bluuebunny/crossref_metadata_2025_split huggingface dataset:
INCREASED INCIDENCE OF ACUTE PATELLAR INSTABILITY AND PATELLAR INSTABILITY SURGERY ACROSS THE UNITED STATES IN PEDIATRIC & ADOLESCENT PATIENTS
Authors: Milewski Matthew D. , Feldman Lanna , Heyworth Benton E. , Kramer Dennis E. , Miller Patricia E. , Kocher Mininder S. , Yen Yi-Meng 
Published: March 2019

Background: Participation in organized sports has been increasing over the last several decades for pediatric and adolescent athletes in this country. It is hypothesized that the overall incidence of acute patellar dislocation in this population would increase with more sports participation. Newer surgical techniques for patellar stabilization have also become popular and have been adapted for younger populations. The purpose of the current study was to evaluate the trend in the frequency of patellar dislocations treated at pediatric hospitals in the U.S. versus patients receiving surgical intervention for patellar dislocation. Methods: The Pediatric Health Information System (PHIS) database was queried for all patients 18 years or younger who underwent orthopaedic surgery between 2004 and 2014. A cohort of patients treated surgically for patellar dislocation was compared to a cohort of patients seen in the Emergency Department for management of a patellar dislocation. Data sets from 25 of the 48 pediatric hospitals participating in the PHIS initiative reported data consistently for the study time period and were included in the analysis. The rate of patellar dislocation surgeries per 1,000 pediatric orthopedic surgeries was analyzed for the 11-year period. Linear modeling was used to assess sex-based and overall trends. Results: During the study period, there were 447,285 orthopaedic surgeries at 25 institutions, which included 3,481 patellar dislocation procedures, suggesting a rate of 7.8 per 1,000 orthopaedic surgeries. An additional 5,244 patellar dislocations treated in the emergency room were identified. Over the study period, the number of patellar dislocation procedures increased 2.1-fold (95% CI = 1.4-3.0), while all surgeries increased 1.7-fold (95% CI = 1.3-2.0). There was only a 1.2-fold increase in patellar dislocation procedures relative to total pediatric orthopedic procedures. Emergency Department treatment of patellar dislocation increased 2.8-fold. Females yielded similar trends between operative and Emergency Department treatment of patellar instability (2.2-fold and 2.3 –fold, respectively); while males experienced a higher trend in the need for Emergency Department treatment compared to operative treatment (3.0-fold versus 2.0-fold, respectively). Conclusion / Significance: This study shows a significant rise in the rate of acute patellar instability events in pediatric and adolescent patients across the country. Interestingly, surgery for patellar instability increased by only slightly more than the rate of all pediatric orthopaedic procedures. Further research is needed to evaluate the link between increased acute patellar instability and risk for chronic patellar instability along with the potential need for surgical intervention.
EARLY RESULTS OF AN INJURY-PREVENTION PROGRAM IN HIGH SCHOOL TRACK ATHLETES
Authors: Dickason Celeste Quitiquit , Marois Whitney , Santos Hannah , Grace Sadie , Krabak Brian , Bompadre Viviana , Schmale Gregory A. 
