bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Multiligament Knee Injury Classification Stratifies Patients into Risk Categories
Authors: Huang Patrick , Li Don , Petit Logan , Porrino Jack , Medvecky Michael , Kahan Joseph 
Published: July 2020

Objectives: Our goal was to characterize the precise ligamentous injury locations and patterns of acute multi-ligament knee injuries (MLKI) and determine associated rates of dislocations, fractures, peroneal nerve palsies, and vascular injuries. Methods: All patients at a single level one trauma center who received operative treatment for MLKI between 2001 and 2019 were retrospectively identified. Demographic, injury mechanism, injury patterns, presence of dislocation, and associated injuries including vascular injury, peroneal nerve palsy, and fracture were assessed for each patient. MLKI both with and without a document knee dislocation were classified into five classes based on pattern of ligamentous tear (Figure 1). Class 1 included unicruciate tear with any combination of collateral tear. Class 2 are a bicruciate tear without collateral involvement. Class 3 are bicruciate tears with either a medial or lateral sided tear. Class 4 are bicruciate tears with both medial and lateral sided tears. Class 5 are periarticular fracture with any of the preceding ligamentous injury patterns. Rates of dislocation, vascular injury and peroneal nerve injury were analyzed among each class. Single variable statistics such as t-tests as well as multivariable techniques such as Chi square and multiple regression analysis was performed to identify patterns of injury and to predict risk of associated injuries. Results: 100 knees were identified as multiligament knee injuries. 34 of the knees (34%) were dislocated at presentation, and the remaining 66 (66%) did not have a documented knee dislocation. Patients with a documented knee dislocation had higher rates of vascular injury (24% vs. 3%, p = 0.0148), but not higher rates of peroneal nerve injury (32% vs. 20%, p = 0.0863). Patients with PLC injuries had statistically higher rates of peroneal nerve injury compared to acute multiligament knee injuries without a lateral sided injury (30% vs. 3%, p = 0.005). Rates of vascular injury between MLK Class are shown in Table 1. MLK Class was found to be predictive of vascular injury, but not of peroneal nerve injury. Conclusion: We present a new classification of multiligament knee injuries with the goal of providing a more precise diagnosis to aid in the surgical planning and decision making as well as to enhance clinical outcomes research of these complicated injury patterns. By classifying these injuries into five separate classes and further subclassified based on presence of dislocation and lateral sided injury, we are better able to predict likelihood of neurovascular injury. We hope that understanding the risks associated with each class will allow physicians to better appreciate the likelihood of potential complications of these injuries.
Incidence of 2nd Surgery after Medial Patellofemoral Ligament Reconstruction and Simultaneous Osteochondral Fracture Fixation in Pediatric Patients Treated for Patellar Dislocation
Authors: Schlichte Lindsay , Aitchison Alexandra , Green Daniel 
Published: July 2020

