bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biodynamic Modeling and Analysis of Human-Exoskeleton Interactions in Simulated Patient Handling Tasks
Authors: Chen Yinong , Yin Wei , Zheng Liying , Mehta Ranjana , Zhang Xudong 
Published: January 2025

Objective To investigate the biodynamics of human-exoskeleton interactions during patient handling tasks using a subject-specific modeling approach. Background Exoskeleton technology holds promise for mitigating musculoskeletal disorders caused by manual handling and most alarmingly by patient handling jobs. A deeper, more unified understanding of the biomechanical effects of exoskeleton use calls for advanced subject-specific models of complex, dynamic human-exoskeleton interactions. Methods Twelve sex-balanced healthy participants performed three simulated patient handling tasks along with a reference load-lifting task, with and without wearing the exoskeleton, while their full-body motion and ground reaction forces were measured. Subject-specific models were constructed using motion and force data. Biodynamic response variables derived from the models were analyzed to examine the effects of the exoskeleton. Model validation used load-lifting trials with known hand forces. Results The use of exoskeleton significantly reduced (19.7%–27.2%) the peak lumbar flexion moment but increased (26.4%–47.8%) the peak lumbar flexion motion, with greater moment percent reduction in more symmetric handling tasks; similarly affected the shoulder joint moments and motions but only during two more symmetric handling tasks; and significantly reduced the peak motions for the rest of the body joints. Conclusion Subject-specific biodynamic models simulating exoskeleton-assisted patient handling were constructed and validated, demonstrating that the exoskeleton effectively lessened the peak loading to the lumbar and shoulder joints as prime movers while redistributing more motions to these joints and less to the remaining joints. Application The findings offer new insights into biodynamic responses during exoskeleton-assisted patient handling, benefiting the development of more effective, possibly task- and individual-customized, exoskeletons.
Common Benign Bone Lesions and Return to Sports: A Case Report and Scoping Review
Authors: Kafchinski Lisa A. , Crawford Anna E. , Stolzenberg Laurence , Gould Sara J. 
Published: January 2025

Background: Benign bone lesions are a common incidental finding in athletes during workup for musculoskeletal complaints, and athletes are frequently advised to halt participation in contact sports. There are no current guidelines to assist clinicians in referring patients with these lesions to a subspecialist or in advising athletes on the safety of returning to sport. Purpose: To assist sports medicine physicians in appropriate referral for patients with benign bone lesions through presentation of a literature review and the case of an adolescent athlete with a benign bone lesion in a location with a significant fracture risk. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature review was performed using the PubMed database. Search terms included “enchondroma,”“unicameral bone cyst,”“UBC,”“simple bone cyst,”“SBC,”“aneurysmal bone cysts, “ABC,”“nonossifying fibroma,”“NOF,”“non-ossifying fibroma,”“chondroblastoma,”“osteochondroma,”“exostosis,”“chondromyxoid fibroma,”“periosteal chondroma,” and “fibrous dysplasia” combined with “fracture,”“sports,”“sport,”“contact sport,”“football,” or “rugby.” Randomized controlled trials, case series, and prospective and retrospective studies were all included. Abstracts were excluded. Results: In total, 42 separate articles were reviewed. The strength of evidence for each lesion was determined using the total number of patients described in the literature with the pathology. Unicameral bone cysts, aneurysmal bone cysts, and fibrous dysplasia, particularly in the spine, are associated with a high risk of fracture; therefore, subspecialist referral is warranted before returning to sport. Osteochondromas (exostosis), juxtacortical chondromas, nonossifying fibromas, chondromyxoid fibromas, and enchondromas were associated with low fracture risk, and decisions regarding referral can be made on a case-by-case basis. Conclusion: The presence of a benign bone lesion does not always necessitate immediate, absolute restriction from participation in contact sports. After appropriate workup and diagnosis, the risk of return to sport should be evaluated based on the pathology present, and the patient and clinician should engage in a shared decision-making process. The guidelines in this paper provide context for stratifying risk and the importance of specialist referral. For athletes with a confirmed diagnosis of an asymptomatic benign bone lesion with a low risk of fracture, return to play without restrictions or referral is often safe.
Epidemiology of Low Back Injuries in National Collegiate Athletic Association (NCAA) Athletes: Results From the NCAA Injury Surveillance Program Between 2009-10 and 2018-19
Authors: Rao Neel , Boltz Adrian J. , Anderson Megan , Collins Christy L. , Chandran Avinash 
Published: January 2025

