bluuebunny/crossref_metadata_2025_split huggingface dataset:
Moderate Return to High Impact Function after Fresh Osteochondral Allograft Transplantation for Chondral Defects of the Knee
Authors: Waterman Brian R. , Thomas Dimitri 
Published: July 2017

Objectives: The purpose of this investigation was to report the patient-reported and occupational outcomes of military servicemembers after fresh osteochondral allograft transplantation (OCA) of the knee at mid-term follow-up. Methods: A query of the Military Health System was performed to identify all United States Army service members undergoing OCA for Outerbridge grade 3 or 4 chondral lesions between January 2009 and June 2013 with minimum 2-year follow-up. Exclusion criteria were applied to individuals with the following: insufficient follow-up or documentation; treatment of bipolar lesions; and use of cryopreserved, fresh-frozen, or fresh osteochondral allografts used greater than 28 days after harvest. Demographic information, lesion characteristics, and clinical outcomes (Visual Analog Scale for pain, functional duty limitations, and/or revision rates) were extracted from the military electronic medical records system. Statistical measures such as the Chi square test and Poisson multivariable regression analysis were utilized to evaluate for variables associated with rate-limiting, knee disability and/or surgical revision. Results: At 3.8 follow-up, 61 patients met the inclusion criteria with an average age was 32 yrs±8.0. Medial femoral condyles were most common (n=40;65.6%), followed by the patella (n=11;18.0%), lateral femoral condyle (n=8;13.1%), and trochlea (3;5.0%). The average cross-sectional size of treated lesions was 364 mm2±193 (48-707 mm2). Thirty-seven knees (61.7%) were treated without concomitant procedure, and 21 knees (34.4%) had staged or simultaneous periarticular osteotomies. Average VAS pain scores significantly decreased from 4.1 to 2.5 postoperatively (p<0.01). At final follow up, 65.6% of patients returned to unrestricted or modified military function, whereas 21(34.4%) individuals were unable to return due to persistent knee limitations. Nine (14.7%) patients experienced preoperative complications, Seven patients (11.5%) required secondary revision after OCA, 3 patients underwent chondroplasty, and 1 patient (1.6%) underwent subsequent total knee arthroplasty. Lesion size was not associated with any adverse clinical or surgical outcomes (p>0.05), and lateral femoral condyle and trochlear lesions had a higher rates of revision, although this failed to achieve significance (p=0.22;p=0.26, respectively). Higher preoperative BMI (OR 1.15;p=0.045) and postoperative VAS(OR 1.36;p<0.01) values were associated with increased risk of knee disability. Conclusion: Fresh OCA can reliably decrease knee pain in a highly-active population, with nearly two-thirds of all patients return to military function. However, approximately one in eight individuals may undergo revision after return to preoperative activities, and individuals of high BMI may be at heightened risk of clinical failure.
Outcomes of Osteochondral Allograft Transplantation with versus without Concomitant Meniscus Allograft Transplantation: A Comparative Matched Group Analysis
Authors: Frank Rachel M. , Lee Simon , Poland Sarah Glen , Leroux Timothy Sean , Cole Brian J. 
Published: July 2017

