bluuebunny/crossref_metadata_2025_split huggingface dataset:
Higher Incidence of Post-traumatic Radiographic Osteoarthritis with Transtibial Femoral Tunnel Positioning Compared to Anteromedial Femoral Tunnel Positioning During Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis (208)
Authors: Cinque Mark , Kunze Kyle , Williams Brady , Moatshe Gilbert , LaPrade Robert , Chahla Jorge 
Published: October 2021

Objectives: Anteromedial (AM) femoral tunnel positioning in anterior cruciate ligament reconstruction (ACLR) has been reported by some authors to yield superior clinical and functional outcomes compared to the transtibial (TT) approach; however, differences in the subsequent rates of post-traumatic osteoarthritis (PTOA) incidence are not clear. To perform a systematic review and meta-analysis of the literature to evaluate the influence of femoral tunnel positioning during primary ACLR on the development of radiographic PTOA. Methods: The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2019), and MEDLINE (1980-2019) were queried for all studies describing the development of PTOA following TT or AM ACLR. Data pertaining to patient demographics, ACLR technique, and radiographic PTOA were extracted. Meta-analysis utilizing the DerSimonian Laird method for random effects was used to compare the weighted proportion of PTOA after ACLR between the TT and AM approaches. Results: Sixteen studies were identified for inclusion with a total of 1,546 patients. The mean follow-up across all studies was 10.9 years (range 5-17.8 years). The mean follow-up specifically in the AM and TT groups were 10.8 years (range, 5.4-17 years) and 11.4 years (range, 6-17.8 years), respectively. A total of 783 (50.6%) patients underwent TT ACLR. Of these patients, 401 (49.3%) developed radiographic PTOA. A total of 763 (49.4%) patients underwent AM ACLR. Of these patients, 324 (mean: 21.8%) went on to develop radiographic PTOA. Meta-analysis demonstrated a significantly greater rate of PTOA following ACLR using a TT technique compared to an AM reconstruction technique overall (49.3% vs.25.4%, p<0.001) and when studies were stratified by 5-10 (53.7% vs. 14.2%, p<0.001) and at greater than 10 year (45.6 % vs. 31.2%, p<0.001) follow-up. Conclusions: Transtibial ACLR is associated with higher overall rates of radiographic PTOA compared to the AM ACLR approach. The rates of radiographic PTOA following ACLR with a TT approach are also significantly higher than using an AM approach when stratified by length of follow-up (5-10 and greater than 10-year follow-up).
The Impact of Socioeconomic Factors on Outcomes Following Anterior Cruciate Ligament Reconstruction (209)
Authors: Kingery Matthew , Baron Samuel , Kaplan Daniel , Resad Sehar , Markus Danielle , Strauss Eric , Gonzalez-Lomas Guillem , Campbell Kirk 
Published: October 2021

Objectives: Socioeconomic factors have been shown to impact patient care in many surgical fields; however, their effects have not been thoroughly evaluated in the context of anterior cruciate ligament reconstruction (ACLR) outcomes. The purpose of this study is to investigate the effects of socioeconomic factors on time to surgery, knee function, and subjective outcomes measures following ACLR. Methods: A retrospective query of primary ACLR surgeries at a single institution performed from 2011 to 2015 with minimum two-year follow-up was conducted. Patient demographics, insurance type, worker’s compensation status, surgical variables, IKDC score, and failure were recorded from chart review. Education level and income were obtained via phone interview. Differences between functional outcome were compared between Medicaid and non-Medicaid groups. Results: 268 patients were included in the analysis (43 patients in the Medicaid group and 225 patients in the non-Medicaid group). The Medicaid group demonstrated lower annual income (p<0.01) and a lower level of completed education compared to the non-Medicaid group (p<0.01). Medicaid patients had a greater duration between time of initial knee injury and surgery compared to the non-Medicaid group (11.8 +/- 16.3 months versus 6.1 +/- 16.5 months, p = 0.04). At the time of follow-up, patients in the non-Medicaid group had a significantly greater IKDC score compared to Medicaid patients (82.5 +/- 13.8 versus 75.3 +/- 20.8, p = 0.03). Conclusions: Socioeconomic factors impacted care in the setting of ACL injury. Medicaid insurance patients were seen significantly later after initial injury when compared to non-Medicaid carriers, and had worse outcomes compared to their non-Medicaid peers. Higher annual income brackets had significantly higher clinical outcomes scores at a minimum of two years postoperatively. Education level did not affect outcomes.
The Direct Effect of Nanofiber-based Vitamin D Sheet Engineered with 3D Printing for Tendon-to-bone Healing and Muscle Regeneration after Repair in a Chronic Rotator Cuff Tear Model of Rabbit (217)
Authors: Rhee Sung-Min , Nam GunWoo , Park Joo Hyun , Jeong Hyeon Jang , RHIE TAE-YON , Park Suk-Hee , Oh Joo Han 
Published: October 2021

