bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of a Symptomatic Knee Following ACL Reconstruction: 84 Month Follow Up
Authors: Ware J. Kristopher , Akelman Matthew , Owens Brett D. , Fadale Paul D. , Hulstyn Michael J. , Fleming Braden C. 
Published: July 2017

Objectives: ACL reconstruction is effective in restoring knee stability and returning a majority of patients to sports. However, these patients remain at a higher risk of developing knee OA and a subset of patients have persistent pain. It is currently unknown what pre-operative and early post-operative measures can be used to help predict outcomes following ACL reconstruction at 7 years. The purpose of this study was to compare clinical data, patient-reported outcomes and imaging findings of knee arthrosis between symptomatic and asymptomatic subject at 84 month follow up after primary ACL reconstruction. Methods: We reviewed prospectively collected data from our previously published randomized controlled trial of outcomes of ACL reconstruction. Clinical, radiographic, and patient-reported outcomes were collected pre-operatively, and at 1,3,5, and 7 years post-operatively. Patient-reported outcome measures included SF-36 and KOOS. Imaging studies were used to evaluate medial joint space width, Osteoarthritis Research Society International (OARSI) radiographic score, and Whole-Organ Magnetic Resonance Imaging Score (WORMS). Symptomatic subjects were defined as those with KOOS-pain subscores, measured at 84 months post-operatively, two standard deviations below the mean for healthy athletic patients with a history of a knee ligament injury. These subjects were compared to the remainder of the study group to identify factors predictive of poor outcomes. Results: patient-report outcome measures were available for 72 patients at 84 month follow up. Of these, 7 subjects had KOOS pain scores less than 72.5 and were considered the symptomatic subgroup. Low pre-operative KOOS-ADL and KOOS-sports subscores were associated with low KOOS pain scores at 7 year follow up. SF-36 scores were lower at most time periods in the symptomatic group. In addition, OARSI scores were worse at 1,5, and 7 years, and WORMS showed greater signs of cartilage injury at 3 and 5 years post operatively in the symptomatic group. Medial joint space width was found to be significantly decreased in symptomatic patients at 7 year follow up. Conclusion: Low preoperative KOOS-ADL and KOOS-sports subscores were found to be associated with worse pain outcomes in primary ACL reconstruction patients at 84 months post-operatively. Additionally, multiple post-operative measures were found to be indicative of the ACL reconstruction patients that would have a symptomatic knee. WORMS collected at 3 and 5 years was shown to identify those subjects that would be symptomatic at 7 years. Also, radiographic changes were evident in this group with significantly decreased medial joint space width relative to control subjects.
Labral Width is Associated with Increased Risk of Severe Cartilage Damage on the Femoral Head
Authors: Locks Renato , Briggs Karen K. , Bolia Ioanna , Philippon Marc J. , Chahla Jorge 
Published: July 2017

Objectives: The objective of this study was to compare the risk of Outerbridge grade 3 or 4 defects in hips with different labrum thickness in patients undergoing primary hip arthroscopy for FAI. Methods: Between 2005 and 2014, patients who underwent hip arthroscopy by a single surgeon and met the inclusion criteria were included in this study. The labrum was measured with an arthroscopic ruler at 3 points that corresponded with 9 o’clock, 12 o’clock and 3 o’clock during hip arthroscopy from the chondrolabral junction to the edge of the labrum. Four specific measurements were stablished as a parameter for the labral thickness (4, 5, 6 and 7 cm). The lower labral thickness measurement of the three performed was used as a guide for the groups classification. Patients were compared based on the labrum thickness regarding the prevalence of Outerbridge grade III and IV on the femoral head (FH) and acetabulum. Patients were excluded if they had previous arthroscopic or open hip surgery, had inmeasurement of the labrum or had insurgical data. Results: Eight hundred forty-three patients were included on this study, the average age was 31.7 years old, regarding gender, 468 females and 367 males. There was no difference in the sample characterization variables. Hips with small