bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arthroscopic Treatment of Posterior Impingement of the Hindfoot
Authors: Carreira Dominic S. , Vora Anand Mahesh , Kozy John 
Published: August 2015

Objectives: Open and arthroscopic techniques have been utilized in the treatment of posterior impingement of the ankle and hindfoot. Because posterior impingement occurs more frequently in patients who repetitively plantarflex the ankle, this population may especially benefit from a procedure that reduces pain and results in maximal range of motion (ROM). The purpose of this study was to assess the outcome of hindfoot endoscopy in patients with posterior ankle impingement through higher level of function outcome measures and physical examination parameters, focused on analysis of ROM. Methods: 20 ankles (19 patients) were followed prospectively at a minimum 1 year follow-up (mean 38.2 months). 19 of 20 patients were competitive athletes. Patients completed a minimum of 3 months of nonoperative treatment. Diagnoses included os trigonum, tibial exostosis, talar exostosis, loose body or fracture nonunion, and ganglion cyst removal. Patients underwent arthroscopic treatment utilizing a posterior approach; all relevant pathology was addressed. Post-surgery, patients were placed in a splint for 3 to 7 days then placed in a CAM boot for 2 to 3 weeks, weight bearing as tolerated. Physical therapy was initiated within 7-10 days; strengthening exercises were initiated postoperatively at 1 month. Results: At most recent follow-up, VAS Pain and AOFAS Hindfoot scores showed significant improvement (p<0.01) pre to post-operatively; Tegner score remained unchanged (p=0.888). 3 patients were professional athletes; all returned to their previous level of professional activity. ROM variables between affected and unaffected sides reached statistical similarity at most recent follow-up. 15% of patients reported post-operative neuritis. No other complications were reported. Conclusion: Posterior ankle arthroscopy allows for maintenance or restoration of anatomic ROM of the ankle and hindfoot, ability to return to at least previous level of activity, and improvement in objective assessment of pain relief and higher level of function parameters. Complications associated with this procedure are minimal.
Treatment And Results Of Combined Mild Bone Loss Instability With The Modified Laterjet
Authors: Yang Justin Shu , Mazzocca Augustus D. , Arciero Robert A. 
Published: August 2015

Objectives: Recurrent anterior glenohumeral dislocation in the setting of an engaging Hill-Sachs lesion is high. The Latarjet procedure has been well-described for restoring glenohumeral stability in patients with over 25% glenoid bone loss. However, the treatment for patients with combined humeral head and mild (<25%) glenoid bone loss remains unclear. We report on the outcomes of the modified Latarjet for this population. Methods: Modified Latarjet was performed in twenty three patients with recurrent anterior shoulder instability, engaging Hill-Sachs by exam confirmed with arthroscopy, and less than 25% anterior glenoid bone loss. The mean follow-up was 3.5 years. All patients were assessed for their risk of recurrence using the Instability Severity Index Score (ISIS), had pre-operative 3D imaging to assess humeral and glenoid bone loss. Single Assessment Numeric Evaluation (SANE), Western Ontario Shoulder Instability Index (WOSI), recurrence rate, radiographs, range of motion and dynamometer strength were used to assess outcomes. Results: Average pre-operative instability severity index score was 6.2 (range 4-9). Pre-operative glenoid bone loss averaged 15.1% (range 5-25%). The humeral defect averaged 40.4% in width and 13.7% in depth on axial computed tomography scan, with an average Hill-Sachs angle of 28°. The mean WOSI index was 457 of 2100 (range 0-1398). The mean SANE score was 81.2 (range 60-100). Five out of ten competitive athletes returned to play for at least one season. There were no recurrent dislocation and three patients had a single episode of recurrent subluxation. Loss of external rotation at the side averaged 8°, and there was no significant loss of abduction. Subscapularis, abduction and external rotation strength averaged greater than 85% of the contralateral shoulder. Fourteen patients on average had 1.4 (range 1-4) previous open or arthroscopic stabilization procedures prior to the Latarjet, nine others had Latarjet done primarily. WOSI scores correlated directly with number of previous surgery (r=0.81, p=0.02). Average WOSI score was 239 (range 0-510) in primary Latarjet, 495 (range 42-1024) in patients with one previous stabilization procedure, and 674 (range 192-1398) in patients with two or more previous stabilization procedures (ANOVA p<0.001). There were three deep infections, two graft fractures, two painful hardware, one broken screw with graft malunion, and one radiographic graft nonunion. All infections, malunion and nonunion occurred in patients with failed previous stabilization procedures. No long-term nerve palsies were found. Resorption of the graft at the superior screw was seen in 28% of patients. Conclusion: The modified Latarjet is a reasonable choice for the treatment of an engaging Hill-Sachs lesion with concomitant mild anterior glenoid bone loss in this very demanding group of patients. However, the complication rate is significant.
Arthroscopic Treatment of FAI in Adolescent Athletes
Authors: Byrd J. W. Thomas , Jones Kay S. 
Published: August 2015

