bluuebunny/crossref_metadata_2025_split huggingface dataset:
Indicators of Bacterial Colonization in Failed Anterior Cruciate Ligament Reconstructions
Authors: Flanigan David C. , Everhart Joshua Scott , DiBartola Alex 
Published: July 2017

Objectives: Anterior cruciate ligament (ACL) repair is one of the most common orthopedic procedures performed, with over 175,000 operations performed each year. While rare, graft failure can be a detrimental complication. A 2003 meta-analysis by Freedman et al. reported failure rates between 1.9% and 4.9%. There is a higher risk of ACL repair failure among younger patients and those that underwent allograft procedures (versus autograft). Despite extensive study of graft failure, the mechanism of graft failure remains poorly understood. However, traumatic loading, infection, and surgical error have all been suggested to play a roll. Colonization of ACL reconstruction graft with low virulence bacteria could cause graft tissue attenuation without overt clinical symptoms and predispose patients to ACL graft failure. Polymerase chain reaction (PCR) is a highly sensitive method for detecting bacteria present in very low concentrations and detecting species that cannot be reliably cultured clinically. We hypothesize that DNA form bacteria may be present in torn graft tissue at time of revision ACL reconstruction. Methods: A total of 31 revision ACL cases (mean age 28; sd 5.1) and 5 primary ACL reconstruction controls (all hamstring autograft; mean age 27; sd 4.6) from one academic medical center were included. All revisions were first time revisions and had no clinical signs of infection. Among revision cases, autograft was used in 22/31 (71%) and allograft in 9/31 (29%) at the time of index operation. Mean time to failure was 15.8 months (range 6 months-7 years). A sample from the graft material was obtained using new sterile instruments from the tribal tunnel and directly transported ot the lab. DNA extraction techniques were used to isolate and purify DNA from each sample. PCR and DNA sequencing analysis were used to determine the presence and quantity of DNA in each sample. Results: Bacterial DNA was detectable in graft tissue in the majority of revision ACL cases 27/31 (87.0%) and less commonly 1/5 (20%) in primary ACL autograft controls (p=0.002, Chi-square test). Median bacterial DNA concentration in torn grafts at time of revision ACL was low at 17.5 ng/ml (range 0-101) with no difference found between revision patients with allograft (median 18.6 ng/ml range 0-45) vs. autograft (median 17.1 ng/ml range 0-105) used at time of primary ACL reconstruction (p=0.56, Wilcoxon rank sum). Conclusion: Bacterial DNA was detectable in graft tissue in the majority of revision ACL cases 27/31 (87.0%) and less commonly 1/5 (20%) in primary ACL autograft controls (p=0.002, Chi-square test). Median bacterial DNA concentration in torn grafts at time of revision ACL was low at 17.5 ng/ml (range 0-101) with no difference found between revision patients with allograft (median 18.6 ng/ml range 0-45) vs. autograft (median 17.1 ng/ml range 0-105) used at time of primary ACL reconstruction (p=0.56, Wilcoxon rank sum).
