bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation Of A Dry Model For The Assessment Of Resident Performance Of Anterior Cruciate Ligament Reconstruction (ACLR)
Authors: Dwyer Tim , Shantz Jesse Alan Slade , Chahal Jaskarndip , Wasserstein David , Schachar Rachel , Devitt Brian M. , Theodoropoulos John S. , Ogilvie-Harris Darrell 
Published: August 2015

Objectives: As the demand increases for demonstration of competence in surgical skill, the need for validated assessment tools also increases. The purpose of this study was to validate the use of a sawbones model for the assessment of performance of anterior cruciate reconstruction (ACLR) by residents. We hypothesized that the combination of a checklist and a previously validated global rating scale be a valid and reliable means of assessing ACLR when performed by residents in a dry model. Methods: All residents, sports medicine staff and fellows were invited to perform an ACLR on an ACL Sawbones model. Demographics regarding previous exposure to knee arthroscopy and ACLR were collected. All participants were asked to perform a hamstring ACLR using an anteromedial portal with Endobutton fixation on the femur - a detailed surgical manuscript and technique video was sent to all residents prior to the study. Residents were evaluated by faculty using a task-specific checklist created using a modified Delphi procedure, and the Arthroscopic Surgical Skill Evaluation Tool (ASSET) global rating scale. Each procedure was recorded, with videotaping of the hand movements and arthroscopic video recordings of the intra-articular procedure. These videos were scored by a fellow blinded to the year of training of each resident. Results: A total of 29 residents, six staff and five faculty performed an ACLR on the sawbones model (40 total). The overall reliability (Cronbach's Alpha) of the test using the total ASSET score was very high (>0.9). The reliability for the femoral checklist was 0.75, for the tibial checklist was 0.78, and 0.68 for the graft passage and fixation. One-way analysis of variance for the total ASSET score and the total checklist score demonstrated a difference between residents based upon year of training (p&lt0.001). Post hoc analysis demonstrated a significant difference in global ratings and checklist scores between junior residents (PGY1-3) and senior residents (PGY4&5), seniors and fellows, and fellows and staff (p<0.05). A good correlation was seen between the total ASSET score and prior exposure to knee arthroscopy (0.73) and ACLR (0.65). The inter-rater reliability (ICC) between faculty rating and blinded assessor for the total ASSET score was very high (>0.8). Conclusion: The use of a sawbones models to assess resident performance of ACLR using the ASSET global rating scale is valid and reliable. These models may be used to ensure a minimal level of competence prior to resident performance of ACLR in the operating room.
Outcomes after Anterior Cruciate Ligament Reconstruction using the Norwegian Knee Ligament Registry of 14,142 Patients
Authors: LaPrade Christopher M. , Dornan Grant , Granan Lars-Petter , LaPrade Robert F. , Engebretsen Lars 
Published: August 2015

Objectives: While the effects of concurrent meniscal resection and anterior cruciate ligament reconstruction (ACLR) are known to decrease patient outcomes and increase the rate of osteoarthritis over the long-term, overall short-term patient functional outcomes in a large cohort of patients are not well known. Therefore, the purpose of this study is to compare the preoperative and two-year postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale scores after ACLR with and without meniscal injury. In comparison to an isolated ACLR, we hypothesized that patients with a medial meniscal (MM) or lateral meniscal (LM) resection with an ACLR would have significantly decreased two-year postoperative KOOS outcomes, while those with an ACLR with a MM or LM repair would be indistinguishable to isolated ACLR. Methods: The Norwegian Knee Ligament Registry (NKLR) was used to evaluate outcomes for a total of 14,142 patients with primary ACLR. The KOOS scoring system was used to evaluate patients on 5 subscales (Pain, Other Symptoms, Activities of Daily Life (ADL), Sport and Recreation Function (Sport/Rec), and Quality of Life (QoL) at time of surgery and at two-year postoperative follow-up. Patients with isolated ACLR and ACLR with LM repair, LM resection, MM repair or MM resection were compared using multiple linear regression modeling. Results: Preoperatively, in comparison to isolated ACLR, patients that had an ACLR with either a MM repair or MM resection had significantly lower scores for all KOOS subscores and LM repair had significantly decreased scores on the Other Symptoms, Pain, and ADL subscales. Postoperatively, in comparison to isolated ACLR, two-year KOOS outcomes were not significantly different between patients with ACLR and either LM repair, MM resection, or LM resection; however, those with MM repair had significantly lower scores on the Other Symptoms and QoL subscales. Conclusion: For the majority of study groups, patients with meniscal repairs or resections with concomitant ACLR had postoperative KOOS scores that were not significantly different from an isolated ACLR. Patients with ACLR with meniscal resections do not exhibit decreased clinical outcomes at two years postoperatively. It is recommended that clinicians follow patients with ACLR and concurrent meniscal treatment for longer than two years postoperatively.
Inter- and Intra-Rater Reliability of Predictive Models for the Non-Operative Healing Potential of Stable Juvenile Osteochondritis Dissecans (JOCD) Knee Lesions
Authors: Haskel Jonathan D. , Uppstrom Tyler J. , Gausden Elizabeth Bishop , Meyer Russell , Shin Yong-Woon , Nguyen Joseph , Green Daniel W. 
Published: August 2015

