bluuebunny/crossref_metadata_2025_split huggingface dataset:
DOES DISCOID MORPHOLOGY AFFECT PERFORMANCE ON RETURN-TO-SPORT TESTING AFTER MENISCUS REPAIR?
Authors: Kuba Megan , Snetselaar Jordan , Gupta Andrew , Bompadre Viviana , Saper Michael 
Published: March 2019

BACKGROUND Return-to-Sport (RTS) after knee surgery involves the return of strength and dynamic knee stability, which can be assessed with isometric strength and functional performance testing. There is little evidence-based data to assist with RTS decision-making after meniscus repair. Furthermore, there is limited RTS data comparing patients with discoid meniscus tears and instability from those with non-discoid tears. The purpose of this study was to compare the performance on functional RTS tests between pediatric patients with discoid and non-discoid meniscus tears. METHODS A retrospective review was performed of pediatric patients that underwent isolated meniscus repair by a single pediatric orthopaedic surgeon from 2010-2016. Thirty patients (14 discoid, 16 non-discoid) were identified who underwent a postoperative RTS assessment consisting of isometric strength testing, the Lower Quarter Y-balance Test (YBT-LQ), and single-leg hop testing (single hop for distance, triple hop for distance, crossover triple hop for distance, and timed hop). Demographic information and RTS data were compared between groups. Recovery of muscle strength was defined by a limb symmetry index (LSI) =90%. Statistical significance was set at P = 0.05. RESULTS The mean age of the patients was 13.95 years (range, 8-19 years). Patients in the discoid group were younger than those with non-discoid meniscus tears (12.9 vs 15.1 years, respectively) (P =0.05). There was a statistically significant difference in the average time from surgery to RTS test between the discoid (269 days) and non-discoid (184 days) groups. (P =0.02). For isometric strength testing, both groups had mean LSIs greater than 90% for quadriceps, hamstring, and hip abduction. There were no statistically significant differences between groups in isometric strength or performance on the YBT-LQ or any of the single-leg hop tests. CONCLUSIONS Pediatric patients who undergo repair of a discoid meniscus may require prolonged rehabilitation to achieve satisfactory completion of RTS testing. In our study, an additional 3 months on average were required to allow adequate recovery of muscle strength and dynamic functional stability when compared to those with a non-discoid meniscal repair. However, upon completion of a structured physical therapy program with stringent RTS guidelines, at the time of testing, there was no significant difference in performance on any of the RTS tests between patients with discoid and non-discoid meniscus tears. The findings of this study can assist orthopedic surgeons in safely returning pediatric patients back to sporting activities following meniscus repair.
MENISCUS ROOT TEARS IN CHILDREN AND ADOLESCENTS
Authors: Willimon S. Clifton , Christino Melissa , Busch Michael , Perkins Crystal 
Published: March 2019

Background: The medial and lateral menisci function to optimize force transmission across the knee by increasing contact area between the femur and tibia, absorbing shock, and transmitting loads. Injuries to the meniscus root attachments result in extrusion of the meniscus, impaired distribution of hoop stresses, and degenerative articular wear. The purpose of this study is to describe meniscus root tears, associated injuries, and treatment in a series of pediatric patients Methods: A single-institution retrospective review was performed of consecutive pediatric patients treated for meniscus root tears from 2013 – 2017. Inclusion criteria were patients less than 19 years of age, arthroscopic evidence of a meniscus root tear, and minimum 6 months clinical follow-up. The primary outcome was surgery for revision of the meniscus repair. Results: Twenty-seven patients were identified to fit inclusion criteria. There were 15 males and 12 females with a mean age of 15.2 years (range 7 – 18 years). Basketball, soccer, and football accounted for the majority (56%) of injuries. The lateral meniscus was involved in 21 patients (78%) and the medial meniscus in 6 patients (22%). The posterior meniscus root was torn in 25 patients (93%) and anterior meniscus root in 2 patients (7%). The most common injury pattern was a lateral meniscus posterior root tear (19 patients, 70%). Associated injuries included an ACL tear (19 patients, 70%), PCL tear (6 patients, 22%), and a tear of the opposite meniscus (7 patients, 26%). Two root tears occurred in isolation, and both were of the posterior root of the medial meniscus. All patients were treated surgically with an arthroscopic transosseous root repair in addition to simultaneous treatment for their associated injuries. Mean follow-up was 14 months (range 6 – 37 months). No patients required additional surgery for their meniscus root tear. Two patients had a second surgery on the affected knee: one for revision ACL reconstruction 2 years following the primary procedure and the other for chondroplasty of the patella 2.5 years following the primary procedure. Conclusions: Meniscus root tears occur in pediatric and adolescent patients, most commonly affecting the posterior root of the lateral meniscus and occurring in association with ACL tears. The adolescent meniscus root injury pattern is unique compared to the adult population in which the medial meniscus posterior root is often injured in isolation. Inspection of the meniscus root attachments with deliberate probing to assess the meniscus roots should be a routine part of every knee arthroscopy. In our case series, transosseous root repair resulted in successful outcomes in all patients without need for any additional meniscus treatment.
