bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Latarjet Procedure for Anterior Shoulder Instability in Pediatric and Adolescent Athletes
Authors: Heyworth Benton E. , Wu Mark , Kramer Dennis E. , Bae Donald S. 
Published: July 2018

Objectives: To investigate surgical outcomes of the Latarjet procedure in the pediatric and adolescent athletic population compared to alternative techniques used to treat anterior shoulder instability with glenoid bone loss. Methods: This retrospective comparative cohort study involved a review of 40 patient records with a mean age of 16.7 years (range: 14.3 to 19.2) with anterior shoulder instability and glenoid bone loss (mean: 19%). Demographic and clinical features were recorded pre- and post-operatively, with mean follow up of 26.3 months (sd, 22.8). Advanced imaging and arthroscopic assessment were used to quantify concomitant pathology. Percent glenoid bone loss was calculated using the “glenoid rim distances” method. Glenoid track width and Hill-Sachs interval (HSI) were measured to determine if shoulders were on-track or off-track. Patients were contacted to obtain validated functional outcome questionnaires, including Quick-DASH, ASES, and Marx shoulder activity scale. Results: Of the 40 patients, 18 underwent the Latarjet procedure and 22 underwent alternative stabilization procedures. At presentation, both groups were statistically similar with regard to presence of HS (overall 92%), and mechanism of initial dislocation. However, patients who underwent the Latarjet procedure were slightly older at surgery (p=0.045), had longer symptom duration (p=0.015), and had failed more arthroscopic Bankart repair procedures (p=0.002). Additionally, more patients had “off-track” glenohumeral bone loss in the Latarjet group (38%) compared to the control group (9%), (p=0.049). Post-operatively, the Latarjet and control groups had comparable minimal loss of external rotation (47% vs .45%, p=0.768) and high rates of return to sports (94% vs 100%) at a similar time (5.3 vs. 5.4 months, p=1.0). There was a 17% recurrent instability rate in the Latarjet cohort similar to 23% in the control cohort (p=0.709). There were no cases of post-operative nerve palsy or coracoid non-union in those who underwent the Latarjet, compared to one non-union following bony Bankart ORIF in the control group. Functional outcome scores were similarly high across both groups (Table 1). Conclusion: Despite being a technically challenging, salvage-type, open reconstructive shoulder procedure, the Latarjet procedure yielded low complication rates and comparably good outcomes in an adolescent cohort with more risk factors for recurrence than a control group of adolescents undergoing other procedures. For young, athletic patients with multiple instability recurrences, previous surgeries, long symptom duration, and glenohumeral bone loss—including severe, ‘off track’ variations—the Latarjet procedure provides a high rate of return to sports, good/excellent functional outcome scores, and low rates of recurrent instability and complications.
A Cam Shaped Femur Might Be A Risk Factor for ACL Injuries
Authors: Pfeiffer Thomas Rudolf , Burnham Jeremy M. , Kanakamedala Ajay C. , Hughes Jonathan Daniel , Irrgang James J. , Debski Richard , Musahl Volker 
Published: July 2018

