bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quadriceps Tendon Autografts Have A Lower Early Graft Failure Rate Than Hamstring Tendon Autografts When Performing Transphyseal ACL Reconstructions
Authors: Pennock Andrew T. , Johnson Kristina Parvanta , Chambers Henry G. , Bastrom Tracey P. , Badrinath Raghav , Turk Robby , Dennis M. Morgan , Edmonds Eric W. 
Published: July 2019

Objectives: It is unclear what the optimal graft choice is for performing a transphyseal ACL reconstruction in a skeletally immature patient. The purpose of the current study was to evaluate outcomes and complications of skeletally immature patients undergoing an ACL reconstruction with hamstring tendon autograft versus quadriceps tendon autograft. Methods: Between 2012 and 2016, 104 skeletally immature patients from a single institution underwent a primary transphyseal ACL reconstruction with either quadriceps tendon autograft or hamstring tendon autograft based on surgeon preference. Patient demographic, injury, radiographic, and surgical variables were documented. Outcome measures included Lysholm score, SANE score, pain score, satisfaction, return to sport, and complications such as graft tears and physeal abnormalities. Results: Ninety patients (87%) including 62 hamstring tendon reconstructions and 28 quadriceps tendon reconstructions were available for a minimum follow-up of 2 years. The mean age of the patients was 14.8±1.3 years. No differences in chronologic age, bone age, gender, patient size, or mechanism of injury were noted between patient groups. There were no differences in surgical variables except the quadriceps tendon grafts were larger than the hamstring tendon grafts (9.6 mm vs 7.8 mm; p<0.001). Patient outcomes at a mean follow-up of 2.8 years revealed no differences based graft type with a mean Lysholm score, SANE score, pain score, satisfaction, and Tegner score were 95, 91, 0.8, 9.3, and 6.9 respectively. While there were no physeal complications in either group, patients undergoing a hamstring tendon autograft reconstruction were more likely to tear their graft (19% vs 0%; p= 0.01). Conclusion: Skeletally immature patients undergoing an ACL reconstruction can be successfully managed with either a quadriceps tendon autograft or a hamstring tendon autograft with good short-term outcomes, relatively high rates of return to sport, and low rates of physeal abnormalities. The primary differences between grafts were that the quadriceps tendon grafts were larger and were associated with a lower retear rate. Although a relatively new graft source for skeletally immature ACL reconstructions, the quadriceps tendon is not only a viable graft option, but it may be superior to the hamstrings tendon when it comes to early graft failures.
Failure and Reoperation Rates Following Arthroscopic Primary Repair Versus Reconstruction of the Anterior Cruciate Ligament
Authors: van der List Jelle P. , Jonkergouw Anne , DiFelice Gregory S. 
Published: July 2019

Objectives: To compare the failure and reoperation rates of arthroscopic primary repair versus reconstruction of the anterior cruciate ligament (ACL). Methods: This study retrospectively reviewed all patients with ACL injury operatively treated between April 2008 and May 2016 by one surgeon. All patients with proximal tears were treated with primary repair using suture anchors, or otherwise underwent standard reconstruction. Patients were included if minimum two-year follow-up was present, and were excluded for multiligamentous injuries. Charts were reviewed and patients were contacted to assess failure (instability, graft rupture or revision), reoperation (other than revision), complications and contralateral failure. Results: 154 patients were included of which 56 underwent primary repair (36.4%). Mean age was 30 years (range 14-57), 70% was male and mean follow-up was 3 years (range 2-9). Patients undergoing ACL reconstruction were younger (28 vs. 33, p=0.002) and were more often male (77% vs. 59%, p=0.02). Failure rates were lower following primary repair (10.7%) than ACL reconstruction (12.2%) but this was not statistically significant (p=0.776). Also, no clinical relevant or statistical significant differences were found between repair and reconstruction in reoperations (7.1% each group), complications (1.8% vs. 3.1%, respectively) and contralateral failures (3.6% vs. 4.1%, respectively) (all p>0.99). With revision surgery, no complications were noted following primary repair revision (primary reconstruction; 0%) but 25% of revision reconstructions failed and 1 needed reoperation (8%). Conclusion: This study is the first study to compare the failure and reoperation rates following arthroscopic primary repair versus reconstruction in a large cohort of patients. With the treatment algorithm of primary repair for proximal avulsion tears and reconstruction of midsubstance tears, equivalent outcomes were noted between both treatments. Arthroscopic primary repair is a safe and good treatment for ACL injuries and has similar failure and reoperation rates when compared to the gold standard of ACL reconstruction.
Distalization Of Tibial Tubercle For Patella Stabilization: Does Length Of Distalization Or Residual Patella Alta Effect Outcome?
Authors: Schmiesing Andrew , Engelking Marta , Agel Julie , Arendt Elizabeth A. 
Published: July 2019

