bluuebunny/crossref_metadata_2025_split huggingface dataset:
High Rate of Recurrent Meniscus Tear and Lateral Compartment Osteoarthritis in Patients Treated for Symptomatic Lateral Discoid Meniscus: A Long-Term Population-Based Study
Authors: Sabbag Orlando , Hevesi Mario , Sanders Thomas L. , Camp Christopher L. , Dahm Diane L. , Levy Bruce A. , Stuart Michael J. , Krych Aaron John 
Published: July 2019

Objectives: Little is known about the natural history and long-term outcome of a surgically treated symptomatic lateral discoid meniscus. The goals of this study were to describe the rate and factors associated with recurrent lateral meniscus tears and progression to symptomatic lateral compartment osteoarthritis (OA) in patients surgically treated for a symptomatic lateral discoid meniscus. Patients with surgically treated lateral discoid meniscus have a high incidence of meniscus re-tear and progression to lateral compartment OA. Methods: A large, geographic database was reviewed to identify and confirm patients presenting with symptomatic lateral discoid meniscus between 1998 and 2015. Charts were reviewed to document treatment and outcomes at a minimum clinical follow-up of two years. Results: 70 discoid meniscus patients (30 F, 40 M) with a mean age of 27 years (Range: 2.0-66.0) were followed for an average of 5.8 years (Range 2.0-23.7). Sixty patients underwent surgical management: 49 (82%) patients underwent partial lateral meniscectomy and 11 (18%) underwent meniscus repair (including saucerization). Tear-free survival following surgery was 93% at 2 years, 69% at 5 years, and 40% at 8 years. Overall progression to symptomatic lateral compartment OA in the surgical group was 10% at 2 years, 23% at 5 years, and 48% at 8 years. Of those patients who developed lateral compartment OA, 55% (11/20) had a Kellgren-Lawrence score 2 or greater at last radiographic follow-up. Young age and open growth plates were associated with increased incidence of postoperative re-tear (HR: 0.96, CI: 0.93-0.99, p = 0.01). Increased age at diagnosis and BMI ≥ 30 were associated with increased risk of progression to lateral compartment OA on final radiographs. Conclusion: Patients with a surgically treated lateral discoid meniscus tear had a high rate of recurrent meniscus tear at long-term follow-up (60% at 8 years) that was associated with young age. Approximately 48% of surgically treated patients developed symptomatic lateral compartment OA at eight years from initial presentation. The risk of progression to OA increased with older age at diagnosis and BMI ≥ 30.
The Proximal and Distal Effects of Blood Flow Restriction Therapy on Upper and Lower Extremity Strengthening: A Randomized Controlled Trial
Authors: Bowman Eric N. , El-shaar Rami , Milligan Heather , Jue Greg , Mohr Karen , Brown Patty , Watanabe Drew M. , Limpisvasti Orr 
Published: July 2019

Objectives: Blood flow restriction (BFR) therapy consists of low-intensity exercise performed under reduced venous return due to an inflatable tourniquet. This produces similar physiologic and clinical effects to high-intensity routines with less joint and tissue stress. Postoperative patients may benefit from more efficient rehabilitation. Proximal and distal effects of BFR have been evaluated, however, minimal literature exists on its use in orthopaedic conditions. The purpose of this study was to determine the effects of low-intensity BFR therapy both proximal and distal, in the upper and lower extremities. Methods: This was a prospective, randomized controlled trial of healthy subjects completing a standardized 6-week course of BFR therapy. Subjects were randomized to BFR therapy on one extremity or to a control group. Subjects were excluded for cardiac, pulmonary, or hematologic disease, pregnancy, or previous surgery in the extremity. Data collected at baseline and completion included: limb circumferences, isokinetic, and manual strength testing. Results: Forty subjects completed the protocol. Average age was 27.7 years; 54% were female. For both upper and lower extremity groups, a statistically significant increase was observed in manual and isokinetic strength both proximal and distal to the BFR tourniquet when compared to both the non-tourniquet extremity and the control group (p<0.05). Limb circumference significantly increased in the upper (p<0.01) and lower extremities (p=0.02). A significant increase in manual strength was noted in shoulder abduction and scaption, and hip extension and abduction even in the non-tourniquet BFR extremity compared to the control group (p<0.05). Conclusion: Low-intensity BFR therapy led to greater increases in muscle strength and hypertrophy. Similar strengthening effects were seen in proximal and distal muscle groups. Strength increases in the contralateral BFR extremity may corroborate a systemic effect. This study provides data to further evaluate the efficacy and safety of BFR therapy in operative and non-operative orthopaedic conditions. [Table: see text]
Risk Factors for Recurrent Anterior Shoulder Instability after Arthroscopic Stabilization in Adolescent Athletes
Authors: Cheng Timothy , Edmonds Eric W. , Bastrom Tracey P. , Pennock Andrew T. 
Published: July 2019

