bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of Stem Cell Therapy for Tendon Disorders: A Systematic Review
Authors: van den Boom Noortje Anna Clasina , Winters Marinus , Haisma Hidde Jacobs , Moen Maarten Hendrik 
Published: April 2020

Background: Stem cell therapy is an emerging treatment for tendon disorders. Purpose: To systematically review the efficacy of stem cell therapy for patients with tendon disorders. Study Design: Systematic review; Level of evidence, 4. Methods: MEDLINE/PubMed, EMBASE, CINAHL, CENTRAL, PEDro, and SPORTDiscus; trial registers; and gray literature were searched to identify randomized controlled trials (RCTs) and non-RCTs, cohort studies, and case series with 5 or more cases. Studies investigating any type of stem cell therapy for patients with tendon disorders were eligible if they included patient-reported outcome measures or assessed tendon healing. Risk of bias was assessed through use of the Cochrane risk of bias tools. Results: This review included 8 trials (289 patients). All trials had moderate to high risk of bias (level 3 or 4 evidence). In Achilles tendon disorders, 1 trial found that allogenic-derived stem cells led to a faster recovery compared with platelet-rich plasma. Another study found no retears after bone marrow–derived stem cell therapy was used in addition to surgical treatment. There were 4 trials that studied the efficacy of bone marrow–derived stem cell therapy for rotator cuff tears. The controlled trials reported superior patient-reported outcomes and better tendon healing. A further 2 case series found that stem cell therapy improved patient-reported outcomes in patients with patellar tendinopathy and elbow tendinopathy. Conclusion: Level 3 evidence is available to support the efficacy of stem cell therapy for tendon disorders. The findings of available studies are at considerable risk of bias, and evidence-based recommendations for the use of stem cell therapy for tendon disorders in clinical practice cannot be made at this time. Stem cell injections should not be used in clinical practice given the lack of knowledge about potentially serious adverse effects.
Tendon Morphology and Mechanical Properties Are Associated With the Recovery of Symptoms and Function in Patients With Achilles Tendinopathy
Authors: Corrigan Patrick , Cortes Daniel H. , Pohlig Ryan T. , Grävare Silbernagel Karin 
Published: April 2020

Background: Achilles tendinopathy is a debilitating overuse injury characterized by pain, altered Achilles tendon structure, and impaired functional performance. Evaluating tendon structure as part of the physical examination may help establish a well-defined prognosis. However, the usefulness of measuring tendon structure for developing a prognosis has been questioned since structural abnormalities can exist without symptoms. Purpose: To determine whether initial measures of tendon morphology and mechanical properties were associated with patient-reported symptoms and calf muscle endurance at baseline, 6-month follow-up, and 1-year follow-up by prospectively following a cohort of individuals with Achilles tendinopathy. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 59 participants with midportion or insertional Achilles tendinopathy completed an initial assessment and follow-up assessments at 6 months and 1 year. At the initial assessment, patient-reported symptoms, calf muscle endurance, and Achilles tendon thickening were evaluated, and Achilles tendon mechanical properties were estimated. At the 6-month and 1-year follow-up assessments, patient-reported symptoms and calf muscle endurance were reevaluated. Results: Greater Achilles tendon thickening at the initial assessment was consistently associated with worse patient-reported symptoms and calf muscle endurance at each assessment. Changes in symptoms over the year were moderated by the initial shear modulus of the tendon, with a lower shear modulus associated with less improvement in symptoms. Lower viscosity at the initial assessment was also associated with worse calf muscle endurance at each assessment. Conclusion: Measures of tendon morphology and mechanical properties appear to be associated with patient-reported symptoms and calf muscle function for patients with Achilles tendinopathy.
EVALUATION OF SERUM RELAXIN CONCENTRATIONS AND KNEE VALGUS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: Gilmer Gabrielle G. , Roberts Michael D. , Oliver Gretchen 
Published: April 2020