labrums were more likely to have a grade 3 or 4 chondral defect on the femoral head. First, comparing patients with 7 and 6 mm of labral thickness, patients measuring 6mm had an 1.7 relative risk for severe chondral damage on the FH [1.04 to 2.7] p=0.033. Second, when patients with 7 and 5 mm are compared, patients with 5mm of labral thickness have a 4.3 relative risk[2.2 to 4.3]p<0.001. Lastly, when the comparison between 7 and 4 mm is established, patients measuring 4mm have a relative risk 4.5 for severe chondral damage on the femoral head. No difference in the prevalence of chondral damage was found between patients measuring 7 and 8 mm. There was no difference in the prevalence of grade 3 and 4 defects on the acetabulum between the all the labrum measurements evaluated. Regarding the labral procedure performed, patients with 4mm of labral width in at least one point, 28% underwent labral reconstruction. On the other hand, in patients with 7, 6 and 5 mm of labral width, 98.6, 94.9 and 85.8% underwent labral repair, respectively. Conclusion: Patients with femoroacetabular impingement with a labrum wide measuring less than 6mm have a higher likelihood to have Grade III and IV chondral damage on the femoral head, but not on the acetabular cartilage. Patients with less than 5mm had a likelihood for labral reconstruction need. [Table: see text]
Do Outcomes of Osteochondral Allograft Transplantation Differ Based on Patient Sex: A Comparative Matched Group Analysis of Male and Female Patients
Authors: Frank Rachel M. , Lee Simon , Poland Sarah Glen , Cole Brian J. 
Published: July 2017

Objectives: Osteochondral allograft transplantation (OAT) is being performed with increasing frequency, though to date, the impact of patient sex on outcomes and failure rates has not been assessed. The purpose of this study was to determine clinical outcomes for male versus female patients undergoing OAT. Methods: A retrospective review of prospectively collected data of patients who underwent OAT by a single surgeon with a minimum follow-up of 2 years was conducted. Males who underwent OAT were compared to a matched group of females who underwent OAT (age ± 3 years, gender, BMI ± 5 kg/m2, the presence of previous ipsilateral knee surgeries, and the presence of meniscal transplantation). The reoperation rate, failure rate, timing of reoperation, procedures performed, findings at surgery, and patient reported outcome scores were reviewed. Failure was defined by revision OAT, conversion to knee arthroplasty, or gross appearance of graft failure at 2nd look arthroscopy. Descriptive statistics, fisher’s exact or chi-square testing, and Mann-Whitney U testing were performed, with P<0.05 set as significant. Results: A total of 98 patients (average age 32.1±9.9 years, 49 males, 49 females) who underwent OAT with an average follow-up of 4.7±2.33 years (range, 2.1-12.1) were included. These patients underwent an average of 2.6±1.8 prior surgical procedures on the ipsilateral knee prior to OAT. A total of 33 patients underwent reoperation at an average 2.4±2.4 years, with 27% (9/33) undergoing additional reoperations (range, 1-2 additional reoperations). Male patients did not have significantly different reoperation rates (42% vs. 27%), time to reoperation (2.50±2.12 vs. 2.29±1.71 years) or failure rates (20% vs. 8%) compared to female patients (P>0.05 for all). Both male and female patients showed significant improvement in Lysholm, IKCD, KOOS, WOMAC, and SF-12 physical subscale as compared to preoperative values (P>0.05 for all for both groups). The SF-12 mental subscale was not significantly improved at final follow-up for either group (P>0.05). There were no significant differences in patient reported outcomes scores at most recent follow-up when comparing males and females. Males demonstrated significantly larger defect areas compared to females (371.65±168.89 vs. 310.63±117.15 mm2, P=0.037), though the defect:condyle ratio was not significantly different (male: 0.19 vs. female: 0.20, P>0.05). Conclusion: Males and females have similar clinical outcomes at 5 years following OAT, though males trended toward increased reoperation rates and increased failure rates. This data implies that overall, similar favorable outcomes may be expected for patients regardless of sex, with an 86% graft survival rate at 5 years. This information can be used to counsel patients when being offered OAT as part of a knee joint preservation strategy.
