bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does One Size Fit All: Variation In Tibial Tubercle Trochlear Groove (TTTG) Measurements As A Function Of Age, Size, And Patellar Instability
Authors: Pennock Andrew T. , Alam Milad , Bastrom Tracey P. 
Published: September 2013

Objectives: The tibial tubercle trochlear groove (TTTG) measurement was developed to quantify rotational abnormalities about the knee associated with patella instability and to help guide surgical decision making. The purpose of this study was to assess variations in TTTG as a function of patient age and size in a population of patients with patella instability compared to those with no instability. Methods: This IRB approved retrospective study assessed all patients under the age of 21 undergoing a surgical procedure for patella instability from 2010 to 2012. A cohort of 180 patients with no history of patella instability or patellofemoral complaints was used as a control group. TTTG was measured in all patients on MR axial images using the centers of the tibial tubercle and the trochlear groove. Data was then normalized based on patient height, weight, BMI, and femur width. Statistical analysis was performed with an alpha set at p<0.05 to declare significance. Results: The average age of the 45 patella instability patients was 15.4 years (range 10 - 18), their mean TTTG was 16.3 mm (range 6.5 - 26), and 51% were male. By comparison, the mean age of the control was 16 years (range 10-19), the mean TTTG was 11.7 mm (range 3 - 22), and 58% were male. The TTTG and the normalized TTTG for height, weight, BMI, and femur width were all greater in the patella instability group compared to the control group (p≤0.001). 31% of patients had a TTTG greater than 20 mm in the instability group compared to 2.7% in the control group (p<0.05, Specificity 97%, Sensitivity 31%). TTTG was found to increase as a function of height in both groups (r =0.14, p=0.04) and decreased with age only in the instability group (r = -0.3, p=0.04). There was no correlation between TTTG and age in the non-instability group (r= -0.04, p=0.5). TTTG was not associated with patient gender, weight, or BMI (p>0.05). Conclusion: Much like adult patients, an elevated TTTG is associated with patella instability both in pediatric and adolescent patients. However, this measurement varies as a function of patient age and height. Normalization of TTTG to patient height may control for size variations and should be undertaken in the work-up and management of patients with patella instability. Given the dependence of TTTG on patient age and height, care should be taken when using absolute values or a singular critical cutoff in the adolescent or pediatric population in the surgical decision process.
Arthroscopic Hip Revision Surgery for Residual FAI: Surgical Outcomes
Authors: Larson Christopher M. , Giveans Russell , Bedi Asheesh , Samuelson Kathryn M. , Stone Rebecca M. 
Published: September 2013

Objectives: There is a steep surgical learning curve when managing femoroacetabular impingement (FAI) and residual FAI can lead to continued pain and disability. There is very limited data reporting outcomes after revision arthroscopy for residual FAI. Methods: The records of patients that underwent arthroscopic hip revision surgery for residual FAI based on plain radiographs and 3D CT scans were reviewed. Pre and post-operative structural pathomorphology, intra-operative findings, and pre and post-operative outcomes measures using Modified Harris Hip Scoring (MHHS), SF-12 scoring, and pain on a visual analogue scale (VAS) were evaluated. Outcomes after revision arthroscopic FAI correction were compared to a cohort that underwent primary arthroscopic FAI correction. Results: 48 patients (53 hips) underwent arthroscopic revision FAI correction (mean 20.0 months follow-up). There were 62 previous arthroscopic surgeries and 4 previous surgical dislocations. There were 23 males and 25 females with a mean age of 29.9 years (range 18 - 59). 48 hips had residual cam-type FAI, and 40 hips had residual pincer-type FAI and underwent femoral and rim resections, respectively. The labrum was debrided in 27 hips, repaired in 24 hips and reconstructed with allograft in 2 hips. Adhesions were excised for 35 hips. The results of revision arthroscopic FAI correction were compared to 154 patients (169 hips) that underwent primary arthroscopic FAI correction (mean 25.2 months follow-up). The mean improvement for outcomes scores after revision FAI correction was 13.7 points (MHHS, p<.01), 8.6 points (SF-12, p<.01), and 2.6 points (VAS, p<.01) compared to 23.7 points (MHHS, p<.01), 22.3 points (SF-12, p<.01), and 4.6 points (VAS, p<.01) after primary arthroscopic FAI correction. Most recent outcomes scores and mean improvement in outcome scores were significantly better after primary (81% good/ excellent results) compared to revision (63.3% good/excellent results) FAI correction (MHS (p=.012), SF-12 (p<.01), VAS (p<.01). Conclusion: With appropriate indications and expectations, arthroscopic hip revision surgery for residual FAI led to significantly improved outcome measures. Outcomes, however, were inferior to those after primary arthroscopic FAI corrective surgery.
