bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematic Review and Meta-analysis of Osteochondral Autograft Transplantation versus Debridement in the Treatment of Osteochondritis Dessicans of the Capitellum
Authors: Bowman Seth , Braunstein Jacob , Rabinowitz Justin , Barfield William R. , Chhabra Bobby , Haro Marc Scott 
Published: July 2016

Objectives: The purpose of this systematic review and meta- analysis is to compare clinical results and functional outcomes in patients with osteochondritis dessicans (OCD) lesions of the capitellum treated with either osteochondral autograft transplantation (OATS) or debridement with or without microfracture. Methods: Systematic review of multiple medical databases was performed after PROSPERO registration and using PRISMA guidelines. A literature search was performed using the multiple medical databases and the methodological quality of the individual studies was assessed by two review authors using the Cochrane Collaboration’s “Risk of Bias” tool. Case reports were excluded and only case series of more than five patients and higher level of evidence were included. All study, subject, and surgery parameters were collected. Data was analyzed using statistical software. Odds ratios (OR) were calculated when possible. Data were compared using Pearson Chi-Square and independent sample T tests when applicable. Results: Fifteen studies were included involving 368 patients (326 males and 42 females). There were a total of 197 patients in the debridement group and 171 patients in the OATS group. The mean age was 16.9 +/-4.1 for the debridement group and 14.6 +/-1.2 for the OATS group. Mean follow up was 29.0 +/-24.3 and 38.0 +/-12.8 for the debridement and OATS groups, respectively. Patients that underwent an OATS procedure had a statistically significant improvement in overall arc range of motion compared to patients that had a debridement (P≤0.001). When compared to patients with debridement, patients with OATS were 5.6 times more likely to return to at least their pre-injury level of sports participation (p≤0.002). Conclusion: Post-operative range of motion was significantly improved in patients undergoing an OATS procedure versus a debridement for OCD lesions of the capitellum. Patients with an OATS were 5.7 times more likely to return to at least the pre-injury level of sports participation compared to patients undergoing a debridement. Further studies are necessary in order to directly compare functional outcomes in patients undergoing a debridement procedures versus and OATS procedure.
Survivorship after Arthroscopic Management of Glenohumeral Osteoarthritis with a Minimum 5 year Follow-up
Authors: Mitchell Justin , Horan Marilee P. , Greenspoon Joshua A. , Menge Travis , Tahal Dimitri S. , Millett Peter J. 
Published: July 2016

Objectives: We previously reported clinical improvement and pain relief following arthroscopic management of glenohumeral osteoarthritis (GHOA) at 2 years. The purpose of this study was to determine 5 year survivorship for the comprehensive arthroscopic management (CAM) procedure for the treatment of GHOA. Methods: This study had prior IRB approval. The CAM procedure was performed on a consecutive series of 42 young patients (44 shoulders) with GHOA who otherwise met criteria for shoulder arthroplasty but instead opted for joint preservation. The procedure included glenohumeral chondroplasty, capsular release, and synovectomy, humeral osteoplasty, axillary nerve neurolysis, subacromial decompression, loose body removal, microfracture and biceps tenodesis. Only patients who were a minimum of 5 years out from surgery were included in the study. Patients completed a subjective questionnaire, and further surgical intervention of the index shoulder was noted for survivorship analysis. Failure was defined as progression to TSA. Kaplan Meier survivorship analysis was performed. Results: Forty-two patients (with 44 shoulders) underwent a CAM procedure between 1/2006-12/2009 and were included. All patients were self-described recreational athletes. Seven patients were former collegiate or professional athletes. Mean follow-up was 5.9 years (range, 5 years to 8.1 years). Mean age at surgery was 52 (range 27- 68) years old in 13 women and 29 men. Eleven shoulders (26%) failed and progressed to TSA at a mean of 2.9 years (1.0-5.4 years). Shoulder status (progression to TSA or not) at minimum 5 years (range 5.3 - 9.4 years) was known for 95% (42/44). One patient progressed to another surgery for stiffness at a mean of 5.6 months and another patient underwent a revision CAM procedure at 7.9 years. From this cohort, Kaplan Meier survivorship was 92% at 1 year, 85.7% at 3 years, and 75.3% survivorship at 5 years. Conclusion: The long term durability of arthroscopic management for symptomatic GHOA is not well studied. Glenohumeral debridement and capsular release may not be enough to address all the pain generating pathology in the osteoarthritic shoulder. After the CAM procedure we found an 84% survivorship at 3 years and 72% survivorship at 5 years. Predictors of success were not known in the early years for this patient cohort. We have since found that factors such as joint space > 2 mm, glenoid morphology (A1, A2, B1) and CSA > 30o are associated with better outcomes. The 72% survivorship at 5 years demonstrated in this study can serve as a benchmark. Hopefully, with better patient selection, excluding those with negative predictive factors, outcomes and survivorship after the CAM procedure for GHOA can be improved.
Minimum 2-Year Outcomes after Resection Arthroplasty of the Sternoclavicular Joint
Authors: Katthagen Jan Christoph , Tahal Dimitri S. , Menge Travis , Horan Marilee P. , Millett Peter J. 
Published: July 2016

