bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining the Borderline Hip: High Variability in Acetabular Coverage and Femoral Deformity
Authors: Schwabe Maria , Pascual-Garrido Cecilia , Clohisy John , Nepple Elizabeth Graesser Jeffrey 
Published: July 2020

Objectives: Borderline acetabular dysplasia is radiographically defined as a lateral center edge angle (LCEA) of 20-25 degrees. It is well accepted that some borderline hips have instability while others have primarily impingement. The optimal management of borderline dysplasia is challenging and particularly complex due to the anatomic variability that exists among patients but has not been well characterized. The purpose of this current study was to investigate the variability in hip deformity present on low-dose CT in a cohort of patients with symptomatic borderline acetabular dysplasia. Methods: Seventy consecutive hips with borderline acetabular dysplasia undergoing surgical treatment were included in the current study. Radiographic evaluation included LCEA, acetabular inclination, anterior center edge angle (ACEA), and alpha angles on AP, Dunn, and frog views. All patients underwent low-dose pelvic CT for preoperative planning. Femoral deformity was assessed with femoral version, alpha angle (measured at 1:00 increments), and maximum alpha angle. Radial acetabular coverage was calculated according to standardized clockface positions [measured from 8:00 (posterior) to 4:00 (anterior)] and defined as normal, undercoverage, or overcoverage relative to 1 SD from the mean of normative values. Results: The mean LCEA was 22.1+1.4, while the mean acetabular inclination was 10.3+3.3. The mean ACEA in the group was 25.3+5.8 (range 10.1-43.9), with 16% having an ACEA < 20 and 50% having an ACEA < 25. The mean femoral version was 17.9° (range -4° to 59°). The mean maximal alpha angle was 57.2° (range 43° to 81°) with 61.4% greater than 55°. Lateral coverage (RAC at 12:00) was deficient in 74.1% of cases. Anterior coverage (RAC at 2:00) was highly variable with 17.1% undercoverage, 72.9% normal, and 10.0% overcoverage. Posterior coverage (RAC at 10:00) was also highly variable with 30.0% undercoverage, 62.9% normal, and 7.1% overcoverage. The three most common patterns of coverage were: isolated lateral undercoverage (31.4%), normal coverage (18.6%), and lateral and posterior undercoverage (17.1%). Conclusion: Patients with borderline acetabular dysplasia demonstrate highly variable three-dimensional deformities including anterior, lateral, and posterior acetabular coverage, femoral version, and alpha angle. Comprehensive deformity characterization in the population is important to guide diagnosis and treatment decisions. [Figure: see text][Figure: see text][Figure: see text]
Are Chondrocytes Overlying Cam Morphology Suitable for Therapeutic Use?
Authors: Coleman Mitchell , Westermann Robert 
Published: July 2020

Objectives: Cam-type femoroacetabular impingement (FAI) results in extra bone and cartilage on the anterolateral femoral head-neck junction, causing abnormal contact between the femur and the acetabulum. We investigated whether chondrocytes isolated from cam lesions in FAI patients are metabolically similar to normal chondrocytes and therefore a potential option for therapeutic use via autologous implantation. Methods: Cam cartilage was obtained intraoperatively from 7 human patients with cam lesions (Alpha angle > 60 degrees) (4 arthroscopy, 2 arthroplasty, and 1 periacetabular osteotomy). Healthy femoral and acetabular articular cartilage was obtained from 8 Yucatan minipig hips for comparison. Chondrocytes were extracted from the cartilage then cultured at a high density for up to 1 week. Mitochondrial stress testing procedures (with 2 mM oligomycin, 2.5 mM carbonyl cyanide p-trifluoromethoxy-phenylhydrazone (FCCP), 2 mM rotenone, 5 mM antimycin A) for determination of the chondrocytes basal and maximal respiration were performed. Results: No significant differences in basal (p = 0.73) or maximum (p = 0.40) respiration were found when comparing chondrocytes from cam lesions to normal porcine articular chondrocytes. There was a significant difference in maximum respiration when comparing chondrocytes from cam lesions in patients who underwent a total hip arthroplasty to chondrocytes from other cam lesions (p = 0.007). Conclusion: Basal and maximum respiration in chondrocytes from cartilage overlying cam lesions suggests a similar level of respiration to healthy articular chondrocytes. Given the importance of mitochondria to cartilage homeostasis, this study supports that chondrocytes overlying non-arthritic femoral cam lesions may be a novel source of healthy chondrocytes.
Intact Ligamentum Teres Predicts Superior Prognosis in Borderline Dysplastic Patients: A Matched Pair Controlled Study with Minimum Five-Year Outcomes Following Hip Arthroscopy
Authors: Domb Benjamin , Chen Sarah , Walker-Santiago Rafael , Shapira Jacob , Rosinsky Philip , Lall Ajay , Maldonado David 
Published: July 2020

