bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre-Draft Elbow Magnetic Resonance Imaging in Major League Baseball Pitchers (127)
Authors: Erickson Brandon , Chalmers Peter , Dangelo John , Ma Kevin , Alexander Frank , Ahmad Christopher 
Published: October 2021

Objectives: Evaluate pre-draft elbow MRI on baseball pitchers who were entering the MLB draft to determine the presence or absence of pathology, and the associations between these pathologies and UCL tears, and inter-observer reliability regarding common MRI pathology. Methods: Pre-draft elbow MRI and X-Rays on prospective MLB pitchers between 2011-2017 were deidentified and reviewed by two separate authors. The authors graded the X-Rays MRI on several factors including presence or absence of ulnar collateral ligament (UCL) ossification, UCL appearance (heterogeneous or not), UCL thickening (and location), UCL tear (partial vs. full thickness and location), muscle strain, flexor tendon tear, posteromedial osteophyte, sublime tubercle enthesophyte, and osseous stress reactions. Results: Overall, 245 pre-draft elbow X-Rays and MRI were reviewed. On X-Ray: 12 (4.9%) had ossification within the UCL; 34 (13.9%) had an olecranon osteophyte; 14 (5.7%) had a sublime tubercle enthesophyte. MRI abnormalities were found in 70% (171/245) of pitchers. UCL thickening was found in 20% of pitchers. Regarding UCL tears, 3% had a full thickness tear and 24% had a partial thickness tear. Of full thickness tears, 86% were distal and one was midsubstance. Of partial thickness tears, 41% (24/58) were distal, 12% (7/58) were midsubstance, and 47% (27/58) were proximal. Periligamentous edema was present in 36% of pitchers while 14% had a flexor pronator muscle strain. Stress reactions were seen in 27% and most commonly involved the sublime tubercle. Based upon the presence of periligamentous edema, distal UCL pathology was more likely to be chronic than acute while proximal UCL pathology was more likely to be acute. Conclusions: The majority (70%) of pitchers entering the MLB draft had abnormal findings on their MRI, most commonly involving changes to the UCL. Interobserver reliability was acceptable following definition of pathology when reading pre-draft elbow MRI on MLB prospects.
Identification of Factors Associated with Disease Progression in the Contralateral Hip of Patients with Symptomatic Femoroacetabular Impingement. (139)
Authors: Khan Adam , Louer Craig , Abu-Amer Wahid , Pashos Gail , Garrido Cecilia Pascual , Clohisy John , Nepple Jeffrey 
Published: October 2021

Objectives: Femoroacetabular Impingement (FAI) is one of the most common causes of hip osteoarthritis. Nevertheless, the factors contributing to symptom development and FAI disease progression are poorly understood. The purpose of this study was to (1) investigate rates of symptom development in the contralateral hip of patients with FAI at mid-term follow-up, and (2) identify predictors of disease progression (symptom development) in the contralateral hip. Methods: This prospective study included 179 patients undergoing ipsilateral FAI surgery with no history of previous contralateral hip surgery. In the current study, the contralateral hip was assessed at minimum 5 year follow-up. Symptoms (defined as moderate pain) and the need for surgery were monitored over the study course. Statistical analysis compared patient and FAI imaging characteristics of patients developing symptoms to those who remained asymptomatic. Results: A total of 146 hips (81.5%) were included at a mean 6.7 years of follow-up. Thirty-nine (26.7%) presented with symptoms in the contralateral hip, while an additional 35 (23.9%) developed symptoms during the follow-up period. Twenty-Six (17.8%) progressed to surgery for their contralateral hip. Head-neck offset ratio (HNOR) on AP pelvis radiographs was significantly lower among hips that developed symptoms (0.16 vs. 0.15 p=0.03). Maximum alpha angle (p=0.41), lateral center edge angle (p=0.70), and crossover sign (p=0.12) were not predictive of symptoms. Patients with a UCLA activity score greater than 9 were less likely to develop symptoms (14% vs. 46%, p=0.081), but this was not statistically significant. The total arc of rotation in 90° of flexion (40.0° vs 50.8°, p=0.01) as well as external rotation at 900 of flexion (28.9° vs 36.6°, p=0.02) were decreased in hips developing symptoms. Internal rotation in flexion was not significantly decreased in symptomatic patients (11.1° vs 14.2°, p=0.11). Kaplan Meier survival analysis demonstrated 53% and 45% of patients remaining asymptomatic at 5 and 8 year time points (Figure). Conclusions: At a mean follow-up of 6.7 years, significant symptoms in the contralateral hip of patients with FAI are present in 50.7% of patients, while 49.3% remain asymptomatic or minimally symptomatic. We identified unique radiographic and physical exam findings that are associated with symptom development in patients with FAI. Specifically, decreased hip rotation arc and decreased HNOR were strongly associated with disease progression and may represent important factors for future risk modeling in FAI patients.
Cost-Effectiveness of Particulated Juvenile Articular Cartilage Versus Matrix-Induced Autologous Chondrocyte Implantation for Patellar Chondral Lesions (176)
Authors: LeBrun Drake , Feingold Jake , Swenson-Buza Stephanie , Gruber Simone , Dennis Elizabeth , Stein Beth Shubin 
Published: October 2021

