bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Anterior-posterior Distance Between the Tibial Tuberosity and Trochlear Groove
Authors: Tanaka Miho Jean , D’Amore Taylor , Elias John J. , Thawait Gaurav , Demehri Shadpour , Cosgarea Andrew J. 
Published: July 2017

Objectives: Tibial tuberosity osteotomy is often performed to correct excessive lateralization of the tuberosity in patients with patellar instability. An anteriorizing component has been recommended in the setting of chondral pathology, yet the ideal anterior-posterior relationship of the tibial tuberosity to the trochlear groove is unknown. Methods: Patients with symptomatic patellar instability underwent static CT imaging, and were compared to age- and gender-matched controls. All knees were imaged in full extension. Tibial-tuberosity-trochlear-groove (TTTG) distance was measured to quantify lateralization of the tuberosity, as well as the anterior-posterior distance between these two points (APTTTG distance). Lateral trochlear inclination (LTI), sulcus angle (SA) and trochlear depth (TD) were measured as indicators of trochlear dysplasia. Measurements were compared between the symptomatic and control groups using paired t-tests. Correlations between APTTTG with LTI, SA and TD were assessed using linear regression analyses. Results: 22 knees in 18 patients with symptomatic patellar instability were included in the study group, with 22 control knees. TTTG and APTTTG distances were 19.9 mm and 8.3 mm in the symptomatic group, versus 16.8 mm and -0.5 mm in the control group, with a difference of 3.1 mm (p=0.002) and 8.8 mm (p<0.0001) respectively. The symptomatic group displayed greater trochlear dysplasia with lower LTI (13.0° vs 21.9°, p<0.0001), higher SA (152.7° vs 137.7°, p<0.0001) and lower TD (1.3mm vs 6.0mm, p<0.0001). There was strong correlation between APTTTG and TD (r=0.62, R2=0.39, p<0.0001). Conclusion: Our findings demonstrate that the trochlear groove is almost 9mm more anterior to the tibial tuberosity in patients with symptomatic instability, and this distance correlates with measurements of trochlear dysplasia. While further studies are needed to determine the relationship between APTTTG distance and patellar instability, these findings suggest that the anterior-posterior relationship between the trochlea and tuberosity may be a factor to consider when planning for tibial tuberosity osteotomy in patients with trochlear dysplasia.
Trochleoplasty is a Viable Option for Patellar Instability in Patients with Severe Trochlear Dysplasia: Early Outcomes Analysis of the U.S. Experience
Authors: Diduch David R. , Burrus Matthew Tyrrell , Cancienne Jourdan M. , Kurkis Gregory M. , Carstensen S. Evan , Griffin Justin W. , Werner Brian C. 
Published: July 2017

Objectives: Patellar instability caused by severe trochlear dysplasia is best treated by sulcus-deepening trochleoplasty. There have been no studies examining outcomes after this procedure in the United States. The purpose of this study was to evaluate the early outcome data of patients undergoing sulcus-deepening trochleoplasty for high-grade trochlear dysplasia at our institution. Methods: A total of 43 patients (49 knees) with severe trochlear dysplasia were prospectively enrolled and underwent sulcus-deepening trochleoplasty. 23 out of 49 (46.9%) knees had prior surgery related to patellar instability, and six knees had more than one such surgery. Concomitant procedures during the trochleoplasty included medial patellofemoral ligament reconstruction (100%), lateral release (49.0%), tibial tubercle osteotomy (36.7%), and some type of cartilage procedure (49.0%). Physical examination, radiographic analysis, and clinical follow up were obtained for all patients. Patients also completed pre and postoperative Kujala and IKDC scores, in addition to reporting on return to sport and any instances of recurrent instability. Results: 79.6% of patients were female with an average age of 20.1 +/- 6.3 years. Follow up ranged from 6 weeks to 49 moths (mean 10.6 +/- 10.5 months). There were no episodes of recurrent instability. All patients reported clinically significant improvements compared with baseline preoperative outcome scores. Patellar tracking was normal in all cases with no patellar apprehension at final follow up. The mean preoperative IKDC score was 49.6, which improved to 78.3 (p < 0.001), and the mean preoperative Kujala score was 54.5 which improved to 82.8 (p < 0.001). Patients reported high satisfaction rates (mean 9.3 +/- 1.8 out of 10), and 81.5% patients were able to return to sport. 9 knees (18.4%) developed arthrofibrosis and required manipulation under anesthesia, 7 of which underwent simultaneous arthroscopic lysis of adhesions. At the latest follow-up, average knee range of motion was 126.6 +/- 13.7 degrees. Radiographic analysis of the sulcus angle demonstrated a significant decrease from 144.2 degrees preoperatively to 133.0 postoperatively (p < 0.001). Conclusion: When indicated in the setting of severe trochlear dysplasia, sulcus-deepening trochleoplasty can provide a reliable and successful surgical solution to recurrent patellar instability. Early follow up demonstrates improved radiographic parameters coupled with excellent clinical outcomes and no recurrent instability.
Open Subpectoral Biceps Tenodesis for Isolated Biceps Reflection Pulley Lesions: Minimum 2-year Outcomes in a Young Patient Population
Authors: Vap Alexander R. , Katthagen Jan Christoph , Pogorzelski Jonas , Tahal Dimitri S. , Horan Marilee P. , Fritz Erik M. , Millett Peter J. 
Published: July 2017

