bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peroneal Nerve Injury after Multiligament Knee Injury
Authors: Werner Brian C. , Gwathmey Frank W. , Lyons Matthew L. , Miller Mark D. 
Published: September 2013

Objectives: The incidence of neurologic injury with multi-ligament knee injuries (MLI) ranges from 10% - 40% and most commonly involves the peroneal nerve. Loss of active ankle dorsiflexion and/or eversion with persistent post-traumatic peroneal nerve palsy portends substantial morbidity as patients may require lifetime use of an ankle-foot orthosis (AFO). Neurolysis, nerve grafting, and nerve transfer have limited efficacy in restoring function. For selected patients with footdrop, posterior tibial tendon (PTT) transfer may restore active dorsiflexion and mitigate AFO dependency. The objectives of this study are: 1) to review all MLI over a 12 year period to help clarify the epidemiology of peroneal nerve injuries; and 2) to compare the outcomes of PTT transfer with non-operative management for these injuries. Methods: Study Design: Retrospective cohort study. The charts of all patients with MLI over the past 12 years were reviewed. A cohort of MLI patients with peroneal nerve injury (n=18) was compared to the entire cohort of MLI patients (n=215). Patients with peroneal nerve injury managed non-operatively (n=11) were compared to those managed with PTT transfer (n=7). The clinical outcomes in patients who underwent PTT transfer were reviewed. Analysis: Means and ranges were calculated for continuous variables (age, BMI) and compared between cohorts using Student’s t test. Frequencies for categorical variables were compared using chi square tests. Results: The peroneal nerve injury cohort had significantly higher BMI, greater prevalence of female gender, higher rate of posterolateral corner (PLC) injury, and lower rate of PCL injury (Table I). Within the peroneal nerve injury cohort, there were no significant demographic differences between patients who underwent non-operative treatment (n=11) and those who had PTT transfer (n=7) (Table II). At an average follow-up of 23.9 months, patients who underwent PTT transfer for peroneal nerve injury demonstrated significant improvement in active ankle dorsiflexion, strength in ankle dorsiflexion and eversion, and elimination of AFO use. (Table III) Conclusion: The management of peroneal nerve injury in the setting of multiligament knee injury remains challenging. Understanding the epidemiology of these injuries allows treating surgeons to identify and stratify at-risk patients preoperatively. In appropriately selected patients, posterior tibial tendon transfer is an option to improve ankle function, regain ankle active dorsiflexion and most importantly eliminate the need for a life-long orthosis.
Subpectoral Biceps Tenodesis for Failed Type II SLAP Repair
Authors: Gupta Anil K. , Bruce Benjamin , Klosterman Emma , McCormick Francis , Harris Joshua D. , Romeo Anthony A. 
Published: September 2013

Objectives: Superior Labrum Anterior-Posterior (SLAP) lesions are a common cause of shoulder pain, however, their diagnosis, classification, and treatment remains controversial. The purpose of this study was to evaluate the outcomes of patients undergoing subpectoral biceps tenodesis as a salvage intervention for failed type II SLAP repair. We hypothesized that patients undergoing subpectoral biceps tenodesis for failed type II SLAP tears will demonstrate improved subjective and objective outcomes at a mean two-year follow-up. Methods: A retrospective review of prospectively collected data was performed on patients who underwent subpectoral biceps tenodesis for failed type II SLAP repair by a single surgeon between 2008 and 2010. Primary outcome measures included Visual Analog Scale (VAS), American Shoulder and Elbow Score (ASES), and Short Form-12 (SF-12) score. Secondary outcome variables included Simple Shoulder Test (SST) and Single Assessment Numeric Evaluation (SANE) Score. Demographic and intraoperative information was recorded for each patient (Table 1). A paired t-test was performed, with a P-value less than 0.05 considered statistically significant. Results: Eleven patients met the study criteria (mean age 40.2, range 22-54). Of these patients, nine completed post-operative surveys (82%) at a mean 26 month follow-up (range 15 to 49 months). Mean VAS scores improved from 4.1 to 2.5 (p=0.03), SST from 5.4 to 9.3 (p=0.005), ASES from 54.5 to 78.0 (p=0.002), and SANE score from 42.5 to 70.4 (p=0.001). SF-12 total improved from 30.5 to 36.1(p=0.06). Furthemore, the improvement in the VAS pain, ASES, and SST scores exceeded the reported minimally clinical important differences (MCID), suggesting that this intervention provided meaningful improvement for the patients (Table 2). There were no failures, perioperative, or postoperative complications, and no patients required additional surgery. Conclusion: The findings suggest that patients who undergo subpectoral biceps tenodesis as a salvage procedure for failed type II SLAP repair demonstrate improved results. To our knowledge, the results for this procedure utilized for this indication have not been reported in the literature. Larger scale comparative studies are required to further justify this technique.
Demographic Trends in Arthroscopic and Open Biceps Tenodesis in New York State
Authors: Laible Catherine Noelle , DiBenedetto Michael , Strauss Eric Jason , Jazrawi Laith M. 
Published: September 2013