Background: Regular epidemiological investigations are needed to investigate factors associated with low back injuries (LBIs) in National Collegiate Athletic Association (NCAA) sports and to inform injury prevention and rehabilitation. Purpose: To describe the epidemiology of LBIs in NCAA sports. Study Design: Descriptive epidemiology study. Methods: Exposure and LBI data collected in the NCAA Injury Surveillance Program during the 2009-10 through 2018-19 academic years were analyzed. Injury counts, rates, and proportions were described by sport, sex, event type (competition, practice), season segment, time loss (>1 day), history (recurrent, new), chronicity, injury mechanism, diagnosis, and activity. Injury rate ratios (IRRs) were used to evaluate differential injury rates, and injury proportion ratios (IPRs) were used to assess differential injury distributions. Effect estimates (IRRs, IPRs) with 95% CIs excluding 1.0 were deemed statistically significant. Results: During the study period, 2629 LBIs from 12,213,285 athlete-exposures (AEs) were reported to the NCAA Injury Surveillance Program (2.15 LBIs per 10,000 AEs). Rates were highest in women's gymnastics (5.39 per 10,000 AEs), men's tennis (3.39 per 10,000 AEs), and women's volleyball (3.38 per 10,000 AEs). Among sex-comparable sports, rates were higher in men's (compared with women’s) basketball and cross country. Competition injury rates were >2 times as high as practice rates in men's sports; no difference was found in injury rates by event type in women's sports. Chronic LBIs were more prevalent in women's sports (compared with men’s) (IPR = 1.51; 95% CI, 1.29-1.76), as were recurrent injuries (IPR = 1.24; 95% CI, 1.05-1.46). Conclusion: Overall, LBI rates were similar in men's sports and women's sports; injuries were most often attributed to noncontact and overuse. LBI rates across event type varied by sport, with notable differences in women's sports. Future research into LBI risk factors and prevention programs that emphasize proper technique, training, and recovery, especially in practice settings, could be beneficial to reducing the burden of lumbar spine injuries in NCAA athletes.
Patient-Reported Outcomes of Bicruciate Multiligament Versus Single Cruciate Multiligament Knee Injuries
Authors: Trøan Ingrid , Bere Tone , Holm Inger , LaPrade Robert F. , Engebretsen Lars , Moatshe Gilbert 
Published: January 2025

Background: Multiligament knee injuries (MLKIs) are heterogeneous, and bicruciate knee ligament injuries are considered a serious form of this injury. The current literature tends not to distinguish between single and bicruciate MLKI when reporting outcomes. Purpose: To investigate patient-reported outcomes after surgical treatment of MLKI comparing single cruciate MLKI with bicruciate MLKI. The secondary aim was to investigate the influence of different factors on patient-reported outcomes after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: This study was designed as a cross-sectional cohort study. Patients who underwent surgical treatment for MLKI at a single level 1 trauma center between January 2013 and December 2020 were included in this study. Patient-reported outcomes included the Tegner score, Lysholm score, International Knee Documentation Committee (IKDC) subjective knee form, Knee injury and Osteoarthritis Outcome Survey (KOOS), and a visual analog scale for pain. Results: Of the 191 patients meeting the inclusion criteria, 124 (65%) agreed to participate and had a complete data set with a follow-up time at a mean 74 ± 27 months. Patients with single cruciate MLKI (type I) had significantly higher scores for IKDC ( P = .007), Lysholm ( P = .012), KOOS Pain ( P = .04), KOOS Activities of Daily Living ( P = .01), KOOS Sport and Recreation ( P = .005), KOOS Quality of Life ( P = .04), KOOS4 (which considers the subscales of Pain, Symptoms, Sport and Recreation, and Quality of Life) ( P = .01), Tegner ( P = .04), and visual analog scale for pain during activity ( P = .004) when compared with patients with bicruciate MLKI (type II-type IV). Furthermore, age was significantly associated with a lower IKDC ( P = .001), and an increased severity of injury was significantly associated with IKDC ( P = .015), KOOS4 ( P = .022), and Lysholm ( P = .029) scores. Conclusion: MLKIs involving a single cruciate ligament had significantly higher patient-reported postoperative outcome measures compared with bicruciate MLKIs. Age and type of injury were important predictors for outcomes. Patients presenting with dislocated knees had lower patient-reported outcomes; however, there was no significant difference in outcomes between bicruciate MLKIs and patients presenting with dislocated knees.
A Novel Proportional Method for the Simplified Assessment of Glenoid Bone Loss in Patients With Anterior Shoulder Instability
Authors: Li Menglong , Fan Mingrui , Zhang Yuchen , Shao Pu , Liu Tong , Zuo Jianlin 
Published: January 2025