Radiographic Evaluation of Pincer-type FAI
Authors: Skendzel Jack G. , Goljan Peter , Briggs Karen K. , Philippon Marc J. 
Published: September 2013

Objectives: Radiographic analysis is utilized by surgeons to evaluate for the presence of both cam- and pincer-type femoroacetabular impingement (FAI). Coxa profunda, in which the acetabular fossa crosses or touches the ilioischial line medially, as well as the acetabular crossover sign, in which the anterior acetabular wall is more lateral than the posterior wall, are two of the methods historically employed in making a diagnosis of pincer-type FAI. It has also been proposed that lateral center edge (LCE) angles > 40 degrees are indicative of acetabular overcoverage. Methods: Between March 2005 and September 2006, 677 consecutive patients presented to the clinic for surgical treatment of hip pain due to FAI and associated chondrolabral dysfunction. All patients underwent radiographic imaging consisting of an AP pelvis as part of a standard clinical evaluation. From these radiographs, the presence of coxa profunda, the crossover sign, and the lateral center edge angle were prospectively recorded for each patient. Patients were included in the study if they had a properly performed AP radiograph of the pelvis. Exclusion criteria included a history of avascular necrosis, previous hip fracture, systemic inflammatory disease affecting the hip, or any prior hip surgery. The incidence of coxa profunda and the acetabular crossover sign was determined. We hypothesized that coxa profunda and the crossover sign are not associated with increased lateral center edge angles. Results: There were 207 patients that met the inclusion criteria and were included in the study. The average age of the patients was 42 (range, 18 to 77). The prevalence of coxa profunda and the acetabular crossover sign was 127/207 (61.3%) and 79/207 (38.1%), respectively. The average LCE angle was 34 degrees (range, 20 to 52). There was no significant difference between LCE angles and gender (p = 0.809) and the presence of an acetabular crossover sign and gender were not associated (p = 0.468). Coxa profunda was more commonly associated with female gender (p = 0.0001). Coxa profunda was not associated with the presence of a crossover sign (p = 0.890), nor was it associated with a LCE angle greater than 40 degrees (p = 0.732). Twenty-eight hips had LCE over 40(13%). There was no significant difference in the LCE angle in patients with a positive crossover sign(34.3 vs 34.0;p = 0.657) or coxa profunda (34.6 vs 33.3;p = 0.119). Conclusion: Coxa profunda and the presence of a crossover sign are not associated with significant lateral acetabular overcoverage (LCE angles > 40 degrees). The presence of an elevated LCE angle does not always indicate acetabular overcoverage.
Hip Labral Tears among Asymptomatic Professional Hockey Players Identified on MRI
Authors: Gallo Robert A. , Silvis Matthew , Smetana Brandon , Mosher Timothy , Stuck Dan , Lynch Scott A. , Black Kevin P. 
