bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hip Arthroscopy Failure in the Setting of Acetabular Dysplasia: A Concerning Trend?
Authors: Clohisy John C. , An Tonya , Haynes Jacob , Nepple Jeffrey J. , Schoenecker Perry , Baca Geneva ,   ANCHOR Group
Published: July 2017

Objectives: Despite the success of hip arthroscopy, evidence suggests that arthroscopy alone is inadequate for treatment of conditions such as acetabular dysplasia (AD) due to its failure to correct structural deformity. Our objective was to define the incidence of failed hip arthroscopy in patients with symptomatic AD requiring periacetabular osteotomy (PAO). We secondarily analyzed the patient and structural characteristics of the failed arthroscopy cases. Methods: Utilizing a prospective, multicenter joint preservation database, we identified a cohort of primary AD patients from 2009-2014 who underwent PAO after a single prior ipsilateral hip arthroscopy. A comparison cohort of PAO patients without prior arthroscopy was isolated. Patients with hip disease attributable to cerebral palsy, Perthes, etc. were excluded. Demographic and radiographic data were summarized for each category. We compared the proportion of PAO after failed hip arthroscopy between the beginning and end of the study period by 2-tailed z-test with P<0.05 regarded as statistically significant. Results: Ninety-nine patients (99 hips) had received arthroscopic surgery prior to PAO, while 1053 patients (1103 hips) underwent PAO without prior hip arthroscopy. The proportion of PAO procedures after previous ipsilateral hip surgery stayed constant (13-19%); however, the incidence of PAO after previous hip arthroscopy increased from 2.5% in 2009 to 9.8% in 2014 (P=0.004). Over the 6 year period, the rate of all PAO procedures increased 12% per year, whereas rates of PAO after hip arthroscopy grew an average 54% per year. Female sex, increased average LCEA and ACEA, and decreased acetabular inclination were associated with failed hip arthroscopy (P<0.01). Conclusion: Over the last six years, we have seen clear increases in the rate of PAO after previous hip arthroscopy. Though the rate of PAO following previous ipsilateral surgery remains constant, hip arthroscopies now constitute almost 60% of those previous surgery attempts. Additionally, we have identified mild dysplastic features and female sex as characteristics that are associated with failure of hip arthroscopy. These results are consistent with prior literature suggesting that inadequately corrected structural deformity is the most common indication for revision surgery. These findings raise concern that isolated hip arthroscopy is being increasingly utilized in patients with acetabular dysplasia and highlight the need for refined surgical indications for hip arthroscopy and further investigation into its impact on subsequent surgeries. [Figure: see text]
O’Donoghue Sports Injury Award 10 Year Outcomes and Risk Factors after ACL Reconstruction: A Multicenter Cohort Study
Authors: Spindler Kurt P. , Huston Laura J. ,   MOON Knee Group
Published: July 2017

