bluuebunny/crossref_metadata_2025_split huggingface dataset:
Partial Meniscectomy Provides No Benefit for Symptomatic Degenerative Medial Meniscus Posterior Root Tears
Authors: Krych Aaron John , Johnson Nick R. , Mohan Rohith , Dahm Diane L. , Levy Bruce A. , Stuart Michael J. 
Published: July 2017

Objectives: Medial meniscus posterior root tears (MMPRTs) are recognized as a source of pain and dysfunction, but treatment options remain a clinical challenge. Currently, outcomes are unknown following partial meniscectomy for these lesions. To determine (1) the efficacy of partial meniscectomy to treat MMPRTs compared to a matched group of non-operatively treated MMPRTs, and (2) risk factors for worse clinical and radiographic outcome. Methods: This retrospective comparative study was performed to include 27 patients with MMPRTs that were treated with arthroscopic partial meniscectomy (PMM) and a minimum 2-year follow-up. These patients were then matched by age, gender, and BMI to a group of 27 patients with MMPRTs treated non-operatively (control group). Demographic data, radiographic findings, final Tegner and IKDC scores were obtained and compared between the two groups. Risk factors for worse clinical and radiographic outcome in the PMM group alone, including age, sex, BMI, initial K-L grade, subchondral edema, and insufficiency fracture on MRI were determined. Results: Overall, 54 patients were included in the study. 27 patients (10M: 17F) with a mean age of 55±9 and a mean BMI of 32.8±5.3 were treated with PMM and followed for a mean of 5.5±2 years (range 2.3-9.3 years). In the PMM group, final median Tegner score was 3, mean IKDC scores were 67.8±20, median KL grades on weight-bearing AP films demonstrated progressive arthritis (median grade 1 to 2, p=0.001) and more patients had grade II or higher arthritis at final follow-up than baseline (91.3% vs. 36% p<0.01. Overall, 14 of the 27 patients (52%) treated operatively progressed to total knee arthroplasty at a mean of 54.3 months. When comparing the PMM and control groups, there was no significant difference in final median Tegner scores, mean IKDC, median K-L grades, progression to arthroplasty, or overall failure rate. Following PMM, female patients had lower final IKDC scores (74.6±16.7 vs. 44.00±2.8, p=0.02) compared to males, as well as a higher rate of arthroplasty (70.6% vs, 20.0%, p=0.009). Higher BMI correlated with lower IKDC scores (r=-0.91, p=0.01) and meniscal extrusion was associated with higher rate of arthritis at final follow-up (100% vs. 57%, p=0.02). Conclusion: Partial meniscectomy for a MMRT provides no benefit in halting arthritic progression. Patients who undergo arthroscopic debridement for MMPRTs still progress to significant arthritis, poor clinical outcomes and a high arthroplasty rate (52%) at over 5-year follow-up. Compared to a non-operative control group, there was no benefit in any subjective or objective outcome measures from the arthroscopic partial meniscectomy. Female patients, higher BMI, and presence of meniscus extrusion were associated with worse outcomes and a higher rate of subsequent knee arthroplasty.
Performance-Based Outcomes after Operative Management of Athletic Pubalgia / Core Muscle Injury in National Football League Players
Authors: Lynch Thomas Sean , Kosanovic Radomir , Gibbs Daniel Bradley , Park Caroline , Bedi Asheesh , Larson Christopher M. , Ahmad Christopher S. 
Published: July 2017

