bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Biceps Lesions in the Setting of the Rotator Cuff Repair: When is Tenodesis Superior to Tenotomy?
Authors: Tokish John M. , Tolan Stefan John , Lee Julia , Shelley Christina , Swinehart S. Dane , Lonergan Keith T. , Kissenberth Michael J. , Hawkins Richard J. , Thigpen Charles A. 
Published: July 2017

Objectives: However, the optimal treatment of biceps pathology is unclear as few studies have compared tenotomy versus tenodesis in the setting of RCTs. Therefore, the purpose of this study is to compare the outcomes of biceps tenodesis versus tenotomy in the setting of RCTs in order to determine if and when an advantage exists for one technique over the other. Methods: We retrospectively reviewed 134 patients(age=59.3± 8.6, males=88) following rotator cuff repair with concomitant biceps procedure and minimum 2-year follow up. Validated outcomes scores, including the American Society of Shoulder and Elbow Surgeons(ASES) score was completed before and after surgery. Patients were stratified by age, RCT size and biceps procedure (tenotomy or tenodesis). Separate mixed model ANOVAs (time by group) were performed to compare ASES scores between biceps procedure groups within each RCT size and age group. Results: There were 91 tenodeses and 43 tenotomies. There were no differences in baseline ASES scores or demographics between the groups( P>0.05). Overall patients displayed improvements in ASES scores(43±13) post-operatively but there were no differences between biceps treatment selection within each RCT size group( P>0.05). However, Patients < 55 years old with RCTs > 4cm and biceps tenodesis(n=18) demonstrated nearly twice the improvement(52±3) in post-operative ASES scores compared to those with a biceps tenotomy(28±14; P=0.03). This difference was not observed in patients > 55 years old or with rotator cuff tears less than 4cm( P=0.56). Conclusion: This is the first study to demonstrate the superiority of tenodesis over tenotomy in setting of RCTs. Specifically, in younger patients with larger tears, tenodesis had nearly double the improvement in ASES score compared to tenotomy. Our results suggest biceps tenodesis should be considered over tenotomy with concurrent greater than 4cm rotator cuff repairs in patients < 55 years old.
Strength Changes Associated with Elongation in Distal Biceps Tendon Repair
Authors: Moutzouros Vasilios , Marshall Nathan E. , Guest John-Michael , Okoroha Kelechi , Muh Stephanie , Makhni Eric C. , Keller Robert A. 
Published: July 2017

Objectives: Operative repair of distal biceps tendon ruptures have shown successful outcomes. However, little is know about the amount of tendon or repair site lengthening after repair and how this may affect strength. The purpose of our study was to evaluate distal biceps tendon repair via radiostereometric analysis and correlate with final strength changes. Methods: Eleven patients with distal biceps ruptures were recruited. During repair, two 2-mm tantalum beads with laser-etched holes were sutured to the distal biceps tendon. Beads were evaluated via CT scans immediately post-operatively and at 16 weeks. X-rays were obtained at time 0 and then at 4, 8, and 16 weeks. Seven patients were available for final strength testing at minimum of 9 months postoperative. Results: The mean amount of tendon lengthening after surgery was 22.8 mm (range 11.2 - 30.9 mm, p < 0.05). The greatest change in lengthening was noted between time 0 and week 4 (mean: 11.3 mm, p<0.05), with the least amount of lengthening between week 8 and week 16 (mean: 2.6 mm, p<0.05). DASH averaged 8.2. Strength testing performed at final follow-up (n=7) showed 78% supination and 88% flexion strength compared to contralateral side (33% with dominant arm repaired). Supination strength loss showed the greatest decreases with increased lengthening from 0-4 weeks (Correlation coefficient: -0.39). Final ultrasound evaluations found all tendons to be in continuity. Conclusion: This study’s findings suggest that all patients undergoing distal biceps tendon repair have significant lengthening after surgery. The greatest amount of lengthening was noted in the early post-operative period, in which the greater the amount of lengthening trended toward a greater loss of supination strength. Further studies will focus on post-operative protocols as they may have an impact on early tendon lengthening and could be adjusted to minimize this consequence on long-term supination strength.
Long Term Results of Arthroscopic Debridement of Osteochondritis Dissecans in Adolescent Athletes
Authors: Matsuura Tetsuya , Iwame Toshiyuki , Sairyo Koichi 
Published: July 2017

