bluuebunny/crossref_metadata_2025 huggingface dataset:
Survival at 11 to 21 years for 779 Metasul® metal-on-metal total hip arthroplasties
Authors: Erivan Roger , Villatte Guillaume , Millerioux Stéphane , Mulliez Aurélien , Descamps Stéphane , Boisgard Stéphane
Published: July 2020

Background:

Total hip arthroplasties (THAs) bearing is one of the most important factors for hip replacement because THA survival depends on it. Metal-on-metal (MoM) bearing has lower wear than metal-on-polyethylene but lot of aseptic loosening decrease utilization. We analyze the survival rate of 28 mm Metasul® bearings after a mean follow-up of 12.9 years.

Methods:

The main objective of this study was to evaluate the survival of the MoM. We evaluate 779 consecutive THAs performed between January 1995 and December 2005 for primary osteoarthritis, congenital dysplasia classified Crowe I, or rheumatoid arthritis. Survival rate was calculated by the Kaplan–Meir method. The association between survival and age, gender, body mass index (BMI), and surface coating was investigated with a proportional odds model. The clinical assessment included Oxford score.

Results:

Six hundred fifty-two THAs were reviewed. Sixty-two revisions (9.5%) were performed including 34 aseptic loosening and 11 deep infections. The survival for prosthesis with any reason at 20 years was 87% (confidence interval (CI) 83–90.2) for aseptic loosening at 20 years was 90.1% (CI 87–93.8). There was no association with age, BMI, and surface coating. Gender was significant with lower aseptic loosening for men, hazard ratio = 0.45, p value = 0.035. Oxford score was 57 ± 6.7 (19–60).

Conclusion:

The survival rate of Metasul was well and seems to be like our clinical finding. However, radiographic aseptic loosening without surgery is not included in the survival rate. The Oxford score was very good with a lot of patients with asymptomatic hip.

Level of Evidence:

Level IV/Retrospective study
Implementing Rapid Initiation of Antiretroviral Therapy for Acute HIV Infection Within a Routine Testing and Linkage to Care Program in Chicago
Authors: McNulty Moira , Schmitt Jessica , Friedman Eleanor , Hunt Bijou , Tobin Audra , Maheswaran Anjana Bairavi , Lin Janet , Novak Richard , Sha Beverly , Rolfsen Norma , Moswin Arthur , Rose Breon , Pitrak David , Glick Nancy
Published: July 2020

Growing evidence suggests that rapid initiation of antiretroviral therapy for HIV improves care continuum outcomes. We evaluated process and clinical outcomes for rapid initiation in acute HIV infection within a multisite health care–based HIV testing and linkage to care program in Chicago. Through retrospective analysis of HIV testing data (2016-2017), we assessed linkage to care, initiation of antiretroviral therapy, and viral suppression. Of 334 new HIV diagnoses, 33 (9.9%) individuals had acute HIV infection. Median time to linkage was 11 (interquartile range [IQR]: 5-19.5) days, with 15 days (IQR 5-27) to initiation of antiretroviral therapy. Clients achieved viral suppression at a median of 131 (IQR: 54-188) days. Of all, 69.7% were retained in care, all of whom were virally suppressed. Sites required few additional resources to incorporate rapid initiation into existing processes. Integration of rapid initiation of antiretroviral therapy into existing HIV screening programs is a promising strategy for scaling up this important intervention.
Impact of Insurance and Practice Type on Access to Orthopaedic Sports Medicine
Authors: Shi Weilong , Anastasio Albert , Guisse Ndeye F. , Faraj Razan , Fakunle Omolola P. , Easley Kirk , Hammond Kyle E.
Published: July 2020

Background:

The Patient Protection Affordable Care Act has expanded Medicaid eligibility in recent years. However, the provisions of the act have not translated to improved Medicaid payments for specialists such as orthopaedic surgeons. The number of health care practitioners who accept Medicaid is already decreasing, with low reimbursement rates being cited as the primary reason for the trend.

Hypothesis:

Private practice orthopaedic groups will see patients with Medicaid or Medicare at lower rates than academic orthopaedic practices, and business days until appointment availability will be higher for patients with Medicaid and Medicare than those with private insurance.

Study Design:

Cross-sectional study.

Methods:

Researchers made calls to 2 regular-sized orthopaedic practices, 1 small orthopaedic practice, and 1 academic orthopaedic practice in each of the 50 states in the United States. Callers described a scenario of a recent injury resulting in a bucket-handle meniscal tear and an anterior cruciate ligament tear seen on magnetic resonance imaging at an outside emergency department. For a total of 194 practices, 3 separate telephone calls were made, each with a different insurance type. Data regarding insurance acceptance and business days until appointment were tabulated. Student t tests or analysis of variance for continuous data and χ2 or Fisher exact tests for categorical data were utilized.

Results:

After completing 582 telephone calls, it was determined that 31.4% (n = 59) did not accept Medicaid, compared with 2.2% (n = 4) not accepting Medicare and 1% (n = 1) not accepting private insurance ( P < .001). There was no significant association between type of practice and Medicaid refusal ( P = 0.12). Mean business days until appointment for Medicaid, Medicare, and private insurance were 5.3, 4.1, and 2.9, respectively ( P < .001).