Background: Surgical planning for anterior shoulder instability (ASI) necessitates accurate measurements of glenoid bone defects, but current methods are either challenging or too complex for practical use. This underscores the need for a simplified, but precise, assessment technique for anterior glenoid bone defects. Purpose: To introduce a new measurement technique that requires only computed tomography (CT) of the affected shoulder joint and simultaneously simplifies the assessment of bone defects in the anterior glenoid. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: CT scans of the glenoid from 285 healthy participants and 43 patients with unilateral ASI were collected and reconstructed in 3 dimensions. Initially, we established the proportional relationship between the maximum height and width in the superior-inferior and anterior-posterior directions of the glenoid as well as the location of their intersection (point O) in healthy participants. Subsequently, glenoid bone defects in patients with ASI were measured using the contralateral comparison method, the best-fit circle method, the CT-specific formula method, and our novel proportional method. We analyzed the differences in defect ratios and sizes as well as glenoid track calculations among the 4 methods. Results: The mean width-to-height ratio of the glenoid was determined to be 0.69 ± 0.04, allowing for the simplification of the calculation to width = 0.7 × height for clinical convenience. Point O was consistently located at the lower one-third of the glenoid height. There was no statistical significance noted in the measurements of bone defect size and bone defect ratio when comparing the novel proportional method, the contralateral comparison method, and the best-fit circle method; however, a significant increase in bone defect size and bone defect ratio was estimated with the CT-specific formula method (defect size: F = 19.20, P < .0001; defect ratio: F = 15.99, P < .0001). Conclusion: We introduced a novel method for estimating the width of glenoid bone defects through the proportion of glenoid width to height, finding that 70% of the glenoid height at its lower one-third closely approximated its maximum width. This approach, requiring only CT data from the affected shoulder, simplified calculations and matched the accuracy of traditional methods. It offers potential clinical benefits in evaluating glenoid defects.
Correlation Between Radiological Measurements for Patellar Instability and Patient-Reported Outcome Measurements in Adolescents: A Study From the Faroese Knee Cohort
Authors: Eysturoy Niclas H. , Husum Hans-Christen , Ingelsrud Lina H. , Blønd Lars , Barfod Kristoffer W. 
Published: January 2025

Background: Radiological measurements can predict patellar dislocation and are used to plan patella-stabilizing surgery in patients who have patellofemoral instability. However, it is unclear whether these measurements can predict subjective symptoms in patients without previous stabilizing surgery. Study Design: Cross-sectional study; Level of evidence, 3. Hypothesis/Purpose: The purpose was to investigate the correlation between radiological measurements and subjective symptoms in individuals with previous patellar dislocation without previous patella-stabilizing surgery. It was hypothesized that this correlation would be negative. Methods: A national cohort of patients with previous patellar dislocation was created by inviting all inhabitants of the Faroe Islands aged 15 to 19 years to answer an online survey. All patients with previous patellar dislocation and no previous surgery to the knee were invited to undergo radiography and magnetic resonance imaging of both knees. The radiological measurements were the Dejour classification, lateral trochlear inclination angle, trochlear depth, Caton-Deschamps index, and tibial tubercle–trochlear groove distance. The participants completed patient-reported outcome measures (PROMs), which were the Banff Patellar Instability Score 2.0, Kujala score, Marx score, and EQ-5D-5L score. Continuous data from each radiological measurement were plotted against each PROM to create scatter plots for visual inspection and analysis. Results: A total of 1714 (46%) invited individuals responded to the survey invitation, of whom 595 were excluded because of not answering at least 1 PROM. After exclusion of participants with previous knee surgery, 102 participants reported a history of patellar dislocation. Of these, 75 participants underwent radiography and magnetic resonance imaging of their knees and were included in the study for further analysis. Scatter plots and R2 values showed no correlation between radiological measurements and PROM scores. Conclusion: This study found no correlation between the most used radiological measurements in patellar instability and PROM scores. The results imply that radiological measurements are not indicative of subjective health and well-being of patients undergoing nonoperative management of patellar dislocations.
Longitudinal Assessment of Intersegmental Abnormalities in the Lumbar Spine of Adolescent Competitive Alpine Skiers Over 48 Months
Authors: Feuerriegel Georg C. , Meyer Daniela , Fitze Daniel P. , Hanimann Jonas , Stern Christoph , Schürmann Flavia , Fröhlich Stefan , Scherr Johannes , Spörri Jörg , Sutter Reto 
Published: January 2025