Objectives: Identify the patient-reported outcomes (IKDC, KOOS, Marx activity scale) and patient-specific risk factors from a large prospective cohort at a minimum 10-year follow-up after ACL reconstruction. Methods: Unilateral ACL reconstructions were identified and prospectively enrolled between 2002 and 2004 from 7 sites in the Multicenter Orthopaedics Outcome Network (MOON). Patients pre-operatively d a series of validated outcome instruments, including the IKDC, KOOS, and Marx activity scale. At the time of surgery, physicians documented all intraarticular pathology, treatment, and surgical techniques utilized. Patients were followed at a minimum of 2, 6, and 10 years post-op, and asked to the same outcome instruments that they d at surgery (T0). Incidence and details of any subsequent knee surgeries were also obtained. Multivariable regression analysis was used to control for patient demographic variables, surgical technique and pathology variables, and incidence of subsequent surgery, in order to identify factors associated with patient-reported outcomes 10 years after ACL reconstruction. Results: A total of 1597 patients were eligible (57% male; median age 23 years). Ten-year follow-up was obtained on 83% (1320) [86% (1379) at 2 years, 86% (1375) at 6 years], while subsequent surgery data was obtained on over 90% of the cohort. Both IKDC and KOOS scores significantly improved after 2 years and were maintained at 6 and 10 years (Figure 1). Interestingly, Marx activity level scores dropped markedly over time, from a median score of 12 pts at baseline, 9 pts at 2 years, 7 pts at 6 years, to 6 pts at 10 years. The patient-specific risk factors for worse 10-year outcomes are shown in Table 1. The significant drivers of poorer outcomes were lower baseline outcome scores, higher BMI, smoker at baseline, history of medial meniscus surgery prior to ACL reconstruction, having a revision ACL reconstruction, grades 3-4 articular cartilage pathology in the medial, lateral and patellofemoral compartments, and having any subsequent ipsilateral surgery. Graft type (autograft BTB, autograft soft tissue, allograft), MCL or LCL pathology, and medial or lateral meniscus surgery at the time of ACL reconstruction were not found to be significant risk factors. Conclusion: Patients are able to perform sports-related functions and maintain a high knee-related quality of life 10 years after ACL reconstruction, although activity level declines over time. Multivariable analysis identified several key modifiable risk factors that significantly influence outcome. This prognostic information will undoubtedly aid physician counseling of patients’ expectations after ACL reconstruction at surgery and at 2 and 6 years to predict 10 year outcome. [Table: see text]
The Frequency of Glenohumeral Cartilage Lesions at the time of Shoulder Instability Surgery: A Multicenter Comparison of Primary and Revision Surgery Patients
Authors: Duchman Kyle R. , Hettrich Carolyn M. , Westermann Robert W. , Glass Natalie , Kuhn John E. , Wolf Brian R. 
Published: July 2017

Objectives: Revision shoulder stabilization procedures present a unique set of challenges that should be recognized by the treating surgeon in order to improve the likelihood of success. The current study aims to compare patient factors, intraoperative findings, and patient reported outcome measures between patients undergoing primary versus revision shoulder stabilization surgery. Methods: The Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort was utilized to identify all patients undergoing primary and revision open or arthroscopic shoulder instability surgery. Patients with concomitant rotator cuff pathology requiring operative repair were excluded. Patient demographic characteristics, intraoperative findings, and patient reported outcome measures at the time of shoulder stabilization were compared between primary and revision shoulder instability surgery patients using univariate methods using chi-square or Fisher exact tests for categorical variables and Wilcoxon rank sum test for continuous variables. Results: Primary shoulder stabilization procedures were performed in 625 (87.0%) patients and revision stabilization procedures in 93 patients (13.0%). Patients undergoing revision surgery were older (25.9 vs. 23.5 years, p<0.001), more frequently smoked (11.8 vs. 6.1%, p = 0.04), had a higher number of reported dislocation events (p = 0.004), and were more likely to undergo an open procedure as opposed to an all arthroscopic shoulder instability procedure (67.7 vs. 5.8%, p<0.001). Patients undergoing revision procedures were more likely to have glenoid or humeral head cartilage lesions at the time of surgery (77.4 vs. 57.8%, p<0.001), with bone loss involving greater than 20% of the glenoid or humeral head more frequently reported in revision procedures (19.4 vs. 2.6%, p <0.001) (Figure 1). However, the presence of glenohumeral bone loss did not negatively impact patient reported outcomes at the time of shoulder instability surgery. Conclusion: Glenohumeral articular cartilage lesions are a common finding at the time of shoulder stabilization procedures and are particularly frequent in patients undergoing revision stabilization procedures. Surgeons routinely performing these procedures should be prepared to deal with the technical challenges associated with glenoid or humeral head bone loss. However, at the time of surgery, the presence of articular cartilage lesions did not appear to negatively influence patient reported outcomes. Future studies should investigate the influence of articular cartilage lesions at mid- and long-term follow-up in this cohort of patients.
Remplissage Versus Modified Latarjet For Off-Track Hill-Sachs Lesions With Subcritical Glenoid Bone Loss
Authors: Yang Justin Shu , Mazzocca Augustus D. , Arciero Robert A. 
Published: July 2017

