bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association of Insurance Status and Complications After Carpal Tunnel Release
Authors: Sun Cao Phoebus , Loewenstein Scott N. , Timsina Lava R. , Adkinson Joshua M. 
Published: February 2021

Background: Carpal tunnel release (CTR) is one of the most commonly performed procedures in hand surgery. Complications from surgery are a rare but significant patient dissatisfier. The purpose of this study was to determine whether insurance status is independently associated with complications after CTR. Methods: We retrospectively identified all patients undergoing CTR between 2008 and 2018 using the Indiana Network for Patient Care, a state-wide health information exchange, and built a database that included patient demographics and comorbidities. Patients were followed for 90 days to determine whether a postoperative complication occurred. To minimize dropout, only patients with 1 year of encounters after surgery were included. Results: Of the 26 151 patients who met inclusion criteria, 2662 (10.2%) had Medicare, 7027 (26.9%) had Medicaid, and 16 462 (62.9%) had commercial insurance. Compared with Medicare, Medicaid status ( P < .001) and commercial insurance status ( P < .001) were independently associated with postoperative CTR complications. The overall complication rate was 2.23%, with infection, wound breakdown, and complex regional pain syndrome being the most common complications. Younger age, alcohol use, diabetes mellitus, hypertension, and depression were also independently associated with complications. Conclusions: The incidence of complications after CTR is low. Insurance status, patient demographics, and medical comorbidities, however, should be evaluated preoperatively to appropriately risk stratify patients. Furthermore, surgeons can use these data to initiate preventive measures such as working to manage current comorbidities and lifestyle choices, and to optimize insurance coverage.
Local Anesthesia Alone for Postaxial Polydactyly Surgery in Infants
Authors: Bjorklund Kim A. , O’Brien Meghan 
Published: February 2021

Background: Surgical excision for postaxial polydactyly type B is advocated to avoid long-term complications. Excision with local anesthesia (LA) in infancy represents a safe and effective treatment for this condition, although general anesthesia (GA) is employed by many surgeons. We present a comparison of surgical outcomes, cost, and time between LA and GA to support widespread change in management. Methods: A retrospective review of patients under 12 months of age undergoing surgical polydactyly excision by a single surgeon was performed. Anesthesia type, patient demographics, and complications were recorded. Comparisons were made between LA and GA groups on procedure cost, operating time, length of stay (LOS), and time from procedure end to discharge. Stepwise forward regression was used to identify the best model for predicting total costs. Results: Ninety-one infants with a mean age of 3 months (±1.9) were examined; 51 (56%) underwent LA alone, 40 (44%) underwent GA. Mean operating time was 11.53 ± 4.36 minutes, with no difference observed between anesthesia groups ( P = .39). LA infants had a significantly shorter LOS (2.5 vs 3.5 hours; P < .05), quicker postoperative discharge (32 vs 65 minutes, P < .05), and fewer overall expenses, 2803 vs 6067 U.S. dollars (USD), P < .05. Two minor surgical complications (1 in each group) were reported. Conclusions: This study demonstrates significantly decreased cost, LOS, and time to discharge using LA alone for surgical excision of postaxial polydactyly type B. Results suggest the approach is quick, economical, and avoids the risks of GA in early infancy.
Identifying the challenges to implementing a neuromuscular warm-up in pre-elite netball
Authors: Smyth Erin , Appaneal Renee , Drew Michael , Antcliff Alanna , Waddington Gordon , Newman Phil , Weissensteiner Juanita , Donaldson Alex 
Published: February 2021