Objectives: Tenodesis of the long head of the biceps is one of many options to reduce pain caused by proximal long head insertional tendinopathy, tendon instability, or part of a superior labrum anterior-posterior lesion. This technique can be performed either as an open or arthroscopic procedure. The purpose of this study is to compare the relative incidence and demographics of patients who underwent either an arthroscopy or open biceps tenodesis procedure in New York State from 2002-2010. Methods: Retrospective review of patients who underwent open or arthroscopic biceps tenodesis surgery were identified from the New York State Statewide Planning and Research Commission (SPARCS) ambulatory surgery database, which includes all outpatient surgeries performed at hospitals, outpatient surgical centers, and rural clinics in New York State. Cases of open and arthroscopic biceps tenodesis were identified by unique Current Procedural Terminology codes (23430, 29828). Data from 2002 to 2010 were available for open procedures and from 2008 to 2010 for arthroscopic procedures. Chi-square test and student’s t-test were used to analyze the data. Variables measured included incidence, age, gender, race, ethnicity, type of operating facility, and primary payor. Results: From 2002 to 2010 the incidence of biceps tenodesis rose over 600%. From 2008 to 2010 there were 2672 open biceps tenodesis procedures and 3289 arthroscopic biceps tenodesis procedures performed in New York State. The arthroscopic group contained significantly more women (33%) than the open group (25%, P<.0001). The average age arthroscopic patients was slightly higher (55.33 years) than that of open patients (54.45 years, P<.01). There was a significantly greater proportion of African- American patients in the arthroscopic group. Patients undergoing arthroscopic surgery were more likely to be treated at a hospital as opposed to a free standing clinic. The most common primary payor for open cases was worker’s compensation at 22% of all cases. Of arthroscopic patients, 18% listed worker’s compensation as the primary payor. Medicare patients accounted for 16% of open cases and 19% of arthroscopic patients (P<.001). Conclusion: Incidence of biceps tenodesis surgery has increased steadily from 2002 to 2010. There were 23% more arthroscopic procedures performed in 2010 than there were in 2008. Arthroscopic patients are more likely to be older, female, and African American. Arthroscopic biceps tenodeis, which require additional skill and training, were more likely to be performed in a hospital setting.
Glenohumeral Passive Range of Motion and the Correlation to Shoulder Injuries in Professional Baseball Pitchers
Authors: Wilk Kevin E. , Macrina Leonard , Fleisig Glenn S. , Aune Kyle , Porterfield Ron , Harker Paul , Andrews James R. 
Published: September 2013