Concomitant Lateral Meniscus Injury Aggravates Rotational Laxity of the Anterior Cruciate Ligament Injured Knees
Authors: Hoshino Yuichi , Miyaji Nobuaki , Nishizawa Yuichiro , Araki Daisuke , Matsushita Takehiko , Kuroda Ryosuke 
Published: July 2017

Objectives: Residual rotational laxity in the anterior cruciate ligament (ACL) reconstructed knees is a remaining problem after the ACL reconstruction. Improper detection and treatment of the secondary restraint for the knee rotational laxity after the ACL were considered as the major reason for the problem. Although anterolateral ligamentous structure of the knee has increasingly been focused on, meniscus injury is frequently accompanied with the ACL injury and assumed to have significant impact on the rotational laxity based on previous studies. The purpose of this study was to determine the effect of the meniscus tear on the rotational laxity in the ACL-deficient knees. Methods: Fifty-seven unilateral ACL-injured patients (26 males and 31 females, 24 ± 10 y.o.) were tested. The protocol of this study was approved by the IRB in Kobe University, and the informed consent was obtained from all the patients. The pivot-shift test was performed under general anesthesia during their ACL reconstruction. (Fig.1) Clinical grading according to the IKDC (none, glide, clunk, and gross) was determined, whereas the quantitative assessment of the pivot-shift was conducted using electromagnetic measurement system to provide the tibial acceleration (m/sec2). Meniscus injuries were finally confirmed under arthroscopy during the ACL reconstruction. The difference of clinical grading and tibial acceleration between the ACL-injured knees with and without additional meniscus tear was assessed, followed by subgroup analysis for each medial and lateral meniscus tear separately. Statistical significance was set at p-value of 0.05. Results: Concomitant meniscus tear was confirmed in 32 knees. Clinical grading was different between the ACL-injured knees with and without meniscus tear (p<0.05), while the quantitative evaluation did not find a statistical significance (meniscus-injured knees 1.6 ± 1.1 m/sec2 vs meniscus-intact knees 1.3 ± 0.8 m/sec2, p=0.09). Subgroup analysis demonstrated increased tibial acceleration in the ACL-deficient knees with lateral meniscus tear (1.8 ± 1.1 m/sec2, n=19) compared to the meniscus-intact knees (p<0.05), whereas the rotational laxity did not rise in the medial meniscus torn knees (1.4 ± 1.0 m/sec2, n=20, p=0.33). Conclusion: Although the meniscus injury is the most common in addition to the ACL injury, the impact of the meniscus injury on the knee rotational laxity has not been fully examined. This study demonstrated the significant impact of the meniscus injury, especially lateral meniscus injury, on the rotational laxity in the ACL-deficient knees, which was successfully detected by using the quantitative measurement device. A careful inspection of the lateral meniscus tear should be required in the ACL-deficient knees with a substantial pivot-shift and, if there is any, it should be repaired as much as possible to avoid additional rotational laxity.
Clinical Outcomes of Patellofemoral Osteochondral Allograft Transplantation: A Prospective Analysis
Authors: Cotter Eric J. , Wischmeier Dillen , Frank Rachel M. , Yanke Adam B. , Farr Jack , Cole Brian J. 
Published: July 2017

Objectives: The use of osteochondral allograft transplantation (OAG) for chondral defects of the knee is increasing, particularly for defects involving the femoral condyles. The purpose of this study was to prospectively evaluate the clinical outcomes for patients undergoing patellofemoral OAG for symptomatic chondral lesions. Methods: Consecutive patients undergoing OAG for full-thickness patella and trochlear lesions between 2007 and 2014 by two senior surgeons were analyzed. Pre- and post-operative patient reported outcomes scores were collected, with a minimum 21-month follow-up. Patient demographics, preoperative clinical data including information on prior ipsilateral knee surgeries, and intraoperative details were analyzed for all patients. Complications, reoperations, and conversion to total knee or patellofemoral arthroplasty were recorded. Statistical analysis was conducted with student’s T-tests, with P<0.05 considered significant. Results: A total of 14 patients (10 females, 4 males) with an average age of 32.8±7.5 years (range, 20-48) were identified for inclusion with an average follow-up of 3.6±1.8 years (range, 1.8-7.8) (Table 1). The average body mass index was 27.5±6.9 kg/m2. Patients experienced an average 5.4±4.2 years of symptoms prior to OAG and 100% of patients had undergone previous ipsilateral knee surgery with an average 4.1±3.5 prior procedures before undergoing patellofemoral OAG. The average defect size on the patella was 855mm2 while that on the trochlea was 322mm2. At the time of OAG, 6 (43%) patients received trochlear grafts, 6 (43%) received patellar grafts, and 2 (14%) received bipolar grafts. Nine patients (64%) received a single allograft, 3 (21%) received 2 allografts to 2 separate lesions, and 2 (14%) received grafts to 4 separate lesions. At final follow-up, there were significant improvements in Lysholm, IKDC, KOOS, WOMAC, and SF-12 Physical outcomes scores; no significant improvements were found in the SF-12 Mental subscale (Figure 1). Two patients (both female, ages 27 and 41) were considered failures as they had converted to knee arthroplasty at an average 2.7 years following OAG. Both of these patients had received allografts to the patella with lesion sizes of 506mm2 and 1800mm2, respectively. Conclusion: Osteochondral allograft transplantation of the patellofemoral joint can be considered a viable restoration procedure for patients with symptomatic chondral lesions to the trochlea and patella. At an average follow-up of 3.6 years, the majority of patients will experience significant improvements in nearly all outcomes scores, with an arthroplasty conversion rate of 14%. Additional information on this difficult-to-treat patient population, including a better understanding of risk factors for failure, prognostic factors for success, and long-term outcomes, is needed. [Table: see text]
Nonoperative Management of Osteochondritis Dissecans: Progression to Osteoarthritis and Arthroplasty over a 35-Year Period in a Geographic Population
Authors: Krych Aaron John , Sanders Thomas L. , Pareek Ayoosh , Johnson Nick R. , Carey James L. , Maak Travis , Stuart Michael J. 
