for revision meniscus surgery in a pediatric population as well as to describe mechanisms of failure and subsequent operative management.

Methods:

A retrospective review was performed of all patients under 20 years who had arthroscopic management for meniscus pathology at a single institution between 2008 and 2012. Demographic data and intraoperative findings at the time of the initial surgery were documented. All patients undergoing a second procedure on the same meniscus were further analyzed to calculate the incidence and risk factors for revision surgery. The mechanism and date of reinjury as well as subsequent surgical management were documented. Patients with persistent pain following the initial operation were considered a non-traumatic surgical failure. Multivariate logistic regression with purposeful selection was performed to identify independent risk factors for revision meniscus surgery.

Results:

Arthroscopic knee surgery was performed on 293 patients and 324 menisci, including 129 repairs, 149 meniscal debridements, and 46 discoid saucerizations. With a minimum follow-up period of 17 months, 13% of the cohort required a revision procedure. The primary repair group had the highest failure rate (18%) followed by the discoid saucerization group (15%) and the meniscus debridement group (7%). Multivariate analysis indicated that meniscus repair was predictive of re-tear (OR = 2.04, 95%CI 1.01-4.1, p=0.046), and children with an open physis and a bucket handle tear had the highest retear rate of 46% (p=0.039). Independent variables shown to have no significant relationship to revision meniscus surgery included: age, gender, BMI, laterality, time to repair, tear location, and associated ligament injury. The most common indication for revision surgery was an acute traumatic re-injury during physical activity. Revision procedures were performed at an average of 14 months after the index surgery and the majority of failures (69%) were identified within a year. 44% of patients undergoing a revision surgery underwent a further debridement whereas 56% underwent a repair.

Conclusion:

Revision meniscus surgery is not uncommon in pediatric and adolescent patients especially those undergoing a primary repair of a bucket-handle meniscus tear when the physes are still open. Most failures are the result of a traumatic injury and nearly half will require further debridement of the torn meniscus. Surgeons treating meniscal lesions in this young population, as well as children and their families, should be aware of the short-term rate of revision meniscus surgery, especially when they are still skeletally immature.
Humeral Torsion as a Risk Factor for Shoulder and Elbow Injury in Professional Baseball Pitchers
Authors: Noonan Thomas J. , Thigpen Charles A. , Bailey Lane Brooks , Wyland Douglas J. , Kissenberth Michael J. , Hawkins Richard J. , Shanley Ellen
Published: August 2015

Objectives:

Participation in baseball causes increased mechanical stress to the throwing arm and has been linked to alterations in shoulder range of motion (ROM) and bony morphology. Range of motion changes, specifically GIRD, has been associated with increased shoulder injury. However, the role of humeral torsion is unclear in shoulder injury. The purpose of this study was to prospectively compare humeral torsion (HT) in professional pitchers who remain healthy as compared with those who go on to suffer shoulder injuries.

Methods:

We prospectively measured and observed 255 professional pitcher-player seasons prior to 2009-2013 spring training. Bilateral HT was assessed in pitchers who were currently asymptomatic and participating without restriction, in all training, and practices. Humeral torsion was assessed via validated, indirect ultrasonography. Two trials of HT were averaged for data analysis. The side-to-side difference in HT was calculated by subtracting the dominant arm (D) HT from the non-dominant (ND) HT. The pitchers were then followed for the development of shoulder injury over the course of each season. Separate mixed model ANOVAs(side X injury) were used to compare pitchers’ dominant and non-dominant HT between those who suffered shoulder injury to those who did not miss games due to arm injury (α=0.05). Tukey's Post-Hoc tests were used to determine minimum significant differences for significant interaction effects.

Results:

We observed 30 shoulder injuries. Pitchers with previous elbow injuries(n=30) were excluded from the comparison.(Table 1) Pitchers who suffered a shoulder injury displayed 3.5° less D humeral retrotorsion compared to those pitchers without injury(n=195; P=0.04).(Figure 1).

