bluuebunny/crossref_metadata_2025_split huggingface dataset:
Glenoid Bone Loss in Posterior Shoulder Instability: Prevalence and Implications in Arthroscopic Treatment
Authors: Hines Adam Christopher , Cook Jay B. , Shaha James S. , Krul Kevin P. , Tokish John M. 
Published: August 2014

Objectives: Glenoid bone loss is a well accepted risk factor for failure after arthroscopic stabilization of anterior glenohumeral instability. While less common than its anterior counterpart, posterior glenohumeral instability can be a significant source of disability in a young athletic population. It has been reported in as high as 10% of all glenohumeral instability cases. Bone loss in posterior instability, however, has been rarely discussed, and it is unknown whether this is commonly present, or clinically significant, in the treatment of posterior glenohumeral instability. Methods: A retrospective review was conducted at an active Military Treatment Facility (MTF) over a five-year period, between 1 Apr 2006 and 31 May 2011. Isolated, primary posterior instability cases which underwent arthroscopic posterior labral repair were identified. Preoperative imaging was available in all patients, and posterior glenoid bone loss was calculated using a standardized “perfect circle” technique often employed in the measurement of bone loss in anterior instability. All medical records were then reviewed to identify complications and reoperation rates from the primary repair. Patients were divided into two groups based on percentage bone loss. Outcomes were analyzed across all patients and within these groups. Results: There were 47 consecutive cases of primary, isolated posterior instability cases, with 44 males and 3 females. The average age at the time of surgery was 28.6 (range 20-47), 19 were documented to have returned to full duty. Posterior glenoid bone loss in excess of 10% was found in 15/47 (32%) of patients, while an additional 26% had no bone loss noted. Greater than 20% bone loss was noted in 2/47 (4.3%). The average across the cohort was 7.6% (range 0-21.5%). Bone loss was associated with younger age. Those with >10% loss had an average age of 25.6 years compared to 30.1 years in those with <10% bone loss (p=0.03). Those with >10% were not associated with lower return to duty, higher complications (i.e. persistent symptoms), or increased return to the operating room. Those who returned to full active duty did not have a significantly decreased bone loss versus those who did not (6.5 vs 8.3%, p=0.17). Conclusion: Posterior instability accounts for up to 10% of all glenohumeral instability. It carries a more an insidious onset, and acute dislocations are not as commonly reported. While anterior glenoid bone loss is known to significantly affect patient outcomes for anterior glenohumeral instability, our data suggests posterior glenoid bone loss may not have as direct of a clinical correlation to patient outcomes.
Recurrence Of Cam Lesions: A Two-year Follow-up
Authors: Gupta Asheesh , Redmond John M. , Dunne Kevin F. , Finch Nathan , Stake Christine E. , Domb Benjamin G. 
Published: August 2014

Objectives: Early skepticism of surgery for femoroacetabular impingement arose in part from suspicion that the cam lesion on the femoral head-neck junction would recur after initial resection. There are currently no studies that have looked at the recurrence of the cam lesion after femoral neck osteoplasty for femoroacetabular impingement (FAI). While Patient Related Outcome (PRO) scores at mid-term follow-up have shown continued success, the maintenance of a normalized alpha-angle has not been shown radiographically. The purpose of the study was to assess the radiographic recurrence of cam deformity at 2-year follow-up after adequate decompression during the index hip arthroscopy and correlate with PRO scores. Our hypothesis is there will be no recurrence or regrowth of the cam deformity at the two-year postoperative time-point following adequate cam decompression during hip arthroscopy. Methods: Between March 2009 and January 2011 data was prospectively collected on all patients undergoing hip arthroscopy with femoral neck osteoplasty. Inclusion criteria consisted of all patients during the study period with preoperative alpha angles greater than 60 degrees and postoperative alpha angle less than 50 degrees after femoral osteoplasty. Minimum follow-up was two years with radiographic images for review. Results: A total of 47 patients met inclusion criteria. The mean age of our study group was 37.18 (31.7 - 47.43) years at the start of the study. There were 28 males (59.57%) and 19 females (40.43%). The mean follow-up was 28.32 months. Mean preoperative alpha angle (Dunn view) was 70 degrees (60-97 degrees). At 2-week postoperative follow-up, the mean alpha angle was 42.79 degrees (32-50 degrees) (p<.0001). The 2-year alpha angle was 42.72 degrees (32-54 degrees) which was not significantly different compared to the 2-week alpha angle (p = 0.93). Additionally, mean preoperative femoral offset was 3.7 mm (0-9.9 mm). Mean two-week postoperative femoral offset measurement was 7.8 mm (0.3 -13.9 mm) which was significantly different (p<.0001). Two-year postoperative femoral offset measurement was 8.0 mm (2.4-12.8 mm) which was not significantly different compared to the 2-week femoral offset measurement (p = 0.63). All Patient Related Outcome (PRO) scores were significantly improved at 3 months compared to preoperative scores and continued to show improvement except for Visual Analog Scale (VAS) at 2-year follow-up. Conclusion: There is no recurrence of cam deformity at 2-years following femoral neck osteoplasty for FAI with improved PRO scores at the 3-month and 2-year postoperative time-points.
Microfracture Of The Hip: A Two-year Follow-up With A Matched-pair Control Group
Authors: Domb Benjamin G. , Gupta Asheesh , Dunne Kevin F. , Stake Christine E. , Redmond John M. 
Published: August 2014