Background: Athletes who sustain an anterior cruciate ligament (ACL) injury are more likely to develop adverse health outcomes, such as knee osteoarthritis, knee pain, and obesity. It is assumed that the long-term consequences of ACL reconstruction are caused by the reconstruction itself. Studies have observed that relaxin, a peptide hormone similar in structure to insulin, interferes with the structural integrity of the ACL and elicits long term effects on bone, joint, muscle, and tendon health. Given the known effects of relaxin, it is reasonable to wonder if relaxin contributes to the development of these long-term health outcomes, independently of the ACL injury. Hypothesis/Purpose: The purpose of this study was to evaluate knee valgus and serum relaxin concentrations (SRC) in athletes who have and have not sustained an ACL injury. It was hypothesized that athletes who previously tore their ACL would have higher SRC and more knee valgus than those who were injury free. Methods: Twenty-two female athletes participated. Participants were assigned to one of two groups: ACL injury (6.0 ± 3.3 years after surgery, N = 4) and injury free (N = 18). Kinematic data were collected at 100 Hz using The MotionMonitor. Participants performed a single leg squat (SLS), single leg crossover dropdown (SCD), and drop vertical jump (DVJ) at two different time points in their menstrual period: pre-ovulatory phase and mid-luteal phase. Blood samples were collected when SRC are measurable (mid-luteal phase), and SRC were determined using a Quantikine Human Relaxin-2 Immunoassay. Results: Independent samples t-tests revealed significant differences between those who tore their ACL and those who were injury free in SRC and knee valgus during the SLS in the mid luteal phase, DVJ in both phases, and SCD in both phases. Specifically, the participants who tore their ACL had significantly higher SRC and more knee valgus than those who did not tear their ACL. Conclusion: These findings suggest that a previous ACL injury could place one at an increased risk of re-tear and other adverse effects on their joints, muscles, and tendons. Thus, further investigating hormonal risk factors during long term monitoring of recovery is needed.
THE INCIDENCE OF CONCUSSION AND SYMPTOM NON-REPORTING AMONG PROFESSIONAL WOMEN’S ICE HOCKEY PLAYERS
Authors: Whitney Darryl , Gonzalez-Lomas Guillem , Carter Cordelia W. 
Published: April 2020

Background: Female hockey players have rates of sports-related concussion that are similar to male hockey players at various levels of play, despite differences in the rules that do not allow for body checking in the women’s game. One proposed hypothesis is that females are more likely than their male counterparts to report concussion symptoms to a coach or medical professional. At the elite level, there are limited data regarding concussion rates and concussion symptom reporting. Purpose: The purpose of this study was to determine the incidence of concussion and concussion symptom reporting in professional women’s ice hockey players. Methods: An anonymous survey was given to players of two National Women’s Hockey League (NWHL) teams at the time of their 2018-2019 end-of-season physicals. Players reported on the number of concussions in their career diagnosed by a physician, the number of times they have had concussion symptoms, how many times they continued playing after experiencing concussion symptoms, how many times they never told a medical professional or coach after having symptoms, and how many times they eventually disclosed their symptoms. Results: Fifty-four players anonymously completed the survey. Thirty-one(57%) of respondents reported at least one concussion diagnosed during their playing career, with 16(30%) reporting 2 or more diagnosed concussions. Thirty-six(67%) players reported experiencing concussion symptoms at least once, with 26(48%) reporting 2 or more occurrences of such symptoms. Of these players, 68% reported that they continued playing at least once after experiencing concussion symptoms. 36% of those players reported that they never told anyone about these symptoms on at least one occasion. Forty-four(81%) players either agreed or strongly agreed with the statement “I’m more likely to report concussion symptoms knowing what I know now.” Conclusion: There is a high incidence of sport related concussions in women’s professional ice hockey players as well as an alarming rate of symptom non-reporting. More than half of players experience at least one concussion during their career, with more than two-thirds of these continuing to play despite having concussion-related symptoms and more than one-third of these never reporting the concussion symptoms at all. Additional research is needed to determine the reasons for the high rates of concussion in women’s ice hockey players despite the no-checking policy; the motivation for not disclosing concussion symptoms when they occur; and the effects that concussion education has had on changing symptom reporting behaviors for ice hockey players at the elite level.
DIFFERENCES IN ACUTE POSTOPERATIVE PAIN AFTER ACL RECONSTRUCTION IN ADOLESCENT PATIENTS: ALL SOFT-TISSUE QUADRICEPS VERSUS HAMSTRING AUTOGRAFT
Authors: Levy Brandon , Holland Erica , Bompadre Viviana , Schmale Gregory A. , Saper Michael 
Published: April 2020

