bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Labral Reconstruction Prevent Osteoarthritis After Posterior Shoulder Instability: A Population-Based Study
Authors: Lee Julia , Woodmass Jarret Murray , Wu Isabella , Camp Christopher L. , Dahm Diane L. , Krych Aaron John 
Published: July 2018

Objectives: Diagnosis of and treatment for posterior shoulder instability (PSI) has improved with advances in surgical technique and radiographic imaging. It is unknown if PSI, or surgical measures to correct PSI, affect the progression of osteoarthritis in the glenohumeral joint. The purpose of this study is to evaluate the effect of posterior capsulolabral reconstruction (PCLR) and demographic risk factors on the rate of radiographic progression of osteoarthritis in shoulders with PSI. Methods: The study population included 115 patients (14 females, 101 males) diagnosed with PSI between January 1994 and July 2012 with an average follow up of 12.5years (range 5-23). Medical records were reviewed to evaluate patient demographics, surgical intervention, and radiographic progression of osteoarthritis. Kaplan Meier survival was used to estimate survival and Cox models were used to examine associations with osteoarthritis progression. Results: Overall, 16/115 (14%) patients had radiographic progression of glenohumeral arthritis with 5-year survival at 88.3% (95% CI 79.7%-97.3%). Age ≥30 at the time of instability was associated with arthritis progression (p<0.05). The number of previous dislocations, sport, and gender each did not affect progression (p>0.05). PCLR with at least one anchor along the posterior glenoid rim was performed in 56/115 (48%) of patients. There was no difference in the rate of radiographic arthritic progression in those who underwent PCLR and those who did not (7/56, 13% vs 10/59, 17%, p>0.05). One male patient who underwent PCLR progressed to end-stage arthritis, necessitating a shoulder arthroplasty at age 53. Conclusion: Radiographic progression of glenohumeral arthritis occurred 14% of patients with PSI. Age ≥30 at the time of initial instability was associated with radiographic progression of glenohumeral arthritis.
Correlation Between Synovial Fluid Biomarker Concentrations and Bone Marrow Edema Lesion Volume in Patients with Acute ACL Ruptures
Authors: Anil Utakarsh , Werner Jordan , Jejurikar Neha , Kenny Lena , Pham Hien , Liu James , Mastio Michele , Burke Christopher , Strauss Eric Jason 
Published: July 2018

Objectives: Bone marrow edema lesions (BMELs) frequently occur following acute anterior cruciate ligament (ACL) rupture secondary to the pivot-shift mechanism of injury. The aim of the current study is to evaluate whether synovial fluid biomarker concentrations are associated with bone edema lesion volume as measured by magnetic resonance imaging (MRI) in patients undergoing ACL reconstruction. Methods: A total of 53 patients (26 females, 27 males, mean age 35.0 years [range 18-59]) undergoing ACL reconstruction with MRI knee scans available for analysis participated in the study. Synovial fluid was collected intra-operatively and analyzed for 10 biomarkers hypothesized to be involved in inflammation and post-traumatic osteoarthritis. BMELs were identified on MRI and their volumes (cm3) were quantified on two independent occasions using FireVoxel imaging software for image segmentation and region-of-interest drawing. The correlation between synovial fluid biomarker levels and BMEL volume was evaluated using Spearman’s correlation coefficient. Measurement reliability was assessed using intraclass correlation coefficient (ICC) analysis. Significance was set at p<0.05. Results: Mean time from initial injury to synovial fluid aspiration was 319 days (std. dev. 892; range 15-4320) and mean lesion volumes were: tibial=6.4 cm3 (range 0-38.6); femoral=5.8 cm3 (range 0-34.0); total=12.2 cm3 (range 0-50.5). Measurement reliability of BMEL volume was excellent [ICC(2,1)=0.968 (CI 0.945-0.981)]. Analysis of patients with MRI within 30 days of injury (n=35) showed increased tibial BMEL volume was significantly (p<0.05) correlated to decreased concentrations of interleukin (IL)-6 (ρ=-0.481), IL-1 receptor antagonist (ρ=-0.361), and vascular endothelial growth factor (VEGF) (ρ=-0.397) and increased time from injury to aspiration was correlated to decreased concentration of IL-6 (ρ=-0.463), monocyte chemotactic protein-1 (ρ=-0.453), VEGF (ρ=-0.457), IL-1Ra (ρ=-0.448), and matrix metalloproteinase (MMP)-3 (ρ=-0.426). However, among all patients, synovial fluid biomarker levels had no significant correlations to BMEL volume or time from injury to aspiration. Conclusion: Analysis of synovial fluid at the time of ACL reconstruction demonstrated that increased volume of injury-associated BMEL on MRI performed within 30 days of initial injury was significantly correlated to decreased concentrations of pro-inflammatory and growth factor cytokines. These findings suggest that the impact of the pivot-shift mechanism of injury and presence of BMEL may have an affect the local joint microenvironment. [Table: see text]
Jones Fracture in the Elite Athlete: Patient Reported Outcomes following Fixation with BMAC
Authors: Carney Dwayne , Chambers Monique C. , Kromka Joseph James , LaBaze Dukens , West Robin Vereeke , Musahl Volker , Lesniak Bryson P. , Hogan MaCalus Vinson 
Published: July 2018