Objectives: Bony morphologic characteristics have been demonstrated to increase the risk of anterior cruciate ligament (ACL) injury. While posterior femoral condyle condylar offset is an aspect of distal femoral bony morphology that has been reported to influence range of motion and other aspects of knee joint kinematics, it remains unclear whether this characteristic influences the risk of ACL injury. The purpose of the study was to examine the relationship between distal femoral morphology and risks of ACL injury, reconstruction failure, and contralateral ACL injury. It was hypothesized that increased posterior femoral condylar depth, quantified as the cam ratio, would correlate with increased risk of primary ACL injuries, ACL reconstruction failures, and contralateral ACL injuries. Methods: Consecutive patients undergoing evaluation for knee complaints at an academic medical center from 2012-2016 with minimum 24-month follow-up were retrospectively reviewed. Subjects were stratified into four groups: a control group consisting of patients with no ACL injuries and three groups of patients with a primary ACL injury, failed ACL reconstruction, or previous ACL injury with subsequent contralateral ACL injury. Using lateral radiographs, the ratio of posterior condylar depth over total condylar distance was defined as the cam ratio. Analysis-of-variance (ANOVA) and post-hoc testing were used to test for differences in the mean tomahawk ratio between study groups (p<0.05). Receiver Operating Characteristic (ROC) analysis was performed to determine the optimal cam ratio cut-off for detecting increased risk for ACL injury. Results: One hundred and seventy-five patients met inclusion criteria. The mean cam ratios in the control, primary ACL injury, failed ACL reconstruction, and contralateral ACL injury groups were 61.1% (± 2.1), 64.2% (± 3.8), 64.4% (± 3.6), and 66.9% (± 4.0), respectively. Patients with a primary ACL injury, failed ACL reconstruction, or contralateral ACL injury had a significantly higher cam ratio compared to the control group (p<0.008). ROC analysis demonstrated a cam ratio of 63% or greater to be associated with an increased risk for ACL injury with a sensitivity of83% and a specificity of 71%. Conclusion: The data from this study show that an increased posterior femoral condylar depth, or cam ratio, might be associated with increased risk of ACL injury, including primary ACL injury, failed ACL reconstruction, and contralateral ACL injury. The data from this study may help clinicians identify patients at greater risk of ACL injury and re-injury. Future prospective studies will be helpful in investigating the mechanism by which an increased cam ratio increases ACL injury risk and potential strategies to mitigate the increased risk posed by this bony characteristic.
Patient-Specific Parameters Associated with Traction Stiffness in Primary and Revision Hip Arthroscopy
Authors: Kapron Ashley L. , Karns Michael , Aoki Stephen Kenji , Adeyemi Temitope F. , Baillargeon Elizabeth A. , Hartley Melissa K. , Todd Jocelyn N. , Maak Travis 
Published: July 2018

Objectives: To quantify the force of traction required for adequate distraction of the hip during arthroscopy and explore the relationship between hip joint stiffness and patient-specific demographics, flexibility, and anatomy. Methods: 101 primary arthroscopy patients (61 females) and 23 patients undergoing revision arthroscopy for capsular repair (all female) were prospectively enrolled. A load cell attached to the traction boot continuously measured traction force. Fluoroscopy images were obtained before and after traction to measure joint displacement. The stiffness coefficient was calculated as the force of traction divided by joint displacement. Primary patients were analyzed in a univariable regression model and re-analyzed separately by gender. Variables significant at p<0.05 were included in a multivariable regression model. Stiffness was compared between female primary and revision patients using independent t-tests. Results: For primary arthroscopy, instantaneous peak force averaged 80 ± 18 kgf, after which the force required to maintain distraction decreased to 57 ± 13 kgf. In univariable regression analysis, gender, alpha angle, hamstring flexibility and Beighton hypermobility score were each correlated to stiffness. However, gender was the only significant variable in the multivariable regression model. Intragender analysis demonstrated increased hamstring flexibility correlated with decreased stiffness in males and higher Beighton scores correlated with decreased stiffness in females. Stiffness was significantly less in the revision cases than the primary cases (p=0.006). Conclusion: A substantial force is required to achieve and maintain hip distraction, with males requiring higher forces. Males with increased hamstring flexibility and females with higher Beighton scores are less stiff than their same gender counterparts. Patients indicated for revision capsule repair were less stiff, supporting the importance of the hip capsule on hip stability. These data may be used to identify patients with microinstability and patients where specific focus on capsular repair and/or plication may be warranted.
Surgical Repair of Distal Triceps Tendon Injuries: Short-Term Clinical Outcomes and Re-Rupture Rate
Authors: Waterman Brian Robert , Dean Robert , Veera Shreya S. , Cole Brian J. , Romeo Anthony A. , Wysocki Robert , Cohen Mark S. , Fernandez John , Verma Nikhil N. 
Published: July 2018

