bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk of Revision for Various Hamstring Fixation Methods after ACLR
Authors: Csintalan Rick P. , Prentice Heather A. , Funahashi Tadashi Ted , Maletis Gregory B.
Published: July 2017

Objectives:

Risk factors for anterior cruciate ligament reconstruction (ACLR) revision have included graft type, as well as fixation methods. Newer fixation techniques and devices for hamstring (HS) autograft have been introduced over the years. The purpose of this study was to compare the risk of aseptic revision after HS autograft ACLR between various femoral and tibial fixation methods/devices.

Methods:

Patients who underwent primary ACLR using a HS autograft from 2007-2014 were identified through a community-based registry for this retrospective cohort study. Bilateral, double bundle, and multiligament ACLRs were excluded. Patients were categorized (crosspin, interference, suspensory, or combination [more than one fixation]) based on the type of fixation utilized for the femur and tibia. Femoral/tibial fixation groupings with more than 500 patients were evaluated as a risk factor for aseptic revision, with adjustment for age, sex, body mass index, and race/ethnicity, using a multivariable Cox proportional-hazards regression model.

Results:

6,716 primary ACLR patients were included, of whom 2,894 (38.8%) were younger than 22 years old, 4,111 (61.2%) were male, 2,956 (44.0%) had a BMI < 25 kg/m2, and 3,163 (47.1%) were caucasian. Five femoral/tibial groupings had more than 500 patients: suspensory/interference (n=2,176, 32.4%), suspensory/combination (n=1,940, 28.9%), interference/combination (n=1,025, 15.3%), interference/interference (n=845, 12.6%), and crosspin/combination (n=730, 10.9%). The cumulative failure probability at 5 years was highest for the suspensory/interference group (9.0%, 95% CI 7.2-11.2), followed by suspensory/combination (6.7%, 95% CI 5.4-8.4), interference/interference (5.1%, 95% CI 3.7-7.2), interference/combination (4.3%, 95% CI 2.9-6.3), and crosspin/combination (3.1%, 95% CI 2.0-4.9). After adjusting for the other covariates, the hazard ratio for aseptic revision was 2.9 (95% CI 1.9-4.7) for the suspensory/interference group, 2.7 (95% CI 1.7-4.5) for the suspensory/combination group, 1.6 (95% CI 0.9-3.0) for the interference/combination group, and 2.1 (95% CI 1.2-3.7) for the interference/interference group when compared to the crosspin/combination group.

Conclusion:

ACLR using HS autograft appears to have the highest risk of aseptic revision when suspensory fixation is used on the femoral side and is coupled with either an interference screw or combination fixation on the tibial side. Understanding the device-related risk of aseptic revision after HS autograft ACLR will help guide surgeons regarding which devices may negatively influence surgical outcomes.
ACL Force and Knee Kinematics After Posterior Tibial Slope-Reducing Osteotomy
Authors: Yamaguchi Kent T. , Cheung Edward , Mathew Justin , Boguszewski Daniel V. , Markolf Keith , McAllister David R. , Petrigliano Frank A.
Published: July 2017

Objectives:

Although many patients have a good outcome after anterior cruciate ligament (ACL) reconstruction, a number of individuals will experience continued instability. There is evidence that the posterior tibial slope (PTS) of the tibial plateau may play a role in ACL injury. Theoretically, under tibiofemoral compression (TFC) a steeper PTS would induce greater anterior tibial translation, thus increasing ACL force. The objective of this study was to evaluate if a PTS-reducing osteotomy would reduce ACL force.

Methods:

Eleven fresh-frozen cadaveric knees were tested (mean age 27 years). The femoral attachment of the ACL was mechanically isolated and attached to a custom designed load cell to measure resultant ACL force. Using a six-degree-of-freedom robot, each knee was flexed from 0°-50° while maintaining 200N TFC combined with the following loading conditions: 45N anterior tibial force (AF), 5Nm valgus moment (VM), 2Nm internal tibial torque (IT), and all loads combined. After testing the normal knee, a 10° PTS-reducing osteotomy was performed. An anterior wedge of bone was removed distal to the plateau, which was then lowered and secured with external fixators. The knee was then re-tested. A paired t-test was used to analyze statistical significance between normal and osteotomized knees every 5° of flexion.

Results:

Osteotomy reduced PTS by 10.0° ± 0.2° (mean ± SD), resulting in a relative change in tibiofemoral position at full extension, in effect hyperextending the knee 9.4°±1.9° and shifting the tibia 7.9 ± 1.6 mm posteriorly, 3.2° ± 2.3° internally, and 3.2° ± 1.5° into valgus. Compared to the normal knee, the osteotomy significantly reduced resultant ACL force when loaded with 200N TFC + 45N AF and 200N TFC + 5Nm VM. However, ACL force was not reduced under 200N TFC + 2Nm IT or 200N TFC + all loading conditions combined (Figure 1).

Conclusion:

Our data shows in the absence of applied internal torque, the posterior tibial slope-reducing osteotomy altered knee kinematics which corresponded to a significant reduction in ACL force. However, this protective effect was lost when internal torque was applied.
Can Competitive Athletes Sustain High-Level Play Following Osteochondral Allograft Transplantation of the Knee?
Authors: McCarthy Mark A. , Meyer Maximilian A. , Weber Alexander E. , Levy David , Tilton Annemarie K. , Yanke Adam Blair , Cole Brian J.
Published: July 2017

Objectives:

The purpose of this study is to investigate the ability of competitive athletes to remain at a high level of competition following osteochondral allograft transplantation (OCA) of the knee.