Objectives: Off track Hill-Sachs lesions have been associated with high rate of recurrent shoulder instability. Both arthroscopic Bankart with Remplissage and modified Latarjet have been described to treat off-track Hill-Sachs lesions. However, few comparative studies exist between the two techniques in heterogeneous populations. The purpose of this study was to examine the outcome of the two procedures in patients with off-track Hill-Sachs lesions with subcritical (<25%) glenoid bone loss, both in the primary and revision setting. Methods: Arthroscopic Bankart with Remplissage was performed in thirty-one patients and modified Latarjet was performed in forty patients with recurrent anterior shoulder instability, off-track Hill-Sachs lesion, and less than 25% glenoid bone loss. Surgeries were performed at two centers. Patients were divided based on if they have had no previous surgical stabilization (Group A) or if they have had one or more previous surgical stabilization (Group B). The mean follow up time was four years. Patients were assessed for their risk of recurrence using the Instability Severity Index score and had preoperative 3-dimensional imaging to assess humeral and glenoid bone loss. Single Assessment Numeric Evaluation (SANE), Western Ontario Shoulder Instability Index (WOSI), radiographs, range of motion, recurrence rate, subsequent procedures and complications were analyzed. Results: In the thirty-two patients of group A, seventeen had remplissage and fifteen had Latarjet performed. Within group A, there were no difference found between the two techniques in regards to SANE, WOSI, range of motion (p>0.35). There were no complications, recurrence or revision with both techniques in group A. In the thirty-nine patients of group B, fourteen had remplissage and twenty-five had Latarjet performed. In group B, the reoperation surgery rate was significantly higher in the remplissage group (36% vs 8%, p=0.044). The reoperation was performed predominately for pain in patients with remplissage and for recurrent instability with Latarjet. Recurrence instability rate were similar between the remplissage and Latarjet group (14% vs 8%, p=0.45). The WOSI score was similar between the remplissage and Latarjet group (405 vs 461, p=0.66). The complication rate was also similar (36% vs 40%, p=1). Conclusion: For off-track Hill-Sachs lesions with subcritical glenoid bone loss, both the remplissage and modified Latarjet can achieve excellent clinical results in the primary setting (no previous instability surgery). However, in the revision setting (one or more previous instability surgery), patients with remplissage may have a higher reoperation rate.
Risk of Revision for Various Hamstring Fixation Methods after ACLR
Authors: Csintalan Rick P. , Prentice Heather A. , Funahashi Tadashi Ted , Maletis Gregory B. 
Published: July 2017

Objectives: Risk factors for anterior cruciate ligament reconstruction (ACLR) revision have included graft type, as well as fixation methods. Newer fixation techniques and devices for hamstring (HS) autograft have been introduced over the years. The purpose of this study was to compare the risk of aseptic revision after HS autograft ACLR between various femoral and tibial fixation methods/devices. Methods: Patients who underwent primary ACLR using a HS autograft from 2007-2014 were identified through a community-based registry for this retrospective cohort study. Bilateral, double bundle, and multiligament ACLRs were excluded. Patients were categorized (crosspin, interference, suspensory, or combination [more than one fixation]) based on the type of fixation utilized for the femur and tibia. Femoral/tibial fixation groupings with more than 500 patients were evaluated as a risk factor for aseptic revision, with adjustment for age, sex, body mass index, and race/ethnicity, using a multivariable Cox proportional-hazards regression model. Results: 6,716 primary ACLR patients were included, of whom 2,894 (38.8%) were younger than 22 years old, 4,111 (61.2%) were male, 2,956 (44.0%) had a BMI < 25 kg/m2, and 3,163 (47.1%) were caucasian. Five femoral/tibial groupings had more than 500 patients: suspensory/interference (n=2,176, 32.4%), suspensory/combination (n=1,940, 28.9%), interference/combination (n=1,025, 15.3%), interference/interference (n=845, 12.6%), and crosspin/combination (n=730, 10.9%). The cumulative failure probability at 5 years was highest for the suspensory/interference group (9.0%, 95% CI 7.2-11.2), followed by suspensory/combination (6.7%, 95% CI 5.4-8.4), interference/interference (5.1%, 95% CI 3.7-7.2), interference/combination (4.3%, 95% CI 2.9-6.3), and crosspin/combination (3.1%, 95% CI 2.0-4.9). After adjusting for the other covariates, the hazard ratio for aseptic revision was 2.9 (95% CI 1.9-4.7) for the suspensory/interference group, 2.7 (95% CI 1.7-4.5) for the suspensory/combination group, 1.6 (95% CI 0.9-3.0) for the interference/combination group, and 2.1 (95% CI 1.2-3.7) for the interference/interference group when compared to the crosspin/combination group. Conclusion: ACLR using HS autograft appears to have the highest risk of aseptic revision when suspensory fixation is used on the femoral side and is coupled with either an interference screw or combination fixation on the tibial side. Understanding the device-related risk of aseptic revision after HS autograft ACLR will help guide surgeons regarding which devices may negatively influence surgical outcomes.
ACL Force and Knee Kinematics After Posterior Tibial Slope-Reducing Osteotomy
Authors: Yamaguchi Kent T. , Cheung Edward , Mathew Justin , Boguszewski Daniel V. , Markolf Keith , McAllister David R. , Petrigliano Frank A. 
Published: July 2017