Objectives: Jones’ fractures, 5th metatarsal metaphyseal-diaphyseal junction fractures, are a debilitating injury for the elite athlete, particularly in cutting/pivoting sports. These injuries are usually managed surgically due to the high rate of nonunion and re-fracture. Despite primary screw fixation, delayed union and nonunion are not uncommon. Bone marrow aspirate concentrate (BMAC), an autologous source of hematopoietic and mesenchymal stem cells, has been used to augment healing due to the poor healing potential in the watershed region. We hypothesize that open reduction internal fixation (ORIF) augmented with BMAC will improve patient-reported outcome measures following Jones’ fractures in athletes. Methods: This study was a prospectively collected and maintained review of elite athletes that underwent intramedullary screw fixation augmented with BMAC for Jones’ fractures at an academic medical institution. All patients were evaluated preoperatively and postoperatively to assess differences in patient reported outcomes including VAS, PROMIS, FAAM, SF-12 scores, return to play, and complications. Student’s t test was used in statistical comparison of the preoperative and postoperative outcome scores. P < 0.05 was considered significant. Results: A total of 41 elite athletes were treated with ORIF with BMAC for a Jones fracture with a mean age of 25.59 years (range 19-42). There were 26 (63%) males and 15 females included in the study. Type of athlete ranged across the following sport activities: football, basketball, soccer, volleyball. Of note, patients had significantly improved with lower visual analog score for pain (mean Δ3.56, p= 0.001), higher FAAM scores (mean Δ 43.6, p< 0.001), and PASS scores (increased from 11% to 85%, p< 0.001) at 6 months. Additionally, patients showed improvement in SF12, PROMIS10, and FAAM scores at 12 months, although this was not statistically significant due to insufficient follow up at this time. The average numbers of days lost to competition was 131 days. All patients that have returned to elite competitive sport activity report minimal to no pain. Conclusion: Intramedullary screw fixation of Jones’ fractures with BMAC results in optimal surgical outcomes in the elite athlete. The use of patient reported outcomes continues to be a focus of quality measures and should guide clinical decision making for surgical intervention, return to play, and to assess impact of treatment. A higher powered and long-term study with validated patient-reported outcomes is needed to confirm our observations.
The Effect of Humeral and Ulnar Tunnel Placement on Achieving UCL Graft Isometry
Authors: Lall Ajay C. , Beason David P. , Dugas Jeffrey R. , Cain E. Lyle 
Published: July 2018