Objectives: The purpose of this study is to describe the clinical, functional, and patient-reported outcomes of distal triceps tendon repairs, as well as to describe perioperative risk profile and re-rupture rates among those with or without pre-existing enthesopathy. Methods: Patients who underwent surgical repair of traumatic triceps tendon injuries between 2008 and 2016 were identified from the surgical database at a single institution. The electronic medical records were queried to determine demographic information, time from injury, mechanism of injury, extent of tear, pre-existing enthesopathy, and postoperative complications. Patients with arthritis, concomitant ligament surgery, and/or secondary rupture following previous elbow surgery were excluded. Follow-up outcome measures included the Mayo Elbow, Disabilities of the Arm, Hand, and Shoulder (QuickDASH), Veterans RAND (VR/SF-12), and Kerlan-Jobe Orthopaedic Clinic (KJOC) scores with a minimum of 1-year follow up. Results: A total of 88 patients (83 males, 5 females) with mean age of 47 years (range, 14-74) were identified with distal triceps tendon repairs at an average of 49 days (range, 1 to 3650 days) after injury. Sixty-nine patients (76.1%) returned for follow-up at average 3.99 years post-operatively (SD, 2.51). The most common mechanisms of injury were direct elbow trauma (45.4%), extension/lifting exercises (18.1%), overuse (13.6%), and hyperflexion or hyperextension (14.8%). Twenty patients were identified with pre-existing, symptomatic enthesophytes, and 68 tears were caused by acute injury; A total of 42 and 46 partial tendon tears were identified (Table 1). Bone tunnels were most commonly used (n=42, 47.7%), while direct sutures (n=31, 35.2%) and suture anchors (n=12, 13.6%) were also used. Postoperative complications occurred in 23.9% of patients, but no patients experienced re-rupture at time of final follow-up. Final postoperative patient-reported outcome measures are noted in Table 1. No statistically significant correlation was found between patient age (p=0.750), degree of tear (p=0.870), or surgical technique (p=0.740) and presence of perioperative complications. Conclusion: Despite heightened risk of perioperative complications after primary repair of distal triceps tendon injuries, the current series identifies favorable functional outcomes and no cases of re- rupture at short- to mid-term follow-up. Furthermore, age, surgical technique, and extent of tear were not associated with adverse patient outcomes in this investigation. [Table: see text]
Release Location in a Risk Factor for Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers
Authors: Portney Daniel Aaron , Buchler Lucas T. , Lazaroff Jake Michael , Gryzlo Stephen , Saltzman Matthew 
Published: July 2018

Objectives: Medial ulnar collateral ligament reconstruction (UCLR) is a common procedure performed for Major League Baseball (MLB) pitchers. The etiology of UCL injury is complex and not entirely understood. The purpose of this study was to use publically available pitch tracking technology (PITCHf/x) to compare the pre-injury throwing mechanics of MLB pitchers who require UCL reconstructive surgery with those of pitchers who have never undergone UCL reconstruction. Methods: Pitch tracking and demographic data on MLB pitchers who had undergone UCL reconstruction between the 2010 and 2017 seasons was gathered. Pitchers were excluded if they did not throw 100 total pitches in each of the three years prior to surgery. Furthermore, only pitch types that a given pitcher utilized more than 25 times in each of the three years prior to surgery were included for individual analysis. Pitch type, release location, and velocity were compared between the UCL reconstructive surgery cohort and a matched-control cohort. Results: The average pitch release location for pitchers who required UCL reconstruction was more lateral in the two years immediately preceding surgery than the control cohort (p=0.001 and p=0.023). Furthermore, a time-based comparison between the year immediately preceding surgery and two years prior showed a more lateral release immediately prior to surgery (p=0.036). Pitchers who required UCL reconstruction throw similar rates of fastballs as the control cohort and the average pitch velocity and fastball velocity were similar between the UCL group and the control group. The control pitchers displayed a significant decrease in average pitch velocity (p=0.005) and average fastball velocity (p=0.012) over the period of the study. Conclusion: Pitch tracking indicates pitch selection and pitch velocity are similar before that the average release point is more lateral preceding UCL reconstruction as compared to the control cohort suggesting that pitch release location might be an independent risk factor for UCL injury and reconstruction. On the other hand, pitch selection and pitch velocity are similar between these cohorts. Powerful technology including PITCHf/x allows for accurate monitoring of factors such as arm position and could potentially be used to identify pitchers at risk for UCL rupture. [Figure: see text]
Pre-operative and Post-Operative Alpha Angles are Significant Independent Predictors of Patient-Reported Outcome Measures at Two Years After Hip Arthroscopy
Authors: Lansdown Drew A. , Kunze Kyle , Ukwuani Gift , Waterman Brian Robert , Neal William H. , Nho Shane Jay 
Published: July 2018

