bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lateral Extra-Articular Tenodesis Reduces Failure of Hamstring Tendon Autograft ACL Reconstruction -Two Year Outcomes from the STABILITY Study Randomized Clinical Trial
Authors: Getgood Alan M. , Bryant Dianne , Litchfield Robert B. , McCormack Robert Gordon , Heard Mark , MacDonald Peter B. , Spalding Tim , Verdonk Peter CM , Peterson Devin , Bardana Davide , Rezansoff Alex J. ,   Stability Study Group
Published: July 2019

Objectives: Persistent anterolateral rotatory laxity following anterior cruciate ligament reconstruction (ACLR) has been correlated with poor outcome and graft failure. We hypothesized that anterolateral complex reconstruction by way of a Lateral Extra-articular Tenodesis (LET) in combination with single bundle ACLR would reduce the risk of persistent rotatory laxity in young individuals who are deemed as being at high risk of failure. Methods: This is a pragmatic, multicenter, randomized clinical trial comparing standard hamstring tendon ACLR with combined ACLR and LET, utilizing a strip of iliotibial band (Modified Lemaire). Patients aged 25 years or less with an ACL deficient knee were included. They also had to have two of the following three criteria: 1) Grade 2 pivot shift or greater; 2) Returning to high risk/pivoting sports; 3) Generalized ligamentous laxity. The primary outcome was graft failure defined as either the need for revision ACLR or symptomatic instability associated with a positive asymmetric pivot shift, indicating persistent rotational laxity. Secondary outcome measures included the P4 pain scale, KOOS, IKDC. Patients were followed for two years with visits at 3, 6, 12 and 24 months postoperatively. A sample size of 300 per group was calculated based on a relative reduction in graft failure by 40%, with type 1 error of 5%, 80% power and 15% loss to follow-up rate. Results: 624 patients were randomized with a mean age of 18.9 (range: 14-25), 293 male. 436 (87.9%) patients presented pre-operatively with high-grade rotatory laxity (grade 2 pivot or greater) and 215 (42.1%) were diagnosed as having generalized ligamentous laxity (Beighton Score of 4 or greater). 523 of the 624 patients are at least 2 years postoperative; 29 lost to follow-up (˜5%). In the ACLR group 104/252 (41%) of patients suffered the primary outcome compared to 61/242 (25%) of the ACLR+LET patients (RR=0.61, 95%CI 0.47 to 0.79), p<0.0001. 39 patients suffered graft rupture, 28/252 (11%) in the ACLR group compared to 11/242 (4.5%) in the ACL+LET group (RR=0.41, 95%CI 0.21 to 0.80, p<0.001). At 3 months postoperative, patients in the ACLR group had less pain (p=0.004); at 3 and 6 months all KOOS subdomains, the IKDC favored the ACLR alone group (p=0.03). At 12 and 24 months, no important between-group differences were observed in any patient reported outcome. Conclusion: The addition of LET to a hamstring autograft ACLR in young active patients significantly reduces graft failure and persistent anterolateral rotatory laxity at 2 years post operatively.
Athletic Hip Injuries in Major League Baseball Pitchers Associated with UCL Pathology
Authors: Kantrowitz David Eric , Trofa David P. , Woode Denzel R. , Ahmad Christopher S. , Lynch Thomas Sean 
Published: July 2019

