bluuebunny/crossref_metadata_2025_split huggingface dataset:
MAGNETIC RESONANCE IMAGING FINDINGS ASSOCIATED WITH ULNAR COLLATERAL LIGAMENT TEARS IN ADOLESCENT BASEBALL PITCHERS
Authors: Cox Ben , Plummer Hillary , Goodrich Eric , Andrews James , Saper Michael 
Published: March 2019

BACKGROUND: The number of ulnar collateral ligament (UCL) injuries in adolescent baseball pitchers has risen over the past 2 decades with the incidence of UCL reconstructions also increasing dramatically over that time period. The Joyner-Andrews magnetic resonance imaging (MRI) classification of UCL tears has previously been described to describe the grade and location of tears, which can aid in surgical decision-making. However, the classification of UCL tears in the at-risk adolescent population has yet to fully investigated. Improving our knowledge of these injuries is crucial to help drive targeted evidence-based treatment strategies. The purpose of this study was to examine the grade and location UCL tears using the Joyner-Andrews MRI classification in a large group of adolescent baseball pitchers. METHODS: We reviewed 225 symptomatic adolescent (aged =19 years) male baseball pitchers with UCL injuries treated by the senior author from 2007-2016. All patients had failed conservative treatment prior to evaluation. Pitchers with a prior history of elbow surgery were excluded. Plain radiographs and MRI arthrograms were evaluated for each patient to categorize the UCL injury and associated pathology. The images were reviewed by a sports medicine-trained orthopedic surgeon. UCL tear grade and location were classified using the Joyner-Andrews classification. RESULTS: The mean age at the time of evaluation was 17.2 ± 1.5 years. 56% of the patients were high school athletes. The majority (59.1%) of UCL tears were high-grade partial tears (Type II). Of those 53.4% were on the humeral side (Type II H). The least common tear types were low-grade partial tears (I) and tears in more than one location (Type IV) in 1.3% and 0.9% of patients, respectively. Plain radiographs revealed 31.4% of patients had abnormal findings; calcifications and olecranon osteophytes were present in 10% and 13% of patients, respectively and more commonly occurred in patients with Type II tears. CONCLUSIONS: The results of this study showed that the majority of adolescent baseball pitchers (59%) sustain high-grade partial tears of the UCL. These findings suggest that effective non-reconstruction options such as platelet-rich plasma and UCL repair with internal brace augmentation could be ideal alternatives to UCL reconstruction for these young patients. The high percentage of radiographic abnormalities in these patients highlights the adaptive changes about the elbow in response to the repetitive stresses experienced by the young elbow during throwing.
IS EARLY EXCELLENT ISOKINETIC AND FUNCTIONAL TESTING FOLLOWING ACL RECONSTRUCTION IN PATIENTS WITH OPEN-PHYSES PREDICTIVE OF SUBSEQUENT ACL DISRUPTION?
Authors: Melugin Heath P. , Samuelsen Brian T. , Hevesi Mario , Levy Bruce A. , Dahm Diane L. , Hewett Timothy E. , Larson Annalise , Stuart Michael J. , Krych Aaron J. , Milbrandt Todd A. 
