bluuebunny/crossref_metadata_2025_split huggingface dataset:
What is the Natural History of Patellar Dislocation in Skeletally Immature Patients?
Authors: Sanders Thomas L. , Pareek Ayoosh , Hewett Timothy E. , Stuart Michael J. , Dahm Diane L. , Krych Aaron John 
Published: July 2017

Objectives: Patellar dislocation can occur in isolation or be associated with chronicinstability. The goals of this study are to describe the rate and factors associated with additional patellar instability events (ipsilateral recurrence and contralateral dislocation), as well as the incidence of patellofemoral arthritis among skeletally immature patients following patellar dislocation. Methods: The study included a population-based cohort of 232 skeletally immature patients who experienced a first-time lateral patellar dislocation between 1990 and 2010. A chart review was performed to collect information related to the initial injury, treatment, and outcomes. Subjects were followed for a mean of 12.1 years to determine the rate of subsequent patellar dislocation (ipsilateral recurrence or contralateral dislocation) as well as clinically significant patellofemoral arthritis. Results: 104 patients had ipsilateral recurrent patellar dislocation. The cumulative incidence of recurrent dislocation was 11% at 1 year, 21.1% at 2 years, 37.0% at 5 years, 45.1% at 10 years, 54.0 % at 15 years, and 54.0% at 20 years. Patella alta (HR: 10.6, 95% CI: 3.6, 36.1), increased TT-TG distance (HR 18.7, 95% CI: 1.7, 228.2), and trochlear dysplasia (HR 23.7, 95% CI: 1.0, 105.2) were associated with recurrence. Similarly, 18 patients (7.8%) had contralateral patellar dislocation. The cumulative incidence of patellofemoral arthritis was 0% at 2 years, 1.0% at 5 years,2.0% at 10 years, 10.1% at 15 years, 17%% at 20 years, and 39.0% at 25 years. Osteochondral injury was associated with arthritis (HR 25.7, 95% CI: 6.2, 143.8). Conclusion: Skeletally immature patients have a high rate of recurrent patellarinstability that is associated with structural abnormalities such as patella alta and trochlear dysplasia. In contrast, the rate of subsequent contralateral dislocation is low. Osteochondral injury is associated with arthritis after patellar dislocation, but the overall incidence of symptomatic arthritis with advanced radiographic changes in pediatric patients is low at 12-year follow-up.
The Influence of a Single Preoperative Ketorolac Dose on Postoperative Opiate Consumption for Ambulatory Knee Arthroscopy: A Double Blinded Placebo Controlled Study
Authors: Slone Harris , Epperson Thomas , Furse Cory , Wolf Bethany , Wilson Sylvia 
Published: July 2017

Objectives: Ketorolac is a non-steroidal anti-inflammatory known to decrease postoperative opiate requirements. While many studies have examined serial ketorolac doses over 48 hours, the optimal ketorolac dose for analgesia following ambulatory surgery is not established. We examined postoperative opiate consumption in morphine equivalents (ME) for patients receiving a randomized ketorolac dose for knee arthroscopy. Methods: Patients undergoing elective, outpatient knee arthroscopy were randomized a dose of ketorolac (0 mg, 7.5 mg, 15 mg, 30 mg) in a double blinded placebo controlled fashion. Postoperative opiate consumption was the primary outcome. Secondary endpoints were patient satisfaction score, Visual Analog Pain Scores (VAS) pre- and postoperative, side effects and total PACU time. Logistic regression was used to compare the results among the different ketorolac groups. Results: A total of 112 patients were enrolled with comparable patient and procedural characteristics in each group. Mean postoperative opiate consumption in ME was 6.36 mg across all groups. The median VAS at PACU arrival was 3.0 and at discharge was 1.6. Median patient satisfaction across all treatment groups was 9.8 out of 10. In univariate models, increased postoperative morphine consumption was associated with decreased ketorolac dose ( P=0.037) and female gender ( P=0.021). In a multivariable model, patients that received 7.5 fewer mg of ketorolac consumed on average 0.6 mg more ME postoperatively controlling for other factors ( P=0.034). Females consumed an average of 2.3 mg more opiates relative to males after controlling for ketorolac dose ( P=0.006). Ketorolac dose was not associated with the occurrence of side effects ( P=0.722). Side effects were associated with female gender ( P=0.023) and increased BMI ( P=0.022). Consumption of each additional 1 mg of postoperative ME had a 13% increase in the odds of having at least one side effect controlling for other factors ( P=0.026, 95% CI: 1.02-1.26). Conclusion: Decreased ketorolac dose is associated with increased opiate consumption controlling other factors. Increased opiate consumption may result in increased side effects, although this did not impact patient satisfaction.
Mid-term Outcomes of the Subchondroplasty Procedure for Patients with Osteoarthritis and Bone Marrow Edema
Authors: Byrd Jennifer Marie , Akhavan Sam , Frank Darren A. 
Published: July 2017