Objectives: Osteochondral fractures occur in 5-15% of cases of acute or recurrent patellar dislocations. In these settings, early surgical intervention with biodegradable fixation nails is recommended to optimize healing. The aim of this study was to determine the incidence of recurrent instability and second surgery following osteochondral fracture fixation with concomitant medial patellofemoral ligament (MPFL) reconstruction. Methods: We conducted a retrospective cohort study of 321 MPFL reconstructions performed by a single surgeon between 2011 and 2019. Thirty-eight knees underwent MPFL reconstruction with osteochondral fixation. Demographic data, surgical details, date of latest radiographic and clinical follow-up, and subsequent surgical procedures were collected. Results: Thirty-seven MPFL reconstructions with osteochondral fracture fixation in 36 patients were performed by a single surgeon from 2011 to 2019 (1 bilateral). The average age at surgery was 14.8 years (range 10.6– 19.6 years). The average length of clinical follow-up was 2.1 years (range 0.3– 5.5 years). The average number of biodegradable fixation nails used was 4.4 (range: 2-8). Twenty-seven (72.9%) fractures were fixed to the patella and 10 were fixed to the lateral femoral condyle or trochlea. There was 1 report of recurrent instability. Ten (27%) patients required a second surgery on the ipsilateral knee, and underwent chondroplasty (n=8), removal of biodegradable fixation nails (n=4), removal of hemi-epiphysiodesis or TTO hardware (n=2), revision MPFL with tibial tubercle osteotomy (n=1), lateral meniscus repair (n=1). The one patient who required revision MPFL reconstruction has juvenile idiopathic arthritis and underwent 3 additional surgeries after the initial MPFL procedure. Eight patients (22%) underwent a second surgery to address cartilage damage or removal of nails. The mean time to second surgery was 40.0 weeks (range:11-82.7). Of the four patients who required removal of nails, the average number of nails initially placed was 7 ± 1.7. This was significantly more than the patients who did not require second surgery related to nail removal (4.1 ± 1.6, p < .05). Conclusion: Approximately 78% of patients undergoing MPFL reconstruction and osteochondral fracture fixation with biodegradable nails showed good fracture healing and patellar stability while 22% went on to require a second surgery. The second surgery most commonly involved debridement of an unhealed portion of the cartilage.
INCREASED PREVALENCE OF JUVENILE OSTEOCHONDRITIS DISSECANS IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS
Authors: Dickason Celeste Quitiquit , Jinguji Thomas , shenoi susan , Thapa Mahesh , Saper Michael , Bompadre Viviana , Schmale Gregory , Hinkle Andrew 
Published: July 2020

Objectives: To determine the prevalence and severity of OCD in patients with JIA. Methods: This was a retrospective review of patients with JIA and OCD treated between January 2008 and March 2019 at one children’s hospital. We queried Department of Rheumatology records for JIA patients treated during this interval as well as Departments of Orthopedics and Radiology records for patients with OCD. Demographic information, classification of the stability of OCD lesions by review of magnetic resonance imaging, and clinical details of treatment were recorded. Results: 2,021 JIA patients were identified, 20 of whom (19 girls, 1 boy) had OCD of the knee and/or talus for a prevalence of 1/100 or 1000/100,000, or approximately 30-200x that of the general population. These 20 patients had a total of 28 OCD lesions: 43% (9 femur, 3 talus) were radiographically stable over time, 50% (10 femur, 2 patella, and 2 talus) were unstable at initial diagnosis, and 7% (femur) were initially stable but progressed to unstable lesions despite drilling. Eleven patients (55%) underwent surgery: 5 with stable femoral lesions for persistent symptoms despite prolonged non-operative treatment, and 6 for treatment of their unstable lesions (femur and patella). Of these 11 patients, 3 underwent two or more surgeries for OCDs, and 3 were treated with hemiepiphysiodesis for concomitant genu valgum. Conclusion: OCD lesions are 30-200x more prevalent in JIA compared to the general population. In JIA, OCD often presents at an advanced stage requiring surgery for stabilization. Patients with JIA may benefit by early screening, to potentially allow for treatment of an OCD lesion prior to the progression to instability.
Osteochondral Allograft Transplantation of the Knee in “Ideal” Candidates: Clinical Outcomes and Graft Survivorship
Authors: Bugbee William 
Published: July 2020

Objectives: Osteochondral allograft (OCA) transplantation of the knee is an effective treatment for chondral and osteochondral lesions, but graft survivorship and clinical outcomes vary by patient-specific factors. Fresh OCA are often used for large or complex lesions or in the revision cartilage repair setting, but recent literature suggests that the most ideal candidates for OCA transplantation may be young patients with a small lesion on the femoral condyle or trochlea due to osteochondritis dissecans or chondral trauma. The purpose of this study was to assess outcomes following OCA transplantation in a cohort of “ideal” candidates. Methods: We identified 91 patients (97 knees) who underwent primary OCA transplantation for osteochondritis dissecans (88%) or a traumatic chondral injury (12%), were age 30 years or younger, and had an isolated lesion(s) of the femoral condyle or trochlea less than 8 cm2. Mean age was 20 years and 70% were male. Lesions were located on the femoral condyle (85%) or trochlea (15%). One graft was used in 85% of knees and two grafts were used in 15%. Mean total graft area was 5.2 cm2. Evaluation included pain, function, satisfaction, and reoperations. OCA failure was defined as revision allografting or conversion to arthroplasty. Median follow-up was 5.7 years (range 2-17 years). Results: Seventeen knees (18%) underwent reoperations. Two knees (2%) were classified as OCA failures (one revision OCA at 2.7 years and one conversion to unicompartmental arthroplasty at 10.2 years). Survivorship was 99% at 5 and 10 years. Pain and function improved (Table 1.), and 93% of patients were satisfied with the results of the OCA transplantation. Conclusion: In this cohort of “ideal” cartilage repair patients undergoing OCA transplantation, graft survivorship and clinical outcomes were excellent, with high satisfaction, pain relief, and functional improvement. Outcomes were equal or superior to other cartilage repair techniques. [Table: see text]
Short Oblique Patellar Tunnels for Patellar Fixation Do Not Increase Fracture Risk in MPFL Reconstruction: A Retrospective Cohort Study
Authors: Lesevic Milos , Deasey Matthew , Burnett Zachary , Diduch David , Moran Thomas 
Published: July 2020

