bluuebunny/crossref_metadata_2025_split huggingface dataset:
United States Trends in Medial Ulnar Collateral Ligament Reconstruction: A retrospective Review of a Large Private-Payer Database from 2007 to 2011
Authors: Erickson Brandon J. , Nwachukwu Benedict U. , Rosas Sam , Schairer William W. , McCormick Francis , Bach Bernard R. , Bush-Joseph Charles A. , Romeo Anthony A. 
Published: August 2015

Objectives: Purpose: Overuse injuries to the elbow in the throwing athlete are common. Ulnar collateral ligament reconstruction (UCLR), commonly known as Tommy John surgery, is performed on both recreational and high-level athletes. There is no current literature regarding the incidence and demographic distribution of this surgical procedure in relation to age, location within the Unites States (U.S.), and gender. The purpose of this study is to determine the current demographic distribution of UCLR within the U.S. Methods: Methods: A retrospective analysis of private payer database using the PearlDiver Supercomputer (Warsaw, IN) was performed to identify UCLR procedures performed between the years of 2007-2011. The Current Procedural Code (CPT) 24346 (reconstruction of the ulnar collateral ligament of the elbow with the use of a tendinous graft) was used. Statistical analysis was performed as appropriate using STATA (Version 12.1; Statacorp; College Station, TX, USA). Results: Results: Between 2007-2011, 790 patients underwent UCLR. The overall average annual incidence was 2.16+/- 0.27 per 100,000 patients, but was 31.9 +/-3.9 for patients aged 15-19. The average annual growth was 5.72%. There were 695 males and 95 females. Fifteen to 19 year olds accounted for significantly more procedures than any other age group 56.8% (p<0.001), followed by 20 to 24 year olds 23.4%. The incidence of UCLR in the 15-19 year old group increased at an average rate of 6% per year (incidence rate ratio = 1.06, p=0.025). The south region performed significantly more UCLR than any other region p<0.001. The number of procedures significantly increased over time (p=0.039). Conclusion: Conclusion: UCLR was performed significantly more in patients aged 15-19 than any other age group. The average annual incidence of UCLR per 100,000 people for patients aged 15-19 is 31.9. The number of UCLR is increasing over time. Further work should address risk-reduction efforts in this at-risk population.
Neuromuscular Performance Varies with Baseline Neurocognition: Implications for Anterior Cruciate Ligament Injury Risk and Prevention
Authors: Herman Daniel C. , Barth Jeffrey C. 
Published: August 2015

Background: Neurocognitive performance may be a risk factor for anterior cruciate ligament injury, and may influence risk via changes in neuromuscular performance; however, there are no existing data the relationship between neurocognition and neuromuscular performance during complex athletic tasks. Hypothesis: Athletes with low baseline neurocognitive performance would demonstrate worse neuromuscular performance during the completion of an unanticipated jump landing task compared to athletes with high baseline neurocognitive performance. Study Design: Controlled laboratory study. Methods: 3-dimensional kinematic and kinetic data of the dominant limb were collected for 37 recreational athletes while performing an unanticipated jump landing task. Subjects were screened using a computer-based neurocognitive test into high (HP) and low (LP) performing groups (HP=20, LP=17). The task consisted of a forward jump onto a force plate with an immediate jump to a second target that was assigned 250msec prior to landing on the force plate. Kinematic and kinetic data were obtained during the first jump landing. Results: The LP group (Mean±SD of LP vs HP) demonstrated significantly altered neuromuscular performance during the landing phase while completing the jump landing task, including significantly increased peak vertical ground reaction force (1.81±0.53BW vs 1.38±0.37BW, p<0.01), peak anterior tibial shear force (0.91±0.17BW vs 0.72±0.22BW, p<0.01), knee abduction moment (0.47±0.56BW*BH vs 0.03±0.64BW*BH, p=0.03), and knee abduction angle (6.1±4.7o vs 1.3±5.6o, p=0.03), and well as decreased trunk flexion angle (9.6±9.6o vs 16.4±11.2o, p<0.01). Conclusion: Athletes with lower levels of baseline neurocognition possess worse neuromuscular performance during a challenging jump landing task. Clinical Relevance: Neurocognitive testing and neuromuscular assessment during dual-attention conditions may improve anterior cruciate ligament injury risk screening, while incorporating neurocognitive challenges into neuromuscular-based training programs may improve injury prevention and rehabilitation.
The Pediatric International Knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form
Authors: Nasreddine Adam Y. , Nelson Susan Elizabeth , Connell Patricia , Kalish Leslie , Kocher Mininder S. 
Published: August 2015