Objectives: While juvenile osteochondritis dissecans (JOCD) lesions have greater healing potential than equivalent lesions in adults, only 50% of JOCD lesions demonstrate radiographic healing after 6 months of non-operative treatment. Krause et al. (2013) and Wall et al. (2008) have described models to predict a patient's probability of healing with non-operative treatment based on patient and lesion characteristics. The Wall et al. nomogram incorporates normalized lesion length, normalized lesion width, and pain type, while the Krause et al. model includes normalized lesion width, patient age, and the size of concurrent cyst-like lesions. The purpose of this study was to determine inter- and intra-observer reliability of the predictive nomograms. Methods: We retrospectively evaluated a consecutive series of children with open physes, who underwent non-operative treatment for stable JOCD lesions. Thirty-four patients (40 knees) were included in the study. At two time points at least one week apart, two medical students, two orthopaedic surgeons, and a radiologist made measurements of the JOCD lesions as described by Wall and Krause. These measurements, along with patient ages and pain type, were used to generate a point value for each lesion based on both the Krause and Wall models. Intra-class correlations (ICC) were calculated using the point value data obtained from the nomograms to determine inter- and intra-rater reliability. Results: Based on the Landis & Koch (1977) threshold, we found near perfect intra-rater correlation for all raters in terms of individual OCD measurements, as well as total point score as calculated by both Krause and Wall methods (Table 1). Additionally, amongst the five raters there was near perfect inter-rater reliabilities in total scores, as well as substantial to near perfect reliability in measuring the individual components of the scores (Table 2). Conclusion: There is high inter- and intra-rater reliability for both the Krause and Wall point systems for predicting healing of JOCD lesions. These models appear to be important tools for helping doctors and patients reliably predict the healing potential of non-operative management of JOCD lesions.
Decellularized Osteochondral Allograft for the Treatment of Cartilage Lesions in the Knee
Authors: Farr Jack , Gracitelli Guilherme , Gomoll Andreas H. 
Published: August 2015

