bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Early Lower Extremity Functional Recovery in Pediatric Patients Following Anterior Cruciate Ligament Reconstruction Using Hamstring Versus IT Band Autograft
Authors: Sugimoto Dai , Heyworth Benton E. , Collines Sara , Kocher Mininder S. , Micheli Lyle J. 
Published: July 2017

Objectives: The influence of graft type and gender in anterior cruciate ligament reconstruction (ACLR) has not been adequately studied in pediatric patients. The purpose of this study was to compare parameters of early lower extremity functional recovery among three cohorts of pediatric patients under 15 years-old: pediatric males who underwent ACLR with hamstring grafts (PM w/HS), pediatric females with hamstring grafts (PF w/HS), and pediatric males with IT band graft (PM w/ITB). Methods: A prospective cohort study design was used. At 6-month post-operative visits following ACLR, thigh circumference, knee ROM (extension and flexion), strength (quadriceps, hamstrings, hip abductors, and hip extensors), Y-balance (anterior, posterolateral, and posteromedial reach), and functional hop tests (single, triple, cross-over, and 6 meter timed hops) were assessed in all ACL-R under 15 years-old. Limb symmetry index was used to compare deficits between involved and uninvolved limb between the three graft groups (PM w/HS, PF w/HS, and PM w/ITB). There was an inadequate number of pediatric females who underwent ITB ACL-R for analysis. Analysis of variance (ANOVA) with post-hoc correction was employed. Results: A total of 87 pediatric ACLR patients (PM w/HS: N=20, Age:14.3±1.1; PF w/HS: N=33, Age:13.9±0.7; PM w/ITB: N=34, Age:13.2±1.3) were examined. There was no statistically significant difference in ROM and Y-balance tests performance between the cohorts. Of the various additional comparisons analyzed, only the following findings were statistically significant: (a) PM w/HS demonstrated greater thigh circumference deficits (-3.7% relative to healthy limb) than PM w/ITB (-1.5% relative to healthy limb, p=0.024); (b) PM w/HS group showed greater hamstring strength deficits (-34.1% relative to healthy limb) than PM w/ITB (-7.1% relative to healthy limb, p=0.001). The hamstring strength deficits of PF w/HS (-13.3% relative to healthy limb) were not statistically different from either of the male cohorts. (c) PM w/HS cohort showed greater deficits in the triple hop test (-40.1% relative to healthy limb) compared to PM w/ITB (-17.9% relative to healthy limb, p=0.019) and PF w/HS (-10.2% relative to healthy limb, p=0.001). Conclusion: While there is a slight age differences exist, PM w/HS patients demonstrated significant thigh circumference, hamstring strength, and functional hop test deficits compared to PM w/ITB at approximately 6 months following ACLR. Autograft type may influence strength and functional recovery following ACLR in pediatric patients. Approximately at 6 months post-operatively, PM w/ITB showed superior recovery in thigh circumference, hamstring strength, and triple hop tests, compared to PM w/HS. Additional research correlating timing and nature of functional recovery with graft retear and athletic performance are warranted.
omes of ACL Reconstruction in Adolescent Female Athletes
Authors: Darmafall Kristyn , Tompkins Marc , Agel Julie , Reams Megan , Nelson Bradley J. 
Published: July 2017