Conclusions:

Access to care remains a significant burden for the Medicaid population, given a rate of Medicaid refusal of 32.2% across regular-sized orthopaedic practices. If Medicaid is accepted, time until appointment was significantly longer when compared with private insurance.
Quantitative Evaluation of Lateral Articular Cartilage Morphology on Magnetic Resonance Imaging at 2-years following Anterior Cruciate Ligament Reconstruction with Or Without A Lateral Extra-Articular Tenodesis
Authors: Bryant Dianne , Milner Jaques , Martindale Ashley , Schulz Jenna , Holdsworth David ,   Stability Group, Getgood Alan , Firth Andrew
Published: July 2020

Objectives:

The purpose of this study is to evaluate whether augmentation of anterior cruciate ligament reconstruction (ACLR) with a lateral extra-articular tenodesis (LET) affects articular cartilage morphology on magnetic resonance imaging (MRI) two years post-operatively in a young, active population.

Methods:

Ninety-seven patients at the Fowler Kennedy Sports Medicine Clinic participating in the Stability study, a multi-center randomized controlled trial of 618 patients comparing ACLR ± LET, underwent bilateral 3T MRI at two-years post-surgery. Quantitative MRI (qMRI) pulse sequences consist of a Sagittal Multi-Echo Spin Echo T2 Mapping sequence, and a 16-shot Gradient Echo T1rho Mapping sequence. The primary imaging outcome was T1rho and T2 relaxation time. Articular cartilage was manually segmented on three consecutive load-bearing slices by three independent raters, and values were averaged for three regions on the tibia and five regions on the femur in both the medial and lateral compartments. Raters were blind to scan order and an ICC (2,1) was used to assess inter-rater reliability. Independent t-tests were used to compare relaxation times between groups in each compartment.

Results:

Ninety-seven participants (47 ACL, 50 ACL+LET), including 59.7% (58/97) females with a mean age of 18.9 years underwent MRI 2-years post-op (range = 20 to 36 months). Currently, 41 scans (23 ACL, 18 ACL+LET) have been analyzed. There were no significant differences between groups for regions in the medial compartment. T2 relaxation times were significantly higher for the ACL+LET group in the central and posterolateral (PL) tibia and the PL femur (Table 1). T1rho relaxation times were significantly lower for the ACL+LET group in the proximal posterior femur. Raters showed good inter-rater reliability with an ICC of 0.85..

Conclusions:

T2 relaxation times are elevated in the lateral compartment following ACLR augmented by LET compared to ACLR alone however, the clinical significance is not currently clear as the differences were small (<4ms). Also, the presence of a metal staple may influence the relaxation times calculated. However, the potential that a LET may lead to early cartilage degeneration cannot be discounted and as such should be monitored in the long-term.
Training with Lighter Baseballs Increases Velocity Without Increasing Injury Risk
Authors: Chalmers Peter , Bassora Rocco , Inzerillo Chris , Beharrie Andrew , Romeo Anthony , Erickson Brandon
Published: July 2020

Objectives:

Pitch velocity has become an increasingly popular metric by which pitchers are graded and compared. Training programs that utilize weighted balls have been effective in increasing velocity but at the cost of increased injury risk. The purpose of this study was to determine if a baseball pitcher-training program utilizing lighter baseballs could increase fastball velocity without increasing injury risk. The author’s hypothesized that the training program with lighter baseballs would increase fastball velocity without causing injuries during the training program to the participants

Methods:

All baseball pitchers who participated in a 15-week pitching mechanic and velocity training program were included. Training program was broken down into three phases, and each participant went through the same program. Lighter balls (4oz and 3oz) and standard baseballs (5oz) were utilized as part of the training program. Weighted (heavier) balls were not used. Velocity was measured at four time points throughout the program. Injury rates for all players were recorded throughout the entire program.

Results:

48 male pitchers aged 10-17 (average age: 14.7 +/- 1.8) years started the program and 44 had complete data and were included in the analysis. No pitcher sustained a baseball-related injury while participating in the training program (one player broke his ankle playing basketball, one player moved, one did not have baseline velocity data, and one experienced biceps soreness after participating in back to back showcases against recommendations). Fastball velocity increased by an average of 4.8mph (95% confidence intervals 4.1 - 5.5mph). Overall 43/44 players (98%) had an increase in fastball velocity over the course of the program.

Conclusions:

A 15-week baseball pitcher-training program with lighter baseballs significantly improved pitching velocity without significantly increasing injuries. Lighter baseballs should be considered instead of weighted baseballs when attempting to increase a pitcher’s velocity.
Defining the MCID, PASS and SCB for Arthroscopic Hip Preservation Surgery at Minimum Five-Year Follow-up
Authors: Nwachukwu Benedict , Beck Edward , Kunze Kyle , Chahla Jorge , Drager Justin , Nho Shane , Rasio Jonathan
Published: July 2020

Objectives:

Minimal clinically important difference (MCID), substantial clinical benefit (SCB) and patient acceptable symptomatic state (PASS) have gained prominence as important variables in the orthopedic outcomes literature. In hip preservation surgery, much attention has been given to defining early clinically significant outcome, however, it is unknown what represents meaningful patient reported outcome improvement in the medium to long-term. The purpose of the present study was to define MCID, PASS and SCB at a minimum five years after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Secondarily, we sought to evaluate the time dependent nature of MCID, PASS and SCB.

