bluuebunny/crossref_metadata_2025_split huggingface dataset:
Which Variables Predict Osteochondral Allograft Failure?
Authors: Bugbee William 
Published: July 2020

Objectives: Osteochondral allograft (OCA) transplantation is a valuable treatment option for chondral and osteochondral lesions of the knee. Understanding the impact of clinical variables on the outcome of OCA transplantation would be useful for counseling patients on the relative risk of the procedure. The purpose of this study was to determine which variables predicted treatment failure in a large cohort of patients undergoing OCA transplantation of the knee. Methods: OCA transplantation was performed in 673 knees from 1997 to 2016; 489 had a minimum follow-up of two years. Average age was 32 years and 63% were male. Mean graft size was 8.9 cm2. Reoperations following the OCA transplantations were assessed, and treatment failure was defined as any procedure that involved removal of the allograft. Variables associated with treatment failure in univariate analyses (age, diagnosis, anatomic location, and graft size) were included in a logistic regression model. Results: Treatment failure occurred in 78 knees (16%); 58 conversions to arthroplasty, 19 revision allografting, and 1 patellectomy. Age, diagnosis, and graft size independently predicted a higher risk of failure (Table 1). Patients who were ≥30 years old were 2.4 times more likely than younger patients to experience a treatment failure. Compared to patients with osteochondritis dissecans or traumatic chondral injury, patients with degenerative chondral lesions, avascular necrosis, or osteoarthritis were more likely to have allograft failure. Grafts >8 cm2 were 2.1 times more likely to fail than grafts ≤8 cm2. Anatomic location and number of grafts were associated with failure in univariate analyses, but not after controlling for other variables in the multivariate analysis. Conclusion: Older age, diagnosis of avascular necrosis or degenerative joint disease, and larger graft size were associated with higher risk of treatment failure. This data is useful in counseling individual patients on the risk of osteochondral allograft surgery. [Table: see text]
Novel MRI Measurements of Extensor Mechanism Containment Can Predict Recurrent Patellar Instability
Authors: Chan Calvin , Mistovich Justin , Urwin John , Gajewski Christopher , Fabricant Peter , Lawrence John , Weltsch Daniel 
Published: July 2020

Objectives: Identifying risk factors for recurrent patellar dislocation (PD) following the first dislocation may help guide treatment. Tools for assessing the relationship of the extensor mechanism can distinguish dislocators from regular patients, but their usefulness in predicting the risk of re-dislocation has not been assessed. The purpose of this study was to determine the association of several novel MRI measures of patellar containment with recurrence in patients presenting with a first-time PD. Methods: An IRB approved query was conducted at a tertiary care children’s hospital (2005-2014) for patients (aged 8-19 years) diagnosed with a first-time PD. Patients were classified as either non-recurrent or recurrent-dislocators based on the review of the medical record. Next, MRI measurements were made by two independent raters. Interobserver reliability was assessed for all measurements via an intraclass correlation coefficient (ICC). Only measurements with ICC > 0.8 were included for further analysis. Univariate and multivariate regression analysis was used to evaluate variables associated with recurrence. Results: One hundred sixty-five patients were identified with a median follow up the length of 12.2 months. Median patients age was 14 years, and 57.6% were females. A second instability event or significant subluxation episode was documented in 98 (59.4%) patients. MRI measurements with excellent correlation (ICC>0.8) were Tibial tuberosity to trochlear groove distance (TT-TG), Tangential axial width of the patella (TAWP), Tangential axial trochlear width (TATW), Axial width of patellar tendon beyond lateral trochlear ridge (PT-LTR), and Lateral trochlear ridge to tibial tuberosity distance (LTR-TT). In univariate analysis, all mentioned MRI measurements had significant differences when comparing the group of RD to those that did not have a recurrent instability event. However, following both backward and forward stepwise regression analysis, LTR-TT was the only independent predictor of RD (p=0.003 in both). Patients with an LTR-TT value greater than -1 had a significantly higher rate of recurrent dislocation (72%) with Odds Ratio 2.4 (95% C.I. 1.2-4.7); p=0.011). Conclusion: Assessment of the relationship of the lateral trochlear ridge to the tibial tubercle had greater predictive value for recurrent instability than the relationship of the tibial tubercle to the trochlear groove. Patients with a tibial tubercle even with or outside of the lateral trochlear ridge have a significantly increased risk of re-dislocation compared with patients with a tibial tubercle inside the lateral trochlear ridge. This novel measurement (LTR-TT) can help predict recurrent patellar instability and may thus aid surgeons and patients when deciding on a treatment strategy. [Table: see text]
RISK FACTORS FOR PATELLAR INSTABILITY USING A QUANTITATIVE ANALYSIS OF TROCHLEAR DYSPLASIA
Authors: Hedgecock Jon , Cheng Christopher , Solomito Matthew , Pace James 
Published: July 2020