Medial and Lateral Distal Femoral Condyle Osseous and Articular Cartilage Topography to Determine Graft Matching
Authors: Yanke Adam Blair , Urita Atsushi , Meyer Maximilian A. , Inoue Nozomu , Cole Brian J. 
Published: July 2017

Objectives: Osteochondral allograft transplantation (OAT) for osteochondral defects of the knee typically matches donor laterality and condyle to the recipient defect location. This study aimed to compare subchondral osseous and articular cartilage surface topography between medial femoral condyle (MFC) and lateral femoral condyle (LFC) donor grafts. Methods: Human femoral hemi-condyles (11 MFC and 6 LFC) were divided into 2 groups: MFC donor to MFC defect (MM) and LFC donor to MFC defect (LM). Computed tomography images were exported into point-cloud models using Mimics software. Articular cartilage and subchondral bone were individually segmented, creating two distinct point clouds. Circular articular cartilage defects (15 mm diameter and 25 mm diameter) were created in the MFC samples at 3 locations (0°, 45° posterior, and 90° posterior. Medial and lateral donor models were virtually placed into the MFC defect model so that articular surfaces were flush. Distance of articular surface between donor and defect and resulting osseous mismatch were calculated (Figure 1). Results: Mean articular surface mismatch was <0.5 mm in both groups, suggesting similar surface matching. Group LM exhibited greater osseous mismatch than Group MM for both 15 mm defects (mean least distance: 0.91 ± 0.45 mm, 0.74 ± 0.20 mm, P = 0.04) and for 25 mm defects (mean least distance: 1.05 ± 0.39 mm, 0.74 ± 0.16 mm, P < .01). Osseous mismatch between groups in the 25 mm defect became significant at 0° (MM, 0.66 ± 0.36 mm and LM, 1.10 ± 1.00 mm, P < .01) and at 45° (MM, 0.76 ± 0.15 mm and LM, 1.06 ± 0.47 mm, P = 0.05). Conclusion: LFC donor grafts provide acceptable cartilage surface matching for MFC defects but have greater osseous mismatch than MFC grafts. This mismatch increases with increasing graft size. The implications of subchondral bone mismatch are yet to be determined.
Unique Biology of Shoulder Cartilage in Comparison to the Cartilage Obtained from the Knee and Ankle Joints
Authors: Chubinskaya Susan , Meyer Maximilian A. , Urita Atsushi , Verma Nikhil N. , Romeo Anthony A. , Yanke Adam Blair , Cole Brian J. 
Published: July 2017

Objectives: Glenohumeral joint (GHJ) arthritis in relatively young active patients presents a considerable clinical challenge. Little is known regarding the biology and reparative capacity of GHJ articular cartilage and how it compares to other diarthrodial joints. The objectives of the current study were to 1) describe the histological and morphological appearance of human normal GHJ cartilage; and 2) investigate cellular responses of GHJ cartilage to interleukin-1β (IL-1β), in comparison to cartilage obtained from the knee and ankle of the same donors. Methods: GHJ, knee (femoral condyle) and ankle (talus) cartilage was obtained through the Gift of Hope Organ and Tissue Donor Network (Itasca, IL) from nine human donors with no documented history of joint diseases (58-75 yo, both genders). Gross morphology of each joint was assessed using Collins grading on a scale 0 to 4. Cartilage explants (3 mm diameter) were removed from each joint, cultured for 48 hours with or without interleukin-1β (IL-1β; 0.1ng/ml or 10ng/ml), and processed for histology with Safranin O, proteoglycan (PG) synthesis/content, and PCR for key extracellular matrix (ECM) genes: Col2, Agg, and SOX9. Results were compared between uncultured and cultured controls and across all three included joints. Results: Unlike grossly normal (Collins grades 0-1) knee and ankle cartilage, grossly normal GHJ cartilage with an intact surface displayed signs of subtle structural changes: loss of Safranin O in the upper layer and in the ECM and increased staining around chondrocytes suggesting elevated metabolic activity. Differences became more apparent with higher Collins grades or in the presence of IL-1β. Treatment with IL-1β (both doses) resulted in more than 2-fold inhibition of PG synthesis in GHJ cartilage (p<0.05), while only high dose IL-1β had the same effect on the knee or ankle cartilage. At the control level, expression of Col2 and Sox9 was comparable between all types of cartilages; Agg expression was the highest in the ankle cartilage. IL-1β increased Agg expression in humeral cartilage and Agg and Col2 genes in glenoid cartilage. Conclusion: GHJ cartilage appears to be more susceptible to catabolic processes than cartilage in the knee or ankle. Elevated expression of key ECM genes in the presence of pro-inflammatory mediator IL-1β may suggest an attempted, but failing repair. This study provides new insight into the histological and biochemical characteristics of GHJ cartilage, both of which may contribute to challenges associated with its reconstruction.