Objectives: Chondrofix® is a pre-shaped cylindrical, decellularized and sterilized osteochondral allograft (OCA). The purpose of this study was to evaluate functional outcomes and graft survivorship among patients treated with this implant for cartilage injuries in the knee. Methods: An IRB-approved database was used to identify a prospective series of 32 patients who had been treated with the Chondrofix implant. The surgeries were performed in two centers by two surgeons. The mean age ± Standard Deviation (SD) of the patients was 35.1 ± 10.6 years; 59% were male. Twenty-four (75%) knees had previous surgery. The mean defect area ± SD was 2.9 ± 2.0 cm² . The mean allograft size ± SD was 13.18 ± 2.3 mm (6 grafts ≤ 9 mm and 59 grafts ≥11mm). The number and type of reoperations were assessed. Failure was defined as structural damage of the graft diagnosed by arthroscopy or magnetic resonance imaging and any reoperation resulting in removal of the allograft. Patients were evaluated pre- and postoperatively using the Knee Injury and Osteoarthritis Outcome Score (KOOS) scale and Marx Sports Activity Scale. Results: Twenty-three of the 32 knees (72%) were considered failures, and 14 of the 32 knees (43%) had further surgery following the index procedure. Implant survivorship was 19.6% at 2 years(Graphic). The mean follow-up duration was 1.29 years (range 0.11- 2.8 years). KOOS Pain, ADL, Sports and Knee-related Quality of Life (QOL) improved significantly from the preoperative visit to latest follow-up (Table). Age was significantly predictive of failure with hazard ratio of 1.68 per 1SD older (95% CI, 1.05 to 2.68, p = 0.030). Conclusion: The decellularized and sterile osteochondral allograft implant demonstrated a 72% failure rate within the first 2 years of implantation in these two institutions.
Variation in Surgical Treatment of Knee Osteochondritis Dissecans (OCD) Among High-Volume OCD Surgeons
Authors: Heyworth Benton E. , Edmonds Eric W. , Kocher Mininder S. , Shea Kevin G. , Nissen Carl W. , Ganley Theodore J. , Murnaghan Michael Lucas 
Published: August 2015

Objectives: Clinical practice guidelines (CPG) for osteochondritis dissecans (OCD) of the knee have demonstrated lower levels of evidence for treatment of this condition. Elucidating variation in treatment is a national priority within healthcare, due to evidence demonstrating that reduction of unnecessary variation can improve outcomes, lower costs, and increase value. The purpose of this study was to assess surgical treatment variation for OCD amongst 20 surgeon-investigator members of an international multi-center OCD study group. Methods: Using a validated arthroscopy classification system, surgeons were queried as to which, amongst 5 different surgical treatment ‘principles’ should be applied for each of 6 different arthroscopic OCD presentations in both skeletally immature and mature patients. The process was repeated with an expanded set of 12 different surgical ‘techniques’ for each of the arthroscopy categories. Intra-class correlation coefficients (ICC) were calculated across all surgeons amongst 5 ‘principles’ and amongst 12 ‘techniques’, as well as for each individual arthroscopic presentation. Results: When assessing the most prevalent treatment ‘principles’ overall, agreement between surgeons was excellent (ICC = 0.79, 95% CI 0.58-0.96) for skeletally immature knees and good (ICC = 0.74, 0.51-0.95) for skeletally mature knees. Agreement of selected treatment ‘principles’ for each individual arthroscopic presentation ranged from excellent to poor, with more advanced-stage lesion presentations yielding poorer agreement. For selection of specific surgical ‘techniques’, agreement was poor for both for skeletally immature knees (ICC = 0.27, 0.09-0.71) and skeletally mature knees (ICC = 0.0, 0.0-0.95), and fair to poor for the individual arthroscopic presentations. Conclusion: High volume OCD surgeons demonstrated good to excellent agreement on the optimal treatment ‘principles’ to apply for the various arthroscopic presentations of knee OCD, but agreement worsens as lesion stage becomes more advanced. Agreement on application of specific surgical ‘techniques’ is consistently poor, suggesting high variation in surgical approaches, even amongst high volume surgeons.Substantiating agreement for surgical ‘principles’ of knee OCD with higher levels of evidence is important, given what the CPG has revealed about literature on OCD. More importantly, the lack of agreement regarding surgical techniques makes multi-center investigations into outcomes following different techniques a critical research initiative in the future. Higher quality prospective research may reduce variation and improve outcomes in surgical techniques for OCD.
Outcomes of Operatively Treated Non-unions and Symptomatic Mal-unions of Adolescent Diaphyseal Clavicle Fractures
Authors: Carsen Sasha , Bae Donald S. , Kocher Mininder S. , Waters Peter M. , Donohue Kyna , Heyworth Benton E. 
Published: August 2015