Objectives: (1) To report minimum five-year patient reported outcomes (PROs) in borderline dysplastic patients with ligamentum teres (LT) tears who underwent hip arthroscopy and (2) to compare these PROs to a pair-matched control group of borderline dysplastic hips without LT tears. Methods: Data was prospectively collected for patients who underwent hip arthroscopy during September 2008 and August 2013. Patients were included if had a preoperative diagnosis of borderline dysplasia [lateral center-edge angle (LCEA) of 18°- 25°] and had preoperative and minimum five-year postoperative modified Harris Hip Scores (mHHS), Non-Arthritic Hip Scores (NAHS), and Visual Analogue Scale for pain (VAS) scores. Exclusion criteria were Tönnis grade osteoarthritis >1, previous hip conditions, any prior ipsilateral hip surgery, or workers’ compensation status. Two borderline dysplastic groups were created. An LT tear group was matched 1:1 to a control group (no LT tear) with similar age, sex, body mass index (BMI), and laterality via propensity score matching. Significance was set at P < 0.05. Results: 24 LT tear patients (24 hips) were matched 24 patients (24 hips) without an LT tear. There was no significant difference in age, sex, BMI, or laterality between groups. Mean age was 36.2 ± 17.2 and 34.9 ± 15.9 years for the control and LT tear group, respectively (P = 0.783). There were 17 (70.8%) and 16 (66.7%) females in the control and LT tear group, respectively and the mean preoperative LCEA was 23.3° and 22.2° in the control and LT tear group, respectively. No differences were observed between groups in baseline PROs, intraoperative findings, or surgical procedures, except for LT treatment. Five-year postoperative PROs were comparable in both groups, with the control group exhibiting superior Veterans RAND 12-Item Health Survey Mental Component (VR-12M) (P = 0.041) and Short Format 12 Mental Health (SF-12M) (P = 0.042). The control group exhibited less pain and higher satisfaction with surgery; however, this trend was not significant. Finally, the LT tear group was significantly less likely to achieve the patient acceptable symptomatic state (PASS) for mHHS (P = 0.022). Conclusion: Following hip arthroscopy, patients with borderline dysplasia and LT tears demonstrated favorable PROs at minimum five-year follow-up. Outcomes were similar to a pair-matched control group without LT tears, with the control group showing higher VR-12M and SF-12M scores. Furthermore, borderline dysplastic patients with LT tears were significantly less likely to achieve the PASS for mHHS.
Acetabular Dysplasia: Three-Dimensional Deformity Predictors of the Diagnosis of Symptomatic Instability Treated with Periacetabular Osteotomy
Authors: Schwabe Maria , Pascual-Garrido Cecilia , Clohisy John , Graesser Elizabeth , Nepple Jeffrey 
Published: July 2020

Objectives: Borderline acetabular dysplasia is classically defined as a lateral center edge angle (LCEA) of 20-25 degrees. The optimal treatment strategy in this patient group remains controversial, with some patients having primarily hip instability-based symptoms, while others have primarily impingement-based symptoms (non-instability). The purpose of the current study was to define the 3D characteristics on low-dose CT that differentiate patients with instability symptoms from those without instability in the setting of borderline acetabular dysplasia. Methods: Seventy consecutive hips with borderline acetabular dysplasia undergoing surgical treatment were included in the current study. All patients underwent low-dose pelvic CT with femoral version assessment for preoperative planning. CT measurements included alpha angle and radial acetabular coverage (RAC) at standardized clockface positions (9:00-posterior to 3:00-anterior), central and cranial acetabular version. RAC was assessed in three sectors (anterior, superior, and posterior) and defined (relative to published normative data) as normal (-1 SD, +1 SD), undercoverage (<-1 SD), or overcoverage (>+1 SD). Statistical analysis was performed to compare the CT characteristics of the symptomatic instability and non-instability groups. Results: Of the 70 hips, 62.9% had the diagnosis of symptomatic instability, while 37.1% had no instability symptoms. Hips with instability (compared to non-instability) had significantly lower alpha angle (maximal difference at 1:00 - 47.0° vs. 59.4°), increased femoral version (22.3° vs. 15.3°), and decreased radial acetabular coverage (maximal difference at 1:00 – 59.9% vs. 62.2%) (all p<0.001). Multivariate analysis identified femoral version (OR 1.1, p=0.02), alpha angle at 1:00 (OR 0.91, p=0.02), and RAC at 1:00 (OR 0.46, p=0.003) as independent predictors of the presence of instability. The model combining these three factors had excellent predictive probability with a c-statistic 0.92. Conclusion: We found significant differences in the 3D hip morphology of the symptomatic instability and non-instability subgroups within the borderline dysplasia cohort. In the setting of borderline dysplasia, three-dimensional deformity characterization with low-dose CT allowed for differentiation of patients diagnosed with underlying instability vs. non-instability. Femoral version, alpha angle at 1:00, and radial acetabular coverage at 1:00 were identified as independent predictors of diagnosis in borderline acetabular dysplasia.
The Evaluation of Trochlear Osseous Morphology: An Epidemiologic Study
Authors: Yalçin Sercan , Onor Gabriel , Kaar Scott , Pace lee , Ferrua Paolo , Farrow Lutul 
Published: July 2020