Objectives: Athletic pubalgia is a condition in which there is an injury to the core musculature that precipitates groin and lower abdominal pain, particularly in cutting and pivoting sports. These are common injury patterns in the National Football League (NFL); however, the effect of surgery on performance for these players has not been described. Methods: Athletes in the NFL that underwent a surgical procedure for athletic pubalgia / core muscle injury (CMI) were identified through team injury reports and archives on public record since 2004. Outcome data was collected for athletes who met inclusion criteria which included total games played after season of injury / surgery, number of Pro Bowls voted to, yearly total years and touchdowns for offensive players and yearly total tackles sacks and interceptions for defensive players. Previously validated performance scores were calculated using this data for each player one season before and after their procedure for a CMI. Athletes were then matched to control professional football players without a diagnosis of athletic pubalgia by age, position, year and round drafted. Statistical analysis was used to compare pre-injury and post-injury performance measures for players treated with operative management to their case controls. Results: The study group was composed of 32 NFL athletes who underwent operative management for athletic pubalgia that met inclusion criteria during this study period, including 18 offensive players and 16 defensive players. The average age of athletes undergoing this surgery was 27 years old. Analysis of pre- and post-injury athletic performance revealed no statistically significant changes after return to sport after surgical intervention; however, there was a statistically significant difference in the number of Pro Bowls that affected athletes participated in before surgery (8) compared to the season after surgery (3). Analysis of durability, as measured by total number of games played before and after surgery, revealed no statistically significant difference. Conclusion: National Football League players who undergo operative care for athletic pubalgia have a high return to play with no decrease in performance scores when compared to case-matched controls. However, the indications for operative intervention and the type of procedure performed are heterogeneous. Further research is warranted to better understand how these injuries occur, what can be done to prevent their occurrence, and the long term career ramifications of this disorder.
Sports Hernia: Diagnosis, Management and Operative Treatment
Authors: Emblom Benton A. 
Published: July 2017

Objectives: Athletic Pubalgia, also known as sports hernia or core muscle injury, causes significant dysfunction in athletes. Increased recognition of this specific injury distinct from inguinal hernia pathology has led to better management of this debilitating condition. We hypothesize that patients who undergo our technique of athletic pubalgia repair will recover and return to high-level athletics. Methods: Using our billing and clinical database, patients who underwent sports hernia repair by single surgeon at a single institution were contacted for Harris hip score, functional outcome, and return to play data. Results: Of 101 patients who met criteria, 43 were contacted. 93% of patients were able to return to play at an average of 4.38 mo. Normal activities were rated at 95.5% and athletic function was rated at 88.9%. Negative predictors were female sex, multiple operations, and prior inguinal hernia repair. Overall complication rate was 4.6%, and reoperation rate was 4.6%. Conclusion: Our method of adductor to rectus abdominis turn up flap is a safe procedure with high return to play success. Patients who had previously undergone inguinal hernia repair or other hip/pelvic related surgery had a worse outcome.
Medial Posterior Capsular Plication Reduces Anterior Shoulder Instability Similar to Remplissage without Restricting Motion in the Setting of an Engaging Hill Sachs Defect
Authors: Werner Brian C. , Chen Xiang , Camp Christopher L. , Kontaxis Andreas , Dines Joshua S. , Gulotta Lawrence Vincent 
Published: July 2017

Objectives: In the present study, the efficacy of a posterior medial capsular plication in addition to Bankart repair was examined as an arthroscopic management strategy for an engaging Hill-Sachs defect. Methods: 8 fresh-frozen human cadaveric shoulders were utilized for the study. After testing baseline translation and motion, 30% Hill Sachs lesions were created in each specimen. Three experimental groups were created: 1) isolated bankart repair (HSD), 2) bankart repair with remplissage (RM) and 3) bankart repair with posterior medial capsular plication (PL). Biomechanical testing was performed to determine anterior translation, range of motion and Hill Sachs engagement. Translation and motion measurements were normalized to the baseline laxity measures for each specimen. Results: Significant reduction in anterior translation was noted at 60° of abduction and 60° of ER for both PL and RM groups compared to the HSD group throughout most of the joint loads tested (p < 0.05) [Figure 1], but no significant differences were noted between PL and RM at any load. The RM group had significantly less normalized ER at 60° of abduction compared to the HSD and PL groups (p < 0.05). There were no differences in IR between the groups. All 8 HSD specimens engaged, while no specimens in the RM and PL groups engaged (p < 0.001). Conclusion: In a cadaveric model, medial posterior capsular plication as an adjunct to Bankart repair offers similar resistance to anterior translation and Hill-Sachs engagement as compared to remplissage in the setting of an engaging Hill-Sachs defect. Medial posterior capsular plication results in less restriction of external rotation compared to remplissage without any significant limitation of internal rotation.
Validity and Responsiveness of the Single Alpha-numeric Evaluation (sane) for Shoulder Patients
Authors: Thigpen Charles A. , Shanley Ellen , Tokish John M. , Kissenberth Michael J. , Tolan Stefan John , Hawkins Richard J. 
Published: July 2017

