bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Latarjet Procedure at the National Football League Scouting Combine: An Imaging and Outcome Analysis
Authors: Provencher Matthew T. , Lebus George , Chahla Jorge , Sanchez George , Ferrari Marcio Balbinotti , Moatshe Gilbert 
Published: July 2017

Objectives: The Latarjet procedure is commonly implemented in the treatment of shoulder instability in the setting of glenoid bone loss, particularly in contact athletes such as American football players; however, little is known regarding the outcomes and failures rates of this procedure in collegiate football players prior to participating in the National Football League (NFL). The purposes of this study were to 1) determine the prevalence, clinical features, and imaging findings of National Collegiate Athletic Association (NCAA) football athletes who presented to the NFL scouting Combine having undergone the Latarjet procedure and 2) to evaluate the impact of this procedure, including imaging findings on these athletes’ performance as they entered the NFL. Methods: All NFL football players at the NFL Combine from 2009 to 2016 were reviewed. Inclusion criteria were any player who had a documented Latarjet procedure in the past and participated in medical and performance testing at the NFL Combine. Medical records, imaging, games and position played, and draft position of each player who had undergone a Latarjet procedure was then analyzed. In addition, radiographic features of each players with a Latarjet were evaluated including type of fixation, hardware complications, position of the bone block, degenerative changes, and healing/union/bony resorption were all assessed. NFL performance outcomes (draft position and number of games played and started within first two years) were assessed. Results: Of the 2285 players who participated in the NFL combine between 2009 and 2016, there were 13 athletes (0.6%) who had undergone a Latarjet procedure. Six patients had a two-screw fixation of the bone block while 7 had only one screw, with two patients evidencing a broken hardware (one with one screw and one with 2 screws) and two patients with bent screws (one with one screw and one with 2 screws). Screw prominence was observed in 1 patient. Eight of the 13 patients identified underwent computed tomography (CT) scans. All had evidence of bony resorption of the bone block on CT imaging. The majority of these (5) had evidence of minimal resorption (<25%). One had a moderate amount of resorption (<50%) and two others had almost resorption of the bone block. Conclusion: Only a small percentage of players at the NFL combine (0.6%) had undergone a Latarjet procedure in the past. Nevertheless, a high number of postoperative complications were observed including broken or bent screws and prominent hardware. Optimal graft positioning was observed in the majority of the patients. However, bone resorption was found in most of them.
Shoulder Injuries in Collegiate Football Athletes: Impact on Draft Status and Professional Performance
Authors: Frangiamore Salvatore Joseph , Mannava Sandeep , Sanchez George , Ferrari Marcio Balbinotti , Frank Rachel M. , Bradley James P. , Provencher Matthew T. 
Published: July 2017

Objectives: Shoulder injuries remain among the most common traumatic injuries in high-level football players. However, there remains a paucity of information available on the impact of shoulder on draft prospect and professional performance. The purpose of this study is to define the epidemiology of shoulder injuries in NFL athletes, and to determine the impact of associated injuries on draft status and performance in the NFL. Methods: All NFL-caliber athletes who attended the NFL Scouting Combine between 2009 and 2015 were analyzed for history of shoulder injury. The impact of shoulder injury on NFL draft pick status and NFL performance, including games started, games played, and position-specific performance outcomes, were analyzed, and compared to control Combine athletes, which were defined as athletes with no history of shoulder injury in college, no surgical history, and no history of missing > 2 total games in college. Results: A total of 1143/2198 (52%) at the Combine had a history of shoulder injury, including 527 acromioclavicular joint (ACJ) injuries (46%), 90 posterior labrum injuries (8%), 77 anterior labrum injuries (7%), 69 clavicle injuries (6%), 42 rotator cuff injuries (4%), 14 superior labrum anterior to posterior (SLAP) lesions (1%), 14 sternoclavicular joint injuries (1%), and 16 biceps injuries (1%). In addition, 267 athletes (23%) had “complex” injuries, indicating multiple sites about the shoulder, while 207 athletes (18%) had shoulder injuries designated as “other.” Combine athletes with shoulder injuries were more likely to go undrafted compared to controls (34% undrafted, vs. 27.3% for controls), and had a higher undrafted rate with biceps (43.8%), SLAP (42.9%), ACJ (35.9%), ACJ (35.6%), labrum (33%), and complex injuries (35.6%) Similarly, of the drafted athletes, those with shoulder injuries were more likely to have a higher (worse) overall draft pick compared to controls. In general, athletes with shoulder injuries played and started fewer games in their first two seasons in the NFL than controls (played: 23.7±7.7, started 11.1±10.5), with sternoclavicular injuries associated with the lowest numbers of games played (17±8.5) and started (10.3±11.2). Conclusion: History of shoulder injury in NFL-caliber players is associated with reduced overall draft rates, higher (worse) overall draft pick, and reduced performance in the NFL compared to control athletes without shoulder injury. Overall, ACJ injuries are the most prevalent of shoulder injuries among NFL-caliber athletes. Additional analysis is warranted to determine the overall impact of specific types of shoulder injuries, as well as shoulder surgery, on position-specific performance and career longevity.
