bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knee Bone Age using MRI: Validation of a Novel Method to Reduce Hand Bone Age Radiographs
Authors: Meza Blake , LaValva Scott , Aoyama Julien , DeFrancesco Christopher , Striano Brendan , Shea Kevin , Nguyen Jie , Ganley Theodore , Carey James 
Published: July 2020

Objectives: Determining bone age in skeletally immature patients is critical for proper management and surgical planning. Pennock et al. recently created and validated a bone age atlas using the ossification pattern of the knee on MRI in pediatric patients, obfuscating the need for a hand radiograph and its associated cost, radiation exposure, and clinical inefficiency. This aim of this study was to create and validate a shorthand method of bone age determination using knee MRI. Methods: We identified patients who underwent both knee MRI and hand bone age radiograph within a ninety-day period. From the findings of Pennock et al., a stepwise algorithm for predicting bone age on knee MRI was developed for males and females separately, in collaboration with a pediatric musculoskeletal radiologist. Six raters at varying levels of training used the algorithm to assign a bone age to each knee MRI. Intraclass correlation coefficient (ICC) was used to compare each rater’s predicted knee bone age to the Greulich and Pyle (G&P) hand bone age and validate the shorthand algorithm. Inter- (two-way random, absolute agreement) and intra-rater (two-way mixed, absolute agreement ) reliability were also calculated using ICC. Results: Thirty-eight patients (44.7% females) underwent a knee MRI at a mean age of 12.8 years (range 9.3-15.7). The mean time between hand bone age x-ray and knee MRI was 20.2 days (range 0-88). The inter-rater reliability for the application of our shorthand algorithm was 0.81 (95% CI: 0.72 – 0.88), indicating good inter-observer agreement. The shorthand algorithm was also shown to be a reliable predictor of hand bone age across level of training, as medical students (ICC 0.77, 95% CI 0.60-0.88), residents (ICC 0.80, 95% CI 0.65-0.89), and attending physicians (ICC 0.80, 95% CI 0.63-0.89) all achieved strong correlation between predicted knee bone age and G&P hand bone age. All respondents also demonstrated consistency, with intra-rater ICCs between 0.85-0.93. Conclusion: This shorthand algorithm is a consistent, reliable and valid way to determine skeletal maturity using knee MRI in patients aged 10 to 15 and can be utilized across different levels of orthopaedic and radiographic expertise. We believe this method is readily applicable in a clinical setting and may reduce the need for routine hand bone age radiographs. [Figure: see text][Table: see text]
Incidence and Risk Factors for Prolonged Opioid Use after Arthroscopic Meniscal Surgery: An Analysis of 107,717 Cases
Authors: Baron Jacqueline , Shamrock Alan , Gulbrandsen Trevor , Wolf Brian , Duchman Kyle , Westermann Robert , Khazi Zain 
Published: July 2020

Objectives: The current opioid epidemic in the United States is a significant cause of increasing morbidity and mortality. The purpose of this study was to determine rate of opioid use before and after arthroscopic meniscal surgery, and assess patient factors associated with prolonged opioid use following primary arthroscopic meniscal surgery. Methods: Patients undergoing primary arthroscopic meniscal surgery procedures from 2007-2016 were retrospectively accessed from the Humana Inc. administrative claims database. Patients were categorized as patients who filled opioid prescriptions within 3 months (OU), within 1 month (A-OU), between 1 to 3 months (C-OU), and never filled opioid prescriptions (N-OU) before surgery. Rates of opioid use were evaluated preoperatively and longitudinally tracked for OU and N-OU cohorts. Prolonged opioid use was defined as continued opioid prescription filling at ≥3 months after surgery. Multiple logistic regression analysis was used to control for various patient characteristics and identify factors associated with opioid use at 12 months after surgery, with significance defined as P<0.05 Results: There were 107,717 patients (54% female) that underwent arthroscopic meniscal surgery during the study period, of which 46.1% (n=49,630) were N-OU. One year after surgery, opioid fill rate was significantly higher in the OU group compared to the N-OU group with a relative risk of 6.98 (21.1% vs 3.02%; 95% CI: 6.61-7.36; p<0.0001). Multiple logistic regression model identified C-OU (OR:10.23, 95% CI: 9.74-10.76, p<0.0001) as the strongest predictor of opioid use at 12 months postoperatively. Furthermore, patients with acute preoperative opioid use (p<0.0001), preoperative diagnosis of diabetes mellitus (p<0.0001), hypertension (p<0.0001), chronic obstructive pulmonary disease (p<0.0001), anxiety or depression (p<0.0001), alcohol abuse (p= 0.0019), and tobacco use (p=0.0345) had a significantly increased odds of opioid use at 12 months postoperatively. However, males (p<0.0001) and patients <40 years (p<0.0001) had a significantly decreased odds of opioid use 12 months postoperatively. Conclusion: Preoperative opioid use is a significant risk factor for opioid use at 12 months following surgery. Diabetes mellitus, hypertension, chronic obstructive pulmonary disease, smoking status, and psychiatric diagnosis were independent risk factors for opioid use 1-year following surgery.
Outcomes of Arthroscopic Loose Body Management in Patella Instability: Medial Patellofemoral Ligament Neglect or Repair Versus Reconstruction
Authors: Carroll Alyssa , Pennock Kristina Johnson Andrew 
Published: July 2020