Objectives: Background: There is limited information in the literature specifically detailing the outcomes of anterior cruciate ligament reconstruction (ACLR) in adolescent female athletes. Purpose: The purpose of this study was to (1) describe the 2-year clinical outcomes in skeletally mature adolescent female athletes undergoing ACLR and (2) determine if graft selection, concomitant injury, sport, body mass index, etc. affect outcomes. Methods: Methods: 200 consecutive skeletally mature adolescent females (207 knees) underwent primary isolated ACLR between June 2011 and January 2014 at a single orthopaedic outpatient clinic, Patients were asked to return for a physical exam and completion of subjective questionnaires. Results: Results: Clinical information was available on 114/207 knees with physical examination performed on 86 knees. Ninety-nine of 114 (86.8%) patients were able to return to play. Thirteen (11.4%) knees sustained a graft retear and eleven (9.6%) patients tore their contralateral ACL during the study period. KOOS data demonstrated a mean of 87.6 (14.1) for sports/rec and a mean of 82.1 (14.7) for quality of life subscales. All knees demonstrated a Lachman’s exam with less than 5mm side to side difference. 5 knees had rotatory instability with a pivot shift of greater than 2+. Twenty-one (21.2% ) knees underwent a subsequent nonrevision surgery on their reconstructed knee. Conclusion: Conclusions: This population of skeletally mature adolescent female athletes reported a high rate of return to play (86.8%) with ACL graft retear rate (11.4% ) and contralateral ACL tear (9.6%) consistent with other reports on male athletes undergoing ACL reconstruction. The variables of patient’s BMI, mechanism of injury, graft type, concomitant meniscal pathology at time of index procedure or undergoing a subsequent second surgery on the ipsilateral knee did not impact patient reported outcomes or physical exam findings at two years. Overall patient reported outcomes were high even in the setting of the 11.4% retear and 9.6% contralateral tear rates.
Assessing Trends in the Epidemiology of Concussions Among High School Athletes
Authors: Schallmo Michael S. , Weiner Joseph Arnold , Hsu Wellington 
Published: July 2017

Objectives: Approximately 300,000 youth athletes suffer a mild form of traumatic brain injury (TBI) known as a concussion annually while participating in organized athletics. Using data from the most recent 10-year period available, this study aimed to track national trends in high school sports-related concussion incidences over time, identify whether a particular sport predisposes athletes to a higher incidence of concussions, and evaluate the association between concussion occurrences and the enactment of TBI legislation that began in 2009. Methods: Injury data for academic years 2005-2006 through 2014-2015 was collected from annual reports generated by the High School Reporting Information Online sports injury surveillance system, which prospectively captures injury data directly from athletic trainers at participating U.S. high schools. Relative proportions of total estimated concussions to total estimated injuries were compared using an injury proportion ratio (IPR) and corresponding 95% confidence intervals (CI). Concussion rate was defined as the number of concussions per 10,000 athlete-exposures (AEs, one athlete participating in one practice or competition), and rates were compared using a rate ratio (RR) and 95% CI. Results: The overall number of concussions increased 2.2-fold ( p<0.0001) between 2005-2006 and 2014-2015, and significant increases were also found in the overall concussion rate (RR=2.30, 95% CI [2.04-2.59]; p<0.0001) and the overall proportion of concussions (IPR=2.68, 95% CI [2.66-2.70]; p<0.0001). Players injured during the 2014-2015 school year were more likely to have sustained a concussion if they played girls soccer than if they played girls volleyball (IPR=1.32, 95% [1.30-1.35]; p<0.0001), girls basketball (IPR=1.35, 95% CI [1.33-1.37]; p<0.0001), or boys football (IPR=1.40, 95% CI [1.39-1.41]; p<0.0001) (Table 1). Conclusion: The overall rate and proportion of concussions increased significantly post-TBI law enactment, suggesting an association between the passage of TBI laws and concussion incidences. To our knowledge, this is the first study to report that concussions now account for a higher proportion of injuries in girls soccer than boys football. Currently, no state TBI laws address the sport- or gender-specific differences identified by this study. Future studies should focus on examining specific risk factors, developing targeted measures to reduce the number of preventable concussions, and developing diagnostic and treatment algorithms to protect young athletes and improve outcomes. [Table: see text]
Impact of Bony Stress Injuries on Professional Basketball Performance
Authors: Khan Moin , Madden Kim , Rogowski Joseph P. , Stotts Jeff , Burrus Matthew Tyrrell , Samani Marisa , Sikka Robby Singh , Bedi Asheesh 
Published: July 2017