Methods:

A retrospective review was performed to identify all competitive athletes (high school, collegiate, professional) who underwent an isolated femoral condyle OCA between 2004 and 2012. Patient reported outcome (PRO) questionnaires (Lysholm, International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMasters Universities Arthritis Index (WOMAC), Short Form-12 (SF-12), Tegner, and Marx) and custom return-to-sport surveys were administered. All subsequent reoperations were documented.

Results:

A total of 13 (7 male, 6 female) athletes were identified with an average follow-up of 5.9 ± 2.5 years. Four athletes competed at an intercollegiate level, while 9 played high-level high-school sports. Seven athletes returned to competitive sport (54%) at an average of 7.9 ± 3.5 months, five of whom were returned to pre-injury levels of play. Of the eight athletes who either did not return to sport or failed to sustain their high level of play, the most common reasons cited were a change in life circumstances, such as graduation, or a fear of re-injury (Figure 1). At final follow-up, regardless of return-to-play, all athletes had significant improvements in all PRO scores except for KOOS-Sport, WOMAC-Stiffness, and SF-12 Mental subscales. Tegner Activity scores dropped significantly from pre-injury to final follow-up (8.2 ± 2.4, 4.5 ± 2.1, p < 0.01). There were three reoperations and zero instances of graft failure.

Conclusion:

OCAs provide acceptable rates of return-to-play and excellent long-term outcomes for high-level athletes with large osteochondral defects. Social factors are three times more likely than persistent pain to prevent return to sport.
Midterm CT and MRI Appearance of Osteobiologic Plugs in the Knee
Authors: Wolin Preston M.
Published: July 2017

Objectives:

The objective of this study is to evaluate the bony integration and cartilage morphology of Trufit Plugs (Smith & Nephew) placed to fill chondral defects in the knee.

Methods:

17 patients underwent osteobiologic plug implantation for chondral defects of the knee. 13 plugs in 7 patients (mean age 38 years, range 21-49) were available for radiographic review. The mean follow up was 36.4 months (range 20-57 months). Each patient underwent CT for evaluation of bony integration as judged by a percentage of integration. The Hounsfield units (HU) of the plug and the native bone were recorded. A percentage of HU implant and HU native cancellous bone (HU implant/HU native bone) was calculated. MRI was used to evaluate the amount and quality of articular cartilage.

Results:

CT results showed percentage of bony integration to be mean 37.7% (range 0-100, SD ±30.1). HU implant/HU native bone was mean 32.2%, range 11.8-64.9. MRI showed articular cartilage fill to be: 38.5% filled 0-25% of the defect, 15.3% filled 25-50%, 23.1% filled 50-75%, and 23.1% filled 75-100%. T2 fat saturated signals were isointense in 26.9%, hyperintense in 34.6%, intermediate in 23.1%, hypointense in 23.1%, and cancellous bone in 7.7%.

Conclusion:

In this study bony integration of the TruFit Plug was poor. The amount of articular cartilage fill was significantly incomplete. The quality of resulting cartilage was inconsistent.
Double-bundle PCL Reconstruction: A Prospective Study of Two-year Patient Reported Outcomes with Stress Radiographs
Authors: Geeslin Andrew , Chahla Jorge , Cinque Mark , Civitarese David Marc , LaPrade Robert F.
Published: July 2017

Objectives:

Reconstruction of grade-III posterior cruciate ligament (PCL) ruptures has historically been compromised by graft elongation and residual laxity. The purpose of this study was to report prospectively collected two-year outcomes and failure rates of double-bundle PCL reconstruction in a consecutive patient series with patient reported outcomes and quantitative stress radiographs. It was hypothesized that double bundle PCL reconstruction would result in improved subjective clinical outcomes, restoration of knee stability, and result in high patient satisfaction.

Methods:

A single surgeon consecutive series of patients that underwent double-bundle PCL reconstruction between June, 2010, and April, 2014, were followed prospectively. The technique is anatomically and biomechanically validated and utilizes two allografts (Achilles tendon for anterolateral bundle, tibialis anterior tendon for posteromedial bundle) in divergent femoral tunnels and a single tibial tunnel, each secured at the tibia at different knee angles to recreate the function of the two PCL bundles. Patient reported outcomes were collected preoperatively, and at a minimum two-year follow-up, including SF12, WOMAC, Tegner, Lysholm, and patient satisfaction. Posterior kneeling stress radiographs were obtained preoperatively and at the 6-month follow-up period. Failures were defined objectively as a difference of more than 3 mm in stress radiographs.

Results:

Sixty patients had greater than 2 year follow-up (mean 2.9 yrs). All subjective outcome measures improved except SF-12 mental component which was unchanged. The mean Lysholm score improved from 48 to 79. The mean WOMAC score improved from 39 to 11. The median SF-12 physical component score improved from 32 to 55. The median Tegner activity score improved from 2 to 5. The median patient satisfaction score was 8. Stress radiographs were available for 36 patients and improved from a preoperative side-to-side difference of 9.6 mm to 1.0 mm at 6 months follow-up. One failure occurred in a patient who had an 8 mm side-to-side difference at final follow-up and 18 mm pre-operatively.

