bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypovitaminosis D Is Not A Risk Factor for Stress Fracture or Reaction in NCAA Division I Track And Field
Authors: Lindsay Adam , Jalali Omid , Korber Shane , Romano Russ , Kang Hyunwoo Paco , Tibone James E. , Weber Alexander E. , Gamradt Seth C. 
Published: July 2019

Objectives: Most research on the role of vitamin D on skeletal health has been dedicated to the elderly for fracture prevention. However, there is a paucity of research examining the role of vitamin D in elite track and field athletes. The objective of this study was to evaluate the prevalence of stress reactions and fractures in NCAA Division I track and field athletes, and to determine the relationship between fractures and serum vitamin D levels. Methods: After IRB approval, we evaluated data for men’s and women’s outdoor track and field teams from 2015-2018 at a large NCAA Division I athletics program. Vitamin D levels were drawn during pre-season annual physicals. The cutoff for hypovitaminosis D was set at 40 nmol/L. Demographic and athletic tenure data were recorded and analyzed, and competitive events were grouped into one of four categories: 1) running events, 2) jumping events, 3) throwing events, and 4) multiple event types. Student T tests, chi-squared tests, and multivariate logistic regression were performed. Results: Of the 148 athletes analyzed, greater than 50% had hypovitaminois D (Figure 1). There were 29 (19.6%) athletes sustained a stress fracture or stress reaction. There was no difference in mean vitamin D levels in the injured group vs the non-injured group (43.55 ± 11.97 vs. 39.61 ± 12.32, respectively; p=0.122). Additionally, multivariate logistic regression failed to demonstrate an association between stress fracture or reaction incidence and vitamin D status, age, BMI, or event type (p>0.05 for all). Conclusion: These data suggest that NCAA Division I track and field athletes suffer a high rate of stress fractures and reactions, though those with hypovitaminosis D are not at increased risk of these injuries. This is the first study to demonstrate this in a heterogeneous population of elite athletes. Future studies investigating other modifiable risk factors for fracture in this population are warranted to prevent the health and athletic consequences of these fractures.
Concussions in the National Basketball Association: An Analysis from 1999-2018
Authors: Okoroha Kelechi , Patel Bhavik H. , Lu Yining , Idarraga Alexander J. , Forsythe Brian 
Published: July 2019

Objectives: Several studies have examined the incidence and effects of concussions in professional football, baseball, and hockey, but there has been limited evaluation of the effects of concussions in National Basketball Association (NBA) players. This study aims to evaluate the epidemiologic trends of concussions, as well as the effects of concussions on in-game performance, in NBA players. Methods: Publicly available records were searched to include all players who sustained an in-game concussion while playing in the NBA from the beginning of the 1999 NBA season to the conclusion of the 2018 season. For each player the following variables were collected: date of injury, number of days and games missed before returning to game play, player efficiency rating (PER) in the season of injury, the season preceding the injury, and the season following the injury, position of the injured player, and the incidence of multiple concussions for a single player. Concussion trends before and after the institution of the NBA Concussion Protocol were calculated, as well as the effects on PER after return to play. Results: From the start of the 1999 season to the end of the 2018 season, 185 basketball-related concussions were incurred across 149 NBA players. All players were able to return to play following a first-time concussion after missing an average of 7.7 days and 3.5 games. The NBA Concussion Protocol was instituted ahead of the 2011-2012 season, prior to which there were 5.7 concussions recorded/season, with an average of 6.7 days and 3.0 games missed per first-time concussion. Following the institution of the concussion protocol, there were approximately 11 more concussions recorded/season (16.7 vs. 5.7, P = 0.007), with 1.7 more days missed (8.4 vs. 6.7, P = 0.27) and 0.9 more games missed (3.9 vs. 3.0, P = 0.24) per concussion, compared to prior seasons. Of the 149 players who suffered concussions, 27 were concussed multiple times (18.1%). There was no difference found in the incidence of recurrent concussions within the same season before vs. after the institution of the concussion protocol (4 vs. 5, P > 0.05). PER was almost identical for concussed players in the season prior to the injury, the season in which the injury occurred, and the season following the injury (13.93 vs. 13.94 vs. 13.91, P = 0.998). Conclusion: There has been a significant increase in the incidence of concussions in the NBA player following the institution of a league-wide concussion protocol. This likely reflects more accurate reporting secondary to advances in player education, medical knowledge, national media coverage, and standardized testing protocols. Despite this increase in reported concussions, the amount of time missed following injury has remained relatively constant. Player performance as reported by PER was not significantly affected by sustaining a concussion. [Figure: see text][Table: see text]
Incidence of Game-Related, High School Football Lower Extremity and Surface Impact Trauma Requiring Elective Imaging and Surgery across Artificial Turf Systems of Various Infill Weight
Authors: Meyers Michael Clinton 
Published: July 2019

Objectives: Artificial turf surfaces are developed to duplicate playing characteristics of natural grass. With the newer generations of sand and rubber infill systems, infill weight is a common component that varies between fields. With the increasing concerns of rising medical costs, the potential for long-term articular changes, and perceived higher incidence of articular trauma while playing on artificial turf, infill weight could be a critical factor that could influence sport trauma and subsequent elective medical decisions. Therefore, this study quantified the incidence of game-related, high school football lower extremity and surface impact trauma requiring elective medical procedures across artificial turf systems of various infill weight. Methods: Artificial turf systems were divided into two sand/rubber infill weight groups by lbs per square foot: 6.0 to ≥9.0, and 0.0-5.9. Fifty-seven high schools participated across four states over 5 seasons. Outcomes of interest included elective medical procedures by injury category (player-turf surface impact trauma, trauma from shoe: surface interaction during physical collision/contact, trauma from shoe: surface interaction during physical noncontact). Data were subject to multivariate analyses of variance (MANOVA) and Wilks’ λ criteria using general linear model procedures. Results: Of 1,837 games documented, 1,049 games were played on 6.0 to ≥9.0 lbs infill/sq. ft, and 788 on 0.0-5.9 lbs infill/sq. ft, with 4,655 total injuries reported. MANOVA indicated a significant main effect across elective medical procedures by injury category (F3,3977 = 16.574; P < .0001). Post hoc analyses indicated significantly lower injury incidence rates (IIR per 10 game season) requiring radiography and MRI procedures following player-turf surface impact trauma [1.7, (95% CI, 1.5 -1.9) vs 3.2 (2.9-3.5); P = .001], trauma from shoe: surface interaction during physical collision/contact [2.4, (95% CI, 2.1-2.6) vs 3.2 (2.9-3.5); P = .001], and trauma from shoe: surface interaction during physical noncontact [0.4, (95% CI, 0.3-0.5) vs 0.7 (0.5-0.9); P = .01], while competing on the 6 to ≥9.0 lbs infill/sq. ft when compared to the lighter infill weight systems, respectively. No significant differences in surgical procedures by injury category were observed between infill weight. Conclusion: As the artificial infill surface weight decreased, the incidence of game-related, high school football lower extremity and surface impact trauma, and subsequent elective medical procedures significantly increased. Based on findings, high school football fields should minimally contain 6.0 to ≥9.0 lbs infill/sq. ft. This is the first longitudinal study to investigate the influence of artificial infill weight influence on high school sport trauma and elective medical decisions.