Objectives: Injuries of the sternoclavicular (SC) joint are rare and are usually caused by high energy mechanisms, such as collision sports or motor vehicle accidents. The aims of this study were to assess functional outcomes and return to sport following resection arthroplasty for osteoarthritis of the sternoclavicular joint. Methods: 20 SC joints (18 patients) had undergone resection arthroplasty of up to a maximum of 10 mm of the medial end of the clavicle for painful osteoarthritis, without instability, between November 2006 and November 2013. Patients at least two years out from surgery and living in the U.S. were included in the study. This was an IRB-approved retrospective outcomes study with prospectively collected data. Preoperative and postoperative function and pain levels were assessed with the ASES, SF-12 PCS, QuickDASH and SANE scores. Additionally, the level of sport intensity and the pain levels during activities of daily living, work and recreation were assessed pre- and postoperatively. The results of the functional outcome scores were normally distributed and were compared with the paired sample t-test. The results of pain level assessment were not normally distributed and were compared with the paired Wilcoxon signed-rank test. Results: 19 SC joints in 17 patients (9 female, 8 male; mean age at time of surgery 39.5±17.1 years) met inclusion criteria. One patient refused participation in the study. Two patients (10.5%) were considered failures as they required additional SC joint surgery (one patient with revision resection of the medial clavicle for persistent symptoms and one patient with secondary figure-of-eight graft stabilization for instability). Minimum 2-year outcomes data were available for 14 of the remaining 16 SC joints (88%). The mean time to follow-up was 3.1 years (range, 2.0-8.8 years). The ASES score, QuickDASH, and pain levels demonstrated significant improvement postoperatively (p<0.05; Table 1). No significant differences were observed between the pre- and postoperative SANE and SF-12 PCS scores (p>0.05; Table 1). All patients (100%, n=11) that answered the question were able to return to sport, with 64% of these patients (n=7) returning to their pre-injury level or slightly below. Conclusion: Resection arthroplasty of up to a maximum of 10 mm of the medial end of the clavicle in patients with osteoarthritis of the SC joint results in significant functional improvement, pain reduction, and a high rate of return to sport at mid-term follow-up.
Rotator Cuff Tear Shape Characterization
Authors: Goodwin David Steven , Kaplan Daniel James , Fralinger David , Gyftopoulos Soterios , Meislin Robert J. , Jazrawi Laith M. 
Published: July 2016

