bluuebunny/crossref_metadata_2025_split huggingface dataset:
Shoulder Surgery in Professional Baseball Players
Authors: Chalmers Peter Nissen , Erickson Brandon J. , D’Angelo John , Romeo Anthony A. 
Published: July 2019

Objectives: Injury rates are increasing in professional baseball players. There is little information regarding shoulder surgeries in these athletes. The purpose of this study is to report the incidence, procedure type, demographics, and return to sport (RTS) rate of shoulder surgeries in MLB players Methods: All MLB players who underwent surgery between 2012-2016 were identified from a database prospectively maintained by the MLB. Demographic information as well as details regarding the procedure were recorded. RTS rates were determined. Only those players with a minimum of six month follow-up were included. Results: There were 581 shoulder surgeries (542 players) performed, and thus the incidence of shoulder surgery among professional baseball players is 1.48%. Pitchers accounted for the majority of players who had shoulder surgery (60%). Overall, 19% surgeries were performed on players in the majors and most players were between 20-25 years old. The majority of procedures were performed on the posterior and anterior labrum. Of these, 67% involved labral repair. Within surgeries that addressed the rotator cuff, 84% involved debridement, most tears were articular sided (87%), and 75% involved the supraspinatus. Overall, 11% of players had a history of prior shoulder surgery and 76% had spent time on the disabled list prior to surgery. The overall rate of RTS was 63%, with 86% of those who returned returning to at least the same level of play as prior to surgery or higher. Of those who returned to their prior level of play, 73% later ascended to a higher level of play or were not able because they were in the major leagues pre-operatively. Conclusion: Shoulder surgery is uncommon among MLB players. Of those players who undergo surgery, the majority are pitchers and minor league players. Most procedures involve the labrum. Rotator cuff tears are mostly articular sided supraspinatus tears. Overall RTS rates are 56%, with only 41% able to return to the same level of play as before surgery.
Biomechanical Comparison of Three Novel Repair Techniques for Radial Tears of the Medial Meniscus
Authors: Buckley Patrick S. , Kemler Bryson , Robbins Colin , Aman Zachary S. , Storaci Hunter , Dornan Grant , LaPrade Robert F. 
Published: July 2019

Objectives: Historically, radial meniscal tears were treated with partial or near- total meniscectomy which usually resulted in with poor outcomes. Radial meniscal tears function similar to a total meniscectomy and are challenging to treat. Repair of radial meniscal tears should be performed to prevent joint deterioration and the need for salvage procedures in the future. The purpose of this study was to compare three novel repair techniques for radial tears of the medial meniscus; the two-tunnel, the hybrid, and the hybrid tunnel techniques. We hypothesized that there would be no difference between the three groups in regards to gapping and ultimate failure strength. Methods: Thirty human male cadaver knees (ten matched pairs (n=20) and ten unpaired (n=10)) were used to compare the two-tunnel, hybrid, and hybrid tunnel repairs. A complete radial tear was made at the midbody of the medial meniscus. Repairs were performed according to the described techniques. Specimens were potted and mounted on a universal Instron testing machine where each specimen was cyclically loaded for 1000 cycles before experiencing a pull-to-failure. Gap distances at the tear site, ultimate failure load, and failure location were measured and recorded. Results: After 1000 cycles of cyclic loading, there was no significant difference in displacement between the two-tunnel repair (3.0 mm ± 1.7 mm), hybrid repair (3.0 mm ± 0.9 mm) or hybrid tunnel repair (2.3 mm ± 1.0 mm) (p=0.4042). On pull-to-failure testing there was also no significant difference in ultimate failure strength when comparing the two-tunnel (259 N ± 103 N), hybrid (349 N ± 149 N), or hybrid tunnel (365 N ± 146 N) repairs (p=0.26). However, the addition of vertical mattress sutures to act as a “rip stop” did significantly reduce the likelihood of the sutures pulling through the meniscus during pull-to-failure testing for the hybrid and hybrid tunnel repairs (4/16=25%) when compared to the two-tunnel repair (7/9=78%) (p=0.017). Conclusion: This study biomechanically evaluated two previously described techniques- the two-tunnel and hybrid repair- as well as one novel repair technique- the hybrid tunnel repair. The results showed equivalent biomechanical testing in regard to gap distance and pull to failure strength among each repair. The addition of the vertical mattress sutures to act as a rip stop suture was effective in preventing meniscal cut out through the meniscus. [Table: see text][Table: see text]
Comparison of Clinical Outcomes in the Treatment of Patellofemoral Chondral Defects: Autologous Chondrocyte Implantation versus Fresh Osteochondral Allografts
Authors: Patel Nirav K. , Varzhapetyan Vahe , Chaudhry Zaira , Salem Hytham S. , Tucker Bradford S. , Freedman Kevin B. 
