bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect on Patient-Reported Outcome of Debridement or Microfracture of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament-Reconstructed Knees
Authors: Røtterud Jan Harald , Sivertsen Einar , Forssblad Magnus L. , Engebretsen Lars , Aroen Asbjorn 
Published: August 2015

Objectives: To evaluate the effect of debridement or microfracture compared with no treatment of concomitant full-thickness (International Cartilage Repair Society [ICRS] grades 3-4) cartilage lesions on patient-reported outcome after ACL reconstruction in a large population-based cohort study. Methods: 644 patients with a primary unilateral ACL reconstruction and a concomitant full-thickness cartilage lesion treated simultaneously by debridement (n=78) or microfracture (n=88), or receiving no treatment (n=191) of the cartilage lesion, registered in the Norwegian and the Swedish National Knee Ligament Registry during 2005-2008 were included. Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to measure patient-reported outcome. At a mean follow-up of 2.1 years (SD, 0.2) after surgery, 357 (55%) patients completed the KOOS. Linear regression analyses were used to evaluate the effect of debridement or microfracture on KOOS. The multiple regression analyses were adjusted for gender, age, previous knee surgery, time from injury to surgery, concomitant ligament injury, concomitant meniscal lesion(s), type of ACL graft, area of cartilage lesion, ICRS grade of cartilage lesion, location of cartilage lesion and preoperative KOOS scores. Results: No significant effects of debridement were detected in the unadjusted or adjusted regression analyses on any of the KOOS subscales at 2-year follow-up. Microfracture treatment of the cartilage lesions had significant negative effects at 2 year follow-up on the KOOS subscales Sport/Recreation (regression coefficient [β] = -8.9; 95% CI, -15.1 to -1.5) and Knee-Related Quality of Life (QoL) (β = -8.1; 95% CI, -14.1 to -2.1) in the unadjusted analyses. When adjusting for confounders, microfracture had significant negative effects on the same KOOS subscales, Sport/Recreation (β = -9.1; 95% CI, -16.9 to -1.2), and QoL (β = -7.3; 95% CI, -13.7 to -0.9). For the remaining KOOS subscales Pain, Symptoms and Activity of Daily Living (ADL) there were no significant unadjusted or adjusted effects of microfracture. Conclusion: Microfracture of concomitant full-thickness cartilage lesions showed adverse effects on patient-reported outcome at 2-year follow-up after ACL reconstruction. Debridement of concomitant full-thickness cartilage lesions showed neither positive nor negative effects on patient-reported outcome at 2-year follow-up after ACL reconstruction.
Physician And Non-physician Inter- And Intra-observer Reliability Of A Field-based Drop Vertical Jump Screening Test For ACL Injury Risk
Authors: Redler Lauren H. , Watling Jonathan P. , Dennis Elizabeth R. , Swart Eric F. , Ahmad Christopher S. 
Published: August 2015