Objectives: The is an ever-increasing demand within the emerging health care arena to demonstrate the efficacy of orthopedic interventions. Widespread implementation of patient reported outcomes are limited in part due to the barriers of clinical infrastructure and resources in a busy orthopedic practice. Prior studies have shown the single alpha-numeric evaluation (SANE) score to correlate at a single point in time with the American Shoulder and Elbow Surgeons(ASES) score. However, no study has validated the SANE in terms of test-retest reliability, responsiveness or clinical utility. Therefore, the purpose of this study was to validate SANE compared to the ASES across a sample of patients with the most common orthopedic shoulder diagnoses. Methods: Shoulder patients (n=105 age=52.7 ± 1.2; female=67) undergoing rotator cuff repair (cuff=44), total shoulder replacement (TSA=23), or physical therapy (PT=38) were administered the SANE and ASES less than 14 days apart prior to surgery and again at their 3 month follow up from initial care or surgery. Interclass Correlation Coefficients (ICC(2,1)) and standard error of the measure(SEM) were used to evaluate the test-retest reliability of the SANE and the validity between the SANE and ASES scores. An ANOVA (treatment group by time) was used to evaluate the responsiveness to treatment, and a Receiver Operating Curve was used to establish the minimally important clinical difference (MCID) for the SANE compared to the ASES (α =0.05). Results: The SANE demonstrated good reliability (ICC(2,1) =0.76 ± 3.4) similar to the ASES (ICC(2,1) =0.82 ± 3.4) pre-treatment. The SANE demonstrated good agreement with the SANE across all treatment groups (Cuff= ICC(2,1) 0.85 ± 3.4; TSA- ICC(2,1) =0.72 ± 5.2;PT- ICC(2,1) =0.82 ± 2.9) pre and post treatment. The SANE displayed similar responsiveness to the ASES after treatment (Figure 1) with similar mean change and standard deviations within each treatment group. The ROC curve revealed an area under the curve of .79 (SE, 0.62; P<.001) and a cutoff of 9.5% on the SANE with a sensitivity of 83% and a specificity of 31% to establish the MCID. Conclusion: Our study is the first to demonstrate the SANE is valid across a range of common shoulder diagnoses to assess patient outcomes across operative and non-operative treatment for shoulder complaints. The MCID of 9.5% is similar to the ASES (11%) suggesting that the SANE is a simple and efficient tool to assess treatment effects for shoulder disorders. Future studies are warranted to confirm these results and compare across other body parts and diagnoses.
Return to Play After Multi-Ligament Knee Injuries in National Football League (NFL) Athletes
Authors: Bakshi Neil K. , Khan Moin , Finney Fred Tolbert , Stotts Jeffrey , Sikka Robby Singh , Bedi Asheesh 
Published: July 2017

Objectives: Return to play (RTP) of NFL athletes following isolated ACL tears has been reported in the literature. However, there have been no studies reporting on RTP of NFL athletes following multi-ligament knee injuries. The authors hypothesize that NFL athletes with multi-ligament knee injuries will have lower RTP rates and longer time to RTP compared to athletes with isolated ACL tears, as reported in the literature. We also hypothesize that athletes with ACL and MCL injuries will have higher RTP rates and shorter time to RTP compared to athletes with an ACL tear and a PCL and/or LCL tear(s). Methods: NFL injury surveillance data was reviewed for all multi-ligament knee injuries between 2000 and 2016 with RTP information. Athletes were excluded if RTP was limited due to reasons unrelated to the injury such as suspension, unrelated injury, or personal matters. Extracted data included injury, RTP, time to return to play (months), number of games played, percent of possible games played, and performance. Results: 51 NFL athletes were found to have multi-ligament knee injuries between 2000 and 2016 that met inclusion and exclusion criteria. 47.1% (24/51) of athletes had ACL and MCL tears. 52.9% (27/51) of athletes had ACL and PCL and/or LCL tears. Of the players with ACL and PCL/LCL tears, there were 8 frank knee dislocations. The overall return to play rate following multi-ligament knee injuries was 62.7%. Athletes with ACL/MCL tears had an RTP rate of 70.8%, while the athletes with ACL and PCL/LCL tears had an RTP rate of 55.6% (p=.26). Athletes with frank knee dislocations had a 50% RTP rate. Mean time to RTP for all 51 athletes was 11.9 ± 3.52 months. The mean time to RTP for athletes with ACL/MCL injuries was 10.4±1.6 months compared with 13.7±4.3 for those with combined ACL and PCL/LCL injuries, and for frank dislocations was 20 ±6.1 (p<.001). Athletes with ACL/MCL injuries were more likely to return to prior performance levels 46% vs 18% compared to those with ACL and PCL/LCL injuries (p < .001). Conclusion: This study is the first to provide important prognostic information for NFL players sustaining multi-ligament knee injuries. The RTP rate for athletes with multi-ligament knee injuries is significantly less than the RTP rate for athletes with isolated ACL tears. In addition, athletes with ACL and MCL tears have a higher RTP rate, a significantly shorter time to RTP, and a higher likelihood of returning to prior performance than athletes with combined ACL and PCL/LCL tears.
Adductor Canal vs. Femoral Nerve Block in Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial
Authors: Xerogeanes John W. , Premkumar Ajay , Godfrey William , Samady Heather , Gottschalk Michael Brandon , Dalwadi Poonam , Karas Spero G. 
Published: July 2017