Objective To identify challenges for implementing Netball Australia’s ‘Knee injury prevention for Netballers and Enhance performance and Extend play’ (KNEE) program for 17/U & 19/U State (i.e. regional/provincial representative) teams. Design Concept mapping, a mixed-methods approach incorporating qualitative and quantitative data collection and analyses. Setting Pre-elite netball. Participants Thirty-nine netball coaches, strength & conditioning coaches and physiotherapists working with State 17/U & 19/U teams. Methods Participants brainstormed challenges to implementing the KNEE program, sorted the challenges into groups based on similar meaning and rated the importance and difficulty of overcoming each challenge on a scale from 0 (least important/easiest to overcome) to 5 (most important/hardest to overcome). Results Forty-six statements (i.e. challenges) were identified and organised into the following eight clusters (mean importance rating out of 5, mean difficulty rating out of 5): ‘athlete engagement’ (3.31, 2.48); ‘supervision and correction of technique’ (3.03, 2.67); ‘time constraints’ (2.79, 2.59); ‘athlete technique’ (2.70, 2.64); ‘education’ (2.56, 2.16); ‘support staff resourcing’ (2.51, 2.67); ‘program flexibility and adaptability’ (2.02, 1.85); and ‘coach and support staff prioritisation’ (1.95, 1.81). Nineteen statements/challenges had above average ratings for importance (2.63) and difficulty (2.41). Conclusions This study identified ‘athlete engagement’, ‘supervision and correction of technique’, ‘time constraints’, ‘athlete technique’, ‘education’ and ‘support staff resourcing’ as the most important and difficult challenges to implementing the KNEE program in pre-elite netball. These multi-factorial challenges are the main barriers to implementing the KNEE program. They can be addressed using the implementation driver’s framework.
Clinical sequencing to assess tumor mutational burden as a useful biomarker to immunotherapy in various solid tumors
Authors: Kim Hana , Hong Jung Yong , Lee Jeeyun , Park Se Hoon , Park Joon Oh , Park Young Suk , Lim Ho Yeong , Kang Won Ki , Kim Kyoung-Mee , Kim Seung Tae 
Published: February 2021

Background: Immune checkpoint inhibitors (ICIs) have become established as a new therapeutic paradigm in various solid cancers. Predictive biomarkers to ICIs have not yet been fully established. Tumor mutational burden (TMB) has been considered as a useful marker to indicate patients who benefit from ICIs. Methods: We performed next-generation sequencing, including TMB analysis, as a routine clinical practice in 501 patients with advanced gastrointestinal (GI), genitourinary (GU), or rare cancers. The TruSight™ Oncology 500 assay from Illumina was used as a cancer panel. Results: In total, 11.6% (58/501) were identified with tumors with high TMB and MSI-high status was confirmed in seven out of 501 cases (1.4%). High TMB was observed in 11.6% of patients with various solid tumors, including: GU cancers (36.0%, 9/25), colorectal cancer (15.2%, 23/151), biliary tract cancer (14.6%, 7/48), melanoma (14.3%, 3/21), gastric cancer (11.2%, 13/116), hepatocellular carcinoma (8.3%, 1/12), other GI tract cancers (4.5%, 1/22), and sarcoma (1.7%, 1/60). The objective response rate (ORR) to ICIs was 75% (nine out of 12) in solid tumor patients with high TMB and 25% (30 out of 40) in those with non-high TMB. Patients with high TMB had better ORR to ICIs than those with non-high TMB ( p = 0.004). Univariate analysis revealed that the status of PD-L1 expression and of TMB (high versus non-high) had significant association in response to ICIs. However, in multivariate analysis, the status of TMB (high versus non-high) was only significantly related to the response to ICIs ( p = 0.036). Conclusion: In the present study, we analyzed the TMB using a cancer panel for various solid tumor patients in routine clinical practice and also demonstrated the usefulness of TMB to predict the efficacy for ICIs.
Accuracy of Rod Contouring to Desired Angles With and Without a Template: Implications for Achieving Desired Spinal Alignment and Outcomes
Authors: Sardi Juan Pablo , Ames Christopher P. , Coffey Skye , Good Christopher , Dahl Benny , Kraemer Paul , Gum Jeffrey , Devito Dennis , Brayda-Bruno Marco , Lee Robert , Bell Christopher P. , Bess Shay , Smith Justin S. 
Published: February 2021

Study Design: Biomechanical Study. Objective: The search for optimal spinal alignment has led to the development of sophisticated formulas and software for preoperative planning. However, preoperative plans are not always appropriately executed since rod contouring during surgery is often subjective and estimated by the surgeon. We aimed to assess whether rods contoured to specific angles with a French rod bender using a template guide will be more accurate than rods contoured without a template. Methods: Ten experienced spine surgeons were requested to contour two 125 × 5.5 mm Ti64 rods to 40°, 60° and 80° without templates and then 2 more rods using 2D metallic templates with the same angles. Rod angles were then measured for accuracy and compared. Results: Average angles for rods bent without a template to 40°, 60° and 80° were 60.2°, 78.9° and 97.5°, respectively. Without a template, rods were overbent by a mean of 18.9°. When using templates of 40°, 60° and 80°, mean bend angles were 41.5°, 59.1° and 78.7°, respectively, with an average underbend of 0.2°. Differences between the template and non-template groups for each target angle were all significant (p < 0.001). Conclusions: Without the template, surgeons tend to overbend rods compared to the desired angle, while surgeons improved markedly with a template guide. This tendency to overbend could have significant impact on patient outcomes and risk of proximal junctional failure and warrants further research to better enable surgeons to more accurately execute preoperative alignment plans.
Outcomes and Tendon Integrity After Arthroscopic Treatment for Articular-Sided Partial-Thickness Tears of the Supraspinatus Tendon: Results at Minimum 2-Year Follow-Up
Authors: Brockmeyer Matthias , Haupert Alexander , Lausch Anna-Lena , Wagenpfeil Gudrun , Stroeder Jonas , Schneider Guenther , Kohn Dieter , Lorbach Olaf 
Published: February 2021