Objectives: To compare the efficacy between the direct effect of nanofiber-based vitamin D sheet engineered with 3D printing (VTD sheet) and vitamin D supplementation (VTDS) as diet on tendon-to-bone healing and muscle regeneration after repair in a chronic rotator cuff tear model of rabbit. Methods: A total of 64 rabbits were randomly allocated into two groups (n=32), then each groups was allocated into four small groups (Group A, A’: VTDS only, Group B, B’: Normal diet + sheet without vitamin D, Group C, C’: Normal diet + VTD sheet, Group D, D’: VTDS + VTD sheet, n=8 each). The supraspinatus tendons which were detached and left for 6 weeks were repaired in a transosseous manner with the sheet only for groups B and B’, and VTD sheet for groups C, C’, D and D’ (Figure 1). Groups A, B, C, and D were extracted at 4weeks after repair, while groups A’, B’, C’, and D’ were extracted at 12 weeks after repair. Serum 25-OH vitamin D level was checked at the time of making tear, repair, and extraction. Regarding tendon-to-bone healing, the expression (relative ratio to control) of genes including type 1 collagen (COL1), type 3 collagen (COL3), bone morphogenic protein-2 (BMP-2), scleraxis (SCX), SOX9, and aggrecan (ACAN) was assessed at 4 weeks (Groups A, B, C, and D), and at 12 weeks (Groups A’, B’, C’, and D’) after repair. The histological and biomechanical evaluations of tendon-to-bone healing were done at 12 weeks after repair. Regarding muscle regeneration, rotator cuff muscle cross-sectional areas were measured at 4 and 12 weeks after repair. Enzyme-linked immunosorbent assay (ELISA) was done to calculate vitamin D level in muscle at 12 weeks after repair. Results: Serum vitamin D level of group D and D’ was highest among groups at the time of repair and extraction (p < 0.001). At 4 weeks after repair, mRNA expression of COL1 in group D was highest among groups (A, B, C, D; 0.86 ± 0.25, 0.90 ± 0.27, 0.93 ± 0.19, and 1.06 ± 0.25, respectively, p = 0.046). At 12 weeks after repair, group D’ showed most dense collagen density (p = 0.037) and had highest load to failure among groups (A’, B’, C’, D’; 102.3 ± 12.6 N, 99.5 ± 8.3 N, 102.3 ± 18.5 N, and 139.6 ± 25.3, respectively, p = 0.024). Regarding muscle regeneration, the cross-sectional area of muscle fiber was largest in group D and D’ at 4 and 12 weeks after repair (p < 0.05, figure 4) with highest vitamin D level of muscle by ELISA at 12 weeks after repair (p = 0.003). Conclusions: The use of nanofiber-based vitamin D sheet engineered with 3D printing may promote tendon-to-bone healing and regenerate rotator cuff muscle after repair in a chronic rabbit rotator cuff tear model.
Massive Rotator Cuff Tear Bridging Reconstruction Using Acellular Dermal Matrix: Mid-term Results (219)
Authors: Awad Moayd , Sparavalo Sara , Ma Jie , Wong Ivan 
Published: October 2021

