bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bone Bruises in Children and Adolescents Not Associated With Ligament Ruptures
Authors: Gómez Jorge E. , Molina Daren D. , Rettig Shaylon D. , Kan J. Herman 
Published: July 2018

Background: Clinical characteristics of uncomplicated bone bruises (ie, not associated with a ligament rupture, meniscal tear, or fracture of the knee) in young athletes have scarcely been reported. Purpose: To identify mechanisms of injury, characterize bone bruise patterns, and identify clinical factors relating to recovery in young patients suffering uncomplicated bone bruises about the knee. Study Design: Case series; Level of evidence, 4. Methods: A review of clinical records and magnetic resonance imaging (MRI) findings of patients seen at a single institution was completed. Results: We identified 62 children and teenagers (mean age, 13.9 years; range, 8-18 years) who had a total of 101 bone bruises on MRI. The injuries occurred during a variety of organized and recreational sporting activities, the most common being football, basketball, and soccer. The majority (61.4%) of bone bruises occurred as a result of noncontact mechanisms. Patients reported a mean pain scale score of 6.3 of 10 (range, 2-10) on presentation. Frequent clinical findings included non–joint-line tenderness (64.5%), limited range of motion (58.1%), joint-line tenderness (54.8%), and positive meniscal signs (50.0%). The majority of bone bruises (61.4%) were located medially, and the most common bone bruise type was subcortical (58.4%), followed by medullary/reticular (35.6%) and articular impaction (5.9%). The only factor related to time to recovery was mechanism of injury; patients reporting a noncontact mechanism required significantly more time to recover than those reporting a contact mechanism (mean, 99.7 ± 74.8 vs 65.7 ± 38.8 days, respectively; F = 3.753, P = .049). Conclusion: In this case series of 62 pediatric patients with non–anterior cruciate ligament (ACL) bone bruises, the majority occurred in the medial compartment, suggesting that these bone bruises result from a mechanism distinct from the pivot-shift mechanism, classically thought to cause ACL injuries.
Fatigue Increases ACL Injury Risk in Youth Athletes: Risk Assessment Study Using Drop-jump Test
Authors: Fidai Mohsin S. , Okoroha Kelechi , Meldau Jason E. , Borowsky Peter A. , Meta Fabien , Lizzio Vincent A. , Redler Lauren H. , Moutzouros Vasilios , Makhni Eric C. 
Published: July 2018

Objectives: The impact of fatigue on injury risk to the anterior cruciate ligament (ACL) in adolescent athletes is unknown. Identifying athletes who demonstrate increased risk for injury may help determine who would benefit from early neuromuscular control intervention for injury prevention. The goal of this study was to determine if fatigue increases ACL injury risk in adolescent athletes using the drop-jump test to assess dynamic valgus. Methods: Youth and adolescent competitive athletes were recruited for this video analysis study. Participants were recorded performing the standard drop-jump test assessing dynamic valgus on landing three times. They then completed a standardized fatigue protocol consisting of a timed period of high-intensity aerobic tasks. A set amount of fatigue was quantified and achieved using a maximum vertical jump, which was compared to pre-fatigue values. The drop-jump test was then repeated three additional times post-fatigue. All drop-jump recordings (six in total) were randomized by order and scored for dynamic knee valgus by three independent reviewers. A multivariable analysis was performed to assess the correlation between demographic variables and injury risk. Results: Forty-seven female patients and thirty-eight male athletes were included in the study. The average age was 15.4 years (age 14-18). Athletes were found to have significantly higher ACL injury risk post-fatigue when compared to pre-fatigue (p = .001). Thirty-five athletes were found to change from low/medium injury risk pre-fatigue to medium/high risk post fatigue. No demographic variables were found to contribute to ACL injury risk. Conclusion: In adolescent athletes, fatigue appears to increase risk of ACL injury through drop-jump testing. Age, BMI, and hip width were not found to contribute to ACL injury risk. Implementation of neuromuscular or conditioning programs for at-risk athletes may reduce injury risk.
Utility of Merchant View Radiographs for Assessment of TT-TG: A Comparison to MRI
Authors: Bernholt David , Lamplot Joseph D. , Eutsler Eric , Nepple Jeffrey J. 
Published: July 2018

