bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiographic Analysis of Glenoid Morphology after Arthroscopic Latarjet vs Distal Tibial Allograft in the Treatment of Anterior Shoulder Instability
Authors: Wong Ivan H. , King JP , Boyd Gordon , Mitchell Michael , Coady Catherine M. 
Published: July 2018

Objectives: The Latarjet procedure for autograft transposition of coracoid to the anterior rim of the glenoid remains the most common procedure for reconstruction of the glenoid after shoulder instability. The anatomic glenoid reconstruction using distal tibial allograft has gained popularity and is suggested to better match the normal glenoid size and shape. However, there is concern for decreased healing and increased resorption using an allograft bone. The purpose of this study was to evaluate the arthroscopic reconstruction of the glenoid with respect to the size, shape, healing, and resorption of autograft coracoid vs allograft distal tibia. Methods: A retrospective review of 50 consecutive patients who had an arthroscopic boney reconstruction of the glenoid (13 coracoid; 37 distal tibial), diagnosed with anterior shoulder instability, and CT confirmed glenoid bone loss >20%. Pre-and post-operative CT scans were reviewed by two fellowship trained musculoskeletal radiologists for: graft position, glenoid concavity, cross sectional area, width, version, total area, osseous union, and graft resorption. Results: Graft nonunion was seen in 3 (23.07%) of the coracoid patients, and in 2 (5.4%) of the tibial allograft patients (OR 5.25; 95% CI: 0.768-35.89). Odds ratios comparing allograft to coracoid for overall resorption was 5.00 (CI: 1.276-19.597). Graft resorption greater than 50% was seen in 3 (8.11%) of the allografts and was absent within the coracoid patients. Graft resorption lesser than 50% was greater in both groups with 27 (72.97%) allograft and 6 (46.15%) coracoid patients. However, no statistically significant difference was found between the two procedures regarding AP diameter of graft (p=0.818) or graft cross sectional area (p=0.797). Conclusion: Arthroscopic anatomic glenoid reconstruction using distal tibial allograft showed greater boney union but higher resorption compared to coracoid autograft. Even so, there was no statistically significant difference between the two procedures regarding final graft surface area and size of grafts. These short-term results suggest distal tibial allograft as an alternative to coracoid autograft in the recreation of glenoid boney morphology.
Correlation of Patient Reported Outcome Measurement Information System Computer Adaptive Test (PROMIS-CAT) and Knee Injury and Osteoarthritis Outcome Score (KOOS) in Knee Osteotomy and Cartilage Procedures
Authors: Sherman Seth L. , Garrone Andrew James , Voss Elliott E. 
Published: July 2018

Objectives: PROMIS-CAT is a novel and efficient method for obtaining patient reported outcomes. Since its inception in 2007, PROMIS has been validated for several body joints, but correlations between PROMIS and orthopaedic legacy measures (i.e., KOOS) have not been evaluated for many knee procedures. The purpose of this study was to determine whether the PROMIS-CAT tool demonstrates correlation with KOOS for patients undergoing either osteotomy or cartilage procedures of the knee. Methods: After obtaining IRB approval, patients were identified who had undergone elective osteotomy (Tibial Tubercle Osteotomy [TTO], High Tibial Osteotomy [HTO], Distal Femoral Osteotomy [DFO]) and/or cartilage restoration (microfracture, DeNovo NT, Osteochondral Allograft Implantation [OCA], Autologous Chondrocyte Implantation [ACI], and meniscal transplant) procedures performed by a single surgeon. Eligible patients completed a series of outcome questionnaires including same day PROMIS-CAT for pain, mobility, physical function and KOOS domains for daily living, pain and sports and recreation. The scores were collected prospectively. Statistical analysis was performed using Spearman’s rank correlations. Results: A total of 212 data points (97 osteotomy, 53 cartilage, 62 combined) were identified to be used in the statistical analysis. Spearman’s rank correlations of all patient scores collected between PROMIS Pain and KOOS Pain (for Pain), PROMIS Mobility and KOOS Daily Living (for Mobility and Living), and PROMIS Physical Function and KOOS Sports and Recreation (for Activity) produced rho values of -0.841, 0.816 and 0.715, respectively. Among osteotomy only patients, Pain scores, Mobility and Living scores and Activity scores correlated with a rho value of -0.828, 0.776, and 0.701, respectively. In patients undergoing cartilage procedures who did not have an osteotomy procedure performed, Pain scores, Mobility and Living scores and Activity scores correlated with a rho value of -0.784, 0.860, and 0.651, respectively. Patients undergoing both osteotomy and cartilage procedures had Pain scores, Mobility and Living scores and Activity scores correlate with rho values of -0.826, 0.830, and 0.732, respectively. Conclusion: The PROMIS-CAT tool was found to correlate well with KOOS domains for patients undergoing osteotomy and/or cartilage procedures of the knee. PROMIS-CAT can be considered as an efficient and reliable method of collecting patient outcomes in this patient population. Advantages include reduced collection time and less of a ceiling effect than legacy outcome scores.
Demonstrating the Value of an ACL Registry
Authors: Maletis Gregory B. , Funahashi Tadashi Ted , Love Rebecca , Wyatt Ronald , Prentice Heather A. , Burfeind William , Paxton Liz 
Published: July 2018