Objectives: Patellar instability is common in adolescents during their growth. Management of the actual patellar instability at the time of arthroscopic treatment for concomitant intra-articular loose body has been debated since many surgeons will manage first-time dislocations without surgery. To demonstrate that medial patellofemoral joint reconstruction, rather than neglect or repair of the ligament, should be performed at the time of arthroscopic loose body removal for first-time patellar instability events in children. Methods: Retrospective study design was performed on all patients who sustained a patellar instability event that resulted in an intra-articular loose body between 2011 and 2017 at our institution. Data was collected using ICD-9/10 and/or CPT codes. Patients included in the analysis were required to have a minimum of 24 month follow-up documented. We then performed chart review and radiographic review (XR and MRI). Variables collected included: demographics, weight, BMI, pain score, SANE score, Kujala score, subsequent recurrent instability, need for second surgery, growth plate status, trochlear dysplasia, TT-TG, Insall-Salvati ratio, and Blackburne-Peel ratio. Data analysis pooled the “neglect” and “repair” groups together and compared it to the “reconstruction” group. Continuous variables were examined for normal distribution and homogeneity and analyzed with ANOVA or Mann Whitney. Chi square was utilized for categorical variables. Results: 64 patients (34 males, 30 females) with a mean age at surgery of 14 years (range 9 to 18) met criteria. These participants had a reported mean weight (kg) and BMI of 67.6 kg and 23.9, respectively. In our two-cohort analysis, the reconstruction cohort demonstrated significantly less subsequent instability, with the rate of recurrence being 58.7% in the neglect/repair compared to 16.7% in the reconstruction group (p=0.002). In addition, the reconstruction group demonstrated significantly less patients that required second surgery (p=0.024). The only continuous variable that showed any statistically significant difference was the Insall-Salvati ratio (p=0.048) with the reconstruction group being a mean 1.3 versus a mean 1.4 in the neglect/ repair group. There was no difference was found for age, weight, BMI, Blackburn ratio, TDI, TT-TG, Pain, SANE, Kujala score, satisfaction, or length of follow-up. Conclusion: Medial patellofemoral ligament reconstruction in the setting of adolescent patellar instability with an intra-articular loose body results in significantly less recurrent instability and reduced need for subsequent surgery compared to those who do not undergo a concomitant ligament reconstruction.
Accuracy of Correction and Postoperative Complications Associated with a PEEK Opening Wedge High Tibial Osteotomy Implant
Authors: Axibal Derek , Joyce Christopher , Houck Darby , Logterman Stephanie , Frank Rachel , Vidal Armando 
Published: July 2020