Objectives: Lateralization of the tibial tubercle plays a significant role in the pathophysiology of patellar instability and is most often assessed by the tibial tubercle to trochlear groove distance (TT-TG) measured on CT or MRI with the knee in extension. However, tracking of the patella in 30 to 45 degrees of flexion has been suggested to be of greater clinical significance. Merchant radiographs can demonstrate the position of the tibial tubercle relative to the trochlear groove in this range of flexion and thus may serve as a valuable tool in the assessment of patellar tracking. The purpose of the current study was (1) to validate radiographic assessment of the merchant view TT-TG and (2) to determine the correlation with MRI-based measurements. Methods: To validate Merchant TT-TG as a marker of the position of the tibial tubercle, 41 patients between the ages of 10-18 had standardized Merchant radiographs in 45 degrees flexion yielding imaging of 82 knees. Lead markers were placed upon the skin centered over the tibial tubercle based on palpation. Radiographs were collected and analyzed. The TT-TG was measured as the distance between lines centered over the deepest point of the trochlear groove and the center of the tibial tubercle and perpendicular to the anterior condylar axis. In order to correlate Merchant TT-TG to MRI TT-TG, 16 additional patients were added to reach a total of 30 patients with a Merchant radiograph and MRI, as power calculation determined 29 knees needed to detect a Pearson correlation coefficient (PCC) of .500. There was excellent interobserver reliability between two readers for Merchant TT-TG with and without use of a radiographic marker (ICC = .975 and .923 respectively). Results: The tibial tubercle could be identified on Merchant radiograph in 67 images (81.7%). Merchant TT-TG measured with use of a marker was very strongly correlated measurement based on bony landmarks alone (PCC = .848). The Merchant TT-TG measured with bony landmarks alone was strongly correlated to MRI TT-TG (PCC = .602). The strength of this correlation was increased by standardizing TT-TG by patellar width (PCC = .710). MRI TT-TG was increased in patients with patellar instability at 13.9 mm compared to 10.5 mm (p <.01); Merchant TT-TG was also increased in patients with patellar instability at 9.1 mm compared to 1.9 mm (p < .001). Conclusion: Standardized Merchant radiographs without radiographic markers allow for assessment of TT-TG in the majority of patients. Merchant TT-TG strongly correlates with MRI TT-TG but measured 5-8 mm smaller than MRI TT-TG.
The Role of Abnormal Tibiofemoral Rotation in Pediatric and Adolescent Patellar Instability
Authors: Bernholt David , Lamplot Joseph D. , Eutsler Eric , Nepple Jeffrey J. 
Published: July 2018

Objectives: Abnormal patellofemoral tracking has been implicated in patellar instability and can be influenced by the bony anatomy and alignment of the femoral trochlea, patella, and tibial tubercle. Tibiofemoral joint rotation has been recently suggested to play a role in patellofemoral kinematics but there has been little investigation of its contribution to patellar instability, including in pediatric and adolescent patients. Methods: A retrospective case-control design was utilized. 30 patients aged 9-18 with a prior patellar dislocation and an MRI of the involved knee were included. Cases were matched for age and gender with controls without patellar instability. Patients with ACL tears, tibial eminence or tubercle fractures, or prior surgery in the involved extremity were excluded. There was no difference in gender, age, height, but BMI was higher in the case group. MRI images taken with knee in extension were analyzed. Tibial tubercle-trochlear groove (TT-TG), tibial tubercle-posterior cruciate ligament (TT-PCL), and tibiofemoral rotation were measured. All measurements were performed by a single reader with excellent intra and interobserver reliability for tibiofemoral rotation (ICC-intra > .954 and ICC-inter > .905) demonstrated in a subset of patients. Results: The TT-TG was increased in patients with patellar instability at 16.3 mm compared to 10.9 mm in controls (p <.001) as was also the TT-PCL at 19.4 mm cases versus 17.6 mm (p=0.02). Tibiofemoral rotation was increased in patients with patellar instability with a mean 6.9° of tibial external rotation compared to 0.8° of tibial internal rotation in controls (p < .001). Overall, 30/41 (75.6%) of patients with patellar instability had tibiofemoral rotation >5° external rotation versus only 3/41 controls (7.3%). There was a strong correlation between TT-TG and tibiofemoral rotation (PCC = 0.776) and a moderate correlation between TT-TG and TT-PCL (PCC = .661). There was only a weak correlation between tibiofemoral rotation and TT-PCL. Conclusion: Increased tibiofemoral rotation is present in patients with patellar instability and may play a role in the pathophysiology of patellar instability. Increased tibiofemoral rotation can lead to an increased TT-TG even when TT-PCL is normal.
Minimum Five-Year Outcomes and Clinical Survivorship Following Arthroscopic Double-Row Repair for Full-thickness Supraspinatus Tears
Authors: Pogorzelski Jonas , Fritz Erik M. , Horan Marilee P. , Hussain Zaamin B. , Katthagen Christoph , Godin Jonathan A. , Millett Peter J. 
Published: July 2018

