bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes Following Single-Stage Revision Anterior Cruciate Ligament Reconstruction versus Two-Stage Revision with Tunnel Bone Grafting
Authors: Cinque Mark , Mitchell Justin J. , Chahla Jorge , Dean Chase S. , Matheny Lauren M. , LaPrade Robert F. 
Published: July 2017

Objectives: Revision anterior cruciate ligament reconstruction (ACLR) is becoming increasingly common as the number of primary ACLR cases continues to rise. Despite this, there is limited data discussing the outcomes of revision ACLR, and even less information specifically addressing the differences in single-stage revision reconstructions versus those performed in a two stage fashion after reconstruction tunnel bone grafting. Our goal was to compare the outcomes, patient satisfaction and failure rates of single-stage versus two-stage revision ACLR. Methods: Following Institutional Review Board approval, a retrospective analysis of prospectively collected data was performed. All patients undergoing a revision ACLR between 2010 and 2014 by a single surgeon were collected, and skeletally mature individuals over the age of 17 were included. Patients were excluded if they were skeletally immature, had a previous intraarticular infection in the ipsilateral knee, underwent a prior alignment correction procedure, cartilage repair or transplant procedure, meniscal allograft transplantation, or had an intra-articular fracture. Patients completed a subjective questionnaire preoperatively and at a minimum two years postoperatively. MRI and CT scans of all knees were obtained preoperatively to assess for associated injuries and to evaluate ACL reconstruction tunnel size and location. Patients with malpositioned tunnels which would critically overlap with an anatomically placed tunnel or those with tunnels >14 mm in size underwent bone grafting. Results: A total of 88 patients met inclusion criteria for this study. There were 39 patients in the single-stage revision surgery group (19 males, 20 females), and 49 patients in the staged revision surgery group who underwent a first-stage tunnel bone grafting (27 males, 22 females). In both groups, the SF-12 PCS, the WOMAC score, the Lysholm score, and the Tegner activity scale significantly improved from preoperative to postoperative status. There was no significant difference in the SF-12 MCS score before and after surgery in either group. Furthermore, there was no significant difference in failure rates or other demographic data between groups. We observed four failures in the one-stage procedure group (10.3%) and three failures in the staged reconstruction group (6.1%). Conclusion: In this study, objective outcomes and subjective patient scores and satisfaction were not significantly different between one-stage and two-stage ACL revision surgeries. Both procedures resulted in significantly improved outcomes and patient subjective outcomes without notable differences in failure rates. Further longitudinal studies comparing one-stage and two-stage ACL revision over a longer time frame are recommended.
The Psychosocial Trauma of ACL Ruptures in Young Athletes
Authors: Padaki Ajay Shridar , Popkin Charles Aaron , Noticewala Manish Suresh , Ahmad Christopher S. 
Published: July 2017

Objectives: Sustaining severe injuries requiring operative fixation causes emotional harm in addition to physical damage in young athletes. While the fear of re-injury following an anterior cruciate ligament ruptures and reconstruction has been established, the extent of the psychosocial trauma, including hyperarousal and intrusion, is largely unknown. We hypothesize that post-traumatic stress disorder symptoms are present young athletes with strong athletic identities following ACL ruptures. Methods: The impact of events scale, the athletic identity measurement score, and a novel specialization instrument were administered to 7 to 21 year old patients following ACL rupture. These instruments represent a modified post-traumatic stress disorder screening tool psychometrically validated in children, a validated tool to measure athletic identity, and an athlete specialization questionnaire designed by the authors respectively. Athletes were recruited from the sports medicine clinic at the senior authors’ academic institution and the instruments were administered upon the patients’ first orthopedic visit following the diagnosis of an ACL rupture. The full extent of the knee injury and any history of prior knee injuries were also assessed. Results: Twenty-one patients with a mean age of 14.9 ± 2.9 years completed the emotional trauma assessment and 52.2% of respondents were female. The most common concurrent injury was a meniscal tear (47.8%) and 9.5% of patients reported a prior ACL rupture and reconstruction. Regarding specialization, one-third of athletes played one sport only, 52.4% of athletes played multiple sports while focusing on one above the others, and 14.2% of athletes balanced their sports equally. Single-sport athletes scored significantly higher on the athletic identity questionnaire (single-sport mean 57.2; multi-sport mean 52.1; p = .02). The majority of patients experience traumatic symptoms in all three major categories as 86.4% endorsed avoidance symptoms, 81.8% admitted intrusion symptoms, and 81.8% admitted hyperarousal symptoms. Older athletes were significantly more likely to experience stronger emotionally traumatic symptoms (p = .03) as 16 - 21 year old athletes scored a mean of 62.6 on the Impact of Events Scale compared to 39.6 for 7 - 15 year old athletes. While male patients experienced stronger traumatic symptoms than female patients, the separation was not found to be statistically significant (male 50.2; female 43.6; p = .12). Conclusion: The emotional trauma for young athletes following ACL ruptures extends beyond the avoidance symptoms that have been previously established. Psychological evaluation and support is imperative to providing holistic care following this injury. [Table: see text]
Prospective Clinical Outcomes Following Microfracture Surgery For Isolated and Multi-Site Defects: Mid-Term Follow-Up
Authors: Erickson Brandon J. , Locker Philip H. , Cvetanovich Gregory L. , Tilton Annemarie K. , Gitelis Matthew E. , Weber Alexander E. , Yanke Adam Blair , Cole Brian J. 
Published: July 2017

