bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Relief from Intra-articular Anesthetic Injection Predict Outcome after Hip Arthroscopy?
Authors: Engasser William , Kuzma Scott , Krych Aaron John , Levy Bruce A. 
Published: August 2014

Objectives: Arthroscopy is being used more frequently as a treatment for intra-articular hip pathology due to femoroacetabular impingement (FAI). Prior to surgery, intra-articular anesthetic injection is commonly performed as a diagnostic test to localize the source of pain. Currently, there is a paucity of data correlating post-injection pain relief and functional outcomes after hip arthroscopy for FAI. The purpose of this study is to determine whether the amount of pain relief after preoperative intra-articular anesthetic injection predicts clinical and functional outcomes following hip arthroscopy with minimum one year follow-up. We hypothesize that increased pain relief (>50%) will correlate with better outcomes after surgery. Methods: The records of patients undergoing hip arthroscopy for FAI at our institution between April 2007 and April 2012 were reviewed. We identified patients who underwent pre-operative intra-articular anesthetic injection and subsequent hip arthroscopy. Inclusion criteria were: ultrasound or fluoroscopic guided intra-articular anesthetic injection performed at our institution, documented pre- and post-injection Numerical Rating Scale (NRS) pain scores, no prior ipsilateral hip surgery, and minimum 1 year follow-up. Pre-operative radiographs were reviewed and degree of osteoarthritis was determined using the Tonnis classification system. Outcomes were assessed with Modified Harris Hip Score (MHHS) and Hip Outcome Score (HOS). Univariate and multivariate models were performed to assess whether percent pain relief correlated with outcome scores. Results: 57 hips in 55 patients met our inclusion criteria and included 37 females (67%) and 18 males (33%) with a mean age of 42.6 ± 14.7 (range 15-68) years. 8 patients had Tonnis grade 0, 35 had Tonnis grade 1, and 14 had Tonnis grade 2. Mean pain relief after intra-articular injection was 74.4 ± 31.9 (range 0-100) percent. 13 patients (23%) had ≤50% pain relief while 44 (77%) had >50% pain relief. Outcome scores were obtained at a mean 25.5 (range 12- 60) months. Mean MHHS, HOS-ADL, and HOS-Sport scores were 82.1 ± 17.4 (range 42.9-100), 85.0 ± 16.6 (range 39.7-100), and 71.8 ± 28.1 (range 11.1-100) respectively. There was no correlation between percent pain relief and MHHS, HOS-ADL, or HOS-Sport scores. There was no significant difference in outcome scores between those with ≤50% and >50% pain relief. When adjusting for Tonnis grade there was no correlation between percent relief and any of the outcome scores measured. Conclusion: In patients undergoing hip arthroscopy for FAI, our data indicates that the amount of pain relief from intra-articular anesthetic injection does not correlate with minimum 1 year clinical and functional outcomes even when adjusting for Tonnis grade. Although pain relief did not predict outcomes in our study, we still believe it is a useful diagnostic tool to localize the source of pain in patients considering hip arthroscopy.
Increased Posterior Tibial Slope and its Association with ACL Rupture in the Pediatric Population
Authors: O'Malley Michael P. , Milewski Matthew David , Solomito Matthew , Erwteman Andrew , Nissen Carl W. 
