bluuebunny/crossref_metadata_2025_split huggingface dataset:
Jones Fractures Identified at the National Football League Scouting Combine: Assessment of Prognostic Factors, Computed Tomography Findings, and Initial Career Performance
Authors: Spang Robert C. , Haber Daniel B. , Beaulieu-Jones Brendin , Stupay Kristen , Sanchez George , Whalen James M. , Van Allen Joseph J. , Price Mark D. , Provencher Matthew T. 
Published: July 2018

Objectives: Jones fractures, which result in loss of playing time and subsequent dysfunction, remain a significant issue for elite contact athletes. The objectives of the present study are to (1) describe the epidemiology, surgical treatment, and impact on early National Football League (NFL) career of Jones fractures identified at the NFL Scouting Combine and (2) establish the value of computed tomography (CT) to determine healing following a Jones fracture in prospective NFL players. Methods: All players who attended the NFL Scouting Combine (2009-2015) were retrospectively reviewed to identify those who previously sustained a Jones fracture with position of play, treatment method, and number of missed collegiate games recorded. Overall mean draft pick, number of games started and played, snap percentage, and position-specific performance scores (Fantasy Score) were compared between Jones fracture athletes and controls without any major injury prior to the NFL Combine and during first three years of NFL career. A classification system, based on the grading of four individual quadrants (plantar, dorsal, medial, lateral), was applied by three orthopaedic surgeons. Results: Overall, the number of Jones fractures among athletes who attended the NFL Combine (2009-2015) was 72/2285 (3.2%) with all athletes treated via intramedullary (IM) screw fixation. Position-specific performance scores for players with a previous Jones fracture were lower than controls across all positions with a significant difference in running backs and defensive linemen. Subgroup CT scan analysis demonstrated a mean overall score of 2.5±1.3 with kappa values of 0.6 and 0.64 for inter- and intra-observer reliability, respectively. 16 Jones fractures (50%) were healed or nearly healed,12 (37.5%) were partially healed, and 4 (12.5%) showed little or no healing. The plantar cortex demonstrated least healing (56%), followed by the lateral cortex (46.9%). Conclusion: Although infrequent, Jones fractures are encountered at the NFL Combine with the highest prevalence at the tight end position and lowest at the running back position. Based on CT, 50% of all players with a previous Jones fracture demonstrate inhealing with least healing at the plantar and lateral cortices. Moreover, position-specific performance scores demonstrate worst performance at all positions for players with a previous Jones fracture versus controls.
Efficacy of an Arthroscopic Virtual Based Simulator for Orthopedic Surgery Residents by Year in Training
Authors: Yari Shahram , Jandhyala Chanakya , Sharareh Behnam , Athiviraham Aravind , Shybut Theodore B. 
Published: July 2018

Objectives: Arthroscopic virtual-reality stimulators are an attractive option for resident training and are increasing across training programs. However, no study has analyzed the utility of the simulator for trainees based on their post-graduate level of training (PGY-level). The primary aim of this study was to determine the utility of the ArthroSTM arthroscopic simulator for orthopedic trainees based on their level of training (to determine at what point in training the simulator offers the most benefit for trainees). We hypothesized that all levels would show similar improvements in performance following completion of the training modules. Methods: Eighteen orthopedic surgery residents performed pre-training diagnostic knee and shoulder tasks on the ArthoSTM simulator. Subjects completed a series of training modules, then repeated the diagnostic tasks. Mean composite scores were calculated. Group differences for discrete variables were evaluated using ANOVA (analysis of variance). Correlation coefficients (R2) were calculated for improvements in mean composite score as a function of subject year-in-training. Results: Average improvement in composite score for participants as a whole was 11.2 points [SD 10; p-value 0.0003] for the knee simulator and 14.9 points [SD 10.9; p-value 0.0352] for the shoulder simulator. When broken down by PGY-level, all groups showed improvement, with greater improvements seen for junior-level residents in the knee simulator and greater improvements seen for senior-level residents in the shoulder simulator. ANOVA for the score improvement variable in the knee simulator data amongst the different PGY-groups yielded an f-value of 1.640 (p-value 0.2258) and that for the shoulder simulator data amongst the different PGY-groups yielded an f-value of 0.2292 (p-value 0.917). The correlation coefficient (r2) was -0.866 for the knee score improvement and 0.887 for the shoulder score improvement (Image 1). Conclusion: We found that residents training on a virtual arthroscopic simulator made significant improvements in both knee and shoulder arthroscopic skills. Most importantly, we report for the first time that the knee simulator appears to be more beneficial for junior residents, while the shoulder simulator appears to be more beneficial for senior residents. Our study adds to the mounting evidence supporting virtual arthroscopic simulator-based training for orthopedic surgery residents.
Tunnel Bone Grafting in Revision Anterior Cruciate Ligament Reconstruction Cruciate Ligament Reconstruction
Authors: Owens Brett D. , Group Mars 
Published: July 2018