Objectives: Bone marrow edema (BME) is a negative prognostic factor for patients with knee osteoarthritis (KOA). BME is strongly associated with pain, decreased function, structural deterioration and rapid progression to total knee arthroplasty (TKA). Subchondroplasty (SCP) (Knee Creations, Zimmer, Warsaw, IN) directly addresses BME in the setting of KOA by injecting calcium phosphate cement into the area of BME. The objective of this research was to show clinical results of the SCP procedure. Methods: A retrospective chart review with follow-up questionnaire was conducted on SCP patients in short-term and midterm (>2 years). All patients failed conservative measures and were candidates for TKA. The questionnaire addressed symptoms before and after SCP, further interventions, the perception of and willingness to undergo SCP again. Results: 133 of 143 subchondroplasty patients responded. The average patient was 57 years old (38-84 years) and 47% male. The average follow-up for short-term patients was 14.6 (4-22) months and for mid-term patients was 32.1 (24-43) months. Pain score decreased from 8.3 pre-op to 3.4 post-op in both groups. 35% in the short-term group required injections, increasing to 41% in the mid-term. The short-term group demonstrated satisfaction of 8.3 out of 10, with 82% willing to undergo SCP again and 89% recommending SCP. In the mid-term group, satisfaction increased to 8.5 with 95% willing to undergo SCP again and 96% recommending the procedure. In all, 32 patients (25%) progressed to TKA (Figure 1) at an average of 17.8 months, with 22 (69%) of these occurring before 2 years. Conclusion: SCP is an effective and well received treatment for patients with KOA and BME. In patients who failed conservative measures and were considering TKA, excellent results are seen at 2.5 years follow-up with only 25% of patients requiring TKA. Of all patients not requiring TKA, 93% would undergo SCP again and 98% would recommend it. [Table: see text]
Does Treatment of the Tibia Matter in Bipolar Chondral Defects of the Knee? Clinical Outcomes with Greater Than Two Years Follow-Up
Authors: Weber Alexander E. , Hannon Charles Patrick , Meyer Maximilian A. , Poland Sarah Glen , Yanke Adam Blair , Cole Brian J. 
Published: July 2017

Objectives: The purpose of this study was twofold: 1) to investigate the optimal treatment of bipolar tibiofemoral cartilage lesions by comparing femoral osteochondral allograft (OCA) with tibial debridement to bipolar lesions treated with femoral OCA and tibial microfracture and 2) to compare the outcomes of bipolar lesions with isolated femoral defects treated with OCA. Methods: A series of 36 patients undergoing femoral OCA for bipolar lesions was identified. Group 1 contained 20 patients with tibial lesions treated with debridement, Group 2 contained 16 patients with tibial lesions treated with microfracture, and Group 3 (control group) contained 20 patients with isolated femoral lesions treated with OCA. Group 3 was matched by gender, BMI, laterality, and OCA size to Groups 1 and 2. Patient-specific, defect-specific data was collected. Patient reported outcomes (PROs) including International Knee Documentation Committee (IKDC) scores, Short Form 12 (SF-12) scores, Knee Injury and Osteoarthritis Outcome Scores (KOOS), and Lysholm scores, were recorded. All patients had greater than two-year follow-up. Results: There were no significant differences between the three groups in terms of gender, body mass index (BMI), number of previous surgeries, femoral or tibial defect size, and OCA size. Preoperative to postoperative patient reported clinical outcomes (PROs) demonstrated statistical and clinically meaningful improvement in all 3 groups (p < 0.05), without differences between groups (Figure 1). Patient-specific and defect-specific factors did not significantly correlate with PROs. The graft survivorship for Group 1 was 85% at 4.5 years, 100% for Group 2 at 2.5 years, and 95% for Group 3 at 3.8 years. Conclusion: Regardless of tibial treatment, debridement or microfracture, patients with bipolar cartilage lesions treated with femoral OCA have significant and clinically meaningful improvements in PROs, which are comparable to isolated femoral defects treated with OCA. In addition, bipolar lesions treated with OCA had excellent graft survivorship at greater than two-years follow-up.
Biceps Tenodesis vs. Repair for Type II SLAP Tears in Patients Under 30 years-old
Authors: Nielen Dominic Van , Wilson Matthew , Hammond James , Joyner Patrick Wakefield 
Published: July 2017