Objectives: One purpose of a registry is to identify procedures or devices that have either good or poor outcomes and improve treatment outcomes through feedback to surgeons. In 2010 we initially reported the influence of graft choice on the risk of early revision after ACL Reconstruction (ACLR). In 2012 we reported a three times higher risk of revision if allograft was used rather than bone-patellar tendon-bone (BPTB) autograft. In subsequent studies of allografts, we have identified poorer results with BPTB allografts compared to soft tissue allografts and with soft tissue allografts irradiated with > 1.8 Mrads or processed with chemical methods. Patients < 21 years of age were also identified to be at particularly high-risk for revision if allograft tissue was employed. These registry findings were disseminated to surgeons within and outside our integrated healthcare system. The purpose of this study was to evaluate the impact of registry feedback on surgeon graft type selection. Methods: Feedback to surgeons on graft performance was presented through a variety of mechanisms including (1) peer-reviewed publications, (2) internal and external meetings and conferences (3) newsletters of study findings, (4) Risk calculators and (5) confidential individualized reports of surgeon’s outcomes. In addition, surgeon champions set a quality improvement goal to reduce allograft usage overall and specifically to decrease the use of high risk grafts and usage in high-risk patient groups. Allograft usage was monitored on a quarterly basis to determine if the target was achieved. Annual graft utilization from 2008-2015 is reported here as proportions, for the overall cohort and for high-risk subgroups. Results: Our integrated healthcare system’s ACLR registry currently includes over 35,000 patients. Beginning in 2008, the annual proportion of ACLR cases using an allograft increased with a peak of 45% in 2010. Allograft use has decreased in the ensuing years and was 33% in 2015, a decrease of 27%. High-risk graft usage decreased from 8% in 2011 to 5% in 2015 which is a 38% decrease. Allograft use in patients < 21 years of age decreased 68% from a high of 28% in 2009 to 9% in 2015. (see Figure) Conclusion: Translating registry findings into evidence-based clinical practice is the goal of a registry. In this study, we found that information derived from an ACL Registry and disseminated to the participants can directly influence the use of specific procedures or implants that are associated with poor outcomes. Registries can provide useful information that may ultimately be used to improve patient care.
Prospective Validation of Patient-Reported Outcomes Measurement Information Systems (PROMIS) CAT Scores in a Hip Preservation Population
Authors: Kollmorgen Robert , Lewis Brian , Mather Richard C. , Olson Steven 
Published: July 2018