Objectives: Management of massive rotator cuff tears remains a challenge despite development of different surgical techniques. Bridging reconstruction was developed to improve clinical outcomes and to avoid the morbidity associated with tendon transfers and arthroplasty. To date, there have been no studies assessing the mid-term clinical outcome for patients undergoing this procedure. The objective of this study was to evaluate the mid-term clinical outcomes of patients who underwent bridging reconstruction using acellular dermal matrix for large/massive rotator cuff tears (> 3 cm). Methods: A retrospective chart review was conducted for patients who underwent bridging reconstruction between 2010 and 2018 by one surgeon (IW). Patients with a minimum follow-up of two years were included. All patients completed self-reported questionnaires (Western Ontario Rotator Cuff (WORC) Index and the Disabilities of the Shoulder, Arm and Hand (DASH) score) pre-operatively and post-operatively at six months, one year and annually thereafter. Results: One hundred charts were reviewed, and 20 patients were excluded due to lack of pre- or post-operative outcome scores. This cohort of patients consisted of 80 patients mean age of 58.6 ± 9.1 years and an average follow-up of 5.1 ± 1.6 years. The mean pre- and post-operative WORC scores (± SD) were 61.4 ± 20.6 and 28.1 ± 25.5 (p < 0.001), respectively. The mean pre- and post-operative DASH scores were 52.2 ± 19.7 and 23.1 ± 22.4 (p < 0.001), respectively. There was an improvement in WORC and DASH over time with the most significant improvement during the first year post-operatively (Figure 1). Seventy-eight percent of patients met the minimal clinically important difference (MCID) for WORC while 77% of patients met the MCID for DASH. Our results show significant mid-term clinical improvement in WORC and DASH scores that is similar to previously published data that showed significant improvements in other patient-reported outcome scores. We believe these positive outcomes to be a result of better force coupling within the shoulder as compared to other surgical treatments such as maximal repair, superior capsular reconstruction, and reverse total shoulder arthroplasty. Conclusions: Arthroscopic bridging reconstruction for the treatment of massive rotator cuff tears results in significant improvement of patient reported outcomes (as measured using the WORC and DASH scores) at a mean follow up of five years. This may suggest that bridging reconstruction is a good treatment alternative as compared to superior capsular reconstruction or reverse total shoulder arthroplasty. Longer follow-up with a prospective study design is necessary to determine the longevity of these outcomes.
Characteristics and Complications of Operative Acromioclavicular Joint Separations in an Active Population (222)
Authors: Colantonio Donald , Panarello Nicholas , Harrington Colin , Bandarra Tahler , Kilcoyne Kelly , Dickens Jonathan 
Published: October 2021

Objectives: Coracoclavicular ligament reconstruction (CCR) is a commonly performed procedure for surgical management of high-grade acromioclavicular separations however there is a dearth of literature describing complications of this procedure. The purpose of this study was to identify the incidence and characteristics of major complications following CCR in a large cohort of active patients. Methods: The Military Data Repository was queried for patients with Current Procedural Terminology (CPT) codes for CCR. Medical records and radiographs were evaluated for major postoperative complications including return to the operating room for surgical site infection (SSI), failure requiring revision, and fracture of the clavicle or coracoid. Results: 953 CCR were performed between October 2013 and March 2020. There were 44 failures requiring revision,18 post-operative fractures, and 18 SSI. Of the patients who developed SSI, 13 required removal of the graft and/or hardware, and 4 required revision reconstruction. There were 11 coracoid (61.1%) and 7 clavicle (38.9%) fractures. Seven coracoid fractures (63.6%) involved a bone tunnel in the coracoid whereas 4 coracoid fractures (36.4%) did not. Fracture incidence was 3.122 fractures per 1,000 person-years. Eleven of the fractures were treated with open reduction and internal fixation, 4 with revision CCR, and 3 were treated non-operatively. Most patients who had a fracture regained full range of motion. Conclusions: This review of a large population who underwent CCR demonstrated an incidence of 1.35 complications per 100 person-years. Clavicle and coracoid fractures after CCR occur in 1.9 out of 100 cases. Fractures occurred after various methods of fixation and most were treated surgically. Coracoid fractures were nearly twice as prevalent as clavicle fractures and occured with and without bone tunnels in the coracoid. This study demonstrates that CCR is a relatively safe procedure in a physically active population. Complications are rare yet typically require surgical management.
Pathology and surgical outcomes of anterior traumatic shoulder instability in gymnasts (235)
Authors: Omodani Toru , Sugaya Hiroyuki , Takahashi Norimasa , Matsuki Keisuke , Tokai Morihito , Morioka Takeshi , Ueda Yusuke , Hoshika Shota , Kamijo Hideki 
Published: October 2021