Objectives: To evaluate the accuracy of correction angle of an all-PEEK medial opening wedge high tibial osteotomy (HTO) system, as well as determine the effect of correction angle on postoperative complications. Methods: Retrospective review was performed on patients who underwent an HTO by the senior author using an all-PEEK HTO system between 2014-2018 with a >6-month follow-up were included. Measurements were performed and classifications formulated by three senior residents and the senior author. Lateral hinge fractures (LHF) were classified according to Takeuchi classification system. Bivariate statistics were performed. Results: Thirty HTOs in 27 patients were included (50% female; age, 37.8±10.8 years). Average follow-up was 16.2±10.1 months. Average post-operative radiographic valgus correction (Δ, 5.8±2.4°) was significantly less than that of the average implant correction angle (8.1±2.3°; p<0.001), indicating an overall average under-correction of 2.3±2.1°. There were 5 failures (16.7%; defined as approximately >5° loss of planned correction) that shared a common mechanism of medial cortical failure inferior to the implant. When selecting out the construct failures, the average correction accuracy of the 25 (83.3%) non-failures (1.5±1.2°) was significantly better than the 5 (16.7%) failures (6.3±1.8°; p=0.002). Four fractures (13.3%) were identified: 3 (10%) Takeuchi type I and 1 (3.3%) type III. All type I fractures were associated with >5° planned correction loss with medial cortex buckling. Overall, 9 knees (30%) experienced minor complications: neuropathy (n=1; 3.3%), deep vein thrombosis (n=2; 6.7%), and superficial infection (n=3; 10%). Conclusion: The use of an all-PEEK medial opening wedge HTO implant is a safe and effective system, with an acceptable average under-correction of 1.5° in patients not sustaining medial cortex failure. Loss of correction was associated with medial cortex failure and Takeuchi type I LHF. This is the first description of this failure mechanism (medial cortex buckling) that is specific to this implant and technique.
Comparing Rates of Tibial Spine Fractures to ACL Tears: A 7-Year Trend
Authors: LaValva Scott , Bram Joshua , Reese Thomas , Ganley Theodore , Aoyama Julien 
Published: July 2020

Objectives: Sometimes referred to as the “pediatric” ACL injury, tibial spine fractures, although less commonly seen, are believed to share the same injury mechanism as anterior cruciate ligament (ACL) tears. And while incidence rates of ACL tears have been known to be increasing in recent years, to our knowledge, trends in incidence rates of tibial spine fractures (TSFs) have not yet been reported in the literature. With sport specialization becoming a more commonly discussed topic, our goal was to report on the incidence rates of TSFs over a 7-year span at a single-center, and to compare rates of injury in these two conditions by sport and other patient characteristics. Methods: This was a retrospective comparison study of all patients presenting between 1/1/2010 and 1/1/17 with either a TSF or an ACL tear at a single pediatric hospital. Medical records were queried for all TSFs and ACL tears using ICD-10 and ICD-9 codes. Incidence rates of both injuries over time were compared against one another. Incidence rates were further stratified based on sex, race, age, BMI, and sport/mechanism of injury, and bivariate analyses were performed to find significant differences between groups. Results: 43 patients with a TSF and 947 patients with an ACL tear were identified during the study dates. On graphical analysis of the rates of ACL tears and TSFs treated at our center, there was an upward trend in the yearly incidence of both injuries, particularly in the last two years. TSF age ranged from 3 to 17 years with an average of 12.5 ± 2.8 years. ACL tear age ranged from 6 to 24 years with an average of 15.2 ± 2.3 years. Comparisons of sport, age, sex, and BMI were all found to have significant differences (p < .001 for all) between the two injuries. Race was not found to be significantly different between the two injuries. Conclusion: Our data supports the hypothesis that, similar to ACL tears, incidence rates of TSFs have been increasing in recent years. Injury during sport was found to be significantly different between the two injuries, with football being the most common sport for TSFs and soccer being the most common sport for ACL tears. ACL tears also draw from a slightly older age population (15.2 ± 2.3 years) than TSFs (12.5 ± 2.8 years), and TSFs are more commonly seen in males and those with lower BMI when compared to ACL tears. [Figure: see text][Figure: see text]
Preoperative Opioid Use is Associated with Inferior Patient Reported Outcomes and Prolonged Opioid Use after Patellofemoral Stabilization Surgery
Authors: Khazi Zain , Hajewski Christina , Glass Natalie , Wolf Brian , Duchman Kyle , Westermann Robert , Bollier Matthew , Shamrock Alan 
Published: July 2020