Objectives: Osteochondritis dissecans (OCD) of the capitellum is a well-recognized cause of elbow pain and disability in adolescent athletes.Treatment of the lesions is determined by the age, symptom, radiographic appearance, and whether the cartilage is intact. Surgical indications include persistent symptoms despite conservative treatment, symptomatic loose bodies, and displacement or detachment of the fragment. Both arthroscopic and open treatments have been proposed and most authors recommend initial arthroscopic treatment with conversion to arthrotomy, as needed. Surgical treatment may consist of removal of loose bodies or fragments, fragment fixation with a bone graft, and autologous osteochondral plug grafting. Arthroscopic debridement is a common and minimally invasive procedure, however, little is known about the long term outcome of arthroscopic debridement for adolescent OCD patients. The purpose of this study was to investigate minimum 10 year follow-up outcome of arthroscopic debridement of OCD in adolescent athletes. Methods: We retrospectively evaluated 25 athletes who had arthroscopic debridement. The average age at surgery was 15.0 years (range, 13-17 years).The sport related to the onset of the symptoms was baseball for 23 patients, and basketball and kendo for 1 patient each. We conducted arthroscopy in the supine position, and use 2.9-mm arthroscopes of 30° and 70°. Arthroscopic treatment for OCD may require 2 anterior and 2 posterior portals. Once the loose bodies are removed, all unstable cartilage of the capitellum lesion is removed to create a stable bed. If any sclerotic changes to the lesion bed are observed, we create microfractures in the lesion bed. The mean follow-up was 12.7 years (range, 10-13.5 years). The assessment included elbow pain, Timmerman and Andrews (TA) scores for the subjective component, and return to sports. Preoperative radiographic lesion size was categorized according to the classification of Takahara et al. Results: At final follow-up, 19 patients (76%) had no elbow pain, 5 patients (20%) had occasional mild pain, and only 1 patient (4%) had pain with moderate activity. TA scores for the subjective component was as follows; 100 points in 19patients, 95 points in 3 patients, 90 points in 2 patients, and 55 points in 1 patient. The evaluation result was excellent in 24 patients (96%) and poor in 1 patient (4%). Of all the patients, 22 patients (88%) returned to a competitive level at which they had previously played. Two patients chose another sport, and 1 patient retired from sport activity (Table 1). TA scores were associated with pain and preoperative radiographic osteochondral defects. The prevalence of elbow pain was 0% in small defect, 20% in moderate defect, and 69.2% in large defect. Conclusion: Long term results suggest that arthroscopic debridement of OCD for small osteochondral defects leads to excellent results and allow a return to the previous sport level. [Table: see text]
Radiographic Validation of a Non-invasive Method of Measuring Hip Joint Reaction Force using a Cartilage Relaxation Technique
Authors: Schaffer Joseph Christopher , Vasconcellos Daniel , Kaplan Nathan , Maqsoodi Noorullah , Olles Mark , Elfar John C. , Giordano Brian D. 
Published: July 2017

Objectives: Joint reaction forces (JRF) and contact pressures are classically measured using destructive techniques which require dissection and interposition of materials into the joint, fundamentally altering the normal joint mechanics. Without an alternate method available, modern hip JRF biomechanical studies involve this stripping of periarticular tissues, potentially sacrificing accurate measurements. As hip arthroscopy is increasingly employed for minimally invasive treatment of hip pathology, there may be a need for minimally invasive biomechanical measurement techniques that reflect JRF more accurately. This study’s objectives were to demonstrate that a non-invasive, non-destructive technique for measuring JRF was feasible in the hip and to validate this concept using simultaneous radiographic imaging. Methods: Twenty fresh frozen male human cadaver hemipelves were instrumented with a custom-made retrograde intramedullary nail-plate construct in the femur and an iliac-crest locking plate. These otherwise fully-intact specimens were rigidly mounted for tensile testing (Instron Model 1122). With the hip in the neutral position, the joint was distracted 5mm along the axis of the femoral shaft at a rate of 0.4mm/s, while simultaneously measuring the force required for distraction. Force-displacement curves generated allowed the best-fit polynomial to be found with resulting revelation of the native state JRF. Next, the joint capsule was vented under fluoroscopic control using an 18 gauge spinal needle and distraction was repeated from the native state with fluoroscopic images captured at 0.5mm increments. All testing was repeated three times, and two specimens were excluded for severe osteoarthritis (<2mm joint-space). Results: Force-displacement curves demonstrated an initially steep but decreasing (concave-down) slope, followed by an inflection point, a linear region and then a relatively non-linear increasing (concave-up) slope with further distraction. High reproducibility between repeated measurements was found within specimens and the average native resting JRF was 115.1 N (n=18). Capsular venting decreased JRF by 16.3 N (mean post-venting=98.8 N). Under fluoroscopy, air arthrograms confirmed cartilage relaxation consistently at the measured force-distraction infection point. Conclusion: This study describes and validates a reproducible method of measuring hip JRF that preserves all periarticular stabilizing soft tissue structures. This is the first study in any joint to correlate force-distraction data with fluoroscopic images, confirming the method’s central premise: That JRF is equal to the measured force-distraction curve inflection point. This may be ideally suited for application in biomechanical studies of minimally invasive arthroscopic hip surgery.
Independent Risk Factors for Revision Surgery or Conversion to THA after Hip Arthroscopy: An Analysis of 3,957 Patients
Authors: Kester Benjamin , Mahure Siddharth Ashok , Capogna Brian , Ryan Michael K. , Wolfson Theodore , Hamula Mathew , Rokito Andrew S. , Youm Thomas 
Published: July 2017