Published: March 2019

Introduction: It is unknown whether functional and isokinetic testing at 6 months following ACL reconstruction in patients with open-physes correlates with longer term outcomes. The purpose of this study was to compare subsequent ACL rupture risk, knee function, and activity level in patients with open-physes who had excellent 6-month testing to those who did not. Methods: Between the years of 2000 and 2015, 86 patients with open-physes underwent ACL reconstruction and had functional and isokinetic testing performed at 6-months post-operatively. Thirty-four (40%) tested in the excellent range in all categories of both functional and isokinetic testing and were labeled the excellent group. The remaining 52 (60%) patients were labeled the delayed testing group. Data regarding patient, injury, and surgical characteristics were retrospectively collected. The rate of second ACL injury as well as clinical outcome scores were collected postoperatively. Results: Graft rupture rate was 23.4% (n = 8) in the excellent group and 15.4% (n = 8) in the delayed group (p = 0.51). In the excellent group, 20.5% (n = 7) had a contralateral ACL tear versus 11.5% (n = 6) in the delayed group (p = 0.40). Five patients in the excellent group and 4 patients in the delayed group sustained both graft failure and contralateral ACL tear. The overall prevalence of second ACL injury was 29% in the excellent group and 23% in the delayed group. The delayed group returned to sport at an average of 8.8 months whereas the excellent group returned at an average of 6.6 months (p < 0.01). At mean follow up of 3.59 years, the excellent group had a higher Tegner activity level (8.9 versus 8.3) than the delayed group (p < 0.02). Conclusion: Pediatric patients with open-physes who had excellent isokinetic strength and functional testing 6-months postoperatively returned to sport sooner than those who did not. There was no statistical difference in either graft failure or contralateral ACL disruption between these groups. However, both groups had unacceptably high rates of second ACL injury (29% for the excellent group and 23% for the delayed group). Significance: Excellent 6 month return of strength and function was not protective of subsequent ACL disruption, the rate of which remains dismal within this pediatric population. Development of more sensitive functional measures for children could help to change these poor outcomes and guide clinicians when to allow return to sport.
THE EVALUATION OF SUPRATROCHLEAR OSSEOUS MORPHOLOGY: AN EPIDEMIOLOGIC STUDY
Authors: Onor Gabriel , Mason Bonnie , Farrow Lutul 
Published: March 2019

Introduction: Patellar instability can impede activities of daily life. The morphology of the femoral trochlea has significant involvement in maintaining patellofemoral joint stability. Trochlear dysplasia, or a shallow trochlear groove, has been implicated as a risk factor for recurrent patellar dislocation. A supratrochlear spur in the setting of existing trochlear dysplasia can generate further patellar instability. Trochleoplasty has been popularized by some surgeons for the treatment of recurrent patellar instability in the setting of significant trochlear dysplasia. Despite recommendation of trochleoplasty in treatment of patellar instability in the setting of trochlear dysplasia, much is unknown about the prevalence of trochlear dysplasia and supratrochlear spurs in the general population. The purpose of this study is to investigate the prevalence of supratrochlear spurs and trochlear dysplasia in the population and investigate the relationship between supratrochlear spurs and dysplastic femoral trochleae. Methods: This study was performed at the Cleveland Museum of Natural History, the Hamann Todd Human Osteological Collection. With over 4,000 complete human skeletons, the Hamann Todd osteological collection at the Cleveland Museum of Natural History is the largest collection of osteological specimens with documented demographic data in the Western Hemisphere. We evaluated femora from over 1,000 individuals aged 16-40 years. Each specimen was evaluated for the presence of trochlear dysplasia and supratrochlear spurs. We excluded skeletally immature specimens as well as specimens with visible signs of osteoarthritis or abnormal, bony deformity. The presence or absence of supratrochlear spurs was documented. Abnormal femoral trochleae were photographed in A/P, axial, and lateral views. The width and length of supratrochlear spurs were measured using digital calipers. Results: Of the 1,148 specimens studied, 135 femora from 93 individuals were found to be dysplastic. Amongst these, 9 femora with trochlear dysplasia had supratrochlear spurs. The average age of individuals with dysplastic trochleae in this study was 32.86. Of the 93 specimens identified, 24 were female (25.8%). Additionally, 52% of individuals with dysplastic trochleae were white while 48% were black. Conclusions: There may be an association of supratrochlear spurs with trochlear dysplasia. Though 25.8% of individuals with dysplastic trochleae were female, it is important to note that the Hamann Todd Collection as a whole is 19% female.
INCONSISTENT 6-MONTH FUNCTION AND ISOKINETIC TEST RESULTS FOLLOWING ACL RECONSTRUCTION IN A GROUP OF SKELETALLY IMMATURE PEDIATRIC PATIENTS
Authors: Samuelsen Brian T. , Melugin Heath P. , Hevesi Mario , Levy Bruce A. , Dahm Diane L. , Hewett Timothy E. , Larson Annalise , Stuart Michael J. , Krych Aaron J. , Milbrandt Todd A. 