Conclusion:

This study showed that pitchers with decreased humeral retrotorsion had a significantly increased risk of shoulder injury. Decreased humeral retrotorsion may hinder the ability of the shoulder to obtain needed ROM, thus increasing stress to the shoulder in late cocking and follow through. Our results should be viewed in context of the relatively small injury numbers but provide preliminary evidence that the influence of HT should be closely examined when considering shoulder injury risk in professional pitchers.
Pre-Operative Femoral Nerve Block for Hip Arthroscopy: A Randomized Controlled Trial
Authors: Xing Jerry G. , Abdallah Faraj W. , Oldfield Stephanie , Dold Andrew , Murnaghan Michael Lucas , Brull Richard , Whelan Daniel B.
Published: August 2015

Objectives:

: Arthroscopy has become a standard method of treatment for a variety of intra-articular hip pathologies. While most arthroscopic hip procedures are performed as day-surgeries, patients can still experience significant post-operative pain and opioid-associated side-effects. Our group has shown the potential benefits of preoperative femoral nerve block (FNB) in a previous retrospective review. It was our objective to confirm these findings in a prospective study.

Methods:

Fifty patients undergoing hip arthroscopy were included in this prospective, single centre, double-blinded, randomized controlled trial. All patients received a pre-operative ultrasound-guided femoral nerve block with either 20 mL of 0.5% bupivacaine (treatment group, n=27) or normal saline (control group, n=23). Nerve blockade was confirmed via standardized sensory testing prior to the induction of general anaesthesia. Groups were compared with respect to patient sex, age, body mass index (BMI), physical status classification according to the American Society of Anaesthesiologists (ASA); procedure performed; and opioid requirements. The primary endpoint was total oral morphine equivalent consumption in 24 hours. Secondary endpoints included visual analog pain scores; Quality of Recovery (QoR-27) score at 24 hours; incidence of nausea and vomiting; patient satisfaction; and block-related complications.

Results:

There were no significant differences between groups with respect to sex, age, weight, height, BMI, ASA classification, or type of procedures performed. Total oral morphine consumption at 24 hours was similar between groups. Patient-reported pain scores were lower at all times points in the femoral nerve block group compared to the placebo group with statistical significance reached at 30 minutes, 1 hour, 2 hour, 4 hour, and 6 hours post-operatively. There was no difference in the rates of nausea and vomiting after surgery, Quality of Recovery score at 24 hours, time to discharge, or symptoms of itching, weakness, and injection site bruising and pain. The placebo group had a significantly higher rate of reported constipation at 48 hours. 6 out of 27 patients in the femoral nerve block reported falls (without injury) at 24 hours compared to 0 out of 23 patients in the placebo group. The satisfaction score, however, was similarly high in both groups at all time-points.

Conclusion:

Pre-operatively administered femoral nerve blocks lead to decreased pain scores in the early post-operative phase without affecting opioid consumption or opioid-related side effects. Patient satisfaction with pain control was similarly high between groups. Given the rate of falls observed in this study, we cannot recommend the routine use of femoral nerve blocks for outpatient hip arthroscopy.
Surgical Trends in Treatment of Meniscus Tears: Analysis of Data from the American Board of Orthopaedic Surgery Certification Examination Database
Authors: Parker Benjamin , Hurwitz Shepard R. , Spang Jeffrey T. , Creighton Robert A. , Kamath Ganesh V.
Published: August 2015

Objectives:

The indications and criteria for meniscal repair are expanding in parallel with new understanding in pathophysiology, biomechanics and novel surgical techniques. In learning from the previous management of meniscal tears with total meniscectomy, there is growing concern for preservation of meniscus and its implication in the development of osteoarthritic changes, specifically in the young population. The American Board of Orthopaedic Surgery (ABOS) has developed a comparative effectiveness program that intends to assist in the geographic variation in various orthopaedic practices, trends in practice patterns for the treatment of various conditions, and the differential effectiveness of certain procedures in the treatment of various conditions. The objective of this study is to analyze the surgical management trends of meniscal pathology from 2004-2012 among recent orthopaedic graduates.

