bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
Effect of anxiety and depression on early pain and range of motion after rotator cuff repair - measured by HADS (Hospital Anxiety and Depression Scale) -
Authors: Park Joo Hyun , Jeong Hyeon Jang , Rhee Sung Min , Oh Joo Han 
Published: July 2020

Objectives: According to previous studies, the prevalence of anxiety and depression was approximately 25% in patients with rotator cuff tear, and psychological status may be an important predictor for clinical outcomes after rotator cuff repair. Considering continuous steady rehabilitation is essential for recovery of postoperative pain and range of motion (ROM), the anxiety or depression would affect this process. The aim of this study was to evaluate the effect of anxiety and depression measured by HADS (Hospital Anxiety and Depression Scale) on early pain and ROM after rotator cuff repair. Methods: Consecutive 156 patients who underwent arthroscopic rotator cuff repair were prospectively enrolled, and divided into two groups defined by HADS scores; Group I with normal psychological status (n = 105, anxiety ≤ 7 and depression ≤ 7), Group II with psychological distress (n = 51, anxiety ≥ 8 or depression ≥ 8). Same rehabilitation protocols were applied to all patients: 4 ˜ 6 weeks of brace according to tear size, and then ROM exercises. Clinical outcomes were measured with pain VAS and ROM at 3, 6 months and 1 year after surgery. Results: There were no significant differences in age, cuff tear size, preoperative external and internal rotation angle between two groups, but more female patients, higher preoperative pain VAS, and lower range of preoperative forward flexion in Group II (all p < 0.05). At 3 months after surgery, the average of pain VAS was 2.2 ± 1.3 in Group I, which was statistically lower than 3.5 ± 2.0 in Group II. The average forward flexion was 145.4° ± 23.4° in Group I, and 122.5° ± 30.3° in Group II. The average external rotation was 42.3° ± 16.1° in Group I, and 34.7° ± 17.6° in Group II. The mean level of internal rotation at back was T11.6 ± 2.8 in Group I, and L1.9 ± 2.4 in Group II (all p < 0.05). At 6 months after surgery, there was no significant difference in forward flexion (148.9° ± 23.2° in Group I compared with 144.9° ± 25.2° in Group II) and external rotation (59.5° ± 13.4° in Group I compared with 54.5° ± 17.5° in Group II). The mean level of internal rotation at back was T9.4 ± 1.8 in Group I, and T10.0 ± 1.5 in Group II (p < 0.05). The average of pain VAS was 0.8 ± 1.6 in Group I, which was statistically lower than 1.6 ± 2.0 in Group II (p < 0.05). However, there was no significant difference in ROM and pain VAS at 1 year after surgery. Conclusion: The recovery of pain and ROM was faster in patients with normal psychological status after arthroscopic rotator cuff repair. Therefore, psychologic intervention including medication should be collaborated to improve early clinical outcomes after rotator cuff repair through the encouragement of rehabilitation, as well as mitigation of anxiety and depression moods. [Figure: see text]
Variations in Glenohumeral Bony Morphology May Predict Recurrent Instability after Arthroscopic Bankart Repair
Authors: Sheean Andrew , Gasbarro Gregory , Como Christopher , Kohut Kevin , Wilmot Andrew , Borrero Camilo , Vyas Dharmesh , Lin Albert , Vaswani Ravi 
Published: July 2020

