bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of Second Anterior Cruciate Ligament (ACL) Injury 2 Years after Primary ACL Reconstruction and Return to Sport
Authors: Paterno Mark V. , Rauh Mitchell , Schmitt Laura C. , Ford Kevin R. , Hewett Timothy E. 
Published: September 2013

Objectives: The incidence of second anterior cruciate ligament (ACL) injury in the first 12 months after ACL reconstruction (ACLR) and return to sport in a young, active population has been reported to be 15 times greater than a previously uninjured cohort. It is unknown if this high relative rate of injury continues beyond the first year after return to sport following ACLR. The tested hypothesis was that the incidence rate of a subsequent ACL injury in the 2 years following ACLR and return to sports would be less than the incidence rate reported within the first 12 months after return to sport, but greater than the ACL injury incidence rate in an uninjured cohort of young athletes. Methods: Seventy-eight subjects who underwent ACLR and were ready to return to a pivoting/cutting sport (RTS) and 47 controls were prospectively enrolled. Each subject was followed for injury and athletic exposure (AE) data for a 24-month period after return to sport. Twenty-three subjects after ACLR and 4 control subjects suffered an ACL injury during this time. Incidence rate ratios (IRR) were calculated to compare the rates (per 1000 athletic exposures [AEs]) of ACL injury in athletes in the ACLR group and control group. For the ACLR group, similar comparisons were conducted for side of injury by sex. Results: The overall incidence rate of a second ACL injury within 24 months after ACLR and RTS (1.39/1000 AE) was nearly 6 times greater (IRR=5.71, 95% CI: 2.0, 22.7, p=0.0003) than healthy control subjects (0.24/1,000 AE). Female ACLR athletes demonstrated 4 times greater rate of injury within 24 months of RTS (IRR=4.51; 95% CI: 1.5-18.2, p=0.0004) than female controls. Within the ACLR group, there was a trend for female subjects to be over two (RR=2.43, 95% CI: 0.8, 8.6) times more likely to suffer a contralateral injury (1.13/1000 AEs) than an ipsilateral injury (0.47/1000 AEs). Overall, 29.5% of athletes suffered a second ACL injury within 24 months of RTS with 20.5% sustaining a contralateral injury and 9.0% incurring an ipsilateral graft re-tear injury. A higher proportion of females (23.7%) suffered a contralateral injury compared to males (10.5%). Conversely, for ipsilateral injuries, the incidence proportion between females (8.5%) and males (10.5%) were found to be similar. Conclusion: These data support the hypothesis that in the 24 months following ACLR and RTS, patients are at greater risk (nearly 6 times) to suffer a subsequent ACL injury compared to young athletes without a history of ACL injury. Additionally, the contralateral limb of female patients appears to be at greatest risk. These 24 month outcome data, analyzed in conjunction with recent 12 month outcome data which noted a 15 times greater risk of ACL injury compared to healthy control subject, indicate that the greatest risk of second ACL injury after ACLR occurs during the initial 12 months after ACLR and RTS than the second year after RTS.
Ultra-Low Velocity Knee Dislocations: A Challenging Population of Multiligament Knee Injuries
Authors: Werner Brian C. , Gwathmey Frank W. , Gilmore Carl J. , Miller Mark D. 
Published: September 2013