Published: August 2014

Objectives: Particular interest has been placed in identifying risk factors for sports related injuries in younger populations. In regards to the relationship between posterior sagittal slope of the tibia as a potential risk factor for ACL injury in the pediatric population, studies at this time remain limited.The purpose of our study is to investigate this relationship between posterior tibial slope and ACL rupture in the pediatric population. Our null hypothesis states that an increased posterior tibial slope does not serve as a contributing risk factor for ACL rupture in pediatric patients with open physes. Methods: A retrospective case-control study was performed at an academic pediatric sports medicine center comparing a target population of skeletally immature patients with an ACL rupture with an age-matched control group. Posterior tibial slope was then measured on plain lateral radiographs in both groups by blinded readers (Figure 1), at two separate time intervals, utilizing a previously examined and accepted technique. Results: Thirty two patients were included in the ACL rupture with open physes group (average age 13 years old, range 9-17) and compared to 32 patients in the control group (average age 13 years old, range 9-16). These groups were also similar in regards to male:female and left:right distribution. The mean posterior tibial slope in the ACL injured population was 10.0° ± 3° versus 8.5° ± 3° in the control group. Statistical significance was seen in comparing slope measurements between the ACL injury and control groups in two of the three readers (Readers 1 and 3) at both time points (Reader 1: p = 0.0348, p = 0.0051; Reader 3: p = 0.0009, p = .0059). Intra-rater proved superior with values correlating with moderate-to-good reliability (Reader 1 ICC = 0.7387, Reader 2 ICC = 0.8853, Reader 3 ICC = 0.5316), while inter-rater values corresponded with fair-to-moderate reliability (Measure 1 ICC = 0.4657, Measure 2 ICC = 0.5146). The average female posterior tibial slope was 9.5° (range of 3-14°) and similar to the posterior tibial slope for males, which was 9.8° (range of 2-16°). Conclusion: The authors reject the null hypothesis and these results uphold that an increased posterior tibial slope serves as a possible risk factor for ACL rupture in a skeletally immature population.
The Hill-Sachs Lesion: Volumetric modeling using Three-Dimensional Computed Tomography Reconstructions
Authors: Bernhardson Andrew , Provencher Matthew 
Published: August 2014

Objectives: The purposes of our study were to identify the volume and relative location of Hill-Sachs lesions, measure the amount of glenoid bone loss in patients who have existing Hill-Sachs lesions, and finally draw any correlations that exist between increased glenoid bone loss and increased Hill-Sachs volume. Methods: A total of 217 consecutive three-dimensional (3D) Computed Tomography (CT) scans were reviewed for the presence and measurement of Hill-Sachs volume and location. Hill-Sachs volume was measured by measuring the size of the Hill-Sachs defect in sequential CT images and a 3D model was created to measure the volume of the defect using Osirix (Osirix Imaging Software, Osirix-viewer.com). The Hill-Sachs lesion was then quantified in terms of both location and size. Further, older classification systems were applied to the data to draw comparison. Location of the lesion was measured by utilizing anterior and posterior margins of the lesion in relation to the biceps groove to give a clock face location. The height, depth and length of each lesion were also recorded in its greatest dimension. In addition a 3D model of the individual Hill-Sachs lesion was generated to observe the rough shape of the bony defect. Results: The Hill-Sachs lesion was identified in 60% of patients, N=130. The mean volume of the Hill-Sachs lesions was 1.22 cm3, with a range of 0.13 cm3 to 5.3 cm3. The three dimensional shape of the Hill-Sachs lesion was consistently an orange slice. Using prism measurements the average volume was 3.19 cm3 with a range of 0.33 cm3 to 9.76 cm3. Average arc of the circle of each lesion measured at the axial mid point (10 mm below the top of the humeral head) was 68.9° with a range of 9.49° to 165.88°. The average depth of the lesion was 6.7 mm with a range of 2.8 mm to 11.1 mm. Conclusion: This study identified a unique yet important way to measure the absolute size of the Hill-Sachs lesion in the shoulder. This method is positively correlated with previous measurement systems, but utilizes novel methods to fully measure the unique shape of Hill-Sachs lesions. Using absolute measures not only increases accuracy, but 3D modeling also shows the nature of the defect and location in order to consider operative repair of the lesion. However, the Hill-Sachs lesion only describes one side of the problem, with this data side by side comparison with glenoid bone loss is needed to fully understand the nature of shoulder instability that is a bipolar problem.