Conclusion:

Double bundle PCL reconstruction results in improved patient reported outcomes and restoration of posterior knee stability. High patient satisfaction and low failure rates were found in this cohort of patients.
Arthroscopic Anatomic Glenoid Reconstruction: Analysis of the Learning Curve
Authors: Moga Iustin , Wong Ivan , Coady Catherine M.
Published: July 2017

Objectives:

This procedure involves the use of distal tibial bone graft to recreate anterior glenoid bone surface with the goal of preventing further dislocations. Recently, an arthroscopic approach has been proposed for this procedure, which uses a similar technique to the Bankart repair. This approach requires one additional medial portal (4 total), for graft placement, and this is established using an insideout technique; it avoids damage to the subscapularis tendon, and preserves the capsule and labrum. By comparison, the Arthroscopic Latarjet technique requires four additional new portals and requires splitting of the subscapularis tendon, as well as excision of the capsule and labrum. This study seeks to (1) identify a learning curve for this procedure, and (2) compare this to the learning curve for Arthroscopic Latarjet.

Methods:

Fiftyseven cases of surgically treated recurrent anterior shoulder instability were reviewed. All operations were carried out with the patient in a lateral decubitus position. Twentynine patients were managed with the Arthroscopic Latarjet procedure using coracoid bone graft, and 28 were treated with Arthroscopic Anatomic Glenoid Reconstruction using distal tibial bone graft. Procedure start and stop times were recorded and procedure durations calculated.

Results:

In the case of Arthroscopic Latarjet, the first 14 cases took an average 184 minutes to perform, with the remaining cases in the cohort averaging 116 minutes each in duration. For Arthroscopic Anatomical Glenoid Reconstruction, the first 14 cases took an average of 90 minutes, with the remaining cases averaging 84 minutes each.

Conclusion:

Arthroscopic Anatomic Glenoid Reconstruction is faster to perform compared to the Arthroscopic Latarjet. Further investigations into the safety and efficacy of this procedure will help determine whether it is a better choice for surgeons looking to learn the skill of boney augmentation for recurrent anterior instability.
Acute Versus Delayed MRI Imaging and Associated Pathology in Traumatic Shoulder Dislocations
Authors: Li Xinning , Orvets Nathan D. , Parisien Robert L. , Curry Emily Joan , Eichinger Josef K. , Murakami Akira
Published: July 2017

Objectives:

Delayed management of patients with shoulder instability may increase the prevalence and severity of concomitant intra-articular shoulder injuries resulting from persistent instability. We hypothesize that patients with a longer delay from an initial dislocation event to MRI demonstrate a greater degree of intra-articular shoulder damage.

Methods:

We performed a retrospective review of 89 patients from a single institution with clinically and radiographically confirmed traumatic, anterior, primary shoulder dislocations. Patients were divided into two groups: those undergoing MRI less than (N=44; LT6) or greater than (N=45; GT6) 6 months from the initial dislocation event. MRI assessment included evaluation of the severity of cartilage damage and bone loss, in addition to the presence of soft-tissue injuries to the labrum, capsule and rotator cuff. Subsequent treatment including type and method of surgical intervention, as well as recurrent postoperative instability, were evaluated.

Results:

The delayed MRI group demonstrated a greater degree of pathology compared to the early imaging group. A higher percentage of SLAP tears (58% vs. 34%), posterior labral tears (22% vs. 7%) and cartilage damage (73% vs. 27%) were present in the GT6 versus LT6 group. There was no difference in anterior glenoid bone loss. For those patients who underwent surgical stabilization for symptomatic instability, there was a statistically significant difference in recurrence of instability between the early MRI group (0/21) than that of the delayed MRI group (6/33 or 18%).

Conclusion:

Patients who undergo MRI greater than 6 months from the time of primary shoulder dislocation demonstrate a greater incidence and severity of intra-articular pathology including SLAP tears, posterior labral tears and anterior glenoid cartilage damage. Recurrent instability is significantly higher after shoulder stabilization surgery when performed more than 6 months from the primary dislocation event.
Biodegradation of Biocomposite Suture Anchor Implants 2,2 years after Rotator Cuff Repair
Authors: Sgroi Mirco , Friesz Theresa , Reichel Heiko , Kappe Thomas
Published: July 2017

Objectives:

Arthroscopic rotator cuff repair is one of the most frequently performed operations in orthopaedic surgery. Resorbable PLLA or PGA implants have been reported to be associated with osteolysis. Biocomposite implants, composed of PLLA and/or PGA and ceramics, have gained popularity due to their biocompatibility and lack of osteolysis. The aim of the present study was to investigate the biodegradation progression of biocomposites suture anchor implants 2 years after rotator cuff repair.

Methods:

Twenty-five consecutive patients (84 implants) with arthroscopically repaired rotator cuff tears using screw-in biocomposite implants with a 5,5 mm diameter and a minimum of 2 years (range, 16,3 to 32,0 months) follow-up were included into the present study. To analyse the biodegradation process of the suture anchors, an MRI of the operated shoulder was performed. The peri-implant fluid, the degradation of the suture anchors and the widening of the bone beds were assessed.

Results:

In the present study, the structure of the suture anchor implants was clearly visible in 23.8%, visible in 42.9%, partially visible in 23.8%, and not visible in 9.5%. No peri-implant fluid was observed in 26,2%. Slight peri-implant fluid was seen in 34,5%, a continuous fringe of fluid at least 1 mm thick in 23,8% and more than 1mm thick in 13,1%. The mean width of the bone beds was 4,38 ± 1,28 mm (apex), 5,41± 1,12 mm (middle) and 5,88 ± 1,39 mm (basis), indicating a widening of 0.33 mm of the basis. The mean length of the bone beds was 19,09 ± 2,38 mm. No significant difference was found between the lateral and medial row or between knotted and knotless implants. No case of gross osteolysis was observed.