Objectives: The purpose of this study is to investigate the prevalence of the trochlear dysplasia in our study population. Methods: We obtained 692 skeletally mature femoral specimens from the [Blinded Institution], [Blinded Collection]. Five observers were asked to evaluate each specimen for trochlear dysplasia on a scale between 0 and 3 (0 – normal/no dysplasia; 1 – mild dysplasia; 2 – moderate dysplasia; 3 – severe dysplasia). Each observer made initial evaluations for interobserver reliability. Each observer then re-evaluated each specimen one month later to determine intraobserver reliability. We evaluated inter and intraobserver reliability utilizing intraclass correlation coefficient (ICC). All statistics were performed with SPSS v.25 (IBM, USA). Results: The interobserver ICC of first and second evaluation of all observers were found to be 0.906 [0.894-0,916] and 0.904 [0.892-0.915], respectively. The intraobserver ICC of observers were as follows: Reviewer1: 0.799 [0.771-0.825]; Reviewer2: 0.686 [0.645-0.724]; Reviewer3: 0.808 [0.781-0.832]; Reviewer4: 0.787 [0.757-0.814]; Reviewer5: 0.778 [0.747-0.806]. These results show intra and interobserver correlation was good to excellent. The percentages of normal trochlea, mild dysplasia, moderate dysplasia and severe dysplasia for first evaluation, by reviewer, are as follows: Reviewer 1: 82.7%, 12.1%, 4.0%, 1.2%; Reviewer 2: 37.3%, 26.2%, 27.5%, 9.1%; Reviewer 3: 57.9%, 28.0%, 12.1%, 1.9%; Reviewer 4: 64.2%, 25.6%, 7.7%, 2.6%; Reviewer 5: 65.6%, 14.9%, 12.3%, 7.2%. The percentages of normal trochlea, mild dysplasia, moderate dysplasia and severe dysplasia for second evaluation, by reviewer, are as follows: Reviewer 1: 78.8%, 16.6%, 3.6%, 1.0%; Reviewer 2: 40.3%, 26.4%, 23.3%, 10.0%; Reviewer 3: 42.2%,35.1%, 18.8%, 3.9%; Reviewer 4: 57.4%, 31.9%, 8.2%, 2.5%; Reviewer 5: 73.7%, 8.2%, 9.7%, 8.4%. In total, the percentages of normal trochlea, mild dysplasia, moderate dysplasia and severe dysplasia were 60.00%, 22.51%, 12.72%, 4.77%; respectively. Conclusions: This study shows that although there was no absolute criteria to grade trochlear dysplasia, observers had similar opinions on the degree of dysplasia. Also, our cohort shows that moderate to severe dysplasia is not uncommon as it is present in around 17% of knees in our cohort. This is the first epidemiologic study evaluating the prevalence of trochlear dysplasia in the normal population.
Synovial Fluid Biomarkers in the Osteoarthritic Knee: Differences in Concentration with Progression of Radiographic Severity
Authors: Whitney Darryl , Klein David , Rodriguez Tiffany , Kenny Lena , Strauss Eric , Kingery Matthew 
Published: July 2020