Objectives: Ulnar collateral ligament (UCL) reconstruction is a reliable treatment for elite overhand throwers with UCL pathology. In recent years, this operation has become increasingly common among Major League Baseball (MLB) pitchers. Predisposing factors and associated comorbidities, however, have not been well elucidated in the literature. The purpose of this investigation is to determine if professional baseball pitchers who underwent UCL reconstruction had an increased incidence of hip or groin injuries 4 years prior to or following their surgery. We hypothesized that MLB pitchers who sustained hip or groin injuries may have been more likely to develop UCL pathology due to kinetic chain alterations and overcompensation at the distal upper extremity during overhand throwing. Methods: This case controlled study utilized a comprehensive list of all 247 MLB players who underwent UCL reconstruction between 2005 and 2017, through aggregation of online publicly accessible data. Application of inclusion criteria yielded a final sample size of 145. These athletes’ injury histories were identified using systematic online searches and cross referenced with the official MLB disabled list. Age, playing time, and ERA-matched controls were generated for comparison of results. Results: Of the 145 MLB pitchers who underwent UCL reconstruction between 2005 and 2017, 40 (27.6%) endured a proximal lower extremity injury within 4 years of their surgery. Specifically, 16 pitchers sustained hip injuries, 13 suffered hamstring injuries, and 14 experienced groin injuries. A significantly lower rate of hip and groin related injuries, 18%, was identified in matched controls during a similar timeframe (p = 0.049). This represents an odds ratio of 1.74, indicating that players who underwent a UCL reconstruction were 74% more likely to have sustained a hip, groin or hamstring injury within an eight-year timeframe compared to matched controls. Hip injuries, specifically, were independently associated with UCL reconstruction compared to matched controls (p = 0.027). Conclusion: The results of this study demonstrate that MLB pitchers who required UCL reconstruction sustained a higher frequency of hip injuries both before and after surgery compared to matched controls. This association is significant as treatment of antecedent hip pathology, as well as emphasis on hip and core muscle mobility and strengthening, may help reduce the UCL injury burden in MLB pitchers.
Comparison of the Rate of Nonunion or Delayed Union in Fifth Metatarsal Fractures Receiving Anti-Inflammatory Medications
Authors: Barnds Brandon , Heenan G. Matthew , Tarakemeh Armin , Mullen Scott M. , Schroeppel John Paul , Vopat Bryan George 
Published: July 2019

Objectives: Controversy exists regarding the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on fracture healing. Our retrospective study uses a private payer database to isolate patients diagnosed with 5th metatarsal (MT) fractures and compare the rate of delayed open reduction and internal fixation (ORIF) or non/malunion repair as a surrogate for nonunion or delayed union, in those prescribed anti-inflammatories and those not prescribed anti-inflammatories. Methods: Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD-10 codes. All patients included had a diagnosis of 5th MT fracture and did not receive ORIF or repair of non/malunion within 60 days of diagnosis. Two groups were then created based on the presence or absence of insurance claim records for anti-inflammatory medications within 60 days of diagnosis. The number of patients in each group who underwent ORIF or non/malunion repair after 60 days post-diagnosis was determined, and the rates were compared using a chi-square analysis. Results: 10,626 patients had a diagnosis of 5th MT fracture and did not undergo early repair/ORIF (within 60 days). 1,615 had records of insurance claims for anti-inflammatories within 60 days of diagnosis, leaving 9,011 who did not receive these medications. 18 (1.11%) patients who received an anti-inflammatory medication underwent ORIF or repair of non/malunion after 60 days post-diagnosis. 44 (0.49%; p=0.0055) subjects who did not receive an anti-inflammatory prescription underwent ORIF or repair of non/malunion at after 60 days post-diagnosis. Conclusion: The rate of delayed ORIF or non/malunion repair of 5th MT fractures, a surrogate for delayed union or nonunion in an insurance database study, was significantly higher in subjects receiving anti-inflammatories within 60 days of diagnosis. This study isolates a specific fracture and finds a negative correlation between NSAIDs and fracture healing. Further, this provides valuable information to help guide future higher level studies.
The Histopathology of the Degenerative Proximal Biceps Tendon
Authors: Dekker Travis John , Chen Angel , Kwon Nicholas J. , Steele John , Eward William C. , Garrigues Grant , Adams Samuel Bruce , Toth Alison P. 
Published: July 2019