Background: Overuse-related intersegmental abnormalities in the spine of competitive alpine skiers are common findings. However, longitudinal changes in intersegmental abnormalities and symptoms throughout adolescence have not been assessed. Purpose: To longitudinally assess and compare overuse-related spinal intersegmental abnormalities in adolescent competitive alpine skiers over 48 months and to compare magnetic resonance imaging (MRI) findings in asymptomatic and symptomatic skiers. Study Design: Case series; Level of evidence, 4. Methods: Adolescent competitive alpine skiers were prospectively recruited between November 2108 and February 2019 and underwent 3-T MRI of the lumbar spine at baseline and after 48 months. All MRI scans were assessed for intersegmental changes of the intervertebral disk, vertebral body, and facet joints. At both time points, athletes’ low back pain (LBP) symptoms were assessed via retrospective interviews relating to the 12-month period before the MRI study. Athletes were classified as symptomatic if at least 1 substantial episode of health problems related to back overuse had occurred in the 12 months before the MRI examination. The Wilcoxon signed-rank test and Pearson chi-square test were used to compare the measurements. Results: A total of 63 athletes (mean age at follow-up, 19.6 ± 1.2 years; 25 female) were included in the study. A significant increase in LBP affecting training and competition was observed at follow-up, with only 2 athletes reporting a history of spinal trauma (baseline, n = 13; follow-up, n = 20; P = .04). Of the athletes with LBP (n = 27), 59% (n = 16) reported recurrent LBP, 15% (n = 4) reported permanent LBP, and 26% (n = 7) reported 1-time LBP since baseline. Assessment of intersegmental changes revealed a significant increase in the number of athletes with disk signal reduction (baseline, n = 10; follow-up, n = 21; P = .001), disk bulging (baseline, n = 7; follow-up, n = 19; P = .002), or disk herniation (follow-up, n = 2; P = .04). Overall, intersegmental abnormalities did not correlate with LBP within the last year ( P = .53). Conclusion: Overuse-related intersegmental abnormalities of the lumbar spine are common in adolescent competitive alpine skiers and are often clinically silent at this age. These abnormalities may persist throughout skeletal maturation and even worsen during adolescence.
PLGA Conical Nail Fixation for Acetabular Chondrolabral Delamination in Femoroacetabular Impingement Promotes Cartilage and Labrum Regeneration in a Porcine Model
Authors: Du Cancan , Gao Guanying , Zhu Yichuan , Zhang Siqi , Zhang Yarui , Wang Jianquan , Liu Zhenlong , Xu Yan 
Published: January 2025

