bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment Of Chronic Lateral Ankle Instability With ATLF And CFL Fibular Advancement: Surgical Technique And Clinical Outcome
Authors: Dwyer Tim , Petrera Massimo , Ogilvie-Harris Darrell 
Published: September 2013

Objectives: To report the 2 to 5 year outcome of ATFL and CFL fibular advancement for the treatment of lateral ligament instability of the ankle. Methods: Fifty-five patients presenting with chronic lateral ankle instability who had failed non-operative management (bracing, taping, physiotherapy) underwent a lateral ligament fibular advancement between 2005 and 2008. In each case the ATLF and CFL were released from the fibula and advanced using two double loaded metallic suture anchors (3.5mm). The senior author DJOH) performed all the cases. Patients were allowed to full weight bear in a walking boot for 6 weeks after surgery. Patients were assessed pre-operatively and post-operatively using the Foot and Ankle Outcome Score (FAOS). Data were prospectively collected and retrospectively reviewed by an independent author. Results: Six patients (11%) were lost at follow-up, leaving a study group of 49 patients (23 male and 26 female). The mean patient age at the time of surgery was 25 years old (range, 18-37 years old), with a mean duration of symptoms of 1.8 years (range, 6 months - 5 years). The mean follow-up was 42 months (range, 24 - 60 months). Significant improvement was seen in the FAOS score from a mean value of 36 pre-op to 75.4 post-op (p<0.001). Pain subscale improved from 35 to 75 (p<0.001); symptoms from 29 to 77 (p=0.01); function from 45 to 77 (p<0.001); function in sports and recreation from 38 to 70 (p<0.001); foot and ankle related quality of life from 35 to 78 (p<0.001). The failure rate was 6%, with three patients complaining of residual instability secondary to re-tear. Two cases of superficial infections were seen. One patient complained of temporary nerve irritation and numbness. Conclusion: This study demonstrates that ATFL and CFL advancement with suture anchor fixation and early, protected weight bearing is an effective procedure for the treatment of chronic lateral ankle instability.
The Demographics And Epidemiology Of Osteochondritis Dissecans Of The Ankle, Elbow, Foot, And Shoulder In Children
Authors: Kessler Jeffrey I. , Nikizad Hooman , Shea Kevin G. , Jacobs John C. , Weiss Jennifer 
Published: September 2013

Objectives: To assess the demographics and epidemiology of osteochondritis dissecans (OCD) of the ankle, elbow, foot, and shoulder in patients age 2-19. Methods: A retrospective chart review was done on OCD between 2007 and 2011. Inclusion criteria included OCD of the ankle, elbow, foot, or shoulder, and patients aged 2-19. Exclusion criteria included the co-existence of any other intra-articular lesions. Joint involvement, laterality, and all patient demographics were recorded. The incidence of OCD in 2010 was determined for the ankle, elbow, and foot. Results: 125 patients with a total of 128 OCD lesions fit the inclusion criteria. 60.2% of lesions were right sided and 39.8% left sided. Males had 53.9% and females 46.1% of all lesions. Lesions of the ankle, elbow, foot, and shoulder represented 66.4%, 31.3%, 0.8%, and 1.6% of all joints, respectively. No OCD lesions were found in the 2-5 year-olds. The incidence of ankle OCD for patients aged 6-19 was 4.7 per 100,000 for all patients, and 3.5, and 6.0 per 100,000 for males and females, respectively. The incidence of elbow OCD was 2.2 per 100,000 for all patients, and 3.8 and 0.6 per 100,000 for males and females, respectively. The incidence of OCD in the foot was 0.15 per 100,000 for all patients. The male/female ratio for elbow OCD was 6.4/1, and 1/1.6 for ankle OCD. In the ankle joint, the vast majority involved the medial talus (71.8%), with most of the rest involving the lateral talus (22.4%). Females had 28.8% of lesions in the lateral talus while males had only 12.1%. Almost all elbow lesions (97.5%) involved the capitellum. In the shoulder, both lesions involved the glenoid, and in the foot, the single lesion involved the metatarsal head. Conclusion: In this population-based cohort study of pediatric OCD in nearly 1 million children, males had a greater incidence of OCD and most were right sided. Females had nearly twice the incidence of ankle OCD, while males had over 6 times the incidence of elbow OCD. To our knowledge, this is the largest epidemiologic/demographic study of pediatric OCD of the ankle, elbow, foot, and shoulder reported.
Baseline Neurocognitive Test Results In Non-concussed Athletes: Does Sleep Matter?
Authors: McClure D. Jake , Zuckerman Scott L. , Kutscher Scott J. , Gregory Andrew , Solomon Gary S. 
Published: September 2013