Objectives: Full thickness chondral defects have been suggested to portend poor prognosis in hip arthroscopy. Although there is a small amount of data suggesting favorable outcomes with microfracture for such cases, no comparative studies have been performed to assess outcomes of full thickness chondral defects treated with microfracture. The purpose of this study is to compare two-year clinical outcomes of patients treated with microfracture to a matched control group that did not have full thickness chondral damage. Methods: During the study period, between June 2008 and July 2011, data were collected on all patients treated with hip arthroscopy who underwent microfracture. A matched-pair control group of patients who did not undergo a microfracture procedure was selected in a 1:2 ratio. Matching criteria were age within 5 years, sex, surgical procedures, and radiographic findings. All patients were assessed pre- and post-operatively with 4 patient-reported outcome (PRO) measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sport Specific Subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS), and satisfaction was measured on a scale from 0 to 10. Results: Forty-nine hips were included in the microfracture group and 98 in the control group. There was no significant difference in pre-operative PRO scores between the groups. For the microfracture group, the score improvement from preoperative to 2-year follow-up was 57.5 to 75.4 for mHHS, 53.6 to 71.8 for NAHS, 59.5 to 79.1 for HOS-ADL, and 35.5 to 55.5 for HOS-SSS. For the control group, the score improvement from preoperative to 2-year follow-up was 59.2 to 79.5 for mHHS, 54.4 to 76.2 for NAHS, 60.6 to 80.4 for HOS-ADL, and 38.6 to 64.2 for HOS-SSS. Both groups demonstrated statistically significant postoperative improvement in all scores (p <.05). All post-operative PRO scores, and all improvements in PRO scores, were found to be similar between the study and control groups. Conclusion: Our study demonstrated that patients receiving microfracture during hip arthroscopy did not show a statistically significant difference in PRO scores when compared to a matched-pair control group at two year follow-up. Both groups demonstrated significant improvement in all PRO scores. These results show that microfracture appears to be a viable treatment option for grade IV cartilage damage identified at the time of hip arthroscopy. Furthermore, full thickness chondral defects may not necessarily portend an inferior functional prognosis when treated with microfracture
Trends in the Presentation, Management and Outcomes of Little League Shoulder
Authors: Heyworth Benton E. , Martin Daniel , Kramer Dennis , Kocher Mininder S. , Bae Donald S. 
Published: August 2014

