bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Prospective Randomized Comparison using MRI of Two Distinct Allogenic Tissue Constructs for Anterior Cruciate Ligament Reconstruction
Authors: Rose Michael , Farooqi Mehwish , Quilici Samantha , Crawford Dennis C. 
Published: March 2015

Objectives: To compare the radiographic and clinical outcomes of anterior cruciate ligament (ACL) reconstruction using quadrupled hamstring tendon (HT) allograft vs. doubled tibialis anterior (TA) allograft. Methods: Methods: A prospective randomized controlled trial (PRCT) at a single center was conducted with enrollment from 7/2010 to 4/2012. One hundred subjects undergoing primary ACL reconstruction were randomized to either HT or TA allograft (47 vs. 53, respectively). Subjects completed KOOS, IKDC, Tegner, VR-12, and Lysholm outcomes measure pre-operatively, and then post-operatively at the 6 month and 24 month time period. Arthrometric testing using KT-1000 (MEDmetric® Corporation) was applied at 6 months post-operatively. At this time patients also underwent MRI to evaluate allograft integrity and ligamentization. The signal to noise quotient (SNQ) was calculated via the Impax markup tool (Afga HealthCare®) using sagittal non-contrast T2 weighted MRI (Figure 1) as follows: SNQ = (Signal graft - Signal Quadriceps)/Signal Background Results: MRIs were obtained in the HT (n=22, 53%, 205.6 ± 35.7 days) and TA (n=23, 47%, 187.3 ± 26.0 days) groups. The average SNQ for the HT and TA allografts were .94 ± 3.03 and 4.14 ± 3.64, respectively (p = 0.12). There was no correlation between MRI SNQ and subject age, BMI, sex, graft diameter or smoking status. With arthrometric testing there was a trend for the HT allografts to have increased laxity as compared to contralateral side but the magnitude of difference was not clinically relevant (average 0.88 vs. 0.40mm, respectively). At an average of 2.4 ± 0.4 years there was no difference detected between groups in any of the outcomes scores with each showing improvement from baseline (Table 1). Allograft re-tear rates were similar between groups (9.5% HT vs. 4.5% TA, p=1.0). Conclusion: Limited data exists directly comparing different ACL allograft soft tissue constructs. Specifically, to the author’s knowledge this is the first prospective RCT comparing quadrupled hamstring tendon and doubled tibialis anterior allografts. Our data indicate no difference in graft failure rate, rate of ligamentization, and similar significant improvement from baseline with respect to subjective outcomes scores between each treatment group after more than two years.
Arthroscopic Repair of Anterior Labroligamentous Periosteal Sleeve Avulsion Lesions Does Not Have an Increased Failure Rate Compared to Arthroscopic Bankart Repair
Authors: Shaha James S. , Song Daniel J. , Cook Jay B. , Rowles Douglas J. , Bottoni Craig R. , Shaha Steven H. , Tokish John M. 
Published: March 2015

Objectives: Anterior labroligamentous periosteal sleeve avulsion lesions (ALPSA) have been identified as a potential risk factor for failure of an arthroscopic labral repair. The objective of this study was to compare the failure rates and clinical outcomes of arthroscopic ALPSA repair to arthroscopic Bankart repair. Additionally, the role of glenoid bone loss on failure rates was analyzed within each group. Methods: This was a retrospective review of 72 consecutive patients with anterior shoulder instability (73 shoulders) who underwent an anterior arthroscopic labral repair at a single military institution by one of three Sports medicine fellowship trained orthopaedic surgeons. At the time of surgery, a diagnostic arthroscopy identified 13 (17.8%) ALPSA lesions and 60 (82.2%) isolated Bankart lesions. All lesions were repaired and placed on standard post-operative protocol. Data was collected on demographics, the Western Ontario Shoulder Instability (WOSI) score, SANE score, and recurrence rates. Failure was defined as recurrent dislocation. Additionally, glenoid bone loss in all patients was calculated using a standardized technique on preoperative images. Outcomes were analyzed by type of initial lesion. The effect of bone loss on failure rate was analyzed between and within groups. Results: The average age at surgery was 26.3 years (range, 20-42) with an average follow-up of 53.3 months (range, 28-63). There were 13 distinct ALPSA lesions and 60 Bankart lesions identified on diagnostic arthroscopy. There were no significant differences between groups with respect to any demographic data. There was 1 failure (7.7%) in the ALSPA group and 8 failures (13.3%) in the Bankart group (p=0.10). There was no significant difference between groups for WOSI or SANE scores. There was no significant difference in glenoid bone loss between groups. The ALPSA group had 13.1% glenoid bone loss compared to 13.5% in the Bankart group (p=0.88). Conclusion: Contrary to previously published data, we did not find patients with ALPSA lesions to be at an increased risk for failure of an arthroscopic repair compared to an isolated Bankart repair, nor was there a difference in functional outcomes between groups. Finally, the presence of an ALPSA lesion was not predictive on increased glenoid bone loss in this population.
Clinical Outcomes Following Revision Shoulder Arthroscopic Capsulolabral Stabilization
Authors: Shin Jason J. , Mascarenhas Randhir , Yanke Adam Blair , Nicholson Gregory P. , Cole Brian J. , Romeo Anthony A. , Verma Nikhil N. 
Published: March 2015