Objectives: The use of hip arthroscopy for the management of hip pathology has increased dramatically in recent years. Despite evidence demonstrating excellent outcomes, there are some patients that may require revision arthroscopy or conversion to total hip arthroplasty (THA). Data regarding risk factors for poor outcomes after hip arthroscopy is limited. The purpose of this study is to evaluate the rates of revision hip arthroscopy and conversion to THA in order to identify risk factors for suboptimal outcomes. Methods: New York State Department of Health Statewide Planning and Research Cooperative Systems database was queried from 2011 through 2014 to identify patients undergoing hip arthroscopy. Patients were longitudinally followed for a minimum of two years to determine the incidence and nature of subsequent hip procedures. Multivariate logistic regression was performed to identify independent risk factors for revision surgery or conversion to THA. Results: We identified 3,957 patients who underwent hip arthroscopy. Mean age of the sample was 35.8 years (SD±13.1). After a minimum follow-up of two years, overall failure rate was 9.6%: 3.7% (n=148) had revision hip arthroscopy at an average of 15.8 months, while 5.9% (n=235) converted to THA at 14.7 months. Index surgery performed by surgeons in the lowest volume tertile was an independent risk factor for both revision (p=0.001) and conversion to THA (p<0.001). Females (p<0.001), older patients (p<0.001) and those with a history of obesity (p<0.001) converted to THA at a significantly higher rate than other patients. Young patients (p<0.001) and females (p<0.001) were more likely to undergo revision hip arthroscopy. Conclusion: Hip arthroscopy may be better performed by medium to high volume surgeons. Additionally, patients with identified risk factors for revision or THA conversion should be counseled pre-operatively on potentially adverse outcomes, thus allowing patient-physician engagement during the shared decision-making process. [Table: see text]
The Dancers Hip: The Hyperflexible Athlete: Anatomy & Arthroscopic Clinical Outcomes
Authors: Larson Christopher M. , Ross James R. , Giveans Russell , Stone Rebecca M. , Ramos Nicole M. , Bedi Asheesh 
Published: July 2017

Objectives: Competitive Dance places high demands on the hips joints and return to these activities after surgical management of intra-articular pathology is not well documented. Methods: Between 2008 and 2016, hip arthroscopy was performed for 63 competitive dancers (78 hips) with a mean age 21.0 years. Specific types of dance performed included 54 studio dance and 43 high kick dance. Morphology included Cam-type FAI (99%), Pincer-type FAI (45%), Subspine impingement (83%), Borderline dysplasia (9%), Dysplasia (10%), and Normal (5%). The mean preoperative LCE angle was 29.9 deg, alpha angle was 52.3 deg (Lateral), and offset ratio was 0.16. A positive Cross-over (COS) and Posterior Wall (PW) sign were present in 60% of hips, and the mean Tonnis angle was 3.2 deg. Outcomes were evaluated with MHHS, SF-12 scores, VAS scores. Results: At mean 19.7 months follow-up, the mean outcome improvements were 23.5 points (MHHS), 10.4 points (SF-12), 3.8 points (VAS), (p<.01 for each). MHHS improved from 60.5 points, preoperatively, to 84.0 points at most recent f/u (p<0.01). Sixty-seven percent returned to their prior level of competitive dance, 22% returned to limited or modified dance, and 10% were unable to return to dance, included 1 retirement. Procedures performed included 95% labral repairs, 10% labral debridements, 99% femoral resections, 55% rim resections, 83% subspine decompressions, and 68% capsular plications. Conclusion: Hip pain in dancers can be challenging secondary to high demands placed on the hips. A specific arthroscopic approach addressing subtle osseous abnormalities and capsular laxity led to significantly improved outcomes for competitive dancers. Eighty Nine percent of Dancers ultimately returned to competitive Dance, although only 67% returned to their pre-injury competitive level.
Patient Reported Outcomes and Symptomatic Impingement in US Women’s Professional Soccer
Authors: Harris Joshua David , Mitchell Ronald J. , Qadeer Ali , Gerrie Brayden John , McCulloch Patrick C. 
Published: July 2017