Objectives: Treatment options for articular cartilage lesions of the patella have evolved over the past several years due to the development of novel cell-based cartilage restoration techniques, including particulated juvenile allograft cartilage (PJAC) and matrix-induced autologous chondrocyte implantation (MACI). The objective of this study was to evaluate the cost -effectiveness of these modalities in the management of patellar cartilage defects. Methods: A Markov state-transition model was utilized to evaluate the cost-effectiveness of three strategies for patients with patellar chondral lesions: (1) nonoperative management, (2) PJAC, and (3) MACI. Probabilities, health utilities, and costs of surgical procedures and rehabilitation protocols were derived from institutional data and literature review. Effectiveness was assessed using quality-adjusted life-year (QALY). Cost-effectiveness was evaluated from societal and payer perspectives over a 15-year time horizon. The principal outcome measure was the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed on pertinent model parameters to assess their effect on base case conclusions. Results: From a societal perspective, nonoperative management, PJAC, and MACI cost $4,140, $52,683, and $83,073 respectively. Nonoperative management, PJAC, and MACI were associated with 4.91, 7.07, and 7.79 QALYs gained, respectively. Therefore, PJAC and MACI were cost-effective relative to nonoperative management (ICERs $22,527/QALY and $27,456/QALY, respectively; Figure 1). Although MACI was more cost-effective than PJAC in the base case, this was strongly sensitive to the estimated probabilities of full versus intermediate benefit following PJAC and MACI (Table 1). If the probabilities of full and intermediate benefit following PJAC were assumed to be the same as those following MACI (i.e., PJAC and MACI were equally effective), then PJAC dominated MACI by being cheaper and more effective. At a $100,000/QALY willingness-to-pay threshold, MACI, PJAC, and nonoperative management were the preferred strategies in 63%, 33%, and 4% of the Monte Carlo probabilistic sensitivity analyses, respectively (Figures 2 and 3). Similar results were seen from a payer perspective. Conclusions: In the management of symptomatic patellar cartilage defects, PJAC and MACI were both cost-effective compared to nonoperative treatment in the management of symptomatic patellar cartilage defects; however, MACI was the preferred strategy in our base-case analysis. The cost-effectiveness of PJAC compared to MACI depended heavily on the probability of achieving full versus intermediate benefit after PJAC and MACI.
Racial, Socioeconomic, and Demographic Disparities in the Management of Meniscal Tears (179)
Authors: O’Donnell Ryan , Lemme Nicholas , Brodeur Peter , Gil Joseph , Cruz Aristides 
Published: October 2021