Conclusion:

The results of the present study show that biocomposite suture anchors are frequently still visible on MRI 2 years after a rotator cuff reconstruction. No gross osteolysis was observed in the present study, indicating good biocompatibility of the implants.
Forearm Rotation Moments are Associated with Elbow Varus Moments
Authors: Nissen Carl W. , Garibay Erin J. , Solomito Matthew J.
Published: July 2017

Objectives:

The incidence of upper extremity injury in baseball has increased over the past decade, and much of the research into the biomechanics of pitching has focused on the shoulder and elbow. However little attention has been placed on how forearm rotation and the forearm rotation moment could affect a pitcher’s risk of injury. Therefore this study sought to determine the association between forearm moments and the elbow varus moment in collegiate baseball pitchers.

Methods:

Collegiate level baseball pitchers that were recruited for this study were actively pitching for an NCAA team and had no history of surgery to their pitching arms. All pitchers underwent a pitching analysis using computerized motion analysis techniques. The forearm’s position, rotational velocity, and supination and pronation moments were analyzed using a random intercept mixed-effects regression model to determine if there were significant associations between the variables of interest and the elbow varus moment. All moments are presented as internal moments.

Results:

A total of 78 collegiate level pitchers with a mean age of 19.9 ± 1.3 years, were include in this study. The average fastball velocity was 32.1 ± 2.5m/s. The results indicated that there was no association with the forearm’s position or rotational velocity and the elbow varus moment. However, there were statistically significant associations between the forearm supination moment and the elbow varus moment (p=0.002). The results showed that for every 1Nm increase in the supination moment there was a corresponding 1 Nm increase in the elbow varus moment. Whereas a pronation moment was associated with a decrease in the elbow varus moment (p=0.013).

Conclusion:

The forearm’s absolute position was not associated with an increased elbow varus moment, indicating that the position of the forearm does not play a role in injury mechanisms for baseball pitchers. However the regression analysis indicated a significant association with the forearm moments and the elbow varus moment. Specifically that an increased supination moment increased the elbow varus moment. Therefore as the body resists the pronation motion associated with pitching this increases the stresses on the medial side of the elbow. Suggesting that an increased need to resist pronation in pitchers that over supinate their arms during a pitch could be placing additional stresses on their elbows and therefore increasing their risk for injury. This finding also provides evidence that a potential injury prevention strategy for pitchers could be to increase their forearm supination and reduce the speed at which they pronate especially during the deceleration of the pitch cycle.
The Relationship of Throwing Arm Mechanics and Elbow Varus Torque: Within-subject Variation for Professional Baseball Pitchers Across 81,999 Throws
Authors: Dines Joshua S. , Tubbs Travis , Fleisig Glenn S. , Dines David M. , Altchek David W. , Dowling Brittany , Camp Christopher L.
Published: July 2017

Objectives:

Likely due to the high level of strain exerted across the elbow during the throwing motion, elbow injuries are on the rise in baseball. In order to identify at risk athletes and guide post-injury return to throw programs, a better understanding of the variables that influence elbow varus torque is desired. The purpose of this work was to describe the within-subject relationship between elbow varus torque and arm slot, arm speed, and shoulder rotation in professional baseball pitchers.

Methods:

A total of 81 professional pitchers performed 81,999 throws while wearing a motusBASEBALL sensor and sleeve (Motus Global, Massapequa, NY, USA). These throws represented a combination of throw types, such as warm-up/catch, structured long-toss, bullpen throwing from a mound, and live game activity. Variables recorded for each throw included arm slot, arm speed, shoulder rotation, and elbow varus torque. Linear mixed-effects models and likelihood ratio tests were utilized to estimate to the relationship between elbow varus torque and arm slot, arm speed, and shoulder rotation within individual pitchers.

Results:

All three metrics, arm slot (χ2 = 428, p<0.01), arm speed (χ2 = 57683, p<0.01), and shoulder rotation (χ2 = 1392, p<0.01), were estimated to have a significant relationship with elbow varus torque. Within individual athletes, a 1-Nm increase in elbow varus torque was associated with a 13° decrease in arm slot, a 116°/s increase in arm speed, and an 8° increase in shoulder rotation.

Conclusion:

Elbow varus torque increased significantly as pitchers increased shoulder rotation during the arm cocking phase and rotational velocity of the arm during the arm acceleration phase of throwing. Thus shoulder flexibility, arm speed, and elbow varus torque (and likely injury risk) are inter-related and should be considered collectively when treating pitchers.
Youth Baseball Players with Elbow and Shoulder Pain Have Both Low Back and Knee Pain: A Cross-sectional Study
Authors: Sekiguchi Takuya , Hagiwara Yoshihiro , Momma Haruki , Kanazawa Kenji , Kuroki KAORU , Tsuchiya Masahiro , Itoi Eiji
Published: July 2017

Objectives:

Serious arm injuries in youth baseball players have been increasing. Though a breakage in the kinetic chain could affect arm injuries, an association between arm injuries and insufficient support of the trunk and lower extremities have not been well understood. The purpose of this study was to investigate the association of low back and knee pain with elbow and/or shoulder complaints among youth baseball players.