Methods:

Patients undergoing hip arthroscopy for FAIS between January 2012 and March 2014 were included. Clinical and demographic data were collected in an institutional hip preservation registry. MCID, PASS, and SCB were calculated for each outcome score at 1-, 2-, and 5- years. MCID was calculated using a distribution-based method while PASS and SCB were calculated using an anchor method.

Results:

Two hundred and eighty-three patients were included with an average age of 34.2+11.9 years. The one year, two year and five-year MCID scores were as follows respectively: HOS-ADL (8.8, 9.7, 10.2); HOS-SS (13.9, 14.3, 15.2); mHHS (6.9, 9.2, 11.4) and iHOT-12 (15.1, 13.9, 15.1). PASS scores were as follows: HOS-ADL (89.7, 88.2, 99.2); HOS-SS (72.2, 76.4, 80.9); mHHS (84.8, 83.3, 83.6) and iHOT-12 (69.1, 72.2, 74.3). SCB scores were as follows: HOS-ADL (89.7, 91.9, 94.6); HOS-SS (78.1, 77.9, 85.8); mHHS (86.9, 85.8, 94.4) and iHOT-12 (72.6, 76.8, 87.5). More patients achieved MCID, SCB and PASS at two-year follow-up than at one-year follow-up. However, 79.3% of the patients achieved MCID by 5 years.

Conclusion:

The greatest proportion of patients achieve clinically significant outcome improvement at two-year follow-up after arthroscopic treatment of FAIS. Improvements are maintained out to five-year follow-up although there is a slight decrease in the proportion of patients achieving clinical significance. [Table: see text]
O’Donoghue Sports Injury Award: Bridge-Enhanced ACL Repair is Non-Inferior to Autograft ACL Reconstruction at 2-Years: Results of a Prospective Randomized Clinical Trial
Authors: Fleming Braden , Badger Gary ,   BEAR II Trial Team, Kramer Dennis , Micheli Lyle , YenMD Yi-Meng , Murray Martha
Published: July 2020

Objectives:

Preclinical studies and an early clinical cohort study have suggested that for complete midsubstance ACL injuries, the technique of suture repair of the anterior cruciate ligament (ACL) augmented with a protein implant placed in the gap between the torn ends (bridge-enhanced ACL repair) may be a viable alternative to ACL reconstruction. We hypothesized that patients treated with bridge-enhanced ACL repair would have non-inferior patient reported outcomes and anteroposterior (AP) laxity, and superior hamstring strength at 2 years after surgery when compared with subjects who had ACL reconstruction with autograft.

Study Design:

Prospective Randomized Control Trial (NCT02664545).

Methods:

One hundred patients, ages 13 to 35, with complete mid-substance ACL injuries, were enrolled and underwent surgery within 45 days of injury. Sixty-five patients were randomized to receive a bridge-enhanced ACL repair (BEAR group) and 35 were randomized to receive autograft ACL reconstruction (ACLR group). Outcomes, including the International Knee Documentation Committee (IKDC) Subjective score, instrumented AP laxity and muscle strength were assessed at 2 years post-operatively. Both patients and assessors were blinded as to surgical assignment until after the 2-year assessment.

Results:

Ninety-six percent of the subjects returned for follow-up at 2 years. The median age of the subjects in both groups at enrollment was 17 years and the median pre-operative Marx score in both groups was 16 points. Non-inferiority criteria were met for both the IKDC subjective score and AP laxity. The BEAR group had significantly better recovery of hamstring strength than the ACLR group (p<0.001). The number of subjects who were reinjured and required a second ACL surgery was not statistically different between the two groups. Subjects who converted from BEAR to ACLR in the study period had outcomes at the 2-year point that were similar to those for subjects who had only a single ipsiateral ACL procedure (BEAR or ACLR).

Conclusion:

Bridge-enhanced ACL repair using a specific protein-based implant led to non-inferior outcomes to that of ACL reconstruction for patient reported and instrumented knee laxity measures at 2 years after surgery in a young and active cohort of patients with acute mid-substance ACL tears.
Machine Learning Accurately Predicts Next Season NHL Player Injury Before It Occurs: Validation of 10,449 Player-Years from 2007-17
Authors: Wright Audrey , Karnuta Jaret , Luu Bryan , Haeberle Heather , Makhni Eric , Schickendantz Mark , Ramkumar Prem
Published: July 2020

Objectives:

With the accumulation of big data surrounding National Hockey League (NHL) and the advent of advanced computational processors, machine learning (ML) is ideally suited to develop a predictive algorithm capable of imbibing historical data to accurately project a future player’s availability to play based on prior injury and performance. To the end of leveraging available analytics to permit data-driven injury prevention strategies and informed decisions for NHL franchises beyond static logistic regression (LR) analysis, the objective of this study of NHL players was to (1) characterize the epidemiology of publicly reported NHL injuries from 2007-17, (2) determine the validity of a machine learning model in predicting next season injury risk for both goalies and non-goalies, and (3) compare the performance of modern ML algorithms versus LR analyses.

