bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medial Meniscus Posterior Root Tear Treatment: A matched cohort comparison of non-operative management, partial meniscectomy and repair
Authors: Bernard Christopher , Tagliero Adam , LaPrade Matthew , Camp Christopher , Saris Daniel , Levy Bruce , Stuart Michael , Krych Nicholas Kennedy Aaron 
Published: July 2020

Objectives: Meniscal root disruption results in a loss of hoop strain resistance, increased articular cartilage contact pressure, and acceleration of degenerative changes. There is limited data comparing the outcomes of similarly matched patients with a medial meniscus posterior root tear treated with non-operative management, partial meniscectomy, or repair. The purpose of this study is to compare treatment failure, clinical outcome scores, and radiographic findings for a matched cohort of patients who underwent either non-operative management, partial meniscectomy, or transtibial pull-through repair for a medial meniscus posterior root tear (MMPRT). Our hypothesis is that patients who underwent meniscus root repair will have lower rates of progression to arthroplasty than patients who were treated with non-operative management or partial meniscectomy. Methods: Patients who underwent transtibial medial meniscus posterior horn root repair were matched by meniscus laterality, age, sex and K-L grades to patients treated non-operatively or with a partial meniscectomy. Progression to arthroplasty rates, IKDC and Tegner scores, and radiographic outcomes were analyzed between groups. Results: Forty-five patients were included in this study (15 non-operative, 15 partial meniscectomy, 15 root repair). Progression to arthroplasty demonstrated significant differences among treatment groups at a mean 74 months (non-operative 4/15, partial meniscectomy 9/15, meniscus repair 0/15, p=.0003). The meniscus root repair group had significantly less arthritic progression, as measured by change in K-L grade from pre-op to post-op (non-operative 1.0, partial mensicectomy 1.1, and meniscus repair 0.1, p=.001). Conclusion: Meniscus root repair leads to significantly less arthritis progression and subsequent knee arthroplasty compared to non-operative management and partial meniscectomy in a demographically matched cohort.
Return to Work and Sport Following Distal Triceps Repair
Authors: Manderle Brandon , Polce Evan , Williams Brady , Nicholson Gregory , Fernandez John , Wysocki Robert , Forsythe Brian , Cole Brian , Verma Nikhil , Beletsky Alexander 
Published: July 2020

Objectives: Outcomes following distal triceps repair are important in order to properly counsel patients on expected postoperative function. Of particular interest are metrics regarding return to work and return to sport, including when return can be expected and at what intensity level. The purpose of this study is to establish important return to sport and work expectations for patients undergoing distal biceps repair. Methods: A prospectively maintained institutional database was retrospectively reviewed for all patients who underwent distal biceps repair since 2004 with minimum 2-year follow-up. A patient survey was conducted over phone with regard to preoperative and postoperative participation in sports, level of intensity, and maximum weight repetitions of barbell and dumbbell biceps curl, bench press, and consecutive push-ups. Mayo Elbow Performance Score (MEPS) and The Disabilities of the Arm, Shoulder and Hand Score (QuickDASH) were collected preoperatively and at final follow up. T-tests and chi-squared analysis was used to examine continous and categorical outcome variables, respectively. Results: A total of 70 patients (41 male) were contacted for final follow-up information. Average age was 48.42 + 13.32 and average time from initial injury to surgical intervention was 3.12 + 2.88 months. 81% of the injuries involve lifting of heavy objects, and 27.7% occurred during sport. Ten percent (n=7) of patients returned to the operating room, most commonly for ulnar nerve repair. Return to work was achieved in 86.3% of patients, occurring at an average of 2.87 months. Heavy duty status workers returned at significantly later time points than sedentary or light duty status workers (5.35 vs. 1.21 months, p<0.01). 81.4% of patients returned to the same or higher level of work. Return to sport was achieved by 79.7% of patients at an average of 3.32 months. 73.9% of patients were either satisfied or very satisfied with their ability to work, and 68.6% were satisfied or very satisfied with their ability to play spots. All competitive athletes (n=11) returned to either the same or higher level of intensity following surgery. Conclusion: Surgical repair of a distal triceps injury results in reliable return to work and sport, with the majority of patients returning to the same physical intensity of work and the same intensity of sporting, respectively. Competitive athletes demonstrate particularly impressive results with heightened return to sport rates at the same or greater intensity level, suggesting motivation level may have a role in determining successful return to sport. Our data may be utilized to better inform the shared decision-making process between providers and patients when considering surgical intervention for distal triceps injuries.
Timing of Return to Batting Milestones Following Ulnar Collateral Ligament Reconstruction in Professional Baseball Players
Authors: Erickson Brandon , Chalmers Peter , John D , Ma Kevin , Sheridan Scott , Schickendantz Mark , Romeo Anthony 
Published: July 2020