Objectives: Multiligament knee injuries (MLI) are usually associated with high energy mechanisms such as motor vehicle accidents or sports injuries. However, obese patients are at risk of MLI from simple falls. Termed “ultra-low velocity” (ULV) dislocations, these may be associated with higher associated risks and complications due to the patient’s inherent size. The objectives of this study are to characterize the epidemiology, risk factors, associated neurovascular injuries, and perioperative complications of ULV dislocations to allow surgeons to make informed decisions regarding their care. Methods: Study Design: Retrospective cohort study. 215 consecutive patients with MLI were identified over a 12 year period. Their charts were reviewed to identify a cohort of patients with mechanisms consistent with ULV dislocation (n=23). This cohort was compared to all MLI. Additionally, ULV patients with neurovascular injury were compared to those without neurovascular injury. Analysis: Means and ranges were calculated for continuous variables (age, BMI) and compared between cohorts using Student’s t test. Frequencies for categorical variables were compared using chi square tests. Results: Compared to all patients with MLI, the ULV cohort had significantly higher BMI, greater prevalence of female gender, and higher rates of both peroneal nerve and popliteal artery injury (Table I). Within the ULV cohort, patients with neurovascular injury demonstrated significantly greater post-operative complications (Table II). There was a trend for higher BMI to be predictive of neurovascular injury in ULV dislocations, but patient numbers limited any additional statistical analysis. Conclusion: ULV knee injuries occur in patients with greater BMI, more frequently in females, and with higher rates of concomitant neurovascular injury compared to other MLI. Additionally, a greater incidence of post-operative complications can be expected after ligament reconstruction in this population.
Identifying Cam Lesions on the False Profile View
Authors: Hellman Michael D. , Fillingham Yale A. , Gupta Anil K. , Frank Rachel , Haughom Bryan D. , Nho Shane Jay 
Published: September 2013

Objectives: Recently the AP, Dunn and Frog Leg Lateral radiographic views have been verified to accurately reflect the findings of three dimensional imaging while assessing for cam lesions. The false profile radiographic view is traditionally used to measure acetabular coverage in the setting of femoroacetabular impingement. We believe it should also be used to assess the femoral head neck junction. Our objective is to verify the accuracy of this view with respect to 3D CT scan findings. Methods: We retrospectively reviewed 37 consecutive surgical patients between May 2012 and September 2012 with preoperative radial oblique reformatted CT scans and plain radiographs. Alpha angles were measured on plain radiographs (AP, Dunn, False Profile) and CT reformats. Abnormal alpha angles were considered greater than 55 degrees and the CT scans were considered gold standard. Post-operative radiographs were also measured. Two physicians independently measured the images and the results were compared. Results: The false profile view was 70.6% sensitive and 95.0% specific for diagnosing a cam lesion. It was noted that the false profile view was 1.31 times better than other views at visualizing the anterior head-neck junction at a 3 o’clock position (See image 1). The false profile view pre-operative mean alpha angle was 53.4° versus its post-operative mean alpha angle was 41.9°, Δ = 11.5° (t = 0.001). The interclass correlation coefficient (ICC) was found to be 0.81. Conclusion: This is the first study to suggest using the false profile view to assess the femoral head neck junction. For diagnostic and treatment purposes, the false profile view effectively characterizes cam lesions, particularly anterior 3 o’clock lesions. Further, it shows promising results as a peri-operative assessment tool to verify adequate osteoplasty. Measuring the alpha angle on this view also appears to be a reproducible with a significant ICC. We believe this view should be used for both acetabular coverage measurements as well as for femoral head neck junction measurements.
Risk Factors for Anterior Glenohumeral Instability
Authors: Owens Brett D. , Campbell Scot , Cameron Kenneth L. 
Published: September 2013