Objectives: Arthroscopic stabilization has become the preferred surgery for adolescent athletes with anterior instability without significant bone loss. Although successful for most patients, 10-40% will experience recurrent instability. The purpose of the current study was to compare a consecutive series of patients who had failed an arthroscopic stabilization to an age and gender matched cohort of patients who had no evidence of recurrent instability with a goal of identifying risk factors for future instability. Methods: A retrospective review was undertaken of all patients undergoing an arthroscopic shoulder stabilization for anterior instability between 2009 and 2016. Patients over the age of 18 years and those with underlying syndromes affecting the musculoskeletal system were excluded. Two patient cohorts were identified: (1) Patients with recurrent instability (frank dislocations or subluxations) after their arthroscopic stabilization; (2) An age and gender matched cohort of patients with no recurrent instability at a minimum of 2 years follow-up from surgery. Patient demographic, injury, radiographic, and surgical variables were recorded. In particular, bone loss measurements were performed on both the glenoid and humerus, and Hill-Sachs lesions were classified as “on-track” or ”off-track”. Variables at p<0.10 on univariate analysis were entered into a binary logistic multivariate regression analysis. Results: 35 patients were identified that failed an arthroscopic stabilization at a mean of 1.2 ± 1.0 years after their index surgery. A separate age and gender matched cohort of 35 patients was also identified with no symptoms of recurrent instability. Univariate analysis identified the following 4 risk factors for recurrent instability (glenoid bone loss > 10%, glenoid retroversion < 5◦, skeletal immaturity, and patients with more than one pre-surgical instability event). Collision sport participation, the presence and size of a Hill-Sachs deformity, and the glenoid track were not predictive of failure. Multivariate regression analysis revealed that loss of glenoid retroversion, skeletal immaturity, and a greater number of prior instability events best predicted future recurrence with two risk factors having a 3x increased risk and patients with all three risk factors having a 4x increased risk of recurrent instability after arthroscopic stabilization. Conclusion: Anterior glenoid bone loss, glenoid version, skeletal immaturity, and multiple pre-operative instability events are risk factors for failed arthroscopic stabilization in adolescent athletes with anterior instability. In the setting of multiple risk factors, patients and families should be counselled of the increased odds of surgical failure and other forms of surgical stabilization may need to be considered.
Oral Contraceptives Provide Protection against Anterior Cruciate Ligament Tears: A National Database Study of 165,748 Female Patients
Authors: DeFroda Steven F. , Bokshan Steven Louis , Worobey Samantha , Ready Lauren , Daniels Alan H. , Owens Brett D. 
Published: July 2019