Objectives: Current Hip Patient Reported Outcome Scores (PROs) are not universally obtained, centers use different forms to try to interpret treatment outcomes, and are limited by floor and ceiling effects. Legacy scores of Modified Harris Hip Score (mHHS), International Hip Outcome Tool (iHOT), and Hip Outcomes Score (HOS) are common place and used in the literature. Patient compliance for legacy PROs have been shown to limit proper data collection. PROMIS measures were developed through NIH funding, vetted against a population norm and PROMIS Computer Adaptive Testing (CAT) has been shown in recent literature to compare well with knee and shoulder legacy scores, and are completed in a quicker amount of time. We hypothesize that in a hip preservation population, the CAT PROMIS Profile V2.0 and PROMIS physical function (PF) would show high correlation with legacy scores of (mHHS, iHOT, and HOS). Methods: After obtaining IRB approval, power analysis revealed 86 patients were needed to detect a significant difference. 100 patients were prospectively enrolled. Patients were asked to complete the iHOT-12, mHHS, HOS and then complete the CAT PROMIS Profile v 2.0. Inclusion criteria for the current study included all Initial encounter and single follow-up patients that have completed the CAT portion and started the legacy scores before opting out. Exclusion criteria will be any patient with a repeat encounter, patients under the age of 18 or a patient that did not complete the legacy or CAT scores. Repeat encounters were excluded due to statistical analysis assuming independence among observers. Correlation between instruments was defined as excellent (>0.7), excellent-good (0.7-0.61), good (0.6-0.4), and poor (0.3-0.2). Results: Demographics of 75 females and 25 males, mean BMI 26.3, and mean age 36.1 (range 18-67). The PROMIS Physical function, Pain Intensity, and Ability to Participate in Social Roles showed excellent correlation with the iHOT-12 (r=0.71 P<0.001), mHHS (r=0.8 P<0.001) and HOS (r=0.82 P<0.001). Patients averaged 21.6 questions to complete all seven arms of the PROMIS Profile. No patient experienced a ceiling effect utilizing the PROMIS Profile CAT. Conclusion: The PROMIS Profile allows for an in-depth look at patients’ dysfunction, not asked in current legacy scores. The PROMIS Physical function and Pain Intensity show excellent correlation with iHOT-12, mHHS and HOS. The CAT PROMIS Profile, shows no observed ceiling effect and can be considered to replace current legacy measures in hip preservation.
Arthroscopic SLAP IIb Repair Using Knot-tying Versus Knotless Suture Anchors: Is There a Difference?
Authors: Arner Justin W. , De Groot Joseph , Bradley James P. 
Published: July 2018

Objectives: SLAP IIb surgical outcomes have traditionally been less predictable when compared to other shoulder injuries. Traditional knotted anchors may partially be to blame by abrading the rotator cuff leading to tearing and pain. Methods: Seventy-four athletes who underwent arthroscopic SLAP IIb repair with traditional (n=42) and knotless anchors (n=32) at minimum 2-year follow-up were evaluated. Demographic, surgical data, return to play (RTP), KJOC, ASES, stability, ROM, strength, and pain scores were compared. Results: Knotless anchors had slightly higher RTP (93.5%, 58.1% same level) vs. traditional (90.2%, 53.7% same level), but was not statistically significant. Knotless anchors were less likely to require revision surgery (9%) compared to traditional anchors (17%), but was not statistically significant. There was no difference in KJOC, ASES, stability, ROM, strength, and pain between the two anchor types (Table 1). Pain was the only variable linked to decreased RTP (p < 0.0001). Younger patients had significantly poorer KJOC (p = 0.02) and ASES scores (p = 0.02) but no difference in RTP. No difference in outcome measures or RTP was found with gender, age, overhead athletes, number of anchors, or sport type (Table 2). Average follow-up was 6.5 years. Conclusion: Knotless anchors required less revision surgery, had higher RTP, ASES, and KJOC scores; however, statistical significance was not achieved in this relatively small cohort. Further evaluation, such as case matching and assessment of a larger sample size should be done. Possible other advantages such as tensioning and surgical time may also be important when considering lower profile knotless fixation.
Outcomes After Arthroscopic Management of Subspinous Impingement in Borderline Hip Dysplasia
Authors: Feghhi Daniel , Bharam Srino , Shearin Jonathan 
Published: July 2018