Objectives: The purpose of the study was to investigate the association between preoperative opioid use and persistent postoperative use, and determine the impact of preoperative opioid use on patient reported outcomes (PROs) in patients undergoing patellofemoral stabilization surgery. Methods: A retrospective analysis of 60 patients after patellofemoral stabilization surgery with a minimum of 2-year follow-up was performed using a prospectively-collected patellar instability registry. Patients were categorized as opioid naïve (n=48) or preoperative opioid users (n=12). Postoperative opioid use was assessed for all patients at 2 and 6 weeks. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Kujala questionnaires were administered at baseline, and 6 months and 2 years postoperatively. Results: Preoperative opioid use was identified as an independent risk factor for postoperative opioid use at 2- and 6-weeks following surgery (p=0.0023 and p<0.0001, respectively). Preoperative opioid use was associated with significantly lower KOOS and Kujala scores at baseline, 6 months and 2 years postoperatively. Both groups significantly improved from baseline KOOS and Kujala scores at 6 months and 2 years postoperatively. Regardless of preoperative opioid use, opioid use at 6 weeks after surgery was associated with worse KOOS scores at 6 months and 2 years postoperatively. Conclusion: In patients undergoing patellofemoral stabilization surgery, preoperative opioid use was predictive of postoperative use. Additionally, preoperative opioid use was associated with worse PROs at 6 months and 2 years following surgery. [Table: see text][Table: see text]
Graft Preparation with Intraoperative Vancomycin Decreases Infection after Anterior Cruciate Ligament Reconstruction: A Review of 1640 Cases
Authors: Shamrock Alan , Cates William , Cates Robert , an qiang , Wolf Brian , Bollier Matthew , Duchman Kyle , Westermann Jacqueline Baron Robert 
Published: July 2020

Objectives: Septic arthritis is a rare but devastating complication following anterior cruciate ligament (ACL) reconstruction. Reported infection rates following ACL reconstruction are low, but associated with high morbidity including reoperation and inferior clinical outcomes. The purpose of the current study was to investigate the rate of infection after ACL reconstruction with and without graft preparation with vancomycin irrigant. Methods: All ACL reconstructions performed from May 2009-August 2018 at a single, large academic institution were reviewed and categorized based on vancomycin use. Those with <90-day follow-up, intraoperative graft preparation with an antibiotic other than vancomycin, or previous ipsilateral knee infection were excluded. Infection was defined as a return to the operating room for irrigation and debridement within 90 days of ACL reconstruction. Descriptive and inferential statistical analysis using t-tests and Poisson regression were performed, with statistical significance defined as p<0.05. Results: In total, 1,640 patients (952 males; 58.0%) with a mean age of 27.7 + 11.4 years underwent ACL reconstruction (1,379 primary procedures; 84.1%) and were included for analysis. Intraoperative vancomycin was used in 798 cases (48.7%) while 842 ACL reconstructions (51.3%) were performed without intraoperative vancomycin. There were eleven total infections (0.7%), with ten infections occurring in patients without vancomycin-soaked grafts (1.2%) and one infection occurring in grafts soaked in vancomycin (0.1%; p=0.008). Age (p=0.571), gender (p=0.707), smoking (p=0.407), surgeon (p=0.124), and insurance type (p=0.616) were not associated with postoperative infection. There was an 89.5% relative risk reduction with the use of intraoperative vancomycin. Increased body mass index (BMI) (p=0.029), increased operative time (p=0.001), and absence of ACL graft preparation with vancomycin (p=0.032) independently predicted postoperative infection. Conclusion: The use of vancomycin-soaked grafts was associated with a ten-fold reduction in postoperative infection after ACL reconstruction (0.1% versus 1.2%; p=0.032). Other risk factors for postoperative infection after ACL reconstruction included increased BMI and increased operative time. [Table: see text][Table: see text][Table: see text][Table: see text]
Single-Stage Revision Anterior Cruciate Ligament Reconstruction: Experience with 92 cases (41 elite athletes), Using an Algorithm
Authors: Borque Kyle , Jones Mary , Ball Simon , Williams Andy , White Nathan 
Published: July 2020