Objectives: Athletic activities are implicated in the development of symptomatic FAI in adolescents as reflected by a high prevalence of sports participation among young individuals who present with this problem. The purpose of this study is to report the outcomes of arthroscopic treatment. Methods: All patients undergoing arthroscopy are prospectively assessed with a modified Harris hip score. 104 athletes (117 hips) were identified among 108 consecutive adolescents (122 hips) less than 18 years of age who had undergone arthroscopic surgery for FAI and had achieved minimum one-year follow-up. This cohort of athletes represents the substance of this report. Results: Follow-up averaged 28 months (range 12-60 months). Average age was 16 years (range 12-17 years). There were 47 males and 57 females. The average improvement was 22 points (preop 73; postop 95) with 113 hips (97 %) improved with 112 (96%) good & excellent results. Eighty-eight athletes (84%) returned to their sport. Among the 16 that did not return to sports, 5 were unable, 6 chose not, and 5 had completed their high school athletic careers. Most common sports were football 15, soccer 13, basketball 13, dance 11, volleyball 7, cross-country 7, swim 7, gymnastics 5, baseball 4, softball 4, and lacrosse 4. FAI correction was performed for 33 cam, 17 pincer, and 67 combined lesions. 107 labral tears underwent 82 refixations and 24 debridements. There were 99 acetabular chondral lesions (42 Grade I, 18 Grade II, 34 Grade III, 5 Grade IV) with four microfractures. There were 3 femoral chondral lesions (1 Grade II, 2 Grade III). Seven loose bodies were removed and 19 lesions of the ligamentum teres were debrided. Concomitant extra-articular procedures included 13 iliopsoas tendon releases, two iliotibial band tendoplasties, and one trochanteric bursectomy. There were two complications, transient pudendal neurapraxias, that resolved within two weeks. Four patients underwent repeat arthroscopy and one a PAO. Conclusion: Athletic activities are implicated in the development of symptomatic FAI at a young age, and this study reports favorable outcomes of arthroscopic treatment of FAI among adolescent athletes. A high portion was improved, although only 84% actually returned to their sport. Return to sport may be influenced by factors other than just the success of the procedure.
Association Of Meniscal Status And Lower Extremity Alignment With Chondrosis At The Time Of Revision Acl Reconstruction
Authors: Brophy Robert H. , Haas Amanda , Huston Laura J. , Nwosu Samuel K. ,   Mars Group, Wright Rick W. 
Published: August 2015

