bluuebunny/crossref_metadata_2025_split huggingface dataset:
Current Diagnosis and Management of Cervical Spondylotic Myelopathy
Authors: Bakhsheshian Joshua , Mehta Vivek A. , Liu John C. 
Published: May 2017

Study Design: Review. Objectives: Cervical spondylotic myelopathy (CSM) is a major cause of disability, particular in elderly patients. Awareness and understanding of CSM is imperative to facilitate early diagnosis and management. This review article addresses CSM with regard to its epidemiology, anatomical considerations, pathophysiology, clinical manifestations, imaging characteristics, treatment approaches and outcomes, and the cost-effectiveness of surgical options. Methods: The authors performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives. Results: The clinical presentation and natural history of CSM is variable, alternating between quiescent and insidious to stepwise decline or rapid neurological deterioration. For mild CSM, conservative options could be employed with careful observation. However, surgical intervention has shown to be superior for moderate to severe CSM. The success of operative or conservative management of CSM is multifactorial and high-quality studies are lacking. The optimal surgical approach is still under debate, and can vary depending on the number of levels involved, location of the pathology and baseline cervical sagittal alignment. Conclusions: Early recognition and treatment of CSM, before the onset of spinal cord damage, is essential for optimal outcomes. The goal of surgery is to decompress the cord with expansion of the spinal canal, while restoring cervical lordosis, and stabilizing when the risk of cervical kyphosis is high. Further high-quality randomized clinical studies with long-term follow up are still needed to further define the natural history and help predict the ideal surgical strategy.
Impact of Operation Time on 30-Day Complications After Adult Spinal Deformity Surgery
Authors: Phan Kevin , Kim Jun S. , Capua John Di , Lee Nathan J. , Kothari Parth , Dowdell James , Overley Samuel C. , Guzman Javier Z. , Cho Samuel K. 
Published: May 2017

Study Design: Retrospective analysis of prospectively collected data. Objective: There is a paucity of data on the effect of operative duration on postoperative complications during adult spinal deformity surgery (ASDS). The study attempts to explore and quantify the association between increased operation times and postoperative complications. Methods: A retrospective cohort analysis was performed on the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2010 to 2014. Patients (≥18 years of age) from the NSQIP database undergoing ASDS were separated into cohorts based on quartiles of operation duration. Chi-square and multivariate logistic regression models were used to identify risk factors. Results: A total of 5338 patients met the inclusion criteria and were divided per quartiles based on operative duration in minutes (154, 235, 346, and 1156 minutes). Multivariate logistic regressions revealed that in comparison to the lowest quartile of operative duration, the highest quartile group was associated significantly with length of stay ≥5 days (odds ratio [OR] = 5.85), any complication (OR = 9.88), wound complication (OR = 5.95), pulmonary complication (OR = 2.85, P = .001), venous thromboembolism (OR = 12.37), intra-/postoperative transfusion (OR = 12.77), sepsis (OR = 5.27), reoperations (OR = 1.48), and unplanned readmissions (OR = 1.29). The odds ratio was higher when comparing a higher quartile group with the reference group across all associations. P < .001 unless otherwise noted. Conclusion: ASDS operation time is associated with multiple postoperative complications, including, but not limited to, wound and pulmonary complications, venous thromboembolism, postoperative transfusion, length of stay ≥5 days, sepsis, reoperation, and unplanned readmission.
Book Review: Sunil Khilnani, Vikram Raghavan and Arun K. Thiruvengadam (eds), Comparative Constitutionalism in South Asia, Maneesha Tikekar (ed.), Constitutionalism and Democracy in South Asia; Political Developments in India’s Neighbourhood and Mark Tushent and Madhav Khosla (eds), Unstable Constitutionalism: Law and Politics in South Asia
Authors: Dhingra Alisha 
Published: May 2017