Methods:

Study participants were mostly school-aged athletes belonging to Junior Sports Club Association of Miyagi prefecture (aged 6 to 15 years old). A self-administered questionnaire and informed consent document were mailed to25,469 registered athletes. Of those, 7,333 athletes replied both written informed consent and questionnaire (response rate was 28.8%). Those who did not play baseball (n = 5,577) and played both baseball and the other sports (n = 26) were excluded from this study. Missing data on variables (n = 192) were also excluded. The final study population was comprised of 1,535 players. We used multiple logistic regression analysis to examine the association of low back and knee pain with elbow and/or shoulder pain. Variables considered in the models were sex, age, BMI, years of athletic experience, position, team level, the amount of practice, participating day in team practice and game per week, frequency of participation in games, and practice intensity.

Results:

The frequency of elbow and/or shoulder pain was 24.8% (n= 393); that of elbow pain, 14.3% (n = 226); that of shoulder pain, 17.3 % (n = 273); that of both elbow and shoulder pain, 6.6% (n = 105); and that of low back and knee pain were 8.4% (n= 134) and 13.1% (n = 208), respectively. The frequency of elbow and/or shoulder pain who had low back and knee pain were 61.2% (n = 82) and 51.9% (n= 108) (p<0.001), respectively. The presence of low back and knee pain were strongly associated with elbow and/or shoulder pain (adjusted ORs (95%CI): 4.23 (2.83 - 6.34), p<0.001 and 3.11 (2.24 - 4.31), p<0.001, respectively), elbow (adjusted ORs (95%CI): 3.19 (1.74 - 5.83), p<0.001 and 2.45 (1.47 - 4.07), p=0.001, respectively), shoulder (adjusted ORs (95%CI): 4.25 (2.59 - 7.29), p<0.001 and 3.31 (2.17 - 5.05), p<0.001, respectively), and both elbow and shoulder pain (adjusted ORs (95%CI): 5.49 (3.08 - 9.79), p<0.001 and 3.52 (2.12 - 5.85), p<0.001, respectively).

Conclusion:

Both low back and knee pain were significantly associated with elbow and/or shoulder pain in youth baseball players. This result suggests that checking the trunk and lower extremities as well as elbows and shoulders are important for preventing sever injuries in youth baseball players.
Clinical Evaluation of an Arthroscopic, Knotless, Suprapectoral Biceps Tenodesis Technique
Authors: Duerr Robert , Akhavan Sam , Nye Darin D.
Published: July 2017

Objectives:

Pathology of the long of head of the biceps tendon (LHB) is a well-known cause of shoulder pain that is commonly managed with arthroscopic suprapectoral biceps tenodesis when conservative treatment fails. The purpose of this study is to present an arthroscopic, knotless, suprapectoral biceps tenodesis technique known as the Loop ‘N’ Tack and report the clinical outcomes in patients with a minimum of 2 years follow-up.

Methods:

The technique grasps the LHB proximally at the superior labrum and fixes it to the most distally visualized portion of the intra-articular bicipital groove. A retrospective review of all patients who had undergone the Loop ‘N’ Tack biceps tenodesis by the senior author between January 2009 and May 2014 was completed. Patients were excluded if any portion of the surgery was performed open, or if they had less than 2 years of follow-up. Charts were reviewed and patients were contacted for demographic data, time from surgery, concomitant procedures, worker’s compensation (WC) status, visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and University of California, Los Angeles (UCLA) scores. Statistical analysis was performed using Mann-Whitney U test for comparing non-parametric data sets.

Results:

follow-up evaluations were performed in 59 of 68 patients (87%). Average follow-up was 43 months. 88% of patients had at least 1 additional procedure performed at the time of biceps tenodesis. The mean ASES scores improved from 42.5 preoperatively to 90.1 postoperatively (p < 0.001). Fifty-four of fifty-nine patients (91.5%) had a good/excellent outcome with UCLA score > 27 and ASES > 70. Three patients (5%) reported biceps cramping pain with overuse. Two patients (3.3%) reported intermittent anterior shoulder pain similar to preoperative symptoms. No patients had developed a “Popeye” deformity at final clinical examination. 97% of patients reported that they were satisfied overall with the procedure. Comparing patients who had a rotator cuff repair or labrum repair at the time of biceps tenodesis with patients who did not have either, there were no significant differences in preoperative VAS or ASES, or postoperative outcomes scores. There were 10 WC patients who had worse postoperative VAS (p = 0.02), ASES (p = 0.03), SANE (p = 0.03), and UCLA scores (p = 0.02) compared to non-WC patients.

Conclusion:

The Loop ‘N’ Tack biceps tenodesis technique provides a high rate of patient satisfaction and high outcomes scores with a low rate of postoperative pain and no reported incidence of ‘Popeye’ deformity. We believe these good clinical results are due to the secure fixation of the LHB while relieving tension and minimizing motion of the tendon within the bicipital groove. [Figure: see text]
The use of PROMIS CAT Physical Function Pre-surgical Scores to Predict Recovery and Establish Pre-surgical Cut-off Values
Authors: Papuga Owen , Voloshin Ilya , Nicandri Gregg , Goldblatt John P. , Bronstein Robert D. , Rouse Lucien M. , Maloney Michael D.
Published: July 2017

Objectives:

There is a lack of standardized outcome measures or methods to study the effects of treatment and to effectively monitor and document patient outcomes. We have used Patient Reported Outcome Measurement Information System (PROMIS) computed adaptive testing questionnaires collected during routine office visits to describe the pre-surgical and postsurgical physical function scores and to assess the ability of pre-surgical scores to predict scores at 6 month after surgery.