Objectives: Distalization of the tibial tubercle (DTT) is a surgical procedure to help stabilize the patella when patella alta is present. The purpose of this study is to: evaluate the accuracy of our operative intervention (i.e. how often is patella height normalization achieved). correlate post-operative (residual) patella alta with recurrent patellar instability correlate the mm of distal displacement with negative outcomes Methods: Data was collected retrospectively on consecutive patients who underwent DTT as part of their surgical procedure for recurrent lateral patella dislocation. All patients had concurrent medial patella ligament reconstruction (MPFLR), performed by a single surgeon between 2009-2015. Data collected included demographics, pre-and post-operative imaging measurements related to patella alta and trochlear dysplasia on MRI and plain radiographs, recurrent lateral patella dislocations, and complications including fracture and knee arthrofibrosis. Surgical planning including the assessment of the Caton-Deschamps index (CD) on sagittal radiographic imaging. The surgical goal was to have a final CD between 1.0 -1.2, or a maximum distance moved of 15 mm in cases of severe patella alta. When CD was within normal limits due to patellar anatomy, we used as a proxy the patellar-trochlear index (PTI), aiming for a PTI of 25% judged intra-operatively. Results: 89 patients underwent DTT over a 7-year period. There were 21 (24%) males/68 (76%) females. Mean (range): age 21 (13-45), BMI 25.8 (17-44.6). Pre-op imaging measurements were: IS ratio 1.5 (1.18-2.06), CD ratio 1.4 (1.05 -1.93), lateral patella tilt 24.7º (1º-53º), TT-TG 18.6 mm (8-28), sulcus angle 158º (123-180), PTI 29% (5-70). Post-operative mean CD was 1.09 (0.92 -1.67). The amount of distalization averaged 9.8 (range 4 to 15). 13 patients had residual patella alta (CD>1.2). One patient with residual patella alta re-dislocated (CD=1.25). The most extreme residual patella alta (1.67) had a pre-op CD of 1.97 and was distalized 15 mm. There was no patellar baja. 6 patients (6%) had frank recurrent patellar dislocation; postoperative patella height in this group averaged 1.11 (1.02 -1.25), indicating that re-dislocation was not due to residual patella alta. Tibia fracture (4%) was not related to mm of distalization; mean (10) /range 8-15 mm. Arthrofibrosis requiring manipulation was needed in 11 patients (13%) whose mean distalization was 11.8 mm (9-15 mm). This distance was significantly different (p=0.009) from those not requiring manipulation. Conclusion: Distalization of TT leads to a high rate of normalization of patellar height measurements, with 94% patella stabilization. Residual patella alta was not associated with an increased risk of recurrence (p=0.57). Distalizing the tibial tubercle up to 15 mm did not increase fracture risk, however there was an increase in arthrofibrosis requiring manipulation.
Risk Factors and Outcomes of Revision Arthroscopic Posterior Shoulder Capsulolabral Repair in Contact Athletes
Authors: Arner Justin W. , Jayakumar Sachidhanand , Vyas Dharmesh , Bradley James P. 
Published: July 2019

