bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arthroscopic Anatomic Glenoid Reconstruction: Analysis of the Learning Curve
Authors: Moga Iustin , Wong Ivan , Coady Catherine M. 
Published: July 2017

Objectives: This procedure involves the use of distal tibial bone graft to recreate anterior glenoid bone surface with the goal of preventing further dislocations. Recently, an arthroscopic approach has been proposed for this procedure, which uses a similar technique to the Bankart repair. This approach requires one additional medial portal (4 total), for graft placement, and this is established using an insideout technique; it avoids damage to the subscapularis tendon, and preserves the capsule and labrum. By comparison, the Arthroscopic Latarjet technique requires four additional new portals and requires splitting of the subscapularis tendon, as well as excision of the capsule and labrum. This study seeks to (1) identify a learning curve for this procedure, and (2) compare this to the learning curve for Arthroscopic Latarjet. Methods: Fiftyseven cases of surgically treated recurrent anterior shoulder instability were reviewed. All operations were carried out with the patient in a lateral decubitus position. Twentynine patients were managed with the Arthroscopic Latarjet procedure using coracoid bone graft, and 28 were treated with Arthroscopic Anatomic Glenoid Reconstruction using distal tibial bone graft. Procedure start and stop times were recorded and procedure durations calculated. Results: In the case of Arthroscopic Latarjet, the first 14 cases took an average 184 minutes to perform, with the remaining cases in the cohort averaging 116 minutes each in duration. For Arthroscopic Anatomical Glenoid Reconstruction, the first 14 cases took an average of 90 minutes, with the remaining cases averaging 84 minutes each. Conclusion: Arthroscopic Anatomic Glenoid Reconstruction is faster to perform compared to the Arthroscopic Latarjet. Further investigations into the safety and efficacy of this procedure will help determine whether it is a better choice for surgeons looking to learn the skill of boney augmentation for recurrent anterior instability.
Acute Versus Delayed MRI Imaging and Associated Pathology in Traumatic Shoulder Dislocations
Authors: Li Xinning , Orvets Nathan D. , Parisien Robert L. , Curry Emily Joan , Eichinger Josef K. , Murakami Akira 
Published: July 2017

Objectives: Delayed management of patients with shoulder instability may increase the prevalence and severity of concomitant intra-articular shoulder injuries resulting from persistent instability. We hypothesize that patients with a longer delay from an initial dislocation event to MRI demonstrate a greater degree of intra-articular shoulder damage. Methods: We performed a retrospective review of 89 patients from a single institution with clinically and radiographically confirmed traumatic, anterior, primary shoulder dislocations. Patients were divided into two groups: those undergoing MRI less than (N=44; LT6) or greater than (N=45; GT6) 6 months from the initial dislocation event. MRI assessment included evaluation of the severity of cartilage damage and bone loss, in addition to the presence of soft-tissue injuries to the labrum, capsule and rotator cuff. Subsequent treatment including type and method of surgical intervention, as well as recurrent postoperative instability, were evaluated. Results: The delayed MRI group demonstrated a greater degree of pathology compared to the early imaging group. A higher percentage of SLAP tears (58% vs. 34%), posterior labral tears (22% vs. 7%) and cartilage damage (73% vs. 27%) were present in the GT6 versus LT6 group. There was no difference in anterior glenoid bone loss. For those patients who underwent surgical stabilization for symptomatic instability, there was a statistically significant difference in recurrence of instability between the early MRI group (0/21) than that of the delayed MRI group (6/33 or 18%). Conclusion: Patients who undergo MRI greater than 6 months from the time of primary shoulder dislocation demonstrate a greater incidence and severity of intra-articular pathology including SLAP tears, posterior labral tears and anterior glenoid cartilage damage. Recurrent instability is significantly higher after shoulder stabilization surgery when performed more than 6 months from the primary dislocation event.
Biodegradation of Biocomposite Suture Anchor Implants 2,2 years after Rotator Cuff Repair
Authors: Sgroi Mirco , Friesz Theresa , Reichel Heiko , Kappe Thomas 
Published: July 2017