Objectives: While anterior glenohumeral instability has been shown to be common in young athletes, the risk factors for injury are poorly understood. The elucidation of risk factors is critical to help develop prevention strategies. We hypothesized that specific modifiable and non-modifiable factors at baseline would be associated with the subsequent risk of injury in a cohort of young athletes. Methods: We conducted a prospective cohort study in which 714 young athletes were followed from June 2006 through May 2010. Baseline assessments included a subjective history of instability, physical examination by a sports-trained orthopaedic surgeon, range-of-motion, strength with a hand-held dynamometer, and bilateral noncontrast shoulder MRI. A musculoskeletal radiologist measured glenoid version, glenoid height, glenoid width, glenoid index (height-to-width ratio), glenoid depth, rotator interval (RI) height, RI width, RI area, RI index, and the coracohumeral interval. Subjects were followed to document all acute anterior shoulder instability events during the 4 year follow-up period. The time to shoulder instability event during the follow-up period was the primary outcome of interest. Univariate and multivariable Cox proportional hazards regression models were used to analyze the data. Results: We obtained complete data on 714 subjects. During our 4 year surveillance period, there were 38 anterior instability events documented. While controlling for covariates, significant risk factors of physical exam were: apprehension sign HR=2.96 (1.48, 5.90, p=0.002) and relocation sign HR=4.83 (1.75, 13.33, p=0.002). Baseline range-of-motion and strength measures were not associated with subsequent injury. Significant anatomic risk factors on MRI measurement were glenoid index HR=8.12 (1.07, 61.72) p=0.043 and the coracohumeral interval HR=1.20 (1.08, 1.34, p=0.001). Conclusion: This prospective cohort study revealed significant risk factors for shoulder instability in this high-risk population. While modifiable risk factors such as strength and range-of-motion were not associated with subsequent instability, some non-modifiable risk factors were. That the exam findings of apprehension and relocation were significant while controlling for prior history of injury suggests that patients may be unaware of prior instability episodes. The anatomic variables of significance are also not surprising - tall and thin glenoids were at higher risk compared to short and wide glenoids; and the risk of instability increased by 20% for every 1mm increase in coracohumeral distance.
The Elite Football Players with a Fifth Metatarsal Fracture
Authors: Ross James R. , Brophy Robert H. , Wright Rick W. 
Published: September 2013

Objectives: Fractures of the proximal fifth metatarsal can be a difficult clinical problem, especially in the athlete who wishes to return to competition. Clinical and radiographic evaluation cannot always be relied upon to assess complete healing. Refracture, after operative and nonoperative treatment, of a fifth metatarsal is a known phenomenon. The purpose of the study was to characterize and describe the prevalence of fifth metatarsal fractures in athletes at the NFL Scouting Combine and test the hypothesis that radiographic healing and symptom free return to play in college predict length of career and risk of re-injury. Methods: A retrospective review was performed of the database of players presenting to the annual NFL National Invitational Camp from 2005 to 2010 to identify athletes in whom fifth metatarsal fractures occurred. Each of these players underwent anteroposterior (AP), oblique, and lateral foot radiographs that were analyzed for indicators of hindfoot malalignment in addition to the presence or absence of a residual fracture gap. The date of the injury, the date of surgery (if applicable), and the number of games missed after the injury were also obtained from history. An internet search and NFL.com was used to determine the effect of their prior fifth metatarsal injury on the player’s career (games played, career length, and re-injury). Results: 87 feet (81 players; 4.4% of all players) were identified. 52.9% of these injuries occurred in the left foot. Among all NFL Scouting Combine participants, fifth metatarsal fractures most commonly occurred in offensive linemen (20.7%), wide out receivers (20.7%), defensive linemen (17.2%), and defensive backs (11.5%). 78.2% of players were treated with an intramedullary screw. A persistent fracture gap was noted in 18.4% of players. 17.2% of players had a re-injury during their career. No radiographic measurements differed between players that had a residual fracture gap or re-injury. Players that played at least one full collegiate season after injury were less likely to have re-injury during professional play (5.6% vs. 46.7%; p < 0.001) or a residual fracture gap (9.7% vs. 60%; p < 0.001). Players without a residual gap were also less likely to have a re-injury (7% vs. 37.5%; p < 0.001). Players treated with surgery were less likely to have re-injury (10.3% vs. 21.1%) but more likely to have gap formation (20.6% vs. 10.5%). Conclusion: Players who are able to complete at least one full year of collegiate football after a fifth metatarsal fracture are less likely to have re-injury or a residual fracture gap. No radiographic measurements are predictive of re-injury or residual fracture gap.
Corticosteroid Injections Hasten Return to Play of National Football League Players Following Stable Ankle Syndesmosis Sprains
Authors: Mansour Alfred A. , Porter David A. , Young Jason Paul , Hammer Dave , Boublik Martin , Schlegel Theodore F. 
Published: September 2013