Objectives: Meniscal surgery, repair or debridement, makes up about a third of all arthroscopic related surgery. In the adult population, there is much debate about which patients should undergo surgical intervention and which should be treated nonoperatively. There seems to be a paucity of literature related to how a patient’s demographics, insurance status, socioeconomic status, and race impact the likelihood of undergoing surgical intervention. In the present study, we sought to determine how these factors influence whether a patient undergoes surgical intervention following a meniscal injury. Methods: From 2009-2018, claims for adult (≥18 years of age) patients who were diagnosed with a primary meniscus injury were identified in the New York Statewide Planning and Research Cooperative System (SPARCS) database. SPARCS is a comprehensive all-payer database collecting all inpatient and outpatient pre-adjudicated claims in New York. ICD 9/10 CM codes were used to identify the initial diagnosis for each patient. ICD9/10 PCS and Current Procedural Terminology (CPT) codes were used to identify subsequent meniscus surgery. The procedures identified were linked with the initial diagnosis and patients were noted as either having meniscus surgery, or not having meniscus surgery. After missing data was removed, logistic regression analysis was performed to determine the effect of patient factors on the likelihood of having surgery after a diagnosis of meniscus injury. Results: Of 394,007 adult meniscus injury diagnoses, 84.7% proceeded to undergo surgical intervention. The median age for no surgery was 51 (mean: 49.4) and the median age for surgery was 52 (mean: 50.2) (p<.0001) (Table 1). Females relative to males (OR=0.757, p<.0001), increased social deprivation index (SDI) (OR=0.994, p<.0001), African American compared to white race (OR=0.822, p<.0001), hispanic relative to non-hispanic ethnicity (OR=0.682, p<.0001), federal relative to private insurance (OR=0.459, p<.0001), and self-pay relative to private insurance (OR=0.437, p<.0001) were all associated with decreased odds of undergoing meniscus surgery. Older patients (OR=1.009, p<.0001), worker’s compensation relative to private insurance (OR=1.284, p<.0001) and patients with a charlson comorbidity index (CCI) score ≥1 had increased odds of undergoing surgery (OR=1.129, p<.0001) (Table 2). Conclusions: Multiple demographic, insurance status, socioeconomic status, and race factors influence the decision to manage meniscal tears surgically. Females, those with increased social deprivation index, African-Americans, Hispanics, or those with federal insurance or self-pay (when compared to private insurance) were less likely to undergo surgical intervention for meniscal tears. Those with workers’ compensation, who were of older age and higher CCI were more likely to undergo surgical intervention. Further research is ultimately needed to elicit causes for disparities between demographic groups.
Prevalence and Role of Psychiatric Conditions in Patients Diagnosed with Anterior Knee Pain (192)
Authors: Swinehart Steven , Bowman Eric , Freeman Thomas , Rees Andrew , Harper Holly , Coronado Rogelio 
Published: October 2021

Objectives: Anterior knee pain is a common musculoskeletal complaint with a multifactorial etiology. Psychiatric conditions may play a significant role in both the evolution of anterior knee pain and recovery from it. This retrospective, matched case-control study evaluates the prevalence of psychologic conditions in patients with anterior knee pain to assess their role as a potential contributor. Methods: 126 patients with anterior knee pain were retrospectively identified using ICD-10 codes and were individually matched to controls based on gender, age, and BMI. Patient demographics, surgical history, medications, and prior or current diagnoses related to musculoskeletal or psychiatric health were recorded. Demographic data between the anterior knee pain group and controls were evaluated using independent t-tests. Differences between the matched pairs related to psychiatric conditions and medication usage were evaluated using a McNemar Test. A subgroup analysis was also performed and defined by gender, age greater than or less than 35, and BMI greater than or less than 25. Results: Evaluation of demographic data between the anterior knee pain group and controls showed no difference with regards to age, gender, and BMI (p>0.05). Analysis of the 126 matched pairs demonstrated similar rates of psychiatric conditions and medication usage between the anterior knee pain group (23 patients, 18.3%) and the control group (18 patients, 14.3%). Statistically, there was no difference between the two groups (p = 0.472). A subgroup analysis also demonstrated no difference between the anterior knee pain group and controls when stratified by gender (Male [p = 0.80]; Female [p = 0.12]), age (< 35 [p = 1.00]; > 35 [p = 0.50]), and BMI (< 25 [p = 0.10]; > 25 [p = 0.82]). Conclusions: There was no difference in the prevalence of psychiatric conditions between patients with anterior knee pain and their controls. This suggests a low likelihood that the psychologic condition of patients with anterior knee pain differ from that of the general population and implies that psychologic conditions alone are unlikely to play an isolated role in the etiology of anterior knee pain.
Outcomes of Meniscal Repair versus Meniscectomy in Patients with Concomitant ACL and Bucket Handle Meniscus Tears (200)
Authors: Keeling Laura , Galel Alexandra , Ehlers Cooper , Wang David , Chang Edward 
Published: October 2021