Objectives: Biceps Reflection Pulley (BRP) lesion is a common generator of anterior shoulder pain and cause of biceps tendon instability. The purposes of this study were (1) to investigate if patients younger than 50 years had improved functional outcomes following open subpectoral biceps tenodesis (BT) for treatment of an isolated BRP lesion with a minimum follow-up of 2-years, and (2) to determine whether a correlation exists between patient age and outcomes scores. It was hypothesized that subpectoral BT would result in reduced pain, improved functional outcomes, and a high return-to-activity rate and that there would be no association between patient age and outcomes scores. Methods: This was an IRB-approved study with retrospective review of prospectively-collected data. All patients who had arthroscopically confirmed isolated BRP lesion treated with open subpectoral biceps tenodesis were at least 2 years out from surgery were included in the study. Patients with additional surgery on the index shoulder were excluded from the study. ASES (pain and function), QuickDASH, and SF-12 scores were collected pre- and postoperatively. Postoperative satisfaction (10-point scale) was also collected. The pre- and postoperative scores of each patient were compared with a Wilcoxon-test, and association between patient age and outcomes scores were investigated with a Spearman correlation test. Further, patient return-to-activity was evaluated by questionnaire. Failure was defined as revision surgery of the biceps tenodesis. Results: 14 shoulders in 14 patients (6 male, 8 female) with a mean age of 37 ± 8.9 years met the inclusion criteria. Minimum 2-year outcomes data were available for 13 (93%) shoulders. The mean follow-up time was 3.6 ± 1.3 years. There were significant improvements postoperatively for all outcome scores (p<0.05, see table 1) and no patients underwent revision surgery of the biceps tenodesis. There was no correlation between age and outcomes scores (p>0.05). Overall, median patient satisfaction was 9 out of 10 (range 3-10). Of 14 patients who answered the “return-to-activity” questions, 5 patients () reported return to activity with no modification; 9 patients reported return to activity with modifications. The 5 patients who returned to activity with no modification had significantly less time from initial injury/onset of symptoms until surgery in comparison to the 9 patients who modified their activity (p <0.05, see table 1). Conclusion: At minimum 2-year follow-up, patients with symptomatic isolated BRP lesions can expect excellent clinical outcomes, high satisfaction, and a high return-to-activity rate with little postoperative pain if treated with an open subpectoral BT close to the time of their initial injury/onset of symptoms. No differences in outcomes were observed upon patient age. [Table: see text]
Open Sub-pectoral Biceps Tenodesis: A Biomechanics Comparison Of Interference Screw And Various Fixation Techniques
Authors: Diaz Miguel , Shi Brendan , Belkoff Stephen , Srikumaran Umasuthan 
Published: July 2017