Objectives: The increased prevalence of anterior cruciate ligament (ACL) reconstructions has led to an increased need for revision ACL reconstructions. Despite the lack of comparative literature, two-stage revisions are often undertaken under the pretense they are safer. Through careful patient selection, pre-operative planning, and meticulous attention to detail, single stage revisions can be performed with good outcomes, decreasing healthcare costs, morbidity and recovery time for the patient. The objective of this paper is to present an algorithm (Figure 1) to determine single-stage or two-stage approaches to ACL revision with good outcomes in recreational and elite athletes. Methods: All revision ACL reconstructions performed by the senior author from September 2009 to July 2016, with minimum two year follow-up, were retrospectively reviewed. Outcomes measured were: any further surgery, graft re-rupture, re-revision, Tegner score, and knee injury and osteoarthritis outcomes score (KOOS). For the elite athlete population, return to play time, duration and level compared to pre-injury were also determined. Results: Ninety-four procedures were performed in 93 patients. This included 41 in elite athletes. In this series only 2 (2%) two-stage procedures were undertaken. At an average of 4.3 years (range: 2-8.5 years) post surgery, there had been two re-revisions. There were two further instances of graft failure which had not been re-revised. The graft failure rate was therefore 4.3%. There were 17 subsequent procedures, including six arthroscopic partial meniscectomies, five removal of prominent implants, and one total knee arthroplasty. The average Tegner score was 8.2 preoperatively, and 7.1 at follow up. At follow up, the average KOOS scores were 79.3 for symptoms, 88.0 for pain, 94.2 for activities of daily living, 73.6 for sport, and 68.9 for quality of life. Thirty-six of 41 elite athletes returned to play, at an average of 338 days post surgery. At an average of 4.6 years, 29 were still playing professionally. Of these, 15 were at the same level, and 14 at a lower level. Five players returned to play but have since retired. This occurred at an average of 3.1 years post op, at an age of 30. Conclusion: Single stage ACL revisions can be performed reliably in the majority, but not all, patients with persistent or recurrent instability following failed ACL reconstruction with good clinical outcomes and return to play, even in the elite athletic population. [Figure: see text]
Pregnancy Outcome Patterns of Medicaid-Eligible Women, 1999-2014: A National Prospective Longitudinal Study
Authors: Studnicki James , Fisher John W. , Reardon David C. , Craver Christopher , Longbons Tessa , Harrison Donna J. 
Published: July 2020

Introduction: The number and outcomes of pregnancies experienced by a woman are consequential determinants of her health status. However, there is no published research comparing the patterns of subsequent pregnancy outcomes following a live birth, natural fetal loss, or induced abortion. Objectives: The objective of this study was to describe the characteristic patterns of subsequent pregnancy outcomes evolving from each of three initiating outcome events (birth, induced abortion, natural fetal loss) occurring in a Medicaid population fully insured for all reproductive health services. Methods: We identified 7,388,842 pregnancy outcomes occurring to Medicaid-eligible women in the 17 states which paid for abortion services between 1999-2014. The first known pregnancy outcome for each woman was marked as the index outcome which assigned each woman to one of three cohorts. All subsequent outcomes occurring up to the fifth known pregnancy were identified. Analyses of the three index outcome cohorts were conducted separately for all pregnancy outcomes, three age bands (<17, 17-35, 36+), and three race/ethnicity groups (Hispanic, Black, White). Results: Women with index abortions experienced more lifetime pregnancies than women with index births or natural fetal losses and were increasingly more likely to experience another pregnancy with each subsequent pregnancy. Women whose index pregnancy ended in abortion were also increasingly more likely to experience another abortion at each subsequent pregnancy. Both births and natural fetal losses were likely to result in a subsequent birth, rather than abortion. Women with natural losses were increasingly more likely to have a subsequent birth than women with an index birth. All age and racial/ethnic groups exhibited the characteristic pattern we have described for all pregnancy outcomes: abortion is associated with more subsequent pregnancies and abortions; births and fetal losses are associated with subsequent births. Other differences between groups are, however, apparent. Age is positively associated with the likelihood of a birth following an index birth, but negatively associated with the likelihood of a birth following an index abortion. Hispanic women are always more likely to have a birth and less likely to have an abortion than Black or White women, for all combinations of index outcome and the number of subsequent pregnancies. Similarly, Black women are always more likely to have an abortion and less likely to experience a birth than Hispanic or White women. Conclusion: Women experiencing repeated pregnancies and subsequent abortions following an index abortion are subjected to an increased exposure to hemorrhage and infection, the major causes of maternal mortality, and other adverse consequences resulting from multiple separation events.