Objectives: The purpose of the current study was: 1) to evaluate the outcomes of patients who underwent microfracture and 2) to determine the patient-related and defect-related factors associated with outcomes including factors predicting additional surgery. Methods: Patients who underwent microfracture for focal chondral defect(s) of the knee were eligible. Patients were excluded if concomitant procedures violated the subchondral bone. Outcomes were determined using preoperative and final follow-up patient reported outcomes (PROs) including; IKDC, KOOS, WOMAC, SF-12 and Overall Satisfaction. Patient-related factors and defect-related factors were analyzed for correlations with outcome. All patient-related and defect-related factors were also analyzed as predictors for subsequent surgery. Results: Overall 101 patients (55M/46F) mean age: 35.9±12.5 years, BMI 26.3±5.5 kg/m2, mean defect size: 2.64±1.81 cm2 underwent microfracture and met enrollment criteria. Lesion location included: 44.90% medial femoral condyle, 21.43% trochlea, 11.22% lateral femoral condyle, 10.20% multiple site, 8.16% patella, and 4.08% tibial plateau. In 72 of 101 (71%) knees, microfracture was performed in insolation. At mean follow-up of 5.7±2.5 years, statistically significant and clinically meaningful improvements (MCID and MCD) were seen in all PROs (p<0.05), aside from SF-12 mental scores which improved although not significantly (p=0.07) (Figure 1). Increased age, higher BMI, isolated tibial microfracture, multi-site microfracture and increased defect size all correlated with lower final follow-up PROs (p<0.05). Males demonstrated greater magnitude of improvement in KOOS symptoms and sports subscales (p=0.006 and p=0.037). In the multivariate analysis, larger defect size (>3.6 cm2) and prior knee surgery were independent risk factors for additional knee surgery. Conclusion: Following microfracture all patients demonstrated significant and clinically meaningful improvements in outcomes at a mean of 5.7 years. Increasing age and BMI are the patient-related factors that may predict a poor outcome. Defect-related predictors of poor outcome include microfracture of tibial lesions and multi-site microfracture as compared to isolated femoral defect microfracture. Larger lesion size (>3.6 cm2) and a history of prior knee surgery may predict the need for additional knee surgery following microfracture.
Lower Mental Component Scores are Associated with Lower Return-to-Work Rates after Patellofemoral Autologous Chondrocyte Implantation
Authors: Jacobs Cale A. , Burnham Jeremy M. , Whale Caitlin , King Patrick M. , Jochimsen Kate N. , Howard Jennifer S. , Malempati Chaitu S. , Mattacola Carl G. , Lattermann Christian 
Published: July 2017