Objectives: When managing sport-related concussions (SRC), sports medicine physicians utilize serial neurocognitive assessments and self-reported symptom inventories when evaluating athlete recovery and safety for returning to play (RTP). Since post-concussive RTP goals include symptom resolution and return to neurocognitive baseline, clinical decisions rest on an understanding of modifiers of baseline performance. Several studies have reported the influence of age, gender and sport on baseline neurocognitive performance, but few have assessed the potential effect of sleep. We hypothesized that: 1) athletes receiving less sleep prior to baseline testing would perform worse on neurocognitive metrics; and 2) decreased sleep would have no association with the quantity of reported symptoms. Methods: We retrospectively reviewed 3,704 non-concussed athletes, 2,385 male, 3,321 high school and 383 college-aged, with baseline symptom and neurocognitive scores on Immediate Post-concussion Assessment and Cognitive Testing (ImPACT). Subjects were stratified into three groups based on self-reported sleep duration the night prior to testing; 1) short < 7 hrs, 2) intermediate 7−9 hrs; and 3) long ≥ 9 hrs). Multivariate analysis assessed the influence of categorical sleep duration on the baseline number of reported symptoms and ImPACT performance, with alpha level of 0.05. Results: When controlling for age, gender and sport as covariates, the multivariate analysis of covariances showed a significant association between shorter sleep duration and poorer verbal memory scores (p=0.019), visual memory scores (p=0.035), and reaction time scores (p=0.044), but not for visual-motor scores. Significance was found between shorter sleep duration and increased number of reported symptoms (P < 0.0001). Subsequent pairwise comparisons revealed these associations to be most significant when specifically comparing the short and intermediate sleep groups. Conclusion: Our results indicate that athletes sleeping less than 7 hours prior to testing perform worse on 3 out of 4 neurocognitive ImPACT scores and endorse more symptoms. Because concussion management and RTP decisions hinge on the comparison to a reliable baseline evaluation, sports medicine physicians should strongly consider amount of sleep prior to neurocognitive testing in the assessment of athletes’ recovery.
SUMMIT Prospective, Randomized, Controlled Trial: Response Rates To Matrix-induced Autologous Chondrocyte Implant (MACI) Versus Microfracture (MFX) By Lesion Characteristics
Authors: Saris Daniel , Price Andrew , Drogset Jon Olav , Podškubka Ales , Tsuchida Anika , Bezuidenhoudt Mauritz , Kili Sven , Levine David W. , Brittberg Mats 
Published: September 2013

Objectives: To compare the response rates of patients treated with the MACI implant with those treated with MFX for the repair of symptomatic articular cartilage defects of the knee, based on lesion characteristics, in the phase 3 SUMMIT (Superiority of Matrix-induced autologous chondrocyte implant versus Microfracture for Treatment of symptomatic articular cartilage defects) trial (sponsored by Sanofi/Genzyme Biosurgery). Methods:: Patients with ≥1 symptomatic focal articular cartilage defect of the femoral condyles (MFC/LFC) and/or trochlea and baseline Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score ≤55 participated in this prospective, randomized, controlled trial (NCT00719576). The co-primary endpoint was improvement in KOOS pain and function (sports/recreational activities) at 2-year follow up. A patient was considered a responder if they had at least a 10-point improvement over baseline in KOOS pain and function scores. The Cochran-Mantel-Haenszel χ2 (α=0.05) was used to analyze differences in response rates between groups by lesion size (>4 cm2, >5 cm2), lesion location (MFC/LFC/trochlea), and osteochondritis dissecans (OCD) etiology (yes/no). Results:: Patients (N=144) had a mean age of 33.8 years and 51% were male. The mean lesion size was 4.8 cm2, and most lesions were on the MFC (74%). The KOOS pain and function (sports/recreational activities) co-primary endpoint improvement was clinically and statistically significantly better in patients treated with the MACI implant versus MFX ( P=0.001) at 2-year follow up. Significantly better improvements were also observed for KOOS activities of daily living ( P<0.001), quality of life ( P=0.029) and symptoms ( P<0.001) with the MACI implant compared with MFX. Response rates for the overall and subgroup analyses are shown in the Table. The incidence of adverse events was similar between the treatment groups and no unexpected safety findings were reported. Based on the small patient numbers in the subgroups, further research on response predictors is warranted. Conclusion:: Clinically and statistically significantly better results in KOOS pain and function co-primary scores were observed with the MACI implant versus MFX for treating cartilage defects of the knee 2 years following surgery. More patients responded with the MACI implant compared with MFX when their lesions were >4 cm2, on the MFC, and not of OCD origin.
Magnetic Resonance Imaging and Clinical Evaluation of Chondral lesions treated with Allografts Juvenile Cells
Authors: Pascual-Garrido Cecilia , Gold Stephanie L. , Snikeris Jaclyn , Burge Alissa , Nguyen Joseph , Potter Hollis G. , Warren Russell F. , Williams Riley J. , Rodeo Scott A. 
Published: September 2013