Published: March 2019

Purpose: The goal of this study was to evaluate patient and surgical factors predictive of excellent functional and isokinetic test results 6-months following anterior cruciate ligament (ACL) reconstruction in a group of pediatric patients with open physes. Methods: We retrospectively reviewed the records of all patients 14 years of age or younger that underwent ACL reconstruction from 2000 to 2015. An excellent 6-month outcome was defined as greater than 85% in isokinetic strength and greater than 90% in functional tests when compared to the non-operative extremity. We then utilized univariate and multivariate statistical models to identify patient and/or surgical factors associated with excellent 6-month outcomes. Results: Eighty-six patients (46 male, 42 female) with open physes on preoperative radiographs were included in the study, with a mean age of 13.6 (range, 8.4-14.9), body mass index (BMI) of 22.1 (range, 15.6-36.0), Tegner activity score of 8.8 (6.0-9.0). Thirty-four patients (40%) met the criteria for the excellent 6-month group, which left 52 (60%) in the delayed 6-month group. In univariate analysis, no single preoperative factor correlated with excellent 6-month outcome. The two groups were statistically similar in terms of age, BMI, time to surgery, preoperative arc of motion, presence of concomitant meniscal tear, cartilage damage, graft size, use of a nerve block or tourniquet, operative time, and tourniquet time. Use of a nerve block trended towards delayed outcomes (p = 0.051). Conclusion: Children undergoing ACL reconstruction only have a 40% chance of achieving an excellent rehabilitation result at 6 months. We found no statistically significant patient or surgical characteristics that could predict this outcome. Utilizing a nerve block is a factor which will need to be further evaluated. Significance: Studies in the adult population have identified preoperative patient and surgical factors associated with excellent 6-month isokinetic and functional test results. This pediatric cohort did not find similar results as many of these children were young, healthy and fit. However, the variability of the outcome casts doubts on applying adult rehabilitation protocols to children.
A BIOMECHANICAL COMPARISON OF SUTURE ANCHOR VS. INTERFERENCE SCREW TECHNIQUE FOR PATELLAR FIXATION FOR MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION
Authors: Mijic Dragomi , Yokhana Sanar , Kalra Kunal 
Published: March 2019

Background: There are numerous techniques for MPFL reconstruction, however, one single technique has not been proven to be superior to another. Suture anchor reconstruction has been shown to provide stable fixation while decreasing the risk of patellar fracture. The aim of the study was to compare the stiffness and clinical load to failure of two common MPFL reconstruction techniques. Our hypothesis was that there would be no significant difference in the stiffness and the clinical load to failure between the suture anchor and interference screw reconstructions. Methods: Eight pairs of fresh frozen cadaveric knees were randomized into two groups undergoing MPFL reconstruction using either a suture anchor technique (n=8) or an interference screw technique (n=8). Testing was performed at 0, 30, 60, and 90 degrees of flexion for the native knee, transected medial structures, and reconstructed MPFL. Next, the reconstructed MPFL specimens were tested until failure in 0 degrees of flexion. T test, One-Way ANOVA, and repeated measures of ANOVA were used for statistical analysis, P values less than 0.05 were considered significant. Results: The average stiffness for the suture anchor and interference screw reconstructions was 12.02 ± 3.96 N/mm and 14.21 ± 4.20 N/mm, respectively (t test, p = 0.27), while average clinical load to failure was 256.57 ± 54.1 N and 237.81 ± 23.82 N, respectively (t test, p = 0.38). There was no significant difference in stiffness between the suture anchor and interference screw techniques at 0, 30, and 60 degrees of flexion. Conclusions: The suture anchor and interference screw reconstruction techniques produce comparable stiffness for sub-failure testing at 0 and 30 degrees of flexion. For testing to failure, the initial stiffness for both reconstruction techniques have been shown to be concordant with previously published values for the native MPFL. Both reconstruction techniques provide greater ultimate failure loads than those reported for the native MPFL in previous studies. Clinical Relevance: Suture anchor reconstruction described in our study provides another reliable option for the reconstruction of the medial patellofemoral ligament. [Figure: see text]