Objectives: Players in the National Basketball Association (NBA) subject their lower extremities to significant repetitive loading during the season as well as during off-season training. Little is known about the incidence and impact of lower extremity bony stress injuries in these athletes. Methods: Using the player injury database maintained by the NBA Players’ Association, all bony stress injuries from 1992 to May 2016 were identified. Those not involving the lower extremity were excluded from the study. Stress fractures and stress reactions were grouped together. Number of games missed due to the injury as well as player statistics including points per game (ppg), assists per game (apg), steals per game (spg), and blocks per game (bpg) were collected from two years prior to the injury to two years after the injury. Results: 76 lower extremity bony stress injuries were identified involving 75 different NBA players with an average player age of 25.4 ± 4.1 years. 55.3% (42/76) involved the foot, 21.1% (16/76) involved the ankle or fibula, 17.1% (13/76) involved the tibia, and 6.6% (5/76) involved either the knee or patella. The majority of injuries occurred in season 82.9% (63/76) with half of the injuries occurring within the first 6 weeks of the season. 38.2% (29/76) of these injuries were managed surgically. An average of 25.1 ± 21.3 games were missed. 19.7% (15/76) of patients who sustained a stress fracture also had a subsequent injury. 29.2% (21/76) of players were not able to return to professional basketball after the season in which the injury was sustained; however, those who were able to return to the same level of play did not see a significant change in performance as measured by ppg, apg, spg, or bpg when comparing the season prior to the injury and either one or two years after the injury. Stress injuries to the foot carried the worst prognosis, 57.1% (12/21) of those unable to return to professional basketball sustained such an injury. Conclusion: While not extremely common in NBA players, lower extremity bony stress injuries may be career-ending. However, if they are able to return to the NBA following this injury, then their level of play should return to their pre-injury level.
The Epidemiology of Injuries Identified at the National Football League Scouting Combine and their Impact on Professional Sport Performance: 2203 athletes, 2009-2015
Authors: Price Mark D. , Rossy William H. , Sanchez George , McHale Kevin Jude , Logan Catherine , Provencher Matthew T. 
Published: July 2017

Objectives: Normal At the annual National Football League (NFL) Scouting Combine, the medical staff of each NFL franchise performs a comprehensive medical evaluation of all athletes potentially entering the NFL. Currently, little is known regarding the overall epidemiology of injuries identified at the Combine and their impact on NFL performance. The purpose of this study is to determine the epidemiology of injuries identified at the Combine and their impact on future NFL performance. Methods: All previous musculoskeletal injuries identified at the NFL combine (2009-2015) were retrospectively reviewed. Medical records and imaging reports were examined. Game statistics for the first two seasons of NFL play were obtained for all players from 2009 to 2013. Analysis of injury prevalence and overall impact on draft status and position-specific performance metrics of each injury was performed and compared versus a position-matched control group with no history of injury and surgery. Results: A total of 2,203 athletes over seven years were evaluated, including 1,490 (67.6%) drafted athletes and 1,040 (47.2%) who ultimately played at least two years in the NFL. The most common sites of injury were the ankle (1160, 52.7%), shoulder (1143, 51.9%), knee (1128, 51.2%), spine (785, 35.6%), and hand (739, 33.5%). Odds ratios (OR) demonstrated quarterbacks were most at risk of shoulder injury (OR 2.78, p=0.001) while running backs most commonly sustained ankle (OR 1.49, p=0.038) and shoulder injuries (OR 1.55, p=0.022). Ultimately, defensive players demonstrated a more negative impact than offensive players following injury with multiple performance metrics impacted for each defensive position analyzed whereas skilled offensive players (i.e. quarterbacks, running backs) demonstrated only one metric affected at each position. Conclusion: The most common sites of injury identified at the Combine were: (1) ankle, (2) shoulder, (3) knee, (4) spine, and (5) hand. Overall, performance in the NFL was significantly impacted by previous injuries. NFL performance was directly dependent on position played as well as anatomic location of injury. Defensive players were more negatively impacted than offensive players. Additional work is necessary to determine longer-term impact of these injuries on NFL career and post-NFL quality of life.
Hyaluronic Acid Injections of the Knee: Predictors of Successful Treatment
Authors: Bowman Eric N. , Hallock Justin , Azar Frederick M. , Throckmorton Thomas 
Published: July 2017