Objectives: Glenohumeral internal rotation deficit (GIRD) indicates a 20 degree or greater loss of IR on the throwing shoulder compared to the non-throwing shoulder. The purpose of this study was to determine whether GIRD and/or bilateral difference in total rotational motion (TRM) of the glenohumeral joint (external rotation + internal rotation) correlated with shoulder injuries in professional baseball pitchers. Methods: This study was conducted over eight competitive seasons (2005-2012). Each year during spring training, the same examiners assessed passive range of motion (PROM) of both the dominant and non-dominant shoulders of professional pitchers using a bubble goniometer. In total, 505 examinations were conducted on 296 pitchers. Glenohumeral joint motion was assessed in supine with the arm at 90 degrees of abduction and in the plane of the scapula for ER and IR. During ER and IR ROM assessment, the scapula was stabilized per methods previously established. Shoulder injuries and days missed due to injury were assessed and recorded by the medical staff of the team. Results: Significant differences were noted during side-to-side comparisons (p<0.0001) within subjects. Amongst this cohort, there were 77 shoulder injuries in 52 players accounting for a total of 3131 days missed. GIRD did not correlate to increased risk of shoulder injuries (p=0.8629). Pitchers with a deficit of more than 5 degrees in TRM between shoulders had a 1.9x higher risk of injury (p=0.0290). Players with < 5 more degrees of ER motion in their dominant shoulder at 90 degrees of abduction were 2.2 times as likely to have a shoulder injury (p=0.0112). Conclusion: Based on these results, pitchers with bilateral differences in total rotational motion had a significant impact on the risk of shoulder injuries. Loss of ER PROM in the dominant shoulder compared to the non-dominant side appears to contribute to shoulder injury risk as well. Clinicians need to be aware of these findings and plan a program that addresses these issues.
A Prospective Follow-up of Patients Treated Surgically or Non-Surgically for Full-thickness Rotator Cuff Tears
Authors: Gagnier Joel Joseph , Oltean Hanna N. , Bedi Asheesh , Carpenter James E. , Miller Bruce S. 
Published: September 2013

Objectives: The objectives of this project are: (1) to compare the efficacy of surgical versus non-surgical management of full-thickness rotator cuff tears, and (2) to detect variables that predict success within each treatment group. Methods: Patients who presented to our care for management of symptomatic full-thickness rotator cuff tears were enrolled in our Shoulder Registry and clinical data were collected prospectively. In addition to baseline demographic information, the following outcome measures were collected at baseline, 6 months, 1 year and annually up to 3 years: Western Ontario Rotator Cuff (WORC) Index, American Shoulder and Elbow Surgeons (ASES) score, Modified Marx Shoulder Activity Level Scale, VR-12, 100-point Single Assessment Numeric Evaluation (SANE) rating, 100-point visual analog scale (VAS) for pain, and a patient satisfaction scale. All patients were allocated treatment as recommended by the attending surgeon. We described all patient demographic characteristics, and performed linear and logistic regression for variables associated with treatment allocation and with treatment effects. We also used Student’ t-tests and Wilcoxon rank-sum tests where appropriate, to explore differences in treatment effects between the groups for all outcome measures at all time points. Results: A total of 292 patients were included with 155 allocated to surgery and 137 to non-surgical treatment. Those allocated to surgery were younger (58.6 years vs 65.2 years; P<.0001), less likely to have diabetes (12% vs 21%; P=0.05), more likely to have a known traumatic injury (71% vs 55%; P=0.002), and tended to be worse off on all outcome measures at baseline then the non-surgical group. Both the surgical group and non-surgical group improved on all outcome measures across the follow up period with several variables predicting changes at each time point. Table 1 contains the list of specific variables that predicted improved outcomes separately for both treatment groups. Also, at one year the surgical group improvement was significantly greater than the non-surgical group on all outcome measures. At both two and three years the surgical group showed a significantly greater degree of improvement than the non-surgical group on both the WORC index and the ASES score. Conclusion: We found that patients with rotator cuff tears who undergo surgical or nonsurgical treatment tend to improve, with patients allocated to surgery improving to a greater degree across three years of follow-up. In addition, there appear to be important predictors of improved outcomes that may help us to tailor our treatments to individuals with specific characteristics.
Outcome Compartison of Concomitant Arthroscopic SLAP / Anterior Bankart Repair with SLAP /Posterior Bankart Repair
Authors: Henn Ralph Frank , Carroll Kaitlin M. , Gill Thomas J. 
Published: September 2013