Sunil Khilnani, Vikram Raghavan and Arun K. Thiruvengadam (eds), Comparative Constitutionalism in South Asia. New Delhi: Oxford University Press. 2013. 401 pages. ₹ 950. Maneesha Tikekar (ed.), Constitutionalism and Democracy in South Asia; Political Developments in India’s Neighbourhood. New Delhi: Oxford University Press. 2014. 181 pages. ₹ 675. Mark Tushent and Madhav Khosla (eds), Unstable Constitutionalism: Law and Politics in South Asia. New York: Cambridge University Press. 2015. 403 pages. US$ 35.99.
The Role of the Peripheral Passive Rotation Stabilizers of the Knee With Intact Collateral and Cruciate Ligaments: A Biomechanical Study
Authors: Vap Alexander R. , Schon Jason M. , Moatshe Gilbert , Cruz Raphael S. , Brady Alex W. , Dornan Grant J. , Turnbull Travis Lee , LaPrade Robert F. 
Published: May 2017

Background: A subset of patients have clinical internal and/or external knee rotational instability despite no apparent injury to the cruciate or collateral ligaments. Purpose/Hypothesis: The purpose of this study was to assess the effect of sequentially cutting the posterolateral, anterolateral, posteromedial, and anteromedial structures of the knee on rotational stability in the setting of intact cruciate and collateral ligaments. It was hypothesized that cutting of the iliotibial band (ITB), anterolateral ligament and lateral capsule (ALL/LC), posterior oblique ligament (POL), and posteromedial capsule (PMC) would significantly increase internal rotation, while sectioning of the anteromedial capsule (AMC) and the popliteus tendon and popliteofibular ligament (PLT/PFL) would lead to a significant increase in external knee rotation. Study Design: Controlled laboratory study. Methods: Ten pairs (N = 20) of cadaveric knees were assigned to 2 sequential cutting groups (group 1: posterolateral-to-posteromedial [PL → PM] and group 2: posteromedial-to-posterolateral [PM → PL]). Specimens were subjected to applied 5-N·m internal and external rotation torques at knee flexion angles of 0°, 30°, 60°, and 90° while intact and after each cut state. Rotational changes were measured and compared with the intact and previous cut states. Results: Sectioning of the ITB significantly increased internal rotation at 60° and 90° by 5.4° and 6.2° in group 1 (PL → PM) and 3.5° and 3.8° in group 2 (PM → PL). PLT/PFL complex sectioning significantly increased external rotation at 60° and 90° by 2.7° and 2.9° in group 1 (PL → PM). At 60° and 90° in group 2 (PM → PL), ALL/LC sectioning produced significant increases in internal rotation of 3.1° and 3.5°, respectively. In group 2 (PM → PL), POL sectioning produced a significant increase in internal rotation of 2.0° at 0°. AMC sectioning significantly increased external rotation at 30° to 90° of flexion with a magnitude of change of <1° in both groups 1 (PL → PM) and 2 (PM → PL). Conclusion: Collectively, the anterolateral corner structures provided primary internal rotation control of the knee from 60° to 90° of knee flexion in knees with intact cruciate and collateral ligaments. The ITB was the most significant primary stabilizer of internal rotation. The POL had a primary role for internal rotational stability at full extension. The PLT/PFL complex was a primary stabilizer for external rotation of the knee at 60° and 90°. Clinical Relevance: This study delineates the primary and secondary roles of the ITB, ALL/LC, POL, and PLT/PFL to rotatory stability of the knee and provides new information to understand knee rotational instabilities.
Radiographic Diagnosis of Pincer-Type Femoroacetabular Impingement: A Systematic Review
Authors: Rhee Chanseok , Le Francois Tina , Byrd J. W. Thomas , Glazebrook Mark , Wong Ivan 
Published: May 2017