Objectives: Ulnar collateral ligament reconstruction (UCLR) is a common procedure in professional baseball position players. Timing of return to hitting following UCLR is unknown. The purpose of this study was to determine the time to return to batting milestones after UCLR as well as the effect of UCLR upon batting performance in professional baseball players. The authors’ hypothesized that position players would return to batting in an in-season game prior to fielding in an in-season game and hitting performance would remain unchanged following UCLR Methods: All professional position players who underwent UCLR between 2010-2018 were included. Time to batting milestones following UCLR was analyzed. Batting performance before and after UCLR was compared and analyzed. Results: Overall, 141 UCLRs (96% performed on the dominant arm) in 137 position players were included (86% minor leaguers). Four players underwent revision, all within one year of the primary UCLR. With regard to position, catchers and shortstops were over-represented. With regard to batting side, 57% batted from the right and 12% batted as switch-hitters, and thus 76% of surgeries were on the lead arm. While 91% of players were able to return to any throwing at all, there was a progressive gradual decline during the rehabilitation progress such that 77% were able to return to hitting in a real game and 75% were able to return to fielding in a real game. The first dry swing occurred at 150±49 days after surgery, first batting practice occurred at 195±58 days after surgery, and first hitting in a real game occurred at 323±92 days after surgery. However, players generally saw a decrease in their utilization, with fewer at bats (p<0.001) translating into fewer hits (p<0.001) and runs (p<0.001). Conclusion: Professional position players begin swinging at 150 days following UCLR while they do not hit batting practice until 195 days and do not hit in a real game until 323 days following UCLR. Players saw a decrease in hitting utilization following UCLR. [Figure: see text]
Lateral Elbow Overuse Injuries in Pediatric Female Gymnasts: A Comparison of Radial Head Stress Fractures and Capitellar OCD
Authors: Searls William , Zynda Aaron , Ellis Henry , Wilson Philip , Wyatt Charles 
Published: July 2020

Objectives: Radial head stress fractures (RHSF) and capitellar osteochondritis dissecans (OCD) are rare and may be seen in pediatric gymnasts. Clinical and radiographic factors correlating with these differential lesions are unclear. To describe the clinical presentation of RHSF and compare the demographic, radiographic, and clinical characteristics of elbows in pediatric gymnasts presenting with RHSF to those presenting with OCD of the capitellum. Methods: An IRB-approved retrospective review of consecutive female gymnasts treated within a pediatric sports medicine practice for either RHSF or capitellar OCD over a 5-year period (1/2014-2/2019) was performed. Gymnasts <18 years old at the time of injury presenting with signs of a radial head stress fracture (Salter-Harris III or IV) or with diagnostic features of capitellar OCD were included. Those with congenital anatomic elbow abnormalities or prior ipsilateral elbow surgery were excluded. Patients were dichotomized into either the RHSF or OCD group; and demographic, radiographic, and clinical characteristics were compared. Statistical analysis was performed using a Mann-Whitney test for continuous variables and a chi-square test for categorical variables. Results: Forty-five patients (9 with bilateral OCD, 1 with bilateral RHSF, and 3 with each lesion in alternate elbows), contributing 58 elbows, met inclusion criteria. Thirty-nine elbows in the OCD group and 19 elbows in the RHSF group were studied. Average age for all gymnasts was 11.58 years (9-16 years), with no difference between groups (OCD: 11.47 vs RHSF: 11.78; p=0.34). No differences in height, weight, BMI, or laterality were noted. Gymnasts presenting with RHSF were competing at a higher level than those with OCD, with 94.74% of RHSF group competing at level 7 or greater compared to 66.67% of OCD patients (p=0.02). Compared to those with OCD, the RHSF group presented more acutely following onset of symptoms (p=0.014), reported significantly more pain with valgus stress (p<0.001), and concurrent medial elbow pain than those with OCD (p<0.01). The RHSF group demonstrated significantly smaller distal humeral width and decreased height of the proximal radial epiphysis, as well as increased valgus angulation of the radial neck shaft angles and distal humeral articular surface (p<0.05). No differences in olecranon or medial epicondyle hypertrophy, or avulsive changes were identified. (Table I) Conclusion: Gymnasts competing at a high competitive level and presenting more acutely may be at risk for RHSF. Additionally, differing anatomy in the lateral elbow may be a predisposing risk factor for RHSF as opposed to OCD and merits further investigation.
Location of the Glenoid Defect in Shoulders with Recurrent Posterior Glenohumeral Instability
Authors: Provencher Matthew , Peebles Liam , Goldenberg Brandon , Millett Peter , Dekker Travis 
Published: July 2020