Objectives: There is an epidemic of ACL injuries in pediatric and adolescent athletes. Poor neuromuscular control is an easily modifiable risk factor for ACL injury, and can be screened for by observing dynamic knee valgus on landing in a drop-vertical jump test. This study aims to validate a simple, clinically useful population-based screening test to identify at-risk athletes prior to participation in organized sports. We evaluated the inter- and intra-rater reliability of risk assessment by various observer groups, including physicians and non-physicians, commonly involved in the care of youth athletes. Methods: The screening involves observers watching a simple drop vertical jump in sports field conditions, without the use of additional analytic equipment. 15 athletes age 9-17 were filmed performing a drop vertical jump test. These videos were viewed by 242 observers including orthopaedic surgeons, residents/fellows, coaches, athletic trainers (ATC), and physical therapists (PT), with the observer asked to subjectively estimate the risk level of each jumper. Analytical objective injury risk was calculated using normalized knee separation distance (measured using Dartfish, Alpharetta, GA), based on previously published studies. Risk assessments by observers were compared to each other to determine inter-rater reliability and to the objectively calculated risk level to determine sensitivity and specificity. 71 observers repeated the test at a minimum of 6 weeks later to determine intra-rater reliability. Results: Overall, between groups (ATCs, attending physicians, coaches, residents/fellows, and PTs), the inter-rater reliability was high, κ = 0.92 (95% CI 0.829-0.969, p<0.05), indicating that no one group gave better (or worse) answers, including comparisons between physicians and non-physicians. With a screening cutoff of only jumpers identified by observers as “high risk”, the sensitivity was 63.06% and specificity 82.81%. Reducing the screening cutoff to also include jumpers identified as “medium risk” increased sensitivity to 95.04% and decreased the specificity to 46.07%. Intra-rater reliability was substantial, κ = 0.55 (95% CI 0.49-0.61, p<0.05), indicating that individual observers made reproducible risk assessments. Conclusion: This study supports the use of a simple, field-based observational drop vertical jump screening test to identify athletes at higher risk for ACL injury. Among those who could potentially be involved in this screening process, our study shows good inter- and intra-rater reliability and high sensitivity, and can be performed without significant training by coaches and athletic trainers in addition to healthcare professionals. Identification of these high-risk athletes may play a role in enrollment in appropriate preventative neuromuscular training programs, which have been shown to decrease the incidence of ACL injuries in this population.
Driving Reaction Time after Right Knee Anterior Cruciate Ligament Reconstruction
Authors: Singh Brian , Weinberg Maxwell , Sherman Orrin H. , Strauss Eric Jason , Jazrawi Laith M. 
Published: August 2015

Objectives: The purpose of the present study was to determine when patients recover the ability to safely operate the brakes of an automobile following a right knee anterior cruciate ligament reconstruction (ACLR). Methods: A prospective case series of 27 patients who underwent a right knee ACLR, nine with a bone patellar tendon-bone (BPTB) autograft, nine patients who had hamstring (HS) tendon autograft and nine patients who had tibialis anterior (TA) tendon allograft for their reconstructions were tested in a validated computerized driving simulator. At 7-10 days, three weeks, and six weeks post operatively, patients were evaluated with respect to their brake reaction time (BRT), brake travel time (BTT), and total braking time (TBT). Each cohort was then compared with thirty healthy volunteers with similar demographics to establish normative mean values. Results: At 7-10 days post-operatively, all patients had statistically significant differences compared to controls for BRT, BTT, and TBT, regardless of the graft used for the reconstruction. By three weeks post-operatively, those reconstructed with TA allografts demonstrated a return to normal braking parameters with no statistically significant differences compared to controls between BRT, BTT, and TBT, whereas those with BPTB and HS autografts continued to have significant delays in their BTT and TBT with BPTB (p = 0.007, p = 0.009) and HS (p = 0.016, p = 0.015), respectively. By six weeks post-operatively, braking parameters for patients receiving an ACL reconstruction with a hamstring autograft returned to normal values while those treated with a BPTB autograft continued to demonstrate impairment in brake travel time and total braking time compared to controls; however, their brake reaction time had recovered to normative values. Conclusion: Patients who underwent a right knee ACL reconstruction with a TA allograft regained normal braking times by three weeks post-operatively and continued to improve through the six week post-operative time point. In contrast, those treated with a BPTB or HS autograft demonstrated impaired ability to operate motor vehicle brakes three weeks following surgery. While at six weeks, the braking ability of patients treated with hamstring autografts normalized, those receiving a BPTB autograft continued to demonstrate limitations in their brake travel time and total braking time. Patients should be counseled appropriately when discussing reconstruction options and when it is safe to resume driving.
Patient Factors Associated with Osteochondral Allograft Success in Knees with or without Co-morbidities
Authors: Nuelle Clayton William , Nuelle Julia , Cook James L. , Stannard James P. 
Published: August 2015