Objectives: The De Novo NT graft (®)(natural tissue) (Zimmer, Warsaw, IN) is a new technique that consists of a scaffold free allogeneic juvenile cartilage. The purpose of this study is to describe the first cases performed in our institution with De Novo NT (®) assessing both clinical outcomes and magnetic resonance imaging. Methods: 17 patients with focal patella femoral cartilage lesions treated with De Novo NT (®) were prospectively followed. The mean age at the time of surgery was 30 years. Clinical assessment was performed with the International Knee Documentation Committee (IKDC), KOOS and MARX at baseline and most recent follow up. Magnetic resonance imaging, including T2 relaxation time maps and T1 rho in six patients, was used to evaluate the cartilage repair morphologic characteristics in 12 patients. Results: Fifteen patients met the study criteria with a mean follow up of 12 months (±3). The mean defect size was 217±100 mm. In 11 cases the lesion was in the patella, 3 in the trochlea and one in both patella and trochlea. Mean improvement in preoperative to postoperative score was significant for the IKDC objective score 45.8 (±28) to 73.3 (±24) (p=.009), IKDC pain score 49.1 (±20) to 69.8 (±23) (p=.003), KOOS 53.5 (±21) to 75.5 (±15) (p=.001), IKDC subjective 41.3 (±21.7) to 72.7 (±15) (p=.004). MRI demonstrated only two cases (16%) with graft hypertrophy. There was only one case with a detached graft. Mild and moderate subchondral edema was present in 90% (11 patients) of the cases. At the interface between the repaired tissue and the native cartilage, there were only two cases with a fissure of more than 2mm. Very good (66 to 100%) and good (between 33-66%) cartilage fill was present in 54% of the cases. Mild synovial reaction was present in 58% of the cases. From the 6 patients with T2 mapping, all repairs showed significantly different prolongation of quantitative T2 values in both the superficial and deep components of the repair tissue (47.18 for repair vs 28.3 for native (p=0.005) in the deep area and 58.6 for repair vs 37.4 for native in the superficial area (p=0.02). (Figure 1). Conclusion: De Novo NT® appears to be an effective treatment for patello-femoral chondral lesions, with significant improvement in the short-term clinical follow up. The MRI indicated implant stability with peripheral integration in most cases. As the implanted cells are allogeneic, synovial reaction is a parameter that should be considered. Only 5 patients had moderate synovial reaction, which did not affect the graft. Quantitative T2 mapping showed stratification of T2 values suggesting maturation to hyaline cartilage.
Are Articular Cartilage Lesions and Meniscus Tears Predictive of IKDC, KOOS, and Marx Activity Level Outcomes after ACL Reconstruction? A 6-Year MOON Cohort Study
Authors: Cox Charles L. , Huston Laura J. , Dunn Warren R. , Parker Richard D. , Wright Rick W. , Kaeding Christopher C. , Marx Robert G. , Amendola Annunziato , McCarty Eric C. , Spindler Kurt P. 
Published: September 2013