Objectives: The purpose of this study was to biomechanically compare six techniques for biceps tenodesis to evaluate the potential difference of anchor size, type and configuration (single- versus double-loaded). The six techniques were interference screws (IS), endobutton (EB), double-loaded 2.9mm PEEK anchor (DL-2.9), double-loaded 1.9mm all-suture anchor (DL-1.9), single-loaded 1.7mm all-suture anchor (SL-1.7), and soft tissue tenodesis (ST) (Smith and Nephew, Memphis, TN, USA). Methods: 42 fresh-frozen cadaver shoulders (mean age, 72 years [range 54 to 89 years; SD, 9.8 years]; 71% male specimens) were dissected leaving the proximal humerus, proximal biceps tendon, and pectorals major insertion. Specimens were randomized 1 to 6 groups and a sub-pectoral biceps tenodesis was performed. The specimens underwent load to failure axial traction on a materials testing machine. Results: The mean failure loads with the 95%Cl are as follows: IS (78.6N, 58.1-99.1 N), ST (100.3 N, 77.7-122.9 N), DL-1.9 (120.6 N, 101.3-139.8 N), EB (136.7 N, 104.5-168.9 N), DL-2.9 (141.0 N, 111.3-170.7 N), and SL-1.7 (142.0 N, 107.9-176.1 N). Failure occurred at the tendon in almost all specimens, however 5 specimens sustained anchor failure during mechanical loading (IS, n=2; DL-2.9, n=1; DL-1.9, n=1; SL-1.7, n=1). Conclusion: The load to failure testing of the interference screw group demonstrated statistically significant lower results than the endobutton and anchor techniques. The endobutton and anchor techniques were not significantly different. The endobutton, double-loaded 2.9mm PEEK anchor, and single-loaded 1.7mm all-suture anchor attained the largest ultimate failure loads at approximately 140 N. These results may be taken into consideration when the orthopedic surgeon selects the appropriate fixation technique.
Hip Arthroscopy Survivorship: A Population-based Study
Authors: Heidari K Soraya , Heckmann Nathanael , Pannell William C. , Hill J Ryan , McKnight Braden Michael , Vangsness C. Thomas , Hatch George F. Rick 
Published: July 2017

Objectives: Recently, hip arthroscopy has been increasingly utilized to address pathology such as femoracetabular impingement and symptomatic labral tears. However, its role in advanced age and degenerative changes has not been clearly defined. The aim of this study was to examine survivorship following hip arthroscopy and identify risk factors for failure. Methods: Data from the California Office of Statewide Health Planning and Development, a mandatory statewide discharge database, was utilized to identify patients who underwent hip arthroscopy from 2000 to 2014. Exclusions included lower extremity trauma, infection, congenital deformities, malignancy, and concurrent arthroplasty. Demographic information was assessed and failure defined as conversion to total hip arthroplasty (THA). Statistically significant differences between patients requiring THA and those who did not were identified by univariate analysis. Multivariate analysis was performed to account for identified differences, and a Kaplan-Meier curve constructed to estimate 5 and 10-year survivorship. Results: After exclusions, 10,061 patients were identified with an average follow-up of 2.7 years. Five and 10-year survivorship were 90.9% and 77.9%, respectively. Patients converted to THA were older (53.1 years versus 40.1 years, p<0.001) and had more comorbidities (27.5% versus 20.1% having at least one comorbidity, p<0.001). THA patients had a higher prevalence of osteoarthritis (41.5% versus 13.24%, p<0.001) and osteochondral defects (44.0% versus 38.9%, p=0.001). On multivariate analysis, each 1-year increase in age presented a 7% increase in failure risk (OR 1.07, p<0.001). Obese patients were more likely to fail (OR 2.19, p=0.049), as were patients with osteoarthritis and osteochondral defects (OR 2.98, p<0.001 and OR 1.13, p=0.081). Patients whose surgery included removal of loose bodies or debridement were also at increased risk of failure (OR 1.58, p<0.001 and OR 1.62, p=0.001). Conclusion: Older age, obesity, and diagnoses of osteoarthritis or osteochondral defects at the time of surgery are risk factors for conversion to arthroplasty following hip arthroscopy. [Table: see text][Figure: see text]
Hip Arthroscopy with Labral Preservation and Capsular Plication in Patients with Borderline Hip Dysplasia: Minimum 5-year Patient Reported Outcomes
Authors: Ashberg Lyall , Chaharbakhshi Edwin , Perets Itay , Close Mary , Walsh John P. , Domb Benjamin G. 
Published: July 2017