Methods:

A query of the American Board of Orthopaedic Surgery (ABOS) database was used to identify patients from 2004-2012 who underwent meniscal repair and partial meniscectomy with and without anterior cruciate reconstruction. The specialty training of the surgeon, the age of the patient, the region where the surgery was performed, and the complications were collected from the case database.

Results:

Among meniscal procedures the frequency of repair has increased from 5% to 7.3% from 2004-2012. However, within this context, partial meniscectomies have decreased disproportionately to the increase in meniscal repair. In contrast, when performed in combination with ACL reconstruction, the frequency of meniscal repairs has increased from 14.9% to 22.3%, while the incidence of partial meniscectomy has increased from 34.8% to 39.3%. When comparing sports fellowship and non-sports trained physicians, there is no significance difference in these procedure trends. There is no variability in region with regards to the type of meniscal procedure being performed. The total complication rate of all ABOS queried meniscal procedures was 5.9% and the implant failure rate was 0.4%. The complication rate was 6.5% in sports trained physicians vs. 5.0% in the non-sports trained physicians.

Conclusion:

Partial meniscectomies are being performed at a significantly decreasing rate in proportion to the increasing rate of meniscal repairs amongst candidate ABOS member surgeons. In combination with ACL reconstruction, both repair and meniscectomy are being performed at an increasing incidence. There is no difference in the rate at which these procedures are being performed based on age, geography, and surgeon training from 2004-2012. These trends may be a reflection of the new understanding of meniscus healing potential, advances in techniques and technology, and new resident core competencies.
United States Trends in Medial Ulnar Collateral Ligament Reconstruction: A retrospective Review of a Large Private-Payer Database from 2007 to 2011
Authors: Erickson Brandon J. , Nwachukwu Benedict U. , Rosas Sam , Schairer William W. , McCormick Francis , Bach Bernard R. , Bush-Joseph Charles A. , Romeo Anthony A.
Published: August 2015

Objectives:

Purpose: Overuse injuries to the elbow in the throwing athlete are common. Ulnar collateral ligament reconstruction (UCLR), commonly known as Tommy John surgery, is performed on both recreational and high-level athletes. There is no current literature regarding the incidence and demographic distribution of this surgical procedure in relation to age, location within the Unites States (U.S.), and gender. The purpose of this study is to determine the current demographic distribution of UCLR within the U.S.

Methods:

Methods: A retrospective analysis of private payer database using the PearlDiver Supercomputer (Warsaw, IN) was performed to identify UCLR procedures performed between the years of 2007-2011. The Current Procedural Code (CPT) 24346 (reconstruction of the ulnar collateral ligament of the elbow with the use of a tendinous graft) was used. Statistical analysis was performed as appropriate using STATA (Version 12.1; Statacorp; College Station, TX, USA).

Results:

Results: Between 2007-2011, 790 patients underwent UCLR. The overall average annual incidence was 2.16+/- 0.27 per 100,000 patients, but was 31.9 +/-3.9 for patients aged 15-19. The average annual growth was 5.72%. There were 695 males and 95 females. Fifteen to 19 year olds accounted for significantly more procedures than any other age group 56.8% (p<0.001), followed by 20 to 24 year olds 23.4%. The incidence of UCLR in the 15-19 year old group increased at an average rate of 6% per year (incidence rate ratio = 1.06, p=0.025). The south region performed significantly more UCLR than any other region p<0.001. The number of procedures significantly increased over time (p=0.039).