Published: July 2019

Objectives: The complex environment and the extreme stresses of the patellofemoral joint make chondral defects a challenge to treat. Autologous chondrocyte implantation (ACI) and osteochondral allograft transplantation (OCA) have been reported as case series in the patellofemoral joint with mixed results. This study compared the clinical outcomes for ACI and OCA treatments for patellofemoral chondral defects at our institution. Methods: We reviewed all consecutive patients undergoing ACI and OCA at a single institution for the treatment of isolated patellofemoral cartilage defects. Treatment type was based on surgeon preference. Medical records were examined for patient demographic, lesion specific data, complications, re-operations and failures (graft delamination requiring surgery, revision cartilage repair or conversion to arthroplasty). Clinical outcomes included International Knee Documentation Committee (IKDC) and Short Form 12 health survey (SF-12) scores. Mean follow up was 5.2 years (range, 3.1-7.5 years). Results: There were 30 patients: 19 in the ACI group and 11 in the OCA group with a mean age of 33 (15-48) and 25.5 (16-55) respectively (p=0.12). Etiology in the ACI group was 63%(n=12) patellar instability, 21%(n=4) post-traumatic osteoarthritis, 10%(n=2) primary osteoarthritis and 5%(n=1) osteochondritis dissecans, whereas it was more evenly distributed in the OCA group (27%, 27%, 19% and 27% respectively). Lesions in the ACI group were either Fulkerson type III (84% (n=16), medial patellar facet) or type IV (16%(n=3), pan-patellar). In the OCA group, lesions varied between type 1 (9%(n=1)), type II (27%(n=3)), type III (9%(n=1)) and type IV (54%(n=6)). The mean lesion size was similar between the two groups (OCA 3.1 cm2 ±1.1 vs. ACI 3.4 cm2 ±2.4, p=0.7) with more bipolar lesions in the OCA group (45%(n=5) vs.11%(n=2), p=0.038). Failures (requiring revision or replacement surgery), were significantly more common in OCA at 36% (n=4) compared to 5.3% (n=1) in ACI patients (p=0.04), one of which was bipolar in the former group. Re-operation was performed in 27%(n=3) OCA patients (each for adhesiolysis) and in 21%(n=4) ACI patients (2 manipulation under anesthesia, 1 adhesiolysis and 1 graft debridement for overgrowth) (p=0.3). There were no significant differences between the OCA and ACI groups in IKDC (60.7 vs. 74, p=0.08) and SF-12 scores (43.5 vs 43.7, p=0.43). Conclusion: Compared to ACI, OCA had significantly more failures for patellofemoral chondral defects at short to mid-term follow-up. This may relate to differences in the etiology and lesion locations between the two groups. Despite these findings, both groups had similar complication rates and functional outcome scores.
Return to Work and Sport After Distal Biceps Repair
Authors: Beletsky Alexander , Manderle Brandon J. , Liu Joseph , Nwachukwu Benedict Uchenna , Cohen Mark S. , Bush-Joseph Charles A. , Cole Brian J. , Nicholson Gregory P. , Wysocki Robert , Verma Nikhil N. 