Isolated Pectoralis Minor Release for Scapular Dyskinesis
Authors: Provencher Matthew , Golijanin Petar , Gross Daniel , Campbell Kevin J. , Gaston Tistia , Anthony Shawn 
Published: August 2014

Objectives: Pectoralis minor (PM) tightness has been linked to pain and dysfunction of the shoulder joint secondary to anterior tilt and internal rotation of the scapula, causing pseudo-impingement of the subacromial space. Most patients with pathologic tightness of the PM are treated successfully with non-operative treatment, yet a minority of patients experience persistent pain and dysfunction due to a pathologically tight PM. The purposes of this study are to describe the outcomes of operative release of PM tightness recalcitrant to nonoperative measures. Methods: Over a 3-year period, a total of 46 patients were enrolled (mean age 25.5, range 18 to 33) who presented with symptoms of shoulder pain, limited range of overhead motion, and inability to participate in overhead lifting activities, with examination consistent with primary abnormality of scapular dysfunction due to a tight PM with tenderness in the PM tendon. All patients underwent an extended period of physical therapy and stretching program (mean 11.4 months, range 5-23 months), and were followed with serial examinations for resolution of symptoms and scapular tilt. 6/46 (13%) patients were unable to adequately stretch the PM, and underwent isolated mini-open PM release. Outcomes were assessed with scapula protraction measurements, pain scales, and ASES and SANE score. Results: A total of 40/46 (87%) patients resolved the tight PM and scapular mediated symptoms with a dedicated therapy program (ASES 58 to 91; SANE 50 to 90, VAS 4.9 to 0.8, p<0.01). The 6/46 patients treated with isolated PM release demonstrated improvement in outcomes after failed nonoperative care (ASES 48 to 89; SANE 40 to 90.4; VAS 5.8 to 0.9, p<0.01). Overall, protraction of the scapula increased. The inferomedial scapular border was a mean of 1.2 cm from the chest wall preoperatively, and 0.3 cm postoperatively (p<0.01), similar to nonoperative responders. There were no complications and all those with isolated PM release returned to full or increased duties after release. Conclusion: In most patients, PM tightness can be successfully treated with non-operative management. However, in refractory pathologically tight PM cases, this series demonstrates predictable return to function with notable improvement in shoulder symptoms. Additional work is necessary to evaluate the long-term efficiency of isolated PM release.
Incidence, Mechanisms, and Severity of Game-Related High School Football Injuries Across Artificial Turf Systems of Various Infill Weight
Authors: Meyers Michael Clinton 
Published: August 2014

Objectives: Today's new generations of artificial turf are increasingly being installed to duplicate or exceed playing characteristics of natural grass. Rather than playing on the polyethylene turf fibers, shoe:surface interaction actually occurs between the cleat and the various proprietary sand/rubber infill composites of varying weight. At this time, the influence of surface infill weight on football trauma is unknown. The purpose of this study was to quantify incidence, mechanisms, and severity of game-related high school football trauma across artificial turf systems of various infill weight. Methods: Artificial turf systems were divided into four sand/rubber infill weight groups based on lbs per square foot: (A) > 9.0, (B) 6.0 - 8.9, (C) 3.0 - 5.9 and, (D) 0.0 - 3.0. A total of 43 high schools participating across four states over 3 competitive seasons were evaluated for injury incidence, injury category, time of injury, injury time loss, player position, injury mechanism and situation, primary type of injury, injury grade and anatomical location, field location at time of injury, injury severity, head, shoulder, and lower extremity trauma, cleat design, turf age, and environmental factors. Results: Of the 847 high school games documented, 301 games (35.5%) were played on infill (A), 231 (27.3%) on infill (B), 189 (22.3%) on infill (C), and 126 (14.9%) on infill (D). A total of 1,979 injuries were documented, with significantly lower total injury incidence rates (IIR), [18.8 (95% CI, 18.3-19.1) vs 23.3 (22.4-24.0) vs 31.6 (30.5-32.2) and 22.1 (20.8-22.9)], substantial IIRs [3.9 (95% CI, 3.4-4.5) vs 4.8 (4.1-5.4), 7.7 (7.1-8.3) and 6.1 (5.2-5.9)], trauma from player-to-player collisions [8.7 (95% CI, 8.2-9.0) vs 11.0 (10.5-11.5), 16.4 (15.5-17.1) and 9.8 (9.4-10.0)], playing surface impact trauma [2.6 (95% CI, 2.1-3.1) vs 4.2 (3.6-4.8), 5.6 (4.8-6.2) and 4.4 (13.5-5.2)], and less muscle trauma [6.1 (95% CI, 5.5-6.6) vs 9.7 (9.4-9.9), 13.7 (12.8-24.4 and 8.7 (8.0-9.2)], while competing on infill weighing >9.0 (A) versus 6.0 -8.9 (B), 3.0 - 5.9 (C), and 0.0-3.0 (D), respectively. Significantly lower trauma (P < .05) was also observed across concussions, muscle-tendon overload, time loss, skill positions, injury mechanism and situation, lower and upper extremity joints, adverse weather conditions, and turf age while competing on infill (A) when compared to infill (C). Conclusion: As the artificial infill surface weight decreased, the incidence of game-elated high school football trauma significantly increased across numerous playing conditions. This is the first study to investigate the influence of artificial infill surface weight on the incidence of game-related high school football trauma. Since this study is in the early stages, initial findings warrant further investigation.
Variation in Health Care Cost: Quality, Utilization, and Efficiency Review for ACL Surgery Cost Variance Within a Health Care System
Authors: Shea Kevin G. , Archibald-Seiffer Noah M. , Jacobs John , Saad Charles , Hooft Lahoma , Humphreys Becca 
Published: August 2014

Objectives: Variation in health care costs is an area of focus amongst national policy experts. While cost variation between facilities is an important area of investigation, cost variation within the same institution is recognized as an opportunity for rapid process change to provide better value to patients. The purpose of this study was to perform a Quality, Utilization, Efficiency (QUE) review for ACL surgery. Methods: This project was reviewed by an IRB and approved for performance improvement. Using models developed by Intermountain Health Care, a QUE review was done for ACL procedures within a 22 surgeon, 7 hospital system. Cost data from January through June 2013 was reviewed. Four consistent cost categories were identified, and analyzed for cost variation among surgeons: tibial fixation, femoral fixation, graft choice, and tools/disposable instruments. Results: The range in costs for these 4 categories to perform an ACL reconstruction ranged from $392.80 to $7,838.73, a difference of $7,445.93 and a mean of $2,128.93. Tibial fixation costs ranged from $42.43 to $580.00 (average $171.78). Femoral fixation ranged from $95.00 to $865.00 (average $287.33). The graft cost ranged from $1,275.00 to $2,545.75 (average $1,976.43). Suture prices for each individual suture, varied from $1.19 to $130.82, a range of $129.63 and mean $28.00. Tools and disposable supplies ranged from $184.00 to $896.00 (average of $346.00). Conclusion: The cost difference in ACL reconstructive surgeries showed a twenty-fold increase from minimum to maximum for different cost categories. In some cases, higher costs may be necessary for more complex and revision cases. As health systems and physicians collaborate to improve health care quality and value for patients, accurate information on cost will be important for providers. Rational variation in health care costs, which arise from patient-centered care, is appropriate. Irrational variations in care and procedural costs are not justified, and these variations offer opportunities to provide better care and value to patients. Providing high quality and timely information about costs is critical for engaging physicians in improving quality.
Complications from a Distal Bicep Repair: A Meta-Analysis of a Single Incision Versus Double Incision Surgical Technique
Authors: Toossi Nader , Amin Nirav Hasmukh , Cerynik Douglas L. , Jones Morgan H. 