Objectives: Autologous chondrocyte implantation (ACI) is a well established treatment for articular cartilage defects of the knee. However, few studies have examined return-to-work rates among ACI patients, and even fewer have investigated the effect of mental health on postoperative outcomes. The purpose of this study was to examine the effect of preoperative mental health on return to work and patient-reported outcomes. Methods: From our IRB-approved prospective outcomes registry, we identified 109 ACI patients (mean age = 34.5 years, mean follow-up = 2.8 years) with pre- and postoperative clinical data. Patients were stratified into those with preoperative VR-12 Mental Component Scores in the bottom quartile (LOW MCS) and in the top 3 quartiles (HIGH MCS) based on normative values. Patients with patellar and/or trochlear lesions were placed in the patellofemoral (PF) group, and all other patients were placed in the tibiofemoral (TF) group. Return to work, IKDC scores, and Lysholm scores were individually compared between the LOW MCS and HIGH MCS groups that had undergone either PF or TF ACI. Fisher’s exact tests were used to compare the return to work rates and frequency of IKDC and Lysholm improvements greater than the minimal clinically important difference. One-way ANOVAs were used to examine magnitude of change of IKDC and Lysholm scores. Results: Preoperatively, 14/55 (25.5%) TF patients and 17/54 (31.5%) PF patients were included in the LOW MCS group. For PF patients, return to work rates were significantly lower for the LOW MCS group (p=.0005). Return to work rates did not differ in the TF group (p>0.99). Changes in IKDC and Lysholm scores did not differ between the LOW MCS and HIGH MCS groups in TF or PF patients (Table 1). Conclusion: Lower preoperative mental component scores were more common in PF ACI patients and were associated with decreased return to work rates in PF ACI patients. The results of this study underscore the need to preoperatively quantify mental health status for this specific patient group in order to set realistic postoperative expectations. [Table: see text]
Tibiofemoral Contact Mechanics with Horizontal CleavageTears and Resection of the Lateral Meniscus in the Human Knee
Authors: Koh Jason L. , Zimmerman Todd A. , Patel Savan , Ren Yupeng , Son Jongsang , Zhang Li-Qun 
Published: July 2017

Objectives: Knee menisci are known to increase contact area, reduce contact pressure and absorb shocks. Meniscectomy is considered likely to lead to arthritic changes to the knee. The effects of a horizontal cleavage meniscus tear, repair and meniscectomy are still not clear for the lateral meniscus. The purpose of this study was to explore the impact of these conditions on tibiofemoral contact mechanics. Methods: Eleven fresh frozen human cadaveric knees were used in this study. Testing conditions included the intact meniscus, horizontal cleavage tear, inferior leaf resection and resection of both inferior and superior leaves of the lateral meniscus. The test was performed at 0° and 60° of knee flexion under 800 N axial loading force. Tekscan® pressure sensors were used to measure the tibiofemoral contact area and pressure. Results: Horizontal cleavage tears and subsequent repair of the lateral meniscus resulted in no significant changes in contact area and peak contact pressure compared to the intact condition. Resection of the inferior leaf resulted in a significant drop in contact area (34.6 ± 14.1% at 0° and 23.9%[Office1] ±14.8% at 60° knee flexion; p < 0.05). Peak contact pressure after resection of the inferior leaf significantly increased by 27.0 ± 22.1%at 0° and 37.9 ±33.6% at 60° knee flexion (p<0.05). Additional resection of the superior leaf resulted in a further decrease in contact area (49.5 ±7.2% at 0° and 47.9± 16.7% at 60° knee flexion compared to the intact condition; p < 0.05). Peak contact pressure increased correspondingly (by 38.6% ± 24.3 at 0° and 55.5 ±34.7%at 60° knee flexion compared to intact; p < 0.05). Conclusion: Resection of the inferior leaf or resection of both leaves of the lateral meniscus after horizontal cleavage tear resulted in decreased contact area and increased peak contact pressure at both knee flexion and extension.
The Effects of Posterior Rotator Cuff Cable Tears on Glenohumeral Biomechanics in a Cadaveric Model of the Throwing Shoulder
Authors: Photopoulos Christos Demetris , ElAttrache Neal S. , Doermann Alex , Akeda Masaki , McGarry Michelle H. , Lee Thay Q. 
Published: July 2017