Objectives Surgical treatment of proximal biceps tendinopathy remains a source of great controversy. Current surgical treatment debates center around the fixation location and not the quality of the tendon because little is known about the intra-tendinous pathology to guide this debate. Therefore, this study aims to evaluate two distinct anatomic regions of pathologic biceps tendons with regard to intra-tendinous architecture, painful neurotransmitters, and inflammatory modulators: the intra-articular portion and the extra-articular portion lying in the bicipital groove. Methods Eleven human degenerative biceps tendons were obtained post-tenodesis. They were divided into intra- and extra-articular portions. They underwent histologic staining with hematoxylin and eosin and Alcian blue as well as immunohistochemistry staining for substance P, tyrosine hydroxylase, and neurofilament. Tendon architecture was assessed according to the modified BONAR tendon score. Immunohistochemistry staining was quantified using ImageJ density analysis. Portions of the tendon sections were cultured for 48 hours and the resultant secretome was assessed for Substance P secretion with ELISA analysis. Results Composite BONAR scores demonstrated pathologic tendons with no significant difference between the intra-articular biceps tendon and the portion of the tendon within the bicipital groove (p= 0.31). Immunohistochemistry (IHC) analysis demonstrated significantly (p<0.05) increased uptake of substance P in the bicipital groove tendon compared to the intra-articular tendon while tyrosine hydroxylase did not (p>0.05). Stained substance P and tyr hydroxylase was intimately associated with intra-tendinous vascularity. ELISA results demonstrated significantly increased secretion of substance P in the bicipital groove tendon compared to the intraarticular portion. Conclusion This study shows abnormal architecture, increased release and staining of painful neurotransmitters, and secretion of substance P from the proximal biceps tendon up to the distal aspect of the bicipital groove. Despite varied surgical techniques for tenodesis, this study supports the removal of the entirety of the long head of the biceps to the distal portion of the bicipital groove. [Figure: see text][Figure: see text]
Predictors of Radiographic Osteoarthritis 2-3 Years after ACL Reconstruction: Data from MOON Onsite Nested Cohort
Authors: Jones Morgan H. , Oak Sameer R. , Andrish Jack T. , Brophy Robert H. , Cox Charles L. , Dunn Warren R. , Flanigan David C. , Fleming Braden C. , Huston Laura J. , Kaeding Christopher C. , Kolosky Michael , Lynch Thomas Sean , Magnussen Robert A. , Matava Matthew J. , Parker Richard D. , Reinke Emily K. , Scaramuzza Erica , Smith Matthew V. , Winalski Carl S. , Wright Rick W. , Zajichek Alex , Spindler Kurt P. 
Published: July 2019

Objectives: Multiple studies have shown patients are susceptible to post-traumatic osteoarthritis (PTOA) after anterior cruciate ligament (ACL) injury even with ACL reconstruction (ACLR). Prospective studies using multivariate analysis to identify risk factors for PTOA are lacking. This study aims to identify baseline predictors of radiographic PT OA after ACLR at an early time point and hypothesizes that meniscal injury and cartilage lesions will be associated with worse radiographic OA using the Osteoarthritis Research Society International (OARSI) atlas criteria. Methods: 421 patients who underwent ACLR returned onsite for standardized posteroanterior metatarsophalangeal radiographs a minimum of 2 years after surgery. At baseline, demographics, graft type, meniscal status/treatment, and cartilage status were collected. OARSI atlas criteria were used to grade all knee radiographs. Multivariable ordinal regression models identified baseline predictors of radiographic OARSI grades at follow-up. Results: The mean age was 19.8 years with 51.3% females. Higher age (odds ratio (OR) 1.06) and BMI (OR 1.05) were statistically significantly associated with higher OARSI grade in the medial compartment. Patients with a meniscal repair and a partial meniscectomy had statistically significantly higher OARSI grades in the medial compartment (meniscal repair OR 1.92 and meniscectomy OR 2.11) and in the lateral compartment (meniscal repair OR 1.96 and meniscectomy OR 2.97). Graft type, cartilage lesion, sex, and Marx activity scales had no significant association with OARSI grade. Conclusion: Older patients with a higher BMI who have an ACL tear with concurrent meniscal tear requiring partial meniscectomy or meniscal repair should be advised of their increased risk of developing radiographic OA. Alternatively, patients with an ACL tear with an articular cartilage lesion can be reassured that they are not at increased risk of developing radiographic knee OA at 2-3 years following ACLR.
Return To Sport Testing At 6 Months After Arthroscopic Shoulder Stabilization Demonstrates Residual Functional Deficits
Authors: Wilson Kevin W. , Li Ryan Tianran , Popchak Adam , Lin Albert , Kane Gillian 
Published: July 2019