Objectives: Recent literature has demonstrated good results with biceps tenodesis (BT) following failed SLAP repair. However, it is still unclear if repair or BT provides better outcomes for treatment of type II SLAP tears. We hypothesize that treatment of type II SLAP tears with subpectoral biceps tenodesis vs SLAP repair improves functional outcomes while providing for shorter rehabilitation times. Methods: A retrospective chart review was conducted for patients under 30 who underwent an open subpectoral biceps tenodesis or primary SLAP repair performed from Jan 1, 2007 to Jan 1, 2014. Patients were contacted and asked to fill out a questionnaire over the phone or via email. American Shoulder and Elbow Score (ASES), visual analog pain scale (VAS), demographics, and subsequent ipsilateral surgical procedures were collected. Results: 55 patients underwent primary BT and 398 patients underwent primary SLAP repair during included period. 33 BT patients (60%) were successfully contacted, these were age and follow-up matched with 33 randomly selected SLAP repair patients. Average age was 25.7 and 26.4 for the SLAP and BT groups, respectively. Follow up averaged 3.5 years for the BT group and 5.1years for the SLAP group. Two patients in the BT group (6%) had a subsequent ipsilateral procedure compared to 5 in the SLAP group (15%), OR 2.78 (p=0.24). Average VAS scores (2.2 BT vs 2.8 SLAP) and ASES Scores (80.9 BT vs 71.7 SLAP) were both improved in the patients who underwent BT vs. primary SLAP repair. Conclusion: Superior labrum injuries are a common cause for shoulder pain. Our results suggest that primary biceps tenodesis provides improved functional results in active patients under 30 when compared to SLAP repair at minimum 2 year follow-up.
The Development and Validation of a Functional Assessment Tool for the Hip in the Athletic Population
Authors: Papaliodis Dean , Banffy Michael B. , Limpisvasti Orr , Mohr Karen , Mehran Nima , Photopoulos Christos Demetris , Kvitne Ronald S. , ElAttrache Neal S. 
Published: July 2017

Objectives: There are no validated functional assessments designed specifically to evaluate the performance and function of the athletic hip. There are subsections of validated outcomes that address recreation, but a full assessment dedicated to athletic hip function does not exist. Current hip scoring systems may not be sensitive to subtle changes in performance and function in an athletic, younger population. The scoring system developed in this study will be valid, reliable, and responsive in the evaluation of hip function in the athlete. Methods: Based on the results of a pilot questionnaire administered to 18 athletic individuals, a final 10-item questionnaire was developed. Two hundred and fifty healthy, competitive athletes from multiple sports completed the final questionnaire, as well as 3 established hip outcome assessments. Each athlete was self-assigned into injury categories including: (1) playing without hip/groin trouble, (2) playing, but with hip/groin trouble, and (3) not playing due to hip/groin trouble. Correlations between the scores and differences between injury categories were measured. Responsiveness testing was performed in an additional group of 24 injured athletes, comparing their scores before and after an intervention. Results: The new score showed high correlation with the modified Harris Hip Score, the non-arthritic hip score, and the International Hip Outcome Tool-33 (i-hot 33). The new score stratified athletes by injury category and demonstrated responsiveness, accuracy and varied appropriately with improvements in injury category after treatment of injuries. Conclusion: The new Athletic Hip Score is valid, reliable and responsive for evaluation of the hip in an athletic population. The results support its use for the functional assessment of the hip in future studies.
Independent Risk Factors for Poor Outcome After Hip Arthroscopy
Authors: Capogna Brian , Hamula Mathew , Begly John , Wolfson Theodore , Looze Christopher , Ryan Michael K. , Youm Thomas 
Published: July 2017