Background: Femoroacetabular impingement (FAI) is a well-recognized condition that causes hip pain and can lead to early osteoarthritis if not managed properly. With the increasing awareness and efficacy of operative treatments for pincer-type FAI, there is a need for consensus on the standardized radiographic diagnosis. Purpose: To perform a systematic review of the evidence regarding imaging modalities and radiographic signs for diagnosing pincer-type FAI. Study Design: Systematic review; Level of evidence, 4. Methods: A literature review was performed in 2016 using the Cochrane, PubMed, and Embase search engines. All articles focusing on a radiographic diagnosis of pincer-type FAI were reviewed. Each of the included 44 articles was assigned the appropriate level of evidence, and the particular radiographic marker and/or type of imaging were also summarized. Results: There were 44 studies included in the final review. Most of the articles were level 4 evidence (26 articles), and there were 12 level 3 and 6 level 2 articles. The crossover sign was the most commonly used radiographic sign (27/44) followed by the lateral center-edge angle (22/44). Anteroposterior (AP) pelvis plain radiographs were the most commonly used imaging modality (33 studies). Poor-quality evidence exists in support of most currently used radiographic markers, including the crossover sign, lateral center-edge angle, posterior wall sign, ischial spine sign, coxa profunda, acetabular protrusion, and acetabular index. There is poor-quality conflicting evidence regarding the use of the herniation pit to diagnose pincer-type FAI. Some novel measurements, such as β-angle, acetabular roof ratio, and acetabular retroversion index, have been proposed, but they also lack support from the literature. Conclusion: No strong evidence exists to support a single best set of current radiographic markers for the diagnosis of pincer-type FAI, largely due to the lack of better quality trials (levels 1 and 2) that compare conventional radiographic findings with the gold standard, which is the intraoperative findings. More sophisticated imaging modalities such as computed tomography and magnetic resonance arthrography are often needed to diagnose pincer-type FAI, and these investigations are relatively accurate in assessing labral pathology or cartilage damage.
Soft Tissue Envelope Preserving Technique for Computer Navigated Total Knee Arthroplasty
Authors: Clark Gavin , Mooney Luke 
Published: May 2017

Objectives: Current techniques in Total Knee Arthroplasty(TKA) are utilitarian in that all patients are recommended to have the same alignment of neutral mechanical axis. It has been well established that the population has a varied natural alignment with less than 20% of patients naturally neutral. The ability to predictably individualise alignment for patients is hypothesised to result in greater patient satisfaction. This technique aims to modify mechanical axis technique to consider an individual’s soft tissue constraints. Methods: Soft Tissue Envelope Preserving (STEP) is an operative technique for performing TKA that utilises the soft tissue data obtained intra-operatively from computer navigation registration to determine the optimal alignment to provide balanced positioning of implants without the need for soft tissue releases. Hence balance is achieved through bone cuts rather than altering the patient’s soft tissue balance. The technique will be described in detail. Results: The last 100 patients performed with complete data sets including navigation files and both pre-op and one year post operative outcome measures were reviewed. The spread of overall alignments and bony resections have been compiled with no outliers outside 5 degrees of neutral. The clinical results were comparable with other series and patient satisfaction of greater than 90% was reported. There were no MCL or LCL releases performed. Ilio-tibial band partial releases were the only reported soft tissue releases made. Conclusions: This technique is a safe and effective method of performing TKA with good short term outcomes. It minimises the use of soft tissue releases by utilising the patient’s own soft tissue envelope to balance the knee whilst maintaining the basic principles of a measured resection mechanical axis technique. It has resulted in excellent patient satisfaction in the short term.
Accuracy of Manual Surgeon-Defined Assessment of Soft Tissue Balance in TKA In Comparison to Sensor-Guided Measures and its Effect on Final Balance
Authors: MacDessi Samuel , Gharaibeh Monther 
Published: May 2017