Objectives: Risk factors and outcomes of revision arthroscopic posterior capsulolabral repairare currently not well defined in contact athletes.Evaluation of risk factors for contact athletes who require revision arthroscopic posterior unidirectional capsulolabral repair is needed. Methods: A total of 186 contact athletes’ shoulders that underwent arthroscopic posterior capsulolabral repair at minimum 2 year follow-up were reviewed. Those who required revision surgery were compared with those who did not. Parameters assessed included age, gender, labral and/or capsular injury, level of sport, and return to sport. Glenoid bone width, bone version, labral width, and labral version were also compared. Results: Eleven shoulders required revision surgery (5.9%) at mean 12.0 year follow-up. The only significant risk factor was glenoid bone width (revision=26.4 mm vs. non-revision=29.1 mm, p=0.005). Cartilage version (p=0.676), labral version (p=0.539), and bone version (p=0.791) were not significantly different between groups, nor was labral width (p=0.751). Gender (p=0.326), labral injury (p=0.349), capsule injury (p=0.683), and level of sport (p=0.381) were not significant factors for requiring revision surgery. Both return to sport at the same level (revision=16.7% vs. non-revision=72.1%, p<0.001) and overall return to sport (revision=50% vs. non-revision=93.7%, p<0.001) was significantly worse in the revision group. Of those who had revision surgery, 33.3% stated their original surgery was not worthwhile, which was significantly higher than the 4.5% in the non-revision group (p=0.041). Conclusion: Contact athletes underwent revision arthroscopic posterior capsulolabral repair at an incidence of 5.9% at 12 year follow-up. The only significant risk factor for requiring revision surgery was smaller glenoid bone width. Return to play was significantly worse in those who required revision surgery. This data is essential for patient selection, optimal treatment techniques, and patient education as posterior shoulder capsulolabral repair in contact athletes that require revision has not previously been evaluated.
Best Practice Guidelines for Hip Arthroscopy in Femoroacetabular Impingement: Results of a Delphi Process
Authors: Lynch Thomas Sean , Minkara Anas , Aoki Stephen Kenji , Bedi Asheesh , Bharam Srino , Clohisy John C. , Harris Joshua David , Larson Christopher M. , Nepple Jeffrey J. , Nho Shane Jay , Philippon Marc J. , Rosneck James T. , Safran Marc R. , Stubbs Allston J. , Westermann Robert W. , Byrd J. W. Thomas 
Published: July 2019

Objectives: Treatment algorithms for the arthroscopic management of femoroacetabular impingement syndrome (FAI) remain controversial due to a paucity of evidence-based guidance. Consequently, significant variability in clinical practice exists between different practitioners, necessitating expert consensus. The purpose of this study is to establish Best Practice Guidelines (BPG) using formal techniques of consensus building among a group of experienced hip arthroscopists driven by the results of a systematic review and meta-analysis. The scope of these guidelines includes preoperative recommendations, intraoperative practices, and postoperative protocols. Methods: The validated Delphi process and nominal group technique (NGT), utilized by the Centers for Disease Control and peer-reviewed orthopedic literature, were used to formally derive consensus among 15 surgeons in North America. Participants were surveyed for current practices, presented with the results of a meta-analysis and systematic literature review, and asked to vote for or against inclusion of non-leading, impartially-phrased items during three iterative rounds while preserving the anonymity of participants’ opinions. Agreement greater than 80% was considered consensus, and items near consensus (70%-80% agreement) were further queried using the NGT in a moderated group session at the American Orthopaedic Society for Sports Medicine (AOSSM) annual meeting. Results: Participants had a mean of 12.3 years of practice (range: 1-29 years) and performed an annual mean of 249 (range 100 to 500+) hip arthroscopies, with a combined total of approximately 52,580 procedures. Consensus was reached for the creation of BPG consisting of 27 preoperative recommendations, 15 intraoperative practices, and 10 postoperative protocols. The final checklist was supported by 100% of participants. Conclusion: We developed the first national consensus-based Best Practice Guidelines for the surgical and nonsurgical management of FAI. The resulting consensus items can serve as a tool to reduce the variability in pre-, intra-, and postoperative practices and guide further research for arthroscopic management of FAI.
Can Combined Trans-physeal and Lateral Extra-Articular Pediatric ACL Reconstruction Techniques Be Employed to Reduce ACL Re-Injury While Allowing for Growth?
Authors: Ellis Henry B. , Boes Nathan , Mitchell Parker , Wyatt Charles , Wilson Philip L. 
Published: July 2019