Objectives: The current standard of care for recurrent patellar instability is reconstruction of the medial patellofemoral ligament (MPFL), the primary soft tissue constraint to lateral subluxation of the patella. Historically, transpatellar bone tunnels have been associated with increased rates of patella fracture. To avoid this dreaded outcome, many surgeons now employ suture anchors to affix the MPFL graft to the patella. This study aims to evaluate the costs and outcomes associated with short oblique patella tunnels as compared to suture anchor fixation in MPFL reconstruction. Methods: A total of 467 knees in 419 patients undergoing MPFL reconstruction between 2011 and 2018 were included in the study. A single institution electronic medical record queried for all patients undergoing extra-articular ligament reconstruction using Current Procedural Technology codes 27422 and 27427. Chart review of operative reports was utilized to identify those who had undergone MPLF reconstruction. Patients undergoing revision MPFL reconstruction were excluded, as were patients for whom fully transpatellar bone tunnels were employed for patellar fixation. This left two groups: those for whom small, oblique tunnels (n = 277) and suture anchors (n = 190) for patellar fixation were compared. Implant pricing for the 3.2 mm drill bit, suture anchors, and allograft were obtained through publicly available databases and prior published research. Results: Short oblique tunnels showed no significant increase in risk of patellar fracture compared to suture anchors for patellar fixation (P = 1.00). Use of suture anchors was associated with an increased risk of subluxation or dislocation compared to small, oblique tunnels (OR = 3.34, P = 0.021). No significant difference in the need for revision MPFL reconstruction surgery was found (OR = 1.964, P = 0.45) [Table 1]. The cost difference between allo- and autograft in ligament reconstruction has been analyzed in multiple prior studies and found to be $1100. The 3.2mm drill bit used to create the tunnels cost $84 but is reusable, while the average cost of two suture anchors was $500, leading to a material cost savings of $1600 per case in which transpatellar tunnels were used for MPFL autograft fixation when compared to a suture anchor and allograft combination. Regardless of the graft choice, material cost savings exceeds $400 per case simply by conversion to short oblique tunnels rather than suture anchors. Conclusion: The use of small, oblique tunnels with hamstring autograft is a safe and cost effective method for patellar fixation in MPFL reconstruction. Value in healthcare is defined as quality divided by cost. As surgeons and institutions are increasingly judged not only by the quality of the care they provide, but also in its cost, employment of this high-value technique should be considered by surgeons performing MPFL reconstruction.
A Practical Pre-Operative Predictive Model for Determining Hamstring Autograft Size for Anterior Cruciate Ligament Reconstruction in Children and Adolescents
Authors: Sherman Benjamin , Schlechter John , Kwan Kevin 
Published: July 2020