SAFETY IN OUTPATIENT SURGICAL PROCEDURES – A REVIEW OF EARLY COMPLICATION RATES OF AMBULATORY SPORTS MEDICINE CASES
Authors: Iyinbor Angelina , Bernard Johnathan A. , Johnson David C. , Ismaeli Zahra , Coleman Nathan , Johnson Timothy S. , Mason Bonnie 
Published: March 2019

Background: Due to rising health care costs, attention has been dedicated to understanding both outcomes and expenditure as it relates to improving value. There is an increasing trend to perform inpatient hospital procedures in the ambulatory setting to lower costs. Complications to surgical procedures are costly. However, there is a paucity of data reporting early complications. This study aims to determine the 30-day postoperative complication rate of ambulatory surgical procedures in a sports medicine practice. Methods: A retrospective review of four Sports Fellowship trained orthopaedic surgeons at a single institution was conducted for all procedures performed over a 29-month period. The inclusion criteria consisted of all ambulatory surgical cases. Surgeon completed infection control surveys were reviewed from the included patients which contained information on intra-operative complications, post-operative infections, emergency room (ER) visit or hospitalization related to the procedure. Demographics on the patients were collected via the institutional electronic medical record (EMR). Descriptive statistics were performed on case type and frequency (Microsoft Excel). Results: From January 1, 2015 through May 31, 2018, 571 surgical procedures performed in the ambulatory setting met inclusion criteria. There was a total of six surgical complications reported (three dermatologic, two deep vein thrombosis, one hemarthrosis). There were no intra-operative complications reported and no surgical site infections reported. Conclusions/Significance: During the two year and five months study period, the sports medicine, orthopaedic surgery institution had an overall complication rate of 0.51%. This rate is within the historical norm for the majority of the procedures performed. There were no intra-operative complications and no surgical site infections. Only one patient required an ER visit in over 2 years. Ambulatory surgery performed by Sports Fellowship trained, Board Certified Orthopaedic Surgeons in select patients can be performed safely with minimal complications thus lowering costs and improving value.
CONCOMITANT POSTEROLATERAL CORNER INJURIES IN SKELETALLY IMMATURE PATIENTS WITH ACUTE ANTERIOR CRUCIATE LIGAMENT INJURIES
Authors: Kinsella Stuart D. , Rider Sean M. , Tepolt Frances , Ecklund Kirsten , Kocher Mininder S. 