Arthroscopic 360-Degree Capsular Release for Idiopathic Adhesive Capsulitis in the Lateral Decubitus Position
Authors: Romeo Anthony A. , Cvetanovich Gregory L. , Leroux Timothy Sean , Bernardoni Eamon , Saltzman Bryan M. , Verma Nikhil N. 
Published: July 2017

Objectives: Idiopathic glenohumeral adhesive capsulitis impairs patient motion and function. If conservative management fails, arthroscopic capsular release is classically performed in the beach-chair position with incapsule release and manipulation under anesthesia. We report outcomes following arthroscopic 360-degree capsular release in lateral decubitus position followed by limited manipulation to confirm restoration of range of motion. Methods: A retrospective case series of patients undergoing arthroscopic capsular release in the lateral decubitus position for idiopathic adhesive capsulitis with minimum 2-year follow-up was conducted. Patient demographics, preoperative range of motion (ROM), postoperative ROM, and postoperative outcome scores were recorded. Complications and reoperations were recorded. Paired t-tests were used to compare preoperative and postoperative ROM, with p<0.05. Results: Overall, 43 patients were identified, of which 10 were excluded due to posttraumatic etiology. Of the remaining 33 patients, 27/33 (81.8%) completed a minimum follow-up of 2-years. The mean age was 54.8+/-7.4 years and 73% female, with duration of symptoms 16.2+/-21.0 months (range 2 to 125). Hypothyroidism was present in 6% and diabetes present in 33%. Pre-operatively, patients had 1.8+/-1.1 preoperative corticosteroid injections (range 0-5). Active forward flexion improved from 115.0+/-21.9 degrees to 156.2+/-16.1 degrees at final follow-up (mean difference 41.2, 95% confidence interval [33.7,48.7], p<0.001). Active external rotation with the arm adducted improved from 28.1+/-16.3 degrees preoperatively to 56.8+/-15.7 degrees at final follow-up (mean difference 27.7, 95% confidence interval [19.1,36.3], p<0.001). Significant range of motion improvements were seen even as early as 2-weeks postoperative (Figure). Overall, final outcomes were excellent, including VAS pain of 0.2+/-0.5, SANE 96.3+/-4.9, SST 11.3+/-1.2, and ASES 97.0+/-4.7. There were no revision surgeries and no complications. Conclusion: Arthroscopic 360-degree capsular release in the lateral decubitus position for idiopathic adhesive capsulitis results in a significant early and lasting improvement in range of motion, excellent functional outcomes, and low revision and complication rates.
Arthroscopic Superior Capsule Reconstruction (ASCR) vs Latissimus Dorsi Transfer (LDT): A Comparison of Early Clinical Outcomes
Authors: Pogorzelski Jonas , Horan Marilee P. , Fritz Erik M. , Katthagen Jan Christoph , Godin Jonathan Alexander , Millett Peter J. 