Published: March 2019

Background Injury prevention programs have been shown to be effective for adolescent soccer, basketball, and handball athletes. Though injuries are common in high school runners, injury prevention programs have not been described for this population. Our objective was to trial an injury-prevention program styled after those found to be successful in other running and jumping sports to see if a group of running athletes sustained fewer and or less serious injuries during the course of a single high school track season. Methods Two suburban high school track coaches volunteered to participate in a program consisting of either injury-prevention exercises or no additional exercises as a part of pre-and in-season practice programs. All runners at each school were invited to participate, with informed consent obtained. The injury prevention program consisted of five jumping and plyometric exercises taught by a physical therapist, with a video of the exercises made available to the coach and team members throughout the season. Surveys pre- and post-season were collected which included demographic information, running history, diet, and injuries. Injuries were reported to coach and trainer at each school. Days of missed practice constituted an injured day, tallied for each runner and each team. A Chi-square analysis compared injury rates by team, and hence by intervention; injury rates by years of experience running; and injury rates by dietary preference. Results 24 runners, 13 from the intervention school and 11 from the control school participated. There was no significant difference in the number of running injuries reported when comparing the intervention group (4/13 runners) to the control group (3/11 runners, Chi-square = 0.035, p = 0.9). Runners with a greater number of years of competitive running experience trended towards having fewer injuries (p = 0.06). Those describing their diet as vegetarian (3/24) were significantly more likely to sustain an injury (p = 0.002). Conclusions / Significance With this limited comparison study examining the impact of an injury-prevention pre-season and in-season training program for running athletes participating on their high school track team, there was no evidence that the addition of a program of jumping and plyometric exercises had an impact on injury rates. However, combining the data from the two schools, we found a trend towards decreased injury likelihood in those with more years of experience running, and a significantly greater incidence of injuries in those who described their diet as vegetarian. These results suggest that novice runners should perhaps have a different set of expectations regarding the pre- and in-season training regimen, and that those whose diet is vegetarian consider review of their nutrition to optimize their energy level and reparative capacity with the increased activity of a high school track running program.
MACHINE-LEARNING IDENTIFIES BEST MEASURES TO PREDICT ACL RECONSTRUCTION OUTCOME
Authors: Potty Anish GR , Potty Ajish S. R. , Punyamurthula Rithesh , Penna Sreeram , Benavides Chris , Chavan Prithviraj , Mistovich R. Justin 
Published: March 2019

Introduction: Knee injury and Osteoarthritis Outcome Score (KOOS) is a widely used patient-reported outcome measurement to track recovery after ACL surgery. This study focuses on the function of daily living subscale (KOOS ADL), which is calculated based on 17 questions. By employing machine learning to predict KOOS ADL scores, we sought to better understand the relative importance of the survey questions and thereby identify its most critical components as well as questions that do not adequately predict outcomes. Methods: Pre- and post-operative patient reported KOOS ADL survey responses and outcomes scores following ACL surgery were obtained from the Surgical Outcome System data registry(SOS), an international patient-reported outcomes database sponsored and maintained by Arthrex. Patients with missing KOOS ADL survey responses were excluded from the study. Machine learning (ML) algorithms such as Random Forest and Gradient Boosting were used to identify the most critical survey questions that predict KOOS ADL scores with high accuracy. These decision tree-based algorithms predict patient outcomes using several decision rules and thereby determining the relative value of individual questions at predicting patient deficits (e.g., if patients have “Severe” difficulty in ascending stairs, they are more likely to have globally worse scores than those with difficulty with other tasks). Results: 4996 patients were initially identified. Based on compliance with the survey, 2407, 2407, 1817 and 1193 patients records for pre-surgery, 3 month, 6 month and 1 year post-surgery responses respectively underwent further analysis. The dataset consisted of 53.9% males and 46.1% females. Mean age was 29 (range 11 to 70 years). Results from the ML models indicated that by 6 key questions, over 80% of the variance in KOOS ADL scores could be explained instead of standard 17 survey questions (Table 1). Interestingly, the analysis provided similar accuracy at both 6 months and 1 year. Discussion and Conclusion: Most patients have similar functional deficits that can be captured using a simplified version of the KOOS ADL survey. The abbreviated survey would result in a better patient reporting experience while still obtaining quality data. Additional work on predicting post-surgery scores using ML from pre-surgery responses and other patient information would provide valuable insights; however, predicting outcome scores with high accuracy remains challenging. We advocate for novel methods to identify and measure meaningful data to assist with understanding patient outcomes and thereby proving the true value of orthopaedic interventions on functional status. [Table: see text]