Published: March 2019

Background: Missed and/or untreated posterolateral corner (PLC) injuries are a known cause of anterior cruciate ligament (ACL) reconstruction failure in the adult population. Failed ACL reconstruction causes significant morbidity in the skeletally immature pediatric population. There is little literature on the character and potential significance of posterolateral corner injuries in skeletally immature patients. Methods: Magnetic resonance imaging (MRI) studies of the knee performed at a single tertiary care pediatric hospital between 01/01/2010 and 12/31/2015 for patients who underwent an ACL reconstruction were retrospectively reviewed. Demographic variables were obtained via medical record review, and MRI studies were evaluated for PLC (popliteus, fibular collateral ligament (FCL), popliteofibular ligament (PFL), arcuate ligament) injury, as well as ACL, medial collateral ligament (MCL), bone bruise, fracture, and meniscal pathology by an experienced pediatric musculoskeletal radiologist. Results: Fifty-two patients, 65% of whom were male, with a mean age of 13.8 years at injury were analyzed. PLC injuries were found in 28 patients (54%), with 7 patients (14%) having a complete tear of a component of the PLC. MCL injuries were found in 13 patients (25%). Meniscus tears were found in 25 patients (48%); 17 were of the medial meniscus (33%), and 10 were of the lateral meniscus (19%). A Segond fracture was seen in four patients (8%). The most common injury pattern involved the PFL only (9, 32% of patients with PLC injuries). There was no association between sex (p=0.29), Segond fracture (p=0.09), meniscus injury (p=0.93), or MCL injury (p=0.32) with the risk of PLC injury. There was an association between patient age and PLC injury (p=0.02). For each additional year of age, the odds of PLC injury increased by 1.7 times (OR=1.7 (1.1, 2.8)). Patients were an average age of 14.0 years at ACL reconstruction, and 9 patients went on to re-tear. There was no association between PLC injury and ACL graft failure (p=0.72). Conclusions: This study demonstrates the prevalence of PLC injuries in the setting of concomitant ACL injuries in the skeletally immature patient population. Age was found to predict the odds of PLC injury, which was significantly higher in older skeletally immature patients. No other concomitant injury predicted likelihood of PLC injury.
RECOVERY OF LOWER EXTREMITY STRENGTH AND FUNCTION FOLLOWING ACL RECONSTRUCTION IN SKELETALLY IMMATURE PATIENTS
Authors: Sugimoto Dai , Heyworth Benton E. , Davis Farren , Kocher Mininder S. , Micheli Lyle J. 
Published: March 2019

BACKGROUND: Following anterior cruciate ligament reconstruction (ACLR) surgery, lower extremity recovery of the uninjured limb >90% is commonly recommended for clearance to return-to-play (RTP). However, evidence regarding the timing of achieving such a recovery is lacking, especially in skeletally immature populations. Therefore, the purpose of this study was to examine the proportion of pediatric ACLR patients (<15 years) who achieve >90% of lower extremity recovery at 6-9 months following ACLR surgery. METHODS: Retrospective case series study design was employed. Following inclusion criteria were used: 1) those who had ACLR surgery, 2) their chronological ages were under 15 years, and 3) growth plates remains open. Status of physis (growth plates) was examined through radiographs and MRI images by orhtopaedic physicians. ACLR patients who had previous ACL surgery in either ipsilateral or contralateral limb were excluded. During RTP tests, bilateral strength (quadriceps, hamstrings, hip abductor, and hip extensor), Y-balance (anterior, posteromedial, and posterolateral reach), and hop (single, triple, cross-over, and 6 meter timed) tests were assessed. Main outcome variables were number of skeletally immature ACLR patients whose limb symmetry index (LSI) were >90% during RTP tests. Descriptive statistics were used to analyze frequency, mean, standard deviation, and percentages (%). RESULTS: A total of 106 skeletally immature ACLR patients were enrolled (Table 1). Hamstrings and iliotibial band grafts were commonly used for ACLR surgery (Table 2). Mean time from ACLR to RTP testing was 6.8±3.4 months (Table 2). The proportion of skeletally immature ACLR patients, overall, achieving >90% of LSI in strength was: 74.5% in quadriceps, 39.0% in hamstrings, 81.0% in hip abductors, and 82.9% in hip extensors. Y-balance test results indicated 79.5% in anterior reach, 84.8% in posteromedial reach, and 86.7% in posterolateral reach. Hop test showed 65.3% in single hop, 69.1% in triple hops, 59.1% in cross-over hops, and 74.2% in 6 meter timed hops. Proportion of skeletally immature ACLR patients who passed all four strength, three Y-balance, and four hop tests were 19.8%, 64.8%, and 27.8%. Only 4.2% of skeletally immature ACLR patients demonstrated >90% of LSI in all tests at RTP tests. CONCLUSION/SIGNIFICANCE: Approximately 7 months following ACLR, approximately 3/4 of the patients achieved >90% of quadriceps, hip abductor, and hip extensor strength, but not hamstrings strength. While over 4/5 of the patients performed >90% in Y-balance, less than 3/4 achieve >90% on hop tests. These results suggest approximately 7 months following ACLR may be too early for returning competitive sports in skeletally immature population. Future studies are warranted to find an association between those RTP test batteries and subsequent ACL tear risks. [Table: see text][Table: see text]
“RELATIVE” RISK OF ACL RE-INJURY
Authors: Bram Joshua T. , Talathi Nakul S. , DeFrancesco Christopher J. , Patel Neeraj M. , Ganley Theodore J. 