Methods:

A retrospective analysis of 619 patients undergoing ACL reconstructive surgery at a large academic medical system was conducted to compare the predictive value of baseline PROMIS physical function scores to predict those scores after surgery. Patients with PROMIS physical Function scores within 1 standard deviation of the normal population at baseline were compare to those who fell below that score. Longitudinal comparisons of PROMIS scores between subsets was then made to identify any significant differences. PROMIS scores were assessed for discriminatory ability using receiver operating characteristic (ROC) curve analyses, with overall accuracy summarized using the area under the ROC curve (AUC). Nonparametric estimates and 95% confidence intervals for the AUC were used for each measurement at similar time points.

Results:

As shown in figure 1 average PROMIS physical function scores at later timepoints were comparable to those who had higher baseline scores. An ANOVA general linear (GROUP x TIME) model found statically significant (p<. 001) differences between the two groups at earlier time points. Further, ROC curve analysis demonstrated that PROMIS physical function scores have moderate to strong predictive ability (AUC>0.826). Using the ROC analysis an “optimal” cut-off pre-surgical score was determined to be a T-Score of 42.6.

Conclusion:

If fully utilized, these outcome measures can help inform physicians in individual surgical cases, as well as be used to show overall practice trends. Early identification of potential poor outcomes after ACL reconstruction may result in ability to intervene earlier to prevent prolonged disability. This investigation into the use of PROMIS physical function assessment tools has shown some utility in the ability to discriminate between those individuals who go on to have a full recovery over a typical recovery timeline and those who go on to have slower recovery.
Validity and Comprehensibility of Current Shoulder & Elbow Functional Outcomes Measures in Children
Authors: Heyworth Benton E. , Cohen Lara , von Heideken Johan , Kocher Mininder S. , Iversen Maura D.
Published: July 2017

Objectives:

To assess the comprehensibility of the Quick Disabilities of the Arm, the Shoulder and Hand Score (Quick DASH) and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) in children, identify sources of response errors, and modify items, in order to develop an original, age-appropriate, validated pediatric shoulder and elbow patient-reported outcome (PRO) survey.

Methods:

49 children with shoulder and/or elbow disorders were recruited from a children’s hospital-based orthopedic outpatient clinic. A researcher, who was trained by a behavioral scientist in cognitive interviewing techniques, used a standardized protocol and conducted cognitive interviews to identify children’s comprehension of the QuickDASH and ASES surveys. In Phase One of the study, 39 children (46% female, mean age=15 years; range 10-18) were purposefully sampled based on age and gender, interviewed, and audiotaped. The questionnaires were given in varying sequential order. Interview probes focused on directions, formatting, item content and matching of responses and items. A behavioral scientist analyzed transcripts, modified items accordingly, and created an original pediatric shoulder and elbow PRO. In Phase Two, 10 children (40% female, mean age=15 years) were interviewed to gather feedback specifically on the original pediatric PRO.

Results:

The average interview time was 26 minutes (range=16 - 44 minutes). 255 comments were generated about the Quick DASH, identifying 60 issues related to item comprehension and 191 issues related to item response format. 51% of children struggled with complex terminology used to describe activities and 41% did not understand symptom-related items such as “tingling”. 294 comments were generated about the ASES, primarily associated with medications (76%) and shoulder instability (47%). Timeframe and format issues were also noted. The resulting original PRO was easy to comprehend, although 40% of children could not interpret a “loose shoulder or elbow”.

Conclusion:

Item comprehension issues were noted in approximately half of the children completing the Quick DASH and ASES. Specific areas of difficulty included items addressing medication use, activity level and symptoms such as shoulder instability and tingling. Modifications were also needed in general instruction, language, survey and item format, layout, and item response mapping. Based on the results of the cognitive interviews, children had minimal difficulty comprehending items and directions of the newly developed pediatric shoulder and elbow PRO. A subsequent study will assess this original PRO’s psychometric properties in an effort to continue its development and provide more comprehensive, methodologically rigorous validation of its use in this population.
Rethinking Intellectual Life in Early Postwar Japan: Shisō no kagaku and Common Man's Philosophy
Authors: Ward Vanessa B.
Published: July 2017

The journal Shisō no kagaku (Science of Thought) and the Institute for the Science of Thought have received relatively little attention in the English-language literature on Japanese intellectual life after the Second World War. Among scholars writing in English, Shisō no kagaku and the Institute for the Science of Thought have been treated as largely incidental to examinations of the high-profile engagement in civil society activism of its young leader Tsurumi Shunsuke in the 1960s and beyond. This essay traces the group's ethos to its foundational principles and first two projects: the introduction to Japan of new trends in foreign thought, and the articulation of a new approach to philosophy based on the everyday thought of the ordinary person (common man's philosophy). A focus on these projects reveals the influence of one of the two women cofounders, Tsurumi Kazuko, and contributes in a small way to rectifying the absence of women's voices in the literature on postwar Japanese intellectual life.
Dishonesty and Selection into Public Service: Evidence from India
Authors: Hanna Rema , Wang Shing-Yi
Published: July 2017

Students in India who cheat on a simple laboratory task are more likely to prefer public sector jobs. This paper shows that cheating on this task predicts corrupt behavior by civil servants, implying that it is a meaningful predictor of future corruption. Students who demonstrate pro-social preferences are less likely to prefer government jobs, while outcomes on an explicit game and attitudinal measures to measure corruption do not systematically predict job preferences. A screening process that chooses high-ability applicants would not alter the average propensity for corruption. The findings imply that differential selection into government may contribute, in part, to corruption. (JEL C91, D12, D73, H83, K42, O12, O17)
Tenure in Office and Public Procurement
Authors: Coviello Decio , Gagliarducci Stefano
Published: July 2017