Published: September 2013

Objectives: We have previously reported on the prevalence of pathologic hip findings on the MRIs of asymptomatic professional hockey players. The significance of these findings, found in the asymptomatic player, is unknown. The purpose of this study is to report clinical follow-up of this cohort at four years. Methods: 21 professional hockey players with no previous hip/groin pain underwent hip/pelvis MRI. Self-reported symptoms were measured using a modified Oswestry Disability Questionnaires at one and two years following MRI. Games played for each player were followed over a four-year period. Variance of games played greater than five per year compared to baseline (games played year prior to MRI) were explored for specific injury. Results: 16/21 and 14/21 minor league hockey players were available at one- and two-year follow-up, respectively. 19/21 players remained active within four years. Fourteen remained at same level, four advanced to higher level of play, and one was demoted to a lower level at the end of four years. At one-year follow-up, two players (both with labral tear) admitted to groin pain; one, who also had bilateral adductor tendinosis, eventually missed games due to lateral hip pain in the third season after the MRI. At two-year follow-up, one other player (bilateral labral tears) admitted to hip tightness for a week but did not miss any games. Of the15 players that had an asymptomatic labral tear, two players advanced to NHL, ten remained at same level, one demoted, and two retired within four-year follow-up period. Among 9 players with labral tears on original MRI and available for questioning at two years, seven had no hip or groin symptoms and only one of 3 “symptomatic” players missed any games or sought treatment. Only four players had no abnormalities on MRI. None developed symptoms within two years. 3/4 remained at same level while the other advanced to the NHL. Conclusion: Although common on MRI among asymptomatic professional hockey players, hip labral tears produce symptoms in 20% within two years, but only 6.7% result in missed games within four years due to hip-related pain.
Pre-operative Femoral Nerve Block in Hip Arthroscopy—A Retrospective Review of 108 Consecutive Cases
Authors: Dold Andrew P. , Murnaghan Michael Lucas , Brull Richard , Whelan Daniel B. 
Published: September 2013

Objectives: To evaluate the safety and efficacy of pre-operative femoral nerve block for post-operative pain control in patients undergoing hip arthroscopy. Methods: A retrospective chart review of 108 consecutive hip arthroscopy cases (in 103 patients) was carried out. All patients underwent hip arthroscopy at a single academic centre by two orthpaedic surgeons with advanced fellowship training in hip arthroscopy. All patients underwent arthroscopy under general anaesthetic with our without pre-operative femoral nerve block. Patients were separated into two groups based on the presence or absence of a pre-operative femoral nerve block prior to induction of general anesthesia. Groups were compared with respect to patient gender, age, body mass index (BMI), ASA Physical Status classification, procedure performed, operative time, total intra-operative morphine-equivalent dose, post-anesthesia care unit (PACU) pain scores (0 to 10) recorded at 0, 15, 30, 45, and 60 minutes post-operatively, total PACU morphine-equivalent dose, presence of nausea or vomiting in the PACU, time to discharge from PACU, oxycodone consumption in the surgical day care unit (SDCU), and highest pain score (0 to 10) in the SDCU prior to discharge. Results: Twelve cases were excluded from analysis for a total of 96 cases (in 92 patients). Forty patients had general anesthesia alone (Group A) and 56 patients had a pre-operative femoral nerve block prior to the induction of general anesthesia (Group B). There was no significant difference between the groups with regard to gender, age, weight, height, BMI, ASA classification, or type of procedure performed. Patients who received a femoral nerve block had a significantly shorter operative time and received a significantly lower total intra-operative morphine-equivalent dose than those patients who did not receive a block. Post-operative pain scores were lower at all time points for the femoral nerve block group, however statistical significance was seen only at the 60 minute post-operative time point (p < 0.05). Patients who did not receive a block had significantly higher morphine-equivalent doses in the PACU. There was no difference in rates of nausea and vomiting and time to discharge from the PACU between the two groups. Oxycodone consumption in the surgical day care unit (SDCU) was similar between groups, but the femoral nerve block patients had significantly lower pain scores prior to discharge from the SDCU. Two patients in Group A group were admitted to hospital post-operatively due to inadequate post-operative pain control. No complications were noted in any patient with regard to the femoral nerve block. Conclusion: A pre-operative femoral nerve block is a safe procedure that may decrease the requirement for intra-operative morphine while providing effective post-operative pain control in patients undergoing hip arthroscopy.