Methods:

Hockey player data was compiled for the years 2007 to 2017 from two publicly reported databases in the absence of an official NHL-approved database. Attributes acquired from each NHL player from each professional year included: age, 85 player metrics, and injury history. A total of 5 ML algorithms were created for both non-goalie and goalie data; Random Forest, K-Nearest Neighbors, Naive Bayes, XGBoost, and Top 3 Ensemble. Logistic regression was also performed for both non-goalie and goalie data. Area under the receiver operating characteristics curve (AUC) primarily determined validation.

Results:

Player data was generated from 2,109 non-goalies and 213 goalies with an average follow-up of 4.5 years. The results are shown below in Table 1.For models predicting following season injury risk for non-goalies, XGBoost performed the best with an AUC of 0.948, compared to an AUC of 0.937 for logistic regression. For models predicting following season injury risk for goalies, XGBoost had the highest AUC with 0.956, compared to an AUC of 0.947 for LR.

Conclusion:

Advanced ML models such as XGBoost outperformed LR and demonstrated good to excellent capability of predicting whether a publicly reportable injury is likely to occur the next season. As more player-specific data become available, algorithm refinement may be possible to strengthen predictive insights and allow ML to offer quantitative risk management for franchises, present opportunity for targeted preventative intervention by medical personnel, and replace regression analysis as the new gold standard for predictive modeling. [Figure: see text]
Clinical Results of the NUsurface® Meniscus Implant versus Non-Surgical Controls at 24 months: Data from a Pooled cohort of a randomized controlled study and single arm study
Authors: Alley R , Alfred Richard , Edelson Richard , Greenleaf Jonathan , Gersoff Wayne , Gomoll Andreas , Kaeding Christopher , McKeon Brian , Zaslav Kenneth
Published: July 2020

Objectives:

To demonstrate comparative KOOS outcomes (Symptoms, Pain, ADL, Sports/Rec, QoL, and Overall) of a synthetic meniscus implant versus non-surgical controls in treatment of persistent post meniscectomy knee pain.

Methods:

242 patients enrolled in a pooled population, randomized controlled trial (RCT) and single-arm study, comparing the investigational device to non-surgical standard of care. Of the first 100 patients enrolled, whose follow-up has exceeded 24 months, 65 patients were treated with the meniscus implant, and 35 were treated non-surgically (Table 1). Validated KOOS scores at baseline, 6-week, 6-month, 12-month, and 24-month time points were obtained from all patients where a “clinically significant improvement” was considered to be an increase of 20 KOOS points, based on Roos et al., (2003). The investigational and control cohorts were compared at each time point using a two tailed t-test. All baseline cohort comparisons of demographics and KOOS scores were not statistically different (p>0.05).

Results:

Improvement in KOOS Pain for the investigational vs control cohorts at 6-months was 25.0 vs 10.5 points at 6-months, 31.1 vs 14.5 points at 12-months, and 29.5 vs 13.6 points at 24-months, respectively (Figure 1). Similarly, improvement in KOOS Overall for investigational vs controls was 23.3 vs 8.0 points at 6-months, 29.2 vs 11.4 points at 12-months, and 29.1 vs 13.4 points at 24-months, respectively. These data show a statistically significant improvement, above the clinically meaningful threshold, in the investigational arm versus the control arm as early as 6 months (p<0.001) and continues through the 12-month timepoint (p<0.001) and the 24-month timepoint (p<0.001). At 24 months, 5 (7.7%) investigational vs. 5 (14.3%) control patients were no longer qualified to remain in the study, and deemed study failures, due to removal of the investigational device, and due to non-surgical control patients receiving surgical intervention (Table 1). Adverse event analysis showed that at 12 months, more patients progressed to advanced knee reconstructive procedures in the non-surgical, control group (n=4, 11.4%) than in the surgical, investigational group (n=2, 3.1%).

Conclusion:

Early results of effectiveness using KOOS subscales and KOOS overall are encouraging. The investigational treatment showed statistically different outcomes, above the clinically important threshold, at 6, 12 and 24 months compared to non-surgical controls. The clinical study is ongoing, with long-term results to be reported in the future. [Table: see text][Figure: see text]
Medial Meniscus Posterior Root Tear Treatment: A matched cohort comparison of non-operative management, partial meniscectomy and repair
Authors: Bernard Christopher , Tagliero Adam , LaPrade Matthew , Camp Christopher , Saris Daniel , Levy Bruce , Stuart Michael , Krych Nicholas Kennedy Aaron
Published: July 2020

Objectives:

Meniscal root disruption results in a loss of hoop strain resistance, increased articular cartilage contact pressure, and acceleration of degenerative changes. There is limited data comparing the outcomes of similarly matched patients with a medial meniscus posterior root tear treated with non-operative management, partial meniscectomy, or repair. The purpose of this study is to compare treatment failure, clinical outcome scores, and radiographic findings for a matched cohort of patients who underwent either non-operative management, partial meniscectomy, or transtibial pull-through repair for a medial meniscus posterior root tear (MMPRT). Our hypothesis is that patients who underwent meniscus root repair will have lower rates of progression to arthroplasty than patients who were treated with non-operative management or partial meniscectomy.

Methods:

Patients who underwent transtibial medial meniscus posterior horn root repair were matched by meniscus laterality, age, sex and K-L grades to patients treated non-operatively or with a partial meniscectomy. Progression to arthroplasty rates, IKDC and Tegner scores, and radiographic outcomes were analyzed between groups.