Objectives: Residual impingement after hip arthroscopy for femoroacetabular impingement (FAI) is a common cause for re-operation; however, the relationship between preoperative and postoperative radiographic parameters and patient-reported outcomes has not been defined. Methods: 749 consecutive patients were reviewed two years after primary hip arthroscopy. Patients undergoing revision surgery were excluded. Pre-operative and post-operative radiographs were analyzed to measure the alpha angle on standardized anteroposterior (AP) pelvis, Dunn-lateral, and false profile (FP) views and anterior and lateral center-edge angles (ACEA, LCEA). Univariate analysis evaluated the association between demographic variables, radiographic measures and hip outcome scores (Hip Outcome Score (HOS)-Activities of Daily Living (ADL), HOS-Sports Specific (SS), and Modified Harris Hip Score (mHHS)). Multivariate modeling was subsequently performed. Significance was defined as p<0.05. Results: 706 patients with mean age of 33.2±12.3 years and mean BMI 25.1± 5kg/m2 were included for final analysis. The alpha angle on the AP, Dunn-lateral, and FP views and the ACEA and LCEA decreased after surgery (p<0.001 for all). Significant univariate correlations with the postoperative HOS-ADL included age, BMI, pre-operative AP, FP, and Dunn and postoperative FP alpha angles. Postoperative HOS-SS was correlated with age, BMI, medial post-operative joint space width (JSW), pre-operative AP, FP, and Dunn and postoperative FP alpha angles, and pre-operative and post-operative (ACEA). Postoperative mHHS correlated with age, BMI, post-operative lateral JSW, pre-operative AP, FP, and Dunn and postoperative FP and Dunn alpha angles, and post-operative ACEA. Multivariate modeling (Table 2) demonstrated that preoperative and postoperative FP alpha angles were independent predictors of postoperative outcomes. Conclusion: Pre-operative and post-operative alpha angles were negatively correlated with the HOS-ADL, HOS-SS, and mHHS at 2 years after arthroscopic surgery for FAI. Specifically, pre-operative and postoperative FP alpha angles were independent predictors of postoperative outcomes. These results highlight the importance of resecting anterior cam lesions to prevent residual impingement and inferior outcomes. [Table: see text]
Perspectives in Treatments of End-Stage Ankle Arthritis Among Orthopaedic Surgeons
Authors: Phisitkul Phinit , Glass Natalie , Ebeling Patrick B. , Klein Sandra E. , Johnson Jeffrey E. 
Published: July 2018

