bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anatomic Anterior Cruciate Ligament Reconstruction - A Prospective Evaluation Using Three-Dimensional Magnetic Resonance Imaging
Authors: Hart Adam , Sivakumaran Thiru , Burman Mark , Powell Thomas , Martineau Paul A. 
Published: July 2017

Objectives: The recent emphasis on anatomic reconstruction of the anterior cruciate ligament (ACL) is well supported by clinical and biomechanical research. Unfortunately, the location of the native femoral footprint can be difficult or even impossible to see at the time of surgery. Most surgeons therefore rely on anatomic landmarks, custom drill guides, or general rules-of-thumb to guide femoral tunnel placement; however, the accuracy of these techniques to reconstruct each patient’s native anatomy is poorly understood. The objective of this study was to use a previously described isotropic magnetic resonance sequence (3D MRI) to image patients with torn ACLs before and after reconstruction and thereby assess the accuracy of graft position on the femoral condyle in comparison to each patient’s native ACL footprint. Methods: Forty-one patients with unilateral ACL tears were prospectively recruited into our study. Each patient underwent a 3D MRI of both the injured and uninjured knees before surgery. The contralateral (uninjured) knee scan was used to define the patient’s native footprint. Patients then underwent ACL reconstruction with hamstring autograft by one of four experienced fellowship-trained sports orthopedic surgeons. The injured knee was reimaged after surgery. The location and percent overlap of the reconstructed femoral footprint was compared to the patient’s native footprint. Results: The center of the native ACL femoral footprint was a mean of 16.4 +/- 4.6 mm distal and 5.3 +/- 2.9 mm anterior to the apex of the deep cartilage. The position of the reconstructed graft was significantly different, with mean distance of 10.4 +/- 2.7 mm distal (P < 0.0001) and 7.7 +/- 3.1 mm anterior (P = 0.001). The mean distance between the center of the graft and the center of the native ACL femoral footprint (error distance) was 5.7 +/- 3.6 mm. Comparing error distances amongst the four surgeons demonstrated no significant difference using the Kruskal-Wallis one-way ANOVA (P = 0.78). On average, 21% of the graft was within the native ACL femoral footprint. Of the 41 patients, 16 (39%) had the graft placed entirely outside the native ACL footprint. Conclusion: Despite contemporary techniques and a concerted effort to perform anatomic ACL reconstructions by four experienced sports orthopedic surgeons, the position of the femoral footprint was significantly different between the native and reconstructed ligaments. Furthermore, each of the four surgeons uses a different technique but all had comparable errors in their tunnel placements. In order to achieve a truly anatomic reconstruction, surgeons may consider using a pre-operative 3D MRI, which enables excellent visualization of the ACL’s native anatomy and could potentially be used as a roadmap to guide anatomic tunnel placement.