Objectives: To aid in the interpretation of Pedi-IKDC scores by characterizing normative data in children and adolescents. Also, to validate the Pedi IKDC by examining differences in Pedi IKDC scores between patients with knee ailments compared to patients without a history of knee problems. Methods: Cross sectional survey of 2000 children and adolescents aged 10-18 years living in the United States, recruited by ORC International to obtain equal numbers by sex and by integer age group. In addition to completing the Pedi-IKDC for one study designated “index” knee (right or left), subjects were asked demographic questions and for information on history of knee surgery and recent (four weeks) activity limitations. Raw Pedi-IKDC total scores were re scaled to a 0-100 scale. Non-parametric Wilcoxon or Kruskal-Wallis tests were used to compare subgroup scores and the van Elteren test was used to adjust for age. Unadjusted and adjusted p values were similar and only unadjusted values are reported. Results: Numbers of respondents are uniform with respect to age and sex, with 11% in each age group (10-18) and 50% female. 68% identified themselves as white, and 86% as non-Hispanic. 49 states and DC are represented. 136 (7%) reported prior surgery in one or both knees; 79(4%) in the index knee. The Pedi IKDC score distribution is skewed left with mean score (±SD) of 86.7(±16.8), median 94.6 and 34% reaching the ceiling value of 100. Subjects reporting prior surgery or limited activity in the index knee had median Pedi IKDC scores about 25 points lower than those without these histories (p<0.0001 for both comparisons). In contrast, although statistically significant, the variation by age (p=0.02), race (p=0.02), ethnicity (p=0.01), and level of sports/exercise participation (p=0.04) was much smaller (all ranges of median scores <4.5). There were no significant differences by sex or geographic region. Conclusion: There is only minor variation in Pedi IKDC scores across demographic factors. The strong association between Pedi IKDC score and prior knee surgery and also with recent limitation of activity in the index knee supports the construct validity of the Pedi-IKDC. Using a large, broadly representative sample, this study supports the use of the Pedi-IKDC as a knee specific outcome instrument for pediatric patients aged 10-18 and provides normative values to aid the interpretation of scores in this age range.
Medial Opening Wedge High Tibial Osteotomy
Authors: Tjoumakaris Fotios P. , Lombardi Nick J. , Tucker Bradford S. , Pepe Matthew D. 
Published: August 2015

Objectives: High tibial osteotomy (HTO) has become a well-established treatment for unicompartmental osteoarthritis of the knee. Over the last 30 years, various techniques have been introduced to advance this procedure. The purpose of this study is to review the outcomes of patients who received medial opening wedge HTO over the last ten years (2002-2012) using a modern, low profile, medially based fixation device. In addition, we sought to determine if obese patients had a less favorable outcome than their non-obese counterparts. Methods: Ninety-three patients were identified from a surgical database as having undergone a HTO for medial compartment osteoarthritis of the knee with varus mal-alignment . All procedures were performed by one of two fellowship trained orthopedic surgeons from 2002-2012 utilizing a low profile fixation device and identical surgical technique. Minimum follow-up was one year for inclusion in the study. Outcomes were measured using Lysholm and WOMAC scores. Radiographs were evaluated to determine delayed union or non-union at the osteotomy site and surveillance was undertaken to evaluate post operative complications. Results: 93 patients were identified from the database, 63 (70%) were available for follow-up and are included in this analysis. Average follow-up time was 48 months (range 17 to 137). There were 44 males and 19 females. The average age was 45 years old. The average final Lysholm and WOMAC scores were 66.4 (range: 13-100) and 18.6 (range: 0-86) respectively. There was no significant difference in reported Lysholm or WOMAC scores between obese (BMI >30) and non-obese patients (p=.31;p=.69). Complications were as follows: 3 patients required a surgical lysis of adhesions, 2 patients developed an infection, and 1 patient experienced a delayed union. At final follow-up, 18 patients received additional treatment on the affected knee: 11 required removal of symptomatic hardware, 5 received viscosupplementation, 2 underwent a total knee replacement. Conclusion: Low profile, medial based devices used in the setting of HTO is an accepted treatment for unicompartmental osteoarthritis of the knee. At final follow-up, a majority of patients reported positive outcomes and few complications. 18 patients required additional treatment for osteoarthritis. In our analysis, obese patients faired equally as well as their non-obese counterparts, with no significant difference in outcomes scores or complication rate. Survivorship of high tibial osteotomy was excellent in this series, with only 2 patients having undergone total knee replacement at last follow-up.
Outcomes of Meniscal Allograft Transplantation in the Pediatric Athlete
Authors: Riboh Jonathan C. , Tilton Annemarie K. , Cvetanovich Gregory , Campbell Kirk A. , Cole Brian J. 
Published: August 2015