Objectives: The rotator cuff cable has been postulated to be the primary load bearing substructure of the superior part of the rotator cuff. Tears of the posterior rotator cable are frequently seen in overhead throwing athletes. Although the biomechanical significance of the anterior rotator cable has been well described, our current understanding of the relevance of the posterior cable is limited. The purpose of this study was to examine how partial-thickness tears and full-thickness tears of the posterior rotator cable would alter glenohumeral biomechanics and kinematics in cadaveric shoulder models. Methods: Eight fresh-frozen cadaveric shoulder specimens were prepared and tested. To simulate the sequence of glenohumeral positions during the throwing motion, specimens were mounted on a custom shoulder testing system with the humerus positioned at 90° of abduction (30° scapular upward rotation, 60° glenohumeral abduction) and tested at 30, 60, 90, and 120 degrees of external rotation. After a circumferential capsulotomy was performed, rotator cuff muscles were loaded based on physiologic cross-sectional area ratios, and testing for each specimen was performed on each the following three conditions: intact posterior cable, partial-thickness (50%) articular-sided posterior cable tear, and full-thickness posterior cable tear. Primary outcome measures tested for each condition under the various degrees of glenohumeral rotation were: 1) anterior and total glenohumeral translation after application of a 30N anterior force; 2) path of glenohumeral articulation; 3) glenohumeral joint force. Results: With a 30N anterior force at 120° of external rotation, there was a significant increase in anterior glenohumeral translation between intact and full-thickness tear specimens (7.28±2.00mm and 17.49±3.75mm, respectively; p<0.05). Similarly, total joint translation at 120° of external rotation significantly increased between intact and full-thickness tear specimens (10.37±3.18mm and 23.37±5.05mm, respectively; p<0.05). No significant differences were apparent at other degrees of rotation (30, 60, 90 degrees), or with partial-thickness tears. Changes in the path of glenohumeral articulation were likewise most evident at 120° of external rotation, with a progressively anterior, inferior, and lateral shift in articulation with sequential sectioning of the posterior cable. Lastly, with regards to alterations in glenohumeral joint force, no significant changes were seen in any of the conditions. Conclusion: In this cadaveric shoulder model of the throwing shoulder, tears of the posterior rotator cuff cable lead to altered glenohumeral biomechanics and kinematics. These changes were most profound at 120° of external rotation, suggesting the importance of an intact posterior cable as a potential stabilizer during the late-cocking phase of throwing.
Increased Valgus Carrying Angle at the Elbow correlates with Shoulder and Elbow injuries in Professional Pitchers: A Prospective Study
Authors: Shah Sarav S. , Goldstein Jeffrey A. , Stein Spencer , Gammal Isaac , Gerland Roger , Lucke Jean-Paul C. , Rokito Steven 
Published: July 2017

Objectives: Injuries to the shoulder and elbow continue to be a problem in overhead athletes. To our knowledge, it has not yet been shown how the bony anatomy measured on physical exam, specifically valgus carrying angle at the elbow (VCA), correlates with injury risk. It is known that athletes commonly have an increased VCA thought to be secondary to adaptive changes due to repetitive stress. The purpose of our study was to prospectively determine whether the presence of an increased dominant arm (D) VCA is correlated with the onset of shoulder and elbow injuries. Methods: The VCA and elbow flexion contracture (EFC) along with passive range of motion of the glenohumeral joint for D and non-dominant (ND) arms were assessed for all pitchers and position players participating in spring training for three minor league baseball teams for the 2016 season. Investigators performed examinations on a total of 61 athletes (34 pitchers, 27 position players). Any shoulder and/or elbow injury necessitating treatment was recorded during the season by the medical staff and defined as an injury. Using VCA as the predictor variable, we estimated the odd ratio of shoulder and elbow injuries in pitchers from a binary logistic regression model. Results: The mean D VCA for pitchers was 13.6° versus 11.1° for players (p=0.04). The mean D EFC was 5.4° for pitchers and 4.8° for position players (p=0.76). No significant differences were noted when comparing D ER, D IR, and D F (Table 2). In addition, a higher mean D VCA was noted in older/more experienced players (14.5° versus 10.9°, p=0.026). There were 10 shoulder and/or elbow injuries with 8 occurring in pitchers. A greater mean VCA was noted for injured pitchers compared with non-injured pitchers (17.5 +/- 4.2 versus 13.1 +/- 5.2). Using logistic regression, a significant association between D VCA and injury was noted. Pitchers with an increased D VCA had a 1.25 times greater odds for injury (P = 0.040; 95% CI, 0.98, 1.59). Conclusion: Increased VCA on the throwing side increased the likelihood of a shoulder/elbow injury in pitchers. Additionally, we noted a significant increased mean D VCA in pitchers compared to position players as well as an increased mean D VCA in older/more experienced players. Understanding a relationship between the throwing motion and osseous anatomy may give us further insight into the etiology of shoulder/elbow injuries. Sports medicine clinicians should be aware of this study’s results and develop a plan that addresses this issue in an effort to deter shoulder/elbow injuries in pitchers. [Table: see text][Figure: see text]
Clavicle Fracture after Coracoclavicular Ligament Reconstruction: A Biomechanical and Finite Element Evaluation of Clavicle Fracture Risk
Authors: Gustafson Peter , Geeslin Andrew , Omwansa Mark , Sytsma Mark J. 
Published: July 2017