Objectives: The purpose of this study was to assess clinical outcomes in patients following revision shoulder arthroscopic capsulolabral stabilization. The hypothesis was that revision arthroscopic stabilization would offer predictable clinical outcomes in appropriately selected patients. Methods: Sixty-two patients (63 shoulders) with failure of primary instability repairs were treated with revision arthroscopic shoulder stabilization at a mean follow-up of 46.9 ± 16.8 months (range, 15-78). Forty-six male patients and 16 females with a mean age of 23.2 ± 6.9 years (range, 14.7 - 47.2) met the inclusion criteria for the study. Revision arthroscopic stabilization was indicated in patients with recurrent instability with limited glenoid bone loss. Clinical outcomes were evaluated using validated patient reported outcome questionnaires including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, visual analog pain scale and Western Ontario Shoulder Instability Index. In addition, patients were queried for recurrent instability events (subluxation or dislocation) or revision surgery. Results: At final follow-up, the mean post-operative Western Ontario Shoulder Instability normalized score was 80.1 (range, 15.0 - 100). There were clinically significant improvements in American Shoulder and Elbow Surgeons scores from 63.7 pre-operatively to 85.1 post-operatively (P < 0.001), Simple Shoulder Test scores from 61.8 pre-operatively to 90.9 post-operatively (P < 0.001), and VAS pain scores from 2.89 pre-operatively to 0.81 post-operatively (P < 0.001). Recurrent instability occurred in 12 shoulders (19.0 %), with number of prior surgeries and hyperlaxity found to be significant risk factor for failure (P < 0.001 and P = 0.04, respectively). Conclusion: Arthroscopic revision stabilization of the shoulder can result in satisfactory outcomes in patients who have failed previous capsulolabral repair. Increased number of prior surgeries and hyperlaxity are predictive of poor outcome. Longer-term studies are required to determine whether similar results are maintained over time, and to provide guidance on focused clinical indications.
Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Autograft Versus Allograft in Young Patients
Authors: Atanda Alfred , O’Brien Daniel Francis , Kraeutler Matthew John , Flato Russell R. , Salminen Matthew Robert , Henrichsen Kevin , Kane Patrick , Dodson Christopher C. , Cohen Steven B. , Ciccotti Michael G. 
Published: March 2015

