bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of ACL Graft Type on Side-Step Cutting in Young Athletes
Authors: Pace James Lee , Mueske Nicole , Padilla Ricardo A. , Katzel Mia , Healy Bitte S. , Wren Tishya 
Published: July 2016

Objectives: Due to the slightly higher re-tear rate for ACL reconstruction (ACLR) with hamstring (HT) versus patellar tendon (PT), differences in movement strategies were assessed during side-step cutting in young athletes with recent ACLR to determine if graft type affected post-operative motion. Methods: Dominant limbs from 21 athletes without lower extremity injury or previous surgery (age 14.9 ± 2.0 years) and 26 limbs with recent (5.1-8.0 months post-operative) unilateral ACLR were included, 18 with HT grafts (age 16.6 ± 3.7 years) and 8 with PT (age 16.7 ± 1.2 years). Lower extremity 3-dimensional data was recorded during the deceleration phase (initial contact to maximum knee flexion) of a 45° cut. Group differences were assessed using analysis of variance with Bonferroni post-hoc tests. Results: The HT group had a slower approach velocity than controls (2.9 vs. 3.5 m/s; p=0.006) with intermediate velocity in the PT group (3.2 m/s). Both the HT and PT groups had lower peak ground reaction force (GRF) compared to controls (HT: 2.0 body weights, PT: 2.2 BW, Control: 2.8 BW; p≤0.02), along with lower peak knee flexion moments (HT: 1.4 Nm/kg, PT: 1.3 Nm/kg, Control: 2.2 Nm/kg; p=0.002). The PT group had less power absorption at the knee than controls (0.3 vs. 0.7 Nm/kg; p=0.07), while the HT group had more at the hip (0.4 vs. 0.1 Nm/kg; p=0.04). The HT group also had higher peak hip flexion (HT: 65.8°, PT: 53.9°, Control: 55.1°; p≤0.06) and hip sagittal plane excursion (HT: 9.4°, PT: 3.6°, Control: 2.8°; p≤0.05) than the PT and control groups. The HT group had lower peak knee valgus moments than controls (0.05 vs. 1.2 Nm/kg; p=0.01) as well as a greater range of frontal plane pelvic (8.2° vs. 3.4°; p=0.03) and hip (7.6° vs. 3.0°; p=0.05) motion. The PT group had intermediate values for valgus moment (0.8 Nm/kg) and pelvic (4.9°) and hip (3.3°) excursion. Conclusion: While both ACLR groups showed reduced GRFs and knee flexion moments compared with controls, the HT group demonstrated greater adaptations proximally with increased hip flexion and frontal plane pelvic and hip excursion. The lower frontal and sagittal plane hip motion in the PT group may be due to anterior knee pain associated with PT grafts. Since the HT group exhibited movement adaptations, but no observable pathologic movement patterns, such as increased knee valgus moment, other factors likely account for the observed higher re-tear rate in HT vs. PT ACLR.
Patient Perception of Reimbursement for Arthroscopic Meniscectomy and ACL Reconstruction
Authors: Okoroha Kelechi , Keller Robert A. , Marshall Nathan E. , Guest John-Michael , Lynch Jonathan , Lock Terrence R. , Rill Brian K. 