Objectives: Proper surgical planning requires accurate and reliable pre-operative patient information. The more comprehensive the data, the more the surgeon can tailor a general surgical technique to an individual patient’s unique anatomy. A previous retrospective study demonstrated that three-dimensional magnetic resonance imaging more accurately characterized rotator cuff tears compared to two-dimensional images when checked against intra-operative pictures. The purpose of this study was to determine if three-dimensional MRI imaging would continue to be more accurate than two-dimensional imaging in a prospective study. Methods: Patients were prospectively included if they had a full-thickness primary rotator cuff tear on pre-operative MRI. Intra-op videos were taken from the posterior and lateral portals, with a grasper fully mobilizing the torn tendon in each view. 7 surgeons then reviewed the videos and independently characterized the shape of the tears into crescent, U-shaped tears, L-shaped tears, or massive tears. This was considered the gold-standard. Two musculoskeletal radiologists reviewed the corresponding MRI studies independently and blind to the arthroscopic findings and characterized the shape on the basis of the tear’s retraction and size 2D MRI. The 3D reconstructions of each cuff tear were reviewed by each radiologist to characterize the shape. Statistical analysis included 95% confidence intervals and fleiss’s kappa. Results: 37 patients were enrolled in the study. Among the 7 surgeons, agreement on cuff tear was 93% ( =.87). The accuracy for differentiating between crescent-shaped, longitudinal, and massive tears using measurements on 2D MRI was 73.4% for reader 1 and 71.2% for reader 2. The accuracy for tear shape characterization into crescent and longitudinal U- or L-shaped using 3D MRI was 92% for reader 1 and 94% for reader 2. When further characterizing the longitudinal tears as massive or not using 3D MRI, both readers had an accuracy of 83%. The overall accuracy of 3D MRI was 91%, significantly different (P=.07) from 2D MRI accuracy (70.4). Conclusion: Our study has demonstrated that 3D MR reconstructions of the rotator cuff improve the accuracy of characterizing rotator cuff tear shapes compared with current 2D MRI-based techniques.
Characterization of Posterior Glenoid Bone Loss
Authors: Yanke Adam Blair , Frank Rachel M. , Shin Jason J. , Van Thiel Geoffrey S. , Verma Nikhil N. , Cole Brian J. , Romeo Anthony A. , Provencher Matthew T. 
Published: July 2016

Objectives: The purpose of this study was to characterize the morphology and location of posterior glenoid bone loss in pat ients with posterior instability instability utilizing computed tomography (CT). Methods: Clinical data was selected for patients with posterior shoulder instability that had undergone posterior stabilization (open or arthroscopic) or posterior osseous augmentation (distal tibia or iliac crest). Three fellowship-trained surgeons from two institutions contributed patients. Pre-operative CT data was collected for all patients. The axial cuts were segmented and reformatted in three-dimensions for glenoid analysis using Osirix. From this three-dimensional model, the following was calculated: percent bone loss (Nobuhara), total arc of the defect (degrees), and a clock-face description (start point, stop point, and average or direction). Pearson correlation coefficients were performed using significance of p<0.05. Results: Fifty shoulders from 50 patients were reviewed. Fourteen patients (average age 30 years; 93% male) had evidence of posterior glenoid bone loss and were included for evaluation. Defects on average involved 13.7±8.6% of the glenoid (range, 2-35%). The average start time (assuming all right shoulders) on the clock face was 10 o’clock ± 40 minutes and stopped at 6:30 ± 25 minutes. The average direction of the defect pointed toward 8:15 ± 25 minutes. The percent bone loss correlated with the total arc of the defect (Pearson: 0.93, p<0.05, R2: 0.86) and the direction of the bone loss (Pearson: 0.64, p<0.05, R2: 0.40). The direction of bone loss significantly moved more posterosuperior the larger the defect became (Pearson: 0.63, p<0.05, R2: 0.40). Conclusion: Posterior bone loss associated with posterior glenohumeral instability is typically directed posteriorly at 8:15 on the clock. As defect get bigger, this direction moves more posterosuperior. This information will help guide clinicians in understanding the typical location of posterior bone loss aiding in diagnosis, cadaveric models, and treatment.
Should We Limit Innings Pitched Following Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers?
Authors: Erickson Brandon J. , Cvetanovich Gregory , Bach Bernard R. , Bush-Joseph Charles A. , Verma Nikhil N. , Romeo Anthony A. 
Published: July 2016