Objectives: Meniscal allograft transplantation (MAT) has a successful clinical track record in adults. The results of MAT in children have not been reported. The goal of this study was to report the results of MAT with minimum 2-year follow-up in this unique population. Methods: After IRB approval, all patients under the age of 16 undergoing MAT between 1999 and 2011 and having > 2 year clinical follow-up were identified from a prospectively collected database. Demographic data including age, height, weight, BMI and prior surgery were collected. Functional outcome scores were collected pre-operatively and at 6 months, 1 year, 2 years and final follow up. Differences between scores at each time point were compared using a mixed model repeated measures ANOVA. All re-operations were documented. Results: 17 patients met inclusion criteria. Mean age was 14.9 +/- 1.4 years (range 11 - 16). 10/17 patients had undergone prior knee surgery. 59% were female and 41% were male. The average BMI was 23.4 +/- 5.9. Concomitant procedures included 7 ACI, 1 ACI biopsy and one ACL reconstruction. All patients were available for follow-up at an average of 38 +/- 30 months (range 24 - 122). Surgery resulted in significant improvements in KOOS pain, KOOS ADL, KOOS sport and KOOS QOL scores (Figure 1). Similar improvements were seen in Lysholm, IKDC subjective, WOMAC pain, WOMAC function, and SF-12 physical scores. 3/17 (18%) patients underwent subsequent surgical intervention, however only one (6%) required a graft meniscectomy. One patient required a plica excision, and the other a combined ACL reconstruction and ACI. No complications were found in this population. Conclusion: MAT results in predictable improvements in functional outcomes in the pediatric athlete. Most of these improvements were sustained at an average follow up of 38 months. The meniscal re-operation rate was low (6%) and no complications were reported.
Long Term Follow Up of Pediatric ACL Reconstruction in New York State
Authors: McCarthy Moira , Dodwell Emily , Pan Ting , Green Daniel W. 
Published: August 2015

Objectives: The primary aim of this study was to determine the rate of subsequent ACL reconstruction and additional non-ACL knee surgery in children that had previously undergone ACL reconstruction in New York State. The secondary aim was to assess factors associated with additional ACL and non-ACL knee surgery. Methods: Pediatric patients (age < 21) who underwent ACL reconstruction between 1997 and 2010 in New York State were identified using the Statewide Planning and Research Cooperative System (SPARCS) database. Patients were tracked for subsequent ACL reconstruction and additional non-ACL knee surgery. Each case had a minimum of one year follow up. A Cox proportional hazards model was used to assess time to subsequent surgery, adjusting for age, sex, race, comorbidity index, insurance type, surgeon and hospital ACL volume, and poverty prevalence. Results: 23,912 primary pediatric ACL reconstructions were identified. 1955 patients (8.2%) underwent subsequent ACL reconstruction. 7.4% had one additional ACL reconstruction and 0.7% had two or more additional ACL reconstructions. 3341 patients (14%) had subsequent non-ACL knee surgery with 11.1% having one subsequent surgery and 2.9% having two or more additional knee surgeries. Risk factors for revision ACL surgery were younger age at time of primary ACL surgery (p<0.001), male gender (p<0.001), white race (p=0.003), private insurance (p<0.001), higher hospital ACL volume (>20 per year; p=0.002), and higher surgeon ACL volume (>10 per year; p=0.003). Risk factors for return to the OR for other non-ACL knee surgeries were younger age at the time of primary ACL reconstruction (p<0.001), white race (p<0.001), private insurance (p=0.016), and higher hospital ACL volume (>20 per year; p=0.007). Conclusion: This study aims to provide information on the rate of return to the operating room and rate of secondary ACL reconstruction in an adolescent population over the past 20 years in New York State. Males and younger patients had a higher rate of subsequent ACL reconstruction. Higher rates of ACL reconstruction in younger children may be due to greater at-risk activities in younger children, longer follow up, or inherently less reliable reconstructions given the non-anatomic reconstructions that are frequently required in the skeletally immature. The association between socioeconomic factors and increased subsequent knee surgeries likely represents a disparity in access to care for low socioeconomic status patients.
Functional Outcomes after Double Row Versus Single Row Rotator Cuff Repair
Authors: Nicholas Stephen J. , Lee Steven J. , Mullaney Michael John , Tyler Timothy F. , Johnson Christopher D. , Fukunaga Takumi , McHugh Malachy P. 
Published: August 2015