DIFFERENCE IN RECOVERY TIME BETWEEN GENDERS AFTER CONCUSSION
Authors: Sarkisova Natalya , Herrera-Hamilton Anita , Edison Bianca , Zaslow Tracy 
Published: March 2019

Background: Recent literature has shown that between the two sexes, females sustain concussions at a higher rate than males. However, other studies have shown that males take a longer time recover after a concussion than females. Currently, there is limited research done on gender and recovery time in adolescents. Sex is defined as a biological concept that is assigned at birth whereas gender is defined as somebody’s internal self-identification. This study aims to determine if there is a difference in recovery time between genders. Methods: Patients diagnosed with a concussion in our sports medicine clinic were prospectively enrolled into a mild traumatic brain injury (mTBI) repository. 300 patient charts were reviewed. Age, non-binary gender identification, date of injury, first appointment date, and clearance date (Level V) were identified. Post-concussive syndrome (PCS) was also noted. Patients were also recognized if they were lost to follow up. Level of clearance was determined by the 4th International Conference on Concussion in Sports (Zurich 2012) with the following supervised protocol: Level 4: Non-contact training drills, Level 5: Full contact training after medical clearance. Results: 60% (180/300) of patients were cleared for return to play. 57% (171/180) of patients were cleared for a Level V and 5% (9/180) patients were cleared for a Level IV with gradual return to play. 120 (40%) patients were lost to follow up and not cleared, 60% (73/120) identified as male and 40% (47/120) identified as female. For the patients that were cleared, 67% (121/180) of patients identified as male (mean age=13 years) (range 5 to 18 years) and 33% (59/180) of patients identified as female (mean age=14 years) (range 5 to 20 years). From date of injury to recovery time, male patients were cleared on average after 62 days and female patients were cleared on average after 82 days. There was no significant difference between the two genders identified in this specific population (p=0.17). 14% of females and 15% of males were diagnosed with PCS. From date of injury to first appointment with a physician, male and female patients reported going an average 17 days post injury, with no significant difference (p=0.53). Conclusion: Rate of recovery time for patients that sustained a concussion showed no significant difference among genders. Further research is necessary for a comprehensive review of all genders to identify recovery time and appropriate treatment management.
PHYSEAL-SPARING DISTAL FEMORAL TROCHLEOPLASTY: A TECHNIQUE ANALYSIS IN A PEDIATRIC CADAVERIC MODEL
Authors: Wilson Philip L. , Ellis Henry B. , Tompkins Marc , Stavinoha Tyler J. , Wyatt Charles W. , Zynda Aaron J. , Mitchell Parker , Jo Chan-Hee , Shea Kevin 
Published: March 2019

Background: To describe the results and extra-physeal position of a pediatric distal femoral trochleoplasty in a pediatric cadaveric model. Methods: Eight pediatric cadaveric specimens (mean maturity: 7.75 years, range 4-11) were used to model a distal femoral anterolateral metaphyseal osteotomy immediately proximal to the physis. A standardized 4 mm wedge was placed at the distal end of an anterior cortical shingle; created by an osteotomy 3.25 mm below the anterior cortex (range 2.5 – 4.4), with a transverse corticotomy just proximal to the physis, and hinged 25.5 mm proximally (range 21.9-28.1). The specimens were evaluated with multi-planar micro-CT scans (0.67 mm) pre and post-osteotomy. Lateral cortical elevation, the pre and post sulcus angle of the anterior supra-trochlear metaphysis, distance from distal elevated margin of the osteotomy to the superior edge of the trochlear cartilage, and distance from the distal margin of the osteotomy to the superior edge of the physis were evaluated. Results: The supra-physeal trochleoplasty elevated the lateral cortex an average of 3.26 mm (range 2.8-3.9). The resultant mean angle of the supra-trochlear metaphyseal sulcus was changed by 15.25° (range 8° -21°) (p<0.001); with the central to lateral cortical angle along the anterior femoral surface changing from 173° (range 166°-178°) pre-trochleoplasty, to 