Results:

Forty-five patients were included in this study (15 non-operative, 15 partial meniscectomy, 15 root repair). Progression to arthroplasty demonstrated significant differences among treatment groups at a mean 74 months (non-operative 4/15, partial meniscectomy 9/15, meniscus repair 0/15, p=.0003). The meniscus root repair group had significantly less arthritic progression, as measured by change in K-L grade from pre-op to post-op (non-operative 1.0, partial mensicectomy 1.1, and meniscus repair 0.1, p=.001).

Conclusion:

Meniscus root repair leads to significantly less arthritis progression and subsequent knee arthroplasty compared to non-operative management and partial meniscectomy in a demographically matched cohort.
Return to Work and Sport Following Distal Triceps Repair
Authors: Manderle Brandon , Polce Evan , Williams Brady , Nicholson Gregory , Fernandez John , Wysocki Robert , Forsythe Brian , Cole Brian , Verma Nikhil , Beletsky Alexander
Published: July 2020

Objectives:

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

Methods:

A prospectively maintained institutional database was retrospectively reviewed for all patients who underwent distal biceps repair since 2004 with minimum 2-year follow-up. A patient survey was conducted over phone with regard to preoperative and postoperative participation in sports, level of intensity, and maximum weight repetitions of barbell and dumbbell biceps curl, bench press, and consecutive push-ups. Mayo Elbow Performance Score (MEPS) and The Disabilities of the Arm, Shoulder and Hand Score (QuickDASH) were collected preoperatively and at final follow up. T-tests and chi-squared analysis was used to examine continous and categorical outcome variables, respectively.

Results:

A total of 70 patients (41 male) were contacted for final follow-up information. Average age was 48.42 + 13.32 and average time from initial injury to surgical intervention was 3.12 + 2.88 months. 81% of the injuries involve lifting of heavy objects, and 27.7% occurred during sport. Ten percent (n=7) of patients returned to the operating room, most commonly for ulnar nerve repair. Return to work was achieved in 86.3% of patients, occurring at an average of 2.87 months. Heavy duty status workers returned at significantly later time points than sedentary or light duty status workers (5.35 vs. 1.21 months, p<0.01). 81.4% of patients returned to the same or higher level of work. Return to sport was achieved by 79.7% of patients at an average of 3.32 months. 73.9% of patients were either satisfied or very satisfied with their ability to work, and 68.6% were satisfied or very satisfied with their ability to play spots. All competitive athletes (n=11) returned to either the same or higher level of intensity following surgery.

Conclusion:

Surgical repair of a distal triceps injury results in reliable return to work and sport, with the majority of patients returning to the same physical intensity of work and the same intensity of sporting, respectively. Competitive athletes demonstrate particularly impressive results with heightened return to sport rates at the same or greater intensity level, suggesting motivation level may have a role in determining successful return to sport. Our data may be utilized to better inform the shared decision-making process between providers and patients when considering surgical intervention for distal triceps injuries.
Timing of Return to Batting Milestones Following Ulnar Collateral Ligament Reconstruction in Professional Baseball Players
Authors: Erickson Brandon , Chalmers Peter , John D , Ma Kevin , Sheridan Scott , Schickendantz Mark , Romeo Anthony
Published: July 2020

Objectives:

Ulnar collateral ligament reconstruction (UCLR) is a common procedure in professional baseball position players. Timing of return to hitting following UCLR is unknown. The purpose of this study was to determine the time to return to batting milestones after UCLR as well as the effect of UCLR upon batting performance in professional baseball players. The authors’ hypothesized that position players would return to batting in an in-season game prior to fielding in an in-season game and hitting performance would remain unchanged following UCLR

Methods:

All professional position players who underwent UCLR between 2010-2018 were included. Time to batting milestones following UCLR was analyzed. Batting performance before and after UCLR was compared and analyzed.

Results:

Overall, 141 UCLRs (96% performed on the dominant arm) in 137 position players were included (86% minor leaguers). Four players underwent revision, all within one year of the primary UCLR. With regard to position, catchers and shortstops were over-represented. With regard to batting side, 57% batted from the right and 12% batted as switch-hitters, and thus 76% of surgeries were on the lead arm. While 91% of players were able to return to any throwing at all, there was a progressive gradual decline during the rehabilitation progress such that 77% were able to return to hitting in a real game and 75% were able to return to fielding in a real game. The first dry swing occurred at 150±49 days after surgery, first batting practice occurred at 195±58 days after surgery, and first hitting in a real game occurred at 323±92 days after surgery. However, players generally saw a decrease in their utilization, with fewer at bats (p<0.001) translating into fewer hits (p<0.001) and runs (p<0.001).

Conclusion:

Professional position players begin swinging at 150 days following UCLR while they do not hit batting practice until 195 days and do not hit in a real game until 323 days following UCLR. Players saw a decrease in hitting utilization following UCLR. [Figure: see text]
Lateral Elbow Overuse Injuries in Pediatric Female Gymnasts: A Comparison of Radial Head Stress Fractures and Capitellar OCD
Authors: Searls William , Zynda Aaron , Ellis Henry , Wilson Philip , Wyatt Charles
Published: July 2020

Objectives:

Radial head stress fractures (RHSF) and capitellar osteochondritis dissecans (OCD) are rare and may be seen in pediatric gymnasts. Clinical and radiographic factors correlating with these differential lesions are unclear. To describe the clinical presentation of RHSF and compare the demographic, radiographic, and clinical characteristics of elbows in pediatric gymnasts presenting with RHSF to those presenting with OCD of the capitellum.