Objectives: The effect of single row (SR) versus double row (DR) rotator cuff repair on functional outcomes was examined in a prospective randomized design. Methods: Fifty patients were randomized to DR or SR repairs; 39 patients (13 women, 26 men, 23 SR, 16 DR, age 62±7 yr) were assessed at an average of 2.2±1.6 yr after surgery (range 1-7 yr; tear size 17 medium, 13 large, 9 massive). The following data were recorded prior to surgery and at follow-up: Penn, ASES and Simple Shoulder Test (SST) scores; range of motion (ROM) for shoulder flexion, external rotation (ER) at 0º and 90º abduction, and internal rotation (IR) at 90º abduction; shoulder strength (Lafayette Manual Muscle Tester) in empty and full can tests, abduction and ER at 0º abduction. Treatment (SR vs. DR) by Time (pre-op vs. post-op) mixed model analysis of variance was used to assess the effect of rotator cuff repair. It was estimated that with 20 patients per group a 10-point difference in improvement in ASES scores between SR and DR treatments could be detected at an alpha level of 0.05 with 80% power. Results: Outcome Scores: RC repair markedly improved Penn, ASES and SST scores (P<0.001), with similar improvement between single versus double row repairs (Treatment by Time P=.49 to P=.67), and excellent scores at follow-up (Double Row vs. Single Row: Penn 91±11 vs. 91±12, P=.98; ASES 92±9 vs 87 ±15, P=.24; SST 11.2±1.2 vs. 11.4±1.0, P=.58). ROM: Patients with DR repairs lost ER ROM at 0º abduction (pre-op to final follow-up 7±10º loss, P=.013). ER ROM did not change with SR repair (3.9±15.6º gain, P=.24; Treatment by Time P=.017). This effect was not apparent for ER ROM at 90º abduction (Treatment by Time P=.26). IR ROM improved from pre-op to final follow-up (P<0.01, SR 17±18º, DR 13±23º, Treatment by Time P=.31). Strength: RC repair markedly improved strength in Empty Can (51%), Full Can (54%), Abduction (45%) and ER (31 %) strength (all P<.001), with no difference between SR and DR repairs (P=.54 to P=.81). Outcomes were not adversely affected by RC tear size, retraction, gender, or BMI. Patients <60 yo had better ASES scores than older patients (96±9 vs. 87±13, P=.021) but an age effect was not apparent for Penn (P=.14) or SST (P=.17). Conclusion: Patients had excellent outcomes regardless of whether they had a SR or DR repair. Rotator cuff repair, and subsequent rehabilitation, markedly improved shoulder strength. DR repair was associated with a loss of ER ROM but this loss did not impact other outcome measures.
Do Innings Pitched Prior To Age 25 Affect MLB Pitcher Longevity?
Authors: Brand Jefferson C. , Hardy Richard , Raymond Bowman , Tiwaloluwa Ajibewa 
Published: August 2015