Objectives: Background: Ulnar collateral ligament reconstruction (UCLR) has become a common procedure amongst major league baseball (MLB) pitchers. It is unclear if a limit on innings pitched following UCLR should be instituted to prevent revision UCLR. Purpose: To determine whether the number of innings pitched or number of pitches thrown in the first full season following UCLR, as well as the pitcher’s overall MLB career, correlated with need for a revision UCLR Hypothesis: Number of innings pitched and number of pitches thrown following UCLR will not affect whether a pitcher undergoes a revision UCLR. Methods: Methods: All MLB pitchers between 1974-2015 who pitched at least one full season following UCLR were included. Pitch counts and innings pitched for the first full season following UCLR as well as total pitch count and total innings pitched following UCLR were recorded. Pitch counts and innings pitched were compared amongst players who required revision UCLR and those who did not. Results: Results: Overall, 154 pitchers were included. Of these, 135 pitchers did not require revision UCLR while 19 underwent revision UCLR. No significant difference existed between pitchers who underwent revision UCLR and those who did not in: number of innings pitched in the season following UCLR (p=0.9016), number of pitches thrown in the season following UCLR (p=0.7337), number of innings pitched in the pitcher’s career following UCLR (p=0.6945), and number of pitches thrown in the pitcher’s career following UCLR (p=0.4789). Furthermore, no difference existed in revision rate between pitchers who pitched more or less than 180 innings in the first full season following UCLR (p=0.6678). Conclusion: Conclusion: The number of innings pitched and number of pitches thrown in the first full season as well as over a player’s career following UCLR does not appear to increase a player’s risk of revision UCLR.
Analysis of Glenoid Inter-anchor Distance with an All-Suture Anchor System
Authors: Kramer Jonathan , Robinson Sean , Dutton Pascual , Dickinson Ephraim , Rodriguez John Paul , Camisa William , Leasure Jeremi M. , Montgomery William H. 
Published: July 2016

Objectives: Arthroscopic shoulder stabilization using suture anchors are commonly used techniques. More recently developed all-suture systems employ smaller diameter anchors, which increase repair contact area and allow greater placement density on narrow surfaces such as the glenoid. Our goal is investigate the strength characteristics of various inter-anchor distances in a human glenoid model. Methods: Twelve fresh-frozen human cadaveric glenoids were potted after the labrum was excised. The glenoids were then implanted with 1.4 mm all-suture anchors (Juggerknot, Biomet, Warsaw, IN) at varying inter-anchor distances. Anchors were implanted adjacent to one another or at 2 mm, 3 mm, or 5 mm distances using a template with pre-drilled holes. The glenoids were then underwent single cycle pullout testing using a test frame (Instron 8521, Instron Inc., Norwood, MA). A 5 N preload was applied to the construct and the actuator was driven away from the shoulder at a rate of 12.5mm/s as seen in Figure 1. Force and displacement were collected from the test frame actuator at a rate of 500 Hz. The primary outcomes were failure strength and stiffness. Stiffness was calculated from the initial linear region of the force displacement curve. Failure strength was defined as the first local maximum inflection point in the force displacement curve. Results: During load to fail testing, all but three of the specimens had both anchors pull out of the glenoid. The other mode of failure included one or both of the sutures failing. Stiffness was 13.52 ± 3.8, 17.97 ± 5.02, 17.59 ± 4.65 and 18.95 ± 4.67 N/mm for the adjacent, 2 mm, 3 mm and 5 mm treatment groups as shown Table 1. The adjacent group had a significantly lower stiffness compared to the other treatment groups. Failure strength was 48.68 ± 20.64, 76.16 ± 23.78, 73.19 ± 35.83 and 87.04 ± 34.67 N for the adjacent, 2 mm, 3 mm and 5 mm treatment groups as shown in Table 1. The adjacent group had a significantly lower failure strength compared to the other treatment groups. Conclusion: These data provide biomechanical evidence that in the glenoid, small diameter all-suture anchors may be implanted as close as 2 mm to one another without significantly decreasing their strength characteristics.
Use of the Knee Injury and Osteoarthritis Outcomes Survey (KOOS) in a Normal US Population
Authors: Sikka Robby Singh , Williamson Tyler , Tompkins Marc , Nelson Bradley J. 
Published: July 2016