Objectives: The purpose of this study was to determine: 1) normative data of multiple general health-, activity-, hip and groin-, and depression-specific patient-reported outcome (PRO) questionnaires; 2) if any PRO’s were able to predict a positive anterior impingement test, in female professional soccer player. Methods: An IRB-approved cross-sectional investigation of adult female US professional soccer players was performed at the team pre-season physical examination day. Adult (>18 years of age) female players without prior hip surgery were eligible. Hip impingement physical examination was performed (anterior, subspine, lateral, posterior) and recorded. Multiple questionnaires were administered to each player, including Short-Form-12 (Mental Component and Physical Component Scores [MCS, PCS]), Tegner activity score, Non-Arthritic Hip Score (NAHS), Hip and Groin Outcome Score (HAGOS), international Hip Outcome Tool-12 (iHOT-12), and Zung Depression Index. Descriptive statistics were calculated. Kolmogorov-Smirnov analysis was performed for data normality and Pearson’s (parametric) or Spearman’s (non-parametric) to assess correlation of ROM and radiographs. Binary logistic regression was performed to ascertain the effects of each PRO questionnaire score and prediction of a positive anterior impingement test. Results: Twenty-four players (48 hips) were analyzed (25.4+/-3.0 years of age; 2.8+/-2.2 years professional experience). Scores were collected: Tegner 9.9+/-0.3; SF-12 PCS 52.9+/-7.4; SF-12 MCS 54.3+/-7.0; iHOT-12 96.6+/-5.4%; NAHS Total 97.9+/-4.9; HAGOS symptoms 90.5+/-10.5, pain 97.8+/-3.4, activities of daily living 99.4+/-2.2, sports 97.1+/-4.2, physical activity 97.9+/-7.1, and quality of life 95.8+/-8.7; Zung 27.6+/-5.9. The iHOT-12 was able to correctly predict 71% of cases of positive anterior impingement test for the left hip and the logistic regression model was statistically significant, (5.2)1, p=0.02. For the right hip, the iHOT-12 was able to correctly predict 79% of cases of positive anterior impingement and the logistic regression model was statistically significant, χ 2 (9.1)1, p=0.003. SF-12 MCS and PCS scores were able to correctly predict 83% of cases for the left hip and the logistic regression model was statistically significant, χ 2 (11)2, p=0.005. The Zung score was able to correctly predict 83% of cases for the left hip and the logistic regression model was statistically significant, χ 2 (4.1)1, p=0.04. Conclusion: Multiple general health-, activity-, hip and groin-, and depression-specific patient reported outcome scores were collected and normative data established in a US women’s professional soccer club, showing that iHOT-12, SF-12 MCS and PCS, and Zung depression scores were able to correctly predict symptomatic impingement.
Return to Play and Career Length following Hip Arthroscopy in Professional Baseball Players
Authors: Mannava Sandeep , Frangiamore Salvatore Joseph , McNamara Shannen , Menge Travis J. , Briggs Karen K. , Philippon Marc J. 
Published: July 2017