Objectives: Rotator cuff tears lead to significant morbidity due to pain and decreased function. Despite the prevalence of cuff repairs, mid-term outcomes have been scarcely reported. The purpose of this study is to report minimum 5-year outcomes and clinical survivorship after double-row rotator cuff repair for full-thickness supraspinatus tendon tears. Methods: Patients at least five years out from arthroscopic double-row repair for a full-thickness cuff tear involving the supraspinatus tendon were included. Pre- and postoperative ASES, SF-12 PCS, QuickDASH, SANE, and satisfaction scores were collected. The relationship between outcomes and (1) tear chronicity, (2) number of tendons involved, (3) type of repair, and (4) primary versus revision procedure, was also evaluated. Kaplan-Meier survivorship analysis was conducted defining failures as progression to revision rotator cuff surgery. Results: From November 2005 to February 2012, a total of 189 shoulders were eligible for inclusion. Fifteen shoulders (7.9%) underwent revision rotator cuff repair and were considered failures. Outcomes data were reported at a mean follow-up of 6.6 (range, 5.0-11.0) years. All outcome scores significantly improved from pre- to postoperative time point, including mean ASES (57.9 to 92.9, P < 0.001), SF-12 PCS (43.4 to 52.0, P < 0.001), QuickDASH (35.2 to 10.5, P < 0.001), and SANE scores (61.5 to 86.5, P < 0.001). Acute tears demonstrated significantly better ASES and SANE scores than chronic tears (ASES 95.1 ± 8.9 versus 91.7 ± 11.2, P = 0.025; SANE 89.6 ± 19.9 versus 85.7 ± 21.3, P = 0.042). No other analyzed variable had a significant association with outcomes scores ( P > 0.05). Survivorship analysis demonstrated a postoperative clinical survivorship of the repair of 96.5% at two years and 93.8% at five years (Figure 1). Conclusion: Patients can expect excellent clinical outcomes and a low failure rate following arthroscopic double-row repair of full-thickness supraspinatus tears at mid-term follow-up. The repair of acute tears and primary repairs were associated with better postoperative outcomes.
Randomized Prospective Trial of Arthroscopic Rotator Cuff With or Without Acromioplasty: No Difference in Patient-reported Outcomes at Long-term Follow-up
Authors: Waterman Brian Robert , Newgren Jonathan , Gowd Anirudh K. , Cabarcas Brandon C. , Bach Bernard R. , Cole Brian J. , Romeo Anthony A. , Verma Nikhil N. 
Published: July 2018