Objectives: Arthroscopic rotator cuff repair is one of the most frequently performed operations in orthopaedic surgery. Resorbable PLLA or PGA implants have been reported to be associated with osteolysis. Biocomposite implants, composed of PLLA and/or PGA and ceramics, have gained popularity due to their biocompatibility and lack of osteolysis. The aim of the present study was to investigate the biodegradation progression of biocomposites suture anchor implants 2 years after rotator cuff repair. Methods: Twenty-five consecutive patients (84 implants) with arthroscopically repaired rotator cuff tears using screw-in biocomposite implants with a 5,5 mm diameter and a minimum of 2 years (range, 16,3 to 32,0 months) follow-up were included into the present study. To analyse the biodegradation process of the suture anchors, an MRI of the operated shoulder was performed. The peri-implant fluid, the degradation of the suture anchors and the widening of the bone beds were assessed. Results: In the present study, the structure of the suture anchor implants was clearly visible in 23.8%, visible in 42.9%, partially visible in 23.8%, and not visible in 9.5%. No peri-implant fluid was observed in 26,2%. Slight peri-implant fluid was seen in 34,5%, a continuous fringe of fluid at least 1 mm thick in 23,8% and more than 1mm thick in 13,1%. The mean width of the bone beds was 4,38 ± 1,28 mm (apex), 5,41± 1,12 mm (middle) and 5,88 ± 1,39 mm (basis), indicating a widening of 0.33 mm of the basis. The mean length of the bone beds was 19,09 ± 2,38 mm. No significant difference was found between the lateral and medial row or between knotted and knotless implants. No case of gross osteolysis was observed. Conclusion: The results of the present study show that biocomposite suture anchors are frequently still visible on MRI 2 years after a rotator cuff reconstruction. No gross osteolysis was observed in the present study, indicating good biocompatibility of the implants.
Forearm Rotation Moments are Associated with Elbow Varus Moments
Authors: Nissen Carl W. , Garibay Erin J. , Solomito Matthew J. 
Published: July 2017

Objectives: The incidence of upper extremity injury in baseball has increased over the past decade, and much of the research into the biomechanics of pitching has focused on the shoulder and elbow. However little attention has been placed on how forearm rotation and the forearm rotation moment could affect a pitcher’s risk of injury. Therefore this study sought to determine the association between forearm moments and the elbow varus moment in collegiate baseball pitchers. Methods: Collegiate level baseball pitchers that were recruited for this study were actively pitching for an NCAA team and had no history of surgery to their pitching arms. All pitchers underwent a pitching analysis using computerized motion analysis techniques. The forearm’s position, rotational velocity, and supination and pronation moments were analyzed using a random intercept mixed-effects regression model to determine if there were significant associations between the variables of interest and the elbow varus moment. All moments are presented as internal moments. Results: A total of 78 collegiate level pitchers with a mean age of 19.9 ± 1.3 years, were include in this study. The average fastball velocity was 32.1 ± 2.5m/s. The results indicated that there was no association with the forearm’s position or rotational velocity and the elbow varus moment. However, there were statistically significant associations between the forearm supination moment and the elbow varus moment (p=0.002). The results showed that for every 1Nm increase in the supination moment there was a corresponding 1 Nm increase in the elbow varus moment. Whereas a pronation moment was associated with a decrease in the elbow varus moment (p=0.013). Conclusion: The forearm’s absolute position was not associated with an increased elbow varus moment, indicating that the position of the forearm does not play a role in injury mechanisms for baseball pitchers. However the regression analysis indicated a significant association with the forearm moments and the elbow varus moment. Specifically that an increased supination moment increased the elbow varus moment. Therefore as the body resists the pronation motion associated with pitching this increases the stresses on the medial side of the elbow. Suggesting that an increased need to resist pronation in pitchers that over supinate their arms during a pitch could be placing additional stresses on their elbows and therefore increasing their risk for injury. This finding also provides evidence that a potential injury prevention strategy for pitchers could be to increase their forearm supination and reduce the speed at which they pronate especially during the deceleration of the pitch cycle.
The Relationship of Throwing Arm Mechanics and Elbow Varus Torque: Within-subject Variation for Professional Baseball Pitchers Across 81,999 Throws
Authors: Dines Joshua S. , Tubbs Travis , Fleisig Glenn S. , Dines David M. , Altchek David W. , Dowling Brittany , Camp Christopher L. 
Published: July 2017