Concussion Symptoms and Symptom Resolution Time in US High School Athletes, 2007/08-2014/15
Authors: Kraeutler Matthew John , Currie Dustin , Schrock John Bradley , McCarty Eric C. , Comstock Dawn 
Published: July 2017

Objectives: There has been increased interest in sports-related concussions from the professional level down to youth leagues in recent years. Symptom types and resolution time are the metrics most often used to monitor concussions. The purpose of this study is to investigate how concussion symptoms, symptom resolution time, and use of diagnostic imaging have changed among US high school athletes from the 2007/08 through 2014/15 academic years. Methods: This study analyzed concussions occurring in all sports available in the High School Reporting Information Online (RIO) database from 2007/08 through 2014/15. Chi-square tests for trend were used to calculate symptom and diagnostic imaging trends over time. Statistical significance was determined at p<0.05. Results: The prevalence of each of the following symptoms was found to significantly decrease over the time period analyzed in athletes diagnosed with a concussion: amnesia (p<0.0001), confusion/disorientation (p<0.0001), dizziness/unsteadiness (p<0.01), loss of consciousness (LOC, p<0.0001), and tinnitus (p<0.0001). Among all athletes diagnosed with a concussion, the prevalence of LOC was 6.6% in 2007/08 and decreased to 2.4% in 2014/15. The prevalence of each of the following symptoms was found to significantly increase over the time period analyzed in athletes diagnosed with a concussion: drowsiness (p<0.01), irritability (p<0.0001), light sensitivity (p<0.0001), and noise sensitivity (p<0.0001). The prevalence of concentration difficulty, headaches, hyper-excitability, and nausea did not change significantly over time. The average concussion symptom resolution time has significantly increased over time (p<0.0001). The use of diagnostic plain radiographs, magnetic resonance imaging (MRI), and computed tomography (CT) scans all significantly decreased over the time period analyzed (p<0.0001 for each diagnostic test). Conclusion: From the 2007/08 to 2014/15 academic years, the prevalence of various symptoms changed significantly in US high school athletes diagnosed with a concussion. The decrease in severe symptoms (LOC, amnesia, disorientation) and the increase in less recognizable symptoms (drowsiness, irritability) may point to a lower threshold used by healthcare providers in diagnosing concussions in more recent years. Improved education among healthcare providers has likely led to increased recognition of lingering symptoms in athletes diagnosed with concussions, thereby leading to a longer average symptom resolution time. Furthermore, the significant reduction in use of all forms of diagnostic head imaging demonstrates an increased recognition of concussions as functional disturbances rather than physical abnormalities detectable on imaging.
Does Patient Education Prior to Arthroscopic Rotator Cuff Repair Decrease Narcotic Consumption? A Randomized Prospective Study
Authors: Tjoumakaris Fotios P. , Syed Usman Ali Mohammed , Aleem Alexander William , Wowkanech Charles Dante , Getz Charles , Weekes Danielle , Pepe Matthew D. , Tucker Bradford S. , Abboud Joseph A. , Austin Luke 
Published: July 2017

Objectives: In order to help combat opioid addiction, our objective is to see, through a randomized prospective study design, if patient education on proper use of narcotic medication would decrease narcotic consumption in the post-operative period after arthroscopic rotator cuff repair (ARCR). Methods: Patients undergoing primary ARCR at our institution were prospectively enrolled in a randomized fashion to receive either formal education on proper use of narcotics versus no education. The education group received instruction on the proper use of opioids, dosage, side effects, dependence, and addiction while the control group received education regarding the surgery alone. The education program consisted of a 2-minute narrated video in addition to a handout. All the subjects were blind to the randomization and true purpose of the study. Variables such as age, sex, and body mass index (BMI) were recorded. To determine risk of opioid abuse of the patient, the physician d a validated Opioid Risk Tool (ORT). Patients were given the same post-operative medication regimen. Patients filled out questionnaires at their 2- and 6- week follow up querying VAS pain score, refills, and total number of narcotic pills remaining. Standard statistical comparison was performed with t test calculations. Results: 67 patients d 6-week follow-up with 34 patients in the control group and 33 patients in the study group. There were no statistically significant differences in age, sex, BMI, ORT score, preoperative and postoperatively VAS score between the groups (Table 1). Patients who received pre-operative education on average consumed 26 pills compared to 35 in the control group (Table 1). More than 20 pills were consumed by only 48% of the study group compared to 76% in the control group (p = 0.01). Conclusion: Patient education is associated with a significant decrease in the number of patients consuming more than 20 narcotic pills in the acute post-operative period. Although the difference in average amount of narcotics consumed was not statistically significant, the increased frequency of patients in the control group that consumed a high number of narcotics was, suggesting benefit in preoperative education on narcotics. This is the first study to document that preoperative education can help reduce the number of patients consuming high levels of post-operative narcotics. Future recruitment and study analysis will help determine if this effect is long-lasting and can help reduce the incidence of drug dependence and addiction among this patient population. [Table: see text]
Risk Factors for Prolonged Narcotic Use Following Arthroscopic Rotator Cuff Repair
Authors: Cancienne Jourdan M. , Gwathmey Frank Winston , Werner Brian C. 