Outcomes of Concussion Injuries to Running Backs and Wide Receivers in the National Football League
Authors: Okoroha Kelechi R. , Jildeh Toufic Raja , Taylor Kevin , Buckley Patrick , Mehta Samir , Moutzouros Vasilios 
Published: July 2019

Objectives: Concussion injuries are common in professional football players, however the impact on player careers remains unclear. The purpose of this study was to quantify the effect of concussions on professional football player performance. Methods: Concussion data from the National Football League was collected for a period of four seasons (2012-2015) for running backs and wide receivers. Demographic variables (age, experience, position, time to return, yearly total yards and touchdowns) were recorded. Power ratings (total yards divided by 10 plus touchdowns multiplied by 6) were calculated for the injury season as well as for the 3 seasons before and after the injury. A control group consisted of running backs and wide receivers without an identified concussion injury who competed in the 2014 season. Results: One hundred and eighteen running backs and wide receivers sustained a concussion over a 4-season period, 25 players (21%) never returned to a National Football League game. Players were able to return in an average of 18.5 ± 8.2 days, missing 1.6 ± 1.0 games. For 18 players with a minimum total power rating of (sum of 4 seasons) of 200 points, power rating per game decreased 43.4 ± 0.4 points from three seasons prior to the concussion to three years postinjury. This change in performance was not statistically significant (P=0.422) when compared with the change for the 343 control players. Conclusion: Over one fifth of National Football League running backs and wide receivers who sustain a concussion never return to play in a game. On return to competition, player performance of injured players reduced from before injury, however there was no difference compared to controls.
Characterizing the Prevalence of Cam-Type Hip Impingement in Women’s Professional Ice Hockey Players
Authors: Whitney Darryl C. , Baron Samuel L. , Kingery Matthew T. , Campbell Abigail L. , Gonzalez-Lomas Guillem , Carter Cordelia W. 
Published: July 2019

Objectives: Participation rates in women’s ice hockey is increasing in North America. Recent studies have demonstrated an increased prevalence of femoroacetabular impingement (FAI) in elite male ice hockey players, yet little is known about hip pathology of players in the National Women’s Hockey League (NWHL). The primary purpose of this study was to determine the prevalence of radiographic FAI in women’s professional ice hockey players. The secondary purpose was to analyze the relationship between the presence of radiographic cam deformity and hip ROM, clinical impingement signs and age of menarche. Methods: In this IRB-approved study, physical examination and demographic data were prospectively collected for 27 NWHL players. Alpha angles were measured on 45-degree Dunn views with an alpha angle &gt55° defined as cam-positive. Pearson correlations were performed to analyze the relationship between alpha angle and ROM measurements, clinical impingement signs and self-reported age of menarche. Players were grouped into those with and without cam impingement and group differences were assessed using the student’s t-test. Statistical significance was set at p&lt0.05. Results: Twenty-seven athletes were included in the study. Nineteen of the 27 players (70%) had radiologic evidence of cam-type impingement with alpha angle &gt55 degrees; 14 players (52%) had bilateral cam deformity. The average age of menarche was 13.9±1.5 years. There was a significant association between age of menarche and right alpha angle (R=0.57, CI [0.16, 0.81], p=0.011), as well as age of menarche and left alpha angle (R=0.48, CI [0.03, 0.77], p=0.039). There was no statistically significant association between alpha angle and any ROM measurement. Additionally, there was no difference in the incidence of clinical impingement for players with or without an alpha angle &gt55°. Conclusion: This study suggests that elite female ice hockey players have a significantly higher prevalence of cam-type morphology than the general population. The clinical significance of this radiographic finding is uncertain as the majority of these deformities seem to be asymptomatic. Interestingly, the positive association between alpha angle and age of menarche lends support to the etiological hypothesis that cam lesions are a result of activity-related stress at the proximal femoral physis. This data suggests that players with earlier menarche (and therefore earlier physeal closure) seem to be less vulnerable to the development of cam deformity of the proximal femur.