Functional Outcomes Following Surgical Repair of Acute and Chronic Ruptures of the Proximal Hamstring Tendons
Authors: Larson Christopher M. , Rust David , Samuelson Kathryn M. , Giveans Russell , Stone Rebecca M. 
Published: September 2013

Objectives: Surgical repair of complete ruptures of the proximal hamstring tendons have shown improved function compared with non-operative treatment, however, results have been less favorable in the setting of a chronic tendon rupture. We previously described our surgical technique using an allograft Achilles tendon reconstruction and now report on functional outcomes of a larger patient cohort with longer follow-up and compare these with patients that underwent acute primary repair. Methods: Between 2002 and 2011, 23 patients with chronic ruptures who had undergone reconstruction using an Achilles tendon allograft and 57 patients with acute ruptures who had undergone primary repair were contacted and asked to rate their current function from 0-100% for both activities of daily living and sports-related activities. Additionally, those with chronic ruptures were asked to rate their level of function after their injury and prior to surgery. Patients were also asked to complete the SF-12 and a Patient Satisfaction Questionnaire. Results: Patients who had an Achilles reconstruction for chronic tears reported significant improvement in their function from pre-surgery to post-surgery for both activities of daily living (51% vs. 90%, p < 0.01) and sports-related activities (20% vs. 68%, p < 0.01) at an average follow-up of 46.8 months. Compared with the acute repair group (average follow-up 42.3 months) those in the chronic reconstruction group reported similar function for activities of daily living (90% vs. 92%, p = 0.484), but decreased function in sports-related activities, which approached statistical significance (68% vs. 79%, p = 0.125). A higher percentage in the acute repair group reported that their hamstring felt “normal” (83% vs. 67%, p=.013). All other quality of life and satisfaction scores were similar between groups. Conclusion: Both acute repair and chronic reconstruction of complete proximal hamstring tears yield favorable results for activities of daily living. With respect to sports-related activities, acute repair yields improved function. For low-demand patients or those with medical comorbidities that preclude acute surgical treatment, initial non-operative management with the option for Achilles allograft reconstruction at a later time can be expected to give approx 90% return of function for everyday activities. For patients that desire to return to sports or higher demand activities, acute repair is recommended.
Risk factors for Recurrent Anterior Cruciate Ligament Reconstruction: A Population Study in Ontario, Canada with 5-year Follow-up
Authors: FRCSC David Wasserstein , Khoshbin Amir , Dwyer Tim , Chahal Jaskarndip , Gandhi Rajiv , Mahomed Nizar , Ogilvie-Harris Darrell 
Published: September 2013

Objectives: Anterior cruciate ligament reconstruction (ACLR) is routinely performed to treat symptomatic instability. Despite being a common procedure, significant variation persists in technique and graft choice. How patient, provider and surgical factors influence the risk of revision or contralateral primary ACLR has not been investigated using administrative data. The goal of our study was to define the rate and risk factors for ACL re-operation in Ontario. Methods: All primary elective ACLR performed in Ontario, Canada from July 2003 to March 2008 in patients aged 15 to 60 years were identified via billing, diagnosis and procedural databases. The main outcomes were revision and contralateral ACLR, sought until January 2012. Patient factors (age, gender, co-morbidity, income quintile, and length of index hospital admission), provider factors (surgeon volume, academic hospital status) and surgical factors (allograft vs. autograft; fixation: screw, button, staple; concomitant operative procedures) were used as covariates in a Cox Proportional Hazards survivorship model to generate Hazard Ratios (HR) with confidence intervals (alpha 0.05). Kaplan-Meier survivorship curves to revision were generated. Results: A total of 12,967 