Published: July 2017

Objectives: Narcotics are commonly prescribed for management of acute pain in the early postoperative period following arthroscopic rotator cuff repair (RCR), but little is known about the frequency and risk factors for persistent use. The goal of this study was to determine risk factors for prolonged narcotic use following arthroscopic RCR. Methods: A national insurance database was queried for patients undergoing arthroscopic RCR from 2007-2015 using CPT codes. Prolonged narcotic use was defined as a new prescription for a narcotic pain medication between 3 and 6 months following the procedure. Patients without minimum 6 months’ follow-up were excluded. A multivariate logistic regression analysis was utilized to evaluate risk factors for prolonged narcotic use, including a prescription for narcotics within the 3 months before surgery, age, sex, obesity, tobacco use, alcohol use, depression and inflammatory arthritis. The regression analysis was used to control for demographics and numerous medical comorbidities. Adjusted odds ratios (OR) and 95% confidence intervals (CIs) were calculated for each risk factor, with P < 0.05 considered statistically significant. Results: 28,331 patients met inclusion and exclusion criteria. 7,543 patients (27%) were characterized as having prolonged narcotic use. Preoperative narcotic use was the most significant risk factor for prolonged postoperative narcotic use (OR 5.4, p < 0.0001). Age < 50 years (OR 1.4), male sex (OR 1.1), obesity (OR 1.1), morbid obesity (OR 1.4), tobacco use (OR 1.8), alcohol use (OR 1.3), inflammatory arthritis (OR 1.5) and depression (OR 2.0) were also all significant risk factors for prolonged postoperative narcotic use [Table 1]. Conclusion: More than a quarter of patients undergoing arthroscopic RCR continue to receive narcotic prescriptions more than 3 months postoperatively. The most significant risk factor for prolonged narcotic use is the use of preoperative narcotics. Additional risk factors include younger age, male sex, obesity, tobacco and alcohol use, depression and inflammatory arthritis. [Table: see text]
Biomechanical Evaluation of Pediatric Anterior Cruciate Ligament Reconstruction Techniques with and without the Anterolateral Ligament
Authors: Pace James Lee , Trentacosta Natasha E. , Metzger Melodie , nelson trevor , Michalski Max , Polakof Landon S. , Mandelbaum Bert R. 
Published: July 2017

Objectives: Management of anterior cruciate ligament (ACL) injuries in skeletally immature patients is controversial and several surgical procedures have been developed. The two most popular physeal sparing procedures are the iliotibial band (ITB) ACL reconstruction (ACLR) and the all-epiphyseal (AE) ACLR. There has been some concern for over-constraint of the knee with the ITB ACLR while the AE ACLR is technically challenging and can still risk growth disturbance. There has been interest recently into the anterolateral ligament (ALL) and its role in rotational stability, but it has not been assessed in the setting of pediatric ACLR techniques. The ITB ACLR includes a lateral tenodesis of the IT band to the femur that closely approximates the ALL. Our hypothesis is that the ITB ACLR and AE ACLR with ALL reconstruction (ALLR) will best replicate the biomechanics profile of the intact ACL. Methods: Eight cadaveric legs were statically loaded with an anterior drawer force and varus, valgus, internal and external rotational moments at 0°, 30°, 60°, and 90° of flexion. Displacement and rotation was recorded in the following conditions: intact ACL/intact ALL, ACL deficient/intact ALL, ITB ACLR/intact ALL, ITB ACLR/ALL deficient, ACL deficient/ALL deficient, AE ACLR/ALL deficient, AE ACLR/ALLR. Results: Both ACLR techniques reduced anterior translation from the ACL deficient state but neither restored translation to the intact state (p<0.05) except in full extension. ALL deficiency increased anterior translation in the ACL deficient state (p<0.05). In rotational testing, only the ACL deficient/ALL deficient state had a significant increase in internal rotation (p<0.05). This was significantly restored at all flexion angles with the ITB ACLR. There was no rotational over-constraint in any flexion angle with the ITB ACLR. The AE ACLR/ALL deficient state and AE ACLR/ALLR improved rotational stability at lower flexion angles, but not at 60° and 90°. There were no significant changes in varus/valgus moments. Conclusion: In this model, the ITB ACLR best corrected both parameters at all angles without over-constraining the knee and without the need for an ALLR. The AE ACLR and AE ACLR/ALLR improved both parameters but not at all flexion angles. The ITB ACLR appears to be the simpler pediatric ACLR technique to regain translational and rotational stability. ALL deficiency in the knee increased anterior displacement and rotational moments in the ACL deficient state.