Published: July 2017

Objectives: Osteochondritis dissecans (OCD) is a disorder of subchondral bone that commonly affects the knee.The purpose of this study is to (1) evaluate the rate of arthritis and knee arthroplasty in a population-based cohort of patients with OCD lesions treated non-operatively and (2) evaluate factors that may predispose patients to knee osteoarthritis and arthroplasty. Methods: 86 patients (mean age 21.4 years) with OCD lesions treated nonoperatively were identified between 1976 and 2014. Information related to the diagnosis, laterality of lesion, details of treatment, and progression to arthritis was obtained from the medical record. Factors predictive of arthritis and arthroplasty (age, gender, body mass index, and lesion location) were examined. Results: At a mean follow-up of 12.6 (±9.8) years from diagnosis, 13 patients (15%) were diagnosed with arthritis corresponding to a cumulative incidence of 5.0% at 5 years, 10.0% at 10 years, 20.0% at 25 years, and 30.0% at 35 years. The cumulative incidence of arthroplasty was 1.0% at 5 years, 3.0% at 10 years, 8.0% at 25 years, and 8.0% at 35 years. BMI greater than 25 kg/m2 (HR 15.4, 95% CI: 1.9, 124.5) and patellar OCD lesions (HR 15.0, 95% CI: 1.3, 345.3) were associated with arthritis. Conclusion: Arthritis following nonoperative treatment of OCD lesions is a challenging problem with an estimated 30% cumulative incidence at 35 years after diagnosis. In contrast, the long-term rate of arthroplasty is low. BMI greater than 25 kg/m2 and patellar OCD lesions are predisposing factors for arthritis. Older age at diagnosis was associated with a greater risk of arthritis and knee arthroplasty.
Meniscus Radial Repair with the Transtibial Two Tunnel Technique: A Non-Inferiority Study with Vertical Mensical Tears Repair Comparison
Authors: Chahla Jorge , Cinque Mark , Geeslin Andrew , Dornan Grant , LaPrade Robert F. 
Published: July 2017

Objectives: Radial meniscus tears disrupt the circumferential fibers and thereby compromise meniscal integrity. Historically, radial tears were often treated with meniscectomy due to an inunderstanding of the biomechanical consequences of these tears, limited information regarding the biomechanical performance of repairs, and the technical difficulty associated with repair. A paucity of studies on the outcomes of repair of radial meniscal tears are available. The purpose was to report early (minimum two-year follow-up) results of a two-tunnel transtibial repair of radial meniscus tears and compare these outcomes to the outcomes of patients who underwent repair of vertical meniscus tears. The hypothesis was that radial tear repair would be safe and efficacious and that there would be no difference between repair and repair of vertical meniscal tears. Methods: The primary study group included patients that underwent a two-tunnel transtibial pullout repair for a radial meniscus tear. The compare group included patients that underwent inside-out repair of vertical meniscus tears. Subjective questionnaires were administered pre-operatively and at a minimum of two years follow-up, including the Lysholm score, the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) score, the Short Form-12 (SF-12) physical component summary (PCS) and mental health component summary (MCS), the Tegner Activity scale and patient satisfaction. ANCOVA models were used to compare postop outcome scores between meniscus repair groups while accounting for baseline score. Adjusted mean effects relative to the radial repair group were reported with 95% confidence intervals. Results: Twenty-seven patients that underwent two tunnel transtibial pullout repairs for radial meniscal tears and 33 patients who underwent inside-out vertical meniscus tear inside-out repair group were available for follow-up at a minimum of two-years. No baseline outcome scale significantly differed between the groups. In the radial repair group, the mean ± SD preoperative SF-12 PCS, WOMAC and Lysholm were 36.7 ± 9.4, 36.6 ± 20.5, and 47.4±22.1, respectively. In the vertical repair group the mean ± SD preoperative SF-12 PCS, WOMAC and Lysholm were 37.4 ± 10.2, 40.4 ± 23.5, and 45.6 ±22, respectively. There were no significant group differences for any of the two-year postoperative outcomes scores. Relative to radial repair, the repaired vertical tear group exhibited an adjusted average of +0.4 (95% CI: -4.2, 5.00), +0.6 (-4.9, 6.0) and -5.1 (-13.6, 3.5) points on the SF-12 PCS, WOMAC and Lysholm scales, respectively. Conclusion: The Two tunnel transtibial pullout repairs for radial meniscal tear technique is a safe and efficacious procedure and produces similar clinical outcomes when compared to repairs of vertical tears.