Background: Postoperative pain after anterior cruciate ligament (ACL) reconstruction is a subjective experience that contributes significantly to patient satisfaction and subjective outcomes. As such, it is important for surgeons to counsel their patients and set appropriate expectations following surgery. ACL reconstruction with hamstring (HS) tendon autograft remains the most popular graft choice in adolescent patients with open physes, yet recently, reconstruction using all soft-tissue quadriceps tendon autograft has gained in popularity. However, studies are lacking that evaluate acute postoperative pain after quadriceps autograft. Hypothesis/Purpose: To investigate differences in acute postoperative pain between adolescent patients undergoing ACL reconstruction with all soft-tissue quadriceps versus HS autograft. Methods: A retrospective review was performed of 65 patients that underwent primary ACL reconstruction using either quadriceps (n = 33) or HS (n = 32) autografts between October 2017 and April 2019. All patients received ultrasound-guided adductor canal catheters and single-shot sciatic nerve blocks preoperatively and followed a standard postoperative multi-modal pain management plan. Intraoperative and postoperative intravenous (IV) morphine equivalents (MEQ), post-anesthesia care unit (PACU) length of stay (LOS), and PACU pain scores (numeric rating scale, 0-10) were recorded. Pain scores and supplemental oxycodone use were recorded on postoperative days (POD) 1-3. Differences were compared between the two groups. Results: The mean age at the time of surgery was 15.2 ± 1.5 years. There were no statistically significant differences in age ( p = 0.62), sex ( p = 0.72), BMI ( p = 0.18), concomitant meniscus repairs ( p = 0.71), or surgical time ( p = 0.52) between the two groups. There were no statistically significant differences in intraoperative IV MEQs ( p = 0.44), PACU IV MEQ ( p = 0.43), or PACU LOS ( p = 0.47) between the two groups. Patients treated with quadriceps autograft has lower max PACU pain scores (3.2 ± 3.2 vs 4.1 ± 3.1; p = 0.27) and required less supplemental oxycodone doses on POD 1 (1.1 ± 1.2 vs 1.8 ± 1.6; p = 0.07) but the differences were not statistically significant. Max pain scores (at rest and with movement) on POD 1-3 and oxycodone use on both POD 2 and POD 3 were similar between groups. Conclusion: In the setting of a multi-modal pain management plan including regional anesthesia, adolescent patients undergoing ACL reconstruction with quadriceps tendon autograft and hamstring autograft have similar pain levels and opioid use in the acute postoperative period.
TRENDS IN CONCOMITANT MENISCAL SURGERY AMONG PEDIATRIC PATIENTS UNDERGOING ACL RECONSTRUCTION: AN ANALYSIS OF ABOS PART II CANDIDATES FROM 2000-2016
Authors: Cruz Aristides I. , Gao Burke , Ganley Theodore J. , Shea Kevin , Beck Jennifer , Ellis Henry 
Published: April 2020

Background: Rates of ACL reconstruction among pediatric/adolescent patients are increasing. Limited knowledge exists about population level rates of concomitant meniscal surgery in this population. Hypothesis/Purpose: To examine trends in concomitant meniscus procedures and describe short-term complications in pediatric/adolescent patients undergoing ACL reconstruction. We hypothesized that overall meniscal surgery rates are increasing, and that the likelihood of performing meniscal repair or meniscectomy is associated with patient and surgeon specific factors. Methods: ACL procedures in patients <19 years reported by ABOS Part II examination candidates from 2000-2016 were queried. Regression models examined associations between patient & surgeon characteristics, year of surgery, follow-up time, meniscal procedure type, and number and type of complications. Results: 9,766 cases were identified. Females represented 46% (n=4,468). Average patient age was 16.1 years (SD: 1.62, range 0-18). The rate of concomitant ACL-meniscal procedures increased from 2000-2016 (49%-60%; p=0.005). Surgeons with sports medicine (+7.0%) or pediatric orthopaedics fellowship (+6.6%) training had a higher likelihood of reporting a concomitant ACL-meniscus procedure (p=0.003; p=0.006, respectively). Sports medicine (+3.0%) trained surgeons were more likely to perform meniscus repair vs. meniscectomy (p=0.016). Younger patient age was associated with increased likelihood of undergoing meniscus repair vs. meniscectomy. Overall reported complication rate was 12.8%. Notable reported complications included: infection (1.61%), arthrofibrosis (1.14%), and DVT/PE (0.11%). Sports medicine and pediatric orthopaedic fellowship training were associated with higher rates of reporting post-operative stiffness/arthrofibrosis. Conclusions: Among ABOS Part II candidates, concomitant ACL-meniscus surgery has become more common than isolated ACL procedures. Surgeries involving sports medicine fellowship trained surgeons and younger patients were associated with increased rates of meniscus repair vs. meniscectomy. Pediatric orthopaedics and sports medicine training were associated with a higher likelihood of being involved in a concomitant ACL-meniscus procedure and also reported a higher incidence of post-operative stiffness/arthrofibrosis. [Figure: see text][Figure: see text]
SYMPTOM PROFILES AND BALANCE CONTROL AFTER CONCUSSION AMONG FEMALE YOUTH ARTISTIC ATHLETES
Authors: Sweeney Emily A , Wilson Julie C , Potter Morgan N , Dahab Katherine S , Denay Keri L , Howell David R 
Published: April 2020