Conclusion:

Conclusion: UCLR was performed significantly more in patients aged 15-19 than any other age group. The average annual incidence of UCLR per 100,000 people for patients aged 15-19 is 31.9. The number of UCLR is increasing over time. Further work should address risk-reduction efforts in this at-risk population.
Neuromuscular Performance Varies with Baseline Neurocognition: Implications for Anterior Cruciate Ligament Injury Risk and Prevention
Authors: Herman Daniel C. , Barth Jeffrey C.
Published: August 2015

Background:

Neurocognitive performance may be a risk factor for anterior cruciate ligament injury, and may influence risk via changes in neuromuscular performance; however, there are no existing data the relationship between neurocognition and neuromuscular performance during complex athletic tasks. Hypothesis: Athletes with low baseline neurocognitive performance would demonstrate worse neuromuscular performance during the completion of an unanticipated jump landing task compared to athletes with high baseline neurocognitive performance.

Study Design:

Controlled laboratory study.

Methods:

3-dimensional kinematic and kinetic data of the dominant limb were collected for 37 recreational athletes while performing an unanticipated jump landing task. Subjects were screened using a computer-based neurocognitive test into high (HP) and low (LP) performing groups (HP=20, LP=17). The task consisted of a forward jump onto a force plate with an immediate jump to a second target that was assigned 250msec prior to landing on the force plate. Kinematic and kinetic data were obtained during the first jump landing.

Results:

The LP group (Mean±SD of LP vs HP) demonstrated significantly altered neuromuscular performance during the landing phase while completing the jump landing task, including significantly increased peak vertical ground reaction force (1.81±0.53BW vs 1.38±0.37BW, p<0.01), peak anterior tibial shear force (0.91±0.17BW vs 0.72±0.22BW, p<0.01), knee abduction moment (0.47±0.56BW*BH vs 0.03±0.64BW*BH, p=0.03), and knee abduction angle (6.1±4.7o vs 1.3±5.6o, p=0.03), and well as decreased trunk flexion angle (9.6±9.6o vs 16.4±11.2o, p<0.01).

Conclusion:

Athletes with lower levels of baseline neurocognition possess worse neuromuscular performance during a challenging jump landing task.

Clinical Relevance:

Neurocognitive testing and neuromuscular assessment during dual-attention conditions may improve anterior cruciate ligament injury risk screening, while incorporating neurocognitive challenges into neuromuscular-based training programs may improve injury prevention and rehabilitation.
The Pediatric International Knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form
Authors: Nasreddine Adam Y. , Nelson Susan Elizabeth , Connell Patricia , Kalish Leslie , Kocher Mininder S.
Published: August 2015

Objectives:

To aid in the interpretation of Pedi-IKDC scores by characterizing normative data in children and adolescents. Also, to validate the Pedi IKDC by examining differences in Pedi IKDC scores between patients with knee ailments compared to patients without a history of knee problems.

Methods:

Cross sectional survey of 2000 children and adolescents aged 10-18 years living in the United States, recruited by ORC International to obtain equal numbers by sex and by integer age group. In addition to completing the Pedi-IKDC for one study designated “index” knee (right or left), subjects were asked demographic questions and for information on history of knee surgery and recent (four weeks) activity limitations. Raw Pedi-IKDC total scores were re scaled to a 0-100 scale. Non-parametric Wilcoxon or Kruskal-Wallis tests were used to compare subgroup scores and the van Elteren test was used to adjust for age. Unadjusted and adjusted p values were similar and only unadjusted values are reported.

Results:

Numbers of respondents are uniform with respect to age and sex, with 11% in each age group (10-18) and 50% female. 68% identified themselves as white, and 86% as non-Hispanic. 49 states and DC are represented. 136 (7%) reported prior surgery in one or both knees; 79(4%) in the index knee. The Pedi IKDC score distribution is skewed left with mean score (±SD) of 86.7(±16.8), median 94.6 and 34% reaching the ceiling value of 100. Subjects reporting prior surgery or limited activity in the index knee had median Pedi IKDC scores about 25 points lower than those without these histories (p<0.0001 for both comparisons). In contrast, although statistically significant, the variation by age (p=0.02), race (p=0.02), ethnicity (p=0.01), and level of sports/exercise participation (p=0.04) was much smaller (all ranges of median scores <4.5). There were no significant differences by sex or geographic region.