Objectives: Multiple studies have described several anatomic and demographic risk factors of patellar instability (PI). Trochlear dysplasia (TD) has been shown to be a dominant risk factor for patellar instability but most prediction models have used the qualitative Dejour system to evaluate the influence of TD on PI. The lateral trochlear inclincation (LTI) angle is a described quantitative method to evaluate TD and a recent measurement technique has near perfect inter and intra rater reliability. Our hypothesis is that, in combination with other known radiographic and demographic risk factors of PI, that using a quantitative and numeric evaluation for TD, a highly reliable prediction model for PI can be created. Methods: 98 patients in a pediatric and adolescent sports medicine practice were identified with documented PI that had magnetic resonance imaging (MRI) studies available for review. A matched cohort of 100 patients with no history of PI but with MRI’s were identified as a control group. Anatomic risk factors evaluated included the LTI, sulcus angle, lateral condyle index (LCI), lateral patellar inclination angle (LPI), proximal and distal tibial tubercle-trochlear groove distance (pTTTG and dTTTG), Caton-Deschamps ratio (CD ratio), and patellotrochlear index (PTI). Demographic data included age and sex. Receiver operator characteristic (ROC) curves were constructed for each variable to identify which variables were the best predictors of PI (ROC value >0.7). Using the ROC curves with a Youden’s J statistic and setting specificity at 0.9, cutoff values for each variable were created. Each radiographic and demographic variable was analyzed for significance and those that were found to be significant were analyzed. Area under the curve (AUC) was determined for each variable. Two predictive models were created. One was developed from the ROC curve results while the other evaluated all measured variables. The models were designed to produce the best possible fit while trying to limit the total number of predictors. These models were tested on a second cohort of 45 patients with PI and 42 control patients. Results: ROC curve data is in Table 1. Of the two models, the superior model was the model that evaluated all variables, regardless of ROC cutoff value. The model takes on the form of a general logistic regression (Eq 1, Eq 2). Model accuracy on the validation set showed 84% accuracy with 78% sensitivity and 88% specificity. These values are based on a probability of >90%. Patellar height measures had significant AUC’s but were not prime drivers of the final model. Age was not significant in the ROC analysis. Conclusion: This study establishes a highly reliable and predictive model for PI that is driven by various direct (LTI, sulcus angle, LCI) or indirect (dTT-TG, LPI) quantitative measurements of TD. Patellar height did correlate with PI but was not a prime driver of the model which suggests that patella alta is a less common risk factor for PI.
Comparison of Joint Space Measurements between Supine and Weightbearing Anteroposterior Pelvis Radiographs for Patients Undergoing Hip Arthroscopy
Authors: Bodendorfer Blake , Mehta Vishal , Tepper Kenneth , Looney Austin 
Published: July 2020