Published: July 2019

Objectives: Outcomes following distal biceps repair are important to establish in order to properly counsel patients on expected postoperative function. Of particular interest are metrics regarding return to work and return to sport, including when return can be expected and at what intensity level. The purpose of this study is to establish important return to sport and work expectations for patients undergoing distal biceps repair. Methods: A prospectively maintained institutional database was retrospectively reviewed for all patients who underwent distal biceps repair since 2005 with minimum 24-month follow-up. A patient survey was conducted over phone with regard to preoperative and postoperative participation in sports, level of intensity, and maximum weight repetitions of barbell and dumbbell biceps curl, bench press, and consecutive push-ups. Results: A total of 49 patients (23 male) were contacted for final follow-up information. Average age was 54.38 + 13.49 and average time from initial injury to surgical intervention was 4.05 + 3.85 months. The dominant side was affected in 63.27% of cases. 32.65% of the injuries involve lifting of heavy objects, and 24.49% occurred during sport. Return to work was achieved in 85.71% of patients, occurring at an average of 1.41 months. Moderate and heavy duty status workers significantly differed from light and sedentary duty status patients in regard to average months to return to work (3.68 months vs. 0.53 months, P<0.001). 73.25% patients returned to the same or higher level of work. Return to sport was achieved by 89.80% of patients, and 44.89% returned to the same or higher intensity of sport. One-repetition maximum (ORM) an average of 15 pounds for barbell bench press and 27.5 pounds for dumbbell curls on the affected arm. Maximum consecutive pushups decreased by an average of 11.66. Time from injury to surgical intervention was found to be significantly associated with decreased push-up counts (P=0.019) and decreased days participating in sports per week (P=0.014) postoperatively. Conclusion: After surgical repair of distal biceps rupture, the majority of patients are able to return to work and sport. Those that work moderate and heavy duty status jobs tend to return at later dates, and patients with longer times to surgical invention have worse functional outcomes with respect to push-ups and frequency of sporting activities. These expected outcomes should be shared with patients to aid in decision making and communicate postsurgical expectations.
Open Reduction Internal Fixation of Medial Epicondyle Fractures After Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers
Authors: Erickson Brandon J. , Chalmers Peter Nissen , D’Angelo John , Ma Kevin , Romeo Anthony A. 
Published: July 2019

Objectives: Ulnar collateral ligament reconstruction (UCLR) is a common procedure among professional baseball pitchers. Currently, 25% of starting Major league baseball (MLB) pitchers have undergone UCLR. Fracture of the medial epicondyle at the level of the humeral tunnel requiring open reduction internal fixation (ORIF) is an uncommon complication following UCLR. The purpose of this study was to determine the rate of return to sport (RTS) and performance upon RTS in professional baseball pitchers following ORIF of the medial epicondyle, and see if there is a difference in RTS rate and performance between players who underwent ORIF and matched controls. The authors hypothesized that there is a high rate of RTS in professional baseball pitchers following medial epicondyle ORIF 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. Methods: All professional baseball pitchers who underwent medial epicondyle ORIF 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 matched controls (no history of UCLR or ORIF). Results: Overall, 15 pitchers (80% starters, 73.3% right-handed) underwent ORIF of a medial epicondyle fracture. All underwent a prior UCLR using either the American Sports Medicine Institute (n=9, 60%) or docking (n=6, 40%) technique. ORIF techniques included fixation with one screw (n=13, 86.7%) and fixation with suture anchors (n=2, 13.3%). Eleven (73.3%) pitchers were able to RTS (which did not differ from controls p=0.537). No significant differences existed in the primary performance outcome variables when comparing pre-operative to post-operative performance. No significant differences in the primary performance outcome measures were seen between cases and controls following surgery although cases pitched fewer innings than controls following surgery (p=0.003) Conclusion: Following medial epicondyle ORIF of professional pitchers with a history of UCLR, 73.3% were able to RTS without a significant decline in most performance variables when compared to their pre-operative performance levels, or when compared to matched controls. Number of innings pitched declined following surgery.