Background: The best surgical treatment option for symptomatic moderate- to high-grade articular-sided partial-thickness rotator cuff tears (PTRCTs) is still controversial. Purpose/Hypothesis: The purpose of this study was to evaluate patient-reported and clinical outcomes and tendon integrity after arthroscopic debridement or repair for PTRCTs at a minimum of 2 years postoperatively. We hypothesized that the overall outcomes would be positive, showing pain relief, good shoulder function, and high tendon integrity. Study Design: Cohort study; Level of evidence, 3. Methods: We evaluated 30 patients (16 men, 14 women; mean age, 51 years) who underwent arthroscopic treatment for symptomatic PTRCTs (Ellman grades 2 and 3). Debridement was performed in 15 patients, and arthroscopic tendon repair was performed in the remaining 15 patients. Patients completed the Constant score; American Shoulder and Elbow Surgeons (ASES) shoulder score; Western Ontario Rotator Cuff Index; Simple Shoulder Test; and visual analog scale (VAS) for pain, function, and satisfaction. In addition, patients were examined clinically (range of motion, impingement tests, rotator cuff tests, and tests for the long head of the biceps tendon), and morphologic assessment of rotator cuff integrity was performed using direct magnetic resonance arthrography and was classified according to Sugaya. Results: The mean follow-up period was 55 months. The patient-reported outcome measures showed high patient satisfaction, reduction in persistent pain, and good shoulder function. Linear regression analysis showed that the debridement group had significantly better results on the Constant (bias-corrected and accelerated [BCa] 95% CI, 4.20-26.30), ASES (BCa 95% CI, 5.24-39.26), and VAS (pain: BCa 95% CI, 0.13-3.62; function: BCa 95% CI, 1.04-4.84; satisfaction: BCa 95% CI, 0.14-6.28) scores than did the repair group. At follow-up, there was no significant difference between the groups in clinical testing results. Good supraspinatus tendon integrity was seen in most patients: Sugaya classification grade 1 in 13 patients, grade 2 in 11 patients, and grade 3 in 6 patients. Conclusion: Midterm results after arthroscopic debridement and repair for PTRCTs showed high patient satisfaction, good shoulder function, and high tendon integrity for both procedures. Patients who underwent arthroscopic debridement had higher Constant, ASES, and VAS scores compared with patients who underwent tendon repair.
Second ACL Injury Rates in Younger Athletes Who Were Advised to Delay Return to Sport Until 12 Months After ACL Reconstruction
Authors: Webster Kate E. , Feller Julian A. , Klemm Haydn J. 
Published: February 2021

Background: Younger patients are at increased risk for anterior cruciate ligament (ACL) graft rupture and contralateral injury after ACL reconstruction (ACLR). Increasing the amount of time between surgery and the resumption of competitive sport may reduce this risk. Purpose: To determine the rates of graft rupture and injury to the contralateral native ACL at 3- to 5-year follow-up in younger patients who were advised to delay a return to competitive sport until 12 months after surgery and compare this with a nondelayed cohort. Study Design: Cohort study; Level of evidence, 3. Methods: The primary study cohort consisted of 142 eligible patients aged <20 years when they underwent their first primary ACLR. All were informed about the risk of further injury and advised not to return to competitive sport before 12 months postoperatively. Return-to-sport status and the number of subsequent ACL injuries (graft rupture or a contralateral injury to the native ACL) were determined at 3- to 5-year follow-up and compared with a historic cohort of 299 patients with ACLR who were not advised to delay their return to sport for a set period. The cohorts were then combined, and injury rates were compared between those who returned to sport before and after 12 months postoperatively. Results: The follow-up rate was 91% (129/142). In the delayed cohort, 63% returned to competitive sport after 12 months (mean, 14 months). Few patients (n = 10) returned before 9 months. In the delayed group, 33% had a subsequent ACL injury; this was not significantly different when compared with the nondelayed group (31% rate), in which a majority (58%) returned to competitive sport before 12 months. Subsequent ACL injury rates were also similar when compared between patients who returned before and after 12 months postoperatively (33% vs 32%, respectively). Conclusion: At midterm follow-up, the overall rates of subsequent ACL injury were high, even for patients who delayed their return until 12 months after surgery. More research is required to identify strategies to reduce the high reinjury rate in younger athletes.
Open or arthroscopic Latarjet? Prospective analysis of the clinical results
Authors: Girard Mathieu , Dalmas Yoann , Azoulay Vadim , Martel Marie , Rattier Simon , Arboucalot Marine , Mansat Pierre , Bonnevialle Nicolas 
Published: February 2021