Objectives: While osteochondral allograft transplantation (OAT) is often performed with concomitant meniscus allograft transplantation (MAT) as a strategy for knee joint preservation, the impact of concomitant MAT on outcomes following OAT has not been assessed. The purpose of this study was to determine clinical outcomes for patients undergoing OAT with MAT compared to a matched cohort of patients undergoing isolated OAT. Methods: A review of consecutive patients who underwent OAT by a single surgeon with a minimum follow-up of 2 years was conducted. Patients who underwent OAT without concomitant MAT were compared to a matched group of patients who underwent OAT with concomitant MAT (age ± 3 years, gender, BMI ± 5 kg/m2, number of previous ipsilateral knee surgeries ± 1, and the presence of concomitant ligamentous surgery). The reoperation rate, failure rate, timing of reoperation, procedures performed, findings at surgery, and patient reported outcome scores were reviewed. Failure was defined by revision OAT, conversion to knee arthroplasty, or gross appearance of graft failure at 2nd look arthroscopy. Descriptive statistics, fisher’s exact or chi-square testing, and Mann-Whitney U testing were performed, with P<0.05 set as significant. Results: A total of 100 patients (average age 32.2±9.9 years; 52 males, 48 females) who underwent OAT (50 isolated, 50 with MAT) with an average follow-up of 4.84±2.7 years (range, 2.0-15.1) were included. These patients underwent an average of 2.6±1.2 prior surgical procedures on the ipsilateral knee prior to OAT. A total of 38 patients underwent reoperation at an average 2.4±2.2 years, with 24% (9/38) undergoing additional reoperations (range, 1-2 additional reoperations). MAT patients did not have significantly different reoperation rates (MAT: 40%; non-MAT: 36%), time to reoperation (MAT: 2.20±2.31 years; non-MAT: 2.56±2.11 years) or failure rates (14% vs. 14%) compared to non-MAT patients. Both MAT and non-MAT patients showed significant improvement in Lysholm, IKCD, KOOS, WOMAC, and SF-12 physical subscale as compared to preoperative values (P>0.05 for all for both groups). The SF-12 mental subscale was not significantly improved at final follow-up for either group. MAT patients demonstrated significantly higher SF-12 physical subscale as compared to non-MAT patients at most recent follow-up (45.81±7.42 vs 42.07±7.97, P<0.05). There were no significant differences detected in the defect size (MAT: 338.64±116.31 mm2; non-MAT: 344.42±171.04 mm2, P>0.05) or defect:condyle size ratio (MAT: 0.19; non-MAT: 0.20, P>0.05). Conclusion: Patients undergoing OAT with MAT have similar survival rates, reoperation rates, and clinical outcomes compared to patients undergoing isolated OAT at an average follow-up of 5 years. This information can be used to counsel patients undergoing concomitant MAT as part of a knee joint preservation strategy.
Return to Play After Shoulder Instability in National Football League Athletes
Authors: Okoroha Kelechi R. , Taylor Kevin , Keller Robert A. , Marshall Nathan E. , Varma Vishal , Moutzouros Vasilios 
Published: July 2017

Objectives: To determine the rate and timing of return to NFL play after a shoulder instability event and to determine what factors predict ability to Return to Play (RTP). Methods: A total of 83 NFL players who sustained an in-season shoulder instability event while playing in the NFL were identified and evaluated. Return to NFL play, incidence of surgery, time to return, recurrent instability events, seasons and games played after injury, and demographic data were collected. Overall RTP was determined and players who had surgery were compared to those who did not have surgery. Playing time after RTP was compared with age, position, size and experience matched control players. Results: Ninety-one percent of NFL players returned to NFL regular season play at an average of 1.6 ± 1.9 weeks (mean ± SD) in those sustaining a shoulder subluxation and 3.7 ± 5.4 weeks in those sustaining a dislocation; p = .53. In players who were able to RTP without surgery, those having a left shoulder instability event were able to return faster (1 week) than those having a right shoulder event (4 weeks); p = .03. A majority of players (62%) underwent surgical stabilization and 86% returned to play the following season. Players who had surgery were more likely to have a second instability event in their career (58% versus 9%); p = .01. No difference was found when comparing playing time after return with matched controls. Conclusion: There is a high rate of RTP following shoulder instability events in NFL players. Players sustaining subluxations in their non-dominant arm return to play at a faster rate. Surgical stabilization of the shoulder following an instability event may not ly eliminate potential for subsequent recurrent events as a high percentage of surgically treated players were found to have another instability event.
A Prospective Outcome Evaluation of Humeral Avulsions of the Glenohumeral Ligament (HAGL) Tears in an Active Population
Authors: Provencher Matthew T. , McCormick Francis , Sanchez George , LeClere Lance E. , Dewing Christopher B. , Solomon Daniel J. 
Published: July 2017