Objectives: Combined unstable tears of the superior labrum (SLAP) and either the anterior or posterior labrum are not uncommon. The goal of this study was to directly compare the results of combined anterosuperiorlabral repairs to combined posterosuperiorlabral repairs. Methods: This is a retrospective study of 34 shoulders (34 patients) treated by a single surgeon at a mean follow up of 25 months (range 12 to 67). 18 patients underwent both SLAP and anterior Bankart repair (AS group) and 15 patients underwent both SLAP and posterior Bankart repair (PS group). All patients had glenohumeral instability (humeral head could be translated over the glenoid rim) on examination under anesthesia in the direction of the Bankart tear. Patients were evaluated with the ASES shoulder score, Simple Shoulder Test (SST), and visual analog scale for pain (VAS), subjective shoulder value (SSV), Short Form 12 (SF12), and physical examination. The two groups were compared using chi-square and t-tests. Results: The mean age in the AS group was 33 years compared to 35 in the PS group (p=0.63). Fifteen patients in each group were men, with 3 women in the AS group and 1 in the PS group (p=0.30). Outcomes in both groups were excellent, with no significant differences between the groups with respect to the ASES, VAS, SSV, SST, SF12 or range of motion at follow-up. Three months postoperatively, the AS group had significantly (p=0.005) less average external rotation (52±16 degrees) compared to the PS group (67.3±5 degrees). 3 shoulders had adverse outcomes in the AS group (1 recurrent anterior instability and 2 required arthroscopic capsular releases) compared to 1 shoulder (revision posterior Bankart) in the PS group (p=0.56). Conclusion: The results of combined Bankart and SLAP repairs are excellent. Combined tears were more common in men. The outcomes were similar in both AS and PS groups at 2-year follow-up. Stiffness was more common in the AS group with a transient deficit in average external rotation at 3 months and two patients that required capsular release.
Spectrum of Childhood Intra-articular Shoulder Pathology
Authors: Edmonds Eric W. , Roocroft Joanna Helena , Parikh Shital 
Published: September 2013

Objectives: With increased sports participation and awareness on behalf of the medical community, there appears to be an increase in childhood musculoskeletal injuries. The spectrum of intra-articular shoulder pathology in this skeletally immature population has not been well described. The purpose of this study was to identify the intra-articular injury pattern seen within the childhood shoulder. Methods: A retrospective review was performed at two tertiary-care children’s hospitals between 2008 and 2011 of all patients who underwent MR imaging and subsequent shoulder arthroscopy. Exclusion criteria included: girls > 14 years old, and boys > 16 years old. Demographics, MR and arthroscopic findings were recorded. Labral pathology was grouped into zones: Zone I (Bankart lesions) - 3 to 6 o’clock for right shoulder, Zone II (posterior labral lesions - 6 to 11 o’clock, Zone III (SLAP lesions) - 11 to 1 o’clock, and Zone IV (anatomic variants) - 1 to 3 o’clock. Results: 115 children met criteria with a mean age of 14.4 years (range 8-16 years). There were 24 girls and 91 boys with 45 left and 70 right shoulders. Football and baseball were the most common activities at the time of shoulder injury. Of 112 children with labral pathology, 72 were Zone I with 14 isolated anterior, 56 were Zone II with 15 isolated posterior, 38 were Zone III with 4 isolated superior, and 2 had an isolated Buford complex. Seventy-six of these children had more than one labral zone injured; moreover, 31 (27%) had injuries to more than two zones. Pathology in Zone 1 included: anterior labral periosteum sleeve avulsions (ALPSA), glenolabral articular disruptions (GLAD), soft and bony Bankart lesions. Non-labral intra-articular pathology included 27 children with partial articular supraspinatus tendon avulsions (PASTA), humeral avulsions of the glenohumeral ligament (HAGL), and greater tuberosity fracture. Conclusion: The childhood incidence of intra-articular pathology is different than the adult population. Although, a quarter of our cohort had partial rotator cuff tears, there were no complete tears. In contrast to adults, the primary intra-articular pathology (97.4%) was labral tearing; moreover, 24% of those involved only the posterior labrum ± superior labrum. Sixty-eight percent had labral pathology that involved at least 2 zones and treating surgeons should be prepared to find anterior tears of the glenoid labrum that extend beyond the zone of a classic Bankart lesion.
Effect of Athletic Activity on Hormone Levels in High School Female Athletes
Authors: Wojtys Edward M. , Jannausch Mary L. , Kreinbrink Jennifer L. , Sowers Maryfran R. 
Published: September 2013