Objectives: For shoulders of artistic gymnasts, stability against various forces such as weight bearing, torsion, and traction is required as well as wide range of motion. The prevalence of shoulder instability in gymnasts has been reported to be high, particularly in female gymnasts; however, there has been no report on its pathology and the surgical outcomes. The purpose of this study was to retrospectively investigate the pathology and surgical outcomes of anterior traumatic shoulder instability in gymnasts. Methods: The subjects of this study were 18 shoulders of 16 gymnasts that underwent arthroscopic surgery for anterior traumatic shoulder instability. They consisted of 4 male and 14 female shoulders with a mean age of 18 years (range, 16-20). The mean follow-up was 30 months (range, 10-66 months). All surgeries were performed arthroscopically, and procedures were determined according to the intraoperative findings. Patients were immobilized with a brace for 3 weeks and started range of motion exercise after the immobilization period. Hand-stand or hanging were normally allowed at 3 month after surgery according to patients’ functional recovery. We investigated injury mechanism, intraoperative findings, surgical procedures, times to start hand-stand or hanging and to start giant swing, time to complete return to gymnastics, and recurrence of instability. Results: Three shoulders experienced dislocations that self-reduction was impossible. The remaining 15 shoulders had self-reducible dislocations or subluxations, and 10 of 15 shoulders were injured with the shoulder hyper-flexed: e.g., pulling up hands during somersaults; pushing off the vault (Figure). Bankart lesion was identified during surgery in 14 shoulders including one bony Bankart lesion. Capsular tear was found in 5 shoulders, and only one lesion was concomitant with Bankart lesion. All lesions were arthroscopically repaired. We additionally performed rotator interval closure in 10 shoulders, superior labrum repair in 13, and rotator cuff repair in 2. One patient retired from gymnastics immediately after surgery, and 2 patients were lost to follow-up. The remaining 13 patients returned to gymnastics. The mean time to start hand-stand or hanging was 4 months (range, 3-10 months), and that to start giant swing was 6 months (range, 3-15 months). The mean time to complete return was 9 months (range, 5-17 months). Two shoulders experienced recurrence (1 dislocation and 1 subluxation) after return to gymnastics. Both shoulders underwent revision surgery and returned to gymnastics. Conclusions: Capsular tear without Bankart lesion was more common (4 shoulder, 22%) in gymnasts than general population. The sport-related characteristics might be associated with the high incidence of capsular tear. The outcomes of arthroscopic stabilization for gymnasts was good with the high complete return rate.
Outcomes Following the Repair of Isolated Supraspinatus Repairs versus those with Concurrent Subscapularis Repairs (242)
Authors: Whicker Emily , Hughes Jonathan , Puyana Jacob , Patel Neel , Fongod Edna , Kane Gillian , Tublin Joshua , Popchak Adam , Lesniak Bryson , Lin Albert 
Published: October 2021

Objectives: While rotator cuff tears often require repair of the supraspinatus, patients can also have a concurrent tear of the subscapularis requiring repair. Previous smaller studies have shown good clinical outcomes following the repair of the subscapularis and rotator cuff during the same procedure.1 The purpose of this study was to compare clinical outcome measures between patients who had isolated supraspinatus repairs versus those who had a supraspinatus tear with a concurrent subscapularis repair. Methods: A retrospective review of 166 patients who underwent arthroscopic supraspinatus repair with or without a concurrent subscapularis repair between 2013-2018 with a minimum of one-year follow up was performed. Patients were separated into two groups based on their treatment: 100 had an isolated supraspinatus repair (SP) and 66 had both a supraspinatus and subscapularis repair (SB). The primary outcome was revision rotator cuff repair. Secondary outcomes were objective measures such as range of motion (ROM) and strength testing, including flexion (FF), external rotation (ER), and internal rotation (IR), as well as patient-reported outcome measures (PROs) including visual analog pain scale (VAS) and subjective shoulder value (SSV). Outcomes were compared using the Mann- Whitney Test and Fisher’s Exact Test with p<0.05, as the data were not parametric (SPSS, IBM). Results: There was no significant difference in the rate of revision surgery required following isolated supraspinatus repair versus those with a subscapularis repair. Additionally, there were no significant differences between groups for all PROs, all ROM parameters, and all strength parameters (all p > 0.05) (Table 1). Conclusions: The data from this study demonstrated that patients who require a subscapularis repair at the time of their rotator cuff repair can expect similar short term outcomes to those patients who only required repair of their supraspinatus.
Dentists’ Attitudes Toward Dental Implant Maintenance in Thailand
Authors: Rudeejaraswan A. , Pisarnturakit P.P. , Mattheos N. , Pimkhaokham A. , Subbalekha K. 
Published: October 2021