Objectives: Traditionally, bone-patella tendon-bone (BTB) autograft has been the gold standard graft choice for younger, athletic patients requiring ACL reconstruction. However, donor site morbidity, post-operative patella fracture, and increased operative time have led many surgeons to choose BTB allograft for their reconstructions. Opponents of allografts feel that slower healing time, higher rate of graft failure, and potential for disease transmission makes them undesirable graft choices in athletic patients. The purpose of this study is to evaluate the clinical outcomes, both subjective and objective, of young patients that who have undergone either BTB autograft or allograft reconstructions with a minimum of 2-year follow-up. Methods: One hundred and twenty patients (60 autograft, 60 allograft), age 25 and below at time of surgery, were contacted after being retrospectively identified as patients having an ACL reconstruction with either a BTB allograft or autograft by one senior surgeon. Patients were administered the Lysholm Knee Scoring Scale and IKDC Subjective Knee Evaluation questionnaires. Fifty (25 BTB autograft and 25 BTB allograft) of the 120 returned for physical examination as well as completion of a single leg hop test and laxity evaluation using a KT-1000 arthrometer evaluation. Of the 120 patients contacted, there were a total of 7 failures (5.8%) requiring revision, 6 in the allograft group (86%) and 1 in the autograft group (14%). Results: The average Lysholm scores were 89.0 and 89.56 and the average IKDC scores were 90.8 and 92.1 in the autograft and allograft groups respectively. The differences in the Lysholm scores and the IKDC scores were not significant. The single leg hop and KT-1000 scores were also not significantly different. One autograft patient had a minor motion deficit. Three allograft patients had a grade 1 Lachman and pivot glide. One autograft patient and two allograft patients had mild patellafemoral crepitus. There was no significant difference in anterior knee pain between the two groups Conclusion: There is no significant difference in patient-rated outcome between ACL reconstructions using BTB autografts versus allografts. However, the overall study group did reveal an increased failure rate requiring revision in the allograft group.
Does Chondrolysis Occur after Corticosteroid-analgesic Injections? An Analysis of Patients Treated for Adhesive Capsulitis of the Shoulder
Authors: Baumgarten Keith M. , Helsper Elizabeth 
Published: March 2015

Objectives: There has been growing concern about the deleterious effects of local anaesthetics on articular cartilage. Clinical studies using continuous infusions of local anaesthetics and basic science studies that model both continuous and single injection of local anaesthetics have demonstrated chondrotoxicity. However, clinical studies do not exist that assess for the risk of chondrolysis on non-arthritic joints exposed to single or intermittent corticosteroid/analgesic injections. Methods: A retrospective review of patient treated for adhesive capsulitis of the shoulder with at least one intra-articular injection of corticosteroid and local anaesthetic was performed. Inclusion criteria were a diagnosis of primary or intrinsic and systemic secondary adhesive capsulitis and a minimum two year follow-up period. Exclusion criteria were patients with extrinsic secondary adhesive capsulitis. Prospective follow-up was performed to obtain patient-determined outcome scores, range of motion, and radiographs to determine the presence of chondrolysis. Results: Fifty-six patients with a mean age of 52.5+7.23 years were enrolled in this study at a mean follow-up of 54 months. The mean number of injections performed was 1.45+0.69 (range 1-4). The mean amount of methylprednisolone acetate used per patient was 111 mg (range 80-320 mg). A mean of 3 ml 0.25% bupivicaine (range 0-12 ml), 2.94 ml of 0.5% bupivicaine (range 0-8.5 ml), and 5.46 ml 1% lidocaine (range 0-16.5 ml) was used per patient. At final follow-up, the mean WOOS was 91.4+14.2%, DASH was 6.66+9.60, SPADI was 7.41+11.4, and SANE was 92.7+10.1%. The Shoulder Activity Score was 8.25+4.71. Initial mean active forward elevation was 110+24º and external rotation was 13+19º. At final follow-up, mean forward elevation (155+11º) and external rotation (65+14º) were improved (P<0.0001). Passive and active forward elevation, external rotation, internal rotation, and cross-body adduction demonstrated no significant differences with the unaffected contralateral shoulder. There was no radiographic evidence of chondrolysis in any patient. Twelve patients (21.4%) did not respond to the nonoperative treatment and required arthroscopic capsular release. Conclusion: This study did not demonstrate chondrolysis in patients treated with intraarticular corticosteroid and local anaesthetic for adhesive capsulitis. At final follow-up, this cohort had normalized patient-derived outcome scores and symmetric range of motion with the contralateral shoulder. The findings of this study do not support the cessation of using intraarticular analgesic/corticosteroid injections for the treatment of adhesive capsulitis. However, the authors do recommend caution and surveillance with continued intra-articular use of corticosteroid/anaesthetic combinations.
Functional Outcomes of Anatomic Anterior Cruciate Ligament Reconstruction: Accessory Medial Portal versus Transtibial
Authors: Stucken Charlton , Flato Russell R. , Salminen Matthew Robert , Cohen Steven B. 
Published: March 2015

