bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biomechanical Comparison of Acute Hill-Sachs Reduction and Remplissage to Treat Complex Anterior Instability
Authors: Dines Joshua S. , Garcia Grant , McGarry Michelle H. , Lee Thay Q. , Degen Ryan 
Published: July 2016

Objectives: Acute Hill-Sachs (HS) reduction represents a potential alternative method to remplissage for the treatment of an engaging HS lesion. The purpose of this study is to biomechanically compare the stabilizing effects of an acute HS reduction technique and remplissage in a complex instability model. Methods: This was a comparative cadaveric study of 6 shoulders. For the acute HS lesion, a unique model was used to create a 30% defect, compressing the subchondral bone while preserving the articular surface in a more anatomic fashion. In addition, a 15% glenoid defect was made in all specimens. The HS lesion was reduced through a lateral cortical window with a bone tamp, and the subchondral void was filled with Quickset (Arthrex) bone cement to prevent plastic deformation. Five scenarios were tested; intact specimen, bipolar lesion, Bankart repair, remplissage with Bankart repair and HS reduction technique with Bankart repair. Translation, kinematics and dislocation events were recorded. Results: For all 6 specimens no dislocations occurred after either remplissage or the reduction technique. At 90 degrees of abduction and external rotation (ABER), anterior-inferior translation was 11.1 mm (SD 0.9) for the bipolar lesion. This was significantly reduced following both remplissage (5.1±0.7 mm; p<0.001) and HS reduction (4.4 ±0.3 mm; p<0.001). For anterior-inferior translation there was no significant difference in translation between the reduction technique and remplissage (p=0.91). At 90 degrees of ABER, the intact specimens average joint stiffness was 7.0 ±1.0N/mm, which was not significantly different from the remplissage (7.8±0.9 N/mm; p=0.9) and reduction technique (9.1±0.6 N/mm; p=0.50). Compared with an isolated Bankart repair, the average external rotation loss after also performing a remplissage procedure was 4.3 ±3.5 deg (p=0.65), while average ER loss following HS reduction was 1.1 ±3.3 deg (p=0.99). There was no significant difference in external rotation between remplissage and the reduction technique (p=0.83). Conclusion: Similar joint stability was conferred following both procedures, though remplissage had 3.2-degree loss of ER in comparison. While not statistically significant, even slight ER loss may be clinically detrimental in overhead athletes. Overall, the acute reduction technique is a more anatomic alternative to the remplissage procedure with similar ability to prevent dislocation in a biomechanical model, making it a viable treatment option for engaging Hill-Sachs lesions.
Outcomes of The Remplissage Procedure and Its Effects on Return to Sports
Authors: Liu Joseph N. , Garcia Grant , Wu Hao-Hua , Huffman G. Russell , Kelly John D. 
Published: July 2016

Objectives: Short-term outcomes for remplissage patients with large engaging Hill-Sachs lesions have demonstrated good results. However, limited data is available for longer-term outcomes. The purpose of this study was to evaluate long-term outcomes of the remplissage and determine the long-term rate of return to specific sports postoperatively. Methods: This was a retrospective review of patients treated with the remplissage procedure from 2007-2013. All had preoperative MRIs demonstrating large Hill-Sachs lesions by Rowe criteria and glenoid bone loss less than 20%. All Hill-Sachs lesions were “off track” by arthroscopic examination and preoperative imaging. At final follow up, patients had a ROM evaluation and were administered a detailed outcomes survey, which included WOSI and ASES as well as questions regarding sports, employment, physical activities and dislocation events. Results: Fifty-one shoulders (50 patients) were included. Average age at surgery was 29.8 years (15.0-72.4 years) and average follow up was 60.7 months (25.5-97.6 months). 20% of patients had previous surgery on their shoulder. Average postoperative WOSI scores were 79.5% and average ASES scores were 89.3. Six shoulders had dislocation events (11.7%) postoperatively: three were traumatic, and three atraumatic. Increasing number of preoperative dislocations increased the risk of a postoperative dislocation (p<0.001). There was also a trend towards higher postoperative dislocation rates in revision patients (p=0.062). Average loss of external rotation was 5.2 degrees (p=0.13). 95.5% of patients returned to one or more sports postoperatively at an average of 7.0 months. 81.0% returned to their previous intensity and level of sport. 65.5% (19) of patients who played a throwing sport stated they had problems throwing. 58.6% (17) felt they could not normally wind up throwing a ball. Direct rates of return for overhead sports were volleyball 100%, basketball 69%, baseball 50% and football 50%. Conclusion: Remplissage’s re-dislocation rate was 11.7% at an average of five years, with 96% of patients returning to full sports at an average of 7 months. For throwing sports, 65.5% complain of decreased range of motion during throwing. The results should be considered preoperatively in remplissage candidates who are engaged in throwing sports.