Objectives: Posterior glenoid bone deficiency is an increasingly recognized entity in the setting of recurrent posterior shoulder instability; however, little is known about the subject. Due to the paucity of literature on posterior bone loss, historical comparisons to anterior bone loss may not be fully accurate. The purpose of this study was to systematically describe the morphology of posterior bone defects in the setting of recurrent posterior shoulder instability based on several quantitative parameters, including the mean location, orientation, and extent of bone loss on a clock face model, as well as the angle of the defect relative to the long axis of the glenoid. Methods: 3-dimensional (3D) reconstructed computed tomography (CT) scans of serially collected patients with a history of recurrent posterior shoulder instability were evaluated by three separate reviewers. The posterior glenoid bone defect was characterized using the following measures: (a) the mean lesion location and orientation based on a clock face model with 6:00 o’clock denoted as inferior and 9:00 o’clock as directly posterior for all patients; (b) the total extent of the posterior bone defect based on the clock face; and (c) the average angle of the bone loss relative to the long axis of the glenoid. Results: A total of 70 male patients and 1 female patient with mean age of 29.3 years (range = 24.4 to 35.1 years) were included in the analysis. The mean clock face location of the posterior glenoid defect originated at 6:44 (range = 4:16 to 8:12) and extended to a mean of 9:28 (range = 7:02 to 10:38). The mean extent of the posterior glenoid defect was 2:43 (range = 1:08 to 4:50), which corresponds to a mean total bone loss arc of 81.5° (range = 34.2° to 144.9°), nearly one quadrant of the glenoid. Posterior bone loss occurred in a posteroinferior direction at a mean angle of 30.7° (range = 8.0° to 80.0°) relative to the long axis of the glenoid. Conclusion: This study describes the location and orientation of posterior glenoid bone loss one can expect when treating this challenging patient population. Posterior bone defects in the setting of posterior shoulder instability most commonly occur in the posterior-inferior quadrant of the glenoid and extend on average from 6:44 to 9:28 (81.5° total degrees of arc) on a clock face model. Posterior bone loss occurs at a mean of 30° off the long axis of the glenoid in a posteroinferior direction, which is historically different from anterior bone loss, which occurs parallel to the long axis of the glenoid. This study serves to highlight the location and orientation of bone loss that one can expect in a patient with recurrent posterior shoulder instability, although additional work is needed to assess why this develops. [Figure: see text][Figure: see text][Figure: see text][Figure: see text]
Return to Sport Following Open Latarjet Procedure for Recurrent Shoulder Instability
Authors: Liu Joseph , Gowd Anirudh , Garcia Grant , Beletsky Alexander , Cabarcas Brandon , Romeo Anthony , Nicholson Gregory , Cole Brian , Verma Nikhil 
Published: July 2020

