bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative Analysis of 30-Day Readmission, Reoperation, and Morbidity Between Lumbar Disc Arthroplasty Performed in the Inpatient and Outpatient Settings Utilizing the ACS-NSQIP Dataset
Authors: Katz Austen David , Perfetti Dean Cosmo , Job Alan , Willinger Max , Goldstein Jeffrey , Kiridly Daniel , Olivares Peter , Satin Alexander , Essig David 
Published: July 2020

Study Design: Retrospective cohort study. Objective: Spine surgery has been increasingly performed in the outpatient setting, providing greater control over cost, efficiency, and resource utilization. However, research evaluating the safety of this trend is limited. The objective of this study is to compare 30-day readmission, reoperation, and morbidity for patients undergoing lumbar disc arthroplasty (LDA) in the inpatient versus outpatient settings. Methods: Patients who underwent LDA from 2005 to 2018 were identified using the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database. Regression was utilized to compare readmission, reoperation, and morbidity between surgical settings, and to evaluate for predictors thereof. Results: We identified 751 patients. There were no significant differences between inpatient and outpatient LDA in rates of readmission, reoperation, or morbidity on univariate or multivariate analyses. There were also no significant differences in rates of specific complications. Inpatient operative time (138 ± 75 minutes) was significantly ( P < .001) longer than outpatient operative time (106 ± 43 minutes). In multivariate analysis, diabetes ( P < .001, OR = 7.365), baseline dyspnea ( P = .039, OR = 6.447), and increased platelet count ( P = .048, OR = 1.007) predicted readmission. Diabetes ( P = .016, OR = 6.533) and baseline dyspnea ( P = .046, OR = 13.814) predicted reoperation. Baseline dyspnea ( P = .021, OR = 8.188) and ASA (American Society of Anesthesiologists) class ≥3 ( P = .014, OR = 3.515) predicted morbidity. Decreased hematocrit ( P = .008) and increased operative time ( P = .003) were associated with morbidity in univariate analysis, but not in multivariate analysis. Conclusions: Readmission, reoperation, and morbidity were statistically similar between surgical setting, indicating that LDA can be safely performed in the outpatient setting. Higher ASA class and specific comorbidities predicted poorer 30-day outcomes. These findings can guide choice of surgical setting given specific patient factors.
The Virtual Spine Examination: Telemedicine in the Era of COVID-19 and Beyond
Authors: Satin Alexander M. , Lieberman Isador H. 
Published: July 2020

Study Design: Narrative review. Objectives: Describe a comprehensive spine telemedicine examination. Methods: We discuss telemedicine examination techniques for commonly encountered spine conditions. Results: Techniques to evaluate gait, the cervical spine, the lumbar spine, adult spinal deformity patients, and adolescent scoliosis patients via telemedicine are described. We review limitations of the spine telemedicine examination and discuss special considerations such as patient safety and criteria for in-person assessment. Conclusions: While there are limitations to the spine telemedicine examination, unique strategies exist to provide important information to the examiner. Efforts have already been undertaken to validate and expand the capabilities of the spine telemedicine examination.
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
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]