Factors Affecting Return to Baseline Function at 6 months Following Anterior Shoulder Instability Surgery
Authors: Hettrich Carolyn M. , Buckwalter Joseph , Wolf Brian R. , Bollier Matthew , MOON Shoulder Group , Glass Natalie 
Published: July 2016

Objectives: Pre-operative and surgical factors related to early return to baseline function after anterior shoulder instability surgery are not clear. This study was designed to determine the pre-operative and operative factors affecting return to baseline function at 6 months following anterior shoulder instability surgery. Identifying these factors will help surgeons establish expectations for functional return post-operatively. Methods: The Multicenter Orthopaedic Outcomes Network (MOON) shoulder group enrolled patients undergoing surgery for shoulder instability from 16 sites throughout the United States. Initial demographic data and validated, patient-oriented outcomes questionnaires were collected along with the physicians documented initial physical exam, treatment, surgical findings and surgical techniques used at the time of surgery. At the 6-month follow up visit, range of motion (ROM) and strength measurement of the operative shoulder were collected and compared to pre-operative measurement. Return to baseline was defined as return to within -10° ROM and full strength at the 6 month physical exam. Continuous and categorical data were analyzed using student t-tests and chi-square tests, respectively. The Kruskal-Wallis/Wilcoxin tests were used to compare groups that were not normally distributed. Factors reaching significance in a univariate analysis were then applied in a multivariable model. Significance was set a p<0.05. Results: A total of 338 patients with history of surgical intervention for anterior instability of the shoulder were identified. 278 patients had complete pre- and post-surgical range of motion and strength measurements. 138 (50%) patients (139 shoulders) returned to baseline and 133 (50%) patients did not return to baseline. Univariate analysis identified age (p=0.0013), Beighton score (p=0.0004), SF-36 general health (p=0.0017), WOSI (p=0.0250), and duration of symptoms (p=0.0046) as significant factors. When these factors were placed into a multivariate model, significant differences were identified in age (p=0.0316), SF-36 General health (p=0.0118), and Beighton score (p=0.0016). Conclusion: Older age, perception of general health and generalized joint laxity are associated with failure to return to baseline function at 6 months after anterior shoulder instability surgery. Duration of symptoms and number of dislocation events did not reach significance in the multivariate model, but trended toward likelihood of failure to return to baseline findings. Moreover, open vs. arthroscopic surgery and number of suture anchors were not significant, suggesting that pre-operative condition and not surgical factors predict return to baseline in the short-term.