Published: July 2017

Objectives: Arthroscopic superior capsule reconstruction (ASCR) has been introduced as an alternative to latissimus dorsi transfer (LDT) for the treatment of irreparable rotator cuff tears in young patients. The hypothesis of this study is that preliminary clinical outcomes for SCR patients will not significantly differ from those of LDT patients for irreparable and massive rotator cuff tears. Methods: Patients who underwent either a LDT or an ASCR and were a minimum of 6 months (mean, 12 months) out from surgery were included. In the SCR technique, a 3-mm acellular human dermal allograft was customized to the exact size of the defect. Surgical, objective, and demographic data were prospectively collected and retrospectively reviewed. Patient-reported outcome (PRO) measures included ASES, SANE, QuickDASH, SF-12 and satisfaction scores. Acromiohumeral distance (AHD) was measured and Hamada classification applied. Patients progressing to reverse shoulder arthroplasty (rTSA) or patients with a graft disruption were considered failures. Results: 34 patients (13 women, 21 men) with a mean age of 52±7.4 years were included in this study. 16 patients underwent SCR reconstruction while 18 patients underwent LDT. Compared to the SCR group, the LDT group was significantly younger (49 years vs. 56 years; p=.006) and had a higher percentage of Workman’s Compensation cases (61% vs. 6%; p=.001). Failure of the repair occurred in one patient in the ASCR group (6.2%), who suffered a graft tear seen on MRI at 141 days postoperatively, and two patients (11%) in the LDT group, both of whom progressed to rTSA. Two additional patients (11%) in the LDT group had subsequent surgery around one-year postoperatively - an arthroscopic cuff repair and hardware removal. In those who did not fail, pain significantly decreased postoperatively in both groups (p<0.05). Only patients who underwent ASCR had a statistically significant functional improvement (p=0.002 vs. p=0.161). Mean change in abduction and flexion were -7.3° and 0.6°, respectively, in the LDT group, compared to 56.0° and 21.7°, respectively, in the ASCR group. At final follow-up, satisfaction was a median 8/10 points in both groups. Conclusion: Patients who underwent ASCR had significantly improved clinical scores and improved range of motion compared to patients who underwent LDT, but longer follow-up is needed.
Electromyographic and Motion Capture Analysis of the Elbow and Forearm in the Overhead Football Throw
Authors: Smith Jarrod , Winnier Scott , Douglas Lonnie , Ostrander Roger V. , Anz Adam William , Andrews James R. 
Published: July 2017

Objectives: Muscle activation patterns and the kinetics of overhead throwing have been well described in the baseball athlete but not in the football athlete. Injury patterns vary between these two populations. The purpose of this controlled laboratory study was to describe the muscle activation patterns of the elbow and forearm during the overhead football throw. A better understanding of muscle activation patterns and kinetics will help clinicians understand the difference in injury between these two populations, with an objective of preventing injury in both groups. The hypothesis was that the unique grip and obligatory pronation upon ball release will cause the elbow and forearm muscles to have a unique activation pattern during the overhead football throw. Methods: IRB approval was obtained. Electromyographic (EMG) and motion capture data was collected on eight male quarterbacks. An EMG direct transmission system measuring at 1200 Hz with 9 surface electrodes was used to collect EMG data, with signals normalized to maximal voluntary contraction values for each subject. EMG sensors were placed on the biceps, triceps, brachialis, brachioradialis, anconeus, extensor digitorum communis, flexor digitorum superficialis, pronator teres, and pronator quadratus. A 13 camera motion capture system measuring at 240 Hz with a full body marker set of 39 retro-reflective 9mm markers was used to capture motion data. The throwing motion was divided into four event segments: early cocking, late cocking, acceleration, and follow through. Results: All athletes had NCAA experience and were aged 18-30 years old. The anconeus (26.9%, 36.3%, 57.6%, and 105.8% MVCs), extensor digitorum communis (22.7%, 28.0%, 31.0%, and 42.8% MVCs), and flexor digitorum superficialis (19.4%, 39.3%, 22.3%, and 104.7% MVCs) had high levels of activity throughout all phases of the football throw. The brachioradialis (56.8%MVC) and anconeus (57.6%MVC) were the most active muscles during the acceleration phase. The pronator teres (78.4%MVC), pronator quadratus (90.9%MVC), and flexor digitorum superficialis (104.7% MVCs) have very high levels of activation during the follow through phase. Conclusion: High levels of activity of the anconeus suggest that it functions as a dynamic stabilizer during all phases of the throwing motion. High levels of activity of the extensor digitorum communis and flexor digitorum superficialis suggest that they are important for grip. The pronator teres and pronator quadratus are important at ball release to produce a spiral motion of the football. High activity of the medial sided musculature may impart dynamic stability to the elbow. These findings may explain why quarterbacks have a lower rate of UCL injury and a higher return to play without surgery.