Objectives: Present literature supports the importance of final alignment and soft tissue balance in total knee arthroplasty (TKA) on implant survivorship and clinical outcomes. Current soft tissue balance techniques mostly depend on subjective static measures that don’t allow for quantitative determination of ligament tension. Sensor guided technique (Verasense, Orthosensor) allows demonstration of the magnitude and location of load in a dynamic way providing quantitative data about knee balance. The aim of this study is to test the accuracy of the surgeon’s manual assessment in judging knee balance in comparison to Verasense. We also aimed to determine whether Verasense can assist in achieving soft tissue balance from the unbalanced state. Methods: 58 patients were enrolled in this prospective cohort study. The level of agreement between SDA and Verasense at 10, 45, 90 degrees was recorded. Initial trial pressures and final pressures after release or re-cut were recorded and compared. Final pressure measurements were then documented to assess whether appropriate knee balance (differential compartmental pressure of 15 lb/inch on 2 or more angular positions) had been achieved. Results: The mean age of the cohort was 67.5 years with deformities ranging from -16 degrees of varus to +20 degrees of valgus (mean -1.26 degrees varus). The capacity for the surgeon to manually identify an unbalanced knee was low with a test sensitivity of 33.3%. Manual test specificity to define a balanced knee was better with a specificity of 77.3%. The manual test had a positive predicitive value of 59.2% and a negative predictive value of 54%. There were 46.5% (27 of 58) of cases where the Verasense lead to a different surgical plan to that initially determined by the manual assessment. In 23 cases, either ligament release or tibial bone recut was performed. In the remaining 4 cases, the Verasense prevented a ligament release being performed. 95% of cases achieved a balanced state within 15lb/inch of pressure between compartments, with 100% balanced within 25 lb/inch. Conclusion: Manual surgeon assessment of soft tissue balance is a poor predictor of unbalanced knees. Verasense has the capacity to subsequently balance the knee within an acceptable pressure range as defined by prior studies. Further analysis to determine the impact on patient outcomes and implant survivorship is warranted.
Patella Eversion in Knee Arthroplasty: Does it lead to an adverse outcome?
Authors: Reid Michael , Booth Grant , Khan Riaz JK , Janes Greg 
Published: May 2017

Objectives: Proponents of minimally invasive knee replacements argue that retracting rather than everting the patella results in quicker postoperative recovery and improved function compared to the standard approach. We aimed to investigate this in a group of patients undergoing knee arthroplasty using a standard medial parapatellar approach. Methods: In a prospective randomized double-blinded study sixty-eight patients undergoing total knee arthroplasty through a standard medial parapatellar approach were assigned to either retraction or eversion of the patella. An independent observer assessed the flexion and secondary outcome measures of Oxford knee score, the SF12 score, visual analog pain scores, range of motion data and radiographs preoperatively, at three months and at one-year post surgery. Results: Early (3 month) follow-up showed no significant difference between eversion and subluxation in flexion (mean and 95%CI, 101°± 5.37 vs 102°±4.14) Oxford knee scores (25±3 vs 27±2.69), SF12 or visual analog pain scores (1.9±0.54 vs 1.1±0.44). A statistically significant improvement in extension was found (-3.9°±1.12 vs 2.0°±0.91 (p=0.034)) but this was not thought to be clinically significant. There was no difference in any outcomes at one year. There was a significant difference in implant malpositioning in the subluxation group with increased percentage lateral tibial overhang (0.45±0.39 vs 1.84±0.82 (p=0.005)) but this did not correlate with functional outcome. There was no statistical difference in alignment between the two groups (178.29°±0.84 vs 178.18°±0.78). There was no difference between the two groups in Insall-Salvati Ratio (1.15±0.06 vs 1.12±0.06) although there was a correlation to a reduction in the ratio and functional outcome. There were two partial divisions of the patella tendon in the retraction group, but no patella related complications in the eversion group. Conclusion: Retracting rather than everting the patella during total knee arthroplasty results in no significant clinical benefit in the early to medium term. There is no increase in patella tendon shortening as a result of eversion rather than subluxation.
The Seasonal Variation of TKR Infection Rates
Authors: Parkinson Ben , Armit Drew , Reid Michael , Lorimer Michelle , Harris Ian 
Published: May 2017