We study the impact of politicians' tenure in office on the outcomes of public procurement using a dataset on Italian municipal governments. To identify a causal relation, we first compare elections where the incumbent mayor barely won or barely lost another term. We then use the introduction of a two-term limit, which granted one potential extra term to mayors appointed before the reform. The main result is that an increase in tenure is associated with “worse” procurement outcomes. Our estimates are informative of the possibility that time in office progressively leads to collusion between government officials and local bidders. (JEL D72, H57, H76)
Profit with Purpose? A Theory of Social Enterprise
Authors: Besley Timothy , Ghatak Maitreesh
Published: July 2017

When social benefits cannot be measured, an organization that selects managers based on pro-social motivation can be used to balance profits with a social purpose. This paper develops a model of social enterprise based on selection of citizen-managers to run firms with flexible missions. We analyze organizational choice between social enterprise, for-profits, and nonprofits. The paper also develops the implications of matching between founders and managers based on their preferences for the mission. (JEL D21, L21, L31)
Affirmative Action Exemptions and Capacity Constrained Firms
Authors: Marion Justin
Published: July 2017

This paper studies how affirmative action exemptions in public procurement can improve efficiency and government expenditures without harming disadvantaged business enterprise (DBE) utilization. I examine a unique program employed by the Iowa Department of Transportation, where prior to 2013 prime contractors were allowed an exemption from a project's affirmative action requirement if their history of DBE utilization was sufficiently high. I find that prime contractors use the exemption to smooth demands on capacity constrained DBEs, building a history of utilization during low demand periods and exploiting the resulting exemption during high demand. The exemption policy was unexpectedly eliminated in 2013, which I exploit to evaluate its effect on DBE utilization and procurement costs. I find that average DBE utilization was unchanged and bids rose on affirmative action contracts. (JEL D22, H76, J15, J16)
Mafia in the Ballot Box
Authors: De Feo Giuseppe , De Luca Giacomo Davide
Published: July 2017

We study the impact of organized crime on electoral results, analyzing in detail the national parliamentary elections in Sicily for the period 1946–1992. We document the significant support given by the Sicilian mafia to the Christian Democratic Party when the electoral competition by the Communist Party strengthened. We also provide suggestive evidence that, in exchange for its electoral support, the mafia obtained economic advantages in the construction sector. (JEL D72, K42, L74)
How Much Can Expanding Access to Long-Acting Reversible Contraceptives Reduce Teen Birth Rates?
Authors: Lindo Jason M. , Packham Analisa
Published: July 2017

We estimate the degree to which expanding access to long-acting reversible contraceptives (LARCs) can reduce teen birth rates by analyzing Colorado's Family Planning Initiative, the first large-scale policy intervention to expand access to LARCs in the United States. Using a difference-in-differences approach, we find that the $23M program reduced the teen birth rate in counties with clinics receiving funding by 6.4 percent over 5 years. These effects were concentrated in the second through fifth years of the program and in counties with relatively high poverty rates. State-level synthetic control estimates offer supporting evidence but suffer from a lack of power. (JEL H75, I18, I32, J13)
ORGANIC GEOCHEMISTRY OF HUMIC ACIDS FROM A NEOGENE LIGNITE SAMPLE, BULGARIA
Authors: Stefanova M. , Marinov S.P.
Published: July 2017

Humic substances naturally occur in Miocene/Pliocene-aged lignite at very high concentrations. Here biomarkers in the bitumen-free extract of humic acids from Thracian lignite, Bulgaria, are studied. Applying methods of organic geochemistry a broad range of compounds are isolated and characterised. Species are classified according to abundance, possible source input and diagenetic transformation. A feature of humic acids derived from Thracian coal is the extremely high content of 16α(H)Phyllocladane, ~60% of aliphatic fraction, or 1.6 wt.% of initial lignite. The high diterpenoids content, especially with abietane skeleton, proved the conifer contribution to the peat-forming helophytes, i.e. Cupressaceae s. str., Podocarpaceae, Araucariaceae, Taxodiaceae, Phyllocladus, Piceae. Tightly-trapped, linear long-chain fatty acids (FAs) are the main constituents of the acidic fraction of humic acids. Their distribution patterns indicate a dominant higher plant origin. The presence of αOH-FAs and hopanoid acids assumes bacterial activity in the plant material reworked. A hint for the input of plant biopolymers, i.e. cutin, suberin, is the relative high content of “even” carbon numbered ωΟΗFAs and α,ω-alkanedioic FAs. “Even” numbered short-chain ωΟΗFAs could originate from cutin-derived constituents of the needles of numerous species of gymnospermous families.
THE ISOTOPIC SIGNATURE OF THE MINERALIZING FLUID OF THE LAVRION CARBONATE-REPLACEMENT PB-ZN-AG DISTRICT
Authors: Tombros S.F. , Seymour K. , Spry P.G. , Bonsall T.A
Published: July 2017