Objectives: Knee viscosupplementation yields variable results for osteoarthritis. Establishing patient and treatment factors that predict a favorable response to intra-articular hyaluronic acid (HA) treatment will better guide patient and treatment selection. Methods: This prospective study evaluated patients presenting with Kellgren-Lawrence grade 1-3 painful, primary knee osteoarthritis. The primary outcome measures were the Western Ontario and McMaster Universities Arthritis Index/ Knee Injury and Osteoarthritis Outcome Score (WOMAC/KOOS) and a standardized visual analog scale (VAS). Surveys were completed at the first and subsequent injections, then at three months post-treatment. Response to treatment was defined according to the Osteoarthritis Research Society International 2004 criteria. Results: We enrolled 135 patients, 102 remained for final analysis. Fifty-seven percent of patients had a positive response to treatment. Factors related to a positive response included those with grade 1 or 2 osteoarthritis (RR=2.17; 95%CI, 1.40-3.37), and those who showed improvement after the first injection (RR=2.22; 95%CI, 1.49-3.31). Seventy-eight percent of people who responded to the first injection had a positive response at follow-up. In multi-variable analysis, those aged 60 or older responded more positively with grade 2 osteoarthritis than those less than 60 years (RR=1.98; 95%CI, 1.18-3.21). Gender, race, BMI, smoking status, HA brand, and initial VAS and KOOS scores were not significant predictors of success in either independent or multivariable analysis. Conclusion: Patients with mild to moderate osteoarthritis (grades 1 and 2), and those who responded positively to the first injection were two times more likely to respond positively to the injection series than those with grade 3 osteoarthritis, or those who did not respond initially. Patients aged 60 or older are twice as likely to respond than those less than 60 years for grade 2 osteoarthritis. Judicious patient selection and counseling may improve outcomes associated with intra-articular HA injections. [Table: see text]
Optimal Fixation of Jones Fractures Sacrifices the Peroneal Brevis Tendon Insertion andthe Plantar Fascia
Authors: van Dijk Pim A.d. , Breuking Sofie , Vopat Bryan G. , Guss Daniel , Johnson Anne H. , Hosseini Ali , DiGiovanni Christopher 
Published: July 2017

Objectives: Patients with Jones fractures (JF) frequently undergo operative management with intramedullary screw fixation. Screw insertion through the base of the fifth metatarsal potentially compromises attachment points of the plantar fascia (PF) and peroneal brevis tendon (PB), and appropriate screw length and diameter remains controversial. The aim of this study was to define the anatomy of the fifth metatarsal bone using CT modeling in order to provide better guidance regarding optimized screw insertion point, screw length, diameter, and thread length and, moreover, to give better insight in the possible compromise of the PB and PF when placing a screw. Methods: Following IRB approval, 21 cadaveric fifth metatarsal bones were harvested. Three reference screws (1mm diameter) were placed and secured on each bone, with 2 screws distally and 1 screw proximally, to act as a geographic register. All bones were CT scanned to create 3D reconstructions using modeling software (Rhinoceros, v5.0). The outer cortex, intramedullary canal and articular cortex of each bone were identified. Using a digitizer (MircoScribe, G2LX), the PB and PF insertions, alongside the reference screws, were mapped onto the corresponding specimen. The total length of the bone, the shape and diameter at the narrowest point of the intramedullary canal were also measured.. Optimal screw diameter and length were calculated in this position, and the impact of screw placement on the insertion sites of both the PB and PF was recorded. Results: The mean length of the bones was 74 ± 3.6mm, with the narrowest diameter of the intramedullary canal being 4.3 ± 0.7 mm. Ideal screw position was identified as parallel to the cuboid and coaxial with the intramedullary cortex, partially sacrificing the PB and PF insertions in 62% (13/21) and 33% (7/21)of specimens respectively, with an average sacrified area of 1.6 ± 0.8 mm of the PB and 1.3 ± 0.8 mm of the PF insertion. The ideal screw length was 48 ± 5.8 mm, with a minimal thread length of 28 ± 6.8 mm and a minimal diameter of 4.5 mm. The screw length:total bone length ratio was 0.64 (range .050-0.72). Conclusion: To maximize compression and pull-out strength, as well as minimize destruction of soft tissue insertions during screw placement for the treatment of JF, screws should be placed parallel to the cuboid and collinear with the intramedullary cortex—mitigating but not avoiding injury to the PB and PF. Average optimal length of the screw should cover 64% of the length of the bone, with a minimum 4.5 mm diameter and 50% thread length. Given variability in anatomy, however, screw choice should be tailored to the individual. Operative treatment of JF, a common foot injury, represent one of the more controversial surgical techniques in foot care today. Improving anatomic understanding of the implications of screw insertion will be paramount to maximizing functional outcomes.
The Efficacy of Intra-Articular Injections for Pain Control Following Hip Arthroscopy for Femoroacetabular impingement
Authors: Nho Shane Jay , Ukwuani Gift , Alter Jennifer , Friel Nicole A. , Basques Bryce A. 
Published: July 2017