Objectives: With rising participation in youth sports such as baseball, proximal humeral epiphysiolysis (“Little league Shoulder,” LLS), is being seen with increasing frequency. However, there remains a paucity of literature regarding the causes or outcomes of LLS. This study’s purpose was to analyze the demographics, symptoms, diagnosis, and treatment of LLS, with an emphasis on identifying underlying risk factors for development and recurrence of LLS. Methods: A departmental database at a single pediatric referral center was queried to identify cases of LLS between 1999 and 2013, which were reviewed to analyze age, sex, physical examination and radiologic findings, treatment details, and rates of recurrence. Results: 95 patients (93 males; mean age 13.1 years, range 8-17 years) were diagnosed with LLS, with volumes increasing over the study period (Figure 1). In addition to the primary complaint of shoulder pain with overhead athletics seen in all patients, 13% reported elbow pain, 10% reported shoulder fatigue or weakness, and 8% reported mechanical symptoms. While the vast majority of patients (97%) were baseball players (86% pitchers, 8% catchers, 7% other positions), 3% were tennis players. On physical exam, 30% were reported to have glenohumeral internal rotation deficit (GIRD). Treatment recommendations included rest in 98% of cases, physical therapy in 79% (100% of patients with GIRD), and position change upon return to play in 25%. Average time to resolution of symptoms was 2.6 months, while average time to return to competition was 4.2 months. Recurrent symptoms were reported in 7.4% in the overall population at a mean of 8 months following symptom resolution. The odds ratio of recurrence between the group with diagnosed GIRD (14.3%) and those without GIRD (4.5%) was approximately 3:1. Conclusion: Little league shoulder is being diagnosed with increasing frequency. While most common in male baseball pitchers, the condition can occur in females, youth catchers, other baseball positions players, and tennis players. Concomitant elbow pain may be seen in up to 13%. After rest and physical therapy, recurrent symptoms can occur, generally 6-12 months after return to sports. Almost one-third of LLS patients with had GIRD, and this group had three times higher probability of recurrence compared to those without GIRD.
The Effects of Ulnar Collateral Reconstruction on Major League Pitching Performance
Authors: Keller Robert A. , Steffes Matt , Zhuo David , Bey Michael J. , Moutzouros Vasilios 
Published: August 2014

Objectives: A tremendous stress is placed on the elbow while pitching a baseball. Due to these stresses, Major League Baseball (MLB) pitchers are at increased risk for Ulnar Collateral Ligament (UCL) injuries. Previous studies have been limited in sample size, but have shown most players return to previous uninjured statistical levels after undergoing UCL reconstruction. We sought the largest cohort of MLB pitchers who have undergone UCL reconstruction and hypothesized that MLB pitchers do not return to their pre-injury statistical level after undergoing UCL reconstruction. Methods: The statistics for 168 major league pitchers, who threw at least one season at the Major League level and subsequently underwent UCL reconstruction, were reviewed. Statistical data including earned run average (ERA), walks and hits per innings pitched (WHIP), win percentage, innings pitched, and salary were compared for the 3 years before and 3 years after undergoing UCL reconstruction. This data was compared to 178 age matched controlled MLB pitchers. All data was analyzed to determine the effects of UCL injury/reconstruction on pitching performance. Risk factors for reconstruction were analyzed using a multivariable generalized estimating equation (GEE) model Results: Of the pitchers undergoing UCL reconstruction surgery 87% returned to the Major League Level. Of the pitchers that returned, they had a statistically significant decline in their ERA (P=0.001), WHIP (P=0.011), Innings Pitched (0.026), compared to pre-reconstruction performance. Reconstructed pitchers had a statistically significant decline in their pitching statistical performance in the season before their surgery (ERA p=0.014, WHIP p=0.036, Innings pitched p<0.001, Win Percentage p=0.004). Approximately 60% of pitchers requiring UCL reconstruction had surgery with in the first 5 years of being in the Major Leagues. Compared to age matched controls, the reconstructed pitchers had statistically more major league experience at the same age suggesting that arm stress from earlier Major League experience contributed to injury. This was validated by a multivariable GEE model that examined risk factors showing an increase in MLB experience being a risk factor for requiring surgery (p<0.001). Conclusion: This is the largest cohort of MLB pitchers, to date, that have undergone UCL reconstruction. Its results suggest that UCL reconstructive surgery does a tremendous job in allowing players to return to their same level of sport. This study is the first to describe a decline in pitching performance after undergoing reconstruction. It also found that there is a statistically significant decline in pitching performance the year before reconstructive surgery and this decline was found to be a risk factor for requiring surgery. We also found that there is an increased risk of players requiring surgery if they enter the Major Leagues at a younger age.
MRI Evaluation of the Anterolateral Ligament of the Knee In The Setting of ACL Rupture
Authors: Wodicka Ross , Jose Jean , Baraga Michael G. , Kaplan Lee D. , Lesniak Bryson P. 
Published: August 2014