Methods:

An IRB-approved retrospective review of consecutive female gymnasts treated within a pediatric sports medicine practice for either RHSF or capitellar OCD over a 5-year period (1/2014-2/2019) was performed. Gymnasts <18 years old at the time of injury presenting with signs of a radial head stress fracture (Salter-Harris III or IV) or with diagnostic features of capitellar OCD were included. Those with congenital anatomic elbow abnormalities or prior ipsilateral elbow surgery were excluded. Patients were dichotomized into either the RHSF or OCD group; and demographic, radiographic, and clinical characteristics were compared. Statistical analysis was performed using a Mann-Whitney test for continuous variables and a chi-square test for categorical variables.

Results:

Forty-five patients (9 with bilateral OCD, 1 with bilateral RHSF, and 3 with each lesion in alternate elbows), contributing 58 elbows, met inclusion criteria. Thirty-nine elbows in the OCD group and 19 elbows in the RHSF group were studied. Average age for all gymnasts was 11.58 years (9-16 years), with no difference between groups (OCD: 11.47 vs RHSF: 11.78; p=0.34). No differences in height, weight, BMI, or laterality were noted. Gymnasts presenting with RHSF were competing at a higher level than those with OCD, with 94.74% of RHSF group competing at level 7 or greater compared to 66.67% of OCD patients (p=0.02). Compared to those with OCD, the RHSF group presented more acutely following onset of symptoms (p=0.014), reported significantly more pain with valgus stress (p<0.001), and concurrent medial elbow pain than those with OCD (p<0.01). The RHSF group demonstrated significantly smaller distal humeral width and decreased height of the proximal radial epiphysis, as well as increased valgus angulation of the radial neck shaft angles and distal humeral articular surface (p<0.05). No differences in olecranon or medial epicondyle hypertrophy, or avulsive changes were identified. (Table I)

Conclusion:

Gymnasts competing at a high competitive level and presenting more acutely may be at risk for RHSF. Additionally, differing anatomy in the lateral elbow may be a predisposing risk factor for RHSF as opposed to OCD and merits further investigation.
Location of the Glenoid Defect in Shoulders with Recurrent Posterior Glenohumeral Instability
Authors: Provencher Matthew , Peebles Liam , Goldenberg Brandon , Millett Peter , Dekker Travis
Published: July 2020

Objectives:

Posterior glenoid bone deficiency is an increasingly recognized entity in the setting of recurrent posterior shoulder instability; however, little is known about the subject. Due to the paucity of literature on posterior bone loss, historical comparisons to anterior bone loss may not be fully accurate. The purpose of this study was to systematically describe the morphology of posterior bone defects in the setting of recurrent posterior shoulder instability based on several quantitative parameters, including the mean location, orientation, and extent of bone loss on a clock face model, as well as the angle of the defect relative to the long axis of the glenoid.

Methods:

3-dimensional (3D) reconstructed computed tomography (CT) scans of serially collected patients with a history of recurrent posterior shoulder instability were evaluated by three separate reviewers. The posterior glenoid bone defect was characterized using the following measures: (a) the mean lesion location and orientation based on a clock face model with 6:00 o’clock denoted as inferior and 9:00 o’clock as directly posterior for all patients; (b) the total extent of the posterior bone defect based on the clock face; and (c) the average angle of the bone loss relative to the long axis of the glenoid.

Results:

A total of 70 male patients and 1 female patient with mean age of 29.3 years (range = 24.4 to 35.1 years) were included in the analysis. The mean clock face location of the posterior glenoid defect originated at 6:44 (range = 4:16 to 8:12) and extended to a mean of 9:28 (range = 7:02 to 10:38). The mean extent of the posterior glenoid defect was 2:43 (range = 1:08 to 4:50), which corresponds to a mean total bone loss arc of 81.5° (range = 34.2° to 144.9°), nearly one quadrant of the glenoid. Posterior bone loss occurred in a posteroinferior direction at a mean angle of 30.7° (range = 8.0° to 80.0°) relative to the long axis of the glenoid.

Conclusion:

This study describes the location and orientation of posterior glenoid bone loss one can expect when treating this challenging patient population. Posterior bone defects in the setting of posterior shoulder instability most commonly occur in the posterior-inferior quadrant of the glenoid and extend on average from 6:44 to 9:28 (81.5° total degrees of arc) on a clock face model. Posterior bone loss occurs at a mean of 30° off the long axis of the glenoid in a posteroinferior direction, which is historically different from anterior bone loss, which occurs parallel to the long axis of the glenoid. This study serves to highlight the location and orientation of bone loss that one can expect in a patient with recurrent posterior shoulder instability, although additional work is needed to assess why this develops. [Figure: see text][Figure: see text][Figure: see text][Figure: see text]
Return to Sport Following Open Latarjet Procedure for Recurrent Shoulder Instability
Authors: Liu Joseph , Gowd Anirudh , Garcia Grant , Beletsky Alexander , Cabarcas Brandon , Romeo Anthony , Nicholson Gregory , Cole Brian , Verma Nikhil
Published: July 2020

Objectives:

Shoulder instability is common within athletic populations, particularly in contact sports. The Latarjet procedure is typically reserved for recurrent instability recalcitrant to soft tissue repair. Limited literature exists regarding return-to-sport following Latarjet stabilization.