Objectives: To evaluate long-term clinical outcomes after arthroscopic rotator cuff repair with and without acromioplasty. Methods: Between 2007-2011, prospectively-enrolled patients undergoing arthroscopic repair for full-thickness rotator cuff tears were previously randomized into either acromioplasty or non-acromioplasty groups. Patients with death, advanced neurologic conditions, or subsequent shoulder arthroplasty were excluded. Baseline and long-term follow-up questionnaires, including the American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), University of California-Los Angeles (UCLA), Visual Analog Scale (VAS) for pain, and Constant scores were obtained. Rates of revision rotator cuff surgery, or secondary reoperation were recorded. Averages with standard deviation (SD) were calculated, and t-tests were utilized to compare outcomes of interest between cohorts. Results: After exclusion of 5 additional patients from the short-term follow-up study, 66 of 90 patients (73.3%) were available at 92.4 months (±10.5). Comparison of baseline demographics and intraoperative information revealed no significant differences, including age, gender, workers compensation, acute mechanism of injury, tear size, degree of retraction, and surgical technique (e.g. single- vs. double-row). At final follow-up, there were no statistically significant differences according to ASES (p=0.33), VAS pain (p=0.79), Constant (p=0.17), SST (p=0.05), UCLA (p=0.19), and SF-12 (p=0.79) in patients with and without acromioplasty (Figure 1). One patient with acromioplasty (2.9%) and two patients without acromioplasty (6.3%) sustained atraumatic recurrent rotator cuff tear with secondary repair (p=0.99). Conclusion: Combined acromioplasty and rotator cuff repair offer no significant long-term benefits in patient-reported outcomes or secondary surgery when compared to arthroscopic rotator cuff repair alone. [Figure: see text]
Incidence and Clinical Significance of Posterior Glenoid Deficiency in Patients with Posterior Glenohumeral Instability
Authors: Elsenbeck Michael , Wolfe Jared , Nappo Kyle E. , Christensen Daniel , Waltz Robert A. , LeClere Lance E. , Dickens Jonathan F. 
Published: July 2018

Objectives: Posterior glenohumeral instability accounts for 10-40% of instability repairs yet the degree posterior bone deficiency contributing to labral repair failure is unclear. The purpose of this study is to determine the incidence, characteristics, and clinical impact of posterior glenohumeral bone deficiency in patients undergoing posterior shoulder stabilization. Methods: All consecutive patients undergoing isolated soft tissue only posterior labral repairs from 2008-2016 at our institution were identified via review of surgical case logs. Posterior bone deficiency was calculated using the best fit circle method along the inferior 2/3 s of the glenoid by two independent observers. The intra-observer and inter-observe reliability ICC of this method was .96 and .86, respectively. Patients were divided into three groups, no bone loss (0-5%), minimal bone loss (5-13.5%) and moderate posterior bone deficit (>13.5%). Our primary outcome, was reoperation for any reason, secondary outcomes were military separation due to the operative shoulder, and placement on permanent restricted duty due to the operative shoulder. Additional comparisons between the groups were made on the basis of preoperative clinical and radiographic characteristics. Results: We identified 66 patients that met our inclusion and exclusion criteria. Our median follow up time was 22 months (range 7-144months). 39 of the 66 patients had no measureable bone deficiency while 18 patients had between 5 and 13.5%, and 9 patients had greater than 13.5%. The greatest amount of bone deficiency in a patient was 27%. The reoperation rates were 7.7% in the no bone deficiency group, 16% in the minimal bone deficiency group, and 33% in the moderate group, this difference was statistically significant (p=.036). There was no difference in rates of military separation, or restricted duty between groups. Additionally, patients with posterior glenoid bone deficiency, were more likely to complain of instability instead of pain on initial presentation (p=.002), and were more likely to have a positive posterior load shift test (p=.027). Conclusion: Posterior glenoid bone deficiency is common and potentially under recognized in patients undergoing surgery for posterior glenohumeral instability with over one-third of our patients having some degree of bone deficiency. In patients with moderate glenoid bone deficiency (>13.5%), soft tissue only stabilization procedures may have higher reoperation rates then in patients without bone deficiency. On preoperative evaluation the primary complaint of instability instead of pain and a positive posterior load shift were predictive of the presence of posterior glenoid bone deficiency.
Automated 3D MRI Allows for Accurate Evaluation of Glenoid Bone Loss as Compared to 3D CT
Authors: Lansdown Drew A. , Dawe Robert , Cvetanovich Gregory L. , Verma Nikhil N. , Cole Brian J. , Bach Bernard R. , Nicholson Gregory P. , Romeo Anthony A. , Yanke Adam Blair 
Published: July 2018