Objectives: The elbow medial ulnar collateral ligament (UCL) is frequently injured in throwing athletes, most commonly baseball pitchers. When conservative management fails, surgical intervention can allow the athlete to return to sport. While extensive research has been devoted to UCL graft incorporation and outcomes based on varying surgical techniques, there is a paucity of literature available addressing optimal bone tunnel placement in achieving medial UCL graft isometry. The purpose of this study is to assess the effect of humeral and ulnar bone tunnel placement on achieving UCL graft isometry through elbow range-of-motion. Methods: Ten fresh-frozen cadaveric upper extremities were dissected to expose the native UCL in its entirety. Three equidistant humeral and ulnar tunnels were created at each UCL footprint. Suture was passed between nine possible tunnel combinations for each elbow affixed to an isometry guage. Each elbow was moved through a 120-degree arc of motion for each tunnel combination at 0, 30, 60, 90, and 120 degrees. Measured changes in isometry gauge tension were recorded and analyzed using one-way analysis of variance (ANOVA) with Tukey’s HSD for pairwise comparisons. A p-value of 0.05 was used to determine significance for all tests. Results: There was an overall significant effect (p < 0.0001) of tunnel placement at all degrees of flexion measured. Pairwise comparisons revealed increases in displacement between the central and posterior tunnel positions of the medial epicondyle, with significant differences (p=0.0009) occurring when paired with both the central and posterior aspect of the sublime tubercle. Profound differences (p < 0.0001) were noted between the anterior and posterior humeral tunnel positions. No significant differences noted between ulnar tunnel locations at any humeral location. Figure 1: Tunnel placement in the central part of the medial epicondyle (Centralepi) was generally the most isometric grouping, with Centralepi - Anteriortub being the most isometric combination of all. Data are represented as mean +/- SEM. Conclusion: Isometric graft placement of the medial elbow UCL is undoubtedly dependent upon optimal tunnel placement and even slight deviations from the native centroid at either the medial epicondyle or sublime tubercle can possibly lead to early graft failure or abnormal joint kinematics. This information can aid surgeons in performing isometric single bone tunnel UCL reconstruction or repair procedures in the future.
Performance and Return to Sport Following Ulnar Nerve Transposition/Decompression in Professional Baseball Players
Authors: Erickson Brandon J. , Chalmers Peter Nissen , D’Angelo John , Ma Kevin , Romeo Anthony A. 
Published: July 2018

Background: Isolated ulnar nerve decompression/transposition is an uncommon surgery amongst professional baseball players. Purpose: To determine the rate of return to sport (RTS) and performance upon RTS in professional baseball players following isolated ulnar nerve decompression/transposition, including those who required an ulnar nerve transposition/decompression following ulnar collateral ligament reconstruction (UCLR), and to determine if outcomes differ between players with isolated ulnar nerve decompression/transposition and matched controls. Hypothesis: There is a high rate of RTS in professional baseball players undergoing isolated ulnar nerve decompression/transposition with no significant difference in RTS rate or performance (specifically related to the primary outcome performance variables of earned run average (ERA), WHIP ((walks +hits)/innings pitched), wins above replacement (WAR), and on base + slugging percentage (OPS)) between cases and controls. Methods: All professional baseball players who underwent isolated ulnar nerve decompression/transposition 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 players, 83% pitchers (14 who underwent prior UCLR) were included. Most surgeries (92%) were anterior subcutaneous transpositions. Overall, 62% of players were able to successfully RTS and 56% returned to the same or a higher level. There was no significant difference between cases and controls in the majority of performance metrics pre-operative or post-operatively, specifically ERA, WHIP, WAR, and OPS. When players who had a UCLR prior to their ulnar nerve transposition/decompression were compared to controls with a history of a UCLR but who did not go on to have an ulnar nerve transposition/decompression, the only performance difference of all the recorded metrics was cases allowed more walks per 9 innings (4.4 vs. 2.8; p=0.011). Conclusion: Anterior subcutaneous transposition is the most common surgery in professional baseball players to address ulnar nerve compression. Players have a 62% rate of RTS. Upon RTS, players performance compared to matched controls remains the same in the majority of performance metrics including ERA, WHIP, WAR, and OPS. Post-operatively, pitchers with a UCLR prior to ulnar nerve transposition/decompression performed the same as matched controls with prior UCLR.
Type VIII Slap Repair: Patient-Reported Outcomes Of 34 Patients With Minimum 4-year Follow-up
Authors: Arner Justin W. , Fourman Mitchell Stephen , Bayer Steven , De SA Darren L. , Vyas Dharmesh , Bradley James P. 
Published: July 2018