Published: July 2016

Objectives: Healthcare policy changes and decreases in Medicare physician reimbursement continue to change the landscape of healthcare. Historically, patient perceptions of surgeon reimbursement have been exaggerated compared to actual reimbursement. Currently there is limited evidence for patient perception for arthroscopic meniscectomy and ACL reconstruction. The purpose of this study was to evaluate patient perception of physician reimbursement for arthroscopic meniscectomy and ACL reconstruction and to compare health care perceptions between urban and suburban clinics. Methods: Surveys were given to 231 consecutive patients, 127 in an urban clinic and 104 in a suburban clinic. Patients were asked their estimation of reasonable reimbursement for arthroscopic meniscectomy and ACL reconstruction as well as their perception on actual Medicare reimbursement to physicians. They were also asked how much would they be willing to pay out of pocket for the procedures. After revealing actual reimbursement rates, patients were asked if reimbursement levels were appropriate, whether surgeon subspecialty training was important, and if additional compensation should be associated with subspecialty training. Survey responses were compared with respondents in an urban versus a suburban setting as well as amongst income and education level. Results: Patients on average reported surgeons should receive $8,096 for a meniscectomy and $11,794 for an ACL reconstruction, 14 times and 11 times as much as actually reimbursed, respectively. Patients estimated that Medicare paid physicians $5,442 for a meniscectomy and $6,667 for an ACL reconstruction. Patients were willing to pay $2,286 out of pocket for a meniscectomy and $11,793 for an ACL reconstruction. Sixty five percent of patients believed reimbursement for meniscectomy was too low and 57% of patients believe reimbursement for ACL reconstruction was too low. Less than 2% of patients believed physician salaries should be cut, whereas 75% believed physicians should be paid extra for sub-specialty training. There were no differences in payment perception between urban and suburban settings. Conclusion: Patients perceived the values of meniscectomy and ACL reconstruction were substantially higher than current Medicare reimbursement. Majority of patients believed that the current reimbursement is too low and patients on average would be willing to pay more out of pocket than is currently reimbursed.
Improved Squat and Gait Biomechanics 6-Months Post-Arthroscopic Surgery for Femoroacetabular Impingement
Authors: Cvetanovich Gregory , Farkas Gary Jordan , Rajan Kumar , Espinoza Alejandro , Nho Shane Jay 
Published: July 2016

Objectives: This study aimed to assess gait and squat biomechanics 6-months following arthroscopic surgery for femoroacetabular impingement. Methods: Symptomatic patients with clinical and radiographic diagnosis of FAI who had failed non-operative treatment underwent gait and squat analysis preoperatively and at 6-months postoperatively following arthroscopic surgery for FAI. Age- and BMI-matched controls without radiographic FAI or other lumbar or lower extremity pathology underwent a single analysis for comparison. Comparisons between preoperative and 6-month postoperative gait and squat parameters as well as comparison to the control group were performed using paired and independent sample t-tests. Statistical significance was set at p<0.05. Results: Fifteen FAI patients and 9 controls were analyzed. Age for the patients vs. controls was 28.7±9.6 y vs. 27.8±6.5 y (p>0.05), respectively; while BMI was 23.5±5.1 kg/m2 vs. 22.8±3.5 kg/m2 (p>0.05). All gait parameters were unchanged between preoperative and 6-month postoperative testing (p>0.05), with a trend toward significance for hip external rotation moment (p=0.056) (Table 1). Squat testing revealed that FAI arthroscopic surgery increased maximum hip extension (p=0.011), with a trend toward significance for hip adduction moment (p=0.059). All other squat parameters did not differ from preoperative to 6-month follow-up (p>0.05). Compared to the control group, preoperative FAI patients had reduced hip external rotation moment during gait (p=0.024), with a trend toward significance for hip abduction moment (p=0.082). No other gait or squat differences were detected between FAI patients preoperatively or 6-months postoperatively compared to controls (p>0.05). Conclusion: Biomechanical gait and squat analysis at 6-month follow-up from arthroscopic FAI surgery revealed a tendency to improve external hip rotation during gait and maximum hip extension and hip adduction during squat. Arthroscopic surgery for FAI may help to restore the reported altered gluteal function by the early 6 months postoperative timepoint.
Mass Screening of Youth Athletes for High Risk Landing Patterns using a Portable and Inexpensive Motion Sensor Device
Authors: Sherman Seth Lawrence , Gulbrandsen Trevor R. , Miller Scott M. , Guess Trent , Willis Bradley W. , Blecha Kyle M. , Huo Zhiyu , Skubic Marjorie , Gray Aaron D. 