Objectives: Circulating endogenous hormone levels may affect the susceptibility of female athletes to anterior cruciate ligament (ACL) injuries. This study tested the hypotheses that (1) the estradiol-progesterone profile of high school females participating in training, conditioning, and competition differs significantly from that of physically inactive age-matched females over a 3-month period; and (2) athletic training/conditioning alters body composition (muscle, bone), leading to an increasingly greater lean body mass to fat mass ratio and accompanying hormone change. Methods: One-hundred six women, ages 14-18 years, were prospectively monitored over a 13-week period with weekly physical activity assessments and 15 urine samples for estrogen (E1c), luteinizing hormone (LH) creatine (Cr), and progesterone (PdG) levels. Each underwent lower extremity strength tests and body composition measurements, both prior to and after the study period. Results: Seventy-four of the 98 women who completed the study classified themselves as athletes. Body-mass index, weight and fat measures remained stable over the course of the study. Seventeen women had no complete menstrual cycle during the observation period. Mean levels of log(E1c/Cr) were slightly higher in nonathletes in cycles <24 or >35 days. Mean log(PdG/Cr) levels in nonathletes were lower in the first half and higher in the second half of the cycle, but the differences were not statistically significant. Conclusion: In this cohort of high school females, the level of athletic or physical activity did not influence urine concentrations of estrogen, progesterone or luteinizing hormones. A significant number (17%) of women in both groups were amenorrheic during the 3-month study period.
The Role of Magnetic Resonance Imaging in a Division I University Sports Medicine Program
Authors: Huston Kellen L. , Cutuk Adnan , Kaar Scott G. 
Published: September 2013

Objectives: Magnetic Resonance Imaging (MRI) is commonly used for examination of soft tissue and some bony injuries. MRIs are seemingly ordered more commonly and sooner after injury diagnosis in athletes than in the general population. There is no published data or guidelines regarding the use of MRI in this patient population. The purpose of this study was to prospectively document musculoskeletal MRI use and its effect on diagnosis, playing status and treatment of athletes at a division I university sports program. We hypothesized that MRI is commonly used early in the injury course and often has little or no effect on the diagnosis or treatment plan for most injuries. Methods: Data was collected of musculoskeletal MRI use in varsity student athletes for 2 full academic years from 2010-12 at a NCAA Division I institution. Data collected included timing of the injury and physician visit as well as pre and post-MRI diagnosis, playing status and treatment. Results: 86 MRI’s were obtained during the 2 years studied. Average age was 19.9 (18-23). 45 percent of injuries occurred during competition season, 34% pre-season and 21% post-season. No statistically significant difference was seen with respect to pre-MRI vs post-MRI diagnosis, treatment or participation status (p>.05) With removal of the 15 MRI’s obtained for preoperative planning no significance was again seen with regards to pre-MRI post-MRI diagnosis, participation status or treatment (p>.05). There was a change in diagnosis in 13 athletes (only 1 led to surgery performed after completion of the season) and there was a change in participation status in 8 athletes (5 increased, 3 decreased). No athlete required surgery immediately following an MRI that wasn’t already being planned. Conclusion: The use of MRI in a division I sports medicine athletic program rarely changed diagnosis, treatment or playing status of an athlete. MRI did not demonstrate significant benefit over history and physical examination. The role of MRI in athletes is mainly for pre-surgical planning and reassurance of the athlete, athletic training.