Objectives: Arthroscopic management of femoroacetabular impingement in the setting of borderline hip dysplasia is controversial. There is concern for iatrogenic hip instability with rim-resection in an already structurally compromised acetabulum. Recently, there has been increased awareness of a prominent anterior inferior iliac spine (AIIS) resulting in subspinous impingement. The purpose of this study was to report on the outcomes of arthroscopic subspinous decompression in patients with symptomatic hip impingement and borderline hip dysplasia. Methods: An IRB approved retrospective study of patients with symptomatic hip impingement, borderline dysplasia (LCEA 18-24°) and prominent AIIS who failed conservative management and subsequently underwent arthroscopic subspinous decompression was conducted. Eighteen patients, 19 hips (4 male and 14 female, average age 28) were identified from 2012 to 2015. 3D-CT imaging was used to categorize AIIS morphology into Type 1, 2 or 3 (Hetsroni classification). Alpha angle and femoral version were determined as well. Patient-reported outcome scores (PROs) consisting of the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Sport-Specific Subscale (HOS-SSS) were obtained preoperatively and at an average of 44 months postoperative (range, 23-61 months). Results: There were no postoperative complications or symptoms of instability. Fourteen hips were of Type 2 AIIS morphology and 6 were categorized as type 1. Femoral osteoplasty was performed in 17 hips (average alpha angle 66°). Repeated measures ANOVA revealed a significant improvement in all PROs from preop to latest follow-up; (mHHS 64.7, 93.4, p< .001; HOS-ADL 62.1, 94.6, p< .001; HOS-SSS 26.5, 93.4 p< .001). An ANCOVA revealed patients with type 2 AIIS had a significantly higher post-op mHHS than those with a type 1 morphology; (88.3, 95.6, p< .01). Conclusion: Arthroscopic AIIS decompression in patients with co-existing borderline dysplasia and subspinous impingement leads to favorable outcomes without compromising hip stability.
Incidence of Heterotopic Ossification Among NFL Athletes Following Platelet-Rich Plasma (PRP) for Treatment of Core Muscle Injuries (CMI)
Authors: Poor Alexander Edward , Roedl Johannes B. , Zoga Adam C. , Meyers William C. 
Published: July 2018

Objectives: Platelet-rich plasma (PRP) therapy is an increasingly-popular treatment to promote healing in damaged tendons, ligaments, cartilage and muscles. Few studies analyze long-term effects of PRP. The authors have a busy practice treating core muscle injuries (CMI) and, in the last several years, have noticed an unusually high incidence of HO among patients with previous PRP injections for these injuries. The purpose of this study is to investigate PRP and heterotopic ossification in core muscle injuries. Methods: NFL players with core muscle injuries treated at a single institution during the 2015 season filled out questionnaires and were included in retrospective analysis. Heterotopic ossification was observed on MRI and intraoperatively and confirmed pathologically. Results: Five NFL players had previous PRP injections for core muscle injuries and 4/5 (80%)had HO. These were 2 linebackers and 2 cornerbacks. The fifth, a kicker, had no ossification but extensive fibrosis around the distal rectus abdominis and proximal adductors. These results are similar for all athletes with previous PRP injections treated around the same time period, 87% (13/15). The incidence of HO among all athletes without a previous PRP injection was 2/1088 (0.18%). Conclusion: Retrospective analysis may be overestimating the true incidence and we have yet to identify patterns related to the variations in PRP technique. But these preliminary results suggest the need for further research and a cautious approach to using PRP in the treatment of CMI.
Complete Radiographic Healing and Related Factors in Juvenile Osteochondritis Dissecans of the Talus
Authors: Gandhi Jigar S. , Park Kunbo , Talwar Divya , Lawrence John Todd R. 
Published: July 2018