Objectives: Hip arthroscopy has been an increasingly used tool in the treatment of labral tears, chondral defects and ligamentum teres lesions and has demonstrated efficacy in returning patients to function and relieving their pain. Despite this, failures continue to occur. Our understanding of risk factors for failure or poor outcome continues to evolve as larger cohorts of patients are available for study. We sought to identify risk factors for poor outcome in our patient population. Methods: Prospectively collected data for all patients undergoing hip arthroscopy by a single fellowship-trained surgeon was obtained. All patients were indicated for hip arthroscopy based on standard pre-operative examination as well as routine and advanced imaging. Baseline demographic data regarding patient age, gender, BMI was collected. Patients without two year follow-up were excluded. Baseline pre-operative modified Harris Hip Scores (mHHS) were compared to mHHS at two-year follow-up. “Poor outcome” of initial hip arthroscopy was defined as any combination of: requiring a revision procedure or conversion to THA or mHHS below 70. Multivariate logistic regression was performed to identify independent risk factors for “poor outcome.” Results: 258 patients met inclusion criteria. Mean age (SD) and body mass index (BMI) were 40.4 years (12.7 years) and 25.6 (4.7) respectively. 62.8% (162/258) of the sample was female. Mean preoperative baseline mHHS was 49.6 (12.5) and average mHHS at two year follow-up was 83.6 (15.6), resulting in a mean improvement of 34.1 (p<0.001). Baseline and 2 year differencess in mHHS by demographic be found in Figures 1,2,3,. Overall revision/THA conversion rate was 16.7% (43/258), while another 10.5% (27/258) of patients reported outcome scores <70, resulting in 27.31% (70/258) having poor outcomes. Independent risk factors for poor outcome were female gender (OR 1.79; p=0.03), obesity (OR 2.1; p=0.04), and pre-operative mHHS lower than 40 (OR 3.34, p<0.001). Conclusion: Our findings that female gender, obesity and poorer preoperative functional status increase the risk for failure of hip arthroscopy coincide and add to an increasing volume of literature examining risk factors for poor outcome after hip arthroscopy. These factors should be taken into consideration with operative indications as well as in counseling patients.
Comparison of Patient Reported Outcomes using PROMIS in Patients with Shoulder Pain
Authors: Strong Benjamin , Kenney Raymond James , Schaffer Joseph Christopher , Hedgecock Jon , Houck Jeff , Maloney Michael D. , Voloshin Ilya 
Published: July 2017

Objectives: Compare a disease specific questionnaire (American Shoulder and Elbow Surgeons [ASES]) and a multidimensional global health scale (Patient reported outcome measurement system [PROMIS]) across a variety of shoulder conditions. Methods: The ASES (Pain subscore, Function subscore, and total score) and PROMIS Physical Function (PF), Pain Interference (PI), and Depression Computer Adaptive Tests (CATs) were collected on all clinic visits for two high volume shoulder surgeons over a 12-week period between 1/26/16 and 4/20/16. Data included all (n=123) records for new patient visits of patients over 18 years old for shoulder diagnoses of Impingement (M75.41, n=50), Pain (M25.11, n=30), Rotator Cuff Tear (M75.10, M75.12; n=12), Arthropathy (M12.9, n=12), Instability (M75.02, n=6), Adhesive Capsulitis (M75.02, n=4), and miscellaneous (n=9). Excluding diagnoses with small samples (n<10) Two way ANOVA’s (Diagnosis by Outcome Measure Domains) with age and gender as covariates were used to determine if specific diagnoses presented with different initial severity of pain, function, or depression. This was followed by univariate analysis to determine the associations between the disease specific ASES scores and non disease specific PROMIS domains. Correlations of r>0.7 were considered strong correlation, r>0.5 moderate, and <0.5 poor. All analyses were carried out using SPSS® version 22 (copyright 2013). Results: Two way ANOVA’s demonstrated no significant differences of ASES or PROMIS scores across diagnoses, suggesting similar levels of pain, function and depression across diagnoses. PROMIS PF was moderately associated with ASES Function (r=0.61, p<0.01), and ASES Total (r=0.59, p<0.01). PROMIS PI was strongly correlated to ASES Function (r=-0.71, p<0.01) and ASES Total (r=-0.74, p<0.01) as well as moderately correlated to ASES Pain (r=-0.56, P<0.01). ASES Pain had poor correlation to ASES Function (r=0.45, p<0.01). PROMIS Depression had poor correlation to all ASES domains. Conclusion: The non-disease specific PROMIS PF and PI demonstrated the ability to determine disease severity across shoulder diagnosis equal to an accepted disease specific scale (ASES). Furthermore, PROMIS PI had a stronger correlation to ASES Function than either PROMIS PF or the ASES Pain subscore and may more accurately describe the true affect of pain on a patient’s daily life. This data shows the potential for the universally available and emerging PROMIS instrument to track shoulder problems similar to a prior established disease specific instrument.
Impact of Oral Hygiene Discontinuation on Supragingival and Salivary Microbiomes
Authors: Belstrøm D. , Sembler-Møller M.L. , Grande M.A. , Kirkby N. , Cotton S.L. , Paster B.J. , Twetman S. , Holmstrup P. 
Published: July 2017