Published: July 2016

Objectives: Biomechanical factors such as dynamic knee valgus predispose young athletes to lower extremity injury including tears of the anterior cruciate ligament (ACL). Identifying these risk factors may allow for targeted injury prevention strategies. Our prior work has validated the Microsoft Kinect vs. Vicon to detect knee-ankle separation ratio (KASR) during the drop vertical jump test (DVJ). Our hypothesis is that screening with the Microsoft Kinect will be safe, efficient, and provide information to help detect injury risk in youth athletes. Methods: A total of 180 healthy high school athletes, ages 14-18 (80 males and 100 females, age of 16.9 ± 1.31 and BMI of 22.8 ± 3.7) participated in this study. Each subject performed three successful DVJ (Fig. 1). We used an inexpensive, portable motion sensor device to measure the KASR, which captures the ratio of the horizontal distance between knees to the horizontal distance between ankles. From previous studies, a KASR value <1 indicates dynamic valgus, while being below 0.6 is considered severe risk. Demographic information and measurements for KASR on initial contact and peak flexion were analyzed statistically. Results: Using two motion sensor device stations, it took 1.5 minutes to screen and test each subject. There were no injuries that occurred during the screening process. Our results showed a statistically significant difference between male and female KASR for both initial contact (p<0.001) and peak flexion (p<0.001). Sixty out of the 100 female subjects (60%) tested positive for valgus (9 initial contact KASR, 1 peak flexion KASR, 50 both initial contact and peak flexion KASR) with two subjects screening for severe risk (KASR<0.6). The average KASR for females was 1.01 (peak flexion) and 0.967 (initial contact). Eighteen out of the 80 male subjects (22.5%) tested positive for valgus (6 initial contact KASR, 2 peak flexion KASR, 10 both initial contact and peak flexion KASR) with no male subjects screening positive for severe risk. The average KASR for males was 1.26 (peak flexion) and 1.13 (initial contact). Comparing males and females that screened positive for KASR, there was a significant gender difference between the KASR at initial contact with females exhibiting more valgus than males (p<0.001) (Table 1). Conclusion: Our findings suggest that a portable and inexpensive motion analysis device can detect dynamic valgus during the DVJ in youth athletes. Large scale screening for dynamic valgus was safe and efficient. Known gender disparities between male and females for neuromuscular imbalances were identified. Potential use of this information for targeted injury prevention is appealing and requires further investigation.
Responsiveness Comparison of the EQ-5D, PROMIS Global Health, And VR-12 Questionnaires In Knee Arthroscopy
Authors: Oak Sameer , Strnad Greg , Bena James , Farrow Lutul D. , Parker Richard D. , Jones Morgan H. , Spindler Kurt P. 
Published: July 2016

Objectives: The EQ-5D, PROMIS 10 Global Health, and VR-12 are generic patient reported outcome (PRO) questionnaires that assess and report patient general health and wellbeing. In choosing a PRO to track patient general health status, it is necessary to consider which measure will be the most responsive to change after treatment. To date, no studies exist comparing the responsiveness among the EQ-5D, PROMIS 10 Global Health, and VR-12. We sought to determine which of the generic PROs were most responsive internally and externally in the setting of knee arthroscopy. Methods: 50 patients undergoing knee arthroscopy were surveyed with a PRO questionnaire pre-operatively and at least 3 months post-operatively. PROs included the EQ-5D, EQ-5D visual analog scale, PROMIS 10 Global Health (PROMIS 10) Physical and Mental components, VR-12 Physical and Mental components, and the Knee injury and Osteoarthritis Outcome Score (KOOS) Pain scale. Internal responsiveness was evaluated by performing paired t-tests on the changes in measures and calculation of two measures of effect size: Cohen’s D and standardized response mean (SRM). External responsiveness was evaluated by calculating and comparing Pearson correlation measures between the disease specific reference KOOS Pain and the general PROs EQ-5D, PROMIS 10, and VR-12 changes. General PRO responsiveness measures were compared head to head with the cocor package in R software. Results: Patients were surveyed pre-operatively and a mean of 3.6 months post-operatively with 90% follow-up. For internal responsiveness, the EQ-5D, VR-12 Physical, and PROMIS 10 Physical scales showed a statistically significant improvement in score after treatment and effect size statistics with moderate change (Cohen’s D and SRM between 0.5-0.8). Assessing external responsiveness, the EQ-5D, VR-12 Physical, and PROMIS 10 Physical instruments showed the highest correlation with the disease specific reference measure, KOOS Pain (Table 1). For both internal and external responsiveness, the EQ-5D, VR-12 Physical, and PROMIS 10 Physical instruments showed significantly higher responsiveness compared to the other general PRO measures, but no statistical differences among themselves. Conclusion: There is no statistical difference between the EQ-5D, VR-12 Physical, and PROMIS 10 Physical instruments in terms of internal or external responsiveness to change. In tracking longitudinal patient health, researchers and administrators have the flexibility to choose any of the general PROs among the EQ-5D, VR-12 Physical, and PROMIS 10 Physical instruments. We recommend that any study tracking PROs in knee arthroscopy include one of these generic instruments.