Objectives: Osteoarthritis and joint space narrowing of the hip have been correlated with poor outcomes and conversion to arthroplasty after hip arthroscopy. However, a standardized protocol for radiographic measurement of minimal joint space width of the hip has not been developed. We hypothesized that minimal joint space width would be significantly lower on the affected side in weightbearing anteroposterior pelvis radiographs versus supine radiographs. We also hypothesized that radiographs with single-leg stance would show the lowest minimal joint space width. Methods: Thirty-one consecutive adult patients with hip pain were prospectively enrolled and each had single-leg and double-leg weightbearing and supine anteroposterior pelvis radiographs in a standardized position. Two independent investigators determined minimal joint space width. Differences between minimal JSW as well as intra- and interobserver reliability were calculated. One and 2-way analyses of variance (ANOVA) were used to compare the measurements. Power analysis determined that recruitment of 30 patients was necessary to achieve 90% power. P<0.05 was considered significant. Results: No significant differences in joint space width were found between supine or weightbearing radiographs for any pelvis site (Figure 1). Comparing those under 50 years of age to those older than 50 years of age, mean joint space width was 3.5±0.5 vs. 3.0±0.9 in the supine position, 3.2±0.8 vs. 3.0±1.0 during double-leg stance, and 3.5±0.5 vs. 3.0±1.1 during single-leg stance (P=0.002). Conclusion: Our data showed no significant difference in joint space width among anteroposterior single-leg or double-leg weightbearing or supine radiographs at any location measured. These findings suggest that either weightbearing or supine radiographs can be used to evaluate hip joint space width and that all locations provide a similar indication of joint space width. These findings support the use of a single view for the evaluation of JSW in patients with hip pain, which may allow for a less burdensome clinical workflow. [Table: see text]
The Ulnar Collateral Ligament Responds to Stress in Professional Pitchers
Authors: English Joy , Cushman Daniel , Zhang Chong , Presson Angela , Yoon Steve , Schulz Brian , Li Bernard , Chalmers Peter 
Published: July 2020

Objectives: It remains unknown whether the frequently injured ulnar collateral ligament (UCL) responds to the stress of baseball pitching. Our purpose was to determine the response of the UCL in professional pitchers to pitching and rest. Methods: In a prospective study supported by Major League Baseball, all pitchers within a single professional baseball club were enrolled. Surgical and pitching history were recorded. An ultrasound (US) of the ligament was then performed by a single fellowship-trained ultrasonographer with extensive UCL US experience at the beginning of the season (T1), the end of the season (T2), and the beginning of the following season (T3). We measured UCL thickness and ulnotrochlear joint opening at 30° of flexion with and without valgus stress. Two US images were saved. Inter- and intra-rater reliability were determined. A multivariable analysis was conducted. Results: 185 total pitchers were included: 94 pitchers at T1, 83 at T2, and 118 pitchers at T3. Excluding player movement, follow-up rate was 70% between T1 and T2 and 91% between T2 and T3. These pitchers were 23 [21, 25] years old (median [inter-quartile range]), had 12 [7, 15] years pitching experience, and had peak velocity of 95 [93, 97] miles per hour. Intra- and inter-rater reliability was excellent. Baseline UCL thickness was associated with peak velocity (p=0.031) and prior UCL reconstruction (UCLR, p=0.024). After accounting for years of pitching experience, peak velocity and time, UCL thickness was greater in those with prior UCLR (p<0.001). After accounting for pitching experience, peak velocity, and prior UCLR, thickness increased during the season (p=0.002) and decreased during the offseason (p=0.001). After accounting for these same variables, valgus laxity at 30° increased during the season (p=0.002) and decreased during the off season (p=0.029). Conclusion: The ulnar collateral ligament responds to stress in professional pitchers by becoming thicker and more lax and to rest by becoming thinner and less lax.
Outcomes of talar osteochondral and transchondral lesions using an evidence-based algorithmic approach based on size, location and subchondral plate integrity: a 10-year study on 204 lesions
Authors: Saxena Amol 
Published: July 2020