Methods:

A single institutional registry was queried between 2012 – 2016 for all open Latarjet stabilization procedures. Patients with no sport history were excluded. Glenoid bone loss was measured using the PICO method. Hill-Sachs defects were categorized as “on-track” or “off-track.” Sport participation was retrospectively surveyed 3-years prior and 3-years following surgery. Factors associated with return-to-sport, throwing, and recurrent instability were assessed using multivariate logistic regressions.

Results:

A total of 92 surgeries were identified, 67 of which were available for follow-up (72.8%). Average follow-up was 53.8 ± 11.6 months. Mean age and BMI were 27.9 ± 11.6 years and 25.9 ± 8.4 kg/m2, respectively. Mean glenoid bone loss was 16.4 ± 5.1%. There were 13 Hill Sachs lesions (5 off track), with a mean defect size of 145.8 ± 60.4 mm3. The dominant side was involved in 36 patients. Fifty-two patients (77.6%) reported return-to-sport at an average of 8.6 ± 4.6 months. Thirty-six patients (53.7%) reported return-to-sport at the same or higher level than their preoperative state. Only 58.6% of throwing athletes returned to throwing post-surgery. Seven patients (10.4%) reported recurrence of instability following surgery. A higher likelihood of recurrent instability was associated with larger Hill-Sachs volume (p=0.021, OR: 1.06, 95% CI: 1.01-1.16). A reduced likelihood of returning to sport at same or better level was associated with dominant-sided surgery (p=0.010, OR: 0.362, 95% CI: 0.210-0.622).

Conclusion:

The open Latarjet procedure is associated with high rate of return-to-sport; however, nearly half were unable to return to their pre-injury level. During preoperative assessment, consideration of Hill-Sachs lesion size and laterality are significant factors for improved outcomes.
Anterior Shoulder Instability: Outcome of Initial Non-operative Treatment in 739 patients with a mean follow up of 15 years
Authors: Bernard Christopher , Leland Devin , Keyt Lucas , Krych Aaron , Dahm Diane , Camp Christopher , Duethman Nicholas
Published: July 2020

Objectives:

There remains a paucity of data describing the efficacy of non-operative treatment following an index anterior instability event. The purpose of this study was to describe the long-term outcomes of non-operative treatment following index anterior instability event, define the success rate of initial non-operative treatment for anterior shoulder instability, and describe factors that predict conversion to surgery after initial non-operative management to help guide surgical decision making in these patients.

Methods:

An established geographic database was utilized to identify patients under the age of 40 treated for anterior shoulder instability between 1994 and 2016. Patient demographics, comorbidities, injury characteristics, instability history, activity level, x-rays, advanced imaging, treatment course, and outcomes were evaluated. Patients treated non-operatively for the first 6 months following index instability event were analyzed to determine long-term outcomes, success rate of continued non-operative treatment, and factors associated with conversion to surgery.

Results:

739 patients met criteria with an average follow-up of 190 months (range 0.13 to 490 months). Average age was 23.8, mean BMI was 25.6, 9.1% had a history of hyperlaxity, and 83.9% of instability events were due to trauma. 29.7% of patients had a Hill-Sachs lesion on index x-ray, and 6.3% had a bony Bankart. 198 shoulders went on to operative treatment (26.8%) with a mean time to surgery of 62.7 months following initial instability event. At final follow-up, 24.0% reported mild pain, 6.2% as moderate, 0.2% as severe. 13.8% of patients had evidence of glenohumeral arthritis on final follow-up x-rays compared to 1.6% on initial radiographs. Factors associated with conversion to surgery included 2 or more dislocations prior to first clinical evaluation (OR=1.75, p<0.001), labor intense occupation (OR=1.49, p=0.031), Hill Sachs lesion on index x-ray (OR=1.31, p=0.034), and MRI findings including: anteroinferior labral tear (OR=2.15, p<0.001), posteroinferior labral tear (OR=1.38, p=0.049), SLAP tear (OR=1.29, p=0.054), Hill-Sachs lesion (OR=1.85, p<0.001), and glenohumeral cartilage injury (OR=1.26, p=0.041).

Conclusion:

The majority of patients less than 40 can be definitively treated non-operatively after an initial 6 month episode of non-operative treatment. A small proportion will report pain over the long-term and/or develop glenohumeral arthritis. Multiple factors upon initial evaluation were associated with future conversion to surgery including: increasing number of prior instability events, occupation, and degree of soft tissue injury on MRI.
Predictors of Clinical Outcomes After Hip Arthroscopy: 5 Year Follow- Up Analysis of 1038 Patients
Authors: Domb Benjamin , Go Cammille , Maldonado David , Chen Sarah , Lall Ajay
Published: July 2020

Objectives:

Identify predictive factors of midterm outcomes after hip arthroscopy in a cohort of 1038 patients, whose outcomes at minimum 2-year follow-up have previously been reported. In addition, to provide a comparison of short-term and midterm predictive factors in outcome measures following hip arthroscopy.