Objectives: The purpose of the current study was to analyze the synovial fluid concentrations of known inflammatory biomarkers in the setting of symptomatic osteoarthritis (OA) of the knee and assess for any differences in biomarker concentrations based on the extent of radiographic disease. Methods: Patients presenting with knee complaints were invited to provide synovial fluid samples from the symptomatic knee during their initial office visit. For this study, a subset of patients with OA was analyzed. The concentration of 16 synovial fluid biomarkers was measured, including TIMP-1, TIMP-2, TIMP-3, MMP-13, IL-6, MCP-1, MIP-1β, VEGF, bFGF, eotaxin, IL-1Ra, MMP-1, MMP-3, MMP-9, RANTES, and TSG-6. Samples were analyzed using a multiplex magnetic bead immunoassay. Patients were divided into a low-grade OA group (K-L ≤ 2 or OARSI ≤ 1) or a high-grade cartilage OA group (K-L ≥ 3 or OARSI ≥ 2). Results: 101 patients were included in this analysis. There was a significant difference in MIP-1β (p=0.025) and bFGF (p=0.015) concentrations between OARSI grade groups. Patients with high-grade joint space narrowing had significantly greater concentrations of MIP-1β (p=0.022) and bFGF (p=0.003). There was a significant difference in MIP-1β concentration between K-L grade groups (p=0.013). Patients in the high-grade K-L group had a significantly greater concentration of MIP-1β (p=0.020). Conclusions: The synovial fluid concentrations of two synovial fluid biomarkers were found to differ significantly based on the extent of radiographic OA present. MIP-1β is a pro-inflammatory growth factor known to induce the synthesis of other inflammatory factors including interleukins and TNF-α. bFGF is a growth factor that is known to promote chondrogenesis, angiogenesis, wound healing, and granulation tissue formation. Continued study of synovial fluid biomarkers in the setting of symptomatic OA may improve our understanding of the pathogenesis of disease and identify treatment targets in an attempt to halt disease progression.
SAUCERIZATION OF DISCOID LATERAL MENISCI. HOW MUCH RESIDUAL WIDTH IS RIGHT?
Authors: Abdalla Abdalla , Meadows Molly , Rauer Thomas , Chan Charles , Ganley Theodore , Shea Kevin , Gamble JAMES , Gamble Jamison 
Published: July 2020

Objectives: Discoid lateral meniscus (DLM) is a congenital anomaly of the knee where the normally “O” shaped lateral meniscus has redundant tissue filling the “O” and covering the lateral tibial plateau. The redundant tissue can degenerate and cause mechanical symptoms and pain. Treatment of symptomatic DLM is arthroscopic saucerization to reshape the meniscus to a more normal contour. Enough tissue must be removed to eliminate mechanical symptoms but not too much as to create instability. The residual width of the meniscus is crucial at the popliteus hiatus because here the peripheral rim is unattached to the capsule. The literature recommends a residual width of 6-8 mm. The primary purpose of this research was to determine the width of the meniscus at the popliteal hiatus in normal specimens. Our null hypothesis was that a residual width of 6-8 millimeters will be sufficient for saucerization of DLM. Methods: We made direct measurements of lateral meniscus radial width from the outer rim at the popliteus hiatus to the inner edge (Figure 1) in 19 specimens (ages 2 months to 11 years.) We measured one four-year-old specimen with bilateral complete DLM (Figure 2.) We also measured 39 digital images of specimens (ages 1-month to 12-years) using ImageJ. Finally, we made direct measurements of 8 skeletally mature specimens. Results: Figure 3 shows the relationship of meniscus width as a function age. The average width of specimens <3-years-old was 5.5mm. The average width of the ten-year-old specimens was 12mm. The average width of the skeletally mature specimens was 16mm. The four-year-old DLM specimen measured 19 mm. Conclusions: We rejected our null hypothesis. Direct measurements suggest that a residual width of 6-8mm is insufficient for children 8-years and older. A width of at least a full centimeter more closely approximates our findings, and for adolescents consider a residual rim of 15 mm. For children less than six-years-old a residual width of 6-8mm is sufficient.
Achieving Successful Outcomes of Hip Arthroscopy in the Setting of Generalized Ligamentous Laxity with Labral Preservation and Appropriate Capsular Management: A Matched Pair Controlled Study
Authors: Domb Benjamin , Chen Jeffrey , Rosinsky Philip , Shapira Jacob , Lall Ajay , Yelton Mitchell , Brayboy Ciaron , Maldonado David 
Published: July 2020