Objectives: ACL tears are more prevalent in females than males. One of the factors responsible for this may be the variation in levels of estrogen and progesterone. The purpose of this study was to query a large nationwide database to determine the potentially protective effects of oral contraceptive pills (OCPs) on ACL tears. We hypothesized that females taking OCPs would exhibit ACL tears at lower rates than a matched population of patients not taking OCPs. Methods: The PearlDiver database (www.pearldiverinc.com, Fort Wayne, IN) was queried for all OCP users amongst females aged 15-49. Female experiencing an ACL tear and undergoing surgery (CPT 29888) were compared to a control group of females undergoing surgery for an ACL tear, but not on OCPs. Patients were matched by age and Charlson comorbidity score. Chi-squared testing was used to assess for significant differences in the rate of ACL tears for the OCP and non-OCP users, according to age groups broken down into age intervals of 5 years. Results: There were a total 82,874 patients in both the OCP and non-OCP groups. There were a total of 569 (0.69%) ACL tears in the non-OCP group and 465 (0.56%) in the OCP group (p<0.001). In the non-OCP group, patients aged 15-19 accounted for 29.35% of all ACL tears, whereas, in the OCP group, this same age group only accounted for 13.33% of ACL tears. Among all age groups, the odds ratios for experiencing an ACL tear while on OCP was 0.82 (χ2=0.001, 95% CI 0.72-0.92) (Figure 1) compared to not using OCP. This protective effect was driven primarily by the 15-19 age group (odds ratio 0.37 (χ2<0.001, 95% CI 0.27-0.50)). Conclusion: This investigation utilizing a large national database found that usage of OCPs was associated with an 18% decrease in the risk of ACL tear when compared to a matched population of patients with ACL tears not taking OCPs. These findings were in line with smaller studies which demonstrated similar results. Additionally, it was shown that OCPs were most protective in the 15-19 year old age group, with a 63% reduction in tears in this group. Ongoing randomized trials in patients without ACL tear could help to demonstrate further clinical evidence for OCP usage as a way to modify risk factors for ACL tear. While clinical evidence is limited, there should be strong consideration for OCP usage in elite high school and college aged athletes, especially those who are at risk of ACL tear.
Performance and Return to Sport Following Open Reduction Internal Fixation About the Elbow in Professional Baseball Players
Authors: Erickson Brandon J. , Chalmers Peter Nissen , D’Angelo John , Ma Kevin , Romeo Anthony A. 
Published: July 2019

Objectives: The results of open reduction and internal fixation (ORIF) of stress reactions and fractures of the olecranon in professional baseball players with regards to return to sport (RTS) are unknown. The purpose was to determine the RTS rate and performance in professional baseball players following ORIF of acute, displaced olecranon fractures and olecranon stress fractures, and to compare RTS rate and performance to matched controls. The authors hypothesized that there is a high rate of RTS in professional baseball players following ORIF of acute, displaced olecranon fractures and olecranon stress fractures with no significant difference in rate of RTS or performance, specifically related to the primary outcome performance variables of win-loss percentage (W-L%), WHIP ((walks +hits)/innings pitched), fielding independent pitching (FIP), and wins above replacement (WAR)) between cases and controls between cases and controls. Methods: All professional baseball players who underwent ORIF of the olecranon between 2010-2016 were included. Demographic and performance data (pre and post surgery) for each player was recorded. Performance metrics were then compared between cases and a group of matched controls. Results: Overall, 52 professional baseball players (average age 22.6 +/- 3.6 years) underwent ORIF of an olecranon fracture. The majority of players sustained a primary olecranon stress fracture (73%), that was fixed with one screw (60%), with a RTS rate of 67.5%. No difference in RTS rate existed between matched controls and the players. No significant difference existed between the primary preoperative and postoperative performance (change in performance) metrics for pitchers who underwent ORIF of an acute, displaced olecranon fracture or ORIF of a primary olecranon stress fracture. No significant difference existed between pitchers who underwent ORIF of a primary olecranon stress fracture and matched controls in any of the primary performance metrics. Conclusion: Professional baseball players who undergo ORIF of an olecranon fracture (either acute, displaced or stress fracture) have a RTS rate of 67.5%, which is no different than natural attrition from matched controls. No decline in performance metrics is seen in players who are able to RTS when compared to their preoperative performance, or to the performance of matched controls.
Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: Updated mean 7 year follow-up
Authors: Larson Christopher M. , Giveans M. Russell , McGaver Rebecca Stone , Weed Katelyn N. 
Published: July 2019