Background: Collision and contact sports are often the focus of concussion research; however, concussions also occur in artistic sports, including gymnastics and cheerleading. Few studies have examined how concussion presents in female youth artistic athletes. Specifically, the effects of concussion on symptom profiles and balance performance among these athletes have yet to be investigated. Hypothesis/Purpose: The purpose of our investigation was to compare post-concussion symptom profiles and balance measures among female youth artistic athletes relative to ball sport athletes. We hypothesized that artistic athletes would have similar concussion symptom profiles to ball sport athletes, but that artistic athletes would display better balance due to the demands of their sport. Methods: Female youth athletes ages 6-18 years who sustained a concussion during gymnastics or cheerleading (i.e. “artistic athletes”) or during volleyball or basketball (i.e. “ball sport athletes”) were seen within 3 weeks of injury. We compared performance between the two groups on measures of self-reported symptom frequency using the Health and Behavior Inventory (HBI), headache severity, and balance control using the Balance Error Scoring System (BESS), tandem gait, and Romberg tests. We compared outcome variables between groups using univariable Mann-Whitney U and Fisher’s exact tests. We constructed multivariable regression models to account for potential confounding variables, defined as those that demonstrated a difference between groups of p < 0.2. Results: Twenty-seven artistic athletes and forty-nine ball sport athletes sustained a concussion during the study period of 2015-2017. The artistic athletes were slightly younger, seen later for initial evaluation after injury, had a lower proportion with prior concussion history, and a lower proportion with pre-injury history of migraine compared to ball sport athletes (Table 1). Thus, these four variables were included as covariates in subsequent regression models. After adjusting for the independent effect of these potential confounding variables, we observed that artistic athletes performed the BESS tandem stance foam condition with significantly fewer errors than ball sport athletes (Table 2). Artistic female athletes demonstrated a higher, yet not statistically significant, headache severity than ball sport female athletes. Conclusion: Female artistic athletes had similar symptom profiles to ball sport athletes. Although artistic athletes performed better on BESS tandem stance foam condition, their other measures of balance control were not significantly different from ball sport athletes. This suggests that although their sports may require higher levels of balance, artistic athletes’ performance on post-concussion balance tests may be similar to athletes of other disciplines. Tables: [Table: see text][Table: see text]
MPFL GRAFT TENSIONING TO TREAT PATELLAR INSTABILITY RELATED TO PATELLA ALTA: DYNAMIC SIMULATION
Authors: Jones Travis , Jones Kerwyn C. , Elias John J. 
Published: April 2020