Objectives: Bucket handle meniscus tears often present concurrently with tears of the anterior cruciate ligament (ACL). However, little is known regarding the influence of demographic factors on surgical decision-making, or on outcomes following treatment of bucket handle meniscus tears in ACL-deficient patients. Furthermore, no study has compared outcomes in this population between patients undergoing meniscectomy versus repair. The purpose of this study was therefore to determine if there is a difference in outcomes between patients presenting with concomitant ACL and bucket handle meniscus tears treated with meniscal repair versus meniscectomy. A secondary aim of this study was to discover if there is an association between the decision to perform a meniscus repair or meniscectomy based on demographic factors. Methods: In this institutional review board-approved retrospective study, we evaluated 62 patients presenting with ACL tear who were found to have a bucket handle meniscus tear preoperatively or at the time of ACL reconstruction. Of those, 30 patients underwent partial meniscectomy, while 32 underwent meniscal repair. Primary outcome measures included ACL and meniscal retear rates, as well as patient-reported outcome measures (PROMs). Documented PROMs included the International Knee Documentation Committee (IKDC), Single Assessment Numeric Evaluation (SANE), and ACL-Return to Sport after Injury (ACL-RSI) scores. Demographic and patient-specific factors evaluated included age, body mass index (BMI), smoking status, and location of meniscus tear. Results: Of 62 patients presenting for ACL reconstruction with concomitant bucket handle meniscus tear, a total of 34 patients with greater than one year (mean 22.4 month) follow-up were included. 14 patients underwent repair, and 20 underwent meniscectomy. No significant differences were noted in IKDC (p = 0.36), delta IKDC (p = 0.18), SANE (p = 0.61), or ACL-RSI (p = 0.67) scores between the repair and meniscectomy groups at final follow-up. No significant differences were found in ACL (p = 1.00) or meniscus (p = 0.49) retear rates between the two groups. Younger age, lower BMI, and tear location (red-red zone) were significantly associated with the decision to perform meniscal repair over meniscectomy (p < 0.05). Conclusions: Among patients presenting with concomitant ACL and bucket handle meniscus tears, we found no difference in patient-reported outcomes or retear rates in patients undergoing meniscal repair versus meniscectomy. Demographic and patient-specific factors including age, BMI, and tear location may influence surgical decision-making when determining the optimal treatment of bucket handle meniscus tears in this population.
MANAGEMENT OF FIRST-TIME PATELLAR DISLOCATION: A SURVEY OF PRISM MEMBERS (201)
Authors: Parikh Shital , Veerkamp Matthew ,   PF RIG group
Published: October 2021

Objectives: There are no current guidelines for optimal management of first-time patellar dislocation in children and adolescents. The objective of this study was to develop consensus-based guidelines for management of first-time dislocation in adolescents. Methods: A 29-question, case-based, multiple-choice survey was developed after 2-rounds of iterations by 20 members of the Patellofemoral RIG. The survey contained two case scenarios of first-time patellar dislocation in adolescents - one with and one without an osteochondral fracture. The survey was administered to primary sports medicine and orthopedic surgeons of the PRISM Society in April 2020 and the responses were analyzed. Consensus-based guidelines were generated when at least 66% of the respondents agreed. Results: 81/276 (29%) members responded to the survey and 6 consensus-based guidelines were generated from those responses (Table 1).There was no consensus between conservative (60%) and operative (40%) treatment of contralateral patellar dislocation. Free-text analysis revealed several variables that influence the decision-making process. Conclusions: There are changes in trends related to management of first-time dislocation in adolescents. MRI, though not recommended for all patients with first-time dislocation, was obtained by 51% of respondents. The survey provides details of conservative treatment, including the role and duration of bracing and physical therapy. For first-time dislocation with an osteochondral fracture, concomitant patellar stabilization is preferred over isolated fixation. Simultaneous guided-growth for genu valgum correction is recommended. There were several variables that influenced the decision-making process and there were several areas of discordance. Further research studies on these parameters could potentially improve outcomes. *PF RIG members: Matthew Ellington, MD, Craig J Finlayson, MD, Joseph Molony, Jr., PT, MS, SCS, CSCS, Nicole Friel, MD MS, Daniel W Green, MD, Jeffery L Mikutis, DO, Todd A Milbrandt, MD, James L Pace, MD, Albert M Pendleton, MD, Lauren H Redler, MD, Jason Rhodes, MD, Shannon D Safier, MD, John A Schlechter, MD, Beth E Shubin Stein, MD, Curtis Vandenberg, MD, Jeffrey M Vaughn, DO, Eric J Wall, MD, Drew E Warnick, MD, Moshe Yaniv, MD, Shital N Parikh, MD.
Can Opioids be Eliminated After Arthroscopic Meniscus Surgery? A Prospective Randomized Controlled Trial (202)
Authors: Jildeh Toufic , Okoroha Kelechi , Kuhlmann Noah , Cross Austin , Abbas Muhammad , Moutzouros Vasilios 
Published: October 2021