Objectives: The acetabular labrum provides sealing function and a degree of hip joint stability. Previous early (16 month) and mid-term (mean 3.5 years) follow-up of this cohort reported better patient related outcome measures in the refixation group. To update the results of labral refixation versus focal labral excision/debridement in a cohort of patients who underwent arthroscopic correction of femoroacetabular impingement (FAI). Methods: We reported patients who underwent labral debridement/focal labral excision during a period before the development of labral repair techniques. Patients with labral tears thought to be repairable with our current arthroscopic technique were compared with patients who underwent labral refixation. In 46 hips, the labrum was focally excised/debrided (group 1); in 54 hips, the labrum was refixed (group 2). Outcomes were measured with modified-Harris-Hip-Score (mHHS), Short Form-12 (SF-12), and a visual-analog-scale (VAS) for pain preoperatively and postoperatively. Results: Mean age was 33 years in group 1 and 28 years in group 2 with mean follow-up of 7 years (range, 2-13.6 years). At mean follow-up, subjective outcomes were significantly improved (P<.01) for both groups compared with preoperative scores. The mHHS (P=.004), SF-12 (P=.016), and VAS pain scores (P<.001) were all significantly better for refixation group compared with debridement group. Although most recent outcomes for both groups fell at mean 7 years’ follow-up in comparison to 16 month and 3.5 year follow-up, the disparity between groups was greater in favor of labral refixation. Good-to-excellent results were 47.7% in debridement and 82.4% in refixation (p<.001), and failure rates were 31.8% (debridement) and 13.7% (refixation group) (p =.034). There were 4 revisions in the debridement group and none in the refixation group. Conclusion: Longer term follow-up comparing focal labral debridement/excision to refixation revealed a decrease in patient related outcome scoring and good/excellent results in both groups. Ultimately, there was a greater drop in outcome measures and good/excellent results in the debridement group and better maintenance of results in the refixation group at mean 7 years follow-up.
Variability in Baseball Throwing Metrics During A Structured Long-toss Program: Does One Size Fit All?
Authors: Leafblad Nels , Larson Dirk , Fleisig Glenn S. , Conte Stan , Fealy Stephen , Dines Joshua , D’Angelo John , Camp Christopher L. 
Published: July 2019

Objectives: The variability of throwing metrics, particularly elbow torque and ball velocity, during structured long-toss programs is yet to be fully elucidated. The primary aims of this study were to assess various throwing metrics through a structured long-toss program using wearable technology and to quantify the intra and inter thrower variability of these metrics at each stage of throwing. Methods: This was a descriptive laboratory study in which 60 high school and collegiate pitchers participated in a predetermined, structured, progressive long-toss program. All players wore a motusBASEBALL sleeve (Motus Global, Inc.; Rockville Centre, NY), which measured arm slot, arm velocity, shoulder rotation, and elbow varus torque. Radar guns were used to measure ball velocity. These metrics were compared within and between all pitchers at each of the following throwing distances: 90 ft, 120 ft, 150 ft, 180 ft, and maximum effort mound pitching. Intra- and inter- thrower reliabilities were calculated for each throwing metric at every stage of the program. Excellent intra-thrower reliability was defined by an Intra-class coefficient (ICC) >0.750. Acceptable inter-thrower reliability was defined by a Coefficient of Variation (CV) <5%. Results: Ball velocity significantly changed at each progressive throwing distance, but this did not consistently correlate with an increase in elbow torque. Pitching from the mound did not place more torque on the elbow than throwing from 120 ft and beyond. Intra-thrower reliability was excellent throughout the progressive long-toss program for each throwing metric. Ninety-one percent of throwers had acceptable inter-thrower reliability for ball velocity, whereas only 79% of throwers had acceptable inter-thrower reliability for elbow torque. Conclusion: Based on trends in elbow torque, it may be practical to incorporate pitching from the mound earlier in the program (once a player is comfortable throwing from 120 ft). Ball velocity and elbow torque do not necessarily correlate with one another, so a degree of caution should be exercised when using radar guns to estimate elbow torque. Given the variability in elbow torque between throwers, some athletes would likely benefit from an individualized throwing program.
Are Baseball Statistics an Appropriate Tool for Assessing Return to Play in Injured Players: An Analysis of Statistically Variability in Healthy Players Using a Machine Learning Approach
Authors: Pareek Ayoosh , Parkes Chad W. , Leontovich Alexey A. , Bernard Christopher D. , Krych Aaron John , Dahm Diane L. , Camp Christopher L. 
Published: July 2019