Objectives: Likely due to the high level of strain exerted across the elbow during the throwing motion, elbow injuries are on the rise in baseball. In order to identify at risk athletes and guide post-injury return to throw programs, a better understanding of the variables that influence elbow varus torque is desired. The purpose of this work was to describe the within-subject relationship between elbow varus torque and arm slot, arm speed, and shoulder rotation in professional baseball pitchers. Methods: A total of 81 professional pitchers performed 81,999 throws while wearing a motusBASEBALL sensor and sleeve (Motus Global, Massapequa, NY, USA). These throws represented a combination of throw types, such as warm-up/catch, structured long-toss, bullpen throwing from a mound, and live game activity. Variables recorded for each throw included arm slot, arm speed, shoulder rotation, and elbow varus torque. Linear mixed-effects models and likelihood ratio tests were utilized to estimate to the relationship between elbow varus torque and arm slot, arm speed, and shoulder rotation within individual pitchers. Results: All three metrics, arm slot (χ2 = 428, p<0.01), arm speed (χ2 = 57683, p<0.01), and shoulder rotation (χ2 = 1392, p<0.01), were estimated to have a significant relationship with elbow varus torque. Within individual athletes, a 1-Nm increase in elbow varus torque was associated with a 13° decrease in arm slot, a 116°/s increase in arm speed, and an 8° increase in shoulder rotation. Conclusion: Elbow varus torque increased significantly as pitchers increased shoulder rotation during the arm cocking phase and rotational velocity of the arm during the arm acceleration phase of throwing. Thus shoulder flexibility, arm speed, and elbow varus torque (and likely injury risk) are inter-related and should be considered collectively when treating pitchers.
Youth Baseball Players with Elbow and Shoulder Pain Have Both Low Back and Knee Pain: A Cross-sectional Study
Authors: Sekiguchi Takuya , Hagiwara Yoshihiro , Momma Haruki , Kanazawa Kenji , Kuroki KAORU , Tsuchiya Masahiro , Itoi Eiji 
Published: July 2017

Objectives: Serious arm injuries in youth baseball players have been increasing. Though a breakage in the kinetic chain could affect arm injuries, an association between arm injuries and insufficient support of the trunk and lower extremities have not been well understood. The purpose of this study was to investigate the association of low back and knee pain with elbow and/or shoulder complaints among youth baseball players. Methods: Study participants were mostly school-aged athletes belonging to Junior Sports Club Association of Miyagi prefecture (aged 6 to 15 years old). A self-administered questionnaire and informed consent document were mailed to25,469 registered athletes. Of those, 7,333 athletes replied both written informed consent and questionnaire (response rate was 28.8%). Those who did not play baseball (n = 5,577) and played both baseball and the other sports (n = 26) were excluded from this study. Missing data on variables (n = 192) were also excluded. The final study population was comprised of 1,535 players. We used multiple logistic regression analysis to examine the association of low back and knee pain with elbow and/or shoulder pain. Variables considered in the models were sex, age, BMI, years of athletic experience, position, team level, the amount of practice, participating day in team practice and game per week, frequency of participation in games, and practice intensity. Results: The frequency of elbow and/or shoulder pain was 24.8% (n= 393); that of elbow pain, 14.3% (n = 226); that of shoulder pain, 17.3 % (n = 273); that of both elbow and shoulder pain, 6.6% (n = 105); and that of low back and knee pain were 8.4% (n= 134) and 13.1% (n = 208), respectively. The frequency of elbow and/or shoulder pain who had low back and knee pain were 61.2% (n = 82) and 51.9% (n= 108) (p<0.001), respectively. The presence of low back and knee pain were strongly associated with elbow and/or shoulder pain (adjusted ORs (95%CI): 4.23 (2.83 - 6.34), p<0.001 and 3.11 (2.24 - 4.31), p<0.001, respectively), elbow (adjusted ORs (95%CI): 3.19 (1.74 - 5.83), p<0.001 and 2.45 (1.47 - 4.07), p=0.001, respectively), shoulder (adjusted ORs (95%CI): 4.25 (2.59 - 7.29), p<0.001 and 3.31 (2.17 - 5.05), p<0.001, respectively), and both elbow and shoulder pain (adjusted ORs (95%CI): 5.49 (3.08 - 9.79), p<0.001 and 3.52 (2.12 - 5.85), p<0.001, respectively). Conclusion: Both low back and knee pain were significantly associated with elbow and/or shoulder pain in youth baseball players. This result suggests that checking the trunk and lower extremities as well as elbows and shoulders are important for preventing sever injuries in youth baseball players.
Clinical Evaluation of an Arthroscopic, Knotless, Suprapectoral Biceps Tenodesis Technique
Authors: Duerr Robert , Akhavan Sam , Nye Darin D. 
Published: July 2017