Objectives: Type VIII superior labrum anterior posterior (SLAP) tears - described as SLAP II injuries with posterior extension of the labral tear to the 6 o’clock aspect of the glenoid - have been shown in short-term outcome work to be a source of noted shoulder instability, pain, and reduced function/range of motion in both throwing and non-throwing athletes. Limiting our evaluation and effective treatment of these injuries in both the professional athlete and weekend warrior is our lack of mid- and long-term post-operative outcomes after surgical repair. It is hypothesized that Type VIII SLAP repairs would fare poorly, particularly in the throwing cohort, at mid- to long-term follow-up. Methods: With a minimum 4-year follow-up after Type VIII SLAP repair by a single surgeon, return to sport, KJOC, ASES, stability, range of motion, and pain were compared between throwers, contact, and non-contact athletes. Results: With an average follow-up of 6.2 years, 34 athletes (19 throwers, 5 contact athletes, 10 non-contact athletes), with a mean age of 24.4 years were evaluated. Significant (p < .0001) improvements were observed between pre- and post-operative pain, range of motion, and ASES total and functional scores in throwers and non-throwers. Stability improved but was not significant (Table 1). There were no post-operative differences between throwers and non-throwers (Table 2). Pre-operative ASES functional score was significantly lower in contact athletes than in throwers and non-contact athletes (p < .01), but post-operatively improved significantly with no difference between groups (Table 3, 4). Overall, there was no difference in return to sport between groups as 73.7% of throwers and 93.3% of non-throwers returned (Table 4) and 62.5% of throwers and 57.9% of non-throwers (p = .73) returned to the same level. Further, 89.5% of throwers and 100% of non-throwers (p = .49) said that their surgery was worthwhile. Conclusion: Given the paucity of literature, current surgical outcomes of athletes who have undergone Type VIII SLAP repairs is limited, particularly in mid- and long-term function and return to sport. The current findings suggest that surgical repair of Type VIII SLAP lesions contributes to significant improvements in pain, function, and shoulder range of motion that persists >4 years after repair. However, stability changes after injury appear more chronic in nature. Further, thrower and non-throwers appear to have similar outcomes, which has not previously been seen in short term studies. [Table: see text][Table: see text][Table: see text][Table: see text]
Effectiveness of ASA for VTE Prophylaxis in Arthroscopic Rotator Cuff Repair
Authors: Austin Luke , Wowkanech Charles Dante , Cypel Bret , Alyea Eric Gordon , Gaston Tara , Pontes Manuel , Williams Gerald R. 
Published: July 2018

Objectives: Venous thromboembolic disease (VTED) is a rare complication following arthroscopic rotator cuff repair (RCR). Historical rates of symptomatic VTED after arthroscopic shoulder surgery, DVT and PE, are 0.26%, and 0.01-0.21%, respectively. At present, the American Academy of Orthopaedic Surgeons (AAOS) and American College of Chest Physicians (ACCP) have no prophylaxis guidelines specific to shoulder arthroscopy. Despite this, many surgeons prescribe Aspirin (ASA) for chemical prophylaxis following RCR. The efficacy of ASA as a thromboprophylaxis after shoulder arthroscopy is unknown, but there are risks associated with its’ use. The purpose of this study is to evaluate the effectiveness of chemical prophylaxis (ASA) and mechanical prophylaxis vs. mechanical prophylaxis alone in preventing VTED following RCR. Methods: A total of 914 patients underwent RCR between the months of January 2010 and January 2015. A retrospective case control study was performed. The control group (n=484) consisted of patients treated with perioperative mechanical VTED prophylaxis (compression boots) and early mobilization. The study group (n=430) also utilized perioperative mechanical prophylaxis and early mobilization, and added chemical prophylaxis (ASA 81 mg daily) for four weeks after surgery. The primary outcome was symptomatic VTED (DVT/PE). Chart records were collected and evaluated for six months after surgery. Patient demographics and other surgical complications were also analyzed. Results: A total of 7 VTED events occurred during the study period, 6 DVTs and 1 PE. The total rate of VTED was 0.88%, DVT was 0.77%, and PE was 0.11%. There was no significant different between DVT (p=0.88, 95% CI= -1.36% - 1.65%) or PE (p=0.45, 95% CI = -0.77% - 1.50%) between the control and study groups. The control group (no ASA) recorded an incidence of 0.62% DVT and 0.00% PE. As compared to the study group (ASA), which recorded an incidence of 0.47% DVT and 0.23% PE. The control group had significantly greater number of documented current smokers (8.68% vs 3.72%, p= 0.0003). The study group had a statistically significant higher mean age of subject (59.1 vs 57.7, p=0.0055), as well as more subjects undergoing revision RCR surgery (4.67% vs 1.86%, p= 0.021). Conclusion: Based on our study of 914 patients, ASA does not provide a clinically significant reduction in VTED rates in patients undergoing RCR. We conclude that the use of mechanical prophylaxis and early mobilization is a sufficient method of VTED prophylaxis in this low risk population.
Biomechanical Analysis of All-Suture Anchor Fixation for Rotator Cuff Repair
Authors: Bernardoni Eamon , Frank Rachel M. , Veera Shreya S. , Griffin Justin W. , Waterman Brian Robert , Shewman Elizabeth , Cole Brian J. , Romeo Anthony A. , Verma Nikhil N. 
Published: July 2018