Objectives: Glenoid bone loss is frequently present in the setting of recurrent shoulder instability. The magnitude of bone loss is an important determinant of the optimal surgical treatment. The current gold-standard for measurement of glenoid bone loss is three-dimensional (3D) reconstruction of a computed tomography (CT) scan. CT scans, however, carry an inherent risk of radiation and increased cost for a second modality. Magnetic resonance imaging (MRI) offers excellent soft tissue contrast and may allow resolution of bony structures to generate 3D reconstructions without a risk of ionizing radiation. We hypothesized that automated 3D MRI reconstruction would offer similar measurements of glenoid bone loss as recorded from a 3D CT scan in a clinical setting. Methods: A retrospective review was performed for fourteen patients who had both pre-operative MRI scan and CT scan of the shoulder. All MR scans were performed on a 1.5 T scanner (Siemens) utilizing a Dixon chemical shift separation sequence and the out-of-phase images with 0.90 mm slice thickness. Reconstructions of the glenoid were performed from axial images (Figure 1A) using an open-platform image processing system (3D Slicer; slicer.org). A single point on the glenoid was selected and a standard threshold was used to build a 3D model (Figure 1B). High-resolution CT scans underwent 3D reconstruction in Slicer based on Houndsfield Unit thresholding. Glenoid bone loss on both scans was measured with the Pico method by defining a circle of best fit using the inferior 2/3 of the glenoid and determining the percent area missing from this circle. Pearson’s correlation coefficient was utilized to determine the similarity between MR and CT based measurements. Statistical significance was defined as p<0.05. Results: The correlation between 3D MR and CT-based measurements of glenoid bone loss was excellent (r = 0.95, p<0.0001). The mean bone loss as measured by the 3D MR was 13.2 +- 7.2% and was 12.5 +- 8.6% for the 3D CT reconstruction (p=0.32). Bone loss in this cohort ranged from 3.7-25.4% on 3D MR and 1.4-26.0% on 3D CT. The root-mean-square difference between measurements was 2.7%. Conclusion: There was excellent agreement between automated 3D MR and 3D CT measurements of glenoid bone loss and minimal differences between these measurements. This reconstruction method requires minimal post-processing, no manual segmentation, and is obtained with widely-available MR sequences. This method has the potential to decrease the utilization for CT scans in determining glenoid bone loss. [Figure: see text]
90-Day Complications Following the Distal Tibia Allograft Procedure
Authors: Frank Rachel M. , Richardson Catherine , Gregory Bonnie , Sumner Shelby , O’Brien Michael C. , Bernardoni Emon , Verma Nikhil N. , Cole Brian J. , Nicholson Gregory P. , Provencher Matthew T. , Romeo Anthony A. 
Published: July 2018

Objectives: To describe complications occurring within 90-days following the distal tibia allograft (DTA) procedure. Methods: Consecutive patients undergoing DTA for anterior glenohumeral instability by fellowship-trained surgeons were included for analysis. Indications for DTA included primary or recurrent anterior instability with clinically significant anterior glenoid bone loss, failed prior arthroscopic stabilization, and/or failed prior Latarjet. All complications that occurred within 90-days of surgery were analyzed and correlated with demographic factors. Results: A total of 63 consecutive patients (average age 26.4±8.2 years, 90% male) were included. Fifty patients (79%) had undergone prior ipsilateral shoulder surgery, including 8 undergoing prior Latarjet (13%). The average glenoid bone loss prior to DTA was 29±7%. There were 5 total complications within 90 days of surgery, for an overall short-term complication rate of 7.9%. The 58 patients without complications had an average age of 26.2±7.9 years (95% male), with 45 (78%) having had prior shoulder surgery. Three of these 5 required subsequent surgery, including 1 revision DTA for hardware failure, 1 subscapularis repair, and 1 debridement for retained foreign body. The remaining 2 complications were transient and resolved with non-operative treatment, including 1 patient with postoperative pain requiring a subacromial injection, and 1 patient with a stitch abscess treated with oral antibiotics. The 5 patients experiencing complications had an average age of 29.0±11.5 years (40% male), with all 5 (100%) having had prior shoulder surgery. There were no episodes of recurrent instability. Conclusion: The overall 90-day complication rate following DTA is 7.9%, substantially lower than the previously described rate of 25% in patients undergoing Latarjet, despite the majority of patients having had at least 1 prior ipsilateral shoulder surgery. This information can be used to counsel patients on the risks of early complications following DTA.