Objectives: Pathology of the long of head of the biceps tendon (LHB) is a well-known cause of shoulder pain that is commonly managed with arthroscopic suprapectoral biceps tenodesis when conservative treatment fails. The purpose of this study is to present an arthroscopic, knotless, suprapectoral biceps tenodesis technique known as the Loop ‘N’ Tack and report the clinical outcomes in patients with a minimum of 2 years follow-up. Methods: The technique grasps the LHB proximally at the superior labrum and fixes it to the most distally visualized portion of the intra-articular bicipital groove. A retrospective review of all patients who had undergone the Loop ‘N’ Tack biceps tenodesis by the senior author between January 2009 and May 2014 was completed. Patients were excluded if any portion of the surgery was performed open, or if they had less than 2 years of follow-up. Charts were reviewed and patients were contacted for demographic data, time from surgery, concomitant procedures, worker’s compensation (WC) status, visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and University of California, Los Angeles (UCLA) scores. Statistical analysis was performed using Mann-Whitney U test for comparing non-parametric data sets. Results: follow-up evaluations were performed in 59 of 68 patients (87%). Average follow-up was 43 months. 88% of patients had at least 1 additional procedure performed at the time of biceps tenodesis. The mean ASES scores improved from 42.5 preoperatively to 90.1 postoperatively (p < 0.001). Fifty-four of fifty-nine patients (91.5%) had a good/excellent outcome with UCLA score > 27 and ASES > 70. Three patients (5%) reported biceps cramping pain with overuse. Two patients (3.3%) reported intermittent anterior shoulder pain similar to preoperative symptoms. No patients had developed a “Popeye” deformity at final clinical examination. 97% of patients reported that they were satisfied overall with the procedure. Comparing patients who had a rotator cuff repair or labrum repair at the time of biceps tenodesis with patients who did not have either, there were no significant differences in preoperative VAS or ASES, or postoperative outcomes scores. There were 10 WC patients who had worse postoperative VAS (p = 0.02), ASES (p = 0.03), SANE (p = 0.03), and UCLA scores (p = 0.02) compared to non-WC patients. Conclusion: The Loop ‘N’ Tack biceps tenodesis technique provides a high rate of patient satisfaction and high outcomes scores with a low rate of postoperative pain and no reported incidence of ‘Popeye’ deformity. We believe these good clinical results are due to the secure fixation of the LHB while relieving tension and minimizing motion of the tendon within the bicipital groove. [Figure: see text]
The use of PROMIS CAT Physical Function Pre-surgical Scores to Predict Recovery and Establish Pre-surgical Cut-off Values
Authors: Papuga Owen , Voloshin Ilya , Nicandri Gregg , Goldblatt John P. , Bronstein Robert D. , Rouse Lucien M. , Maloney Michael D. 
Published: July 2017