The Influence of Laxity on Injury Severity at the Time of Anterior Shoulder Stabilization Surgery
Authors: Baron Jacqueline , Duchman Kyle R. , Hettrich Carolyn M. , Ortiz Shannon F. , Glass Natalie ,   MOON Shoulder Group, Wolf Brian R. 
Published: July 2019

Objectives: To determine whether a greater degree of translation measured under anesthesia during anterior shoulder stabilization surgery was associated with greater injury severity, more dislocations in the previous year, and a greater duration of injury. Methods: This study evaluated Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group shoulder instability participants who underwent anterior shoulder stabilization surgery between October 2012-September 2016. Surgeons measured shoulder mobility under anesthesia following a standardized protocol and graded translation as 0, 1+, 2+ or 3+. Using this measure, translation was defined as having a grade ≥2+. Labral tear length, duration of injury, and number of times dislocated in the previous year were compared between mobility groups using the Wilcoxon Rank Sum Test while categorical variables were compared between groups using the chi-square or exact test. Logistic regression was also used to model the relationship between mobility grade as an ordered variable and presence of >10% bone loss as well as HSL >20%. Age and BMI were compared between groups using t-tests. Results: A total of 679 participants (19% women) with an average age of 24.8±9.5years and BMI of 25.4±4.4 kg/m2were included in analyses. Mobility grade groups <2 had a slightly higher BMI than ≥2 (27.0±5.2 vs 25.0±4.1kg/m2, <0.01) but did not significantly differ in age (26.0±10.7 vs 24.4±9.0yrs, p=0.31) or proportion of women (14% vs 20%, p=0.12), respectively. Labral tear length (median: 126, range: 0-360°) and the proportion with >10% bone loss (5.8% vs 9.8%) did not significantly differ between groups (all p>0.05). However, there was a greater proportion of HSL >20% in the ≥2 (3.2%) vs <2 (0%, p<0.01) groups. In addition, mobility under anesthesia was associated with a larger number of dislocations reported in the previous year (p<0.01), but not a greater duration of injury (p=0.76). A greater proportion of the ≥2 (13.7%) vs <2 (4.7%) mobility groups also had a Beighton score ≥4 (p<0.01). Results were similar looking at EUA grade as an ordinal variable except that an increase in EUA grade was associated with a greater odds of >10% bone loss (OR: 1.51, 95%CI: 1.01-2.27, p=0.046). Labral tear length was significantly greater in individuals who reported at least two dislocations in the previous year (median=144, 0-360°) vs less than two (126, 0-360°, p=0.02). Conclusion: Measures of translation during EUA in patients undergoing anterior shoulder stabilization surgery demonstrated higher likelihood of HSL and increased glenoid bone loss>10% as positive predictors of translation ≥2 intra-operatively. Self-reported number of dislocations and Beighton scores≥4 were also found to be correlated with increasing translation under EUA and may serve as a reliable clinical predictor of patients at risk for recurrent instability.
The Rate of Posterior Labral Extension In Operatively Treated Bankart Lesions
Authors: Golan Elan J. , Li Ryan Tianran , Vaswani Ravi Surender , Lesniak Bryson P. , Lin Albert 
Published: July 2019

Objectives: Traumatic avulsion of the antero-inferior glenoid labrum is a well-recognized sequela of shoulder dislocation. Such Bankart lesions are readily identified on pre-operative imaging, and results of arthroscopic management of these lesion are favorable. However, the frequency with which such antero-inferior lesions propagate posteriorly remains unclear. Further, how well pre-operative imaging detects posterior labral extension remains unknown. The purpose of this study was to investigate both the rate of posterior extension in operatively managed Bankart lesions and the ability of MRI to identify such lesions prior to surgery. Methods: A retrospective review was conducted of patients undergoing operative management for a diagnosis of Bankart Lesion. All patients had a history of traumatic anterior shoulder dislocation. Patients with a history of known concomitant pathology in the ipsilateral shoulder, multi-directional instability, or prior shoulder surgery were excluded. All patients underwent a pre-operative arthrogram which was read by a trained MSK radiologist and reviewed by an orthopedic practitioner assessing for involvement of the posterior labrum. Operative dictations were then reviewed as a gold standard for posterior labral involvement. Follow up data was also reviewed to determine if