Objectives: Injuries to the ankle syndesmosis are common in contact athletes and may result in significant time lost from sport. Syndesmosis sprains require more treatment and time off for recovery as compared to lateral ankle sprains. A previous study of collegiate football players described an average of 31 days lost from these injuries treated with standard conservative measures and rehabilitation protocols. Treatment methods for stable syndesmosis sprains are not well documented in the literature. The purpose of this study was to compare our series of stable ankle syndesmosis sprains treated with or without corticosteroid injections. Methods: A retrospective review of ankle syndesmosis sprains from two National Football League (NFL) teams over an eight-year period (2003-2011) was performed. All players were evaluated with standard radiographs as well as magnetic resonance imaging (MRI) to confirm their diagnosis. All players were subsequently treated with (Group 1) or without (Group 2) a corticosteroid injection into the syndesmosis within 72 hours of injury and progressed through a nonoperative rehabilitation program based on the treatment practices of the team. Time lost was calculated as total days from date of onset before returning to unrestricted activity including practice and games. Results: A total of 31 stable ankle syndesmosis sprains were identified. All injuries confirmed with MRI were reviewed. Thirteen players received a corticosteroid injection (Group 1) within the syndesmosis and had an average return of 15 days (5-26). Eighteen players did not receive a corticosteroid injection (Group 2) within the syndesmosis and had an average return of 25 days (1-43). This difference in return was statistically significant (p=0.0097). All players in both groups returned to play. There was one recurrence in Group 1 and two recurrences in Group 2. Conclusion: Ankle syndesmosis sprains are debilitating injuries for NFL players and result in significant time lost from sport. Compared to our control group, the use of corticosteroid injection coupled with standard rehabilitation for acute stable ankle syndesmosis sprains hastened return to play by an average of 40% (10 days). In a highly competitive athlete, this may represent a significant clinical difference.
Does Sex Matter? Analysis Of Results At 5 Years After Matrix-assisted Autologous Chondrocyte Transplantation In A Large Cohort Of Patients
Authors: Kon Elizaveta , Patella Silvio , Filardo Giuseppe , Martino Alessandro Di , Perdisa Francesco , Matteo Berardo Di , Merli Maria Letizia , Marcacci Maurilio 
Published: September 2013

Objectives: The main purpose was to document and analyze the influence of sex on the clinical outcome in a large cohort of patients treated with a cartilage regenerative procedure for knee chondral lesions and prospectively followed at medium-term follow-up. Methods: 250 knees have been treated with matrix-assisted autologous chondrocyte transplantation (MACT) and prospectively evaluated at 1, 2, and minimum 5-year follow-up. The patients were 182 men and 68 women affected by focal International Cartilage Repair Society (ICRS) grade III-IV chondral knee defects involving femoral condyles, trochleae and patellae. Two homogeneous groups of 56 patients each have been selected by a blinded independent statistician for a case-control comparative analysis. The clinical outcome was analysed using the Cartilage standard Evaluation Form as proposed by ICRS and the Tegner score. Results: After the treatment, a statistically significant improvement in all the scores was observed in both groups. The IKDC subjective score showed better results for men at all follow-ups in the general population: 79.5±18.6 vs 64.3±20.2 for men and women respectively (p<0.0005) at 5 years; the same trend was confirmed by EQ-VAS and Tegner scores. The case control analysis with scores standardized according to the specific patient category didn’t confirm the sex related difference and did not show any statistically significant difference at all follow-ups between men and women. Etiology, lesion site and pre-injury activity level differ in women and men affected by cartilage lesions and are responsible for the difference in the final outcome of the general population. Conclusion: Women have a different chondral lesion pattern; more frequently they present unfavorable conditions related to etiology, site and activity level; they also reach lower not normalized scores. However, a case-control analysis with normalized data for the specific patient's categories showed that on equal terms women have the same success possibilities than men after a surgical treatment for knee cartilage regeneration.
Comparable Maintenance of Tibial Slope in Two High Tibial Osteotomy Techniques
Authors: Hamilton Stephen Christopher , Bennett Grant Whitby , Bush Curtis Anderson , Wyland Douglas J. 
Published: September 2013