Conclusion:

There is only minor variation in Pedi IKDC scores across demographic factors. The strong association between Pedi IKDC score and prior knee surgery and also with recent limitation of activity in the index knee supports the construct validity of the Pedi-IKDC. Using a large, broadly representative sample, this study supports the use of the Pedi-IKDC as a knee specific outcome instrument for pediatric patients aged 10-18 and provides normative values to aid the interpretation of scores in this age range.
Medial Opening Wedge High Tibial Osteotomy
Authors: Tjoumakaris Fotios P. , Lombardi Nick J. , Tucker Bradford S. , Pepe Matthew D.
Published: August 2015

Objectives:

High tibial osteotomy (HTO) has become a well-established treatment for unicompartmental osteoarthritis of the knee. Over the last 30 years, various techniques have been introduced to advance this procedure. The purpose of this study is to review the outcomes of patients who received medial opening wedge HTO over the last ten years (2002-2012) using a modern, low profile, medially based fixation device. In addition, we sought to determine if obese patients had a less favorable outcome than their non-obese counterparts.

Methods:

Ninety-three patients were identified from a surgical database as having undergone a HTO for medial compartment osteoarthritis of the knee with varus mal-alignment . All procedures were performed by one of two fellowship trained orthopedic surgeons from 2002-2012 utilizing a low profile fixation device and identical surgical technique. Minimum follow-up was one year for inclusion in the study. Outcomes were measured using Lysholm and WOMAC scores. Radiographs were evaluated to determine delayed union or non-union at the osteotomy site and surveillance was undertaken to evaluate post operative complications.

Results:

93 patients were identified from the database, 63 (70%) were available for follow-up and are included in this analysis. Average follow-up time was 48 months (range 17 to 137). There were 44 males and 19 females. The average age was 45 years old. The average final Lysholm and WOMAC scores were 66.4 (range: 13-100) and 18.6 (range: 0-86) respectively. There was no significant difference in reported Lysholm or WOMAC scores between obese (BMI >30) and non-obese patients (p=.31;p=.69). Complications were as follows: 3 patients required a surgical lysis of adhesions, 2 patients developed an infection, and 1 patient experienced a delayed union. At final follow-up, 18 patients received additional treatment on the affected knee: 11 required removal of symptomatic hardware, 5 received viscosupplementation, 2 underwent a total knee replacement.

Conclusion:

Low profile, medial based devices used in the setting of HTO is an accepted treatment for unicompartmental osteoarthritis of the knee. At final follow-up, a majority of patients reported positive outcomes and few complications. 18 patients required additional treatment for osteoarthritis. In our analysis, obese patients faired equally as well as their non-obese counterparts, with no significant difference in outcomes scores or complication rate. Survivorship of high tibial osteotomy was excellent in this series, with only 2 patients having undergone total knee replacement at last follow-up.
Outcomes of Meniscal Allograft Transplantation in the Pediatric Athlete
Authors: Riboh Jonathan C. , Tilton Annemarie K. , Cvetanovich Gregory , Campbell Kirk A. , Cole Brian J.
Published: August 2015

Objectives:

Meniscal allograft transplantation (MAT) has a successful clinical track record in adults. The results of MAT in children have not been reported. The goal of this study was to report the results of MAT with minimum 2-year follow-up in this unique population.

Methods:

After IRB approval, all patients under the age of 16 undergoing MAT between 1999 and 2011 and having > 2 year clinical follow-up were identified from a prospectively collected database. Demographic data including age, height, weight, BMI and prior surgery were collected. Functional outcome scores were collected pre-operatively and at 6 months, 1 year, 2 years and final follow up. Differences between scores at each time point were compared using a mixed model repeated measures ANOVA. All re-operations were documented.