The purpose of the present study was to characterize and compare supragingival and salivary microbiotas during a 10-d period of oral hygiene discontinuation. We tested the hypothesis that the composition of the salivary microbiota will reflect local microbial changes associated with accumulated biofilm formation and maturation. Pooled supragingival plaque ( n = 145) and stimulated saliva ( n = 145) samples were collected and plaque and gingival indices were recorded from 29 orally healthy individuals at baseline, during oral hygiene discontinuation (days 4, 7, and 10), and 14 d after resumption of oral hygiene. Supragingival and salivary microbiotas were processed by next-generation sequencing (Human Oral Microbe Identification using Next Generation Sequencing) and microbial community profiles were compared. Microbial composition of supragingival plaque samples collected after 4, 7, and 10 d of oral hygiene discontinuation, as well as 14 d after reuptake of oral hygiene, differed significantly from baseline samples, by a 3-fold increase in relative abundance Leptotrichia species and a 2-fold decrease in Streptococcus species (adjusted P < 0.01). In saliva samples, a significant increase in relative abundance of Leptotrichia species (adjusted P < 0.01) was evident at day 7 but completely reversed 14 d after resumption of oral hygiene. While the salivary microbiota was resistant to accumulated local biofilm formation, data from this study showed that compositional changes of supragingival microbiotas were not reversed 14 d after resumption of oral hygiene, despite the restoration of plaque to baseline levels. ( ClinicalTrials.gov UCPH_OI_002, NCT02913235). Knowledge Transfer Statement: Data from this study showed compositional changes of supragingival microbiotas as a consequence of a 10-d period of oral hygiene discontinuation, that was not reversed 14 d after resumption of oral hygiene. Notably, oral hygiene discontinuation was associated with a significant increase in relative abundance of potential cariogenic Leptotrichia species and a decrease in Streptococcus species. Thus, findings from this study highlight the necessity of regular oral hygiene in the maintenance of oral homeostasis.
The Role of Perioperative Anti-VEGF During Vitrectomy for Vitreous Hemorrhage in Relation to Postoperative Nonclearing Vitreous Hemorrhage and Cystoid Macular Edema
Authors: Nagpal Manish , Mehrotra Navneet , Vishnoi Avijit 
Published: July 2017

Purpose: To assess the role of perioperative anti–vascular endothelial growth factor (anti-VEGF) on the incidence of rebleed and foveal thickness in patients undergoing pars plana vitrectomy (PPV) for nonclearing vitreous hemorrhage due to retinal vascular disorders. Design: Retrospective, randomized, comparative interventional study. Methods: Three hundred twelve eyes were assigned to group A (eyes undergoing PPV without anti-VEGF, n = 165) and group B (eyes undergoing PPV with anti-VEGF, n = 147) and were followed up for a minimum of 6 months. The incidence of rebleed and 1 month postoperative central foveal thickness (CFT) was recorded and analyzed. Results: The incidence of postoperative vitreous hemorrhage (POVH) in group A was 21.81%, which was significantly ( P = .025) higher than in group B (12.24%). Mean CFT in group A (289.24 ± 49.47 μm) was higher as compared to group B (263.42 ± 94.42), but the difference was not statistically significant. Conclusion: Perioperative intravitreal anti-VEGF given at the end of the surgery significantly reduces the incidence of POVH and helps in achieving better CFT postoperatively.
CASAS: Cancer Survival Analysis Suite, a web based application
Authors: Rupji Manali , Zhang Xinyan , Kowalski Jeanne 
Published: July 2017

We present CASAS, a shiny R based tool for interactive survival analysis and visualization of results. The tool provides a web-based one stop shop to perform the following types of survival analysis: quantile, landmark and competing risks, in addition to standard survival analysis. The interface makes it easy to perform such survival analyses and obtain results using the interactive Kaplan-Meier and cumulative incidence plots. Univariate analysis can be performed on one or several user specified variable(s) simultaneously, the results of which are displayed in a single table that includes log rank p-values and hazard ratios along with their significance. For several quantile survival analyses from multiple cancer types, a single summary grid is constructed. The CASAS package has been implemented in R and is available via http://shinygispa.winship.emory.edu/CASAS/. The developmental repository is available at https://github.com/manalirupji/CASAS/.