157° (range 146°-166°) following the osteotomy. The magnitude of the change in angle was associated with age; with larger corrections in the younger specimens (p<0.05). The distal margin of the trochleoplasty was on average 9.56 mm (range 2.73-13.24) from the superior margin of the trochlear articular cartilage. The distance from the distal extent of the osteotomy to the superior margin of the physis was 5.54 mm (range 1.95-9.55). No fracture into the physis, or physeal deformity was demonstrated. Conclusion: A technique for an extra-physeal, metaphyseal, distal femoral trochleoplasty resulted in alterations to the anterior femoral cortex that may serve as deterrents to lateral patellar translation. Lateral cortical elevation immediately superior to the trochlea may serve as a guide for centralizing patellar motion during early flexion in the setting of patella alta and trochlear dysplasia that is not uncommon in pediatric lateral patellar instability. A pediatric cadaveric model demonstrated changes in close proximity to the superior entrance of the femoral trochlea, while avoiding injury to the distal femoral physis. Significance: A supra-trochlear, lateral metaphyseal elevating osteotomy may be feasible and merit further study as an option for the treatment of lateral patellar instability in the skeletally immature.
HEALTH-RELATED QUALITY OF LIFE FOLLOWING ADOLESCENT SPORTS-RELATED CONCUSSION OR FRACTURE: A PROSPECTIVE COHORT STUDY
Authors: Russell Kelly F. , Selci Erin , Black Brian , Ellis Michael 
Published: March 2019

Background: Sport-related concussion is a form of traumatic brain injury that often presents with a combination of symptoms that reflect disturbances in physical, cognitive, sleep, and emotional functioning. The longitudinal effects of adolescent sports-related concussion (SRC) on health-related quality of life (HRQOL) remain poorly understood. The objectives of this study were to 1) compare HRQOL outcomes among adolescents with an acute SRC or sports-related extremity fracture (SRF) who were followed until physician-documented clinical recovery and 2) to identify the clinical variables associated with worse HRQOL among adolescent SRC patients. Methods: We conducted a prospective cohort study of adolescents with acute isolated SRC or SRF who underwent clinical assessment within 30 days post injury and follow-up at tertiary sub-specialty clinics. Longitudinal patient-reported HRQOL was measured at initial assessment and at each follow-up appointment using the adolescent version (age 13-18) Pediatric Quality of Life Inventory generic core scale and Cognitive Functioning scale. Demographic characteristics were collected from the medical charts. Results: Participants in this study included 135 patients with SRC (60.0% male; mean age 14.7 years; time from injury to initial assessment 6 days) and 96 with SRF (59.4% male, mean age 14.1 years; time from injury to initial assessment 8 days). At initial assessment, SRC patients reported significantly worse cognitive, school and overall HRQOL compared to SRF patients with no differences in physical, emotional and social HRQOL. Clinical variables associated with worse HRQOL among SRC patients differed by domain but were significantly impacted by initial symptom burden and the development of delayed physician-documented clinical recovery (> 28 days post-injury). Overall, 132 (97.8%) SRC patients and all SRF patients achieved physician-documented clinical recovery during the study period. The median days until physician-documented clinical recovery for the SRC patients was 26 days (IQR: 17, 49) and this was not significantly different than SRF patients (31 days, IQR: 23, 42; p=0.12). At the time of physician-documented clinical recovery, patients with SRC did not have persistent impairments in HRQOL. Conclusions: Adolescent SRC is associated with temporary impairments in HRQOL that resolve in patients followed until physician-documented clinical recovery. Compared to SRF, adolescent SRC patients experience significantly greater impairments in cognitive, school, and overall HRQOL. The degree of impairment experienced by adolescent SRC patients across HRQOL domains is impacted by initial symptom burden and length of clinical recovery. Future studies are needed to identify the clinico-pathological features associated with impaired HRQOL and assess whether the initiation of multi-disciplinary targeted rehabilitation strategies lead to an improvement in HRQOL in acute SRC patients.