The Pb-Zn-Ag carbonate-replacement deposits in the Lavrion district are genetically related to a 7- 10 Ma-old granodiorite, felsic dikes and sills. These deposits are hosted in the Upper and Lower marble and schists of the Cyclades Blueschist unit and occur along the major Legraina detachment fault. Carbonate-replacement orebodies occur as “mantos” and veins, dominated by base metal sulfides and Ag, Bi, Sn, Sb, As, and Pb sulfosalts. Calculated carbon and oxygen isotope compositions of the hydrothermal fluid range from δ13CCO2 of -13.7 to 0.8 per mil and δ18OH2O of 4.2 to 27.4 per mil, at 400º, 350º, 320º, 300º, 250º and 200ºC. These isotopic compositions reveal water-torock ratios ranging from 4.8 to 52.6%, which reflect intense interaction of the ore fluid with the host rock in a water-dominated, transitional closed to open hydrothermal system. The range of δ34SH2S for sulfides in the deposits were from -8.5 to 6.8 per mil, for similar temperatures, whereas for barite-fluorite veins from δ34SH2S of -43.6 to -16.4 per mil, at 200º, 150º and 100ºC. This range implies that there was contribution from a magmatic sulfur component exsolved from the Plaka pluton, as well as contribution from a metasedimentary component. Based on the isotopic signature of sulfur for barite, the ranges from -6.7 to -7.6, comprising an increase in the fluid influx. Isotopic temperatures based on pyrite-galena and sphalerite-pyrite pairs revealed at least three major events of carbonate-replacement ore deposition, (i) at ~ 360º, (ii) 320º-280ºand (iii) 260º-200ºC.
MUNICIPAL WASTEWATER TREATMENT WITH BENTONITE FROM MILOS ISLAND, GREECE
Authors: Bourliva A. , Michailidis K. , Sikalidis C. , Filippidis A. , Apostolidis N.
Published: July 2017

Bentonite clay minerals belonging to the smectite group have a wide range of chemical and industrial uses. The structure and chemical composition, exchangeable ion type and small crystal size of smectite are responsible for several properties, including a large chemically active surface area and a high cation exchange capacity. A wastewater treatment using bentonite from Milos island, Greece, was investigated. Raw wastewater sample (influent) from the wastewater treatment plant (WTP) of the city of Kilkis, Northern Greece was treated using bentonite in conjunction with chemical coagulants (polyaluminium chloride-PAC and cationic polyelectrolyte), in batch type experiments. Theremoval of suspended solids (SS), chemical oxygen demand (COD), nitrate ion, ammonium ion, phosphate ion, and toxic metals were evaluated. The treatment gave overflowed clear water improved concerning the quality parameters. The bentonite adding prior to flocculation resulted in effective removal of heavy metals such as chromium and copper. Additionally, the bentonite removed nitrogen compounds with relatively high efficiency, while the clay presence highly improved the COD removal. The quality parameters after treatment were improved fulfilling the requirements for disposition as downstream, irrigation, swimming and fish waters.
EPITHERMAL MANGANESE MINERALIZATION, KIMOLOS ISLAND, SOUTH AEGEAN VOLCANIC ARC, GREECE
Authors: Lykakis N. , Kilias S. P.
Published: July 2017

Manganese mineralization is hosted by a marine monomictic, lithic volcaniclastic breccia, possibly an andesitic in situ hyaloclastite, and shallow-marine or subaerial epiclastic conglomerates, in the Korakies area, NE Kimolos, active south Aegean volcanic arc. Old mine workings (in the form of rubble, adit and shaft), and abandoned rail and ship loading facilities, exist in the area. Mineralization occurs as a quartz/chalcedony vein system filling extensional NNE-SSW–trending faults and fractures, of Pliocene age. Maximum vein width reaches 5 m; length may extend to 250 m. The ore shares strong textural analogies with volcanic-hosted epithermal-style deposits, i.e. crustiform banding, vugs, hydrothermal breccias, cockade and comb textures. Vein wall rocks are hydrothermally altered to quartz-adularia±illite, chlorite and barite. Pyrolusite, hollandite, cryptomelane, and coronadite are the main ore minerals, with quartz, chalcedony, jasper and barite gangue. Ore samples contain up to 25.8 % MnO2, 14.7 % FeOTOT, 2860 ppm Zn, 1132 ppm Pb and 136 ppm Cu; Mn and Zn show mutual positive correlation (r2=0.61). Trace element enrichment (i.e. Zn, Pb, and Cu) may suggest a proximal base metal sulfide mineralization. Concentrations of 4.3 % Na, 0.09 % Mg and barite presence may suggest genetic involvement of sea water. The mineralization studied is similar to volcanic-hosted low-sulfidation epithermal ore deposits deposited from neutral pH fluids. This is a rare example of a vein-type epithermal-style hydrothermal manganese deposit formed in a marine environment.
THE GENETIC HYPOTHESIS OF THE URANIFERUS MINERALIZATION, EASTERN CHALKIDIKI (NORTHERN GREECE)
Authors: Persianis D. , Katsikis J. , Karageorgiou D.E.
Published: July 2017

This paper presents the genetic hypothesis of αn uranium mineralization observed in Eastern Chalkidiki-Greece. In the area of Stratoni (location Asprochomata) a uranium mineralization is expressing by disseminated primary (orthobrannerite) and secondary (torbernite) U minerals, in the granodioritic body of this area. Genetically it may be the result of uranium redistribution, which occurs in the resisting accecory minerals (e.g monazite) of the granodiorite, by magmatic or meteoric hydrothermal fluids of low temperature. The mineralized granodiorite of Stratoni gives no evidence of a metalliferous pluton, based on the study of hydrothermally altered samples and this ascertainment is a fact that should be confronted with a lot of carefull thought. In the granite of Arnea area, uranium mineralization is in generally absent, excluding some poor one’s, located along the contacts of the granite with small remnants of the hosting rock, expressed in the form of impregnations or veinlets. The possible cause for its formation being the interaction of a secondary low temperature hydrothermal system mainly of meteoric water participation (convective hydrothermal system) with the granite and the hosting wall-rock minerals. The granite of Arnea indicates all the characteristics of a metalliferous granitoid.