Objectives: Variations in bony anatomy may be associated with failure of stabilization surgery. The aim of this study was to develop a method to measure bony morphology on magnetic resonance imaging (MRI) to identify risk factors for failure after Bankart repair. Methods: This was a retrospective case-control study of 118 patients. Cases of postoperative dislocation were compared to matched controls. Demographic data was obtained by chart review and radiographic data from preoperative MRI. Volume was measured using a 3-D model. Radius of curvature of the humeral head and glenoid was measured on axial MRI images. Statistical analysis used student’s t-test for continuous variables and either Fisher’s exact or Chi-squared test for categorical variables; P value < 0.05 was significant. Interrater reliability between reviewers was calculated using interclass correlation coefficients (r). Results: Forty-six patients who had a postoperative dislocation met inclusion criteria and were matched to 72 controls. There was no difference between groups for demographic (age, sex, percentage of contact athletes) or radiographic (glenoid bone loss, off-track Hill-Sachs lesions) parameters. The average number of preoperative dislocations was higher in the case group (3.2 vs. 2.0, p=0.003). The humeral head (68.8 ml vs 62.8 ml, p=0.05) volume was greater in the case group, though this did not reach statistical significance. Glenoid volume (13.5 ml vs 12.8 ml, p=0.31) was similar between groups. The radius of curvature of the glenoid was larger, or shallower, in the case group compared to the control group (23.6 mm vs 22.6 mm, p=0.05), though the difference did not reach statistical significance. A greater percentage of patients with a glenoid radius of curvature > 24.5 mm experienced a postoperative dislocation compared to those who had a smaller radius of curvature (62.0% vs 29.8%, p < 0.01). In fact, patients who had glenoid radius of curvature > 24.5 mm were 5 times as likely to experience a postoperative dislocation compared to those who did not (odds ratio 5.04, 95% CI 2.13 – 11.94, p < 0.01) There was no significant difference between the number of preoperative dislocations between patients with larger or smaller glenoid radius of curvature (2.6 vs 2.3, p = 0.55). There was a strong interrater reliability for measurement of humeral head volume, glenoid volume, radius of curvature of glenoid and radius of curvature of humeral head (r = 0.94, 0.88, 0.89, 0.95). Conclusion: The results of this study demonstrate that a larger radius of curvature, indicative of a shallower glenoid, is associated with failure following primary arthroscopic Bankart. These findings suggest that the bony concavity of the glenoid may play a role in stability. [Figure: see text]
Arm abduction angle at ball release influences shoulder forces and torques during the windmill softball pitch
Authors: Scarborough Donna , Fallon Ryan , Berkson Eric , Linderman Luke Oh, Shannon 
Published: July 2020

Objectives: Shoulder pain and ligamentous injury is a common complaint among fast pitch softball pitchers. In addition to extreme shoulder joint motion during pitch delivery, sudden deceleration immediately after ball release places increased stress across the shoulder joint. Some pitchers release the ball with the throwing arm tucked close to the trunk, while others let the arm float outwards in a more abducted position. The position of the arm at ball release (BR) may be key to the mechanism of shoulder pain. Previous work demonstrated that during the change up pitch, softball pitchers with upper extremity pain demonstrated greater shoulder abduction at stride and less trunk lateral flexion at BR compared to athletes without pain (Oliver et al 2018). The purpose of this study was to test the hypothesis that placement of the arm closer to the trunk (shoulder adduction) at ball release will produce less shoulder stress during fastball windmill pitches. Methods: Twenty-six female fast pitch softball pitchers with a mean age of 18 +/- 6 y, including 16 high school, 7 collegiate, and 3 professional athletes, underwent 3D biomechanical pitch analyses using 20 Vicon high-speed motion capture cameras (240 hz). All pitchers threw the standard 13.11 m mound-to-plate distance at a strike zone target while a radar gun collected pitch speeds. The fastest, most accurate fastball pitches for each subject were selected for analyses (average of 5 pitches per subject). A total of 103 pitches were used to calculate: shoulder abduction angle and shoulder compression force during the BR phase (10 frames surrounding BR) and peak shoulder torques. Pearson correlations were performed to determine the relationship of shoulder frontal plane (adduction/abduction) angle during the ball release phase to these biomechanical measures. Results: The smallest abduction shoulder angle reached during the BR phase (avg: 14.06 +/- 6.71 degrees) demonstrated a significant positive correlation with shoulder compression force, p=0.008 and with peak flexion torque, p< 0.001 (Table 1). This shoulder abduction angle during the BR phase demonstrated negative correlations with peak shoulder adduction torque, p<0.001 and shoulder internal rotation torque, p< 0.001. Conclusion: These initial findings support the hypothesis that pitchers who release the ball with their arm close to their trunk demonstrate lower shoulder compression forces and shoulder flexion torques than those with a more abducted arm position. Future studies are needed to explore the interplay of pitching technique mechanics, shoulder joint stresses, and injury history to inform pitching instruction and injury prevention efforts. [Table: see text]
Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-Analysis of Operative and Nonoperative Treatment
Authors: Bodendorfer Blake , McCormick Brian , Wang David , Conroy Christine , Fryar Caroline , Kotler Joshua , Ferris William , Postma William , Chang Edward , Looney Austin 
Published: July 2020