Objectives: To compare a multimodal nonopioid pain protocol to traditional opioid medication in controlling postoperative pain following meniscal surgery. We hypothesized that our nonopioid protocol would show no significant difference in pain and reduced side effects when compared to the standard opioid regimen. Methods: Ninety-nine patients undergoing primary meniscectomy or meniscal repair were assessed for participation. A prospective randomized control trial was performed in accordance with the CONSORT (Consolidated Standards of Reporting Trials) 2010 statement. The two arms of the study included a multimodal non-opioid analgesic protocol and a standard opioid regimen with a primary outcome of postoperative pain level (visual analog scale) for 10 days. Secondary outcomes included patient reported outcomes, complications and patient satisfaction. Randomization was achieve using a random number generator. Patients were not blinded. Data collection was done by a blinded observer. Results: Eleven patients did not meet the inclusion criteria, and 27 declined participation. A total of 61 patients were analyzed with 30 randomized to the opioid regimen, and 31 randomized to the non-opioid regimen. Patients receiving the nonopioid regimen demonstrated non-inferior VAS scores compared to patients who received opioid pain medication (p>0.05) No significant differences were found in preoperative (opioid: 58.9 ± 7.0; nonopioid: 58.2 ± 5.5, p = 0.724) nor postoperative (opioid: 59.8 ± 6.5; nonopioid: 54.9 ± 7.1, p = 0.064) PROMIS-PI SF scores. No difference was found in recorded side effects between both groups: constipation (p = 0.124), nausea (p = 0.979), diarrhea (p = 0.464), upset stomach (p = 0.174), and drowsiness (p = 0.572). Conclusions: This study found that multimodal nonopioid pain protocol provided equivalent pain control and patient outcomes following primary meniscus surgery while having an equivalent side effect profile. All patients reported satisfaction with their pain management without requiring emergency opioid analgesia.
Creation and Validation of a Shorthand Knee MRI Bone Age Assessment Tool as an Alternative for Skeletal Maturity Assessment (203)
Authors: Politzer Cary , Bomar James , Pehlivan Hakan , Gurusamy Pradyumna , Edmonds Eric , Pennock Andrew 
Published: October 2021

Objectives: In managing pediatric knee conditions, an accurate bone age assessment is often critical for diagnostic, prognostic, and treatment purposes. Historically, the Greulich and Pyle Atlas (hand atlas) has been the gold standard bone age assessment tool. In 2013, a shorthand bone age assessment tool based on this atlas (hand shorthand) was established as a simpler and more efficient alternative. Recently, a knee MRI bone age atlas (MRI atlas) was created potentially to circumvent the need for a left hand radiograph. Our objective is to create a shorthand version of the magnetic resonance imaging atlas. Methods: A shorthand bone age method (Figure 1) was created utilizing the previously published MRI atlas, which utilizes several criteria that are visualized across a series of images. The MRI shorthand draws on the most characteristic criteria for each age that is best observed on a single MR image. For validation, we performed a retrospective assessment of skeletally immature patients that had a knee MRI and left hand radiograph within four weeks. Four readers who were familiar with the hand atlas, hand shorthand, MRI atlas, and MRI shorthand read each of the images in a blinded fashion. Inter- and intra-observer reliability was evaluated using intraclass correlation coefficient (ICC), variability among observers was evaluated using percent agreement. Results: 26 patients with a mean age of 13.6 years (range 9.0-16.9) met the inclusion criteria. The intra- and inter-observer reliability of all four assessment tools was excellent (ICC ≥ 0.8, p<0.001) (Table 1). When comparing the MRI shorthand to the MRI atlas, there was excellent agreement (ICC = 0.974), whereas the hand shorthand compared to the hand atlas had good agreement (ICC = 0.765). The MRI shorthand also had perfect agreement in 58% of reads among all four readers and 96% of reads had agreement within 1 year, whereas the hand shorthand had perfect agreement in 32% of reads and 77% agreement within 1 year (Table 2). Conclusions: The MRI shorthand is a simple and efficient means of assessing skeletal maturity of adolescent patients with a knee MRI. This bone age assessment technique has inter-observer and intra-observer reliability equivalent or better than the standard means utilizing a left hand radiograph.