Results:

17 patients met inclusion criteria. Mean age was 14.9 +/- 1.4 years (range 11 - 16). 10/17 patients had undergone prior knee surgery. 59% were female and 41% were male. The average BMI was 23.4 +/- 5.9. Concomitant procedures included 7 ACI, 1 ACI biopsy and one ACL reconstruction. All patients were available for follow-up at an average of 38 +/- 30 months (range 24 - 122). Surgery resulted in significant improvements in KOOS pain, KOOS ADL, KOOS sport and KOOS QOL scores (Figure 1). Similar improvements were seen in Lysholm, IKDC subjective, WOMAC pain, WOMAC function, and SF-12 physical scores. 3/17 (18%) patients underwent subsequent surgical intervention, however only one (6%) required a graft meniscectomy. One patient required a plica excision, and the other a combined ACL reconstruction and ACI. No complications were found in this population.

Conclusion:

MAT results in predictable improvements in functional outcomes in the pediatric athlete. Most of these improvements were sustained at an average follow up of 38 months. The meniscal re-operation rate was low (6%) and no complications were reported.
Long Term Follow Up of Pediatric ACL Reconstruction in New York State
Authors: McCarthy Moira , Dodwell Emily , Pan Ting , Green Daniel W.
Published: August 2015

Objectives:

The primary aim of this study was to determine the rate of subsequent ACL reconstruction and additional non-ACL knee surgery in children that had previously undergone ACL reconstruction in New York State. The secondary aim was to assess factors associated with additional ACL and non-ACL knee surgery.

Methods:

Pediatric patients (age < 21) who underwent ACL reconstruction between 1997 and 2010 in New York State were identified using the Statewide Planning and Research Cooperative System (SPARCS) database. Patients were tracked for subsequent ACL reconstruction and additional non-ACL knee surgery. Each case had a minimum of one year follow up. A Cox proportional hazards model was used to assess time to subsequent surgery, adjusting for age, sex, race, comorbidity index, insurance type, surgeon and hospital ACL volume, and poverty prevalence.

Results:

23,912 primary pediatric ACL reconstructions were identified. 1955 patients (8.2%) underwent subsequent ACL reconstruction. 7.4% had one additional ACL reconstruction and 0.7% had two or more additional ACL reconstructions. 3341 patients (14%) had subsequent non-ACL knee surgery with 11.1% having one subsequent surgery and 2.9% having two or more additional knee surgeries. Risk factors for revision ACL surgery were younger age at time of primary ACL surgery (p<0.001), male gender (p<0.001), white race (p=0.003), private insurance (p<0.001), higher hospital ACL volume (>20 per year; p=0.002), and higher surgeon ACL volume (>10 per year; p=0.003). Risk factors for return to the OR for other non-ACL knee surgeries were younger age at the time of primary ACL reconstruction (p<0.001), white race (p<0.001), private insurance (p=0.016), and higher hospital ACL volume (>20 per year; p=0.007).

Conclusion:

This study aims to provide information on the rate of return to the operating room and rate of secondary ACL reconstruction in an adolescent population over the past 20 years in New York State. Males and younger patients had a higher rate of subsequent ACL reconstruction. Higher rates of ACL reconstruction in younger children may be due to greater at-risk activities in younger children, longer follow up, or inherently less reliable reconstructions given the non-anatomic reconstructions that are frequently required in the skeletally immature. The association between socioeconomic factors and increased subsequent knee surgeries likely represents a disparity in access to care for low socioeconomic status patients.
Functional Outcomes after Double Row Versus Single Row Rotator Cuff Repair
Authors: Nicholas Stephen J. , Lee Steven J. , Mullaney Michael John , Tyler Timothy F. , Johnson Christopher D. , Fukunaga Takumi , McHugh Malachy P.
Published: August 2015

Objectives:

The effect of single row (SR) versus double row (DR) rotator cuff repair on functional outcomes was examined in a prospective randomized design.