Objectives: There is a rising trend among surgeons to administer intra-articular local anesthetic to help alleviate postoperative pain following hip arthroscopy. The purpose of this study was to evaluate the analgesic efficacy of intra-articular Marcaine for postoperative pain control after hip arthroscopy for femoroacetabular impingement (FAI). Methods: A prospective cohort study was performed. A total of one hundred consecutive patients who underwent hip arthroscopy by a single surgeon for FAI were included in this study. Patients were divided into two groups, with one group receiving intra-articular Marcaine (0.5% Marcaine plain) and the other group receiving intra-articular saline. The primary outcome measure was VAS pain measured at specific time intervals immediately upon arrival to the post-anesthesia care unit (PACU), at 10, 20, and 30 minutes postoperatively, and at the 1 week follow up visit. Propensity scores were generated from baseline patient demographics and comorbidities, and patients were matched 1:1 based on propensity scores in order to reduce potential confounding. Results: A total of 100 patients were included. Of these, 38% were males and the average age was 29.7 + 12.1. 50 patients received intra-articular Marcaine while the other 50 did not. Before and after matching, there were no statistically significant difference in age, BMI, gender and preoperative VAS pain between the cohorts (Table 1). No differences in preoperative and postoperative VAS pain were found between the Marcaine and non-Marcaine cohorts within the immediate postoperative period. However, there was significant reduction in the absolute VAS at 1 week follow up in the Marcaine cohort compared to the non-Marcaine cohort. All patients were discharged home and did not experience any complications from the procedures. Conclusion: This study suggests that injecting intra articular Marcaine during hip arthroscopy for FAI may not be necessary as it may only provide minimal pain control. [Table: see text]
How Comprehensive and Efficient are Patient Reported Outcomes for Femoroacetabular Impingement?
Authors: Meadows Molly , Makhni Eric C. , Hamamoto Jason Taizo , Higgins John , Nho Shane Jay , Verma Nikhil N. 
Published: July 2017

Objectives: Increasing emphasis is placed on patient reported outcomes following common orthopedic procedures as a measure of quality and patient satisfaction. When considering patient reported outcome (PRO) utilization in patients with hip pain secondary to femoroacetabular impingement, several different PRO exist with varying levels of utilization and accuracy. Understanding which disease-specific PRO may be most efficiently administered in patients with femoroacetabular impingement, particularly those undergoing arthroscopic hip procedures, may assist in promoting increased patient and physician adoption of these useful scores. Using a novel assessment criterion, this study assessed all commonly used PRO in hip arthroscopy literature. We hypothesize that surveys with fewer numbers of questions may remain comparable (with regards to comprehensiveness) to longer surveys. Methods: Commonly utilized PRO in hip arthroscopy literature were analyzed with regards to number of survey components, comprehensiveness, and efficiency. Comprehensiveness (maximum score 13) was scored as the total number of pain (at rest/baseline, at night, during activities of daily living, during sport, during work, and mechanical symptoms) and functional (range of motion, ability to perform ADL, sport, work, ability to sit, and pre-injury level of function) metrics included, along with inclusion of quality of life/satisfaction metrics. Efficiency was calculated as comprehensiveness divided by number of survey components. Results: Thirteen different PRO were studied. Number of components ranged from 1 (UCLA Activity Score) - 40 (HOOS). Only the iHOT-33 included all six pain components, while only the iHOT-33 and HOS PRO contained all six functional components. Seven PRO included a quality of life/satisfaction component. The most comprehensive scores were the iHOT-33 (score = 13) and HAGOS (score = 10), and the least comprehensive score was the UCLA (score = 2). The most efficient PROs were the UCLA, MHHS, and EQ-5D scores. The least efficient scores were the HOS and SF-36 scores. Conclusion: Many commonly utilized PRO for FAI are lacking in comprehensiveness and efficiency. Continued critical assessment of PRO quality may help practitioners identify the most comprehensive and efficient PRO to incorporate into daily clinical practice. [Figure: see text]