SQUATTING MECHANICS FOLLOWING AN OSTEOCHONDROPLASTY FOR IDIOPATHIC FEMOROACETABULAR IMPINGEMENT
Authors: Ellis Henry B. , Fletcher Amanda L. , Tulchin-Francis Kirsten , Loewen Alex , Anderson Anthony , Stevens Wilshaw , Sucato Dan , Podeszwa David 
Published: March 2019

Background: Femoroacetabular impingement (FAI) is primarily due to the repetitive motion of aberrant bone in provocative positions such as hip flexion and internal rotation (IR). The purpose of this study is to evaluate the kinematic changes that occur in the hip during a squat prior to and following an osteochondroplasty for idiopathic FAI. Methods: Subjects were prospectively enrolled when scheduled to undergo hip preservation surgery for primary CAM hip impingement by one of 3 surgeons. Prior to the procedure, subjects were evaluated in the movement science lab while performing a standardized bilateral limb gravity squat. Kinematic data of the trunk, pelvis and lower limbs were analyzed during the descent phase of the squat. Statistical comparison of the operative and non-operative hips was performed prior to and at a minimum of one year following surgery. Results: Twenty-seven hips with a mean age of 16.3 years (12.4 – 19.9 years, 8 males) underwent an osteochondroplasty (8 arthroscopic, 19 surgical hip dislocation) resulting in a decrease in the alpha angle (60.8° versus 46.8°, p<0.001) and a significant improvement in HOOS and UCLA scores. When combining the entire cohort, no statistical difference was seen in side to side nor pre-operative to post-operative kinematic or kinetic data. Asymmetry was seen in the transverse plane hip rotation with 6/27 subjects demonstrating an average reduction of 9.4° in ROM on the affected side and a decrease in both peak IR and external rotation (ER) (average decrease 4.7°). Following osteochondroplasty, asymmetry resolved in 4/6 patients. Also, 16/27 subjects demonstrated asymmetry in rotation at 40° of hip flexion during the squat (11 more ER, 5 more IR) in which 37.5% had resolution of the asymmetry following an osteochondroplasty. Conclusion: Asymmetry in squatting mechanics in patients with FAI is not consistent with all subjects. Those with asymmetry in rotation at 40° of hip flexion during the squat or reduction in overall hip rotation may see a resolution in asymmetry following an osteochondroplasty. Dynamic impingement may present as asymmetry during different positions of hip flexion in a squat.
DEMOGRAPHICS OF PEDIATRIC AND ADOLESCENT PATIENTS WITH DISCOID MENISCI
Authors: Pandya Nirav K. , Robinson Sean P. , Merriman Jarrad 
Published: March 2019

BACKGROUND There has been an increase in the understanding of meniscus tears in pediatric and adolescent patients particularly with the rise of intensive sport training in this age group. Yet, discoid menisci represent a congenital entity for which there exists controversy as to the optimal workup, treatment, and long-term outcomes. Although there have been multiple reports on the surgical treatment of these patients, there is limited examination of these patient’s demographic characteristics and presentation. The purpose of this study is to define the demographics, presentation, and treatment patterns of discoid menisci in a single surgeon’s patient cohort METHODS We performed a retrospective review of all discoid meniscus patients from a single institution from 2012 to 2017. Demographics, history and physical examination notes, and intra-operative findings were reviewed. RESULTS Eighty-one patients were identified. Patients identifying as Hispanic (38%) and Caucasian (23%) made up the most common ethnic group. The average age at the time of presentation was 12.5 years old. Ninety-eight percent of patients reported pain upon presentation; however, this was commonly in conjunction with other symptoms. Most patients (48%) reported only short duration of symptoms (0 to 3 months) prior to presentation. In about one half of patients, tears were identified in 44 (54%) patients, and nearly 2/3 of patients (52) elected to undergo surgical intervention. Patients undergoing operative intervention had a high proportion of range of motion deficits (69% v 17%, p<0.001), meniscal tears (77% v 17%, p<0.001) and cartilage damage (33% v 3%, p=0.002). Nearly 2/3 of patients who required intervention necessitate meniscal repair with or without concomitant cartilage procedures. CONCLUSIONS / SIGNIFICANCE Unlike prior studies, the vast majority of patients with discoid menisci in our population were Hispanic or Caucasian. Although congenital, the vast majority of patients presented with a short duration of complaints (less than 6 months) in the second decade of life. A complex constellation of symptoms was present with isolated knee pain seen less commonly as well as athletic participation. Loss of range of motion drives surgical intervention with meniscal repair being more commonly performed regardless of symptom duration as opposed to saucerization. Nearly 1/3 of patients demonstrated cartilage damage intra-operatively; demonstrating the need for surgeons to not only counsel patients pre-operatively but also be prepared to repair and/or treat cartilage rather than perform saucerization.