Objectives: (1) To report minimum two-year PROs in patients with generalized ligamentous laxity (GLL) who underwent hip arthroscopy and (2) to compare clinical results to a matched-pair control group without GLL. Methods: Data from a prospectively collected database was retrospectively reviewed between August 2014 and December 2016. Patients were considered eligible if they received primary arthroscopic treatment for symptomatic labral tears and femoroacetabular impingement (FAI). Inclusion criteria included preoperative and minimum two-year follow-up scores for the following PROs: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Scale (HOS-SSS), and Visual Analogue Scale (VAS). Patients were excluded if they had preoperative Tönnis ≥ 2, ipsilateral hip condition, prior hip surgery, worker’s compensation status, or dysplasia. From the sample population, two groups were created: the GLL group (Beighton ≥ 4) and the control group (Beighton < 4). Patients were matched in a 1:2 ratio via propensity-score matching according to age, gender, body mass index (BMI), acetabular and femoral head Outerbridge grade, and preoperative lateral center-edge angle (LCEA). Patient Acceptable Symptomatic State (PASS) and Minimal Clinically Important Difference (MCID) for mHHS and HOS-SSS were calculated. PASS was also calculated for International Hip Outcome Tool-12 (iHOT-12) as well as MCID for VAS. Significant differences were noted if P < 0.05. Results: 95 patients with GLL were matched to 143 control patients. Age, gender, BMI, and follow-up times were not different (P > 0.05). Preoperative radiographic measurements demonstrated no difference. Intraoperative findings and procedures between groups were similar except for capsular treatment, with the GLL group receiving more plications (P = 0.004). Both groups reported similar baseline PROs and VAS. At minimum two-year follow-up both groups showed significant improvement in PROs and VAS (P < 0.001), furthermore, the postoperative PROs at minimum two-year follow-up showed no difference (P > 0.05) and the magnitude of improvement (delta value) was similar for mHHS (P = 0.93), NAHS (P = 0.809), HOS-SSS (0.398) and VAS (P = 0.824). Moreover, groups reached comparable rates of MCID and/or PASS for mHHS, HOS-SSS, iHOT-12, and VAS. Conclusions: Patients with GLL following hip arthroscopy for symptomatic FAI and labral tears, may expect favorable outcomes with appropriate labral and capsular management at minimum two-year follow-up. When compared to a pair-matched control group without GLL, results were comparable for mHHS, NAHS, HOS-SSS, VAS and reaching PASS and/or MCID for mHHS, HOS-SSS, iHOT-12 and VAS.
What Are the Outcomes of Meniscus Repair vs Excision in Stable Knees in High School and College Athletes: A Prospective Cohort Study
Authors:   Cleveland Clinic Sports Health Group, Egger Anthony , Flynn Megan , Jin Yuxuan , Strnad Greg , Spindler Kurt , Saluan Paul 
Published: July 2020

Objectives: In high school and college athletes, the results of isolated meniscectomy compared to meniscal repair in ligamentously stable knees is unknown. Our objective was to compare patient-reported outcomes and reoperation rates at a minimum 1 year of follow-up for high school and college athletes undergoing isolated meniscal repair compared to meniscectomy. We hypothesized that both groups would see significant improvement in outcomes with meniscectomy having higher reported outcomes and a lower reoperation rate compared to meniscal repair. Methods: Patients aged 13-22 years old undergoing meniscal surgery at a single institution between 2015-2017 were prospectively enrolled and followed in our outcomes management evaluation system (OME). Pre-operatively, patients’ baseline demographics and patient-reported outcomes (PROMs) specific to meniscal pathology were collected, including Knee Injury and Osteoarthritis Outcome Score (KOOS) pain and quality of life (QoL) subsets. Post-operatively, intra-operative findings and treatments were recorded from OME. Patients were contacted and completed a minimum 1- or 2-year patient-reported outcome measures survey. Embedded in the post-operative survey was a question designed to evaluate the Patient Acceptable Symptom State (PASS). Patients were also specifically asked if they had undergone any subsequent surgeries to either knee since their primary procedure as a preliminary assessment of early failure. Results: A total of 145 patients were enrolled (70% male; median age, 18 years). One-year minimum PROMs were obtained on 73% (n=106) of the cohort. The results are displayed in the table and figure. KOOS QoL (see figure) and pain scores at minimum 1-year follow-up were not significantly different between meniscal repair compared to meniscectomy. Reoperation rate was 7.5% overall with no significant difference noted between the groups. No individual variables, including body mass index (BMI), smoking, level of education, mental health status, or grade 3 or 4 cartilage lesions were found not to be significant risk factors for outcome in either group. A PASS was achieved in 82% of the meniscectomy group and 71% of the meniscal repair group. Conclusion: High school and college athletes undergoing isolated meniscal surgery had equally significant improvements in minimum 1-year PROMs regardless of whether they underwent meniscectomy or meniscal repair. Preliminary reoperation rates were similar amongst the two treatment groups and the majority of both groups achieved a patient acceptable symptom state. No individual variable was identified as a modifiable risk factor to poor outcome after isolated meniscal surgery in this age group. [Figure: see text]