Objectives: The incidence of pectoralis major tendon tears is rising, and repair is generally considered, but there is a paucity of comparative data to demonstrate the superiority of operative treatment. We sought to compare the outcomes of operative and nonoperative treatment of pectoralis major tendon tears. We hypothesized that repair would result in superior outcomes compared to nonoperative treatment. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the literature was completed using MEDLINE, SPORTDiscus, CINAHL, Cochrane, Embase and Web of Science databases. English-language studies were included with a minimum of 6 months average follow-up and 5 cases per study. Methodological Index for Nonrandomized Studies was utilized to assess the quality of the existing literature. Meta-analysis of pooled mechanisms of injury and outcomes was completed. Pooled effect-sizes were calculated from random effects models. Continuous variables were assessed using mixed model analysis with the individual study designated as a random effect and the desired treatment for comparison as a fixed effect. Bivariate frequency data was transformed using the Freeman-Tukey log-linear transformation for variance stabilization and then assessed using a mixed model with a study-level random effect and subsequently back-transformed. Significance was set at P<.05. Results: Twenty-three articles with 664 injuries met the inclusion criteria for comparison (Figure 1). All patients were male with 63.2% of injuries occurring during weight training, with an average age of 31.48 years and follow-up of 37.02 months. Included studies had moderately high methodological quality. Operative treatment was significantly superior to nonoperative treatment with a relative improvement of functional outcome by 0.70 (P=.027), full isometric strength by 77.07% (P<.001), isokinetic strength by 28.86% (P<.001) compared to the uninjured arm, cosmesis satisfaction by 13.79% (P=.037), and resting deformity by 98.85% (P<.001) (Table 1). There was an overall complication rate of 14.21%, including a 3.08% rate of rerupture, for operative treatment. Conclusion: Pectoralis major tendon repair resulted in significantly superior outcomes as compared to nonoperative treatment with an associated 14.21% complication rate. There was a statistically significant improvement in functional outcome, isokinetic strength, isometric strength, cosmesis, and resting deformity. [Figure: see text][Table: see text]
Preoperative opioid education has no effect on opioid use in patients undergoing arthroscopic rotator cuff repair: a prospective, randomized clinical trial
Authors: Klein David , Campbell Kirk , Jazrawi Laith , Bloom David , Baron Samuel 
Published: July 2020

Objectives: Opioid analgesics are frequently utilized among orthopaedic surgeons to mitigate postoperative pain. These drugs are well-known for their addictive potential and recent literature has suggested that preoperative patient-focused education on narcotic consumption may decrease post-operative opioid use. The purpose of this study was to determine whether preoperative opioid education reduces consumption following arthroscopic rotator cuff (ARTC) repair in the context of our current environment of limiting post-operative narcotic consumption. Methods: This is a single center randomized controlled trial. Opioid-naïve patients undergoing ARTC repair were randomized into one of two groups. Preoperatively, the control group received our institution’s standard of care for pain management education while the experimental group was shown a brief educational video on the proper use and dangers of opioids. All patients were discharged with 30 tabs of oxycodone-acetaminophen (5mg/325mg) prescribed as 1-2 tablets every 4-6 hours as needed for pain. They were contacted daily and asked to report opioid use, VAS pain, and satisfaction with overall pain management. A chart review was conducted at 3 months post-op to see if patients had been given narcotic refills after the initial postoperative period. Results: Our institution enrolled 106 patients, 87 of whom completed the study (41 control, 46 experimental). There were no statistically significant differences (p>0.05) with respect to patient demographics between groups (age at time of surgery, gender, ASA, or BMI). Additionally, there was no statistically significant difference with respect to Visual Analogue Scale (VAS) pain between groups preoperatively (p=0.85) or at 1-week follow up (p=0.29). Additionally, patients in each group were equally satisfied with their post-operative pain medication management (p=0.71). Patients in the education group did not utilize a statistically significant different number of narcotics than the control group throughout the first post-operative week (14.74 pills experimental vs. 13.71 pills control, p=0.68). At 3-month follow up, patients in the experimental group (n=9) were equally likely to have utilized at least one narcotic prescription refill as the control group (n=5) (odds ratio 1.65, p=0.56). Conclusion: The findings of this study suggest that preoperative video-based opioid education may have no effect on reducing the number of narcotic pills consumed following ARTC repair. As such, this form of intervention may not be of use with respect to mitigating the current opioid crisis.
Epidemiology of Acromioclavicular Joint Injuries in Professional Baseball
Authors: Ramkumar Prem , Frangiamore Salvatore , Jones Grant , Soloff Lonnie , Pollack Keshia , Curriero Frank , Schickendantz Mark , Frantz Travis 
Published: July 2020