Objectives: Treatments outcomes for articular lesions of the talus are variable based on size. MRI has been used to assess size and location, and base treatment. We prospectively analyzed talar lesions and the outcomes of surgical procedures based on lesion size, which are typically measured two-dimensionally, intact cartilage/subchondral plate and activity level. We propose following a treatment algorithm will yield favorable results and outcomes. Methods: Over a ten-year period, transchondral and osteochondral lesions of the talus were measured tri-dimensionally on pre-operative MRI, location noted based on a nine-region grid pattern of the talar dome, and patients’ activity level documented. Procedures were performed based on lesion size, integrity of cartilage and lesion location. They were assessed with pre- and post-operative AOFAS scores, post-operative Roles Maudsley score and time to return to activity. Lesions below 125 mm³ were treated with microfracture or retrograde drilling, lesions less than 1500 mm³ were treated with autogenous bone graft, and larger lesions were treated with fresh allograft. Results: 204 talar lesions were analyzed. The following surgeries were performed: arthroscopy with microfracture or retrograde drilling (with or without bone graft) N =159, arthrotomy (with or without osteotomy) with autogenous bone graft N = 60, and fresh allograft with osteotomy N =7. The average follow-up post-index surgery was 82.53± 34.62 (range 24-132) months for the entire cohort. The average time to return to activity was 7.93 ± 5.00 (range 2-36) months. The average pre-AOFAS score was 76.44 ± 10.98 (range 52-86) and average post-AOFAS score was 96.12 ± 3.46 (range 81-100), P=.0001. Post-surgery RM score was 1.28 ± 0.49 (range 1-3). There were no differences in outcomes based on lesion size. Conclusion: Similar outcomes were able to be achieved regardless of talar lesion size using the treatment algorithm.Clinicians should consider using three-dimensional measurements when determining the best treatment approach to talar lesions.Microfracture, while successful for certain talar lesions, may not have a role for larger lesions. Other techniques such as retrograde drilling, autogenous bone grafting and allograft can yield good results, along with microfracture when used appropriately based on lesion size.
Differences in articular hip cartilage gene expression between femoroacetabular impingement (FAI) and end-stage hip osteoarthritis
Authors: Reuter John , Soles Gillian , Ackert-Bicknell Cheryl , Giordano Brian , Kuhns Benjamin 
Published: July 2020

Objectives: The morphological deformities in Femoroacetabular Impingement (FAI) have been associated with hip osteoarthritis (OA), however the molecular mechanisms for OA initiation and progression are poorly understood. The purpose of this study was to use whole genome RNA sequencing to characterize differences in gene expression articular cartilage samples isolated from patients undergoing surgery for FAI and idiopathic OA. We hypothesized that there would be significant differences in genes expression in pathways related to inflammation as well as cartilage and bone turnover. Methods: 20 patients undergoing either hip arthroscopy for FAI (5 male, 5 female) or total hip arthroplasty (5 male, 5 female) for end-stage osteoarthritis were included in the study. FAI patients required a Cam deformity with an Alpha Angle greater than 55 while patients with dysplasia (LCEA<25) or prior hip surgery were excluded. Exclusion criteria for the THA cohort included dysplasia, and post-traumatic OA or inflammatory OA. Cartilage samples were obtained over the Cam deformity prior to femoroplasty in the FAI group or over anterosuperior femoral head-neck junction in the OA group following extraction of the femoral head. Following RNA isolation, Next Generation RNA sequencing was performed to evaluate gene expression. Differential expression data was incorporated into the Ingenuity Pathway Analysis (IPA) platform to identify differences in canonical signaling pathways associated with osteoarthritis. Results: There were 3531 genes that were significantly differentially expressed between the FAI and OA cohorts. Of these, there were 27 genes that were upregulated by a greater than 2 log-fold change in the OA cohort and 524 genes that were upregulated by a greater than 2 log-fold change in the FAI cohort. There was significant differential expression in genes related to cartilage metabolism (Table 1) and canonical osteoarthritis pathways involving BMP, TGFβ, and Wnt signaling. (Table 2). Additionally, FAI samples had significant upregulation of EGF-ERBB mediated signaling which compared to osteoarthritic tissue. Conclusion: The results of the present study support our hypothesis that there are significant differences in gene expression between FAI and OA samples in multiple pathways that are implicated in osteoarthritis. Osteoarthritis samples had increased expression of cartilage breakdown and inflammation while femoroacetabular impingement samples had greater expression of chondroprotective genes. Further study of cartilage samples from FAI patients may provide insight into the molecular mechanisms of osteoarthritis progression. [Table: see text][Table: see text]
Lower Extremity Musculoskeletal Injury Is Associated with Increased Risk of Concussion in High School Athletes
Authors: Lutz Adam , Thigpen Charles , Gilliland R. Gil , Thorpe John , Kissenberth Michael , Shanley Ellen 
Published: July 2020