Objectives: Transtibial (TT) and accessory medial portal (AM) techniques are two of the most widely used methods for drilling the femoral tunnel in anterior cruciate ligament (ACL) reconstructions, both with the common goal of placing the graft centrally or anatomically in the ACL footprint. While previous studies have looked at drilling through a standard anteromedial portal, no study has investigated clinical outcomes, femoral tunnel length, and radiographic evaluation after drilling from either an AM portal or TT technique. The purpose of this paper is to compare these results for a single surgeon performing “anatomic” ACL reconstruction. In addition to the femoral tunnel lengths, radiographic tunnel obliquity and femoral starting points were compared between the two methods. Methods: Over a three-year period all patients who underwent anatomic ACL reconstruction by a single surgeon were evaluated for eligibility. During surgery, the center of the anatomic femoral footprint (just posterior to the bifurcate ridge) was marked with an awl viewed through the medial portal and the tibial tunnel was drilled first. If the exact mark could be reached through a transtibial approach using a freehand pin (no guide), then it was utilized; otherwise, an accessory medial portal was created and used for femoral drilling (with the knee placed in hyperflexion). Seventy-five patients met inclusion criteria for evaluation of tunnel length and radiographic analysis (tunnel obliquity, clockface starting point). The mean age of the patient population was 29.8 (+/- 10.3). Functional outcomes (IKDC scores) were evaluated at a minimum of 24 month follow-up (Avg = 26 months; range:24-32 months). Results: In the study group of 75 patients (TT group, 47; AM group, 28) there were no significant differences between AM (74.8 +/- 13.6) and TT (75 +/- 12.9) with regard to postoperative IKDC score (p = 0.95). There was a significant difference (p < 0.001) between femoral tunnel lengths, with AM tunnels averaging 34.5mm (+/- 3.3) and TT tunnels averaging 42.13 mm (+/- 6.3). There was a significant difference in femoral tunnel obliquity (AM 39.5 +/- 6.45 degrees, TT 27.2 +/- 7.7 degrees, p<0.001) and femoral starting point (AM 9:59 o’clock +/- 20 mins, TT 10:12 o’clock +/- 18 mins, p<0.001) on AP radiograph. Conclusion: This study demonstrates no significant difference in functional outcomes for ACL reconstruction between AM and TT techniques when the femoral starting point is independently judged as anatomic between techniques. Nearly 40% of the time the anatomic femoral footprint could not be reached from a TT portal and thus conversion to AM was necessary. AM tunnel lengths of less than 30mm were rare in this study.
Effect of transfusion of fresh frozen plasma on parameters of endothelial condition and inflammatory status in non-bleeding critically ill patients: a prospective substudy of a randomized trial
Authors: Straat Marleen , Müller Marcella CA , Meijers Joost CM , Arbous Mendi S , Spoelstra - de Man Angelique ME , Beurskens Charlotte JP , Vroom Margreeth B , Juffermans Nicole P 
Published: March 2015

AbstractIntroductionMuch controversy exists on the effect of a fresh frozen plasma (FFP) transfusion on systemic inflammation and endothelial damage. Adverse effects of FFP have been well described, including acute lung injury. However, it is also suggested that a higher amount of FFP decreases mortality in trauma patients requiring a massive transfusion. Furthermore, FFP has an endothelial stabilizing effect in experimental models. We investigated the effect of fresh frozen plasma transfusion on systemic inflammation and endothelial condition.MethodsA prospective predefined substudy of a randomized trial in coagulopathic non-bleeding critically ill patients receiving a prophylactic transfusion of FFP (12 ml/kg) prior to an invasive procedure. Levels of inflammatory cytokines and markers of endothelial condition were measured in paired samples of 33 patients before and after transfusion. The statistical tests used were pairedttest or the Wilcoxon signed-rank test.ResultsAt baseline, systemic cytokine levels were mildly elevated in critically ill patients. FFP transfusion resulted in a decrease of levels of TNF-α (from 11.3 to 2.3 pg/ml,P = 0.01). Other cytokines were not affected. FFP also resulted in a decrease in systemic syndecan-1 levels (from 675 to 565 pg/ml,P = 0.01) and a decrease in factor VIII levels (from 246 to 246%,P<0.01), suggestive of an improved endothelial condition. This was associated with an increase in ADAMTS13 levels (from 24 to 32%,P<0.01) and a concomitant decrease in von Willebrand factor (vWF) levels (from 474 to 423%,P<0.01).ConclusionsA fixed dose of FFP transfusion in critically ill patients decreases syndecan-1 and factor VIII levels, suggesting a stabilized endothelial condition, possibly by increasing ADAMTS13, which is capable of cleaving vWF.Trial registrationsTrialregister.nlNTR2262, registered 26 March 2010 and Clinicaltrials.govNCT01143909, registered 14 June 2010.
The administration of dextrose during in-hospital cardiac arrest is associated with increased mortality and neurologic morbidity
Authors: Peng Teng J , Andersen Lars W , Saindon Brian Z , Giberson Tyler A , Kim Won Young , Berg Katherine , Novack Victor , Donnino Michael W ,   for the American Heart Association’s Get With The Guidelines®-Resuscitation Investigators
Published: March 2015