Methods:

Fifty patients were randomized to DR or SR repairs; 39 patients (13 women, 26 men, 23 SR, 16 DR, age 62±7 yr) were assessed at an average of 2.2±1.6 yr after surgery (range 1-7 yr; tear size 17 medium, 13 large, 9 massive). The following data were recorded prior to surgery and at follow-up: Penn, ASES and Simple Shoulder Test (SST) scores; range of motion (ROM) for shoulder flexion, external rotation (ER) at 0º and 90º abduction, and internal rotation (IR) at 90º abduction; shoulder strength (Lafayette Manual Muscle Tester) in empty and full can tests, abduction and ER at 0º abduction. Treatment (SR vs. DR) by Time (pre-op vs. post-op) mixed model analysis of variance was used to assess the effect of rotator cuff repair. It was estimated that with 20 patients per group a 10-point difference in improvement in ASES scores between SR and DR treatments could be detected at an alpha level of 0.05 with 80% power.

Results:

Outcome Scores: RC repair markedly improved Penn, ASES and SST scores (P<0.001), with similar improvement between single versus double row repairs (Treatment by Time P=.49 to P=.67), and excellent scores at follow-up (Double Row vs. Single Row: Penn 91±11 vs. 91±12, P=.98; ASES 92±9 vs 87 ±15, P=.24; SST 11.2±1.2 vs. 11.4±1.0, P=.58). ROM: Patients with DR repairs lost ER ROM at 0º abduction (pre-op to final follow-up 7±10º loss, P=.013). ER ROM did not change with SR repair (3.9±15.6º gain, P=.24; Treatment by Time P=.017). This effect was not apparent for ER ROM at 90º abduction (Treatment by Time P=.26). IR ROM improved from pre-op to final follow-up (P<0.01, SR 17±18º, DR 13±23º, Treatment by Time P=.31). Strength: RC repair markedly improved strength in Empty Can (51%), Full Can (54%), Abduction (45%) and ER (31 %) strength (all P<.001), with no difference between SR and DR repairs (P=.54 to P=.81). Outcomes were not adversely affected by RC tear size, retraction, gender, or BMI. Patients <60 yo had better ASES scores than older patients (96±9 vs. 87±13, P=.021) but an age effect was not apparent for Penn (P=.14) or SST (P=.17).

Conclusion:

Patients had excellent outcomes regardless of whether they had a SR or DR repair. Rotator cuff repair, and subsequent rehabilitation, markedly improved shoulder strength. DR repair was associated with a loss of ER ROM but this loss did not impact other outcome measures.
Do Innings Pitched Prior To Age 25 Affect MLB Pitcher Longevity?
Authors: Brand Jefferson C. , Hardy Richard , Raymond Bowman , Tiwaloluwa Ajibewa
Published: August 2015

Objectives:

Baseball pitchers are among the most valued players in major league baseball because of their influence on the outcome of a game. Anecdotal cases suggest that pitching more innings, arbitrarily determined to be 160 innings a year, may shorten careers. Our hypothesis was that pitchers who threw more innings/year before age 25 would have a shorter career.

Methods:

Inclusion criteria were baseball pitchers who entered the Major League System from 1989-1992 only including those with no missing information for the following variables: Average Innings pitched per year before and after age 25, Earned Run Average (ERA), Walks and Hits divided by Innings Pitched (WHIP), Strike to Walk ratio (SWR), Strikeouts, Walks, Length of career, starting and Retirement age. 96 pitchers met those criteria. We did not analyze career statistics since these are created after the respective player's career ends rather analyzed their statistics before age 25. The information was obtained from http://www.baseball-reference.com . We used ANOVA to compare differences between groups and a regression model to assess relationship between variables (statistics) before age 25 and career length.