Objectives: Peripheral nerve blocks are commonly performed as a part of multimodal pain control regimens, especially for outpatient surgical procedures. Femoral nerve blocks (FNB) have been the traditional gold standard nerve block in the setting of ACL reconstruction; however, adductor canal blocks (ACB) have emerged as a promising alternative. While early findings show less quadriceps strength deficits following adductor canal blocks, results comparing analgesia from adductor canal nerve blockade to femoral nerve blockade are inconsistent. The purpose of this study was to compare adductor canal nerve block to femoral nerve block for pain control following ACL reconstruction. Methods: This study was a prospective, single-blinded, randomized, controlled, parallel single-center trial. 77 adult patients receiving ACL reconstruction were enrolled between December 2015 and April 2016. All patients received either a traditional FNB or an ACB immediately prior to surgery. All patients were given a post-operative smartphone application to record medication usage, pain scores, hours of sleep, and time to straight leg raise for one week following ACL reconstruction. Results: Of the 77 patients recruited, 64 patients were analyzed (83.1%). 13 patients were lost to follow-up. There were no statistically significant differences in post-operative pain, home medication use, recovery room time, or hours of sleep between the two study groups. Patients receiving an ACB had significantly shorter time to straight leg raise and reported greater satisfaction with acute post-operative pain control. Conclusion: Adductor canal nerve blockade had similar analgesic outcomes, improved post-operative mobility, and greater patient satisfaction with pain control than femoral nerve blockade. Our study supports the use of adductor canal block as a viable alternative to femoral nerve block following ACL reconstruction.
The Relation Between Volume of ACL Reconstruction and Future Knee Surgery
Authors: Schairer William W. , Marx Robert G. , Dempsey Brendan , Ge Yile , Lyman Stephen 
Published: July 2017