Objectives: Although many patients have a good outcome after anterior cruciate ligament (ACL) reconstruction, a number of individuals will experience continued instability. There is evidence that the posterior tibial slope (PTS) of the tibial plateau may play a role in ACL injury. Theoretically, under tibiofemoral compression (TFC) a steeper PTS would induce greater anterior tibial translation, thus increasing ACL force. The objective of this study was to evaluate if a PTS-reducing osteotomy would reduce ACL force. Methods: Eleven fresh-frozen cadaveric knees were tested (mean age 27 years). The femoral attachment of the ACL was mechanically isolated and attached to a custom designed load cell to measure resultant ACL force. Using a six-degree-of-freedom robot, each knee was flexed from 0°-50° while maintaining 200N TFC combined with the following loading conditions: 45N anterior tibial force (AF), 5Nm valgus moment (VM), 2Nm internal tibial torque (IT), and all loads combined. After testing the normal knee, a 10° PTS-reducing osteotomy was performed. An anterior wedge of bone was removed distal to the plateau, which was then lowered and secured with external fixators. The knee was then re-tested. A paired t-test was used to analyze statistical significance between normal and osteotomized knees every 5° of flexion. Results: Osteotomy reduced PTS by 10.0° ± 0.2° (mean ± SD), resulting in a relative change in tibiofemoral position at full extension, in effect hyperextending the knee 9.4°±1.9° and shifting the tibia 7.9 ± 1.6 mm posteriorly, 3.2° ± 2.3° internally, and 3.2° ± 1.5° into valgus. Compared to the normal knee, the osteotomy significantly reduced resultant ACL force when loaded with 200N TFC + 45N AF and 200N TFC + 5Nm VM. However, ACL force was not reduced under 200N TFC + 2Nm IT or 200N TFC + all loading conditions combined (Figure 1). Conclusion: Our data shows in the absence of applied internal torque, the posterior tibial slope-reducing osteotomy altered knee kinematics which corresponded to a significant reduction in ACL force. However, this protective effect was lost when internal torque was applied.
Can Competitive Athletes Sustain High-Level Play Following Osteochondral Allograft Transplantation of the Knee?
Authors: McCarthy Mark A. , Meyer Maximilian A. , Weber Alexander E. , Levy David , Tilton Annemarie K. , Yanke Adam Blair , Cole Brian J. 
Published: July 2017

Objectives: The purpose of this study is to investigate the ability of competitive athletes to remain at a high level of competition following osteochondral allograft transplantation (OCA) of the knee. Methods: A retrospective review was performed to identify all competitive athletes (high school, collegiate, professional) who underwent an isolated femoral condyle OCA between 2004 and 2012. Patient reported outcome (PRO) questionnaires (Lysholm, International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMasters Universities Arthritis Index (WOMAC), Short Form-12 (SF-12), Tegner, and Marx) and custom return-to-sport surveys were administered. All subsequent reoperations were documented. Results: A total of 13 (7 male, 6 female) athletes were identified with an average follow-up of 5.9 ± 2.5 years. Four athletes competed at an intercollegiate level, while 9 played high-level high-school sports. Seven athletes returned to competitive sport (54%) at an average of 7.9 ± 3.5 months, five of whom were returned to pre-injury levels of play. Of the eight athletes who either did not return to sport or failed to sustain their high level of play, the most common reasons cited were a change in life circumstances, such as graduation, or a fear of re-injury (Figure 1). At final follow-up, regardless of return-to-play, all athletes had significant improvements in all PRO scores except for KOOS-Sport, WOMAC-Stiffness, and SF-12 Mental subscales. Tegner Activity scores dropped significantly from pre-injury to final follow-up (8.2 ± 2.4, 4.5 ± 2.1, p < 0.01). There were three reoperations and zero instances of graft failure. Conclusion: OCAs provide acceptable rates of return-to-play and excellent long-term outcomes for high-level athletes with large osteochondral defects. Social factors are three times more likely than persistent pain to prevent return to sport.
Midterm CT and MRI Appearance of Osteobiologic Plugs in the Knee
Authors: Wolin Preston M. 
Published: July 2017