THE UTILITY OF PUPILLARY LIGHT REFLEX AS AN OBJECTIVE BIOMARKER OF ACUTE CONCUSSION IN THE ADOLESCENT ATHLETE
Authors: Podolak Olivia E. , Joshi Nabin , Ciuffreda Kenneth , Mohamed Fairuz , Sharma Shelly , Kessler Ronni , McDonald Catherine , Arbogast Kristy B. , Grady Matthew , Master Christina L. 
Published: March 2019

Background: Visual deficits and autonomic dysfunction have been well recognized following pediatric concussion. Testing of the pupillary light reflex (PLR) is a simple, non-invasive, and objective approach to examine the autonomic nervous system by accessing the brain pathways. The aim of this study was to objectively evaluate adolescent pupillary responses to a light stimulus after a physician-diagnosed concussion and compare them to baseline responses. Methods: In this prospective cohort study, PLR was assessed in 135 adolescent athletes (ages 14-18) during their sport pre-season. All of the athletes were not recovering from a concussion at the time of their baseline assessment. Within this cohort, seven athletes (ages 14-17) sustained a concussion during their sport season and had longitudinal post-injury assessments of PLR through their recovery. The PLR was obtained in response to a brief step-input (0.8 seconds) white light stimulus using a hand-held pupillometer (stimulus recording duration= 5 seconds, light intensity= 150 lux). Pre-set and automated device-generated parameters used for analysis include the minimum and maximum pupil diameter, response amplitude and latency, mean constriction and dilation velocities and the maximum constriction velocity of the eye in response to a light stimulus. During each assessment, three monocular trials were performed in each eye alternatively, and the responses for each eye were subsequently averaged. Results: Six out of the seven concussed adolescents showed response enhancement of about 20% (IQR 11-33%). Enhancement was noted in the steady state diameter with a mean of 24% (median 18%), minimum pupil diameter mean of 17% (median 11%) and maximum constriction velocity mean of 28% (median 33%) following concussion, which decreased during the recovery process (days to weeks post-injury) to pre-injury or below initial pre-injury baseline measurements. Pupillary responsivity was found to be significantly enhanced after concussion compared to baseline measurements, waning over time. Maximum constriction velocity better highlighted the enhancement compared to the baseline pupil diameter. Conclusions/Significance: Pupil responsivity was found to be significantly enhanced after concussion compared to baseline measurements which waned over time during recovery. Assessment of dynamic PLR responses has potential utility as an objective biomarker to aid in concussion diagnosis on the sidelines or in the office, allowing physicians to quantify function (and dysfunction) of the autonomic nervous system under parasympathetic and sympathetic control after concussion.