Objectives: Identifying risk factors for inferior outcomes after ACL reconstruction (ACLR) is important for prognosis and future treatment. Study goal: analyze a sufficiently large enough cohort to evaluate whether articular cartilage and meniscal variables are predictive of three validated sports outcome instruments. We hypothesized that articular cartilage lesions and meniscus tears/treatment would be predictors of IKDC, KOOS (all 5 subscales), and Marx Activity Level at 6 years after ACLR. Methods: From 2002-2004, 1411 ACLR subjects were prospectively enrolled and followed longitudinally with the IKDC, KOOS, and Marx completed at entry, 2 and 6 years. A logistic multivariable model consisted of patient demographics, surgical technique variables, and articular cartilage injuries and meniscus tears/treatment for determining predictors (risk factors) of IKDC, KOOS, and Marx at 6 years. Results: We completed a minimum follow-up on 93% (1307/1411) of our cohort at 6 years. Baseline results: 56% male, median age 23 years, 75% with non-contact injury mechanism, articular cartilage pathology (MFC-25%, LFC-20%, MTP-6%, LTP-12%, patella-20%, and trochlear-9%), and meniscal pathology (medial-38%, lateral-46%). Both articular cartilage lesions and meniscal tears significantly predicted 6 year outcomes on IKDC and KOOS (Table 1). Grade 3 or 4 articular cartilage lesions (excluding patella) significantly reduced IKDC and KOOS scores at 6 years. Figure 1 focuses on IKDC and demonstrates worse outcomeswith chondral injuries on the MFC, MTP, and LFC. Likewise, KOOS was negatively affected by cartilage injury. The sole significant predictor of reduced Marx activity was the presence of a grade 4 lesion on the MFC. Lateral meniscus repairs did not correlate with inferior results, but medial meniscus repairs predicted worse IKDC and KOOS scores. Lateral meniscus tears left alone significantly improved prognosis. Small partial meniscectomies (<33%) on medial meniscus fared worse, but conversely, larger excisions on lateral meniscus (>50%) improved prognosis. Analogous to previous studies, other significant predictors of worse outcome scores were lower baseline scores, higher BMI, lower education level, smoking, and revisions. Conclusion: Both articular cartilage injury and meniscal tears/treatment at the time of ACLR were significant predictors of both IKDC and KOOS scores at 6 year follow-up. Similarly, having a grade 4 MFC lesion significantly reduced a patient’s Marx activity level score at 6 years.
Joint Space Loss after Arthroscopic Partial Meniscectomy: Data from the Osteoarthritis Initiative
Authors: Rothy Alexander , Cherney Steven , Fening Stephen D. , Duryea Jeffrey , Winalski Carl S. , Jones Morgan H. , Miniaci Anthony 
Published: September 2013

Objectives: Knee osteoarthritis (OA) is a prevalent disease that causes substantial disability and use of medical resources, and knee arthroscopy is frequently performed in patients with OA or at risk of developing OA. While meniscectomy has been associated with progression of OA in multiple studies, none have assessed progression of joint space width (JSW) loss compared to matched controls. The Osteoarthritis Initiative (OAI) provides a unique cohort to enable this evaluation. We hypothesize that JSW significantly decreases in meniscectomy patients versus matched controls within a one-year period, and that joint space loss continues to be more rapid in subsequent years. Methods: A prospective cohort study with matching was conducted using records from the OAI public use data sets. The cohort (n=4796) is contains the incidence subcohort (normal radiographs with risk of developing OA) and the progression subcohort (radiographic evidence of OA). Subjects have fixed-flexion radiographs taken at yearly intervals and validated measurements of JSW are performed. Additional details about the OAI and study design are publicly accessible at http://oai.epi-ucsf.org/datarelease/About.asp. 141 meniscectomy knees were identified and 141 controls were randomly selected while matching for subcohort, gender, study site, age, knee side, and year. Paired t-test was used to evaluate change in JSW over the first year in the 141 matched pairs. Repeated measures MANOVA with adjustment for age, gender, race, and BMI was used to assess longitudinal changes in JSW in a subset of 33 matched pairs with 4 years of JSW measurements available. Results: Meniscectomy and control groups were balanced with respect to age, gender, race, BMI, and baseline JSW. The JSW decrease overa 1-year period was 0.948 mm in meniscectomy knees and 0.137 mm in controls p<0.0001). Table 1 shows similar results when stratifying by subcohort. In the crude and adjusted analyses of knees with 4 years of follow-up, the rate of JSW loss after the first year was not significantly different between meniscectomy knees and controls as shown in Figure 1. Conclusion: Arthroscopic partial meniscectomy is associated with increased loss of JSW during the first year after surgery in knees with OA and knees at risk of developing OA; however, the rate of JSW loss is not accelerated over the next 3 years. Immediate JSW narrowing may occur due to loss of the interposed meniscus, due to morphologic changes such as flattening and extrusion, or due to rapid degeneration of articular cartilage in response to increased tibiofemoral contact stress. Significance among both subcohorts suggests that meniscectomy causes progression of osteoarthritis independent of disease stage. Future investigation of change in cartilage and meniscal volumes on MR imaging may further explain the cause of this joint space loss.
Locked Intramedullary Fixation vs Anatomically Contoured Locked Plating Of Clavicle Shaft Fractures – A Prospective Randomized Controlled Trial
Authors: King Reggie Paul 
Published: September 2013