Published: March 2019

Background Several studies have examined ACL injury history among relatives of patients undergoing ACL reconstruction, but they have primarily analyzed adult populations with variable results. Additionally, few studies have examined concomitant injuries or post-operative outcomes among pediatric patients with a family history of ACL tear. Therefore, the purpose of this study was to identify the proportion of pediatric ACL patients with a first degree relative who had suffered an ACL tear while also examining concomitant meniscal or ligamentous injuries and subsequent complication rates. Methods 1009 patients who underwent ACL reconstruction at an urban tertiary care children’s hospital between January 2009 and May 2016 were contacted via email and/or telephone and asked to complete a follow-up survey. Data collected included subsequent complications – including graft rupture, contralateral ACL injury, and meniscus tears – along with information regarding any relatives who had suffered an ACL tear. Patient medical records were reviewed to determine the age of the patient at the time of surgery as well as concomitant meniscus and ligamentous injuries at the time of injury. Results 425 patients who underwent primary ACL reconstruction completed the survey. The mean age at surgery was 15.0? 2.4 years with a mean follow-up time of 4.6? 2.1 years. Patients were stratified into three groups by the number of first degree relatives (parent or sibling) who had an ACL tear history: no relatives, one relative, or more than one relative. 101 respondents (23.8%) reported at least one first degree relative who had previously torn an ACL. 15 (3.5%) had more than one first degree relative with an ACL tear. There were no differences in the age at time of surgery or the number of concomitant meniscus and ligamentous injuries suffered across the three stratified groups. While children with zero or one affected first degree relative had similar rates of graft failure (11.4% and 9.3%, respectively), those with two or more affected first-degree relatives had a significantly higher graft failure rate (40.0%, p=0.003). There were no differences in the number of post-operative contralateral ACL tears (p=0.438) or meniscus tears (p=0.477) across the groups. When these complications were analyzed together as one outcome, patients with more than one affected first-degree relative suffered more combined graft ruptures, contralateral ACL tears, and meniscal tears (53.3%) than patients with zero (21.9%) or only one affected first degree relative (22.1%, p=0.02). This group of patients also suffered more total complications that required surgical intervention (66.7%) than patients with zero (21.0%) or only one affected first degree family member (22.1%, p<0.001). Conclusion/Significance Patients undergoing primary ACL reconstruction who have a strong family history of ACL tear appear more likely to suffer a post-operative graft rupture and suffer a complication requiring surgery.
DO TIBIAL EMINENCE FRACTURES AND ANTERIOR CRUCIATE LIGAMENT TEARS HAVE SIMILAR OUTCOMES?
Authors: Melugin Heath P. , Desai Vishal S. , Camp Christopher , Hewett Timothy E. , Milbrandt Todd A. , Dahm Diane L. , Levy Bruce A. , Stuart Michael J. , Krych Aaron J. 