Introduction: As implant therapy is a widely applied treatment modality, general dentists are in the frontline of maintaining health in patients with implants. It is however unknown to what extent general dentists are competent and feel prepared to deliver maintenance of implants to patients. Objectives: The aim of this study was to investigate the attitudes and self-reported and objectively assessed competences of general dentists with maintenance of dental implants in patients. Methods: A questionnaire designed and validated for the purpose of the study, including attitudes and self-reported and objectively assessed competences, was distributed by means of an online platform. Results: Data from 429 questionnaires were included in the study. Half of the participants were 28 to 33 y old and 78% had been working <10 y. Seventy-eight percent believed that dental implant maintenance should be performed by general dentists, but only 51% were prepared to do this, citing obstacles such as insufficient knowledge and limitations of their working environment. The mean ± SD objectively assessed competence score was 8.97 ± 2.74 of 17. There were significant differences (P < 0.001, 1-way analysis of variance) in the scores among dentists who offered the full range of maintenance and management of complications (10.83 ± 2.45) with those willing to provide comprehensive oral examination and implant maintenance only (9.31 ± 2.73), those offering comprehensive examination but unwilling to conduct maintenance (8.22 ± 2.28), and those who refer all dental implant patients elsewhere (7.2 ± 2.66). Around half of the dentists believed that implants last for life. Conclusions: While general dentists appeared to largely acknowledge the importance of providing implant maintenance care and present with positive attitudes, a large portion was unwilling to engage with maintenance of implants in patients and appeared to lack essential competences to this end. The main obstacles for providing implant maintenance care included insufficient knowledge and lack of a properly equipped clinical environment. Knowledge Transfer Statement: The results of this study can identify deficiencies in the currently available maintenance competences and schemes for patients with implants. These results can also help dental professionals, scientific bodies, and associations to design appropriate education and professional development strategies that can strengthen the confidence and competences of general dentists, thus offering better service to the public.
The tenacity of trust in petrochemical communities: Reckoning with risk on the Fawley Waterside (1997–2019)
Authors: Brown David , Mah Alice , Walker Gordon 
Published: October 2021

Around the world, people living close to polluting industries have different perceptions of the risks of toxic exposure, ranging from anger to acceptance to denial. We draw attention to a case with relatively high levels of social trust, but also relatively high levels of risk perception: the communities living adjacent to the Fawley (UK) oil refinery and petrochemical complex, a site that has been operated by Esso since the early 1950s.Our findings are based on a novel comparative analysis of two qualitative studies of local risk perceptions in Fawley conducted more than two decades apart in 1997 and 2019, incorporating focus group and individual interviews with residents, alongside documentary analysis and stakeholder interviews. Perceptions of risk and trust in the local polluting industry have fluctuated over the years, with unease never far from the surface as industrial employment has slowly contracted. Yet overall, the picture in 2019 was not too dissimilar from that in 1997: while community–industry relations were strained amidst periodic risk incidents and a sense of decline, a cautious sense of trust in the polluting enterprise had endured, based on a delicate balance of heritage, risk, and recognition. We draw attention to the residents’ careful reckoning with risks over time and the tenacity of social trust as an act of negotiation that took risk into account but also included other important factors such as recognition and reciprocity. Local risk perceptions in Fawley are closely bound up with the residents’ shared industrial heritage and enduring perceptions of Esso as a ‘good neighbour’. Our longitudinal analysis allowed us to reflect on changes over time in Fawley, providing greater temporal depth to the risk perception literature.