Background: This study aimed to assess the preferred operative treatment for patients over the age of 60 with end-stage ankle arthritis and perspectives on total ankle replacement (TAR) among American Orthopaedic Foot & Ankle Society (AOFAS) members. Associated factors were analyzed for potential contraindications among members with different levels of experience. Method: A questionnaire containing 6 questions was designed and sent to 2056 members of the AOFAS. Responses were received from 467 orthopaedic surgeons practicing in the United States (76%), Canada (5%), and 26 other countries (20%). Participants were grouped for response comparisons according to country as well as experience level. Differences in contraindications were compared using χ2 tests or exact tests. Results: Respondents practicing in the United States and surgeons who perform 11 or more TARs per year tended to recommend operative treatments favoring TAR and displayed recognition of its increasing role ( P < .05). Overall, respondents felt that 41% of typical patients over 60 years old with end-stage arthritis would be best treated with TAR. Talus avascular necrosis, morbid obesity (body mass index >40 kg/m2), and poorly controlled diabetes with neuropathy were most recognized as the absolute contraindications to TAR. Surgeon’s experience affected the consideration of these clinical factors as contraindications. Conclusions: Total ankle replacement has a substantial and increasing role in the treatment of end-stage ankle arthritis in patients over the age of 60. Absolute and potential contraindications of the procedures were indicated from a cross-sectional survey of AOFAS members. Surgeons more experienced with total ankle replacement felt more comfortable employing it in a wider range of clinical settings. Level of Evidence: Level III, therapeutic.
ERS/EACTS statement on the management of malignant pleural effusions
Authors: Bibby Anna C. , Dorn Patrick , Psallidas Ioannis , Porcel Jose M. , Janssen Julius , Froudarakis Marios , Subotic Dragan , Astoul Phillippe , Licht Peter , Schmid Ralph , Scherpereel Arnaud , Rahman Najib M. , Cardillo Giuseppe , Maskell Nick A. 
Published: July 2018

Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomised clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature.Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE.The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.
Association between internal migration and epidemic dynamics: an analysis of cause-specific mortality in Kenya and South Africa using health and demographic surveillance data
Authors: Ginsburg Carren , Bocquier Philippe , Béguy Donatien , Afolabi Sulaimon , Kahn Kathleen , Obor David , Tanser Frank , Tomita Andrew , Wamukoya Marylene , Collinson Mark A. 
Published: July 2018

Abstract
Background
Many low- and middle-income countries are facing a double burden of disease with persisting high levels of infectious disease, and an increasing prevalence of non-communicable disease (NCD). Within these settings, complex processes and transitions concerning health and population are underway, altering population dynamics and patterns of disease. Understanding the mechanisms through which changing socioeconomic and environmental contexts may influence health is central to developing appropriate public health policy. Migration, which involves a change in environment and health exposure, is one such mechanism.

Methods
This study uses Competing Risk Models to examine the relationship between internal migration and premature mortality from AIDS/TB and NCDs. The analysis employs 9 to 14 years of longitudinal data from four Health and Demographic Surveillance Systems (HDSS) of the INDEPTH Network located in Kenya and South Africa (populations ranging from 71 to 223 thousand). The study tests whether the mortality of migrants converges to that of non-migrants over the period of observation, controlling for age, sex and education level.

Results
In all four HDSS, AIDS/TB has a strong influence on overall deaths. However, in all sites the probability of premature death (45q15) due to AIDS/TB is declining in recent periods, having exceeded 0.39 in the South African sites and 0.18 in the Kenyan sites in earlier years. In general, the migration effect presents similar patterns in relation to both AIDS/TB and NCD mortality, and shows a migrant mortality disadvantage with no convergence between migrants and non-migrants over the period of observation. Return migrants to the Agincourt HDSS (South Africa) are on average four times more likely to die of AIDS/TB or NCDs than are non-migrants. In the Africa Health Research Institute (South Africa) female return migrants have approximately twice the risk of dying from AIDS/TB from the year 2004 onwards, while there is a divergence to higher AIDS/TB mortality risk amongst female migrants to the Nairobi HDSS from 2010.

Conclusion
Results suggest that structural socioeconomic issues, rather than epidemic dynamics are likely to be associated with differences in mortality risk by migrant status. Interventions aimed at improving recent migrant’s access to treatment may mitigate risk.