Objectives: The arthroscopic bone block procedure in the treatment of anterior shoulder instabilities is now a validated technique. Nevertheless, few studies have compared the clinical results of this technique to the conventional Latarjet procedure. Therefore the objective of this study was to compare the short-term clinical results of the 2 surgical techniques. Methods: We conducted a monocentric prospective comparative study, including patients who had undergone a bone block procedure for anterior instability with a minimum follow-up of 12 months. Patients with a surgical history concerning the affected shoulder were excluded. Evaluation was based on the measurement of mobility, the Walch-Duplay score, the Rowe score, the Subjective Shoulder Value (SSV), return to sports, the Net Promoter satisfaction Score, and recurrence (subluxation/luxation). Scarring was assessed by the POSAS score. Results: It was possible to follow 45 patients: arthroscopy (A) n=22, open (O) n=25. With an average follow-up of 20 months (12-30), no recurrence of instability was recorded. No significant difference was noted between groups A and O in terms of the Walch-Duplay score (85±19 vs 91±11 points; p=0.3), the Rowe score (93±14 vs 95±9 points; p=0.9), the SSV (72% vs 88%; p=0.2) and the Net Promoter Score (9.3 vs 9.7; p=0.5). At 3 months, return to sports was 11% for group A vs 48% for group O (p=0.01). This difference was no longer significant at 6 months. Loss of external rotation in group A was significantly greater at 1.5 months -58°±18° vs -41°±17° (p=0.01) and 3 months -35°±20° vs -19°±18° (p=0.01). There was no difference in the POSAS score between the 2 groups. (p= 0.9). Conclusion: With a longer recovery time for joint amplitudes and a delayed return to sports, the arthroscopic double-button fixation procedure does not seem to provide any short-term clinical benefit. Longer follow-up is required to confirm these results.
Evaluation of 3 different rehabilitation protocols after rotator cuff repair, and the effectiveness of pool therapy: a randomized control study
Authors: Laedermann Alex , Kadri Fayssal , Cikes Alec 
Published: February 2021

Objectives: Exercises performed in water have shown to improve strength and range of motion in various joint pathologies. This study aims to identify the best rehabilitation protocol for patients who undergo arthroscopic rotator cuff repair, and the effectiveness of a pool therapy protocol. Methods: Patients who underwent arthroscopic rotator cuff repair for small to medium sized rotator cuff tears, with small to moderate retraction of the affected tendon and who underwent surgery between 2013 and 2016, were randomized in 3 different groups at the time of surgical indication. Groups: 1. Patients who had rehabilitation with physical therapy and no aquatic protocol; The "Dry group", 2. Patients who had rehabilitation with physical therapy, including an aquatic protocol; The "Pool Group", 3. Patients who had self-rehabilitation alone, with no physical therapist. The "Self Group" follow-up: all patients were assessed by an independent observer. The mean outcome measures consisted of pre and postoperative SSV, Constant score, and patient satisfaction. Patients were followed-up at 4, 8 and 12 weeks postoperatively, as well as in 1 and 2 years. Results: Group 1 (Dry group) and Group 2 (Pool group) showed better Constant scores 2 months postoperatively, although this was not statistically significant. However, patients in group 2 (Pool group) showed statistically better Constant scores and overall satisfaction 3 months postoperatively. All the groups had similar results 6 months, 1 year and 2 years postoperatively, with slightly better outcomes for the Dry and Pool groups compared to the Self group. Conclusion: Water therapy after rotator cuff repair provides better early results compared to traditional "dry" rehabilitation or self-exercise therapy. The results remain better for patients who had pool or dry rehabilitation 1 and 2 years postoperatively, although the difference is not statistically significant in the long term.
The mechanical effect of the common fibers of the anterior talofibular and calcaneofibular ligaments
Authors: Cordier Guillaume , Nunes Gustavo Araujo , Dalmau-Pastor Miki 
Published: February 2021