Anisometry of Medial Patellofemoral Ligament Reconstruction in the Setting of Patella Alta and Increased Tibial Tubercle-Trochlear Groove (TT-TG) Distance
Authors: Redler Lauren H. , Meyers Kathleen N. , Munch Jacqueline , Dennis Elizabeth R. , Nguyen Joseph , Stein Beth E. Shubin 
Published: July 2016

Objectives: Medial patellofemoral ligament (MPFL) reconstruction is a common procedure to treat recurrent patellofemoral instability. However, the effects of an elevated tibial tubercle-trochlear groove (TT-TG) distance and patella alta, as measured by the Caton-Deschamps (C/D) ratio, on MPFL isometry remain unclear. We hypothesized that increased lateralization and proximalization of the tibial tubercle (TT) will have increasingly adverse effects on the isometry of the MPFL. Methods: Ten fresh-frozen cadaveric knees were placed on a custom testing fixture, with a fixed femur and tibia mobile through 120 degrees of flexion. The quadriceps tendon was loaded with 10.8 N in an anatomic direction using a weighted pulley system. A 0.2 N patellar lateral displacement load was used to simulate an intact lateral retinaculum to avoid over-medializing the patella. A tunnel was drilled under fluoroscopic guidance from Schottle’s point on the medial distal femur through the lateral cortex. A suture anchor was placed at the upper 66% of the medial border of the patella and the sutures were shuttled through to the lateral side and attached to a pulley with a 1 N weight. Retroreflective markers were attached to the femur, tibia, patella, and suture. MPFL length change, as measured by suture marker motion, was assessed using a 3D motion capture system through a range of motion between 0 deg and 110 deg with the native TT anatomy. Recordings were repeated after a flat TT osteotomy and transfer to a TT-TG of 20 mm and 25 mm and a C/D ratio of 1.2 and 1.4, including all combinations. Generalized estimating equation (GEE) modeling technique was used to analyze and control for the clustered nature of the data. SAS version 9.3 (SAS Inc., Cary, NC) was used for all data analyses. Results: Analysis was performed on 9 specimens secondary to significant deviations in the baseline normative data. Intact knees showed MPFL isometry through 20-70 degrees range of motion. Tibial tubercle lateralization significantly altered MPFL isometry with a threshold TT-TG of 25 mm (p=0.045) (Figure 1). Patella alta significantly altered MPFL isometry with a threshold C/D of 1.4 (p=0.025) (Figure 2). The effect of TT lateralization combined with patella alta compounded the anisometry, lowering the threshold for patella alta to a C/D of 1.2 when combined with a TT-TG of 25 mm (P<0.001) (Figure 3). Conclusion: Increased TT lateralization and proximalization significantly alter MPFL isometry. Tibial tubercle transfer should be considered when performing an MPFL reconstruction for recurrent patellofemoral instability in the setting of significant patella alta, elevated TT-TG and especially when both are present as an isolated MPFL reconstruction may be prone to failure given the anisometry demonstrated.
A Novel Injective Approach For Osgood-schlatter Disease
Authors: Nakase Junsuke , Numata Hitoaki , Oshima Takeshi , Takata Yasushi , Tsuchiya Hiroyuki 
Published: July 2016

Objectives: Despite first being reported more than 100 years ago, Osgood-Schlatter disease(OSD) currently has no effective treatment. The recent use of ultrasonography in the orthopedic surgery and sports medicine fields revealed that patellar tendinopathy and deep infrapatellar bursitis contributes to the pain experienced by patients with OSD. Considering the reported effectiveness and safety of hyperosmolar dextrose injection for patellar tendinopathy, here we investigated the efficacy and safety of hyperosmolar dextrose injection as a novel treatment for OSD. Our hypothesis was that hyperosmolar dextrose injection would be safe and well tolerated by patients with OSD. Methods: We performed this prospective randomized double-blind clinical trial between April 2012 and June 2015. A total of 44 knees in 36 boys (average age, 12.3 ± 1.1 years) for whom conventional conservative therapy for >1 month was ineffective were randomly assigned to the double-blind injection of 1% lidocaine (1 mL) with saline (1 mL) (Saline group) or 1% lidocaine (1 mL) with 20% dextrose (1 mL) (Dextrose group). Half of the solution was injected into the distal attachment of the patellar tendon, while the remaining half was injected into the deep infrapatellar bursa or infrapatellar fat pad under ultrasound guidance. Injections were administered monthly for 3 months by a single investigator. The Victorian Institute of Sport Assessment (VISA) score was used to evaluate pain. Results: A total of 40 knees in 33 boys were included in this clinical trial. The mean pre-injection VISA scores of the Dextrose and Saline groups were 59.6 ± 19.1 and 62.5 ± 16.6, while those at the final follow-up were 83.6 ± 19.3 and 84.1 ± 19.1, respectively. There were no significant differences in the two group pre-injection versus at the final follow-up (P = 0.61 and 0.93, respectively). In contrast, the mean VISA score significantly increased in both group between pre-injection and final follow-up (P < 0.01). There were no adverse effects of the injection. Conclusion: We were not able to prove the efficacy of the Dextrose injection compared with control; however, our results suggest superior symptom reduction efficacy of injection therapy for both treatments compared to usual care in the treatment of OSD. Thus, injection over the distal attachment of the patella tendon and into the deep infrapatellar bursa or infrapatellar fat pad under ultrasound guidance may become a new treatment method for OSD.