Objectives: Rates of healing following treatment of juvenile osteochondritis dissecans (OCD) of the talus remain scarce. Additionally, there is a paucity of research into the outcomes associated with the treatment of these lesions. The purpose of this study was to evaluate radiographic healing of talar dome OCDs in adolescents. Methods: This was a retrospective review of patients ≤18 years of age with talar OCD from a single pediatric institution within a 12-year period. Charts and radiographs were reviewed for demographics and clinical data, lesion’s location and dimensions, and physeal status. The final radiologic healing was evaluated at 1-year follow-up. Complete and incomplete healing groups were compared using multivariable logistic regression models to examine the predictive effects for the independent variables. A nomogram was produced from the study sample to allow predictions to be made in individual patients. Results: Ninety-two lesions in 74 patients with mean age of 13.1 years (range 7.1 to 18.0 years) were analyzed. 60.8% of the patients were female. Thirty-three (41.8%) lesions were treated conservatively, and 59 (58.2%) were treated surgically (drilling, debridement, microfracture, bone grafting, or loose body removal). Thirty-nine (42.4%) lesions demonstrated complete healing. Patients with complete healing were younger ( p 0.032) and had lower BMIs ( p 0.006) compared to those with incomplete healing. In a multivariate regression model, the factors that correlated significantly were the age, BMI, Berndt and Harty’s stage at presentation and type of treatment (observation vs. surgical). Location and dimension of the lesion, physeal status (open vs. closed), presenting symptoms, and type of surgical procedure showed no association with likelihood of healing. A nomogram was developed using the independent variables that correlated significantly with the likelihood of complete radiographic healing (Figure 1). Conclusion: Complete radiologic healing of juvenile OCDs was more likely in patients with younger age and lower BMI. Although the difference in outcome between various surgical treatment types was not statistically significant, initial management with surgery was more likely to result in a complete healing compared to observation alone. To our knowledge, this is the first time a nomogram predicting outcome in terms of complete radiographic healing has been developed for juvenile OCD lesions of the talus. Besides its potential role in treatment decision making process, this nomogram can be used to counsel patients and their families with regard to the prognosis for healing. [Figure: see text]
Long-term Follow Up of Arthroscopically Repaired Meniscal Tears in a Pediatric Population
Authors: Hagmeijer Michella , Kennedy Nicholas I. , Tagliero Adam J. , Stuart Michael J. , Dahm Diane L. , Krych Aaron John 
Published: July 2018

Background: Meniscal repair is desirable over resection to prevent post-meniscectomy arthritis, especially in young and active patients. However, long-term data is currently lacking following meniscus repair, particularly in the pediatric population. Purpose: To report long-term follow-up of isolated meniscus tears treated by meniscal repair in a pediatric population, and to compare those results to previous mid-term follow-up data reported. We hypothesized that these patients would have satisfactory function and reoperation rates at long-term follow-up. Methods: Patients less than 18 that had a meniscal repair procedure performed between 1990 and 2005 were included. Concomitant ACL reconstructions were excluded from the present study. At the time of final follow-up, recurrent meniscus tear, reoperation rates, and IKDC and Tegner scores were determined. Wilcoxin signed ranks tests were performed to calculate the differences in clinical outcome for the 3 time points (pre-operative, average 7 years post-op, and average 18 years post-op) and Spearman coefficients were calculated for Tegner and IKDC with different variables. Results: At an average follow-up of 18 years (range 13.2 - 25.9 years), 34 patients with 35 isolated meniscus repairs (4F: 30 M) with an average age of 16 (9.9 - 18.7) were included in this study. Of the 35 knees (34 patients), none had “failed” or re-injured their affected meniscus since mid-term follow-up in 2008. The average IKDC score was 92.1 which was found to be significantly increased when compared to both preoperative IKDC 64.7 (P<.0001) and mid-term IKDC scores, 89.8 (p=.02). However, the average Tegner score (6.5) was significantly lower than both pre-operative 8.28 (p<.0001) and the mid-term Tegner average 8.25 (p<.0001). Patients with a meniscus re-tear and subsequent partial meniscectomy had lower IKDC scores than clinically successful repairs (88.9 vs 94.0), but this did not reach statistical significance (p=.09). There was no correlation for Tegner or IKDC values with 1) rim width, 2) current age, 3) time elapsed since surgery, or 4) time from injury to surgery. There were also no differences in Tegner or IKDC scores when comparing; medial versus lateral, left versus right, tear types, surgical repair technique, or male vs female. Conclusion: This study demonstrates very good clinical long-term outcomes following meniscal repair in a pediatric population.