Methods:

Data were prospectively collected and retrospectively reviewed on all patients undergoing hip arthroscopy between February 2008 and June 2012. Patients were included if they had minimum 5-year follow-up on 3 patient reported outcomes: Nonarthritic Hip Score (NAHS), modified Harris Hip Score (mHHS), and Hip Outcome Score-Sport Specific Subscale (HOS-SSS). Patients were excluded if they had any prior ipsilateral hip conditions. Using bivariate and multivariate analyses, we analyzed the effect of 36 preoperative and intraoperative variables on NAHS.

Results:

A total of 1038 patients met our listed inclusion and exclusion criteria, with a mean follow-up time of 62.0 months (range, 60.0 - 120.0 months). The bivariate analysis identified 11 variables (4 categorical and 7 continuous) that were predictive of 5-year postoperative NAHS. For the multivariate analysis, 7 variables were identified as being significant: preoperative NAHS, body mass index (BMI), age, lateral joint space, alpha angle, revision hip arthroscopy, and acetabular microfracture. These 7 variables were also predictive in the bivariate analysis.

Conclusion:

This study reports favorable midterm clinical outcomes in the largest cohort of hip arthroscopies with minimum 5-year follow up in the literature to date. Seven variables were identified as being significant predictors in both the bivariate and multivariate analysis: preoperative NAHS, body mass index (BMI), age, lateral joint space, alpha angle, revision hip arthroscopy, and acetabular microfracture. Of these, preoperative NAHS, BMI, age, and revision hip arthroscopy were predictive of both 2-year and 5-year postoperative NAHS. These predictive factors may prove useful to clinicians in determining indications for hip arthroscopy and counseling patients on its expected outcomes.
Acetaminophen, Bupivacaine, Duramorph, and Toradol: A comparison of Gene Expression changes in Osteoarthritic Human Chondrocytes
Authors: Sakalian Philip , Cooke Christopher
Published: July 2020

Objectives:

To determine if exposure to Duramorph results in a lower level of chondrotoxicity than Acetaminophen, Bupivacaine, or Toradol.

Methods:

Distal femur and proximal tibia cross sections were obtained during total knee arthroplasty and a 3D Chondrocyte culture technique was performed. Digested cartilage was then treated via an alginate bead culture method to ensure lower rates of differentiation. Chondrocyte cells were exposed to the study chemicals and gene expression and chondrocyte viability were measured by RT-PCR and flow cytometry, respectively.

Results:

Exposure to Bupivacaine leads to cellular apoptosis with a % PI+ (dead) cells of 30.45, significantly greater than the other test groups P<0.001. Exposure to Toradol, duramorph and acetaminophen did not result in a significant increase in cell death. Bupivicaine also lead to an increase in Caspase 3 gene expression (p<0.001) when compared to all other groups. Acetophinophen also lead to an increased Caspase 3 gene expression when compared to control. Neither Toradol nor Duramorph led to an increase in caspase 3 gene expression.

Conclusion:

Our data show Duramorph and Toradol were not cytotoxic to human chondrocytes and may be better alternatives to the frequently used and more cytotoxic Bupivacaine. Acetominophen did not result in increased cell death however did show increased caspase 3 gene expression and caution should be considered.
The Impact of the Helmet-Lowering Rule on Regular Season NFL Injuries
Authors: Stapleton Erik , Cohn Randy , Burgess Colin
Published: July 2020

Objectives:

The National Football League (NFL) has been under growing scrutiny from the public due to the apparent rise in concussions and head injuries and the subsequent deleterious effects. In efforts to address these concerns, the NFL implemented a new “Helmet-lowering” rule prior to the 2018-2019 season. This rule is defined as “a foul if a player lowers his head to initiate and make contact with his helmet against an opponent.” The purpose of this paper was to compare incidence of injuries in NFL players prior to and after implementation of this new rule.

Methods:

NFL injury data was retrospectively reviewed from public league records for all players in regular season games played from the 2017 and 2018 NFL seasons. An injury was defined as any player listed on a team’s injury report that was not previously documented on the team’s report one week preceding the index injury. Injury rates were reported as the number of injuries per 1000 athletic exposures (AE’s). Athletic exposures were defined as equal to the sum of the total number of NFL regular-season games played. Relative risk (with 95% CI) was calculated by using the number of injuries per 1000 athletic exposures for the season before and after the new rule implementation. Risk reduction was then calculated for the overall injuries, upper/lower extremity and head injuries.

Results:

Over the 2 seasons there were a total of 2,774 injuries identified. After rule implementation at the beginning of the 2018 season, there was an overall relative risk (RR) of 0.91 for injury (95% CI 0.88 to 0.95, p<0.0001), with an injury risk reduction of 8.73%. Upper extremity injuries had a RR of 0.76 (95% CI 0.65 to 0.87, p=0.0005) and a risk reduction of 24.10%. Lower extremity injuries had a RR of 0.91 (95% CI 0.87 to 0.96, p=0.0005) with a risk reduction of 8.63%. In concussions and head injuries there was an overall RR of 0.55 for injury (95% CI 0.44 to 0.69, p<0.0001), with an injury risk reduction of 45.10%. Wide receivers and linebackers were most commonly injured players on offense and defense, respectively.

Conclusion:

Implementation of the new Helmet-Lowering rule seems to have played a role in significantly decreasing the NFL athlete’s risk of injury across all measures, most notably in concussion and head injuries.