Objectives: Previous research indicates that concussion increases the risk of lower extremity injuries (LE) after return to sport. However, no study has examined the risk of precedent lower extremity injuries and their relationship to the development of a sport related concussion (SRC). To determine if the risk of combined injuries (LE injury-SRC) is elevated in high school athletes accounting for athlete sport and gender. Methods: 33,386 high school athletes were monitored over 4 seasons. 4223 LE injuries and 1132 concussions were reported. Injured athletes were identified by their school athletic trainer (AT) time-loss injury during a team-sponsored practice or game. ATs documented the date, mechanism, and sport of injury. Injured athletes were referred to a board-certified sports medicine physician for diagnoses and follow up care. Cumulative injury rates were calculated with 95% confidence intervals. Rate ratios were used to compare frequency of SRC after RTS following a LE injury. Comparisons were made overall cohort between those participating athletes with and without isolated and combined injuries as well as by gender. (α=0.05). Results: A cumulative incidence for athletes sustaining an isolated SRC was 2.3/100 athletes (95% CI= 2.1-2.5) and for isolated LE injury was 11.5/100 (95% CI=11.2-11.9) athletes. Athletes presenting with a LE injury had an increased risk (RR= 4.7; 95% CI = 4.2-5.2) of sustaining a subsequent SRC within 1 year when compared to athletes that did not suffer precedent LE injuries. Male athletes presenting with a LE injury had an increased risk (RR= 4.9; 95% CI = 4.2-5.7) of sustaining a subsequent SRC within 1 year when compared to male athletes that did not suffer precedent LE injuries. Female athletes presenting with a LE injury had an increased risk (RR= 4.4; 95% CI = 3.6-5.2) of sustaining a subsequent SRC within 1 year when compared to female athletes that did not suffer precedent LE injuries. In football, presenting with a LE injury had an increased risk (RR= 5.8; 95% CI = 4.5-7.4) of sustaining a subsequent SRC within 1 year when compared to football athletes that did not suffer precedent LE injuries. Conclusion: Our results are the first to show that high school athletes who suffer a time-loss LE injury are at 4.4-5.8 times increased risk to suffer a sports related concussion within the next year. Additional studies are warranted to confirm these findings.
Defining Meaningful Functional Improvement on the Visual Analog Scale for Satisfaction at 2-years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome
Authors: Beck Edward , Nwachukwu Benedict , Mehta Nabil , Jan Kyleen , Okoroha Kelechi , Drager Justin , Nho Shane , Rasio Jonathan 
Published: July 2020

Objectives: Patient satisfaction is being increasingly reported in orthopaedic sports medicine and the field of hip preservation surgery. The Visual Analog Scale (VAS) for Satisfaction is most commonly utilized. Currently there is limited understanding for what should be considered as clinically important improvement on the VAS Satisfaction. The purpose of this study is to 1) define Substantial Clinical Benefit (SCB), Patient Acceptable Symptomatic State (PASS), and Minimal Clinically Important Difference (MCID) for the VAS Satisfaction in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS), and 2) identify preoperative predictors of achieving each outcome end-point. Methods: Data from consecutive patients who underwent primary hip arthroscopy between November 2014 and January 2017 were collected and analyzed. Baseline data and postoperative patient-reported outcome (PRO) scores were recorded at 2-years postoperatively. In order to quantify clinical significance of outcome achievement on the VAS Satisfaction we calculated MCID, PASS and SCB for this outcome measure. A multivariate logistic regression analysis was used to identify preoperative predictors of achieving SCB, PASS, and MCID satisfaction. Results: A total of 335 patients were included in the final analysis, with an average age and body mass index (BMI) of 32.8(SD+12.4) years and 25.2(SD+5.3) respectively. The values on the VAS satisfaction were identified to represent MCID, PASS and SCB respectively: 12.3, 80.9 and 89.7. The rates of achieving clinically significant improvement on the VAS Satisfaction was 97.1%, 68.1% and 56.9% for MCID, PASS and SCB respectively. A larger preoperative alpha angle was predictive for achieving SCB (OR:1.076; p =0.046), while lower BMI (OR:0.955; p =0.047) and larger preoperative alpha angle (OR:1.12; p-value=0.025) were predictors for achieving PASS. Conclusions: This study identifies scores on the VAS Satisfaction that can be used to define clinically significant outcome after arthroscopic treatment of FAIS. Specifically, an improvement of 12.3 points is a clinically important improvement in satisfaction, while an absolute score above 89.7 represents the upper threshold of Satisfaction performance. Almost all patients (97.1%) demonstrated a clinically important improvement in satisfaction. Additionally, there are both modifiable and non-modifiable factors that predict achieving a clinically significant level of post-operative satisfaction on the VAS Satisfaction.