Do Age and Weight Bearing Films Affect Lateral Joint Space and Fibular Height Measurements in Patients with Discoid Lateral Meniscus?
Authors: Milewski Matthew David , Krochak Ryan , Duarte Andrew J. , Marchese Joseph , Pace James Lee , Broom Alexander M. , Solomito Matthew 
Published: July 2016

Objectives: Several radiographic parameters have been associated with discoid lateral meniscus. We sought to determine the effect of age and weight bearing (WB) on radiographic parameters associated with lateral discoid menisci in pediatric patients. Methods: Radiographs of patients with arthroscopically confirmed lateral discoid meniscus were compared to age, side, sex matched individuals with confirmed normal menisci. The radiographs were measured by a pediatric orthopaedic sports medicine attending and two orthopaedic residents for the following parameters: lateral joint space width (LJSW), fibular head height (FHH), width of the distal femur (WDF), tibial spine height (TSH), cupping of the lateral tibial plateau (CLTP), and obliquity of the lateral tibial plateau (OLTP). The results of this review focus on FHH and LJSW only. Results: 68 knees with discoid lateral menisci with a mean age of 11.6 ± 3.3 (15 WB films) were compared to 67 control knees with a mean age of 11.9 ± 3.2 (15 WB films). Results indicated that there were significant differences between the discoid and control groups when comparing LJSW (8.7 ± 2.2 mm discoid compared to 7.6 ± 2.1 mm control p=0.002) and FHH (13.5 ± 4.5 mm discoid compared to 18.6 ± 3.9 mm control p<0.001). Inter-rater reliability was satisfactory for LJSW and FHH (ICC 0.635 and 0.759 respectively). WB films were noted to have better inter-rater reliability compared to NWB films for LJSW (ICC 0.729 vs 0.514 respectively) but reduced inter-rater reliability for FHH (ICC 0.625 vs 0.868 respectively). Subgroup analysis based on age was also done comparing patients under 10 years old, patients between 10-14 years old, and patients over 14 years old. The FHH measurement was significantly decreased (indicative of a high fibular head) in the discoid group in all age groups. However, LJSW was only noted to be significantly different in patients over the age of 14. Conclusion: Increased lateral joint space width and a high fibular head were associated with discoid lateral menisci and also showed satisfactory inter-rater reliability. Weightbearing films showed better inter-rater reliability for LJSW but decreased reliability for FHH. Higher fibular height was consistently seen across age groups but increased LJSW was only significantly different in the over 14 years old group. Fibular height might be a better radiographic parameter for discoid lateral meniscus evaluation across all age groups while lateral joint space may be better in older adolescent patients.