Objectives: The most commonly used graft for pediatric and adolescent anterior cruciate ligament (ACL) reconstruction is the hamstring autograft. Recent evidence has suggested that graft sizes less than 8 mm and age less than 20 years old are the most significant factors influencing graft failure. Additionally, studies examining the role of augmenting smaller grafts with allograft have demonstrated mixed results and potentially increased failure rates. Efforts to predict hamstring size preoperatively using MRI and ultrasound in the adult population have shown promise. However, there have been no studies in an entirely pediatric population. The purpose of this study was to evaluate the predictive value of MRI in determining hamstring autograft size preoperatively for pediatric ACL reconstructions. Methods: Children and adolescents from 10-20 years old that had undergone ACL reconstruction using hamstring autograft were identified from 2017-2018. Semitendinosus and gracilis cross-sectional area and diameter were measured on preoperative knee MRIs using the field of interest (FOI) and distance measurement tools. The slice used for measurement was identified as the largest section by the measuring surgeon. Two surgeons independently measured all MRIs. Preoperative demographic data (height, weight, body mass index (BMI), gender) and operative data (graft size) was collected. Data was analyzed by an independent statistician. Ordinal regression analysis was performed to determine the relationship between demographic data and graft size. A Classification and Regression Tree (CART) was constructed to identify predictors for the pre-determined graft sizes of 8 mm. Receiver operating characteristics (ROC) analysis were then created to assess the performance of the predictive model and determine sensitivity and specificity. All analyses were performed using SPSS v. 24 with alpha set at p<0.05 to declare significance. Results: One hundred and ten children (54 boys, 56 girls) were included in this study with an average age of 15.93 years (range 11.81-20.22) and average BMI of 25.98 (range 16.02-40.08). CART analysis determined that if the sum of the cross-sectional areas of the semitendinosus and gracilis tendons were greater than 31.17 mm then 87.5% of children had graft sizes of 8 mm or greater. The ROC analysis determined the model to have an 80% sensitivity and 74% specificity for predicting a graft size of 8 mm or larger. Conclusion: A preoperative summation of the cross-sectional areas of the semitendinosus and gracilis tendons greater than 31.17 mm predicts an intraoperative graft size of 8 mm or larger in 87.5% of children. [Figure: see text][Table: see text]
Building an Innovative and Entrepreneurial Dimension in an Institution of Higher Education
Authors: Corso Ron 
Published: July 2020

Institutions of higher education in the twenty-first century are undergoing a transformation locally and globally from traditional pillars of learning to being more entrepreneurial in their core business. There is increasing pressure on universities to becoming more flexible and adaptable as organizations and in the graduate attributes, they imbed in their students. There is a need to build deeper links with business, to both maximize innovation and promote growth, to ensure students are equipped to excel in the workforce. This change is having a disruptive effect on the role of universities, from classical research institutions to entrepreneurial universities mimicking more of the modern workplace working environment, requiring autonomy in their decision-making and in the way new research is developed, implemented and transferred in the relationships formed within their respective regions. This article outlines work in progress on the University of South Australia’s attempts to rebrand itself as a University of Innovation and Enterprise (Australia’s University of Enterprise) in both its end-user inspired research outcomes and industry-informed teaching and learning.
Perceptions of Cultural Competency Among Premedical Undergraduate Students
Authors: Goyal Reeti , Martin Skky , Garbarski Dana 
Published: July 2020

Background: Cultural competence is a difficult skill to teach, as it has several operational definitions as well as limited and unstandardized training procedures. Currently, there is no formal cultural competency training at the undergraduate level for students who seek to become a medical doctor. The purpose of this study is to explore perceptions of cultural competence among premedical undergraduates by assessing how they define and understand cultural competency and their knowledge (and sources thereof) of sociocultural realities in health and medicine. Methods: Structured in-depth interviews took place in 2016 and 2017 at a medium-sized private college in the Midwestern United States. Twenty premedical students were interviewed. The interviews were transcribed and thematically coded following an inductive, iterative, and systematic process. Results: Most students can provide a definition of cultural competence that includes at least one component of how it is conceptualized by the Association of American Medical Colleges. However, students focus largely on defining cultural competence as individual attitudes and interaction rather than systemic or structural realities that produce inequalities in health care. When explicitly asked, students varied in the level of detail provided in explaining the social determinants of health (such as race or ethnicity, sex, gender, and socioeconomic status) and varied in the accuracy of their definitions of traditional health practices. Each student noted the importance of training on cultural competence and many placed patients’ health at the center of their reason for doing so rather than focusing on their own training as a motivation. Students discussed various aspects of sociocultural differences and the need for physicians to understand patients’ outlooks on health care and be able to communicate to patients the purpose of suggested medical treatment, as well as the inherent tension in balancing patients as individuals and members of sociocultural groups. Premedical undergraduate students see their own cultural competence as an informal skill that is gained through social interactions across various areas of life, such as work, family, friends, and school. Conclusion: This study traces the sources of sociocultural information that premedical students will bring to their medical training as well as places where cultural competence can be further explored, practiced, and formally integrated in premedical education.
Developing a Workplace-Based Learning Culture in the NHS: Aspirations and Challenges
Authors: Gawne Suzanne , Fish Rebecca , Machin Laura 
Published: July 2020