Objectives: Knees undergoing revision ACL reconstruction (rACLR) have a high prevalence of articular cartilage lesions. The purpose of this study was to test the hypothesis that the prevalence of chondrosis at the time of rACLR is associated with meniscus status and lower extremity alignment. Methods: Data from the prospective Multicenter ACL Revision Study (MARS) cohort was reviewed to identify patients with pre-operative lower extremity alignment films. Lower extremity alignment was defined by the weight bearing line (WBL) as a percentage of the tibial plateau width, while the chondral and meniscal status of each weight bearing compartment was recorded at the time of surgery. Multivariable proportional odds models were constructed and adjusted for relevant factors in order to examine which risk factors were independently associated with the degree of medial and lateral compartment chondrosis. Results: The cohort included 246 patients with lower extremity alignment films at the time of rACLR. Average (SD) patient age was 26.9 (9.5) years with a BMI of 26.4 (4.6). The medial compartment had more chondrosis (Grade 2/3: 42%, Grade 4: 6.5%) than the lateral compartment (Grade 2/3: 26%, Grade 4: 6.5%). Disruption of the meniscus was noted in 35% of patients on the medial side and 16% in the lateral side. The average (SD) WBL was measured to be 0.43 (0.13). Medial compartment chondrosis was associated with BMI (p=0.025), alignment (p=0.002)(see figure), and medial meniscus status (p=0.001). None of the knees with the WBL lateral to 0.625 had Grade 4 chondrosis in the medial compartment. Lateral compartment chondrosis was significantly associated with age (p=0.013) and lateral meniscus status (p<0.001). Subjects with ‘intact’ menisci were found to decrease their odds of having chondrosis by 64-84%. Conclusion: The status of articular cartilage in the tibiofemoral compartments at the time of rACLR is related to meniscal status. Preserving the meniscus at the time of ACL reconstruction has the potential to be chondroprotective, particularly in patients who go on to require rACLR. Lower extremity alignment and BMI are associated with medial compartment chondrosis, suggesting that optimizing alignment and minimizing weight gain may be important in these patients.
Transcriptomic Signatures of Meniscal Tears and Articular Cartilage from Knees Undergoing Arthroscopic Partial Meniscectomy Show Evidence for Early Osteoarthritis
Authors: Brophy Robert H. , Sandell Linda , Wright Rick W. , Rai Muhammad Farooq 
Published: August 2015

Objectives: Despite clinical evidence demonstrating that meniscus tears are early events in the initiation and propagation of knee osteoarthritis (OA), the biology of how meniscus injury leads to changes in the articular cartilage is not well studied. Therefore, we compared the molecular biology of articular and meniscal cartilage within the same knees undergoing partial meniscectomy to advance our understanding of early molecular events in the knee that contribute to the development of OA following a meniscus tear. The purpose of this study was to test the hypothesis that meniscal and articular cartilage from knees undergoing arthroscopic partial meniscectomy will demonstrate molecular signature representative of early OA. Methods: Patients (n=12) with a known isolated medial meniscus tear without any knee chondrosis or radiographic OA were consented prior to surgery. During arthroscopic partial meniscectomy, a sample of their injured meniscus and a small fragment of their articular cartilage off the medial femoral condyle were procured. The transcriptome signatures measured through Affymetrix microarray were compared between the two tissues and underlying biological processes were explored computationally. Results: 3566 gene transcripts, representing several underlying biological processes, including extracellular matrix organization, wound healing, cell adhesion, chemotaxis, blood vessel morphogenesis, and angiogenesis, were differentially expressed between meniscus and articular cartilage. Conclusion: Articular cartilage and meniscus exhibit molecular events associated with OA at the time of partial meniscectomy despite no gross evidence of degeneration in the knee. These findings identify early effects of meniscus injury on meniscus and articular cartilage, which likely lead to the development of knee OA.
Revision Meniscus Surgery in Children And Adolescents: the Effect Of Skeletal Immaturity
Authors: Shieh Alvin , Edmonds Eric W. , Pennock Andrew T. 
Published: August 2015