Objectives: A good outcome after arthroscopic stabilization for recurrent shoulder instability is often characterized by a successful return to sport while minimizing complications. While many physicians use a minimum of 5 months as a time to return, there is currently no consensus regarding timing or objective criteria for return to sport. The objective of this study is to evaluate the ability of postoperative patients to meet expected goals of achieving appropriate strength and using standardized objective evaluations of strength and physical function. Methods: 33 consecutive patients who underwent arthroscopic shoulder stabilization surgery from 2012 until 2018 and completed their postoperative rehabilitation with the same institution were subjected to functional testing to evaluate their readiness for return to sport. Isometric unilateral external rotation to internal rotation (ER/IR) ratio was measured using a hand held dynamometer at 0 and 90 degrees of shoulder abduction. Posterior rotator cuff activation was evaluated using a repetition to failure technique with 5% body weight at 0 and 90 degrees of abduction. Prone trapezius activation was measured in repetitions to failure with a prone Y exercise. A subset of throwing athletes (N= 11) were evaluated for total arc of motion. Results: Isometric testing at revealed that 18% (6/33, mean ratio 71%) patients met the expected goal of 80% ER/IR strength at both 0 and 90 degrees of abduction, with mean ratios of 71% and 62%, respectively. 73% (24/33) and 42% (14/33) of patients met goal of 90% of the contralateral ER repetitions to failure in rotator cuff activation testing at 0 and 90 degress of abduction, respectively. 55% (18/33) of patients met goal of 90% of contralateral prone Y repetitions to failure on lower trapezius activation testing, with mean. Mean total arc of postoperative motion for the 11 throwers was 91.6% of the contralateral shoulder. Thirty-six percent (4/11) patients did not reach 90% of the total arc of motion of the uninvolved shoulder. Conclusion: A substantial number of athletes in our cohort do not meet the expected goals for their operative shoulder in achieving appropriate strength, particularly in ER, nor arc of motion compared to the contralateral shoulder.
Insulin Dependence Predicts Risk of Complications Following Shoulder and Knee Arthroscopy
Authors: Traven Sophia A. , Reeves Russell Abbott , Walton Zeke J. , Woolf Shane K. , Slone Harris S. 
Published: July 2019

Objectives: Diabetes mellitus is a growing health concern in the U.S. affecting an estimated 23.1 million citizens. While diabetes is a risk factor for complications following total joint arthroplasty, it is unclear whether this risk holds true for arthroscopy and, whether this risk is stratified by insulin-dependence (IDDM) and non-insulin dependent diabetes (NIDDM). The goal of this study is to evaluate complications following shoulder and knee arthroscopy in patients with IDDM and NIDDM. Methods: A retrospective analysis of the American College of Surgeon’s National Surgical Quality Improvement Program’s (ACS-NSQIP) database for the years 2005-2016 was conducted. Logistic regression analyses were used to assess the relationship between diabetic status and outcomes. Adjusted odds ratios (AOR) and confidence intervals (CIs) were calculated. Multivariate models were established to adjust for age, sex, BMI, hypertension, congestive heart failure, chronic obstructive pulmonary disease, smoking status, functional status, and ASA classification. A post-hoc power analysis was performed based on the observed variances between groups using an alpha equal to 0.05 and power equal to 0.8. Results: 86,023 patients undergoing knee arthroscopy and 58,442 patients undergoing shoulder arthroscopy were identified. Patients with IDDM undergoing knee arthroscopy were at a much higher risk for surgical complications, AOR 2.186 (95% CI: 1.226 -1.157, p = 0.001), including deep infections (AOR 3.082, 95% CI: 1.753-5.419, p < 0.001) and return to OR (AOR 1.933, 95% CI: 1.280-2.919, p = 0.002), as well as unplanned hospital admission (AOR 1.770, 95% CI: 1.289-2.431, p = 0.002). Patients with IDDM undergoing shoulder arthroscopy were at a much higher risk for medical complications (AOR 1.524, 95% CI: 1.082-2.147), hospital readmission (AOR 1.581, 95% CI: 1.153-2.169), and 30-day mortality (AOR 3.821, 95% CI: 1.243-11.750). However, NIDDM was not an independent risk factor for subsequent medical or surgical complications, unplanned hospital admission, or 30-day mortality in either group. Conclusion: Patients with IDDM undergoing knee arthroscopy were more likely to have surgical complications, whereas those undergoing shoulder arthroscopy were more likely to have medical complications, hospital readmission, and mortality. These risks diminished among those with NIDDM, with their risks comparable to those without diabetes. Physicians and hospitals should keep these issues in mind when counseling patients regarding their risks for shoulder and knee arthroscopy.
Predicting the Need for Surgical Intervention Prior to First Encounter for Individuals with Knee Complaints: A Novel Approach
Authors: Vega Jose F. , Student Medical , Bena James , Strnad Greg , Spindler Kurt P. 
Published: July 2019