Objectives: Humeral avulsion of the glenohumeral ligament (HAGL) is an infrequent but significant contributor to shoulder dysfunction, instability, and functional loss. The purpose of this study is to prospectively evaluate the clinical history, examination findings, and surgical outcomes of patients with HAGL lesions. Methods: Over a 6-year period, patients with shoulder dysfunction and a HAGL lesion confirmed via magnetic resonance arthrogram (MRA) were prospectively evaluated with a minimum 2-year follow-up. Patient demographics, presentation, examination and surgical findings were documented. Outcomes of return to activity and SANE and WOSI scores were recorded at final follow-up. Anterior HAGL (aHAGL) lesions were repaired with a mini-open approach, while reverse (rHAGL) lesions were repaired arthroscopically. Results: A total of 27 of 28 patients (96%) d the study requirements at a mean of 36.2 months (range 24-68 months). There were 12 females (44%) and 15 males (56%) with a mean age of 24.9 years (range 18-34). The primary complaint was pain in 23 patients (85%) and only 4 (15%) patients complained of instability symptoms. There were 14 patients (52%) with aHAGL lesions, 10 patients (37%) with rHAGL lesions, and 3 patients (11%) with combined anterior and posterior HAGL lesions. Ten patients (37%) had concomitant HAGL lesions and labral tears, whereas 17 patients (63%) presented with an isolated HAGL lesion. The 17 patients (63%) with aHAGL lesions or combined lesions underwent a mini-open surgical repair, while the remaining 10 patients (37%) with rHAGL lesions underwent arthroscopic surgical repair. After surgery outcomes improved from WOSI = 54%, SANE = 50% to WOSI = 88%, SANE = 91% (p<0.01). Conclusion: This study demonstrated that patients with symptomatic HAGL lesions complain predominantly of pain and shoulder dysfunction and present with few instability complaints or findings. After surgery, patients showed predictable return to full activity, improvement in objective and patient-reported outcomes, and patient satisfaction.
Arthroscopic Treatment of Shoulder Instability with Glenoid Bone Loss Using Distal Tibia Allograft Augmentation
Authors: Wong Ivan , Amar Eyal , Coady Catherine M. , Smith Ben , Glazebrook Mark , Konstantinidis George , Dillman Daryl B. 
Published: July 2017

Objectives: The purpose of this study was to retrospectively analyze prospectively collected data to present the clinical and radiological short term outcomes of patients who underwent anatomic glenoid reconstruction using distal tibia allograft to treat shoulder instability with glenoid bone loss. Methods: Over four years, 44 patients (31 patients were male and 13 female with mean age of 29.73 years) underwent arthroscopic stabilization with capsulelabral Bankart repair and allograft bony augmentation of the glenoid for recurrent shoulder instability with significant bone loss by the same surgeon. 14 patients were revision cases of previous surgery. Preoperative and postoperative functional assessment was performed with the Western Ontario Shoulder Instability Index (WOSI) questionnaire, and radiological assessment was performed with radiographs and CT scans. The Average follow-up was 2 years. Results: 97% (43/44) patients had no dislocations or subluxations at the most recent followup. The mean pre and postoperative WOSI scores were 40.54 and 72.65 respectively (p<0.001). No patients developed nerve injury. One patient presented with hardware failure at 3 years post-op. Two other patients had graft absorption and 6 patients had partial graft resorption but none had symptoms of instability. The mean postoperative active shoulder range of motion was forward flexion 170.1o, abduction 168.9o, internal rotation 69.5o and external rotation 57.5o. Grafts positioning was flush with the glenoid in 93% of cases, vertical positioning was excellent in 89% (35 o’clock). Conclusion: Arthroscopic stabilization of the shoulder with distal tibia allograft augmentation is a good safety profile technique with good results at average of two years follow up.
Equivalent Knee injury and Osteoarthritis Outcome Score after 1 and 2-year following Anterior Cruciate Ligament Reconstruction - Results from The Swedish National Knee Ligament Register
Authors: Samuelsson Kristian , Magnussen Robert A. , Alentorn-Geli Eduard , Spindler Kurt P. , Forssblad Magnus L. , Karlsson Jon 
Published: July 2017