Introduction: A seasonal variation in the incidence of surgical site infections has been described following a number of common surgical procedures. However in the setting of elective Total Knee Replacement (TKR), the role of environmental factors is an area of research that is currently lacking from the literature. Data recently presented from our institution demonstrates a possible trend toward higher infection rates during periods of increased temperature and humidity. The aim of this study was to investigate if seasonal and geographical factors influence the rate of TKR infection within Australia. Methods: Data from the AOA National Joint Registry for all primary TKRs performed within the last 5 years was analysed to determine the revision rates for early (<12 months) post-operative infection. The infection rates for tropical regions (Darwin, Cairns, Townsville, Mackay) were compared to the remainder of the country. A month-by-month analysis was performed to determine if there was a seasonal variation within the 2 study groups. Results: During the study period a total of 207,540 primary TKRs were performed (6,514 tropical vs 201,026 non-tropical regions). Overall, the rate of revision for infection was significantly higher for the tropical regions of Australia (0.80% vs 0.39%). In non-tropical regions, there was no observed seasonal variation of infection rates. In tropical regions, there was a clear seasonal variation found, with the winter months being associated with a significantly lower rate of infection than the remainder of the year (0.37% vs 0.94%). The infection rates were not significantly different between tropical (0.37%) and non- tropical (0.38%) regions during the winter period. Conclusion: To the best of our knowledge, this is the first study to investigate and demonstrate a significant influence from seasonal variation on primary TKR infection rates. This phenomenon is evident only within tropical regions, with the periods of warmer and humid weather resulting in a significantly increased risk of primary TKR infection. These findings require further investigation and research.
Return to sport outcomes in the younger patient with anterior cruciate ligament reconstruction
Authors: Whitehead TS , Feller JA , Webster KE 
Published: May 2017

Objective: Anterior cruciate ligament (ACL) reconstruction is generally regarded as a successful procedure, however only 65% of patients return to their pre-injury sport. While return to sport rates are likely higher in younger patients, there is a paucity of data on this topic. The purpose of this study was to investigate a range of return to sport outcomes in younger athletes who had undergone ACL reconstruction surgery. Methods: This was a cross-sectional study design. A group of 140 young patients (<20 years at surgery) who had one ACL reconstruction and no subsequent ACL injuries were surveyed regarding details of their sport participation at an average follow up of 5 years (range 3-7). Results: Overall, 76% of the young patient group returned to the same pre-injury sport. Return rates were higher for males than females (81% vs. 71% respectively, p>0.05). Of those who returned to their sport, 65% reported that they could perform as well as before the ACL injury and 66% were still currently playing in their respective sport. Young athletes who never returned to sport cited fear of a new injury (37%) or study/work commitments (30%) as the primary reasons. For those who had successfully returned to their pre-injury sport but subsequently stopped playing, the most common reason was study/work commitments (53%). At follow-up 48% of female patients were still participating in Level I sports as were 54% of males. Conclusions: A high percentage of younger patients return to their pre-injury sport following ACL reconstruction surgery. For this group who have not sustained a second ACL injury, the majority continue to play and are satisfied with their performance.
Histological Analysis of the Tibial Anterior Cruciate Ligament Insertion
Authors: Siebold Rainer , Oka Shinya , Traut Ulrike , Schuhmacher Peter , Kirsch Joachim 
Published: May 2017

Objective: To describe the morphology of the tibial ACL insertion by histological assessment in the sagittal plane. Methods: For histology the native (undissected) tibial ACL insertion of 6 fresh-frozen cadaveric knees was cut into 4 sagittal sections parallel to the long axis of the medial tibial spine. The slices were stained with hematoxylin and eosin, Safranin O and Russell-Movat pentachrome. All slices were digitalized and analyzed at a magnification of ×20. Results: From medial to lateral the anterior-posterior lengths of the ACL insertion were an average of 10.2, 9.3, 7.6 and 5.8 mm. The anterior margin of the tibial ACL insertion raised from an anterior ridge. The most medial ACL fibers rose along with a peak of the anterior part of the medial tibial spine in which the direct insertion was adjacent to the articular cartilage. Parts of the bony insertions of the anterior and posterior horns of the lateral meniscus were in close contact to the lateral ACL insertion. A small fat pad was located just posterior to the tibial ACL insertion. There were no central or posterolateral inserting ACL fibers in the area intercondylaris anterior. Conclusion: The functional intraligamentous midsubstance ACL fibers arose from the most posterior part of its bony tibial insertion in a flat and “C-shape” way. The anterior border of this functional ACL started from a bony ‘anterior ridge’ and the medial border was along with a peak of the medial tibial spine.