Increased Glenoid Index is a Risk Factor for Pediatric Anterior Glenohumeral Dislocation: An MRI-Based Case-Control Study
Authors: Fabricant Peter D. , Yellin Joseph L. , Anari Jason Brett , Neuwirth Alexander , Ganley Theodore J. , Chauvin Nancy A. , Lawrence John Todd R. 
Published: July 2017

Objectives: In the adult population, anterior glenohumeral instability has been associated with a tall and narrow glenoid morphology, assessed using glenoid index (GI). This morphological association has not been assessed in children and adolescents. This study was designed to examine the association of GI with anterior glenohumeral dislocation in patients 19 years old and younger using a case-control study design. Methods: An institutional radiology database was queried over a 10-year period to identify patients 19 years old and younger who underwent glenohumeral MRI arthrography and were diagnosed with anterior shoulder dislocation (cases) and those without dislocation and normal shoulder arthrogram studies (controls). Those with bony Bankart lesions were excluded. Glenoid index (glenoid height-to-width ratio) was measured by an attending pediatric musculoskeletal radiologist and a fellowship-trained attending orthopedic surgeon. Comparative analysis between the two groups was performed using Student’s t-test for each variable, followed by receiver-operating-characteristic (ROC) analysis to determine discriminative ability when statistically significant. Results: Thirty-three males and 22 females (mean age: 15.4±2.1 years old) meeting inclusion and exclusion criteria were identified. Mean glenoid index in the dislocator group was significantly greater than the control group (1.55±0.14 vs. 1.38±0.08, P<0.001). ROC analysis revealed adequate discrimination of glenoid index in predicting glenohumeral dislocation (area under the curve [AUC] = 0.88). A glenoid index ≥1.45 was 83% sensitive and 79% specific for predicting dislocation in the study cohort. Conclusion: Patients with anterior glenohumeral dislocation were noted to have increased glenoid index (taller and narrower glenoid morphology) than controls. Glenoid index may help identify patients at risk for primary or recurrent anterior glenohumeral instability events, and can help guide treatment and anticipatory guidance.