Objectives: It is not clear if there is an additional value to assess the Knee injury and Osteoarthritis Outcome Score (KOOS) at both 1 and 2-years after primary Anterior Cruciate Ligament (ACL) reconstruction. The purpose was to investigate within individual patient if there is an equivalence between KOOS at 1 and 2-years after primary ACL reconstruction in The Swedish National Knee Ligament Register. Methods: This cohort study was based on data from the Swedish National Knee Ligament Register during the period of January 1, 2005, through December 31, 2013. The longitudinal KOOS scores for each individual at 1-year and 2-year follow-up were assessed through the Two One-Sided Test procedure with an acceptance criterion of 4. Subset analysis was also performed with patients classified by sex, age, graft type and by patients with meniscus and/or cartilage injury. Results: A total of 23 952 patients were eligible for analysis after applied exclusion criteria’s (women, n=10,116; 42.2% and men, n=13,836; 57.8%). The largest age group was between 16 and 20 years of age (n=6,599; 27.6%). The most common ACL graft was hamstring tendon (n=22,504; 94.0%) of which the combination semitendinosus and gracilis was the most common. A total of 7,119 patients reported on the KOOS Pain domain at both 1 and 2-year follow-up with a mean difference of 0.21 (13.1 SD, 0.16 SE, [90% CI, -0.05 - 0.46], p<0.001). The same results were found for the other KOOS subscales: symptoms (mean difference -0.54, 14.1 SD, 0. SE, [90% CI, -1.05 - -0.39], p<0.001), ADL (mean difference 0.45, 10.8 SD, 0.13 SE, [90% CI, 0.24 - 0.66], p<0.001), sports and recreation (mean difference -0.35, 22.7 SD, 0.27 SE, [90% CI, -0.79 - 0.09], p<0.001), quality of life (mean difference -0.92, 20.0 SD, 0.24 SE, [90% CI, -1.31 - -0.44], p<0.001) and in the combined KOOS-4 score (mean difference -0.41, 14.5 SD, 0.17 SE, [90% CI, -0.70 - -0.13], p<0.001). Analysis with specific subsets of patients all showed equivalent results between the two follow-ups. Conclusion: Equivalent results within a patient can be found in KOOS in 1-year and 2-year follow-up after ACL reconstruction. The finding is consistent across all KOOS subscales and for all evaluated subsets of patients. The implication of this research is that there is no additional value to capture both 1 and 2-year KOOS outcomes following ACL reconstruction. [Table: see text]
Economic Impact of Community Sports Coverage by Outreach Athletic Trainers on a Health System: Implications for Program Growth and Sustainability
Authors: Buckner Jeannie , Hewson Kirstie , Barr Michael , Woolf Shane K. , Crawford Thomas , Slone Harris 
Published: July 2017

Objectives: Coverage of high school and community athletics integrated within a comprehensive sports medicine program is becoming the standard of care to optimize medical treatment of athletes. While the economic benefit of clinic-based athletic trainers (AT) has been clearly demonstrated, there has been little published on the benefit of outreach AT. The purpose of the present investigation is to examine the cost-effectiveness of outreach AT for both orthopaedic providers and the health system as a whole. Methods: Review of an electronic prospective database of the outreach AT referrals to our institution was conducted for a four-year fiscal period (July 2011-June 2015). New patients as well as patients with established care at our institution were identified, and cumulative referred episodes of care and downstream revenue were recorded from billing records. New patients were defined as having no association with the hospital in the three years prior to the initial referral. All episodes of care included in this review were referred initially through the AT program; Data were recorded for the ensuing fiscal year of service. Results: Eight thousand five hundred and seventy total episodes of care resulted from 843 patients referred into the system, yielding $2,286,733 in total revenue (Table 1). There were 187 new patients, yielding 1602 referred episodes of care across both professional-based and hospital-based services. On average, each referred patient generated 10.17 episodes of care, with each episode generating an average of $267. Combining revenue from both professional-based and hospital-based care, an average of $2712 per patient was generated through the AT program over the four year period. Combining musculoskeletal revenue from hospital-based services and orthopaedic revenue from professional-based services yielded $761,052 in total revenue, indicating a 33% capture rate of the total profit of the program; the remaining 66% was distributed across the health system. Conclusion: Affiliation between high school and community sports teams and orthopaedists through outreach AT is an economically sustainable, symbiotic relationship. Additionally, there is not only a positive economic impact for providers, but a distinct benefit to the entire health system. [Table: see text]
Return to Sport as Outcome Measure for Shoulder Instability: Surprising Findings in Non-Operative Management in a High School Athlete Population
Authors: Shanley Ellen , Tokish John M. , Thigpen Charles A. , Ruffrage Lauren , Wyland Douglas J. , Kissenberth Michael J. 
Published: July 2017