Objectives: Orthopedic complaints, particularly those relating to the knee, are some of the most common conditions that bring patients to the hospital. Many patients bypass their primary care physician to seek the care of an orthopedic surgeon without a referral, leaving the surgeon to manage an increasingly large number of patients, many of which will never require surgery. We set out to develop a brief questionnaire that can be administered via phone/web at the time of appointment request to predict an individual patient’s probability of requiring a surgical intervention. Methods: All patients (N=1307) seeking an appointment for a new knee-related complaint completed a branching-logic questionnaire. A retrospective chart review was conducted following the conclusion of each patient’s episode of care to determine whether or not surgery was recommended. Logistic regression models were used to predict the risk of surgery based on triage question responses, basic demographics (age, gender), and laterality (unilateral vs. bilateral). The ability of the models to discriminate between those who did and did not receive a surgical recommendation was measured using a concordance index (C-index). Results: The model developed provided a high level of discrimination between surgical and nonsurgical patients (C-index = 0.69). Recent injury with inability to walk, and no recent injury with no pain were both associated with increased probability of receiving a recommendation of surgical intervention compared to patients that reported pain without recent injury (OR=3.51, p<0.001; OR=2.78, p=0.008, respectively). A unilateral complaint was associated with needing surgical intervention (OR=4.52, p<0.001). Age has a significant, non-linear relationship with odds of needing of surgery, with middle age patients (20-50) having the greatest odds. Conclusion: Our model was able to accurately predict the probability of receiving a recommendation for surgical intervention as high as 65% and as low as 5%. Our model can quickly and easily triage patients at the time of appointment request to ensure that those with the highest likelihood of receiving a recommendation for surgical intervention are seen by surgical providers while those that are unlikely to receive such a recommendation can be seen by nonsurgical providers. To our knowledge, this represents the first attempt at developing an evidence-based scheduling algorithm.
Radiographic Prevalence Of Sacroiliac Joint Abnormalities And Clinical Outcomes In Patients With Femoroacetabular Impingement Syndrome
Authors: Krishnamoorthy Vignesh Prasad , Kunze Kyle , Cancienne Jourdan M. , Beck Edward , O’Keefe Lauren Elizabeth , Nho Shane Jay 
Published: July 2019

Objectives: Patients with femoroacetabular impingement syndrome (FAIS) typically present with a gradual onset of groin pain. They may also presentwith gluteal pain, which can be related to posterior acetabular impingement or posterior joint degeneration secondary to FAIS or more commonly aberrant gait mechanics secondary to abnormal hip morphology. Gluteal pain is also a common presenting symptom in patients with sacroiliac joint (SIJ) problems. The date, the literature on the correlation between SIJ pathology and FAIS has been limited. As such, the purpose of the current study id to quantify the prevalenceof SIJ abnormalities FAIS patients using imaging modalities and to compare outcomes based on SIJ abnormalities. Methods: Radiographs, CT and MRI scans of 1,009 consecutive patients who underwent primary hip arthroscopy for FAIS from January 2012 to January 2016 were identified. Exclusion criteria included patients undergoing bilateral or revision surgery, history of dysplasia, and less than two-year follow-up. On radiographs, SIJ joints were graded using modified New York criteria for spondyloarthropathy. CT scans and MRIs were reviewed for joint surface erosions, subchondral sclerosis, joint-space narrowing, pseudo-widening, bone marrow edema, and ankylosis. Patients with SIJ abnormalities were matched 1:2 to patients without SIJ abnormalities by age and BMI. Outcomes included the hip outcome score- activities of daily living (HOS-ADL), sports-subscale (HOS-SS), modified Harris hip score (mHHS), and visual analog scales (VAS) for pain and satisfaction. Results: 743 patients were included; 187 (25.2%) demonstrated SIJ changes. 164 (87.7%) had radiographic changes, 88 (63.3%) on CT, and 125 (66.8%) on MRI. SI changes on any imaging modality were correlated with pain to palpation (PTP) of the SI joint (r=0.11; p=0.004) on physical exam. History of SI pain was correlated with PTP of the SI joint (r=0.21; p<0.001). After matching, patients without SIJ abnormalities had significantly greater HOS-ADL (95.4 vs. 90.6;p=0.001), HOS-SS (91.1 vs. 77.5;p<0.001), and mHHS (91.3 vs. 84.5;p<0.001) scores and significantly less VAS pain (10.9 vs. 25.7;p<0.001) than those with abnormalities. Patients without SIJ abnormalities had greater odds of achieving the MCID for the HOS-ADL (Odds ratio [OR]=2.91, 95%confidence interval [95% CI]=1.5-5.5;p=0.001) and for the HOS-SS (OR=2.83, 95% CI = 1.6-4.9;p<0.001), but not for the mHHS (OR=1.73, 95% CI = 0.93-3.2; p=0.081). Conclusion: There is a high prevalence of SIJ abnormalities in patients with FAIS. Patients with abnormalities may expect inferior outcomes and persistent post-operative pain. [Table: see text]