A Novel Non-operative Protocol for the Acute Management of In-season Acromioclavicular Separations
Authors: Heard Wendell M.R. , O’Brien Michael John , Taylor Daniel , Massey Andrew , STEWART GREGORY W. , Savoie Felix H. 
Published: July 2017

Objectives: Traditional treatment of acromioclavicular (AC) sprains has been a sling with rest and rehabilitation. We have developed a protocol that uses a static scapular retraction brace (Figure 1) to reduce the displaced upper extremity back to the clavicle. We hypothesized that the brace in combination with oral and injected steroid and a rehabilitation protocol that emphasizes postural restoration, facilitates a more anatomic reduction of the AC joint that quickly eliminates discomfort, allows for more anatomic healing and a rapid return to normal activities in type 1, 2, and 3 AC separations. Methods: Data was prospectively collected and retrospectively reviewed on all collegiate football AC separations at an NCAA division I university. Data included treatment, the number of practices missed, the number of games missed, and time to full return to play. Inclusion criteria were all consecutive in-season Type I-III AC separations sustained during football activities that requiring medical attention. Exclusion criteria include fractures, glenohumeral dislocations, rotator cuff tears, nerve injuries, other concomitant shoulder injuries, and injuries sustained during the last game of the season. The end points measured were number of games missed and time to full return to play. Results: During seven football seasons (2008-2014), 56 acromioclavicular separations occurred. Fifty-two (52) AC separations are included in the current study. Full return to play ranged from 0-31 days, with an average 5.7 days to full return to play. On average, athletes missed 0.25 games (range 0-3 games). Quarterbacks missed the most time, and an injury to the quarterback’s throwing shoulder required the most time to return to full play (mean 26 days and 3 games). The return to play in our group of athletes was more rapid and than that reported in the literature. Conclusion: The unique aspect of this protocol is anatomic reduction of the AC joint with the use of a static, three-point brace to pull and rotate the entire forequarter back to the clavicle. It is common in fracture reduction to reduce the distal piece to the proximal segment to achieve anatomic restoration. This principle attempts to do the same. A secondary effect of the static reduction is the diminution of rotator cuff pain due to opening the subacromial space by scapular retraction, thus decreasing pressure on the contused supraspinatus tendon and allowing more rapid resolution of the inflammation. This study represents a specific non-operative protocol for the in-season management of AC injuries to quickly and safely return athletes to play.