Objectives: The purpose of this study was to investigate the incidence and risk factors for revision meniscus surgery in a pediatric population as well as to describe mechanisms of failure and subsequent operative management. Methods: A retrospective review was performed of all patients under 20 years who had arthroscopic management for meniscus pathology at a single institution between 2008 and 2012. Demographic data and intraoperative findings at the time of the initial surgery were documented. All patients undergoing a second procedure on the same meniscus were further analyzed to calculate the incidence and risk factors for revision surgery. The mechanism and date of reinjury as well as subsequent surgical management were documented. Patients with persistent pain following the initial operation were considered a non-traumatic surgical failure. Multivariate logistic regression with purposeful selection was performed to identify independent risk factors for revision meniscus surgery. Results: Arthroscopic knee surgery was performed on 293 patients and 324 menisci, including 129 repairs, 149 meniscal debridements, and 46 discoid saucerizations. With a minimum follow-up period of 17 months, 13% of the cohort required a revision procedure. The primary repair group had the highest failure rate (18%) followed by the discoid saucerization group (15%) and the meniscus debridement group (7%). Multivariate analysis indicated that meniscus repair was predictive of re-tear (OR = 2.04, 95%CI 1.01-4.1, p=0.046), and children with an open physis and a bucket handle tear had the highest retear rate of 46% (p=0.039). Independent variables shown to have no significant relationship to revision meniscus surgery included: age, gender, BMI, laterality, time to repair, tear location, and associated ligament injury. The most common indication for revision surgery was an acute traumatic re-injury during physical activity. Revision procedures were performed at an average of 14 months after the index surgery and the majority of failures (69%) were identified within a year. 44% of patients undergoing a revision surgery underwent a further debridement whereas 56% underwent a repair. Conclusion: Revision meniscus surgery is not uncommon in pediatric and adolescent patients especially those undergoing a primary repair of a bucket-handle meniscus tear when the physes are still open. Most failures are the result of a traumatic injury and nearly half will require further debridement of the torn meniscus. Surgeons treating meniscal lesions in this young population, as well as children and their families, should be aware of the short-term rate of revision meniscus surgery, especially when they are still skeletally immature.
Humeral Torsion as a Risk Factor for Shoulder and Elbow Injury in Professional Baseball Pitchers
Authors: Noonan Thomas J. , Thigpen Charles A. , Bailey Lane Brooks , Wyland Douglas J. , Kissenberth Michael J. , Hawkins Richard J. , Shanley Ellen 
Published: August 2015

Objectives: Participation in baseball causes increased mechanical stress to the throwing arm and has been linked to alterations in shoulder range of motion (ROM) and bony morphology. Range of motion changes, specifically GIRD, has been associated with increased shoulder injury. However, the role of humeral torsion is unclear in shoulder injury. The purpose of this study was to prospectively compare humeral torsion (HT) in professional pitchers who remain healthy as compared with those who go on to suffer shoulder injuries. Methods: We prospectively measured and observed 255 professional pitcher-player seasons prior to 2009-2013 spring training. Bilateral HT was assessed in pitchers who were currently asymptomatic and participating without restriction, in all training, and practices. Humeral torsion was assessed via validated, indirect ultrasonography. Two trials of HT were averaged for data analysis. The side-to-side difference in HT was calculated by subtracting the dominant arm (D) HT from the non-dominant (ND) HT. The pitchers were then followed for the development of shoulder injury over the course of each season. Separate mixed model ANOVAs(side X injury) were used to compare pitchers’ dominant and non-dominant HT between those who suffered shoulder injury to those who did not miss games due to arm injury (α=0.05). Tukey's Post-Hoc tests were used to determine minimum significant differences for significant interaction effects. Results: We observed 30 shoulder injuries. Pitchers with previous elbow injuries(n=30) were excluded from the comparison.(Table 1) Pitchers who suffered a shoulder injury displayed 3.5° less D humeral retrotorsion compared to those pitchers without injury(n=195; P=0.04).(Figure 1). Conclusion: This study showed that pitchers with decreased humeral retrotorsion had a significantly increased risk of shoulder injury. Decreased humeral retrotorsion may hinder the ability of the shoulder to obtain needed ROM, thus increasing stress to the shoulder in late cocking and follow through. Our results should be viewed in context of the relatively small injury numbers but provide preliminary evidence that the influence of HT should be closely examined when considering shoulder injury risk in professional pitchers.
Pre-Operative Femoral Nerve Block for Hip Arthroscopy: A Randomized Controlled Trial
Authors: Xing Jerry G. , Abdallah Faraj W. , Oldfield Stephanie , Dold Andrew , Murnaghan Michael Lucas , Brull Richard , Whelan Daniel B. 
Published: August 2015