Sex, Age, and Graft Size as Predictors of ACL Re-tear
Authors: Nguyen Duong 
Published: July 2016

Objectives: The minimum size required for a successful quadrupled hamstring autograft ACL reconstruction remains controversial. The risks of ACL re-tear in younger patients who tend to participate in a higher level of sports activity, and female athletes who have numerous predisposing factors, are poorly defined. Purpose: To identify risk factors for graft re-tears within 2 years of ACL surgery. The hypotheses are that female sex, a smaller size graft, and younger patients will increase the odds of failure. Study Design Cohort Study. Level of evidence, 3. Methods: A cohort of 503 athletes undergoing primary, autograft hamstring ACL reconstruction, performed by a single surgeon using the same surgical technique and rehabilitation protocol, between September-December 2012, was followed for a total duration of 2 years. Return to play was allowed between 6 and 12 months post-surgery upon completion of functional testing. Exclusion criteria included infections, revisions, double bundle techniques, multi-ligament injuries, non-compliance, BTB/allografts/hybrid grafts. Primary outcome consisted of binary data (ACL graft re-tear or no tear) as measured on physical exam (Lachman and pivot shift) and MRI. Multivariate logistic regression statistical analysis with model fitting was used to investigate the predictive value of sex, age, and graft size on ACL re-tear. Secondary sensitivity analyses were performed on the adolescent subgroup, age and graft size as categorical variables, and testing for interactions among variables. Sample size was calculated based on the rule of 10 events per independent variable for logistic regression. Results: The mean age of the 503 athletes was 27.5 (SD 10.6; range = 12-61). There were 235 females (47%) and 268 males (53%) with a 6% rate of re-tears (28 patients; 17 females). Mean graft size was 7.9 (SD 0.6; range = 6-10). Univariate analyses of graft size, sex, and age only in the model showed that younger age (odds ratio [OR] = 0.86; 95% confidence interval [CI] = 0.80-0.93; P = .001] and smaller graft size (OR = 0.36; 95% CI = 0.18-0.70; P = .003) were significantly predictive of re-tear. Female sex was correlated with re-tear but was not significant (OR = 1.8; 95% CI = 0.84-3.97; P = .13). Multivariate analysis with all 3 variables in the model showed similar significant results. Graft size < 8 mm (OR = 2.95; 95% CI = 1.33-6.53; P = .008) and age < 25 (OR = 7.01; 95% CI = 2.40-20.53; P = .001) were significantly predictive of re-tear. Entire model was statistically significant (Omnibus test P = .001; Hosmer-Lemeshow statistic P = .68; Receiver Operating Curve [ROC] = 0.8). Conclusion: Surgeons should counsel their patients who are female, younger than 25 and with a graft size less than 8 mm accordingly and consider modifying their surgical or rehabilitation techniques to mitigate these re-tear risks.
Vascularity Visualized by Doppler Sonography as a Predictor of Healing Potential of the OCD of the Humeral Capitellum
Authors: Kida Yoshikazu , Morihara Toru , Kotoura Yoshihiro , Sukenari Tsuyoshi , Furukawa Ryuhei , Kabuto Yukichi , Onishi Okihiro , MInami Masataka , Tsujihara Takashi , Hojo Tatsuya , Fujiwara Hiroyoshi , Kubo Toshikazu 
Published: July 2016

Objectives: The significance of vascularity visualized by Doppler sonography in osteochondritis dissecance (OCD) lesion of the humeral capitellum is unclear. The objectives of this study were twofold: 1) to evaluate the relationship between Doppler ultrasound (US) signals observed in OCD lesion of the humeral capitellum and X-ray stage; 2) to determine if the presence of Doppler US signals in OCD lesion of the humeral capitellum could be the predictor of healing potential. Methods: Fifty patients with OCD of the humeral capitellum treated conservatively were enrolled in this study. During the conservative treatment period, Doppler sonography was performed on affected elbow to assess the presence of vascularity in the OCD lesion (Figure 1), and radiographic examination were evaluated on the same day to determine the X-ray stage (stage I: radiolucent stage, stage II: fragmentation stage, and stage III: loose body stage) of the OCD lesion (Figure 2). Radiographic examination of the elbow was examined after 6 weeks to evaluate the healing of the lesion. If the size of the lesion decreased or new bone formations were observed around the fragments, the healing of the lesion was considered to be improve. The χ2 test was used to determine if the presence of Doppler US signals were related to X-ray stage and the improvement of the healing. P < 0.05 was considered significant for all statistical analyses. Results: The Doppler US signals in OCD lesions were positive in 23 patients and negative in 27 patients. Of these patients, 19 were X-ray stage I, 17 were stage II, and 9 were stage III. The healing of OCD lesions improved in 78.2% for the positive Doppler US signal group, but only 18.5% for the negative Doppler US signal group (Figure 3). The presence of the Doppler US signal was significantly related to the improvement of healing (P = 0.00002). The Doppler US signal were positive in 78.9% for stage I, 36.4% for stage II, and 0.0% for stage III (Figure 4). The presence of Doppler US signal was significantly related to early X-ray stage (P = 0.0002). Conclusion: From this study, the presence of vascularity in the OCD lesion of the humeral capitellum is important for the improvement of healing during the conservative treatment period. The vascularity visualized by Doppler sonography could be a useful predictor for healing potential of the OCD of the humeral capitellum when treated conservatively.