Results:

The mean number of innings pitched per year before age 25 was 66.6, Confidence Interval (CI) 12.90-120.3. In fact, only 11 of 96 pitchers threw over 148 innings/year. ERA (mean 5.51 CI: 2.50-8.52) and WHIP (mean 1.66, CI: 1.04-2.28) may be most commonly used measurements of pitcher performance. If pitchers are divided by those who throw 80 innings/year or over, 28 over and 68 under, the over 80 innings/year before age 25 group had significantly better ERA's (4.20, CI: 2.52-5.88 vs 6.03, CI: 2.66-9.40, P=.0087), WHIP's (1.35 CI: .98-1.72 vs 1.79 CI: 1.13-2.45, P=.0012), and longer careers (13.1, CI: 8.5-17.7 years vs 8.7, CI: 2.8-14.6 years, P=.0007). In fact, the regression analysis between career length and innings pitched per year before age 25 is a positive relationship with an R2 of .15, suggesting 15% of the career length variability is positively associated with the number of innings pitched per year before age 25. ERA and WHIP had weak positive relationship with career length, R2=.039 and R2=.025 respectively.

Conclusion:

Pitchers who threw over 80 innings a year before age 25, had the lowest ERA's, WHIP's, and the longest careers. Our hypothesis was disproved. In this population, there was not an advantage to restricting the number of innings pitched before age 25 for a young pitcher.
How Much Can We Expect the Rise in U.S. Domestic Energy Production to Suppress Net Energy Imports?
Authors: York Richard
Published: August 2015

A reason commonly stated by policymakers in the United States for increasing domestic energy production is to reduce energy imports. However, the degree to which domestic production actually displaces imports is an open question. To help provide an answer to this question, I analyze data for the United States from 1960 to 2011 to assess how many units of imported energy are suppressed by each unit of domestic production, controlling for economic activity and energy prices. I show that the pattern is one where domestic energy production spurs energy use, so that the effect of production on net imports is less than one-for-one. This finding has important implications, which I discuss, about the ease with which reliance on foreign energy sources can be overcome and about the environmental consequences of rising domestic production.
Alternative and Authoritative Knowledge
Authors: Henley Megan M.
Published: August 2015

Doulas are maternity support workers who provide supportive care to women in childbirth. Doulas do not have medical training, yet they offer an important but underused type of expertise. Certification is not required for work as a doula. This study analyzes the role of certification in legitimating doulas’ alternative knowledge about childbirth. Do doulas believe that certification matters for establishing their work as legitimate to mothers and/or to medical clinicians? Certification allows physicians to practice medicine, lawyers to practice law, and teachers to educate students. Why do some doulas get certified by national or international organizations while others do not? To explore these questions, this article uses narrative data from 25 interviews with doulas in the southwestern United States. The majority of these doulas (80 percent) had completed or were in the process of completing their certification. Results indicate that although doulas believe that experience providing support is their primary source of knowledge and defines their expertise among clients, many also argue that certification makes their role legitimate to medical clinicians. Recent changes in health care may give doulas greater access to women most in need of their care, but certification could play a crucial role in gaining this access.
School Segregation in the Era of Accountability
Authors: Davis Tomeka , Bhatt Rachana , Schwarz Kelsey
Published: August 2015

Although a great deal of research has examined the impact of accountability on a number of different outcomes, particularly achievement, little research to date has assessed the impact of school accountability reform on racial segregation in schools. Using school, district, and state-level data from the Common Core of Data from 1987 to 2010 and data on school accountability from other sources, we examine black-white within-district segregation before and after the passage of the No Child Left Behind Act (NCLB) in 2002. We find that NCLB was associated with significant increases in black-white segregation within school districts, even after controlling for other factors that might have led to increased segregation (e.g., release from court-ordered segregation, recent Supreme Court decisions). This effect was especially pronounced among districts in states that had implemented school accountability policies prior to NCLB. Our results lead us to conclude that policymakers must also consider the negative unintended consequences of education reform policies, even those designed to have an ameliorative impact on inequality.