Abstract
Introduction
Dextrose may be used during cardiac arrest resuscitation to prevent or reverse hypoglycemia. However, the incidence of dextrose administration during cardiac arrest and the association of dextrose administration with survival and other outcomes are unknown.

Methods
We used the Get With The Guidelines®-Resuscitation national registry to identify adult patients with an in-hospital cardiac arrest between the years 2000 and 2010. To assess the adjusted effects of dextrose administration on survival, we used multivariable regression models with adjustment for multiple patient, event, and hospital characteristics. We performed additional analyses to examine the effects of dextrose on neurological outcome and return of spontaneous circulation.

Results
Among the 100,029 patients included in our study, 4,189 (4.2%) received dextrose during cardiac arrest resuscitation. The rate of dextrose administration increased during the study period (odds ratio 1.11, 95% confidence interval (CI) 1.09-1.12 per year, P <0.001). Patients who received dextrose during resuscitation had lower rates of survival compared with patients who did not receive dextrose (relative risk 0.88, 95% CI 0.80-0.98, P = 0.02). Administration of dextrose was associated with worse neurological outcome (relative risk 0.88, 95% CI 0.79-0.99, P = 0.03) but an increased chance of return of spontaneous circulation (relative risk 1.07, 95% CI 1.04-1.10, P <0.001).

Conclusions
In this dataset, the administration of dextrose during resuscitation in patients with in-hospital cardiac arrest was found to be associated with a significantly decreased chance of survival and a decreased chance of good neurological outcome.
Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study
Authors: Umbrello Michele , Formenti Paolo , Longhi Daniela , Galimberti Andrea , Piva Ilaria , Pezzi Angelo , Mistraletti Giovanni , Marini John J , Iapichino Gaetano 
Published: March 2015

Abstract
Introduction
Pressure-support ventilation, is widely used in critically ill patients; however, the relative contribution of patient’s effort during assisted breathing is difficult to measure in clinical conditions. Aim of the present study was to evaluate the performance of ultrasonographic indices of diaphragm contractile activity (respiratory excursion and thickening) in comparison to traditional indices of inspiratory muscle effort during assisted mechanical ventilation.

Method
Consecutive patients admitted to the ICU after major elective surgery who met criteria for a spontaneous breathing trial with pressure support ventilation were enrolled. Patients with airflow obstruction or after thoracic/gastric/esophageal surgery were excluded. Variable levels of inspiratory muscle effort were achieved by delivery of different levels of ventilatory assistance by random application of pressure support (0, 5 and 15 cmH2O). The right hemidiaphragm was evaluated by B- and M-mode ultrasonography to record respiratory excursion and thickening. Airway, gastric and oesophageal pressures, and airflow were recorded to calculate indices of respiratory effort (diaphragm and esophageal pressure–time product).

Results
25 patients were enrolled. With increasing levels of pressure support, parallel reductions were found between diaphragm thickening and both diaphragm and esophageal pressure–time product (respectively, R = 0.701, p < 0.001 and R = 0.801, p < 0.001) during tidal breathing. No correlation was found between either diaphragm or esophageal pressure–time product and diaphragm excursion (respectively, R = −0.081, p = 0.506 and R = 0.003, p = 0.981), nor was diaphragm excursion correlated to diaphragm thickening (R = 0.093, p = 0.450) during tidal breathing.

Conclusions
In patients undergoing in assisted mechanical ventilation, diaphragm thickening is a reliable indicator of respiratory effort, whereas diaphragm excursion should not be used to quantitatively assess diaphragm contractile activity.