Objectives: Shoulder instability is common within athletic populations, particularly in contact sports. The Latarjet procedure is typically reserved for recurrent instability recalcitrant to soft tissue repair. Limited literature exists regarding return-to-sport following Latarjet stabilization. Methods: A single institutional registry was queried between 2012 – 2016 for all open Latarjet stabilization procedures. Patients with no sport history were excluded. Glenoid bone loss was measured using the PICO method. Hill-Sachs defects were categorized as “on-track” or “off-track.” Sport participation was retrospectively surveyed 3-years prior and 3-years following surgery. Factors associated with return-to-sport, throwing, and recurrent instability were assessed using multivariate logistic regressions. Results: A total of 92 surgeries were identified, 67 of which were available for follow-up (72.8%). Average follow-up was 53.8 ± 11.6 months. Mean age and BMI were 27.9 ± 11.6 years and 25.9 ± 8.4 kg/m2, respectively. Mean glenoid bone loss was 16.4 ± 5.1%. There were 13 Hill Sachs lesions (5 off track), with a mean defect size of 145.8 ± 60.4 mm3. The dominant side was involved in 36 patients. Fifty-two patients (77.6%) reported return-to-sport at an average of 8.6 ± 4.6 months. Thirty-six patients (53.7%) reported return-to-sport at the same or higher level than their preoperative state. Only 58.6% of throwing athletes returned to throwing post-surgery. Seven patients (10.4%) reported recurrence of instability following surgery. A higher likelihood of recurrent instability was associated with larger Hill-Sachs volume (p=0.021, OR: 1.06, 95% CI: 1.01-1.16). A reduced likelihood of returning to sport at same or better level was associated with dominant-sided surgery (p=0.010, OR: 0.362, 95% CI: 0.210-0.622). Conclusion: The open Latarjet procedure is associated with high rate of return-to-sport; however, nearly half were unable to return to their pre-injury level. During preoperative assessment, consideration of Hill-Sachs lesion size and laterality are significant factors for improved outcomes.
Anterior Shoulder Instability: Outcome of Initial Non-operative Treatment in 739 patients with a mean follow up of 15 years
Authors: Bernard Christopher , Leland Devin , Keyt Lucas , Krych Aaron , Dahm Diane , Camp Christopher , Duethman Nicholas 
Published: July 2020

Objectives: There remains a paucity of data describing the efficacy of non-operative treatment following an index anterior instability event. The purpose of this study was to describe the long-term outcomes of non-operative treatment following index anterior instability event, define the success rate of initial non-operative treatment for anterior shoulder instability, and describe factors that predict conversion to surgery after initial non-operative management to help guide surgical decision making in these patients. Methods: An established geographic database was utilized to identify patients under the age of 40 treated for anterior shoulder instability between 1994 and 2016. Patient demographics, comorbidities, injury characteristics, instability history, activity level, x-rays, advanced imaging, treatment course, and outcomes were evaluated. Patients treated non-operatively for the first 6 months following index instability event were analyzed to determine long-term outcomes, success rate of continued non-operative treatment, and factors associated with conversion to surgery. Results: 739 patients met criteria with an average follow-up of 190 months (range 0.13 to 490 months). Average age was 23.8, mean BMI was 25.6, 9.1% had a history of hyperlaxity, and 83.9% of instability events were due to trauma. 29.7% of patients had a Hill-Sachs lesion on index x-ray, and 6.3% had a bony Bankart. 198 shoulders went on to operative treatment (26.8%) with a mean time to surgery of 62.7 months following initial instability event. At final follow-up, 24.0% reported mild pain, 6.2% as moderate, 0.2% as severe. 13.8% of patients had evidence of glenohumeral arthritis on final follow-up x-rays compared to 1.6% on initial radiographs. Factors associated with conversion to surgery included 2 or more dislocations prior to first clinical evaluation (OR=1.75, p<0.001), labor intense occupation (OR=1.49, p=0.031), Hill Sachs lesion on index x-ray (OR=1.31, p=0.034), and MRI findings including: anteroinferior labral tear (OR=2.15, p<0.001), posteroinferior labral tear (OR=1.38, p=0.049), SLAP tear (OR=1.29, p=0.054), Hill-Sachs lesion (OR=1.85, p<0.001), and glenohumeral cartilage injury (OR=1.26, p=0.041). Conclusion: The majority of patients less than 40 can be definitively treated non-operatively after an initial 6 month episode of non-operative treatment. A small proportion will report pain over the long-term and/or develop glenohumeral arthritis. Multiple factors upon initial evaluation were associated with future conversion to surgery including: increasing number of prior instability events, occupation, and degree of soft tissue injury on MRI.
Predictors of Clinical Outcomes After Hip Arthroscopy: 5 Year Follow- Up Analysis of 1038 Patients
Authors: Domb Benjamin , Go Cammille , Maldonado David , Chen Sarah , Lall Ajay 
Published: July 2020