Published: August 2014

Objectives: Anatomical reinsertion of the distal biceps is critical for restoring elbow flexion and forearm supination strength. Surgical techniques utilizing one and two incisions have been reported in the literature, describing complications and outcomes. However, which technique is associated with a lower complication rate remains unclear. Methods: A systematic review was conducted using the PubMed, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SPORTSDiscus, and the Cochrane Central Register of Controlled Trials database to identify articles reporting distal biceps ruptures through August 2013. We included English language publications based on adult patients with a minimum of three cases. Both single and dual incision technique studies were incorporated. The demographic and outcome data of all studies was retrieved and pooled. A Meta-analysis on the pooled data was then conducted to determine the role of surgical technique on different complications. This was adjusted for age, gender and other independent variables. Results: Fifty-five articles met the inclusion criteria. The complication rate in the single incision group was 28.3% (222/785) versus 20.9% (104/498) in the double incision group. Neuropraxia was the most common complication in the single incision group at 9.8% (77/785), while heterotopic ossification was the most common in double incision cases at 7% (35/498). Re-rupture and failed reattachment occurred in 2.5% of single incision cases, versus 0.6% of double-incision cases (p < 0.034). Posterior interosseous nerve (PIN) palsy occurred in 2.7 % (13/785) of single incision procedures versus 0.2% (1/498) in the double incision group (p< 0.001). When combining heterotopic ossification and synostosis rates, the double incision group demonstrated complications in 9.8% of cases versus 3.2% for single incision cases. Conclusion: Surgical intervention for distal biceps ruptures may help restore function to an active individual; however, this procedure is not without risk of complications. The single incision technique has a higher rate of failed re-attachment and re-rupture compared to the double incision technique. The single incision technique also has a higher rate of overall nerve palsy (PIN, LABC, and Radial Nerve) compared to the double incision technique. The double incision technique does have higher rates of HO compared to the single incision. These complications are important for surgeons to consider and disclose to patients deciding on operative repair.
Validation of the Microsoft Kinect as a Portable and Inexpensive Screening Tool for Identifying ACL Injury Risk
Authors: Gray Aaron D. , Marks Jeff M. , Stone Erik E. , Butler Michael C. , Skubic Marjorie , Sherman Seth Lawrence 
Published: August 2014

Objectives: A widespread screening tool to assess anterior cruciate ligament (ACL) injury risk should ideally be portable, inexpensive, markerless and easy to use. We hypothesize that our software program - for use with the Microsoft Kinect Motion Sensor - fulfills the above requirements. This study compares the measurements of knee abduction during a drop vertical jump (DVJ) between the Microsoft Kinect and the “gold standard” marker-based Vicon motion analysis system. Methods: Thirteen participants (10 male: 3 female; age 20-31) took part in this IRB approved study. Each participant performed between 5 and 7 DVJs, yielding a total of 84 DVJs. We simultaneously measured knee valgus motion (KVM) as measured from initial contact (IC) to the point of peak flexion (PF), frontal plane knee angle (FPKA) at both IC and PF, and knee-to-ankle separation (KASR) ratio measured at PF with the Kinect and Vicon systems. The intra-class correlation coefficient (ICC) (two-way, single measure, absolute agreement) was used to assess the degree of agreement between the Kinect and Vicon for each measure. Results: KVM had the lowest ICC value; 0.81 and 0.85 for the left and right leg, respectively. The other measures had similar ICC values of approximately 0.89 for both legs. Standard interpretations of the ICC suggest values above 0.75 indicate excellent agreement between the measurements (Table 1). Conclusion: This study demonstrates good correlation between the Microsoft Kinect and the Vicon system for measuring frontal plane knee kinematics during the DVJ. The DVJ test has been established as an ideal task for evaluating the motions that put athletes at risk for ACL injuries. Screening and early detection of ACL injury risk factors may lead to a relative risk reduction between 30% to 80% with an appropriate ACL injury prevention program. As compared to the “gold standard” Vicon system, the Microsoft Kinect is a portable, inexpensive, marker-less, and expedient system that likely has acceptable accuracy to become a practical means of mass screening of athletes for ACL injury risk factors. Further study will focus on validating the system with a larger and varied sample size and over a variety of functional tasks.