Background: Acetabular chondrolabral delamination (ACD) is one of the most common hip cartilage injuries. However, there are very limited clinical treatments for this injury. Purpose: To evaluate the effectiveness of poly (lactic-co-glycolic acid) (PLGA) conical nail fixation in the treatment of acute and chronic ACD in a porcine model. Study Design: Controlled laboratory study. Methods: In this study, 24 pigs underwent surgically induced delamination of the chondrolabral junction. Pigs were randomly divided into 3 groups: the control group (delaminated chondrolabral junction without treatment), ACD acute refixation (ACDA) group (delaminated chondrolabral junction fixed with a PLGA nail), and ACD chronic refixation (ACDC) group (placement of a nonabsorbable spacer at the stripped chondrolabral junction for 6 weeks before fixation with a PLGA nail). Porcine specimens underwent magnetic resonance imaging (MRI), hematoxylin and eosin staining, safranin O/fast green (SO/FG) staining, immunohistochemistry examination (collagen 1, collagen 2, and collagen 10), and immunofluorescence examination ( SOX9 and aggrecan) to evaluate the chondrolabral regeneration at 6 and 12 weeks postoperatively. Results: MRI showed focal discontinuity of cartilage and fluid located between the acetabular cartilage and subchondral bone plate in the control group. The acetabular cartilage stained with SO/FG showed significantly more proteoglycan deposition at 12 weeks in the ACDA group than in the control group ( P = .0109) and ACDC group ( P = .0484). In accordance with the results of the SO/FG and collagen 10 staining, the aggrecan of the femoral head at 6 and 12 weeks was upregulated in the ACDA group ( P < .0001) and downregulated in the ACDC group ( P < .0001). Conclusion: PLGA conical nail fixation achieved a good treatment outcome on MRI and histological evaluations. Early treatment upregulated the expression levels of SOX9 and aggrecan and promoted proteoglycan deposition. Clinical Relevance: The PLGA conical nail fixation technique may be a viable and effective treatment approach for patients with ACD in clinical practice.
Injectable Fibrocartilage-Forming Cores Enhance Bone-Tendon Healing in a Rat Rotator Cuff Model
Authors: Yuan Yuhao , Mao Yiyang , Sun Buhua , Chen Can 
Published: January 2025

Background: After surgical repair of rotator cuff (RC) tears, the torn tendon heals unsatisfactorily to the greater tuberosity owing to limited regeneration of the bone-tendon (BT) insertion. This situation motivates the need for new interventions to enhance BT healing in the RC repair site. Purpose: To develop injectable fibrocartilage-forming cores by tethering fibroblast growth factor 18 (FGF18) on acellular fibrocartilage matrix microparticles (AFM-MPs) and evaluate their efficacy on BT healing. Study Design: Controlled laboratory study. Methods: We harvested normal fibrocartilage tissue from the porcine RC insertion, after which it was decellularized and then micronized for fabricating AFM-MPs. The collagen-binding domain was fused into the N-terminus of FGF18 to synthesize recombinant FGF18 (CBD-FGF18), which was tethered to the collagen fibers of AFM-MPs to prepare the injectable fibrocartilage-forming cores (CBD-FGF18@AFM-MPs). After examining the influence of the CBD-FGF18@AFM-MPs on the viability and chondrogenic differentiation of bone marrow mesenchymal stem cells in vitro, we determined the function of the CBD-FGF18@AFM-MPs on BT healing in a rat RC tear model. A total of 80 Sprague-Dawley rats with RC injuries were randomly assigned to 4 supplemental treatments during RC repair: saline injection (control group), AFM-MPs injection, natural FGF18@AFM-MPs injection, and CBD-FGF18@AFM-MPs injection. At 4 and 8 weeks postoperatively, the harvested RC specimens were evaluated via micro–computed tomography, histologic staining, and mechanical testing. Results: In vitro, the CBD-FGF18@AFM-MPs were highly biomimetic, suitable for cell growth and proliferation, and superior in stimulating chondrogenesis. In vivo micro–computed tomography results showed that the CBD-FGF18@AFM-MPs group had significantly more new bone formation and better bone remodeling than the other 3 groups. Histologically, at 4 and 8 weeks postoperatively, the CBD-FGF18@AFM-MPs group had the best continuity of the BT insertion with regular collagen alignment and extensive fibrocartilage regeneration. Importantly, at 8 weeks postoperatively, the RC specimens from the CBD-FGF18@AFM-MPs group presented the highest failure load and stiffness. Conclusion: The injectable fibrocartilage-forming cores provide a new biological intervention to promote RC healing. Clinical Relevance: The injectable fibrocartilage-forming cores may be a new complementary treatment for surgical repair of RC tears.