Objectives: The treatment of displaced clavicle shaft fractures has evolved due to complications experienced by conservatively treated patients. Numerous operative modalities are available with various positive and negative aspects associated with each technique. This prospective randomized controlled trial compares the outcome of patients treated operatively with a novel locked intramedullary device and patients treated by traditional anatomically contoured locked plating. Methods: Patients with displaced and shortened clavicle shaft fractures were randomized according to presentation into 2 groups - intramedullary fixation and anatomically contoured locked plating. All patients were operated by the same surgeon with similar post-operative regimes for both groups. Outcomes accessed were DASH and Constant Shoulder scores at 6 weeks, 3 months and 6 months, scar size and quality, operative time, union rate and incidence of supraclavicular nerve injury at the time of surgery. Patients were assessed by the operative surgeon, a physiotherapist and an occupational therapist. Progression to union was assessed by a radiologist. Results: 40 patients with 6 months follow-up were available for review - 20 in each group. No statistically significant difference in average DASH and Constant Shoulder scores at 6 weeks, 3 months and 6 months for the two groups were found. The surgical scars were smaller and the cosmetic result better in the intramedullary group. Operative time was significantly shorter in the intramedullary group. Both groups achieved a 100% union rate at 6 months post-op. The rate of supraclavicular nerve injury in the plating group was higher and most patients complained of prominent hardware. Conclusion: Locked intramedullary fixation of clavicle shaft fractures using the Sonoma CrX system was found to be a reliable method of achieving fracture reduction and fracture union. Shoulder function was restored and union achieved with a good cosmetic result. Supraclavicular nerve injury is rare and a second operation to remove prominent hardware is not necessary. Patient outcomes were found to be similar to that achieved by anatomically contoured locked plating - the current accepted gold standard method of treatment.
Trends In The Volume Of Operatively Treated Mid-shaft Clavicle Fractures In Children And Adolescents
Authors: Heyworth Benton E. , Suppan Catherine A. , Kocher Mininder S. , Bae Donald S. 
Published: September 2013

Objectives: Clavicle fractures are common in children and adolescents and are traditionally treated nonoperatively. With youth sports participation increasing in popularity, including contact sports, the frequency of such injuries may be increasing. The purpose of this study was to examine institutional trends in the volume of operative plate fixation for mid-shaft clavicle fractures in children and adolescents. Methods: Medical records, identified through a departmental database and cross-referenced for accuracy against billing records using ICD-9 codes, were retrospectively reviewed to identify otherwise healthy 10-18 years-olds who presented with a clavicle shaft fracture between 1999-2011 at a single tertiary-care pediatric hospital. Demographic data, fracture characteristics and treatment details were analyzed. Radiographic review of operative cases was used to confirm fracture location and surgical implant. Annual volumes were determined for the overall number of clavicle fractures, mid-shaft clavicle fractures, and mid-shaft fractures that underwent operative plate fixation. Additionally, the annual rate was determined for the number of operative cases among all mid-shaft fractures. Kendall’s Tau-b was used to assess the relationship between case volume and time. Results: From 1999-2011, a total of 882 patients were seen at our institution with a diaphyseal clavicle fracture (mean age: 14.3), 644 (73%) of which were mid-shaft. Of these 644, 111 were treated with operative plate fixation (mean age: 15.9). There was a significant increase in the number of mid-shaft clavicle fractures seen annually over that period, from 20/yr to 85/yr (r=0.80, p<0.0001). The percent of mid-shaft clavicle fractures treated with plate fixation also increased significantly from 5% to 25% (r=0.84, p<0.0001) while the rate of mid-shaft fractures among all diaphyseal fractures remained more stable. Among the mid-shaft fracture cases that received operative plate fixation, 53.2% presented with fractures received during a competitive sporting event. Conclusion: The volumes of clavicle fractures and of mid-shaft clavicle fractures treated operatively appear to be increasing. Additionally, despite a lack of evidence based support, the frequency of operative plate fixation of mid-shaft clavicle fractures appear to be increasing in the pediatric population. Many of these fractures are of a sports-based etiology.