Background: Medial patellofemoral ligament (MPFL) reconstruction is a popular treatment for lateral patellar instability. For knees with patella alta, however, tibial tuberosity distalization is the most common approach due to concerns about graft tensioning. A MPFL graft is tensioned intra-operatively to prevent lateral subluxation without over-constraining the patella by allowing some translation. Purpose: To analyze the effects of MPFL reconstruction on lateral tracking and cartilage pressure for knees with patella alta using dynamic simulation of knee function. Methods: Knee function was simulated with 8 multibody dynamic simulation models (RecurDyn) constructed from 3.0 T MRI scans of subjects being treated for recurrent patellar instability. The models were validated in previous studies and included ligaments, tendons, and retinacular structures represented by tension-only springs (Fig1). Four models displayed patella alta; the remaining 4 models were made to reflect patella alta by lengthening the springs. Forces were applied to simulate a dual limb squat from 0º to 90º. Motion was simulated in a pre-operative condition and for three MPFL graft tensioning techniques (1.0, 0.5, and 0 patellar quadrants of lateral translation). The maximum bisect offset index during flexion was used as a measure of patellar instability and the maximum pressures applied to patellar cartilage (lateral, medial) as measures of the risk of overloading cartilage. Statistics were used to compare the parameters with significance set at p < 0.05. Post- and pre-operative maximum bisect offset index were also correlated. Results: MPFL reconstruction with 0.5 and 0 quadrants of allowed lateral translation significantly decreased the maximum bisect offset index compared to the pre-operative condition, but not for 1.0 quadrants (Table 1). MPFL reconstruction did not significantly influence the maximum pressure applied to medial or lateral cartilage. The maximum post-operative bisect offset index was significantly correlated with the pre-operative bisect offset index for 1.0 and 0.5 quadrants of lateral translation allowed (r2 = 0.80, 0.65, and 0.48 for grafts allowing 1, 0.5 and 0 quadrants of translation, respectively). Conclusion: For knees with patella alta, the influence of MPFL reconstruction on patellar tracking varied with the allowed patellar translation during graft tensioning. None of the graft tensioning conditions significantly decreased the maximum lateral pressure or increased the medial cartilage pressure. Significance: The graft tensioning process for MPFL reconstruction typically allows some lateral patellar translation to avoid overconstraining the knee. For knees with patella alta, reducing the allowed lateral translation seems to limit maltracking without overconstraining the knee. [Table: see text][Figure: see text]
ACL LENGTH IN PEDIATRIC POPULATIONS: AN MRI RETROSPECTIVE STUDY
Authors: Tran Emily P. , Chen Anthony Y. , Dingel Aleksei B. , Terhune Bailey , Segovia Nicole A. , Ganley Theodore J. , Fabricant Peter D. , Green Daniel W. , Stavinoha Tyler J. , Shea Kevin G. 
Published: April 2020

Background: Young athletes have the highest rates of primary and recurrent anterior cruciate ligament (ACL) tears, and recent research has identified graft diameter as a predictor of graft failure. Newer ACL reconstruction techniques have been developed to increase graft diameter and reduce re-rupture rates. Graft diameter can be modified based upon graft length, number of graft strands/configuration, and native ACL length. While the ACL has been well-studied in adult populations, there is limited research examining the ACL dimensional characteristics in a pediatric population. Appropriate preoperative anatomic dimensions may help surgeons plan for optimal graft length, diameter and bundle arrangement Purpose: To develop MRI-based predictors of native ACL graft length in pediatric populations and enhance preoperative planning to optimize graft length, strand configuration and graft diameter to lower the risk of recurrent ACL injury. Methods: One hundred and ten subjects were included from the STRIDE database (64 females and 46 males, median age 10 years, range 1-13 years). Our exclusion criteria were if the subjects had musculoskeletal diseases or history of knee injury. Using MRIs, researchers evaluated ACL length, sagittal and coronal inclination of the ACL, inclination and width of the intercondylar notch, depth and width of the femoral condyles, and the medial and lateral tibial slopes. Association between measurements, sex, and age were investigated using linear and multivariate regression models. Results: When examining the predictors for ACL length by sex, the best predictor (R⁁2 = 0.65) for female ACL lengths was the depth of the lateral femoral condyle taken in the sagittal view (p<0.001). Other predictors that were statistically significant (p < 0.005) were distal femoral condylar width (R⁁2 = 0.62), age (R⁁2 = 0.52), and coronal notch width (R⁁2 = 0.15). For males, the best predictor (R⁁2 = 0.70) of ACL length was the distal femoral condyle width as viewed coronally (p < 0.001). Other statistically significant predictors (p < 0.005) of male ACL lengths were lateral femoral condyle depth (R⁁2 = 0.62), age (R⁁2 = 0.48), and coronal notch width (R⁁2 = 0.20). Conclusion: When predicting the ACL length in pediatric populations, femoral condylar depth and width, and patient age may be valuable predictors for those undergoing ACL reconstructions. Surgical planning to maximizing graft diameter is contingent upon native ACL graft length, and the use of this information to optimize graft utilization may lower the rates of ACL graft failure in the highest risk pediatric populations. Tables/Figures: [Table: see text][Figure: see text][Figure: see text]