Objectives: There is a lack of standardized outcome measures or methods to study the effects of treatment and to effectively monitor and document patient outcomes. We have used Patient Reported Outcome Measurement Information System (PROMIS) computed adaptive testing questionnaires collected during routine office visits to describe the pre-surgical and postsurgical physical function scores and to assess the ability of pre-surgical scores to predict scores at 6 month after surgery. Methods: A retrospective analysis of 619 patients undergoing ACL reconstructive surgery at a large academic medical system was conducted to compare the predictive value of baseline PROMIS physical function scores to predict those scores after surgery. Patients with PROMIS physical Function scores within 1 standard deviation of the normal population at baseline were compare to those who fell below that score. Longitudinal comparisons of PROMIS scores between subsets was then made to identify any significant differences. PROMIS scores were assessed for discriminatory ability using receiver operating characteristic (ROC) curve analyses, with overall accuracy summarized using the area under the ROC curve (AUC). Nonparametric estimates and 95% confidence intervals for the AUC were used for each measurement at similar time points. Results: As shown in figure 1 average PROMIS physical function scores at later timepoints were comparable to those who had higher baseline scores. An ANOVA general linear (GROUP x TIME) model found statically significant (p<. 001) differences between the two groups at earlier time points. Further, ROC curve analysis demonstrated that PROMIS physical function scores have moderate to strong predictive ability (AUC>0.826). Using the ROC analysis an “optimal” cut-off pre-surgical score was determined to be a T-Score of 42.6. Conclusion: If fully utilized, these outcome measures can help inform physicians in individual surgical cases, as well as be used to show overall practice trends. Early identification of potential poor outcomes after ACL reconstruction may result in ability to intervene earlier to prevent prolonged disability. This investigation into the use of PROMIS physical function assessment tools has shown some utility in the ability to discriminate between those individuals who go on to have a full recovery over a typical recovery timeline and those who go on to have slower recovery.
Validity and Comprehensibility of Current Shoulder & Elbow Functional Outcomes Measures in Children
Authors: Heyworth Benton E. , Cohen Lara , von Heideken Johan , Kocher Mininder S. , Iversen Maura D. 
Published: July 2017

Objectives: To assess the comprehensibility of the Quick Disabilities of the Arm, the Shoulder and Hand Score (Quick DASH) and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) in children, identify sources of response errors, and modify items, in order to develop an original, age-appropriate, validated pediatric shoulder and elbow patient-reported outcome (PRO) survey. Methods: 49 children with shoulder and/or elbow disorders were recruited from a children’s hospital-based orthopedic outpatient clinic. A researcher, who was trained by a behavioral scientist in cognitive interviewing techniques, used a standardized protocol and conducted cognitive interviews to identify children’s comprehension of the QuickDASH and ASES surveys. In Phase One of the study, 39 children (46% female, mean age=15 years; range 10-18) were purposefully sampled based on age and gender, interviewed, and audiotaped. The questionnaires were given in varying sequential order. Interview probes focused on directions, formatting, item content and matching of responses and items. A behavioral scientist analyzed transcripts, modified items accordingly, and created an original pediatric shoulder and elbow PRO. In Phase Two, 10 children (40% female, mean age=15 years) were interviewed to gather feedback specifically on the original pediatric PRO. Results: The average interview time was 26 minutes (range=16 - 44 minutes). 255 comments were generated about the Quick DASH, identifying 60 issues related to item comprehension and 191 issues related to item response format. 51% of children struggled with complex terminology used to describe activities and 41% did not understand symptom-related items such as “tingling”. 294 comments were generated about the ASES, primarily associated with medications (76%) and shoulder instability (47%). Timeframe and format issues were also noted. The resulting original PRO was easy to comprehend, although 40% of children could not interpret a “loose shoulder or elbow”. Conclusion: Item comprehension issues were noted in approximately half of the children completing the Quick DASH and ASES. Specific areas of difficulty included items addressing medication use, activity level and symptoms such as shoulder instability and tingling. Modifications were also needed in general instruction, language, survey and item format, layout, and item response mapping. Based on the results of the cognitive interviews, children had minimal difficulty comprehending items and directions of the newly developed pediatric shoulder and elbow PRO. A subsequent study will assess this original PRO’s psychometric properties in an effort to continue its development and provide more comprehensive, methodologically rigorous validation of its use in this population.