Objectives: To describe outcomes, including failure rates, following a pediatric ACL reconstruction (ACLR) employing combined trans-physeal technique with hamstring autograft (TPH) and a hybrid extra-articular technique using iliotibial band autograft (ITB). Methods: Consecutive skeletally immature patients undergoing combined TPH/ITB ACLR from 1/2012 to 4/2017 were reviewed. With the goal of decreasing ACL graft re-injury in this high-risk group; this technique employed anterior-medial portal drilling for TPH, with an extra-osseous femoral ITB technique and intra-articular combined TPH/ITB grafts fixed within the tibial bone tunnel (Figure 1). Inclusion required a minimum 12 months follow up; exclusions were prior knee surgery and multi-ligamentous injury. Demographics, bone-age (hand), standing alignment XR for growth and mechanical axis grade, and PROs were documented. T-tests, Mann-Whitney tests, and Spearman’s correlation coefficients were employed. Results: 60 knees in 59 adolescents underwent the combined TPH/ITB ACLR, with 49 knees meeting inclusion criteria with a mean follow up = 23 months (r = 12-48 m). Only 1/49 knees (2%) sustained ACL re-injury. Mean age was 12.9y (11-16y) with 29 males (mean bone-age = 14.1) and 19 females (mean bone-age =13.3). There was a high level return to pre-operative sport. No families reported cosmetic, functional alignment or length concerns, and no clinical deformity was diagnosed. Outcome measures at final follow up indicated a high functional level with a mean Pedi-IKDC = 90.39 and mean Pedi-Fabs = 22.66. To critically assess growth, a cohort of 22 knees (mean age = 12.8y) with > 18 months of growth remaining at surgery were evaluated at maturity. No difference was seen in mean operative and non-operative leg growth (54.1 mm and 53.0 mm). One patient, 1/22 (4.5%), had a final LLD > 10 mm (12 mm), and peri-operative alignment difference [0-GII (central compartment) valgus]. Growth and alignment were not significantly associated with age, bone age, height, weight, demonstrated growth, or pre-operative alignment. Conclusion: Combined TPH/ITB ACLR in adolescent patients resulted in return to high activity levels (Pedi-Fabs = 22.66), and a low (2%) re-injury rate at an average of 23 months. A novel pediatric ACLR employing combined trans-physeal hamstring and extra-osseous iliotibial band grafts merits further study as a technique for reducing re-injury in high-risk, growing adolescents by maximizing articular graft size while adding anterior-lateral rotational knee control. [Figure: see text]
Long-term Results after Repair of Isolated Meniscus Tears in Patients 18 Years and Younger: An 18-Year Follow-up Study
Authors: Hagmeijer Michella , Kennedy Nicholas I. , Tagliero Adam J. , Levy Bruce A. , Stuart Michael J. , Saris Daniël B. , Dahm Diane L. , Krych Aaron John 
Published: July 2019

Objectives: Meniscus repair is desirable over resection to prevent post-meniscectomy arthritis, especially in young and active patients. However, long-term data is currently lacking following isolated meniscus repair, particularly in the pediatric population. The purpose of this study was to report long-term follow-up of isolated meniscus tears treated by meniscus 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 undergoing repair of an isolated (without concomitant ACL injury) meniscus tear performed between 1990 and 2005 were included. At the time of final followup, recurrent tear, reoperations, and IKDC and Tegner scores were determined. With logistic regression, the overall failure between different tear types was calculated. Wilcoxon signed ranks tests were performed to calculate the differences in clinical outcome for different time-points, and Spearman coefficients were calculated for Tegner and IKDC with different variables. Results: At an average followup of 17.6 years (13.1 - 26.0 years), 32 patients with 33 isolated meniscus repairs (29 M: 3F) with an average age of 16.1 (9.9 - 18.7) were included in this study. At early follow-up, complex tears (80%) had a higher overall failure rate compared to simple tears (18.2%). However, no further failures occurred since mid-term follow-up with any tear type. At final follow-up, the average IKDC score was 92.3, which was significantly increased when compared to both preoperative 65.3 (p< 0.0001) and mid-term scores, 90.2 (p= 0.01). However, the average Tegner score (6.5) was significantly lower than both pre-operative 8.3 (p< 0.0001) and mid-term 8.4 (p< 0.0001) scores. There was no correlation for Tegner or IKDC values with any risk factors. Conclusion: In conclusion, this study demonstrates overall good to excellent long-term clinical outcomes following isolated meniscus repair in a pediatric population. Early failure and reoperation rates were variable depending on tear type, with complex multiplanar tears having more failures at short-term follow-up. However, at long-term follow-up, IKDC and Tegner scores were not significantly different for those with complex tears compared to other tear types.
Return-to-Play after Concussion in American versus European Professional Soccer Players: A Comparative Short-Term Analysis of Performance and Longevity
Authors: Ramkumar Prem N. , Navarro Sergio M. , Haeberle Heather S. , Jang Albert S. , Frangiamore Salvatore Joseph , Farrow Lutul D. , Schickendantz Mark S. , Williams Riley J. 
Published: July 2019