Objectives: Suture anchors are commonly utilized during arthroscopic rotator cuff repair (RCR). Recently, all-suture suture-anchor (ASSA) constructs have been introduced for RCR; however, the biomechanical properties of these implants are poorly understood. The purpose of this study was to compare the biomechanical properties of ASSA to conventional suture anchor (CSA) fixation during RCR. Methods: Fourteen fresh-frozen matched pair human cadaveric shoulders (average age 52 ± 13 years) with no documented prior rotator cuff tears or shoulder surgery were dissected. The supraspinatous tendon was isolated and detached from its footprint, and then was repaired in an anatomical position. Specimens were randomized into two repair constructs: Q-FIX double-loaded ASSA (N=7) and TWINFIX double-loaded conventional suture anchor (CSA) (N=7) (Smith & Nephew, Andover, MA). Each construct was cyclically loaded from 10 to 160 N for 100 cycles at 100N/s, and then pulled to failure at 1mm/s starting from the zero position. Load, crosshead displacement, failure mode, and time were recorded. Correlations between BMD, tendon gage length, maximum load, and stiffness were assessed. The groups were statistically analyzed with independent samples t-test, Fisher’s exact test, and a linear regression analysis, with p<0.05 considered significant. Results: There was no statistically significant difference in maximum load (ASSA: 617.73±177.8, CSA: 545.13±212.98 N, p=0.339), cyclic extension (ASSA: 7.88±1.33, CSA: 8.49±2.14 mm, p=0.117), construct stiffness (ASSA: 62.43±11.06, CSA: 68.14±10.77 N/mm, p=0.973), or extension at maximum load (ASSA: 17.03±4.73, CSA: 15.45±1.73 mm, p=0.122) between the ASSA and CSA groups. Failure modes consisted of suture tearing out of the tendon (ASSA: N=3, CSA: N=3) and anchor pull out (ASSA: N=4, CSA: N=4), with no difference in failure mode between groups (p=0.99). An association trended towards significance between higher BMD and higher maximum load in the CSA group (p=0.053) but not the ASSA group (p=0.125) Conclusion: ASSA constructs for RCR have similar biomechanical properties compared to CSA constructs. Additional clinical data is necessary to determine if these biomechanical results can be translated clinically.
Resolution of Large Outer Retinal Fold Following Retinal Detachment Surgery With Visual Acuity Restoration to 20/20: A Case Report and Literature Review
Authors: Alhabshan Rashed , Sabbagh Osama , Patronas Marena 
Published: July 2018

Purpose: To report a case of macular fold formation following surgical repair of rhegmatogenous retinal detachment in a 57-year-old man treated with pars plana vitrectomy (PPV), subretinal fluid endodrainage, gas-fluid exchange and sulfur hexafluoride tamponade, and postoperative face-down positioning. We also discuss etiology and prevention of macular fold following retinal detachment surgery and review the literature regarding current trends in the management of this complication. Methods: Case report and literature review. Results: The macular fold has resolved spontaneously with eventual flattening of and restoration of vision to 20/20 at 12 months postoperatively. Conclusions: This case and other recently published reports suggest good outcomes with conservative management of outer retinal folds and partial thickness macular folds. Further research is needed to identify clinical and imaging features that could be used to build criteria to guide management of this complication.
Highly cytotoxic natural killer cells are associated with poor prognosis in patients with cutaneous T-cell lymphoma
Authors: Mundy-Bosse Bethany , Denlinger Nathan , McLaughlin Eric , Chakravarti Nitin , Hwang Susan , Chen Li , Mao Hsiaoyin Charlene , Kline David , Youssef Youssef , Kohnken Rebecca , Lee Dean Anthony , Lozanski Gerard , Freud Aharon G. , Porcu Pierluigi , William Basem , Caligiuri Michael A. , Mishra Anjali 
Published: July 2018

Key Points
Paradoxically higher NK-cell activity in CTCL patients is associated with increased expression of phosphorylated STAT5. These highly effective NK cells are associated with poor prognosis in patients with leukemic CTCL.