Objectives: : Arthroscopy has become a standard method of treatment for a variety of intra-articular hip pathologies. While most arthroscopic hip procedures are performed as day-surgeries, patients can still experience significant post-operative pain and opioid-associated side-effects. Our group has shown the potential benefits of preoperative femoral nerve block (FNB) in a previous retrospective review. It was our objective to confirm these findings in a prospective study. Methods: Fifty patients undergoing hip arthroscopy were included in this prospective, single centre, double-blinded, randomized controlled trial. All patients received a pre-operative ultrasound-guided femoral nerve block with either 20 mL of 0.5% bupivacaine (treatment group, n=27) or normal saline (control group, n=23). Nerve blockade was confirmed via standardized sensory testing prior to the induction of general anaesthesia. Groups were compared with respect to patient sex, age, body mass index (BMI), physical status classification according to the American Society of Anaesthesiologists (ASA); procedure performed; and opioid requirements. The primary endpoint was total oral morphine equivalent consumption in 24 hours. Secondary endpoints included visual analog pain scores; Quality of Recovery (QoR-27) score at 24 hours; incidence of nausea and vomiting; patient satisfaction; and block-related complications. Results: There were no significant differences between groups with respect to sex, age, weight, height, BMI, ASA classification, or type of procedures performed. Total oral morphine consumption at 24 hours was similar between groups. Patient-reported pain scores were lower at all times points in the femoral nerve block group compared to the placebo group with statistical significance reached at 30 minutes, 1 hour, 2 hour, 4 hour, and 6 hours post-operatively. There was no difference in the rates of nausea and vomiting after surgery, Quality of Recovery score at 24 hours, time to discharge, or symptoms of itching, weakness, and injection site bruising and pain. The placebo group had a significantly higher rate of reported constipation at 48 hours. 6 out of 27 patients in the femoral nerve block reported falls (without injury) at 24 hours compared to 0 out of 23 patients in the placebo group. The satisfaction score, however, was similarly high in both groups at all time-points. Conclusion: Pre-operatively administered femoral nerve blocks lead to decreased pain scores in the early post-operative phase without affecting opioid consumption or opioid-related side effects. Patient satisfaction with pain control was similarly high between groups. Given the rate of falls observed in this study, we cannot recommend the routine use of femoral nerve blocks for outpatient hip arthroscopy.
Surgical Trends in Treatment of Meniscus Tears: Analysis of Data from the American Board of Orthopaedic Surgery Certification Examination Database
Authors: Parker Benjamin , Hurwitz Shepard R. , Spang Jeffrey T. , Creighton Robert A. , Kamath Ganesh V. 
Published: August 2015

Objectives: The indications and criteria for meniscal repair are expanding in parallel with new understanding in pathophysiology, biomechanics and novel surgical techniques. In learning from the previous management of meniscal tears with total meniscectomy, there is growing concern for preservation of meniscus and its implication in the development of osteoarthritic changes, specifically in the young population. The American Board of Orthopaedic Surgery (ABOS) has developed a comparative effectiveness program that intends to assist in the geographic variation in various orthopaedic practices, trends in practice patterns for the treatment of various conditions, and the differential effectiveness of certain procedures in the treatment of various conditions. The objective of this study is to analyze the surgical management trends of meniscal pathology from 2004-2012 among recent orthopaedic graduates. Methods: A query of the American Board of Orthopaedic Surgery (ABOS) database was used to identify patients from 2004-2012 who underwent meniscal repair and partial meniscectomy with and without anterior cruciate reconstruction. The specialty training of the surgeon, the age of the patient, the region where the surgery was performed, and the complications were collected from the case database. Results: Among meniscal procedures the frequency of repair has increased from 5% to 7.3% from 2004-2012. However, within this context, partial meniscectomies have decreased disproportionately to the increase in meniscal repair. In contrast, when performed in combination with ACL reconstruction, the frequency of meniscal repairs has increased from 14.9% to 22.3%, while the incidence of partial meniscectomy has increased from 34.8% to 39.3%. When comparing sports fellowship and non-sports trained physicians, there is no significance difference in these procedure trends. There is no variability in region with regards to the type of meniscal procedure being performed. The total complication rate of all ABOS queried meniscal procedures was 5.9% and the implant failure rate was 0.4%. The complication rate was 6.5% in sports trained physicians vs. 5.0% in the non-sports trained physicians. Conclusion: Partial meniscectomies are being performed at a significantly decreasing rate in proportion to the increasing rate of meniscal repairs amongst candidate ABOS member surgeons. In combination with ACL reconstruction, both repair and meniscectomy are being performed at an increasing incidence. There is no difference in the rate at which these procedures are being performed based on age, geography, and surgeon training from 2004-2012. These trends may be a reflection of the new understanding of meniscus healing potential, advances in techniques and technology, and new resident core competencies.