Dynamic Loading Assessment at the Fifth Metatarsal in Elite Athletes with a history of Jones Fracture
Authors: Hunt Kenneth , Goeb Yannick 
Published: July 2016

Objectives: Fractures of the proximal metaphysis of the fifth metatarsal (i.e., Jones fractures) are common in the athletic population and frequently require surgical fixation to optimize healing rates and return to sport. Subtle hindfoot varus alignment, which likely results in greater forces at the fifth metatarsal, has been associated with increased risk of Jones fractures due to presumed increase in forces on the lateral foot. The goal of the present study was to dynamically assess plantar pressure loads at the fifth metatarsal in elite athletes with a history of Jones fracture. We hypothesize that athletes who have suffered Jones fractures will apply significantly higher loads at the fifth metatarsal base during athletic activities compared to matched uninjured athletes. Methods: Sixteen elite, competitive athletes were recruited to participate. Eight athletes had a history of Jones fracture and eight age, gender and position-matched athletes without a history of foot injury were recruited as controls. While wearing calibrated, wireless pressure mapping insoles, all athletes performed a standardized series of athletic movements including walking, running and cutting. Tests were repeated with the patient’s standard corrective insole. Peak pressure, mean pressure, maximum force, and force-time integral (i.e., impulse) were recorded for each activity. Comparison between groups was performed using a paired Wilcoxon Sign Rank test. Results: Athletes with a history of Jones fracture showed a significantly increased peak pressure (183 ±23 kPA vs. 138±7 kPA), mean pressure (124±14 kPA vs. 95±4 kPA), and maximum force (15±1.2%BW vs. 12±1.2%BW) at the fifth metatarsal base during walking and running compared to uninjured matched controls (all P<0.05). Use of the corrective orthotic insole did not significantly reduce peak or mean pressure, maximum force, or impulse at the fifth metatarsal base during running or cutting. Conclusion: Athletes with a history of Jones fracture exert significantly increased peak and mean forces at the base of the fifth metatarsal during common athletic activities. Standard corrective orthoses do not appear to offload this region in all cases. These increased loads may contribute to the development of stress injury to the fifth metatarsal during repetitive loading, and ultimately fracture of the bone. Identifying patients at risk for Jones fracture using dynamic loading assessment may facilitate an injury prevention program. Further study of orthotic devices, training programs, shoe wear, and devices designed to offload the fifth metatarsal is necessary.
Physeal Disruption During ACL Reconstruction in Skeletally Immature Patients
Authors: Cruz Aristides Ignacio , Lakomkin Nikita , Fabricant Peter D. , Lawrence John Todd R. 