Objectives: Many studies have focused on the long-term impact of concussions in professional sports, but few have investigated short-term effects. This study examines concussion effects on individual players in the Major League Soccer (MLS) and English Premier League (EPL) by assessing 1) return-to-play (RTP) time, 2) career length, and 3) performance. Methods: Contracts, transactions, injury reports, and performance statistics from 2008-17 were obtained from the official MLS and EPL online publications. Players who sustained a concussion were compared with the 2008-17 non-concussed player pool. Career length was analyzed using Kaplan-Meier survival curves and athletes were stratified by player age, experience, and longevity. Player performance changes were evaluated between the years before versus after concussion. RTP and games missed were analyzed and compared. Results: Of the 1,784 eligible MLS and 2,001 eligible EPL players evaluated over the 10-year period, 102 MLS players sustained 165 concussions and 124 EPL players sustained 142 concussions resulting in injury protocol initiation. MLS players on average missed 7.5 games after a concussion, with 33.5 days missed, whereas EPL players on average missed 0.5 games after a concussion with 9.5 days missed, which was statistically different (p<0.001, p<0.0001). Performance was reduced at all non-goalie positions for goals and assists post-concussion for players in the MLS and in the EPL (p < 0.01). Concussed MLS players playing non-goalie positions scored 2.5 points/year less following a concussion and played in 20 fewer games/year on average. Concussed EPL players playing non-goalie positions scored 3.1 points/year less following a concussion and started in 5.8 fewer games/year on average. Concussed MLS and EPL goalies saw no significant change in performance, although EPL goalies played 3.2 additional games/year on average (p <0.05). The probability of playing a full season post-concussion was not significantly decreased compared with the non-concussed pool (p > 0.05) in both leagues Conclusion: This study investigating the short-term effects of concussion on professional soccer players demonstrates that performance is reduced for non-goalie players, without a significant difference in career longevity between concussed and non-concussed controls.
The Effectiveness of Mandated Headgear Use in High School Women’s Lacrosse at Reducing the Rate of Head and Face Injuries
Authors: Baron Samuel L. , Veasley Shayla J. , Kingery Matthew T. , Alaia Michael J. , Cardone Dennis A. 
Published: July 2019

Objectives: There has been continued controversy regarding whether or not headgear use in women’s lacrosse will increase or decrease the rate of head injuries. In 2017, the Public Schools Athletic of New York City became the first high school organization in the country to mandate ASTM standard F3137 headgear for all women’s lacrosse players. The purpose of this study is to investigate the effect of mandated headgear use on the rate of head and face injuries in high school women’s lacrosse. Methods: This was a prospective cohort study. The study group included eight varsity and junior varsity women’s lacrosse teams, as well as their game opponents, who were mandated to wear F3137 headgear for all practice and game events over the course of the 2017 and 2018 seasons. Certified athletic trainers assessed and documented all injuries that occurred as a result of participation on the lacrosse teams and athlete exposures were estimated based on the number of team practice and game events. Injury rates were compared with those from the High School RIO (Reporting Information Online) injury data reports from the 2009 to 2016 seasons. Results: Over the study period, 17 total injuries were reported during 22,397 exposures for an injury rate of 0.76 injuries per 1,000 athlete-exposures. Two head/face injuries, both of which were classified as concussions, were reported during the study for a head/face injury rate and concussion rate of 0.09 per 1,000 athlete-exposures. The headgear cohort demonstrated significant decreases in rates of in-game head/face injury (RR 0.141, 95% CI [0.004, 0.798]), in-game concussion (RR 0.152, 95% CI [0.004, 0.860) and practice non-head/face injury (RR 0.239, 95% CI [0.049, 0.703]) when compared to the control cohort. Conclusion: Mandated use of F3137 headgear was shown to be effective at lowering the rate of head or face injury and concussions in women’s lacrosse. Additionally, mandated headgear use was also shown to lower the rate of injury to body locations other than the head or face during practice. [Table: see text]