Objectives: Shoulder injuries account for a large portion of all recorded injures in professional baseball. Much is known about other shoulder pathologies in the overhead athlete, but the incidence and impact of acromioclavicular (AC) joint injuries in this population is unknown. The purpose of this study was to examine the incidence, rates, and characteristics of AC joint injuries in professional baseball, and determine the impact on time missed. Methods: The Major League Baseball Health and Injury Tracking System (HITS) was used to compile records of all major and minor league player from 2011-2017 with documented AC joint injuries. These injuries were classified as acute (sprain or separation) or chronic (AC joint arthritis or distal clavicular osteolysis), and associated data included laterality, date of injury, player position, activity, mechanism of injury, length of return to play (RTP), and need for surgical intervention. Results: A total of 312 AC joint injuries (183 MiLB, 129 MLB; range 39-60 per year) were recorded (acute n=201, 64.4%; chronic n=111, 35.6%). A total of 81% of acute injuries resulted in time missed with an average RTP of 22.8 days whereas 59% of chronic injuries resulted in days missed with an average RTP of 32.2 days (p<0.001). Acute injuries occurred most commonly in outfielders (42.7%), followed by infielders (27.3%). Chronic injuries were seen in higher proportions among pitchers and catchers (45.5-56.4% chronic injuries). Acute AC injuries occurred most often while playing defense (n=100; 49.8%) in the infield or outfield (n=138; 68.7%), with 63.2% the result of a contact injury. Chronic AC joint injuries were most commonly with throwing or pitching (n=48; 43.2%) and non-contact injuries (n=79; 71.2%). Conclusion: Acute AC joint injuries are contact injuries occurring most commonly among infielders and outfielders that result in more than 3 weeks missed before return to play whereas chronic AC joint injuries occur more commonly in pitchers and catchers from repetitive overhead activity. Knowledge of these data can better guide expectation management in this elite population to better elucidate the prevalence of two common injury patterns in the acromioclavicular joint.
Ultrasound-guided Percutaneous Tenotomy Shows Sustained Clinical and Sonographic Outcomes for Recalcitrant Lateral Elbow Tendinopathy at 7.5 Years
Authors: Koh Joyce , Png Meng Ai , Howe Tet Sen , Lee Brian , Morrey Bernard , Mohan Benjamin Ang FRCS Chandra 
Published: July 2020

Objectives: In our previously published study, 20 patients who underwent ultrasound-guided percutaneous tenotomy for recalcitrant lateral elbow tendinopathy were followed up clinically and sonographically for 3 years, demonstrating sustained pain relief and functional improvement, with sonographic evidence of tissue healing. We aim to explore the long-term clinical and sonographic results of ultrasound-guided percutaneous tenotomy. Methods: The same cohort of patients were recalled at 7-8 years and assessed for visual analog scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand (DASH) scores, need for secondary intervention, and overall satisfaction. They were also reassessed with ultrasound imaging to evaluate tendon hypervascularity, tendon thickness, and the progress or recurrence of the hypoechoic scar tissue. Results: We successfully scored 19 subjects and performed ultrasound on 16 subjects, with a follow up of 90 (median±standard deviation: 90±2.7; range: 86-94) months. Among them, one patient had subsequently undergone surgical fixation for an ipsilateral radial head fracture 6 years after ultrasound-guided percutaneous tenotomy, and was thus excluded from the study. There were no adverse outcomes and satisfaction remained at 100% (6 satisfied, 12 very satisfied). No patient developed a recurrence of lateral elbow tendinopathy, and therefore no secondary intervention was required. The improvement from baseline and early term scores was sustained as seen in figure 1. There was no significant change in VAS score (median±SD: 0±1.0; range: 0-4) at 7.5 years, compared to 3 years (0±0.9; 0-3) (p=1.000) or DASH-Compulsory score (0±4.51; 0-13.3) at 7.5 years compared to 3 years (0±0.644; 0-2) (p=0.627) or DASH-Work score (0±6.61; 0-25) at 7.5 years compared to 3 years (0±0; 0)(p=1.000), although there were isolated cases of increased DASH scores due to rotator cuff issues, as described by the patients, which were consistent with degeneration. DASH-Sports/performing arts had too few responses for analysis. At current, hypervascularity remained resolved in 13/16 (81%) subjects, 16/16 (100%) subjects had reduced tendon swelling, and 15/16 (94%) had sustained resolution or reduction of the hypoechoic lesion (Figure 2). Conclusion: At long term follow up, ultrasound-guided percutaneous tenotomy, previously shown to enhance recovery of lateral elbow tendinopathy, demonstrates good sustainability of pain relief and functional recovery that was previously achieved, accompanied with sonographic evidence of tissue healing at 7.5 years. [Figure: see text][Figure: see text]