Objectives: Patient-reported outcome instruments are frequently used for assessing clinical outcomes after injury and surgery. Previously reported normative data for the Knee Injury and Osteoarthritis Outcome Survey (KOOS) instrument is limited to a narrow subset of ages and has not accounted for a history of knee injury. Methods: The KOOS was administered to 1000 patients or accompanying family members who presented to an outpatient orthopaedic clinic in a suburban metropolitan city for an orthopaedic issue unrelated to their knee in July 2014. Participants were eligible if they self-reported a medical history negative for ankle, knee, or hip surgery. KOOS scale means, standard deviations, medians, ranges, interquartile ranges, and percentiles were calculated by sex, age range, laterality, and history of knee injury in the past year. Non-parametric statistical analysis was used to evaluate differences in KOOS scale scores between five age ranges and between those with or without a history of knee injury. Results: There were 402 males and 598 females in the final study cohort. Males scored lower on the Symptoms scale compared to other scales (median score = 96.4 for Symptoms; median score = 100 for all other scales) in all age cohorts except ages 56-64. Females also reported lower scores in the Symptoms scale. Median Symptoms score for females in each of the age groups from 18-55 years old was 96.4, and median score for the 56-64 year old cohort was 92.9. Median scores for Pain and Knee-related Quality of Life scales were lower in the 56-64 year old female cohort (97.2 and 93.8 respectively). Conclusion: Normative values for KOOS scale scores at all age ranges suggest a high level of functioning among participants with no history of knee injury in the past year. Symptoms, Pain, and Knee-related Quality of Life scales showed the greatest variability in KOOS scores for patients, particularly in the youngest and oldest cohorts. This study can aid surgeons in counseling patients and in developing expectations after treatment of injuries.
Deficits in Sagittal and Frontal Plane Mechanics during Drop Jump in Young Athletes with Recent Anterior Cruciate Ligament Reconstruction
Authors: Pace James Lee , Brophy Christopher , Mueske Nicole , Katzel Mia , Healy Bitte S. , Wren Tishya 
Published: July 2016

Objectives: While the vertical drop jump (VDJ) is an established predictor of ACL injury risk, most studies have focused on frontal and transverse plane assessment in young adult athletes. This study assessed sagittal as well as frontal plane biomechanics during VDJ in adolescent athletes following recent anterior cruciate ligament reconstruction (ACLR). Methods: 29 limbs with unilateral ACLR (69% female, mean age 15.8 ± 1.6 years, 5 to 12 months post-surgery), 29 contralateral non-operative limbs, and 19 control limbs (53% female, mean age of 15.5 ± 1.8 years) were evaluated during VDJ. Lower extremity three-dimensional kinematic and kinetic data from initial contact to peak knee flexion were compared among groups using analysis of variance with Bonferroni post-hoc tests. Results: The operative limbs had significantly lower peak ground reaction forces (GRF) than both control and contralateral limbs (ACLR: 1.7 body weights (BW), Contralateral: 2.1 BW, Control: 2.1 BW; p≤0.01) along with lower average external knee flexion moments (ACLR: 0.7Nm/kg, Contralateral: 0.9Nm/kg, Control: 1.1Nm/kg; p≤0.05) and reduced power absorption at the knee (ACLR: 0.9Nm/kg, Contralateral: 1.5Nm/kg, Control: 1.2Nm/kg; p≤0.01). Operative limbs had lower peak knee flexion (ACLR: 96.8°; Contralateral: 100.7°; p=0.001) and knee flexion excursion (ACLR: 75.0°, Contralateral: 82.5°; p=0.003) than contralateral limbs, but did not differ from controls in these measures. Both operative and non-operative limbs had greater peak hip flexion (ACLR: 98.9°, Contralateral: 99.8°, Control: 83.5°; p≤0.006), hip flexion excursion (ACLR: 60.8°, Contralateral: 65.6°, Control: 49.6°; p=), and power absorption at the hip (ACLR: 1.0Nm/kg, Contralateral: 1.2Nm/kg, Control: 0.7Nm/kg; p<0.03) compared with controls. In the coronal plane, both the operative and non-operative limbs demonstrated higher peak knee valgus moments compared to controls (ACLR: 0.5Nm/kg, Contralateral: 0.4Nm/kg, Control: 0.2Nm/kg; p≤0.02) and utilized less hip ab/adduction range (ACLR: 1.7°, Contralateral: 1.9°, Control: 6.1°; p≤0.003) though there were no differences in knee valgus angles (p≥0.31) or excursion (p≥0.52). Conclusion: Lower GRF and less energy absorbed at the knee during VDJ suggests a landing strategy that shifts loading from the post-surgical knee to the hip and contralateral limb. The frontal plane knee deficits in both the operative and non-operative limbs may place the limb at an elevated risk for future injury or re-injury. Avoidance of loading the reconstructed knee and residual deficits in frontal plane hip and knee control on either limb may indicate lack of readiness to return to full activity after recent ACLR.