Distal Femoral Osteotomy Survivorship: A Population-based Study
Authors: Heidari K Soraya , Heckmann Nathanael , Pannell William C. , Hill J Ryan , McKnight Braden Michael , Vangsness C. Thomas , Hatch George F. Rick 
Published: July 2017

Objectives: Malalignment of the lower extremity can lead to functional impairment and degenerative changes at an early age. Distal femoral osteotomies (DFO) are often performed concurrently with arthroscopic procedures to correct malalignment while addressing intra-articular pathology. The aim of this study was to examine survivorship following distal DFO and to identify risk factors for failure. Methods: Data from the California Office of Statewide Health Planning and Development, a mandatory statewide discharge database, was utilized to identify all patients who underwent a DFO from 2000 to 2014. Patients with lower extremity trauma, infectious arthritis, rheumatologic disease, congenital deformities, malignancy, or concurrent arthroplasty were excluded. Patient demographic information was assessed for every patient. Failure was defined as conversion to total or unicompartmental knee arthroplasty. Statistically significant differences between patients who required arthroplasty and those who did not were identified on univariate analysis. A multivariate analysis was performed to account for identified differences and a survivorship curve was constructed to estimate 5 and 10-year survivorship. Results: After exclusions were applied, 420 patients were identified and followed for an average of 5.0 years. Of those, 53 were converted to arthroplasty at an average of 5.9 years. 5-year survivorship was 98.3% and 10-year survivorship was 92.3%. Patients converted to arthroplasty tended to be older (43.6 years versus 36.9 years, p<0.001) and had a higher number of comorbidities (47.2% with at least one comorbidity versus 27.5%, p=0.021). A diagnosis of osteoarthritis at the time of surgery was more prevalent amongst patients who went on to arthroplasty (81.1% versus 53.7%, p<0.001). On multivariate analysis, patients were 4% more likely to undergo arthroplasty for each additional year of age (OR 1.04, p=0.013). Patients with osteoarthritis were also at increased risk of conversion to arthroplasty (OR 2.57, p=0.025). Conclusion: Older age and a diagnosis of osteoarthritis at the time of surgery were associated with conversion to arthroplasty. These factors should be taken into account when performing this procedure. [Table: see text]
Long-Term Clinical Outcomes after Microfracture of the Glenohumeral Joint: Minimum 7-Year Follow-up
Authors: Frank Rachel M. , Meyer Maximilian A. , Poland Sarah Glen , Leroux Timothy Sean , Griffin Justin W. , Hannon Charles Patrick , Verma Nikhil N. , Romeo Anthony A. , Cole Brian J. 