Objectives: Hip arthroscopy is a highly effective treatment for symptomatic femoroacetabular impingement (FAI). High level, professional athletes have been able to return to their professional sport following arthroscopic hip surgery intervention. To date, there is a paucity of literature related to professional baseball player’s ability to return to sport following hip injury as a result of FAI. The purpose of this study was to determine the rate of return to play and length of career in professional baseball players following hip arthroscopy for FAI. We hypothesized that professional baseball players were able to return to the same level of pre-surgical competition following FAI arthroscopic hip surgery for a sustained period of time. Methods: 44 professional baseball players (51 hips) underwent hip arthroscopy for FAI between 2000 and 2015 by a single surgeon. Return to play was defined as a player competing in a pre-season or regular season minor or major league baseball game following surgery. Data was obtained for each player from MLB.com, MiLB.com, Baseballreference.com and individual team websites. Results: The average age of players at the time of arthroscopy was 26.6 years (18 to 38 years;StDev=4.8). No players had bilateral arthroscopy on the same day. Of the 44 players, 24 were pitchers and 27 were position players (12 infielders, 10 outfielders, 5 catchers). In hitters, 74% (20/27) of the procedures involved the front side hip of their batting stance. In pitchers, 71% (17/24) of procedures involved the lead leg of their pitching stance. Average career length prior to hip surgery was 6.2 years (range 1-20 years;stdev=5.1). Following hip arthroscopy, 96% (49/51) returned to professional baseball after each hip arthroscopy. Those who returned played for an average of 3.6 seasons (range 1 to 14 seasons;stdev=2.9) after hip arthroscopy. The average career length of players in this cohort was 10 seasons (range 1 to 21;stdev=5). There was no difference in the years played after arthroscopy by position (pitchers average =3.3(stdev=2.5) years and position players average = 3.9 (stdev=3.2) years) (p=0.48). Conclusion: Professional baseball players who underwent hip arthroscopy were able to return to the same high level of competition after surgery. Pitchers were more likely than position players to undergo surgical intervention with hip arthroscopy. Irrespective of player position, hip arthroscopy seems to be a surgical intervention that can allow for treatment of FAI pathology in a minimally invasive manner, while allowing for return to professional competition following full recovery. As hip arthroscopy continues to evolve, future interventions may improve post-operative return to play in baseball—lengthening playing career and level of play. At this time, hip arthroscopy is an effective surgical intervention that allows players to return to their professional level of baseball play.
A T-Capsulotomy Provides Increased Hip Joint Visualization Compared to an Extended Interportal Capsulotomy: Implications For Improved Capsular Management
Authors: Cvetanovich Gregory L. , Weber Alexander E. , Kuhns Benjamin D. , Ukwuani Gift , Wuerz Thomas H. , Khair Mahmoud Michael , Nho Shane Jay 
Published: July 2017

Objectives: Growing biomechanical and clinical evidence suggests that the treating hip arthroscopist must balance creating a capsulotomy large enough to adequately address underlying pathology while not compromising the integrity of the hip capsule, which can potentially lead to iatrogenic hip instability. The purpose of this study was to compare the cross-sectional area (CSA) of joint visualization between interportal and T-capsulotomies. Methods: 12 fresh-frozen cadaveric hips were dissected to their capsuloligamentous complexes and fixed in a custom apparatus in neutral hip position. Eight hips underwent sequential interportal capsulotomies at lengths of 2, 4, 6, and 8 cm. Four hips underwent sequential T-capsulotomies, 4 cm interportal and 2 cm T-capsulotomy (Half-T), then expansion of the T-capsulotomy to 4 cm (Full-T). A high-resolution digital photograph was taken of the capsulotomies from a standardized distance and angle with a calibration marker in place. Joint exposure gained from each capsulotomy was determined by measuring joint cross-sectional area (CSA) with ImageJ software (NIH, Bethesda, MD). Comparisons were made using t-tests and analysis of variance (ANOVA). Results: There was no significant difference in the age of cadaveric hips in both groups (65.6 ± 10.83 years: interportal vs 63.3 ± 2.5 years: T capsulotomy, p=0.53). There was statistically significant increase in CSA visualization with each increase in length (2cm: 0.58 ± 0.21cm2; 4cm: 2.14 ± 0.48 cm2; 6cm: 3.57±0.96 cm2; and 8cm: 4.22 ± 1.16 cm2, p<0.001 for all). For the T-capsulotomy group the average CSA visualization significantly increased from 3.54 ± 0.86 cm2 for the Half-T to 6.63 ± 0.90 cm2 for the Full-T (p=0.005). Half-T CSA visualization was statistically comparable to the 6 cm and 8 cm interportal capsulotomy (p=0.09, ). The Full-T had significantly superior CSA visualization area as compared to the 6 cm and 8 cm interportal capsulotomies (p<0.0001 for both). Conclusion: When improved joint exposure is necessary, T-capsulotomy should be considered given the decreased morbidity of cutting the IFL inline with its fibers and the significantly increased joint visualization compared to extending the interportal capsulotomy.