Objectives: To determine preoperative variables that may influence outcomes after osteochondral allograft transplantation for treatment of large cartilage defects in the knee. Methods: A retrospective review of 75 patients who underwent osteochondral allograft transplantation for large (>1 cm) grade IV cartilage defects in knees was performed. Patient variables evaluated included: smoking, workers compensation, BMI, pre-injury activity level (high level athlete, recreational athlete, active non-athlete, minimal activity, sedentary), number and type of co-morbidities in the operated knee (meniscal, ligament, and/or other cartilage pathology), lesion location (medial femoral condyle, lateral femoral condyle or multiple lesions), number of grafts placed (1, 2 or >2) and patients who underwent revision surgery related to OCA transplantation. Preoperative and postoperative VAS pain scores were used as the primary outcome measure. Success was defined as a VAS pain score of 0 or improvement in score (decrease) of 2 or more at final follow-up. The mean follow-up time was 19.5 months (3-53 months). Statistically significant (p<0.05) effects on successful outcomes were evaluated using Fisher's exact tests and odds ratios. Results: The study population was 41 males and 34 females with an average age of 34.2 years (14-61). 53 patients (71%) had successful outcomes. 59 patients (79%) had co-morbidities with the average being 2 comorbidities (1-4) per patient. 68% of patients with co-morbidities achieved a successful outcome versus 81% of patients with no co-morbidities, but this difference in proportions was not statistically significant (p=0.46). Active patients (HLA, REC, ACT) were significantly (p=0.023) and 4.5 times more likely to have a successful outcome than minimally active or sedentary patients. Patients with BMI <30 were 3.7 times more likely to have a successful result and the difference was significant (p=0.011). Smoking, workman's compensation, OCA-related revision surgery, lesion location and number of grafts placed did not have statistically significant effects on outcome. Conclusion: Osteochondral allograft transplantation can be a successful treatment option for large cartilage defects in the knee with patients having no intra-articular co-morbidities achieving an 81% success rate. Patients who are more active preoperatively and those with BMI <30 were significantly more likely to have successful outcomes.
Increased Risk of Second Anterior Cruciate Ligament Injury for Female Soccer Players
Authors: King Alexander Harrison , Krych Aaron John , Sousa Paul L. , Stuart Michael J. , Levy Bruce A. , Dahm Diane L. 
Published: August 2015

Objectives: Female athletes are an at-risk population for anterior cruciate ligament (ACL) injury, with rates of injury significantly higher than the general population. Few studies have reported on a second ACL injury for female athletes. The purpose of this study was to (1) report the rate of subsequent ACL injury (ACL graft rupture or contralateral ACL tear) in competitive female soccer players, (2) compare these rates to those of other female athletes of similar competitive level, and (3) determine risk factors for second ACL injury in this athletic population. Methods: The medical record at our institution was reviewed for patients treated with primary ACL reconstruction between 1998 and 2013. Female patients injured during a competitive athletic event were included for further review, and followed for an average of 7.1 years postoperatively (range 1.0 - 17.7 years). Chi-square analysis was used to compare rate of graft rupture and contralateral ACL injury based on pre-operative Tegner score, graft type, and injury side for soccer players vs. other female athletes. Wilcoxon rank-sum test was used to compare rate of subsequent ACL injury to patient age. Results: 337 patients met our inclusion/exclusion criteria (90 soccer players; 247 non-soccer playing athletes) with a mean age of 24.0 years. Of the 337 athletes, 6 were injured during professional competition, 43 were injured during collegiate athletics, 184 during high school play, and 136 during recreational athletics. No patient demographical differences were found at baseline between the soccer group and non-soccer group, including Tegner scores. Overall, 21 soccer players (23.3%) sustained a second ACL injury compared to 21 (8.5%) non-soccer athletes (P < 0.001). Soccer players had significantly more graft ruptures (10.0% vs. 2.0%, P = 0.003) and more contralateral ACL tears (13.3% vs. 6.5%, P = 0.04). Risk factors for ACL graft tear included young age (mean 16.0 vs 24.3 years; P < 0.0001) and higher Tegner Activity Level scores (mean 8.1 vs. 7.4, P = 0.049), but were not risk factors for contralateral ACL injury. Graft selection and injury side showed no statistical significance on graft rupture or contralateral injury. Conclusion: Female soccer players treated with ACL reconstruction had an increased rate of second ACL injury, including graft tear and contralateral ACL injury, compared to a similar group of non-soccer female athletes (23.3% vs. 8.5%, P < 0.001). In addition, young age and higher activity level were risk factors for graft rupture in this population.
Percutaneous Partial Medial Collateral Ligament Release (PPMCLR) Does Not Result in Residual Medial Collateral Laxity (MCL)
Authors: Hinton M. Alan 
Published: August 2015