Background: The delivery of patient care in the United Kingdom is under increasing financial pressure. The need to continuously improve service delivery while making financial savings is challenging. Alongside this, National Health Service (NHS) Trusts must provide a suitable educational environment that meets the needs of all learners while meeting performance standards and targets set by external regulating authorities. This research addresses the gap in literature concerning educational culture in the NHS. Methods: This case study examines the delivery of postgraduate medical education in the workplace. Semi-structured interviews were conducted with 6 lead educators in the Medical Division of a North West NHS Trust to glean their insights into what works and what needs to change. Results: A thematic analysis of the transcripts revealed a number of factors that facilitated and hindered educational opportunities for doctors in training, including the role of leadership, the demands of external regulatory authorities, and the pressures on frontline staff to deliver safe, personal, and effective care. Conclusion: Opportunities for developing a collaborative approach between educational and clinical leaders and the individuals delivering education in the workplace to enhance the educational environment are discussed. Finally, an evaluatory toolkit based on the themes emerging from the data is proposed, as a resource for other health care organisations to help improve the delivery of workplace-based medical education.
A phase 1b study of AFM13 in combination with pembrolizumab in patients with relapsed or refractory Hodgkin lymphoma
Authors: Bartlett Nancy L. , Herrera Alex F. , Domingo-Domenech Eva , Mehta Amitkumar , Forero-Torres Andres , Garcia-Sanz Ramon , Armand Philippe , Devata Sumana , Izquierdo Antonia Rodriguez , Lossos Izidore S. , Reeder Craig , Sher Taimur , Chen Robert , Schwarz Sylvia E. , Alland Leila , Strassz Andras , Prier Kim , Choe-Juliak Cassandra , Ansell Stephen M. 
Published: July 2020

Abstract
In relapsed/refractory Hodgkin lymphoma (R/R HL), immunotherapies such as the anti-programmed death-1 inhibitor pembrolizumab have demonstrated efficacy as monotherapy and are playing an increasingly prominent role in treatment. The CD30/CD16A-bispecific antibody AFM13 is an innate immune cell engager, a first-in-class, tetravalent antibody, designed to create a bridge between CD30 on HL cells and the CD16A receptor on natural killer cells and macrophages, to induce tumor cell killing. Early studies of AFM13 have demonstrated signs of efficacy as monotherapy for patients with R/R HL and the combination of AFM13 with pembrolizumab represents a rational new treatment modality. Here, we describe a phase 1b, dose-escalation study to assess the safety and preliminary efficacy of AFM13 in combination with pembrolizumab in patients with R/R HL. The primary objective was estimating the maximum tolerated dose; the secondary objectives were to assess safety, tolerability, antitumor efficacy, pharmacokinetics, and pharmacodynamics. In this heavily pretreated patient population, treatment with the combination of AFM13 and pembrolizumab was generally well tolerated, with similar safety profiles compared to the known profiles of each agent alone. The combination of AFM13 with pembrolizumab demonstrated an objective response rate of 88% at the highest treatment dose, with an 83% overall response rate for the overall population. Pharmacokinetic assessment of AFM13 in the combination setting revealed a half-life of up to 20.6 hours. This proof-of-concept study holds promise as a novel immunotherapy combination worthy of further investigation. This phase 1b study was registered at www.clinicaltrials.gov as NCT02665650.