Objectives: Arthroscopic management of hip pathology in patients with hip dysplasia has been controversial, and historically demonstrated mixed results. Studies on patients with borderline dysplasia, emphasizing the importance of the labrum and capsule as secondary stabilizers, have shown favorable outcomes. We predicted that patients with borderline dysplasia, who are undergoing hip arthroscopy for intrarticular pathology and who have commensurate labral preservation and capsular plication, will have favorable outcomes at mid-term follow up. Methods: Data was prospectively collected for patients < age 40, who underwent hip arthroscopy for intra-articular pathology. Inclusion criteria included lateral center-edge angle (LCEA) between 18° and 25°, concurrent capsular plication and labral preservation, and minimum five-year follow-up. Exclusion criteria were severe dysplasia (LCEA ≤ 18°), Tönnis grade ≥ 2, preexisting childhood hip conditions, or prior hip surgery. Patient-reported outcome scores (PROs) including modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-sport specific subscale (HOS-SSS) and Visual Analogue Score for pain (VAS) were collected preoperatively, at 3 months, and annually thereafter. Complications and revisions were recorded. Results: Twenty-five hips (24 patients) met inclusion criteria. Twenty-one hips (19 patients, 84%) were available for follow-up. Mean age was 22.9 years. Mean preoperative LCEA and Tönnis angle were 21.7° and 6.9°, respectively. Mean follow-up was 68.8 months. Mean mHHS increased from 70.3 to 85.9 (p < 0.0001), NAHS from 68.3 to 87.3 (p < 0.0001) and HOS-SSS from 52.1 to 70.8 (p = 0.0002). VAS improved from 5.6 to 1.8 (p < 0.0001). Four hips (19%) required secondary arthroscopic procedures, all of which resulted in improved PROs at latest follow-up. No patient required conversion to arthroplasty. Conclusion: Using strict patient selection, hip arthroscopy with labral preservation and capsular plication can provide a safe, durable means of managing intra-articular pathology in the setting of borderline acetabular dysplasia. For this select group, this procedure may offer a viable alternative to open surgery (PAO).
Clinical Outcomes and Return to Sport in Competitive Athletes Undergoing Iliopsoas Fractional Lengthening as a Part of Hip Arthroscopy - Minimum Two-Year Follow-Up
Authors: Perets Itay , Hartigan David Edward , Walsh John P. , Chaharbakhshi Edwin , Close Mary R. , Domb Benjamin G. 
Published: July 2017

Objectives: The iliopsoas is a hip flexor and stabilizer that may be associated with internal snapping. Although flexion and stability are important in competitive athletes, painful internal snapping may be debilitating and may necessitate arthroscopic iliopsoas fractional lengthening (IFL). The purpose of this study was to report minimum two-year results for athletes’ patient-reported outcomes (PROs), returning to sports, and competitive abilities after IFL during hip arthroscopy. We hypothesized that IFL for internal snapping in athletes is a safe procedure and will demonstrate favorable outcomes, with a majority of athletes returning to sports with the same or higher competitive abilities. Methods: Data were prospectively collected and retrospectively reviewed for 1,682 patients undergoing hip arthroscopy between February 2008 and October 2013. Inclusion criteria were as follows: high school, collegiate, or professional athlete, who underwent arthroscopic IFL, and agreed to preoperative modified Harris Hip Score (mHHS), Non-Arthritic Athletic Hip Score (NAHS), Hip Outcome Score - Sports Specific Subscale (HOS-SSS), and Visual Analog Scale (VAS). All patients failed to improve with at least three months of conservative treatment, including physical therapy, anti-inflammatories, and rest. Exclusion criteria were as follows: patients under 16 years old, Tönnis grade > 1, previous hip conditions such as Legg-Calve-Perthes disease, hip fractures, slipped capital femoral epiphysis, avascular necrosis of the femoral head, hip dysplasia, and previous surgical intervention for either hip. Results: Fifty athletes were eligible for inclusion, 44 (88%) of which had minimum two-year follow-up. All PRO scores demonstrated significant improvements at latest follow-up (p < 0.0001). Mean improvements were as follows: mHHS (65.1 to 83.7), NAHS (60.7 to 86.2), HOS-SSS (41.5 to 75.4), VAS (5.8 to 2.0). Mean satisfaction was 8.1. Painful snapping was resolved in 41 patients (93%). Six patients (14%) had non-painful snapping at latest follow-up. Of the 44 athletes, 6 (14%) did not return to sport due to their hip symptomatology, 29 (65.9%) returned to sports, and 24 (54.5%) maintained or improved their competitive abilities. Nine patients (20.5%) did not return to sports for reasons unrelated to their hip (e.g., loss of interest, aging, etc.). The only complications were two (4.6%) superficial wound infections that resolved with topical treatment. There were no complaints of weakness in hip flexion. Conclusion: In competitive athletes, IFL during hip arthroscopy is safe and demonstrates favorable improvements in PROs and VAS, high satisfaction, and high rate of symptom resolution at a minimum of two years postoperatively. The majority of patients were able to return to sports and maintain or improve their competitive levels.
Arthroscopic Treatment of Acetabular Condral Defects Using BST-CarGel
Authors: Wong Ivan , Rhee Chanseok (Chris) , Amar Eyal , Glazebrook Mark , Coady Catherine M. 
Published: July 2017