Objectives: The anterolateral ligament (ALL) of the knee was recently described in the literature. It was hypothesized to help control internal tibial rotation and affect the pivot shift phenomenon. The purpose of this study was to identify the normal appearance of the ALL on magnetic resonance imaging (MRI) and to examine its role in stability of the knee. Methods: A retrospective chart review was performed and 50 patients from a single surgeon’s practice with full thickness anterior cruciate ligament tears over a 2 year period were selected at random. Operative reports detailing the pivot shift examination under anesthesia were documented. Preoperative MRIs were reviewed by a fellowship trained musculoskeletal radiologist. Axial, sagittal, and coronal cuts were used to identify the presence and degree of injury to the ALL (Grade 0-3). The popliteus tendon, lateral collateral ligament, biceps femoris tendon, and iliotibial band were analyzed and graded 0-3. The presence or absence of a Segond fracture was noted. Results: The ALL was identified in 100% of the anterior cruciate ligament deficient knees evaluated. In 27 knees, there was no MRI evidence of ALL injury (Grade 0). A grade 1 injury was noted in 18 knees. A grade 2 injury was noted in 2 knees. A grade 3 injury was observed in only 1 knee. This was the same knee in which the single Segond fracture among the group was noted. Eighty four percent (42/50) of knees showed a positive pivot shift on examination under anesthesia. A positive pivot shift was noted in 37 patients who had no (Grade 0) or mild (Grade 1) ALL injury. Thirteen MRIs showed evidence of injury to the posterolateral corner structures, with 92% (12/13) consisting of mild (Grade 1) injuries. Conclusion: The anterolateral ligament of the knee is readily identifiable on MRI. Its structural integrity was maintained in the overwhelming majority of knees with a complete tear of the ACL, both with and without the presence of rotatory instability on examination. We found no correlation between degree of injury to the ALL and degree of instability. The only complete rupture of the ligament was in the setting of complete rupture of the IT band, which supports its identity as an extension of the IT band. Therefore, we propose that the ALL in itself plays a minimal if any role in stability of the knee. Further biomechanical studies are needed to confirm this.
Autograft vs Allograft ACL Reconstructions: A Prospective, Randomized Clinical Study with Minimum 10 Year Follow-up
Authors: Bottoni Craig R. , Smith Eric L. , Raybin Sarah G. , Shaha James S. , Shaha Steven H. , Tokish John M. , Rowles Douglas J. 
Published: August 2014

Objectives: To evaluate the long-term results of primary Anterior Cruciate Ligament (ACL) reconstructions using either allograft or autograft. Methods: From June 2002 to August 2003, patients with a symptomatic ACL deficient knee were randomized to either hamstring autograft (AUTO) or tibialis posterior allograft (ALLO). All allografts were from a single tissue bank, aseptically processed and fresh frozen without terminal irradiation. Graft fixation was identical in all knees. All patients followed the same post-operative rehabilitation protocol, blinded to the therapists. Preoperative and postoperative assessments were performed via examination and/or telephonic and internet-based questionnaire to ascertain functional and subjective status using established knee metrics. The primary outcome measures were graft integrity, subjective knee stability and functional status. Results: There were 99 patients (100 knees); 87 were male and 95 active duty military. Both groups were similar in demographics and preoperative activity level. The mean and median age of both groups was identical at 29 and 26, respectively. Concomitant meniscal and chondral pathology, microfracture and meniscal repairs performed at the time of reconstruction were similar in both groups. At a minimum 10 years (range: 120-134 mos) from surgery, 96 pts (97 knees) were contacted (2 patients were deceased and 1 was unable to be located). There were 4 (8.3%) autograft and 13 (26.5%) allograft failures which required revision reconstruction. In the remaining patients whose graft was intact, there was no difference in the mean SANE, Tegner, or IKDC scores. Conclusion: At a minimum of 10 years following ACL reconstruction in a young athletic population, over 80% of all grafts were intact and had maintained stability. However, those patients who had an allograft, failed at a rate over three times higher than those reconstructed with a autograft.
ACL Injury, Return To Play And Reinjury In The Elite, Collegiate Athlete: An Analysis Of A Single, Division I NCAA Cohort
Authors: Kamath Ganesh V. , Murphy Timothy , Creighton Robert A. , Taft Timothy N. , Spang Jeffrey T. 
Published: August 2014