Published: July 2017

Objectives: Microfracture is an effective surgical treatment for isolated, full-thickness cartilage defects with current data focused on applications in the knee. Currently, only early outcomes are available analyzing patients undergoing microfracture in the glenohumeral joint. The purpose of this study is to present long-term clinical outcomes of patients undergoing microfracture of full-thickness articular cartilage defects of the glenohumeral joint. Methods: A review of a consecutive series of patients who underwent arthroscopic microfracture of the humeral head and/or glenoid surface with a minimum follow-up of 7 years between 2001 and 2007 was conducted. All patients d surveys containing the Simple Shoulder Test (SST), American Shoulder and Elbow Score (ASES), and visual analog scale (VAS) outcomes scores. Failure was defined by reoperation, including conversion to arthroplasty. Reoperation and failure rates were compared to a previous analysis of these patients at an average follow-up of 28 months. Results: A total of 15 patients (16 shoulders) with an average age of 37.0±14.7 years (8 females, 7 males) were available for analysis at an average 9.3 ± 0.7 years following surgery (range, 8.5 to 10.5 years). The average size of humeral and glenoid defects was 5.07 cm2 (range, 1.0-7.8 cm2) and 1.66 cm2 (range, 0.4-3.8 cm2), respectively. Five patients (5 shoulders) underwent at least 1 reoperation, for an overall reoperation rate of 31%. Of these 5 patients, 4 underwent shoulder arthroplasty (2 initially, 2 after additional arthroscopic procedures) and were considered failures, for an overall failure rate of 25%. Of the patients who did not progress onto arthroplasty, there were statistically significant improvements in SST, VAS, and ASES outcomes scores compared to preoperative values. When compared to short-term follow-up at 28 months, in which 3 patients had already been considered failures, 1 additional patient progressed to failure at 9.6 years after the original microfracture. Conclusion: The management of full-thickness symptomatic chondral defects of the glenohumeral joint is challenging. For some patients, microfracture can result in improved function and reduced pain, however, in this small series, up to 25% of patients required conversion to arthroplasty less than 10 years following the index microfracture procedure. Additional studies with larger patient cohorts are needed.
Bridge-enhanced ACL Repair: Mid-term Results of the First-in-human Study
Authors: Micheli Lyle J. , Flutie Brett , Fleming Braden C. , Murray Martha M. 
Published: July 2017

Objectives: Bridge-enhanced ACL repair (BEAR) is a new technique for treating midsubstance ACL injuries. The technique involves placing a scaffold loaded with the patient’s own blood between the torn ligament ends prior to using suture to realign the ends of the ligament (Fig. 1). Preclinical studies in large animal models found that the mechanical properties of the bridge-enhanced repaired ligaments were similar to reconstructed grafts, and that animals receiving the repair had less osteoarthritis compared to those receiving traditional ACL reconstruction. In this first-in-human study, our goal was to determine if bridge-enhanced ACL repair would be safe in humans and to compare the early outcomes of this new technique with ACL reconstruction in a small cohort of patients. Methods: Nonrandomized controlled trial (Level 2). Both FDA Investigational Device Exemption Approval and IRB approval was obtained prior to starting the study. Twenty patients were enrolled in this study; ten undergoing the bridge-enhanced repair and ten patients having an ACL reconstruction with hamstring autograft. The inclusion criteria were patients ages of 18 to 35, surgery performed within 30 days for the BEAR technique and within 90 days for ACL reconstruction. All surgeries were performed by a single surgeon (LJM). Results: At this time, we have six month follow-up data for 10 of the BEAR patients and 5 of the ACL reconstruction control patients. To date, no patients have had any infection or other serious adverse reaction to the implanted scaffold. At three months and six months post-operatively, there was no significant difference in IKDC scores for the two groups, and effusion and range of motion recovered similarly in both groups. The average side-to-side difference in AP laxity at three and six months post-operatively as measured by manual Lachman testing was also similar for the two groups. MRI showed presence of tissue in the region of the torn ACL in all ten BEAR patients at three and six months. Conclusion: Bridge-enhanced ACL repair can be performed in patients and early results show a low risk of adverse reactions to the implant. Early results suggest the knees are stable and recover motion after bridge-enhanced ACL repair. Whether these results will hold up in the longer term requires further study and we will plan to present additional data, good or bad, at the meeting in July. [Figure: see text]