Alterations in Glenohumeral Forces Following Rotator Cuff Injury and Repair
Authors: Golan Elan J. , Krochak Ryan , Garofolo Garret , Culbertson Maya Deza , Choueka Jack 
Published: July 2017

Objectives: Rotator cuff repair is associated with an unusually high incidence of osteoarthritic changes and cartilage damage in the glenohumeral joint. Such degeneration may be secondary to improper tensioning of muscular stabilizers during surgical intervention; however, existing studies have not specifically examined changes in joint congruity following rotator cuff repair. Therefore, the purpose of this study was to assess for changes in glenohumeral contact forces following the repair of rotator cuff injury. Methods: Transduction mapping was performed on the glenohumeral joint of ten fresh-frozen cadaveric shoulder specimens. A calibrated pressure-mapping sensor was introduced through the rotator interval and secured along the concavity of the glenoid labrum. Following a baseline force measurements, analysis of force intensity and total glenohumeral contact area was performed in each specimen for 6 simulated injury and treatment conditions: A) A 1 cm supraspinatus lesion; B) 2-suture repair of the 1 cm lesion; C) removal of the 2-suture repair; D) a 2 cm supraspinatus lesion; E) 3-suture repair of the 2 cm lesion and; F) removal of the 3-suture repair. All repairs were performed via bone tunnels in the standard method described. Data were recorded over 60s intervals at a rate of 4 frames per second and included raw force, area, and force per unit area. Values for lesion, repair, and post-repair conditions were expressed as a proportion of initial baseline measurements. Means and standard deviations were then calculated for each condition and compared via Student’s t-tests. Results: For baseline measurements, the mean intact glenohumeral force was 38.55 ± 24.79 N and the mean contact area was 313 ± 84.09 mm2. In comparison to baseline values, 3-suture repair yielded a significant increase in both total glenohumeral force (mean proportion: 2.16 ± 3.26; p=0.046) as well as proportion of force per unit area (1.73 ± 1.86 N/mm2; p=0.024). Both the 2 cm lesion and the 2-suture repair removal yielded significant decreases in contact area when compared to baseline, with the former exhibiting a proportion of 0.76 ± 0.19 (p=0.040) and the latter yielding a proportion of 0.60 ± 0.29 (p=0.004). No other conditions exhibited significant changes from baseline measurements. Conclusion: Rotator cuff injury leads to alterations in glenohumeral forces, with significant increases in articular contact-pressures following repair of larger supraspinatus lesions. These findings offer a possible explanation for the high rate of degenerative changes demonstrated following rotator cuff repair. Further study is warranted to determine how current treatment methods might be improved to result in glenohumeral contact pressures resembling those experienced prior to injury.
Epidemiology of Ulnar Collateral Ligament Reconstruction in Major and Minor League Baseball Pitchers: Comprehensive Report on 1,313 Cases
Authors: Camp Christopher L. , Conte Stan , D’Angelo John , Fealy Stephen 
Published: July 2017

Objectives: Although much as been done to better understand and characterize the epidemic of UCL reconstruction in pitchers, a comprehensive review of all UCL reconstructions performed in professional baseball pitchers is surprisingly lacking. Accordingly, the purpose of this work was to provide an epidemiologic report on every UCL reconstruction ever performed in professional baseball with a special focus on outcomes (return to play rates and time) and overall survivorship. Methods: Three resources (including the Major League Baseball [MLB] injury tracking system) were combined and cross-referenced to identify all professional baseball players who had ever undergone primary UCL reconstruction (1974 to 2015). Variables analyzed included the date of injury, date of surgery, time out of play, geographical region, and revision status. Trends over time were analyzed collectively and based on level of play at the time of surgery. A minimum of 2 years of follow up was required to determine return to play status. Revision free Kaplan-Meier survivor analysis was performed. Results: A total of 1,313 UCL reconstructions were identified. The annual rate of primary and revision UCL reconstructions rose significantly for all levels of play from 1974 to 2015 and from (p<0.001). The overall mean time to return to play (RTP) was 436 days (range 98 to 1,643). The rate of RTP to any level was 93.9% for MLB pitchers vs. 76.3% for MiLB pitchers (p<0.001), and MLB pitchers RTP at the MLB level in 73.1% of cases. The time to RTP was longer (by 54 days) for revisions (p=0.025) compared to primaries, and MLB pitchers RTP from primary surgery 95.6% of the time but only 81.8% for revision surgery (p=0.008). The revision rate was 10.7%, and the percentage of players free of revision and still playing professional baseball was 92% at 2 years, 53% at 5 years, and 17% at 10 years. Survivorship was improved for players undergoing UCL reconstruction before age 25 opposed to after 25. Conclusion: This study represents the most robust epidemiologic report of UCL reconstruction in baseball to date, and a number of novel findings are reported. A number of key differences in MLB and MiLB, as well as primary and revision surgeries, were identified. Although the revision rate (10.7%) is higher than prior reports, 75% of players who had surgery before age of 25 are revision free and still playing professional baseball four years post operative.