MENISCUS REPAIR VERSUS DEBRIDEMENT FOR MENISCAL TEARS IN PEDIATRIC PATIENTS – PREDICTORS FOR TREATMENT BASED ON DEMOGRAPHICS
Authors: Agatstein Lauren , Skaggs Alton W. , Brown Matthew J. , Friel Nicole , Haus Brian 
Published: March 2019

BACKGROUND: Pediatric and adolescent patients with meniscus tears have a relatively high rate of healing after meniscus repair – up to greater than 80% in the literature. Despite this fact, many patients undergo meniscus debridement for treatment of their meniscus tears. In this study, we investigated the demographic factors predictive of whether a pediatric patient would receive a meniscal repair or a meniscal debridement for their meniscal tear. METHODS: The California statewide ambulatory surgery database (OSHPD) was queried for all patients under 18 years old who underwent meniscus debridement or meniscus repair from 2008-2016. The effect of age, hospital setting (adult versus pediatric hospital), injury chronicity, gender, insurance type, race, and year of service was assessed using logistic regression. RESULTS: A total of 13,906 pediatric patients had meniscal surgery during the timeframe. 83% (11,561/13,906) underwent meniscal debridement and 17% (2,345/13,906) underwent meniscal repair. Age, hospital type, nature of injury, gender, private insurance, being Hispanic, and year of service were statistically significant in predicting the odds of having meniscus repair versus meniscus debridement. Surgery at a children’s hospital increases the odds of having meniscus repair (p < 0.001). Of the 82.6% of pediatric patients (11,491/13,906) treated at non-children’s hospitals, 16% (1839) had repair and 84% underwent debridement (9,652). Of the 17.4% (2,415) treated at children’s hospitals, 21% (506) had repair and 79% (1,909) underwent debridement. As patients age, the odds of receiving a meniscus repair decrease (p < 0.001). Acute meniscus injury (p < 0.001) or private insurance (p < 0.05) increase the odds of having meniscus repair. However, females (p < 0.05) and Hispanics (p < 0.01) had decreased odds of having meniscus repair. As time between injury and surgery progressed, the odds of having meniscus repair versus meniscus debridement increased (p < 0.001). CONCLUSIONS: There is increasing evidence that pediatric patients have successful outcomes after meniscal repair surgery. The results of this study demonstrate that the majority of pediatric patients with meniscus tears undergo a meniscal debridement rather than a repair. Treatment at a children’s hospital, private insurance, and a short time frame between injury and surgery were positive predictors of meniscus repair over debridement. The results of the study may help inform patients, families, and referring physicians about what type of treatment a patient may receive for a meniscus tear, based on their demographic profile.
Minority Patients Have a Higher Number of Shoulder Dislocations and More Frequent Cartilage Lesions: Data from the MOON-Shoulder Instability Group
Authors: Hettrich Carolyn M. , Zacharias Anthony J. , Ortiz Shannon , Cronin Kevin J. ,   Shoulder Group MOON, Wolf Brian R. , Jacobs Cale A. 
Published: March 2019

Objectives: Previous investigations have shown decreased utilization and outcomes based on racial status in total knee arthroplasty (TKA) and total shoulder arthroplasty (TSA) cohorts; however, the impact of racial status in patients undergoing shoulder stabilization is poorly understood. The purpose of the current study was to compare how minority status affects surgical timing as well as pre- and intraoperative findings in patients undergoing operative treatment of shoulder instability. Methods: As part of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort, 1010 patients consented to participate in pre- and intraoperative data collection. Demographic characteristics, injury history, preoperative patient-reported outcome scores (PROs), and radiologic and intraoperative findings were then compared between Caucasian and minority patients undergoing surgical shoulder stabilization. In addition, the Economic Innovation Group’s 2017 Distressed Communities Index (DCI) was recorded for each patient’s home zip code. DCI Scores are based on percentages of adults without a high school education, percentage living under the poverty line, unemployment rates, and the overall housing and business climate in a given area. DCI Scores range from 0 to 100, with higher scores indicative of greater economic distress, and DCI Scores ≥ 80 are considered to be highly distressed regions. Continuous variables were compared between groups using two-tailed independent t-tests and categorical variables were compared using chi-square tests. Results: Of the 1010 patients, 988 patients (97.8%) had complete preoperative and intraoperative data. The cohort was largely Caucasian (851, 86.1%), with 137 minority patients, including 71 African American, 49 Asian, 13 Native American, and 4 Hawaiian or Pacific Islander. DCI scores were significantly worse for minority patients than Caucasians (39.4 vs. 28.1, p<0.001), as were preoperative expectations (p=0.02). A greater percentage of minority patients had 2 or more dislocations (69.1% vs. 57.7%, p=0.01) which corresponded with more frequent articular cartilage lesions (64.2% vs. 51.0%, p=0.004). Conclusion: Racial minorities were found to have more preoperative dislocations, higher rates of articular cartilage lesions, and worse preoperative expectations. DCI scores were lower in the racial minority group; however, this was not found to be an independent predictor of pre- and/or intraoperative findings. These findings identify a need to identify barriers in an action to reduce racial disparities in the treatment of shoulder instability.