Objectives: Recurrence rates have traditionally been used as a proxy for “failure” when comparing conservatively vs. operatively managed patients with anterior shoulder instability. Return to sport has been evaluated as an outcome proxy after surgical intervention, but no study has compared conservative vs. operative management using sustained return to sport as the main outcome measure. The purpose of this study was to compare the results between conservatively and operatively treated patients as to their ability to return a patient to uninterrupted sport in a subsequent season after an anterior instability event. Methods: We identified and followed 179 scholastic athletes who were treated for a confirmed diagnosis of anterior shoulder instability. 97 were treated initially with conservative management, and 32 were managed surgically. Patients were excluded if they did not have remaining eligibility to play a subsequent season of athletics (high school seniors), or if they were treated with benign neglect (neither conservative nor operative treatment). “Ultimate success” was defined as return and completion of the subsequent season without time loss due to any shoulder related diagnosis. We substratified by age, sport, and type of instability event (subluxation vs. dislocation) using ANOVA and binary logistic regression. Results: In the conservatively managed group, 85% met the definition of ultimate success by returning to play a subsequent season of scholastic athletics in the same sport without any time loss due to a shoulder condition. In the surgical group, 72% were able to achieve this status (p<0.05). Age did not differ between the two groups. Patients were 5x less likely to return to sport if they had sustained a dislocation requiring reduction compared to a subluxation confirmed as an anterior instability event (OR: 4.96, 95%CI= 1.2-9.6). Conclusion: Patients who were treated conservatively for an anterior shoulder instability event were far more likely to have a “successful” outcome than published results if the definition of outcome is changed from no recurrence to completion of a subsequent season in their same sport. Patients sustaining a subluxation were nearly uniformly successful in doing so. While surgical success using this definition was quite lower, there was likely a selection bias in the decision making process due to bone loss, surgeon preference or other factor. Nevertheless, this data would suggest that if a patient’s goal is to return to the same level of sport and “next season”, conservative management is highly effective. Further study to determine whether these results hold out with longer term follow up are warranted, but the routine fixation of the first time dislocator based on better outcomes, is called into question depending on what one’s definition of success is.
High Return to Sports after TSA Under 55
Authors: Garcia Grant , Degen Ryan , Liu Joseph N. , Dines David M. , Gulotta Lawrence Vincent 
Published: July 2017

Objectives: Young, active shoulder arthroplasty candidates are a unique group of patients. Not only due they demand longevity and improved function, but they also desire a return to physical activities. Our objective was to determine the rate of return to sports in total shoulder arthroplasty patients’ age 55 and younger. Methods: This was a retrospective review of consecutive patients who underwent total shoulder arthroplasty at a single institution. Exclusion criteria included age at surgery greater than 55 years and less than 2 years of follow up. Final follow-up consisted of a patient-reported sports questionnaire, ASES and VAS scores. Results: 61 shoulders were included with an average follow-up of 61.0 months (23-103) and average age at surgery of 48.9 years (25-55). VAS improved from 5.6 to 0.9 (p<0.001), and ASES improved from 39.3 to 88.4 (p<0.001). 80.3% (49) were done for osteoarthritis. 4 shoulders returned to the operating room, none were for glenoid loosening. There was a 93.2% satisfaction rate and 67.7% (40) stated they had their surgery to return to sports. 96.4% (55/57) restarted at least one sport at an average of 6.7 months. Direct rates of return were as follows: fitness sports (97.2%), golf (93.3%), singles tennis (87.5%), swimming (87.5%), basketball (75%) and flag football (66.7%). 82.4% (47) returned to similar or higher level of sport. 90.3% returned to a high demand sport and 83.8% returned to a high upper extremity use sport. There was no significant difference in rate of return to sport by BMI, sex, age, preoperative diagnosis, revision status, and dominant extremity. Conclusion: In patients age 55 and younger undergoing total shoulder arthroplasty, there was a 96.4% rate of return to sports at an average of 6.7 months. Furthermore, at an average follow up of 5 years, no patients needed revision of their glenoid component despite an 83.8% rate of return to high upper extremity use sports. While caution should still be advised in young active patients undergoing total shoulder replacement, these results demonstrate a high satisfaction rate and improved ability to return patients to most sports after surgery.