Objectives: Bone grafting of lytic or malpositioned tunnels may be required in ACL revision reconstructive surgery. Little is known of the characteristics of these patients and the impact of this practice on the results following revision ACL reconstruction (rACLR). The purpose of this study was to report the differences in preoperative characteristics, surgical assessment, and 2-year outcomes for rACLR patients undergoing tunnel bone grafting procedures. Methods: 1205 patients who underwent rACLR were enrolled in the Multicenter ACL Revision Study (MARS) consortium between 2006 and 2011, comprising the prospective cohort. Two-year questionnaire follow-up was obtained on 989 (82%), while telephone follow-up was obtained on 1112 (92%). Subjects undergoing previous or concurrent bone grafting of ACL tunnels were compared with subjects without tunnel grafting. Group characteristics were compared using chi-squared and ANOVA statistical analyses. Results: At total of 158 subjects (13%) underwent tunnel grafting procedures compared to 1,047 who did not. Of these, 95 underwent prior staged bone grafting and 63 underwent concomitant bone grafting. Femoral bone grafting was performed on 31 subjects, tibial grafting in 39, and combined grafting in 88. Significant differences were noted in baseline patient reported outcomes (KOOS sports/recreation, KOOS QOL, and Marx activity) favoring the control group. Significant differences were noted in the number of prior ACL reconstructions, prior graft type, prior femoral fixation method, prior femoral and tibial tunnel locations between the two groups. Significant differences were also noted in the current choice of ACL revision reconstruction technique including graft selection, method of femoral tunnel drilling, femoral fixation, tibial fixation and aperture assessment. Both femoral and tibial bone quality was deemed to be abnormal in 20% of revision surgeries in the bone graft group, compared with 6 and 7% in control group (both p<0.001). Two-year patient reported outcomes were inferior in the bone graft group (KOOS sports/recreation, KOOS QOL, and Marx activity). Conclusion: Tunnel bone grafting was performed in 13% of ACL revision patients. These patients had inferior baseline and 2-year patient reported outcomes and activity levels compared to patients not undergoing bone grafting.
Advanced Patellar Tendinopathy Is Associated With Increased Rates of Bone-Patellar Tendon-Bone Autograft Failure in Anterior Cruciate Ligament Reconstructions
Authors: Lazarides Alexander Leandros , Alentorn-Geli Eduard , Vinson Emily , Samuelsson Kristian , Toth Alison P. , Moorman Claude T. , Garrett William E. , Taylor Dean C. 
Published: July 2018