Proximal Adductor Avulsion: A Biomechanical Comparison of Suture Anchor Repair Techniques
Authors: Golan Elan J. , Yohe Nicholas , Schilders Ernest M. J. , Bharam Srino 
Published: July 2019

Objectives: Acute avulsion of the proximal fibrocartilaginous origin of the adductor longus (AL) is an injury mostly occurring in individuals that perform cutting and rapid lateral movements such as in hockey, soccer, and rugby. Especially in competitive athletes, recent trends have advocated for surgical repair of these acute injuries. However, while multiple repair configurations have been proposed, the current literature lacks biomechanical data to guide surgical technique. Therefore, the purpose of this study was to determine load-to-failure values for two proximal adductor repair techniques and to compare their strength to that of a native, uninjured proximal adductor tendon. Methods: Seventeen cadaveric fresh frozen pelvic specimens were dissected to preserve the proximal adductor tendon and the fibrocartilage attachment to the pubis. The specimens were then divided into three groups: an intact AL tendon(baseline control), and ‘torn’ tendons repaired with either a 2-suture anchor or 4-suture anchor technique. Once repaired, specimens were cyclically loaded on a custom jig to simulate a maximal effort soccer-style kick. Testing endpoints included suture anchor pull-out, loss of clamp fixation, or catastrophic tendon failure. To control for individual differences, values were reported both in terms of gross force and as load-to-displacement ratios. Following collection, data from each of the three groups were recorded and analyzed via Kruskal-Wallis and multiple comparison tests. Results: The mean load to failure for the 4-anchor group was 83.74±19.28 N, which was significantly greater than for either the intact (25.43±3.46 N, p <0.05) or 2-anchor repair (20.58±1.33 N, p <0.001) conditions. All intact and 4-anchor repair specimens failed via disruption distal to the adductor’s musculotendinous junction, with no failure at the bone-anchor interface noted in either of these groups. In contrast, 80% of 2-anchor repairs failed at the bone to anchor interface. In this group, following initial pullout, failure of a secondary anchor occurred with 41.4% less force than for the index failure (p < 0.001). Conclusion: This study provides biomechanical data which identifies a 4-anchor repair as being much more resistant to surgical-site failure than a 2-anchor construct. Further, the 4-anchor group failed at the same anatomic location as the intact adductor group, suggesting that a 4-anchor construct results in a repair that acts similar to an uninjured control. Based on this finding, a 4-anchor repair construct should be preferentially used in proximal adductor repair whenever clinically feasible. [Figure: see text][Figure: see text]
Short Term Clinical Outcomes Following Arthroscopic Suprapectoral Onlay Biceps Tenodesis with a Single Suture Anchor
Authors: Cabarcas Brandon C. , Liu Joseph , Gowd Anirudh K. , Garcia Grant Hoerig , Manderle Brandon J. , Beletsky Alexander , Verma Nikhil N. 
Published: July 2019

Objectives: The long head of the biceps tendon is a well-recognized potential source of anterior shoulder pain. Arthroscopic biceps tenodesis has emerged as a popular surgical option, however, limited studies exist evaluating postoperative outcomes after an arthroscopic approach. The purpose of this study was to assess short term clinical and functional outcomes after arthroscopic suprapectoral onlay biceps tenodesis with a single suture anchor. Methods: A prospective case series of 50 patients undergoing arthroscopic suprapectoral biceps tenodesis by a single surgeon. Patients were evaluated preoperatively and postoperatively at six months with the American Shoulder and Elbow Surgeons (ASES) questionnaire, Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), Veteran Rand 12-Item Health Survey (VR-12), and 12-Item Short Form Survey (SF-12). Strength, range of motion (ROM), biceps apex distance, provocative tests and return to work (RTW) were assessed postoperatively. Results: 26 males and 24 females were evaluated. Average ± SD age at surgery was 50.14 ± 10.94 years, and average follow up was 6.48 ± 1.28 months. Biceps apex distance, active/passive elbow flexion, extension, supination, or pronation ROM did not differ (p>0.192 for all) between affected