Clinical Utility of Continuous Radial MRI Acquisition at 3T in Patellofemoral Kinematic Assessment
Authors: Kaplan Daniel James , Campbell Kirk A. , Alaia Michael Joseph , Strauss Eric Jason , Jazrawi Laith M. , Chang Gregory , Burke Christopher 
Published: July 2017

Objectives: Continuous gradient-echo (GRE) acquisition or “dynamic magnetic resonance imaging”, allows for high-speed examination of pathologies based on joint motion. We sought to assess the efficacy of a radial GRE sequence with in the characterization of patellofemoral maltracking. Methods: Patients with suspected patellofemoral maltracking and asymptomatic volunteers were scanned using GRE (Siemens LiveView WIP; Malvern, PA, USA) at 3T in the axial plane at the patella level through a range of flexion-extension (0-30°). The mean time to perform the dynamic component ranged from 3-7 mins. Lateral maltracking (amount patella moved laterally through knee ranging) was measured. Patella lateralization was categorized as normal (≤ 2mm), mild (2-5mm), moderate (5-10mm), or severe (>10mm). Tibial tuberosity:trochlear groove (TT:TG) distance, trochlea depth, Insall-Salvati ratio, and patellofemoral cartilage quality (according to the modified Outerbridge grading system) were also assessed. Results: Eighteen symptomatic (6 men; 12 women, age range 14-51 years) and 10 asymptomatic subjects (6 men; 4 women, age range 25-68 years) were included. Two symptomatic patients underwent bilateral examinations. Lateralization in the symptomatic group was normal (n=10), mild (n=2), moderate (n=5) and severe (n=3). There was no abnormal maltracking in the volunteer group. Lateral tracking significantly correlated with TT:TG distance (F=38.0; p<.0001), trochlea depth (F=5.8; p=.023), Insall-Salvati ratio (F=4.642; p=.04) and Outerbridge Patella score (F=6.6; p=.016). Lateral tracking did not correlate with Outerbridge Trochlear score. Conclusion: Lateral tracking measured on GRE was found to significantly correlate with current measures of patellar instability including, TT:TG, trochlea depth, and the Insall-Salvati ratio. GRE is a rapid and easily performed addition to the standard protocol for kinematic patellofemoral motion and can add dynamic information on patellofemoral tracking. This may be help determine if an isolated MPFL or an MPFL reconstruction and tibial tubercle osteotomy is needed to treat patella instability.
Combined Reconstruction of the Medial Patellofemoral Ligament (MPFL) and Medial Quadriceps Tendon - Femoral Ligament (MQTFL) for Patellar Instability in Children and Adolescents: Surgical Technique and Outcomes
Authors: Redler Lauren H. , Spang Robert C. , Tepolt Frances , Davis Eric A. , Kocher Mininder S. 
Published: July 2017

Objectives: A variety of surgical options exist to treat the challenging problem of recurrent patellar instability in skeletally immature patients. The current study describes a combined reconstruction technique involving both the medial patellofemoral ligament (MPFL) and the medial quadriceps tendon - femoral ligament (MQTFL) and reports patient outcomes of a single-surgeon series. Methods: All patients studied underwent combined MPFL and MQTFL reconstruction for patellar instability. Demographic data, pre- and post-operative radiographic data were collected. Reconstruction was performed using gracilis allograft. The graft midportion was fixed to the MPFL insertion on the femur via suture anchor. One arm of the graft (MPFL) was tunneled under medial retinaculum to the medial border of the patella and fixed there via suture anchor, while the other (MQTFL) arm was tunneled, delivered under the VMO and brought through the medial distal quadriceps tendon and sutured in place. Subjective outcome scores (Kujala, Pedi-IKDC, Lysholm) were collected via questionnaires mailed to patients more than one year from surgery. Results: A total of 25 patients (27 knees), including 15 females and 10 males with an average age of 15.0 ± 2.2 years (range 10.3-18.9), underwent combined MPFL and MQTFL reconstruction. 6/25 (24%) had undergone prior ipsilateral patellofemoral surgery for instability. 5/25 (20%) underwent simultaneous guided growth via hemiepiphysiodesis for valgus deformity at the time of combined reconstruction. Preoperative imaging showed a mean TT-TG of 17.2 ± 3.8, Caton-Deschamps Index (CDI) of 1.13 ± 0.16, and trochlear dysplasia Dejour A/B (22/26 (85%)) or Dejour C/D (4/26 (15%)). A total of 18 patients (19 knees, 72%) returned outcomes questionnaires at a mean 2.0 ± 0.5 years after surgery. Mean Kujala, Pedi-IKDC, and Lysholm scores were 85.9 ± 13.9, 81.5 ± 15.2, and 84.3 ± 13.5, respectively. 2/25 patients (8%) later required a revision procedure (tibial tubercle osteotomy) for recurrent patellar instability, and another patient reported persistent instability not requiring revision. 10/13 patients (77%) were able to return to sports at a mean of 5.8 +/- 3.9 months (range 2-15). Conclusion: The current study describes a novel anatomically-validated surgical technique involving the simultaneous reconstruction of both the MPFL and MQTFL in a pediatric patient population. Follow-up data presented demonstrates overall positive results in treating this challenging problem in a young patient population.