Objectives: Revision ACL reconstruction can be potentially devastating for a patient. As such, it is important to identify prognostic factors placing patients at increased risk for re-rupture. There are no data on the effects of patellar tendonopathy on failure of ACL reconstruction when using bone-patellar tendon-bone (BPTB) autograft. The purpose of this study was to investigate the effects of patellar tendinopathy on the risk of graft failure in primary ACL reconstruction when using BPTB autograft. Methods: All patients undergoing ACL reconstruction at a single institution from 2005 to 2015 were examined. A total of 168 patients undergoing primary BPTB autograft for primary ACL reconstruction were identified. Patient MRIs were reviewed for the presence and grade of patellar tendinopathy by two musculoskeletal fellowship-trained radiologists; both were blinded to the aim of the study, patient demographics, surgical details and outcomes. Patients were divided into two cohorts: failure and non-failure of the ACL graft, defined as rupture of the ACL graft. Statistical analyses were run to examine the role of patellar tendinopathy in failure of ACL reconstruction using BPTB autograft. Results: At a mean follow up of 18 months, there were 7 (4.2%) patients with graft failure. Moderate or high-grade patellar tendinopathy was associated with ACL graft failure (p=0.011). Age, gender and side of reconstruction were not associated with risk of re-rupture, though the majority of patients in our study who failed were younger than 20 years of age. Use of patellar tendon with moderate to severe tendinopathy was associated with a relative risk of rupture of 6.1 as compared to autograft tendon without tendinopathy (95% CI 1.37-27.3). Conclusion: The presence of moderate or severe patellar tendinopathy significantly increases the risk of graft failure when using BPTB autograft for primary ACL reconstruction. Consideration of patellar tendinopathy should be made when determining the optimal graft choice for patients undergoing primary ACL reconstruction with autograft tendons.
Performance and Return to Sport Following Latissimus Dorsi and Teres Major Injuries in Professional Baseball Pitchers
Authors: Erickson Brandon J. , Chalmers Peter Nissen , D’Angelo John , Ma Kevin , Romeo Anthony A. 
Published: July 2018

Background: Latissimus dorsi and teres major (LD/TM) tears are becoming an increasing common cause of injury and disability amongst professional baseball pitchers. Purpose: To determine the rate of return to sport (RTS) and performance upon RTS in professional baseball pitchers following LD/TM tears treated both operatively and non-operatively, and to see if there is a difference in RTS rate and performance between players who sustained a LD/TM tear and matched controls within each treatment group. Hypothesis: There is a high rate of RTS in professional baseball pitchers following LD/TM tears with no significant difference in rate of RTS or performance, specifically related to the primary outcome performance variables of earned run average (ERA), WHIP ((walks +hits)/innings pitched), fielding independent pitching (FIP), and wins above replacement (WAR)) between cases and controls for both operative and non-operative treatment. Methods: All professional baseball pitchers who sustained a LD/TM tear between 2011-2016 were included. Demographic and performance data (pre and post injury) for each player was recorded. Performance metrics were then compared between cases and matched controls within both operatively non-operative treatment. Results: Overall 120 pitchers sustained a LD/TM tear; 42 (35%) were playing at the major league level at the time of injury. The majority of players (107 (89.2%)) were treated non-operatively. The average time to return to the same level of competition for pitchers treated non-operatively was 170.7 +/- 169.7 days while for those treated operatively was 536.6 +/- 300.4 days. Of the players treated with surgery, the mean time from injury to surgery was 97.5+/-115.5 days (range 12-453 days). The RTS rate among players treated non-operatively and operatively was identical at 75%. Players treated non-operatively had no change in ERA, FIP, or WAR following injury but had a higher WHIP after injury (p=0.039). Players treated operatively had no change in any measured performance metrics following surgery. No difference existed between cases and controls in the primary performance variables Conclusion: LD/TM tears occur more frequently than previously reported. The majority of LD/TM tears in professional baseball pitchers are treated non-operatively. RTS rate for professional baseball pitchers following LD/TM tears treated operatively or non-operatively is 75%. No significant difference in performance was seen in these pitchers following tear/surgery compared to matched controls.
Endoscopic Proximal Hamstring Repair: Portal Site Anatomy - A Cadaveric Study
Authors: Ryan Michael K. , Beason David P. , Emblom Benton A. 
Published: July 2018