posterior extension was a risk factor for post-surgical failure. Calculated rates of posterior involvement, as well as the ability of MRI arthrogram to detect posterior labral pathology were analyzed and compared via chi-squared tests. Results: Review yielded 95 shoulders with arthroscopy confirming an antero-inferior labral avulsion. Of these, 20% (19 shoulders) demonstrated involvement of the posterior labrum during arthroscopy. MRI arthrogram findings were equivalent to the arthroscopic findings 82.1% (78/95) of the time when read by a radiologist as compared to 91.6% (87/95) of the time when reviewed by a sports-trained orthopedist (p= .053). Posterior extension was detected in 8/19 (42.1%) of cases when the arthrogram was read by a radiologist alone compared to 16/19 (84.2%) of cases when the arthrogram as read by a sports-trained orthopedist (p= .007). There was no association between Bankart lesions with demonstrated posterior extension and those repairs that eventually went on to failure (p = .29). Conclusion: Propagation of a Bankart lesion into the posterior labrum is relatively common following shoulder dislocation, with data from this review demonstrating a rate of 20%. Based on our findings, careful assessment of the posterior labrum on MRI arthrogram may reveal the majority, but not all, of these lesions prior to surgery. Practitioners should maintain a high level of suspicion for posterior labral involvement, both for pre-operative planning and during operative management of traumatic shoulder dislocations.
Clinical Outcomes For Open Reduction Internal Fixation Of Midshaft Clavicle Fractures In Adolescent/post-adolescent Athletes Utilizing A Two Month Return To Play Protocol
Authors: Lindeman Robert W. , Lanier Brandon S. , Parsell Douglas E. , Ramsey James R. 
Published: July 2019

Objectives: The success rate and the return to sport after midshaft clavicle fracture has been shown to improve with open reduction internal fixation (ORIF) treatment versus non-operative management. The period of time for return to sport, post-ORIF, has been reported in the literature with considerable range. Return to sport times for NFL athletes are reported to typically require three to seven months, while professional cyclists have resumed training in only one week. As the percentage of clavicle fractures in athletes is likely dominated by the high school and college populations, it is clinically relevant to evaluate the success of specific return to sport protocols after clavicle ORIF with respect to age. To evaluate this aspect of care, a retrospective study utilizing an adolescent/immediate post-adolescent and an adult control patient was performed. Methods: A single surgeon performed locking plate ORIF of clavicle fractures with patient population of athletes, ages 13 to 22 years old (mean 16.7 yrs.), and an adult control group (mean 50.8 yrs.). A uniform period for return to sport of two months was utilized for the athlete group, unless complications were present. The athlete group contained 90 patients, and the adult control group contained 64 patients. The athlete group had 48% of fractures resulting from football. High energy mechanisms (auto accident, ATV accident, etc.) accounted for 23.3% of the athlete group fractures, while these mechanisms accounted for 46.9% of the adult group fractures. Post-operative complications and adverse outcomes were monitored for a minimum period of one year. Results: Clavicle fractures within both patient groups were dominantly midshaft fractures with 97.7% of the athlete fractures and 88.5% of the adult fractures being located midshaft. The athlete group exhibited minimal post-operative complication/adverse outcomes with one patient reporting pain with weightlifting and two patients requiring minor scar revisions, for a total complication/adverse outcome rate of 3.3%. The adult group included ten patients with significant residual pain and one patient requiring revision for non-union, yielding a total complication/adverse outcome rate of 15.6% in this group. Applying a Chi-square analysis, a statistically significant difference in complication/adverse outcome rates exist between the patient groups (p=0.003). Additionally, all patients in the athlete group, desiring to return to their sport, did so within the two-month post-operative period. Conclusion: Locking plate ORIF of midshaft clavicle fractures allowed for a successful two month return to sport, with a low occurrence of complications, for a young athlete patient group. High energy fracture events and an adult aged patient group were associated with higher rates of adverse clinical outcome.