Objectives: The objective of this study is to evaluate the bony integration and cartilage morphology of Trufit Plugs (Smith & Nephew) placed to fill chondral defects in the knee. Methods: 17 patients underwent osteobiologic plug implantation for chondral defects of the knee. 13 plugs in 7 patients (mean age 38 years, range 21-49) were available for radiographic review. The mean follow up was 36.4 months (range 20-57 months). Each patient underwent CT for evaluation of bony integration as judged by a percentage of integration. The Hounsfield units (HU) of the plug and the native bone were recorded. A percentage of HU implant and HU native cancellous bone (HU implant/HU native bone) was calculated. MRI was used to evaluate the amount and quality of articular cartilage. Results: CT results showed percentage of bony integration to be mean 37.7% (range 0-100, SD ±30.1). HU implant/HU native bone was mean 32.2%, range 11.8-64.9. MRI showed articular cartilage fill to be: 38.5% filled 0-25% of the defect, 15.3% filled 25-50%, 23.1% filled 50-75%, and 23.1% filled 75-100%. T2 fat saturated signals were isointense in 26.9%, hyperintense in 34.6%, intermediate in 23.1%, hypointense in 23.1%, and cancellous bone in 7.7%. Conclusion: In this study bony integration of the TruFit Plug was poor. The amount of articular cartilage fill was significantly incomplete. The quality of resulting cartilage was inconsistent.
Double-bundle PCL Reconstruction: A Prospective Study of Two-year Patient Reported Outcomes with Stress Radiographs
Authors: Geeslin Andrew , Chahla Jorge , Cinque Mark , Civitarese David Marc , LaPrade Robert F. 
Published: July 2017

Objectives: Reconstruction of grade-III posterior cruciate ligament (PCL) ruptures has historically been compromised by graft elongation and residual laxity. The purpose of this study was to report prospectively collected two-year outcomes and failure rates of double-bundle PCL reconstruction in a consecutive patient series with patient reported outcomes and quantitative stress radiographs. It was hypothesized that double bundle PCL reconstruction would result in improved subjective clinical outcomes, restoration of knee stability, and result in high patient satisfaction. Methods: A single surgeon consecutive series of patients that underwent double-bundle PCL reconstruction between June, 2010, and April, 2014, were followed prospectively. The technique is anatomically and biomechanically validated and utilizes two allografts (Achilles tendon for anterolateral bundle, tibialis anterior tendon for posteromedial bundle) in divergent femoral tunnels and a single tibial tunnel, each secured at the tibia at different knee angles to recreate the function of the two PCL bundles. Patient reported outcomes were collected preoperatively, and at a minimum two-year follow-up, including SF12, WOMAC, Tegner, Lysholm, and patient satisfaction. Posterior kneeling stress radiographs were obtained preoperatively and at the 6-month follow-up period. Failures were defined objectively as a difference of more than 3 mm in stress radiographs. Results: Sixty patients had greater than 2 year follow-up (mean 2.9 yrs). All subjective outcome measures improved except SF-12 mental component which was unchanged. The mean Lysholm score improved from 48 to 79. The mean WOMAC score improved from 39 to 11. The median SF-12 physical component score improved from 32 to 55. The median Tegner activity score improved from 2 to 5. The median patient satisfaction score was 8. Stress radiographs were available for 36 patients and improved from a preoperative side-to-side difference of 9.6 mm to 1.0 mm at 6 months follow-up. One failure occurred in a patient who had an 8 mm side-to-side difference at final follow-up and 18 mm pre-operatively. Conclusion: Double bundle PCL reconstruction results in improved patient reported outcomes and restoration of posterior knee stability. High patient satisfaction and low failure rates were found in this cohort of patients.