Objectives: Hamstring injuries commonly cause pain, weakness and functional limitations. While most hamstring injuries involve the musculotendinous junction or muscle belly, proximal hamstring tendon avulsions are a subset of hamstring injuries that are frequently more debilitating. Nonoperative treatment has demonstrated poor outcomes, thus surgical repair has become the mainstay. Open surgical repair has been the standard, but improved endoscopic techniques have enabled proximal hamstring fixation with decreased risk of infection and numbness, without the morbidity of a large, posterior incision. Prior anatomic studies described relevant anatomy near the proximal hamstring origin at the ischial tuberosity in the setting of an open repair, but literature describing pertinent anatomy during endoscopic repair is sparse. This cadaveric study enhances knowledge and safety of endoscopic proximal hamstring repair by describing pertinent anatomy surrounding four commonly used endoscopic portals. Methods: Ten fresh-frozen pelvis specimens (5 M, 5F) underwent endoscopic proximal hamstring repair and dissection with evenly distributed laterality (5 R, 5 L). Proximal hamstring ruptures were simulated endoscopically with an arthroscopic knife. Endoscopic repair was then completed on each specimen through four endoscopic portals (Inferolateral, Medial, Superolateral and Accessory Superior) using two double-loaded 3.0 mm polyether ether ketone (PEEK) suture anchors and two 3.75 mm PEEK knotless screw-in anchors. After repair, portal tracts were maintained by inserting four 2.0 mm k-wires through cannulas placed through the portals, securing the wires in bone in the ischial tuberosity beyond the zone of repair. The specimen was dissected in layers around the wires, and measurements from portal tracts to nine pertinent anatomic structures were obtained using a digital caliper. Each measurement was repeated three times, then averaged to obtain a composite mean. Measurements were statistically verified with an intraclass correlation coefficient (ICC), all but two of which were above 0.90. Results: Ten cadaveric specimens demonstrated a mean age and BMI of 45.4 and 27.3, respectively. With respect to anatomic measurements, on average no portal tract was closer than 2.0 cm to the sciatic nerve, inferior gluteal neurovascular bundle or posterior cutaneous nerve, and all double-row repairs were easily completed with good fixation through these four portals (Table 1). Additional anatomic landmarks surrounding the hamstring origin were identified endoscopically, and when routinely located, each landmark helped improve reproducibility and safety of endoscopic proximal hamstring repair (Figure 1). Conclusion: This cadaveric study of the proximal hamstring origin maps the anatomic landscape encountered endoscopically, and supports the efficacy and safety of endoscopic proximal hamstring repair. [Table: see text][Figure: see text]
What is The Impact of PAO Surgery on Patient Function and Activity Levels?
Authors: Petrie Jeff , An Tonya , Schoenecker Perry , Zaltz Ira , Kim Young-Jo , Millis Michael B. , Beaule Paul , Sierra Rafael J. , Trousdale Robert , Sucato Daniel J. , Podeszwa David , Sink Ernest , Clohisy John C. 
Published: July 2018

Objectives: The Bernese periacetabular osteotomy (PAO) is becoming a widely utilized procedure. Patients are younger, highly active, and may desire to return to sport activity. Counseling and managing expectations in these patients is challenging as there is limited information regarding activity level after PAO. The purpose of this study was to analyze physical activity levels after PAO in a large, prospective multicenter cohort. Methods: Assessment of prospectively collected data from a multicenter group included 456 hips treated by PAO for hip dysplasia. After exclusions, 359 hips (80 male, 279 female) remained with a mean age of 25.9 years and mean BMI of 25. Demographics, radiographic measures, and clinical outcomes were evaluated preoperatively, at 1 year follow-up, and at minimum 2 years postoperatively (mean 44.9 months). Activity level was assessed with the University of California-Los Angeles (UCLA) activity score, patients were stratified into low, moderate, and high activity groups based on preoperative function. Descriptive statistics and linear regressions were performed for the primary outcome of change in UCLA. Results: UCLA scores were improved on average 0.6 points at final follow up (p = 0.001). When stratified, the low activity and moderate activity groups had significant improvement in UCLA scores (p<.0001 and p=0007) while the high activity group saw a decrease in UCLA scores (p<.0001). mHHS, HOOS Pain, and HOOS Sports and Recreation scores were significantly improved across all activity levels. Univariable linear regression analysis identified prior ipsilateral surgery, arthroscopy at time of PAO, and preoperative ACEA to be predictors of the change in UCLA score (p<0.05). With the multivariable model, the effect of prior ispilateral surgery was maintained (p = 0.002). Conclusion: The data suggests that improvements in activity level and function can be expected following PAO surgery, with greater gains experienced by patients with lower preoperative level of activity. [Figure: see text][Figure: see text]
Indomethacin Does Not Reduce Heterotopic Ossification In Two-incision Distal Biceps Repairs
Authors: Hudson Justin , Dunphy Taylor R. , Butler Rebecca K. , Mirzayan Raffy 
Published: July 2018