Objectives: The intra-articular posterior medial knee can be difficult to approach during arthroscopy. This is especially true for medial meniscal tears, medial meniscal repairs or medial meniscal transplantation. Various methods and instruments have been proposed to help with this approach. PPMCLR is one of these methods. This study found that this is a safe technique and does not result in measurable laxity of the MCL. Methods: 50 consecutive patients took part in the study. The patients were then randomized into a control or partial percutaneous release group (25 in each group). Prior to arthroscopy each patient had standardized 30 degree valgus stress radiograph performed. The MCL was stressed with the Telos Stress Device GA/III at 30 degrees of flexion; utilizing 150 Newton's of stress. The stress radiographs were measured independently for the maximal separation at the medial compartment. At six weeks the stress radiographs were repeated and the results again recorded. The postoperative care for each group was the same. Results: The results were then statistically evaluated using the, finding no radiographic evidence of residual laxity P<.005. There was also no difference in the control and PPMCLR group p<.0005. No patient complained of residual laxity. Patient follow up will be discussed. Conclusion: PPMCLR is an effective and safe method to reach the intra-articular posterior aspect of the knee during arthroscopy. PPMCLR does not result in measurable laxity of the MCL.
Short-Term Outcomes of the Subchondroplasty Procedure for the Treatment of Bone Marrow Edema Lesions in Patients with Knee Osteoarthritis
Authors: Davis Adrian Thomas , Byrd Jennifer Marie , Zenner Justin Angelo , Frank Darren A. , DeMeo Patrick J. , Akhavan Sam 
Published: August 2015

Objectives: To determine the short-term outcomes, effectiveness and perception of the subchondroplasty (SCP) procedure in patients with radiographic evidence of bone marrow edema (BME) in the setting of knee osteoarthritis (OA). Methods: A retrospective chart review in conjunction with a follow-up questionnaire was conducted on fifty patients with radiographic evidence of BME lesions who underwent the SCP procedure performed at a single academic medical institution. All patients failed prior conservative measures, including medications, injections, physical therapy, and bracing. The questionnaire focused on symptoms before and after the procedure, the perception of the procedure, any other interventions performed after the procedure, and willingness to undergo SCP again. Results: The average patient age was 55 years (range 36-82 years) and 53.2% of patients were male. The average follow-up period was 14.6 months (range 12.9-25.1 months). Preliminary data from 50 patients demonstrated an average 4.7 point improvement in pain on a 10 point visual analog scale (pre-SCP 8.3, post-SCP 3.6). Eighty-eight percent (44 of 50) of patients experienced improvement in their pain and 72% (36 of 50) experienced improvement in pain-free walking distance. Forty-eight percent (24 of 50) of patients required additional interventions: eighteen received cortisone or hyaluronic acid injections, two required serial aspirations, and four went on to total knee arthroplasty. The average satisfaction level was 7.8 on a 10 point scale. Seventy-eight percent (39 of 50) of patients stated they would undergo SCP again and 86% (43 of 50) would recommend the procedure to a friend or family member. Conclusion: SCP is an effective treatment modality in the management of patients with knee OA and BME lesions. The goal of the procedure is to provide enduring pain relief caused by BME, hopefully delaying the need for TKA in this select patient population. Future studies are necessary to evaluate the long-term outcomes of SCP.
Incidence Of Delayed Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients With Previous Anterior Tibial Spine Fractures
Authors: Mitchell Justin , Fader Ryan R. , Rhodes Jason , Vidal Armando F. 
Published: August 2015