Objectives: The purpose of this study is to retrospectively analyze prospectively collected data to evaluate the shortterm outcome of patients treated arthroscopically with BSTCarGel for acetabular chondral defect. Methods: Between November 2014 and December 2015, 22 patients (23 hips) underwent hip arthroscopy for correction of femoroacetabular impingement, labral repair and treatment of acetabular chondral defect. Patient evaluations included general assessment with iHOT33 questionnaire at the time of preoperative consultation, and the postoperative followup at 2 weeks, 6 weeks, 3 months, 6 months, 1 year and 2 year marks. Additionally, preoperative and postoperative plain radiographs and MRarthrogram scans were analyzed for evaluation. Results: 22 patients (23 hips) have been evaluated with a mean age of 33.34 years at the time of the index operation. There were 16 males (17 hips, mean age of 32.00) and 6 female (6 hips, mean age of 37.15). The average followup was 1 year, with a minimum followup of 6 months. The preoperative iHOT33 score was 47.1, the 6 months postoperative score was 54.8, and the 12 month postoperative score was 63.7 (p < 0.05) MRIArthrograms demonstrated a decrease in the size of the chondral defects. No significant adverse outcomes have been reported. Conclusion: Arthroscopic treatment of chondral acetabular defect with BSTCarGel demonstrates encouraging signs of cartilage healing as shown on MRarthrograms, without significant adverse outcomes. Longer followup is required to determine if this improvement is maintained.
Association of Hip Strength with the Hip Sports Test: A Functional Test to Measure Athlete’s Ability to Return to Sport Activity after Hip Arthroscopy
Authors: Bolia Ioanna , Briggs Karen K. , Locks Renato , Utsunomiya Hajime , Philippon Marc J. 
Published: July 2017

Objectives: Excellent clinical outcomes and high rates of return to pre-operative level of activity has been reported in athletes that underwent hip arthroscopy. However, physicians often struggle to decide whether or not in an athlete is able to return to full activity. The Hip sports test (HST), like the already established knee test, may be a useful assessment tool towards this direction. The purpose of our study was evaluate the the correlation of the hip muscle strength values with the HST performance of athlete (measured on the same day) during the post-operative rehabilitation period. Muscle strength could serve as a complimentary, to sports test, tool in order to evaluate the return to sport ability of the athletes. Methods: The HST score as well as the muscle strength measurement were obtained on the same day in 115 athletes. Hip muscle strength was assessed using the MicroFET Dynometer pre-operatively and post-operatively. Measurements were made in hip flexion, extension, abduction, adduction, internal rotation, external rotation, gluteus medius and hamstrings. During the HST assessment patients were assessed in single leg squats (single knee bents), lateral agility, diagonal agility exercises as well as in forward single leg lunges in order to obtain their score. The score of 18 or more is considered a passing score for this test. Pre-operatively, 62 tests were performed whereas 53 tests were performed post-operatively. Our data were normally distributed- however, correlation was done non-parametrically using Spearman’s rank correlation coefficient (Spearman’s rho) due to the limited scale of HST. Results: The pre-operative strength change compared to the uninjured hip was -4.8% for flexion, -2.2% for extension, 2.4% for abduction, 0.3% for adduction, -2.1% for internal rotation, -1.7% for external rotation, -1.5% for gluteus medius and 1.3% for hamstring. The pre-operative median HST score was 12.5 (range: 0-20). Post-operative hip strength measurements and the distribution of HTS scores are summarized in the table.The Total HST score performance was correlated with hip muscle strength in extension (rho=0.344; p=0.001) and external Rotation (rho=0.260; p=0.006). Conclusion: The HST score performance is correlated with the hip muscle strength of hip extension and hip external rotation. [Table: see text]