Objectives: A large body of volume-outcomes literature has now demonstrated a strong positive relationship between increasing annual surgical volume and improved patient outcomes across a wide variety of surgical procedures, including orthopedics. Unfortunately, most previous research has been limited by methods that arbitrarily assign cutoffs of “low” or “high” volume that may not be clinically meaningful. Thus, it is unknown how many cases should be performed each year to maintain competence in the procedure. The purpose of this study was to determine meaningful annual volume thresholds for ACL reconstruction. Methods: We identified ACL reconstructions performed in New York (NY) State hospitals between 2003 and 2014 using the NY-SPARCS hospital in-patient and ambulatory surgery database. These cases were followed until subsequent ipsilateral knee surgery (revision ACL, meniscus/cartilage surgery, or total knee replacement) or until the end of the study period, December 31, 2014. Surgeon volume was calculated as the number of ACL reconstructions performed by that surgeon in the 365 days prior to the case of interest. Stratum specific likelihood ratio (SSLR) analysis is a method to identify clinically meaningful cutpoints by correlating volume with outcomes through evaluating a receiver operating characteristic (ROC) curve. A Cox proportional hazards model was used to measure the effect of surgeon annual ACL reconstruction volume on risk of subsequent ipsilateral knee surgery adjusting for patient characteristics: age, sex, race, and insurance type. Results: Between 2003 and 2014, 77,899 ACL reconstructions were performed in NY State by 1,316 surgeons. Mean patient age was 30.8+/- 12.5 years, and patients were 61% male, 65% white race, and 74% covered by private insurance. SSLR analysis revealed 2 meaningful cutpoints in risk of subsequent ipsilateral knee surgery: 17 & 35 cases per year. The Cox proportional hazards model demonstrated a 29% decreased risk of ipsilateral knee surgery for those ACL reconstructions by surgeons performing >35 cases per year compared to those performing <17 (Hazard Ratio [HR] 1.29, 95% confidence interval [CI] 1.23-1.35, p<0.001). Further, surgeons in the mid-range group performing 18-35 ACL reconstructions per year demonstrated a 6% decreased risk of subsequent ipsilateral knee surgery (HR 1.06, 95% CI 1.01-1.11, p=0.014). Conclusion: This study identified three ranges for ACL reconstruction volume that result in different clinical outcomes. The highest cutpoint was 35 ACL reconstructions per year, which resulted in the lowest percentage of future knee surgery. These findings suggest orthopedic surgeons should perform a minimum of 35 ACL reconstructions per year to maintain clinical competence with the procedure.
Femoral Tunnel Drilling Method: Revision Risk After Anterior Cruciate Ligament Reconstruction
Authors: Tejwani Samir , Prentice Heather A. , Wyatt Ronald , Maletis Gregory B. 
Published: July 2017

Objectives: The femoral tunnel in anterior cruciate ligament reconstruction (ACLR) can be created by the transtibial (TT) or tibial-independent (TI) methods. An anatomically located femoral tunnel can be more consistently achieved by TI methods, which include the medial portal (MP) and lateral (outside-in, retrodrill) techniques. Non-anatomic graft placement in ACLR may result in postoperative instability and meniscal or chondral pathology. An anatomically located graft may be subjected to higher postoperative physiologic forces than one placed non-anatomically. The purpose of this study was to examine isolated primary ACLR and determine the risk of aseptic revision based on femoral tunnel drilling method. Methods: A retrospective cohort study was conducted using an integrated U.S. healthcare system’s ACLR Registry to identify primary isolated unilateral cases from 2009 to 2014. Bilateral, double-bundle and multi-ligament reconstructions were excluded. Patients were divided into two groups based on femoral tunnel drilling method, TT or TI. Drilling method was evaluated as a risk factor for aseptic revision, with adjustment for age, sex, body mass index (BMI), race, and graft type using multivariable Cox proportional-hazards regression models. Results: 19,022 primary ACLR patients were included, of whom 6,991 (36.8%) were younger than 22 years old, 11,772 (61.9%) were male, 7,632 (40.1%) had a BMI < 25 kg/m2, 8,894 (46.8%) were White, and 7,403 (38.9%) received an allograft. There were 12,336 (64.9%) ACLRs performed using TI techniques (MP n=10,149, lateral n=2,187) and 6,686 (35.1%) using the TT method. Usage of TI approaches increased from 34% of all ACLR in 2009 to 84% in 2014. The cumulative reoperation probability at 5-year follow-up was lower in the TI group, 7.5% (95% CI 6.6-8.4), compared to the TT group, 8.2% (95% CI 7.4-9.1). After adjusting for the covariates, the cumulative failure probability at 5-year follow-up was higher in the TI group, 6.3% (95% CI 5.6-7.2), compared to the TT group, 5.0% (95% CI 4.3-5.7). [Figure 1] After adjusting for the covariates, the TI group had a higher risk for aseptic revision than the TT group (HR=1.4. 95% CI=1.1-1.7). Conclusion: In the largest known study of its type examining femoral tunnel drilling method for primary ACLR, after adjusting for age, sex, BMI, race and graft type, TI techniques were found to have a 1.4 times higher risk of revision than the TT method. Surgeons should be aware that ACLR grafts placed more anatomically by TI methods have a higher risk of revision, possibly due to higher postoperative physiologic graft forces experienced.