and unaffected sides. Elbow flexion strength significantly increased postoperatively (p=0.004). Significant improvements were noted (p ≤ 0.001 for all) in ASES, VAS pain, SANE, Constant-Murley, and VR/SF-12 Physical Component scores. Four procedures were revisions (8.0%), which were significantly correlated with postoperative bicipital groove pain (p = 0.034), positive Yergason’s test (p = 0.047), and takingpostoperative opioids (p = 0.037). These revision cases and patients with increased BMI were significantly less likely to achieve MCID for VR/SF-12 Physical Component scores (p < 0.05). No patients required subsequent surgery involving the biceps. Out of 45 employed patients, 32 (71.11%) returned to work at an average of 4.68 ± 2.95 months. Light duty had a statistically greater return to work rate compared to heavy duty (p = 0.027). Popeye deformity was seen in 5 (10%) patients, which had significantly increased biceps apex distances (p = 0.029). However, no significant differences were noted in these patients (p > 0.05 for all) for patient-reported outcomes, range or motion, or strength. Only one reported awareness of cosmetic deformity. Conclusion: Shoulder strength, ROM, and multiple outcome measures improved significantly post-operatively with use of arthroscopic biceps tenodesis using a single anchor technique. Although 10% of patients developed cosmetic deformity, this did not significantly affect postoperative outcomes. Revision patients should be counseled preoperatively regarding the increased likelihood of postoperative pain and appropriate opioid medication use. [Table: see text]
Minimum 5-Year Outcomes of Arthroscopic Hip Labral Reconstruction with Nested Matched-Pair Benchmarking Against a Labral Repair Control Group
Authors: Domb Benjamin G. , Battaglia Muriel R. , Perets Itay , Lall Ajay C. , Chen Austin , Ortiz-Declet Victor , Maldonado David R. 
Published: July 2019

Objectives: Labral reconstruction has demonstrated short-term benefit for the treatment of irreparable labral tears. Nonetheless, there is a scarcity of evidence for mid-term outcomes of this treatment. The purpose of our study was to report 5-year outcomes in patients who underwent segmental labral reconstruction. In addition, we compared 5-year outcomes of patients who underwent primary segmental labral reconstruction (PLRECON) with a matched-pair control group that underwent primary labral repair (PLREPAIR). We hypothesized that arthroscopic segmental reconstruction in the setting of irreparable labral tears would show improvement in patient-reported outcomes (PROs) and high patient satisfaction at minimum 5-year follow-up. Secondly, PLRECON would experience similar improvement in PROs at minimum 5-year follow-up when compared to a matched-pair PLREPAIR control group. Methods: Data from February 2008 to April 2013 was retrospectively reviewed. Patients were included if they underwent hip arthroscopy for segmental labral reconstruction in the setting of irreparable labral tear and femoro-acetabular impingement (FAI), with minimum 5-year follow-up for modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and Visual Analogue Scale (VAS) for pain. Exclusion criteria were Tönnis osteoarthritis grade >1, prior hip conditions, or Workers’ Compensation claims. PLRECON were matched in a 1:3 ratio to a PLREPAIR group based on age ±5 years, gender, and body mass index (BMI) ±5 kg/m2. Results: Twenty-eight patients were eligible for the study, of which 23 (82.14%) had minimum 5-year follow-up. We found significant improvement from preoperative to latest follow-up in all outcome measures recorded: 17.8-point increase in mHHS (P=0.002), 22-point increase in NAHS (P<0.001), 25.4-point increase in HOS-SSS (P=0.003), and a 2.9-point decrease in VAS pain ratings (P<0.001). Average patient satisfaction was 7.1 out of 10. In the nested matched-pair analysis, 17 PLRECON were matched to a control group of 51 PLREPAIR patients. PLRECON demonstrated comparable survivorship and comparable improvements in all PROs with the exception of patient satisfaction. Conclusion: Hip arthroscopy with segmental labral reconstruction resulted in significant improvement in PROs at minimum 5-year follow-up. PLRECON reached comparable functional outcomes when compared to a benchmark PLREPAIR control group, but demonstrated lower patient satisfaction at latest follow-up. [Figure: see text]