Objectives: Graft survivorship, reinjury rates, and career length are poorly understood after ACL reconstruction in the elite, NCAA Division-I athlete. The purpose of this study was to examine the outcomes of ACL reconstruction in a Division-I athlete cohort. Methods: Retrospective chart review was performed of all Division-I athletes at a single, public university from 2000 to 2009 until completion of eligibility. Athletes with a Pre-collegiate (PC) and Intra-collegiate (IC) ACL reconstruction were separated into two cohorts. Graft survivorship, reoperation rates, and career length information was collected. Results: 35 athletes were identified with a pre-collegiate (PC) ACL reconstruction; 60 with an intra-collegiate (IC) reconstruction. The PC group had a 17.1% injury rate to the original graft, with a 20.0% rate of contralateral ACL injury. For the IC group, the reinjury rates were 1.9% to the ACL graft, with a 9.2% rate of contralateral ACL injury after an IntraCollegiate ACL reconstruction. The PC group used 78% of their total eligibility (avg 3.11 yrs). Athletes in the IC group used an average of 77% of their remaining NCAA eligibility. 88.3% of the IC group played an additional non-redshirt year after their injury. Reoperation rate for the PC group was 51.4% and 20.3% for the IC group. Conclusion: Reoperation and reinjury rates are high after ACL reconstruction in the Division-I athlete. Pre-collegiate ACL reconstruction is associated with a very high rate of repeat ACL reinjury to the graft or opposite knee (37.1%). The majority of athletes are able to return to play after successful reconstruction.
Lateral Tibial Slope is Increased with Patients with Early Graft Failure Following ACL Reconstruction
Authors: Christensen Joshua , Engasser William , Vanhees Matthias , Collins Mark S. , Dahm Diane L. 
Published: August 2014

Objectives: To determine the relationship between lateral tibial slope and probability of early graft failure in patients who have undergone anterior cruciate ligament (ACL) reconstruction. Methods: Fifty-eight patients were initially identified who experienced graft failure following primary ACL reconstruction and were revised between 1989 and 2009. Exclusion criteria were: clinical follow-up of less than four years, graft failure occurring greater than two years from primary surgery, skeletal immaturity, deep infection, lack of availability of preoperative MRI imaging, and history of previous trauma to the proximal tibia. This left 35 cases of early (within 2 years) failure of primary ACL reconstruction. These cases were matched to 35 controls that had undergone ACL reconstruction with a minimum of 4 years of clinical follow-up and no evidence of graft failure. Patients were matched by age, gender, date of primary surgery, and graft type. Lateral tibial slope was then determined on MRI imaging in blinded fashion. Results: All 35 cases failed within 2 years of primary ACL reconstruction. Mean time to failure in this group was 1 year (range 0.6-1.4 years). Mean follow-up of the matched control group was 6.9 years (range 4.0-13.9 years). Mean lateral tibial slope in the early ACL failure group was found to be 8.4 degrees, which was significantly larger than the control group at 6.5 degrees (p=0.02). The odds ratio for failure considering a 2 degree increase in tibial slope was 1.5 (95% CI 1.02-2.2), and continued to increase to 2.2 (95% CI 1.1-4.6) and 3.3 (95% CI 1.1-10) with 4 degree and 6 degree increases in tibial slope, respectively (Fig 1). No significant association was identified between graft type and primary ACL reconstruction failure. Conclusion: Increased lateral tibial slope is associated with an increased risk for early ACL graft failure, regardless of graft type. Orthopaedic surgeons should consider measuring lateral tibial slope as part of the preoperative assessment of ACL-injured patients.