Objectives: Identify predictive factors of midterm outcomes after hip arthroscopy in a cohort of 1038 patients, whose outcomes at minimum 2-year follow-up have previously been reported. In addition, to provide a comparison of short-term and midterm predictive factors in outcome measures following hip arthroscopy. Methods: Data were prospectively collected and retrospectively reviewed on all patients undergoing hip arthroscopy between February 2008 and June 2012. Patients were included if they had minimum 5-year follow-up on 3 patient reported outcomes: Nonarthritic Hip Score (NAHS), modified Harris Hip Score (mHHS), and Hip Outcome Score-Sport Specific Subscale (HOS-SSS). Patients were excluded if they had any prior ipsilateral hip conditions. Using bivariate and multivariate analyses, we analyzed the effect of 36 preoperative and intraoperative variables on NAHS. Results: A total of 1038 patients met our listed inclusion and exclusion criteria, with a mean follow-up time of 62.0 months (range, 60.0 - 120.0 months). The bivariate analysis identified 11 variables (4 categorical and 7 continuous) that were predictive of 5-year postoperative NAHS. For the multivariate analysis, 7 variables were identified as being significant: preoperative NAHS, body mass index (BMI), age, lateral joint space, alpha angle, revision hip arthroscopy, and acetabular microfracture. These 7 variables were also predictive in the bivariate analysis. Conclusion: This study reports favorable midterm clinical outcomes in the largest cohort of hip arthroscopies with minimum 5-year follow up in the literature to date. Seven variables were identified as being significant predictors in both the bivariate and multivariate analysis: preoperative NAHS, body mass index (BMI), age, lateral joint space, alpha angle, revision hip arthroscopy, and acetabular microfracture. Of these, preoperative NAHS, BMI, age, and revision hip arthroscopy were predictive of both 2-year and 5-year postoperative NAHS. These predictive factors may prove useful to clinicians in determining indications for hip arthroscopy and counseling patients on its expected outcomes.
Acetaminophen, Bupivacaine, Duramorph, and Toradol: A comparison of Gene Expression changes in Osteoarthritic Human Chondrocytes
Authors: Sakalian Philip , Cooke Christopher 
Published: July 2020

Objectives: To determine if exposure to Duramorph results in a lower level of chondrotoxicity than Acetaminophen, Bupivacaine, or Toradol. Methods: Distal femur and proximal tibia cross sections were obtained during total knee arthroplasty and a 3D Chondrocyte culture technique was performed. Digested cartilage was then treated via an alginate bead culture method to ensure lower rates of differentiation. Chondrocyte cells were exposed to the study chemicals and gene expression and chondrocyte viability were measured by RT-PCR and flow cytometry, respectively. Results: Exposure to Bupivacaine leads to cellular apoptosis with a % PI+ (dead) cells of 30.45, significantly greater than the other test groups P<0.001. Exposure to Toradol, duramorph and acetaminophen did not result in a significant increase in cell death. Bupivicaine also lead to an increase in Caspase 3 gene expression (p<0.001) when compared to all other groups. Acetophinophen also lead to an increased Caspase 3 gene expression when compared to control. Neither Toradol nor Duramorph led to an increase in caspase 3 gene expression. Conclusion: Our data show Duramorph and Toradol were not cytotoxic to human chondrocytes and may be better alternatives to the frequently used and more cytotoxic Bupivacaine. Acetominophen did not result in increased cell death however did show increased caspase 3 gene expression and caution should be considered.