Published: March 2019

Background: Avulsion fractures involving the tibial eminence are considered equivalent in etiology to anterior cruciate ligament tears, however there is limited data comparing outcomes of adolescent patients undergoing surgical fixation of tibial eminence fractures to those undergoing anterior cruciate ligament (ACL) reconstruction. Purpose: The purpose of this study was to compare clinical outcomes, subsequent ACL injury rates, and activity levels between adolescent patients who underwent tibial eminence fracture fixation to patients with mid-substance ACL tears who required acute ligament reconstruction. Methods: This study included a group of patients with tibial eminence fractures treated with surgical fixation matched to a group of similar patients with ACL tears treated with reconstruction between the years of 2001 and 2015. Data regarding initial injury, surgical intervention, ACL/ACL graft injury rates, and physical examination findings were recorded. Clinical and functional outcomes were obtained using physical examination, IKDC subjective scores, Lysholm scores, and Tegner Activity levels. Results: Sixty patients with a mean follow-up of 57.7 (24-206) months were included. 20 patients (11 M:9 F) who underwent surgical fixation for tibial eminence fractures (TEF) with a mean age of 11.9 (7-15) years were matched to a group of 40 patients (23 M:17 F) who underwent ACL reconstruction for ACL tears with a mean age of 12.5 (8-15) years. The TEF group demonstrated significantly lower postoperative IKDC (TEF group: 94.0, ACL group: 97.2 (p=0.04)) and Lysholm scores (TEF group: 92.4, ACL group: 96.9 (p=0.02)). The TEF group returned to sport 121 days sooner (p<0.01), but there was no difference in postoperative Tegner scores (TEF group: 7.3, ACL group: 7.6 (p=0.16)). The TEF group demonstrated increased postoperative anterior laxity (p=0.02) and a higher rate of postoperative arthrofibrosis (p=0.04). There was no difference in subsequent ACL injury (p=0.41). Conclusion: Patients with tibial eminence fractures demonstrated lower mean clinical outcome scores compared to patients with ACL tears at minimum 2-year follow up. Additionally, they experienced more postoperative anterior laxity and had a higher rate of postoperative arthrofibrosis. There was no difference in subsequent ACL injury rate. The TEF group returned to sport sooner than the ACL group, but the postoperative activity level was similar.
NOVEL TECHNIQUE FOR REPAIRING PARTIAL ACL TEARS: BIOMECHANICAL ANALYSIS OF AN OSTEOTOMY USING A CADAVERIC MODEL
Authors: Nhan Derek T. , Singh Prerna , Belkoff Stephen , Sullivan Brian T. , Klyce Walter , Lee R. Jay 
Published: March 2019

Introduction: Partial ACL tears can result in knee instability despite continuity of native ACL tissue with its femoral and tibial attachments. Though current treatment consists of replacement of the residual ACL, we propose that retensioning the residual ACL can restore knee stability. Thus, our aim was to assess if a coring osteotomy restores joint stability after a partial ACL tear in a cadaveric model. Methods: Adult cadaveric knees were used. Baseline translational and rotational measurements were obtained for each knee at 30° and 90° of knee flexion with a MTS Bionix 858 machine with the ACL intact, as well as after each subsequent intervention. First, we sectioned the anteromedial ACL bundle to replicate a partial ACL injury. Subsequently, an oblique coring osteotomy was performed. The osteotomy was both rotated to centralize and then distalized to retension the posterolateral ACL bundle. Finally, an ACL deficient knee was created as a control, involving complete sectioning of the ACL. Results: Each of the eight knees demonstrated varying degrees of baseline translational (range 3.9-15.8 mm at 90° and 6.2-15.6 mm at 30°) and rotational laxity. Sectioning of the anteromedial ACL bundle resulted in a significantly increased anterior translation in all of the knees at both 90° (p=0.041) and 30° (p=0.0088), without a statistically significant change in rotation (p=0.45). The coring osteotomy improved knee translation compared to the partial ACL injury state in all of the knees at 90° (p=0.0022) and 30° (p<0.001), again without a change in rotation (p=0.053). Five of the 8 osteotomized knees had less translation than the intact state, and the other 3, the values neared the intact state, had greater anterior translation than the intact state. Finally the ACL deficient knees demonstrated both increased translation compared to both the intact (p=0.0015 at 90° and p<0.001 at 30°) and partially sectioned states (p=0.036 at 90° and p=0.0094 at 30°). Conclusions: In our cadaveric model, we demonstrate that a coring osteotomy of the residual ACL fibers can be used to restore knee stability after a partial ACL tear, while preserving the native ACL. Further studies are needed to validate this procedure. [Figure: see text][Figure: see text]