ACLR with a mean follow-up of 5.2 years were identified. The revision rate was 2.6% [after a median 2.72 years (interquartile range 1.38, 4.11)]. The rate of primary contralateral ACLR was 4.6% [after a median 2.71 years (interquartile range 1.49, 4.22)]. In the Cox model, younger age [15-19 years; HR=2.1 (95% CI: 1.5-2.9), p<0.001], ACLR performed at an academic hospital [HR=1.6 (95% CI: 1.2-2.1), p<0.001] and the use of allograft [HR=1.7 (95% CI: 1.1-2.6), p=0.02] significantly increased the risk of revision ACLR. The K-M curves to revision ACLR for allograft and autograft demonstrated equivalent survivorship for approximately 3 years, after which allograft ACLR were more commonly revised (Figure 1). Only younger age [15-19 years; HR=2.1, (95% CI: 1.6-2.7), p<0.001] was associated with an increased risk of contralateral ACLR. Conclusion: Contralateral ACLR was more frequent than revision ACLR in this population, while both re-operations were significantly more common in patients <20 years old. Academic hospital status but not surgeon volume, and the use of allograft also increased the risk of revision ACLR. Late failure of allograft ACLR is a novel finding.
Defining Patient Acceptable Symptom State Thresholds for the IKDC Subjective Knee Form and KOOS for Patients Undergoing ACL Reconstruction
Authors: Muller Bart , Yabroudi Mohammad A. , Lai Chung-Liang , Lynch Andrew , Harner Christopher D. , Dijk C. Niek Van , Fu Freddie H. , Irrgang James J. 
Published: September 2013

Objectives: In clinical practice and research, the magnitude of change in patient-reported outcome (PRO) is often used to assess outcome of treatment. However, a clinically meaningful change in PRO may not be associated with an acceptable state that corresponds to “feeling well”, which is also called the Patient Acceptable Symptom State (PASS). Thresholds for common PRO measures for achieving a PASS after ACL reconstruction have not been determined. The purpose of this observational cross section study was to determine thresholds for the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and the Knee Injury and Osteoarthritis Outcome Scale (KOOS) that indicate achievement of the PASS. Methods: Patients 1 to 5 years after primary ACL reconstruction completed a survey that included the IKDC-SKF and KOOS. Patients assessed satisfaction with their current state by answering the question “Taking into account all the activity you have during your daily life, your level of pain and also your activity limitations and participation restrictions, do you consider the current state of your knee satisfactory?” The IKDC-SKF and KOOS scores associated with a positive and negative response to this question were determined. Additionally, receiver operator characteristic (ROC) curves and the Youden Index were used to determine the PASS thresholds with the best sensitivity and specificity for each PRO that differentiated patients with an acceptable versus an unacceptable symptom state. Results: One hundred and sixty seven patients (mean age, 28.8±10.9 years) completed the survey. One hundred and forty six patients indicated they were in an acceptable symptom state (PASS-Y) and 21 were not (PASS-N) (Table 1). All PROs were significantly different between the PASS-Y and PASS-N groups (p<.001). Based on ROC curve analysis, threshold values that best distinguished an acceptable versus an unacceptable symptom state, with values of sensitivity and specificity, are reported in Table 1. Conclusion: Patients who did not achieve a PASS have worse IKDC-SKF and KOOS scores, indicating limitations in function, sports participation, and knee-related quality of life (QoL). The differences between PASS-Y and PASS-N for the KOOS pain, symptoms and activities of daily living (ADL) subscales were smaller than differences for sports & recreation, knee-related QoL, and the IKDC-SKF. This indicates that after ACL reconstruction, achieving an acceptable symptom state is more dependent on the ability to participate in sports than on the absence of symptoms or participation in ADL. The threshold values identified will aid in determining if patients after ACL reconstruction have achieved an acceptable symptom state based on their IKDC-SKF and KOOS scores.