Objectives: Biomechanical testing supports anatomic reconstruction for high-grade acromioclavicular injuries to achieve improved stability, however, clavicle fractures have been reported following reconstruction. Thus, this study used laboratory experiments and finite element models to investigate the influence of tunnel parameters on the clavicle biomechanical performance. Methods: Composite synthetic clavicles were subjected to four-point bending on a servohydraulic load frame. Two established surgical techniques were compared; a single 3 mm tunnel technique and a double 6 mm tunnel technique. Finite element (FE) models were validated against experimental findings. Subsequent FE models explored a broad range of tunnel parameters to determine their biomechanical consequences. Results: The single tunnel (3 mm) specimens exhibited a stiffness of 19.9 ± 1.55 Nm2 and failed at 686 ± 45.2 N through the tunnel. The double tunnel technique exhibited a stiffness of 15.8 ± 1.18 Nm2 and failed at 390 ± 31.7 N through the medial tunnel. In FE models of the experiments (Fig. 1), the double tunnel technique has 69% of the strength of the single tunnel (vs 57% in the experiments) and failure was predicted at the medial tunnel. In 200 variations of tunnel configuration, the double tunnel technique exhibited increased stress concentration relative to a single tunnel. Larger tunnels exhibited higher stresses than smaller tunnels. Fig. 1: FE models exhibit greater stress concentration of the double 6 mm tunnel (right) technique compared to the single 3 mm tunnel (left) and technique. Conclusion: Experimental and FE results demonstrate that the double 6 mm tunnel reconstruction has a higher stress concentration than the single 3 mm tunnel technique when subjected to four-point bending. The validated FE model supports the use of small tunnels and suggests that a double tunnel configuration may have biomechanical disadvantages that must be weighed against the perceived advantages of “anatomic” reconstruction.
Equivalent Outcomes for Patients Following Trochleoplasty as a Primary or Revision Patellar Stabilizing Procedure
Authors: Burrus Matthew Tyrrell , Cancienne Jourdan M. , Kurkis Gregory M. , Conte Evan J. , Griffin Justin W. , Werner Brian C. , Diduch David R. 
Published: July 2017

Objectives: Patients with trochlear dysplasia often undergo primary procedures other than a trochleoplasty for recurrent patellar instability. When these other procedures fail and a trochleoplasty is performed, it is unknown if these patients do as well as those that had a trochleoplasty as their primary operation. The purpose of this study was to compare the clinical outcomes after trochleoplasty for severe trochlear dysplasia between a group of patients who previously underwent surgery for patellar instability to a group who underwent trochleoplasty as their initial procedure. Methods: In this prospective cohort study with IRB approval, 40 patients who underwent a sulcus-deepening trochleoplasty as well as additional related procedures with at least one year follow-up were divided into two cohorts: 1) patients with prior surgery for patellar instability (n=19) [Table 1] and 2) patients with no prior surgery for patellar instability (n=21). Preoperative and postoperative IKDC and Kujala scores, in addition to patient satisfaction scores, recurrent dislocation events, and reoperations were compared between the two cohorts. Results: 33 females and 7 males with an overall average age of 20.4 years with an average follow-up of 2 years were included in the study. Compared to preoperative scores, significant increases were seen in the postoperative IKDC and Kujala scores in both the primary (26.9 +/- 24.3, 21.5 +/- 22.3, respectively) and revision cohorts (22.7 +/- 23.0, 12.7 +/- 15.7, respectively) [Table 2]. There were no significant differences between outcome scores between cohorts with regard to final scores (p=0.661, 0.810, respectively) or absolute improvement (p=0.624, 0.284, respectively). There were no episodes of recurrent instability in either cohort. 23.8% of the primary cohort and 26.3% of the revision cohort underwent a secondary procedure for arthrofibrosis (p=0.420). There was no significant difference in satisfaction scores between the two cohorts, with an average score of 9.2 +/- 1.8 amongst all patients (p=.404). Conclusion: Patients with severe trochlear dysplasia will experience significant improvement postoperatively and will have equivalent outcomes if a trochleoplasty is performed as an index procedure or as a revision procedure following a prior failed patellar stabilizing procedure. [Table: see text][Table: see text]