Published: July 2016

Objectives: The purpose of this study was to radiographically assess differences in distal femoral physeal disruption between transtibial and independent femoral tunnel drilling techniques following ACL reconstruction in skeletally immature patients. Methods: A retrospective, matched comparative cohort study was performed of skeletally immature patients who underwent transphyseal ACL reconstruction between January 1, 2008 and March 31, 2011. All skeletally immature patients between ten and fifteen years old who underwent independent femoral tunnel drilling and had adequate baseline and post-operative radiographs were analyzed. These patients were matched with a transtibial technique cohort based on age and sex. Demographic characteristics and peri-operative metrics were collected. Radiographic measurements were recorded from pre-operative MRI and post-operative plain radiographs. Results: Twenty patients were analyzed. Between groups, there were significant differences between independent tunnel drilling and transtibial tunnel drilling in the estimated area of physeal disruption (1.64 cm2 vs. 0.74 cm2, P<0.001), femoral (32.1º vs. 72.8º, P<0.001) and tibial (50.1º vs. 60.5º, P=0.003) tunnel angles, medial/lateral location of the femoral tunnel (24.2 mm vs. 36.1 mm from lateral cortex, P=0.001), and distance from the lateral aspect of the distal femoral physis and the femoral tunnel exit (4.7 mm vs. 26.7 mm from the perichondrial ring, P<0.001), respectively. All patients who underwent femoral tunnel drilling at an angle of less than 25º from the transverse axis experienced a greater than 6% disruption of physeal area. There was a significant inverse correlation between femoral tunnel angle and estimated area of femoral physeal involvement (r=-0.8255, P=0.003). Conclusion: With femoral tunnel drilling techniques that create more oblique tunnels, the area of distal femoral physeal damage is larger, more eccentric and closer to the perichondrial ring. Since most studies noting the safety of transphyseal ACL reconstruction have utilized a vertical femoral tunnel, surgeons should be aware that if an independent femoral tunnel drilling technique is utilized during transphyseal ACL reconstruction, the physis is at greater risk when drilling at more horizontal angles. Angles greater than 25º from the transverse axis may safely create <6% physeal area damage.
Subsequent Surgery after Revision Anterior Cruciate Ligament Reconstruction
Authors: Ding David , Group Mars 
Published: July 2016

Objectives: Failure or reinjury after anterior cruciate ligament (ACL) reconstruction can lead to recurrent instability and concomitant intra-articular injuries. While revision ACL reconstruction (rACLR) can be performed to restore knee stability and improve patient activity level, outcomes after these surgeries are reported to be inferior to primary ACL reconstruction. Further reoperation after rACLR can have an even more profound effect on patient satisfaction and outcome. Yet, there is a current lack of information regarding the rate and risk factors for subsequent surgery after rACLR. Methods: 1205 patients who underwent rACLR were enrolled between 2006 and 2011, comprising the prospective cohort. Two-year questionnaire follow-up was obtained on 989 (82%), while telephone follow-up was obtained on 1112 (92%). If a patient reported having a subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categoriezed. A repeated meaures ANOVA was used to reveal significatnt differences in patient reported outcomes. Multivariate regression analysis was performed to determine independent risk factors for reoperation. Results: One hundred and twenty-two patients (10.1%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperation procedures, 26.7% were meniscus procedures (69% meniscectomy, 26% repair), 18.6% were subsequent rACLR, 17.4% were cartilage procedures (61% chondroplasty, 17% microfracture, and 13% mosaicplasty), 10% hardware removal, and 9.3% were procedures for arthrofibrosis such has lysis of adhesions and synovectomy. Patients who had reoperations had significantly lower IKDC, KOOS symptoms and pain scores, and WOMAC stiffness scores at two-year follow up. Multivariate analysis revealed that patients under 20 years old were 2.1 times more likely than patients aged 20-29 to have a reoperation. Use of allograft at the time of rACLR and staged revision (bone grafting of tunnels before rACLR) were also significant predictors for need for reoperation within 2 years. Patients with grade IV cartilage damage seen during rACLR were 47% less likely to undergo subsequent operations within 2 years. Gender, BMI, smoking history, Marx activity score, technique for femoral tunnel placement and meniscal tear or meniscal treatment at the time of rACLR showed no significant effect on reoperation rate. Conclusion: There is a significant reoperation rate following rACLR at two years (10.1%). The most prevalent reoperations involved meniscal procedures. Independent risk factors for subsequent surgery on the ipsilateral knee include age<20 years old, a staged revision and use of allograft tissue at the time of rACLR.