Objectives: Baseball pitchers are among the most valued players in major league baseball because of their influence on the outcome of a game. Anecdotal cases suggest that pitching more innings, arbitrarily determined to be 160 innings a year, may shorten careers. Our hypothesis was that pitchers who threw more innings/year before age 25 would have a shorter career. Methods: Inclusion criteria were baseball pitchers who entered the Major League System from 1989-1992 only including those with no missing information for the following variables: Average Innings pitched per year before and after age 25, Earned Run Average (ERA), Walks and Hits divided by Innings Pitched (WHIP), Strike to Walk ratio (SWR), Strikeouts, Walks, Length of career, starting and Retirement age. 96 pitchers met those criteria. We did not analyze career statistics since these are created after the respective player's career ends rather analyzed their statistics before age 25. The information was obtained from http://www.baseball-reference.com . We used ANOVA to compare differences between groups and a regression model to assess relationship between variables (statistics) before age 25 and career length. Results: The mean number of innings pitched per year before age 25 was 66.6, Confidence Interval (CI) 12.90-120.3. In fact, only 11 of 96 pitchers threw over 148 innings/year. ERA (mean 5.51 CI: 2.50-8.52) and WHIP (mean 1.66, CI: 1.04-2.28) may be most commonly used measurements of pitcher performance. If pitchers are divided by those who throw 80 innings/year or over, 28 over and 68 under, the over 80 innings/year before age 25 group had significantly better ERA's (4.20, CI: 2.52-5.88 vs 6.03, CI: 2.66-9.40, P=.0087), WHIP's (1.35 CI: .98-1.72 vs 1.79 CI: 1.13-2.45, P=.0012), and longer careers (13.1, CI: 8.5-17.7 years vs 8.7, CI: 2.8-14.6 years, P=.0007). In fact, the regression analysis between career length and innings pitched per year before age 25 is a positive relationship with an R2 of .15, suggesting 15% of the career length variability is positively associated with the number of innings pitched per year before age 25. ERA and WHIP had weak positive relationship with career length, R2=.039 and R2=.025 respectively. Conclusion: Pitchers who threw over 80 innings a year before age 25, had the lowest ERA's, WHIP's, and the longest careers. Our hypothesis was disproved. In this population, there was not an advantage to restricting the number of innings pitched before age 25 for a young pitcher.
Hemostatic efficacy, safety, and pharmacokinetics of a recombinant von Willebrand factor in severe von Willebrand disease
Authors: Gill Joan C. , Castaman Giancarlo , Windyga Jerzy , Kouides Peter , Ragni Margaret , Leebeek Frank W. G. , Obermann-Slupetzky Ortrun , Chapman Miranda , Fritsch Sandor , Pavlova Borislava G. , Presch Isabella , Ewenstein Bruce 
Published: August 2015

AbstractThis phase 3 trial evaluated the safety and hemostatic efficacy of a recombinant von Willebrand factor (rVWF) for treatment of bleeds in severe von Willebrand disease (VWD). rVWF was initially administered together with recombinant factor VIII (rFVIII) and subsequently alone, as long as hemostatic factor VIII activity (FVIII:C) levels were maintained. Pharmacokinetics (PK) were evaluated in a randomized cross-over design (rVWF vs rVWF:rFVIII at 50 IU VWF:ristocetin cofactor activity [RCo]/kg). Bleed control for all treated bleeds (N = 192 bleeds in 22 subjects) was rated good or excellent (96.9% excellent; 119 of 122 minor, 59 of 61 moderate, and 6 of 7 major bleeds) on a 4-point scale (4 = none to 1 = excellent). A single infusion was effective in 81.8% of bleeds. Treatment success, defined as the number of subjects with a mean efficacy rating of &lt;2.5, was 100%. The PK profile of rVWF was not influenced by rFVIII (mean VWF:RCo terminal half-life: 22.6 hours for rVWF and 22.5 hours for rVWF:rFVIII). FVIII:C levels increased rapidly after rVWF alone, with hemostatic levels achieved within 6 hours and sustained through 72 hours after infusion. Eight adverse effects (AEs; 6 nonserious AEs in 4 subjects and 2 serious AEs [chest discomfort and increased heart rate, without cardiac symptomatology] concurrently in 1 subject) were associated with rVWF. There were no thrombotic events or severe allergic reactions. No VWF or FVIII inhibitors, anti-VWF binding antibodies, or antibodies against host cell proteins were detected. These results show that rVWF was safe and effective in treating bleeds in VWD patients and stabilizes endogenous FVIII:C, which may eliminate the need for rFVIII after the first infusion. This trial was registered at www.clinicaltrials.gov as #NCT01410227.
Prognostic value of circulating Bcl-2/IgH levels in patients with follicular lymphoma receiving first-line immunochemotherapy
Authors: Zohren Fabian , Bruns Ingmar , Pechtel Sabrina , Schroeder Thomas , Fenk Roland , Czibere Akos , Maschmeyer Georg , Kofahl-Krause Dorothea , Niederle Norbert , Heil Gerhard , Losem Christoph , Welslau Manfred , Brugger Wolfram , Germing Ulrich , Kronenwett Ralf , Barth Juergen , Rummel Mathias J. , Haas Rainer , Kobbe Guido 
Published: August 2015

Key Points
Independent prognostic relevance of quantitative Bcl-2/IgH monitoring in the PB of patients with FL before and after first-line therapy.