Objectives: Pediatric avulsion fractures of the anterior tibial spine are injuries similar to anterior cruciate ligament injuries in adults. Sparse data exists on the association between anterior tibial spine fractures (ATSFs) and later ligamentous laxity and need for anterior cruciate ligament (ACL) reconstruction. Understanding that there is a component of stretch injury to the ACL during initial ATSF, and that there is limited ability for the ACL to undergo remodeling of mid substance fibers, it would stand to reason that this injury could cause weakness in the ACL and lead to delayed instability or injury. This research presents a retrospective review of clinical records, operative reports, and patient reporting to characterize the incidence of delayed ACL reconstruction in cases of ATSFs in children. The purpose of this study was to better delineate the incidence of delayed instability or ACL rupture requiring further surgery in the form of ACL reconstruction. Methods: We identified 44 patients who sustained an ATSF and met inclusion criteria for this study between 1996 and 2011. The subjects were aged between 5 and 18 at the time of injury and were separated by the Myers and McKeever classification into type I, II, and III fractures. All patients had at least two-year follow-up after initially injury by clinical examination and/or via telephone. Patients were asked if any further surgical intervention was performed on their injured knee, and if so, operative reports were reviewed thereafter. Results: Eleven percent of children with an ATSF sustained a delayed ACL rupture requiring ACL reconstruction. No delayed ACL reconstruction with type I fractures (0/6) was found. Fourteen percent of type II injuries (4/21) reported delayed ACL reconstruction after a second injury. Six percent (1/17) type III fractures went onto later reconstruction. Conclusion: This data suggests that a small subset of patients with previous ATSF may be at risk for delayed ACL rupture. At this time, it is unclear as to whether these delayed ACL ruptures are related to initial injury or caused only by a secondary event that would have otherwise caused ACL rupture. Further patient follow-up and prospective studies are required. Although ATSF is a rare injury, our cohort of patients suggests that a subset of patients with type II and III fractures will require later ACL reconstruction. There is a need to council patients that delayed ACL rupture is a potential risk after an ATSF.
Long-Term Follow-Up of Arthroscopic Treatment of Discoid Lateral Meniscus in Children
Authors: Haskel Jonathan D. , Uppstrom Tyler J. , Dare David , Rodeo Scott A. , Green Daniel W. 
Published: August 2015

Objectives: The discoid meniscus, occurring almost exclusively on the lateral side, can lead to pain, popping, snapping, and decreased knee extension. The purpose of this study was to examine the long-term clinical outcomes of arthroscopic partial meniscectomy for the treatment of discoid lateral meniscus in children. Methods: A previous study at our institution identified 27 consecutive patients who underwent arthroscopic meniscal saucerization by one of two surgeons between 1997 and 2002. These patients were included in this study if they were willing and able to complete the five outcomes questionnaires (IKDC Subjective Knee Evaluation, Kujala Scoring Questionnaire, Lysholm Knee Scoring Scale, Marx Activity Rating Scale and Tegner Activity Scale). Seven additional patients that were treated consecutively at least 10 years ago were also included in the study. Patients were also given the opportunity to receive a knee exam performed by one of the two treating surgeons. The exam was documented as per the IKDC knee examination protocol. Associations between outcome scores and discoid type, meniscal stability, location of instability, and age at time of surgery were identified. Results: Of the 34 eligible patients (23 female, 11 male), 22 patients were contacted, and 21 agreed to participate. The average length of follow-up was 13.7 years, ranging from 10.3 years to 16.6 years. Average age at the time of surgery was 9.3 years. Long-term follow-up revealed average IKDC, Kujala, and Lysholm scores of 82.87, 86.63 and 83.73, respectively. Additionally, average Marx and Tegner scores were 5.36 and 5.63, respectively. Stratifying the Lysholm scores revealed outcomes that were 45.4% excellent, 18.2% good, 27.3% fair, and 9.1% poor. The average IKDC Knee Examination score was A (normal). In total, 20.6% (7 of 34) of eligible patients underwent a subsequent surgical procedure on the affected knee. Conclusion: Numerous studies have demonstrated good to excellent short-term outcomes after arthroscopic treatment of discoid meniscus. At an average follow-up of nearly 14 years, our data suggests that clinical outcome scores decline over time. Compared to our previous study with 2-year follow-up, there is an increased rate of knee pain, mechanical symptoms, and functional limitations. Despite excellent post-operative IKDC examination scores, approximately 40% of our patient cohort demonstrated relatively low Lysholm scores (fair and poor).