Objectives: Our objective was to evaluate whether indomethacin would reduce the incidence of heterotopic ossification (HO) after two-incision distal biceps repairs. Methods: After obtaining IRB approval, all two-incision distal biceps tendon repairs performed between 2008 and 2015 by 17 surgeons in a multi-center (14) integrated, health care system were retrospectively reviewed. Indomethacin use was confirmed by the use of our pharmacy database search of a prescription being filled 10 days prior and up to 6 weeks after to surgery. A minimum of 1 year of follow-up was required for all patients. Variables recorded were patient demographics, time from injury to surgery, re-operation rate, infection, re-rupture, nerve complications, and time to release from medical care. Inclusion criteria included age 18 and over, primary repairs using the two-incision technique with bone tunnel - suture fixation. A Fischer Exact test was performed to test for significance. Results: 146 patients met our inclusion criteria. The average age was 48 years (range: 23-69). All (100%) were male. The non-dominant side was involved in 76 patients (52.1%). There was no difference in age, gender, time from injury to surgery in groups receiving indomethacin to those not receiving it (P>0.05). 109 (74.7%) patients underwent distal biceps repair without indomethacin and 6 (5.5%) patients developed HO. In 37 patients who received indomethacin prophylaxis, 5 (13.5%) patients developed HO. There was no statistically significant difference in HO formation between patients who received indomethacin prophylaxis and those who did not (P=0.14). Conclusion: Based on our findings and the risk of gastrointestinal complications, we do not recommend indomethacin prophylaxis for two-incision distal biceps repairs.
Incidence and Risk Factors for Failure of Arthroscopic Posterior Capsulolabral Reconstruction
Authors: Bradley James P. , Arner Justin W. , Jayakumar Sachidhanand , Vyas Dharmesh 
Published: July 2018

Objectives: Risk factors and outcomes of revision arthroscopic posterior capsulolabral repair is not well defined. It is hypothesized that athletes who require revision arthroscopic posterior unidirectional capsulolabral repair will have poorer outcomes and return to play with risk factors including younger age, injury size, bone loss, anchor number, and anchor type. Methods: A review of 161 shoulders who underwent arthroscopic posterior capsulolabral repair using modern techniques at minimum 2 year follow up was completed. In addition to surgical data, ASES, stability, ROM, strength, and pain scores were compared pre- and post-operatively as well as return to sport. Those who required revision surgery were identified and compared to those not undergoing revision. Results: Twenty shoulders required revision surgery (12.4%) at 5.3 year follow-up. Significant risk factors included female gender (p = 0.001), dominant shoulder (p = 0.005), and concomitant rotator cuff injury (p = 0.029). Patients with 3 or fewer anchors were more likely to require revision (OR = 3.48). There was no difference after normalization to tear size and location (p > 0.05). Return to sport at the same level was significantly lower if revision surgery was required (15.4% vs. 64.3%) (p = 0.004). All patients had significant improvements in ASES, pain, ROM, and strength after the original surgery, however, those who required revision surgery had less improvement (p < 0.05). Stability improved significantly in non-revision athletes (p < 0.001), but did not in revision patients (p = 0.662). Conclusion: Athletes required revision arthroscopic posterior capsulolabral repair at an incidence of 12.4% and had poorer outcome scores and return to play with risk factors being dominant shoulder surgery, female gender, concomitant rotator cuff injury, and the use of 3 or fewer anchors. This data is essential for patient selection, optimal treatment techniques, and patient education as posterior shoulder instability failure requiring revision has not previously been evaluated. [Table: see text]