Objectives: Traditional pitching statistics (ERA, WHIP, etc) have been used as surrogates for pitcher performance without being validated. Even amongst healthy pitchers, the normal variability of these parameters has not yet been established. The purpose of this study was to determine the normal variability of basic and advanced pitching statistics in non-injured Major League Baseball (MLB) pitchers. It is our hope that this work will serve as the foundation for the identification and implementation of validated, pitcher dependent statistical measures that can be used to assess return to play performance following injury. Methods: Publicly available data from MLB Statcast and Pitch/Fx databases was used to analyze all non-injured MLB pitchers during 2015 and 2016 seasons who pitcher greater than 100 innings each season without injury. Traditional and advanced baseball pitching statistics were analyzed. The variability of each parameter was assessed by computing coefficient of variation (CV) between individual pitchers and across all pitchers. A CV below 10 is typically indicative of a relatively constant parameter, and parameters with a CV > 10 are generally considered inconsistent and unreliable. Results: A total of 118 pitchers met all inclusion criteria. For each of these healthy pitchers, 38 basic/traditional parameters and 17 advanced parameters were analyzed. Of the traditional pitcher statistics, only 1 (3%) demonstrated a CV value < 10 (average fastball velocity [FBv]; CV 1.5) (Figure 1). In advanced statistics, 9 of 17 (53%) variables demonstrated acceptable consistency as evidenced by a CV value < 10 (Figure 2). Release position from plate (release_pos_y) along with velocity from the plate (vy0) where the two most constant advanced parameters. When separated by pitch type, these two parameters were the most constant (lowest CV) in every pitch type. Conclusion: The validity and variability of baseball statistics as surrogate markers for performance after injury/surgery have not yet been evaluated. It is critical that baseball statistics undergo proper vetting prior to being used to assess recovery. This study reveals average fastball velocity and release position from the plate to be the least variable basic and advanced baseball statistics in MLB pitchers. In total, only 10 of the 55 statistics analyzed demonstrated acceptable consistency and reliability. This study can be further used to determine the minimum time that each of these variables needs to be followed to ensure an appropriate sample size is obtained to detect significant differences in pre- and post- injury performance. [Figure: see text][Figure: see text]
A Comparison of Collegiate Women’s Court and Beach Volleyball Injury Data: A Three Year Retrospective analysis
Authors: Juhan Tristan , Kang Hyunwoo Paco , Homere Andrew , Jalali Omid , Tibone James E. , Gamradt Seth C. , Weber Alexander E. 
Published: July 2019

Objectives: NCAA Division I beach volleyball is a recently introduced sport that has been played for 3 seasons to date. Since the introduction of this new level of athletic participation for women’s’ beach volleyball, no study has been performed to compare the injury patterns between court and sand volleyball playing surfaces. The goal of this study is to compare the injury patterns and incidence in women’s collegiate court and beach volleyball in order to aid trainers, coaches and medical staff in effectively preparing and treating these collegiate athletes. Methods: A 3 year, retrospective review of all training room injury reports were analyzed for both beach and court volleyball from the 2015 through 2017 seasons. Non-athletic injuries or illness were excluded from analysis. Standardized injury rates for beach and court surfaces were calculated by normalizing the total number of injuries by the number of athletes and sets played. To compare the injury patterns among court versus beach volleyball players, injuries were categorized into one of six body regions (abdomen, lower extremity, upper extremity, thorax, head, and back). The proportion of injuries to each of these regions by playing surface was then calculated to compare injury patterns by playing surface. Chi-squared test and odds ratios were used to compare injury rates. Results: Between 2015 and 2017, 90 court volleyball injuries were recorded, while 49 beach volleyball injuries were recorded in the same time period. Court volleyball players had nearly quadruple the injury rate when compared to beach volleyball players, 0.039 and 0.010 injuries per athlete-set respectively (OR 4.05, 95%CI 2.85-5.76, p<0.0001). Court volleyball players suffered a higher proportion of lower extremity injuries when compared to beach volleyball players (51.5% vs. 12.8% respectively, p=0.004), and beach volleyball players suffered a significantly higher proportion of back injuries when compared to court volleyball players, (23.4% vs. 7.8% respectively, p=0.010). Conclusion: The data suggests a significantly higher incidence of injury for court volleyball players when normalized for gameplay exposure. There were, also significant differences in injury patterns with court volleyball players having a higher proportion of lower extremity injuries and beach volleyball having a higher proportion of back injuries. Recognizing these differences can aid in the establishment of preventative strength and conditioning programs as well as post training treatment protocols for these athletes which may increase both the individuals as well as the teams overall competitive success.