The Influence of Preoperative Full-Thickness Chondral Defects on Outcomes Following Meniscal Allograft Transplantation
Authors: Saltzman Bryan M. , Meyer Maximilian A. , Leroux Timothy Sean , Gitelis Matthew E. , Debot Margaret , Yanke Adam Blair , Cole Brian J. 
Published: July 2017

Objectives: The impact of full-thickness chondral defects (FTD) on outcomes after meniscus allograft transplantation (MAT) remains unknown. The purpose of this study was to determine the impact of FTD on outcomes following MAT. Methods: Patients undergoing MAT between 9/1997-3/2013 with minimum two-year follow-up were identified and split into two groups based upon presence or absence of FTD identified intra-operatively: No defect (“ND’, Outerbridge Grade 0/I) or FTD (Outerbridge Grade IV). All FTD were treated with cartilage restoration procedures (microfracture, osteochondral allo/autograft, DeNovo or autologous chondrocyte implantation). Reoperations, failures (revision MAT or conversion to arthroplasty), and patient-reported outcomes (PROs) were reported at six-months, one-year, two-years and final follow-up. Inter-group comparisons were made using unpaired student t-tests. Results: A total of 91 patients - 22 with ND and 69 with a FTD were identified and followed for a mean 4.48 and 3.84 years, respectively. There were no significant between-group differences in age, body mass index (BMI), or number of prior surgeries. One complication occurred in the FTD group (1.3%), and no complications in the ND group. There were no significant differences in number of subsequent surgeries or failures. Comparison of the cohorts found no differences in PROs preoperatively. At 6-months postoperative, significantly greater values were reported in the FTD cohort for KOOS-Pain and KOOS-ADL and greater values for the ND cohort for WOMAC-Function and WOMAC-Total. At 1-year postoperative, significantly greater values were reported for the ND cohort for KOOS-Symptoms and KOOS-QOL, but at 2-years postoperative and final follow-up, no further significant differences in any PROs were present. At final follow-up, the ND and FTD cohorts reported significant improvements in the majority of PRO categories, with a greater number of PRO subscales demonstrating significance in the FTD group (Figure 1; Table 1). Conclusion: FTD when treated at the time of MAT have no significant influence on outcome following MAT, including PROs, failures or reoperations. Clinicians performing MAT in meniscus deficient patients with full-thickness chondral defects should counsel their patients that if these defects are treated concomitantly with MAT that they can expect similar outcomes to patients without full-thickness chondral defects at long-term follow-up. [Table: see text]
The LM Posterior Root Stabilizes the ACL Deficient Knee
Authors: Moatshe Gilbert , Frank Jonathan M. , Dornan Grant , Brady Alex , Slette Erik , LaPrade Robert F. 