Objectives: The subject of the lateral ankle ligament complex is a familiar one. Common fibers between the inferior bundle of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) have been described. The purpose of this study is to investigate the possibility of transmitting a force to the CFL through the inf. ATFL. Methods: An anatomical study was carried out on 12 ankles. Each specimen was dissected according to a protocol to expose the lateral ligaments. A proximal section was made in the superior and inferior bands of the anterior talofibular ligament. A device capable of measuring shifting from one point in relation to another fixed point was used. The fixed point was implanted on the calcaneus and the other part of the sensor on the CFL. Traction of 1-kilogram was applied to the inferior band of the ATFL while the device measured the shifting of the CFL in millimeters. Two measurements were taken on each specimen by two observers. Sample data and distance measurements were recorded and analyzed. Results: It was possible to analyze 12 specimens. The specimens were from 7 women and 5 men and included 6 right and 6 left ankles. The anterior talofibular ligament was identified as a two-band ligament in all cases. One ankle had a lesion on the superior band of the ATFL. Common fibers that connect the inferior ATFL and the CFL were observed in all samples of this study. The measuring device showed shifting of the CFL in each case. The first series of measurements indicated average shifting of 0.74 mm (0.46; 1.35; +/- 0.34) and a median of 0.59 mm. The second series indicated a mean of 0.60 mm (0.23 - 1.13; +/- 0.32) and a median of 0.46 mm. Conclusion: There is an anatomical connection between the inferior ATFL and the CFL that is capable of transmitting a mechanical force to the CFL when the inferior ATFL is placed in traction. Improvement in the knowledge of the mechanical properties of the lateral ligament plane helps to clarify the possibilities for surgical repairs.
A prospective comparative study of arthroscopic Brostrom procedure alone vs. Brostrom-Gould procedure in the repair of isolated ATFL injury at follow-up in one year
Authors: Tomes Sébastien 
Published: February 2021

Objectives: Arthroscopic Brostrom-Gould procedure is the reference technique in the treatment of isolated anterior talofibular ligament injury. Extensor retinaculum reinforcement uses the proximal part, without any mechanical function. The objective is to compare the isolated ATFL reinsertion technique with reinsertion + biological augmentation. Methods: This is a prospective study that compares the isolated ATFL reinsertion technique (Brostrom) vs. reinsertion + retinaculum reinforcement (Brostrom-Gould) at one year follow-up. 2 groups of 25 patients were selected. The two groups matched in terms of age, weight, and gender. All patients presented with isolated ATFL with stage 1 or 2 lesions according to the French arthroscopy society (SFA) classification. Patients were clinically evaluated preoperative and in one year with the FAAM and FAOS scores and the recurrence rate was assessed as well as passive joint amplitudes pre- and postoperatively. There was a single operator for the series and the surgical technique was chosen before surgery. Patients had the same postoperative rehabilitation protocol (ankle splint to be worn for 30 days with weight-bearing, no work in varus before 30 days, rehabilitation at D2). Results: Regarding clinical scores, in both groups there was a significant improvement in the sports FAAM and FAOS scores in the postoperative period. In the isolated Brostrom group, the FAAM score increased from 20 to 29 and the FAOS score from 75% to 95%. In the Brostrom-Gould group, the FAAM score increased from 19 to 30 and the FAOS score from 77% to 96%. There was no significant difference between the 2 groups. We identified no postoperative complications in either group. A sprain recurred in 2 patients in the Brostrom-Gould group and in 3 patients in the isolated Brostrom group. The sprain was mild in all cases and was controlled by ultrasound. The joint amplitudes in active plantar flexion were 36° in the isolated Brostrom group and 34° in the Brostrom-Gould group. There was no significant difference between the 2 groups. Conclusion: Our study shows that there is no difference between the isolated arthroscopic Brostrom technique and the Brostrom-Gould technique in the management of isolated ATFL grade 1 and 2 lesions in terms of recurrence and clinical scores and that the isolated Brostrom technique can be used to treat these lesions.