Objectives: High tibial osteotomies (HTO) are commonly performed to correct coronal malalignment in young, active patients who have concomitant cartilage lesions and/or cruciate ligament insufficiency. An unintended change of native tibial slope can negatively affect both the strain on reconstructed cruciate ligaments and the contact forces on cartilage. Therefore, one of the goals when performing an HTO is to minimize any change in posterior tibial slope. This study was designed to determine if there is a time zero difference in the maintenance of native tibial slope when performing valgus producing opening wedge HTOs using two distinct surgical techniques and fixation devices. Methods: Controlled Laboratory Study. Experienced surgeons performed valgus producing opening wedge HTOs in 24 matched paired cadaveric specimens using free hand (FH, n=12) and biplanar cutting jig (Jig, n=12) techniques. Digital fluoroscopy was used to capture anteroposterior and lateral images in all specimens, and the angle of posterior tibial slope (TS) was measured using digital software (NIH image; Bethesda, MD) in a manner blinded for technique and fixation. Results: There was good to excellent intra- and inter-observer reliability with the measurement technique using a Model 3, k, intra-class correlation coefficient (ICC). Both observers’ measurements passed tests for homogeneity (p=0.07, and p=0.12). There was no significant change in the maintenance of tibial slope between JIG and FH groups for observer 1 [JIG = 2.40° (SD = 1.3°) FH= 2.95° (SD=2.89°), p = 0.55] or observer 2 [JIG = 2.32° (SD = 2.5°) FH = 3.14° (SD=3.3°), p = 0.49]. Conclusion: When performing a valgus producing opening wedge HTO, neither the cutting jig nor the free hand technique maintained native posterior tibial slope. Both techniques increased posterior tibial slope by an average of 2-3° with no significant difference between the groups. This change in posterior tibial slope is consistent with previously reported values in the literature.
Intra- And Inter- Observer Agreement In The Classification And Treatment Of Midshaft Clavicle Fractures
Authors: Jones Grant L. , Bishop Julie , Lewis Brian , Pedroza Angela , MOON Shoulder Group 
Published: September 2013

Objectives: The purpose of this study was to determine the intraobserver and interobserver reliability in the classification of midshaft clavicle fractures via standard plain radiographs and to determine the intraobserver and interobserver agreement in the treatment of these fractures. Methods: Charts of patients seen by the two senior authors from 2006 to 2011 were reviewed to identify patients treated for clavicle fractures (CPT 23500 and 23515). AP and 30 degree cephalad radiographs were selected, representing midshaft clavicle fractures treated both operatively and non-operatively. Thirty pairs of radiographs were included in the investigation. The radiographs were standardized for size to allow accurate measurements within a non-PACS program. A PDF file was created with all representative radiographs. Clinical scenarios were created for each set of radiographs, and the evaluators were asked to perform the following tasks: 1) measure the degree of shortening in millimeters; 2) determine the percent displacement; 3) determine whether the fracture was comminuted; and 4) state whether they would treat the fracture operatively or non-operatively. The radiographs and clinical scenario handout, along with instructions on how to use the measuring tool with Adobe Reader, were distributed to 16 shoulder/sports medicine fellowship-trained orthopaedic surgeons who completed the evaluations. The radiographs and scenarios were then reordered and redistributed approximately three months later. Results: Intra and interobserver results are summarized in table 1. The following variables statistically predicted whether surgery was recommended (p< 0.001): 1) odds of surgery are 2.26 if comminution was noted holding displacement and the interaction between displacement and shortening constant, and 2) the odds of surgery are 3.37 if there is displacement > 100% compared to displacement 0-49% holding comminution and shortening constant. Conclusion: Our study demonstrated that there was moderate to strong interobserver and intraobserver agreement for both displacement and comminution when utilizing standard plain radiographs. However, there was only weak to no interobserver agreement and minimal intraobserver agreement on the amount of shortening. Also, there was minimal interobserver and only moderate intraobserver agreement on whether operative treatment should be selected, most likely due to the poor reliability of plain radiographs in determining the degree of shortening. Therefore, other modalities including comparison radiographs of the contralateral clavicle should be considered to more reliably measure the degree of shortening and help determine the need for surgery.