Published: July 2017

Objectives: The menisci have an important role in stabilizing the knee joint. The biomechanical effects of lateral meniscal posterior root tears with or without meniscofemoral ligament (MFL) tears in anterior cruciate ligament (ACL) deficient knees have not been studied in detail. The aim of this study was to determine the biomechanical effects of disruption of the lateral meniscus posterior root attachment in ACL-intact and ACL-deficient knees. It was hypothesized that disruption of the posterior horn lateral meniscal root attachment would cause a significant increase in both anterior tibial translation (ATT) and internal rotation during a simulated pivot shift and also in internal rotation tests in the ACL-deficient knee, both with and without intact meniscofemoral ligaments. Methods: Ten paired (n = 20) fresh-frozen cadaveric knees were mounted in a 6 degree-of-freedom robot for testing and divided into two sequential cutting groups. The sectioning order for group 1 was (1) ACL, (2) lateral meniscus posterior root and (3) MFL. The sectioning order for group 2 was (1) lateral meniscus posterior root, (2) ACL, and (3) MFL. For each cutting state, displacements and rotations of the tibia were measured and compared to the intact state following a simulated pivot shift test (5 Nm internal rotation torque combined with a 10 Nm valgus torque) at 0°, 20°, 30°, 60° and 90° of knee flexion; an anterior translation load (88 N) at 0°, 30°, 60° and 90° of knee flexion; and internal and external rotation (5-Nm) at 0°, 30°, 60°, 75° and 90° of knee flexion. Results: Cutting the LM root and MFLs significantly increased ATT during a simulated pivot shift test at 20° and 30° when compared to the ACL cut state (p<0.05) (Figure 1). Cutting the LM root in ACL intact knees significantly increased internal rotation by between 0.4° ± 0.4° and 1.3° ± 0.9° (p<0.05), except at 0° (p=0.136). When the ACL + LM root cut state was compared to the ACL cut state, the increase in internal rotation was significant (p<0.05) at higher flexion angles (75° and 90°) but not between 0°- 60°. For an anterior translation load, cutting the LM root in ACL deficient knees significantly increased ATT at 30° (p<0.05). Conclusion: The LM posterior root was a significant primary stabilizer of the knee for internal rotation and anterior tibial translation during pivoting activities at lower flexion angles and internal rotation at higher flexion angles. Lateral meniscal posterior root tears should be repaired concurrently with ACL reconstruction. Increased knee instability due to lateral meniscal root deficiency may contribute to increased functional limitations in patients and potentially to ACL reconstruction graft failure.
Lateral Extra-articular Tenodesis Does Not Influence Knee Abduction Moment During Drop Vertical Jump Following ACL Reconstruction
Authors: Getgood Alan M. , Daniluk Michal , Hewison Christopher , Bryant Dianne , Litchfield Robert B. , Willits Kevin , Birmingham Trevor 
Published: July 2017

Objectives: The combination of anterior cruciate ligament (ACL) reconstruction plus lateral extra-articular tenodesis (LET) has shown promising results during preclinical biomechanical and clinical testing at reducing anterolateral rotatory laxity; however, no studies have examined its effectiveness during a dynamic functional task. Therefore, we used the drop vertical jump (DVJ) to compare in vivo biomechanics of ACL reconstructed patients with and without LET from a subset of patients within the Stability randomized clinical study. We hypothesized that there would be a difference in peak knee abduction moment (KAM) between the two treatment groups at six months following surgery. Methods: This is a subset of patients taken from one center, within a pragmatic, multicenter prospective randomized clinical trial. Thirty patients were randomized to receive ACL reconstruction alone (n=16) or ACL reconstruction plus LET (n=14). At six months postoperative, all patients performed a drop vertical jump test and knee kinetics and kinematics were measured using three-dimensional motion analysis. Biomechanical variables of interest included peak initial contact and stance values for knee abduction moment and angle, knee flexion moment and angle and knee internal rotation moment and angle. Independent groups t-tests were used to assess kinetic and kinematic differences between the injured limbs of both treatment groups. Results: There was no significant difference in peak KAM between those who received ACL reconstruction alone (1.31 %BW×ht) and those who received an ACL reconstruction plus LET (1.14 %BW×ht) (Mean Difference, 0.17; 95% CI, -0.50 to 0.84, p = 0.60). Similarly, there were no differences in peak knee flexion moment or peak knee internal rotation moment between treatment groups (p=0.59 and p=0.37 respectively). There were also no significant differences in knee abduction angle, knee flexion angle or knee internal rotation angle at initial contact (p=0.40, p=0.08, p=0.23 respectively) or peak stance phase (p=0.10, p=0.44, p=0.19 respectively). Conclusion: We found no significant biomechanical differences between treatment groups at six months postoperative. However, these are the preliminary results of a larger continuing study and, at this time, no definitive conclusions can be made.