Objectives: The purpose of the study was to review the clinical characteristics and outcomes of adolescent diaphyseal clavicle fractures treated surgically for non-union, impending non-union, or symptomatic mal-union, which are rare complications of primary non-operative treatment. Methods: Records of all patients 10-18 years-old who underwent surgery at a tertiary-care children's hospital between 2003-2013 for a symptomatic mal-union, non-union (no bony bridging >6 mo post-fx), or impending non-union (no callus 1-6 mo post-fx) of a clavicle shaft fracture were reviewed. Demographic data, radiographic features, operative details, and post-operative course were analyzed and compared to an age-matched, sex-matched, and fracture pattern-matched control group of adolescents who underwent plate fixation as primary fracture treatment. Results: Sixteen patients (56% male; mean age 15.4 years, range 12.4-17.7 years) met inclusion/exclusion criteria, most of whom (87.5%) were initially treated at an outside hospital. Plate fixation, with or without osteotomy, was performed in 14 cases (87.5%), with bone grafting in 13 cases (81.3%), including iliac crest autograft (n=4), local bone graft (n=4), cancellous allograft (n=1), or local graft + cancellous allograft (n=4). Two mal-union cases (12.5%) underwent ostectomy only. Comparisons of mean time between injury and surgery, time to healing, duration between surgery and return to sports, and rate of removal of hardware (excluding the two ostectomy patients) are detailed in Table 1. Conclusion: Adolescents who underwent surgery for diaphyseal clavicle fracture non-union, impending non-union or symptomatic mal-union demonstrated bony healing and returned to sports within 2-4 months, with a comparable post-operative course and rate of subsequent hardware removal to patients treated with plate fixation for their primary clavicle fracture. To address the rare instance of slow, failed, or painful healing following non-operative management of diaphyseal clavicle fracture in adolescents, surgical treatment, which may be more technically challenging and often requires bone grafting, has clinical and radiographic results that are comparable to primary fracture fixation.
Return to Sports in a General Hip Arthroscopy Cohort: Minimum Two-Year Follow-Up
Authors: Domb Benjamin G. , Dunne Kevin F. , Martin Tim , Gui Chengcheng , Finch Nathan , Stake Christine E. 
Published: August 2015

Objectives: Previous studies have assessed elite athletes’ level of return to sport, but few have investigated a general hip arthroscopy cohort. The study purpose was to compare patient-reported outcomes (PRO) scores and ability to perform sports-related movements between a group of patients that returned to sport (RTS) and a group that did not return to sports (NRTS). Methods: Between September 2008 and April 2012, 1343 patients underwent hip arthroscopy, of which, 157 patients (168 hips) reported playing a sport before surgery and also indicated their postoperative involvement in sports. Of these, 148 patients (158 hips, 94%) had two-year follow-up. Four PROs were used. The Hip Outcome Score - Sports Specific Subscale (HOS-SSS) was the primary measure to assess return to sports and ability to perform sport-related movements. Results: In the overall cohort of 148 amateur and professional athletes (158 hips) who underwent hip arthroscopies, 25 (17%) did not return to sports due to hip-related issues. An additional 32 patients (22%) did not return to sports due to non-hip-related issues, while three patients did not return sports for unidentified reasons. These 60 patients (65 hips) were considered the NRTS group. The remaining 88 patients (93 hips) were defined as the RTS group. Average ages for the RTS and NRTS groups were 30.7 and 30.4 years, respectively. Both groups demonstrated significant improvements from preoperative to postoperative scores based on all PRO measures. While there was no significant difference between groups for HOS-SSS scores preoperatively, the RTS group had significantly higher HOS-SSS scores at one year and two years post-surgery. Postoperatively, patients in the RTS group had significantly better ability to: run one mile, jump, land from a jump, stop quickly and perform cutting/lateral movements (p<0.05). Patients with HOS-SSS>20 at two years post-surgery were 2.3 times as likely to return to sport as those with HOS-SSS < 20. Conclusion: In a mixed group of hip arthroscopy athletes, 84% returned to sport or discontinued participation due to non-hip related issues. Patients who returned to sport demonstrated significantly higher HOS-SSS scores and abilities to perform several sport-related movements. movements.
Magnetic Resonance Arthrography and the Prevalence of Acetabular Labral Tears in Patients 50 Years of Age and Older: Is It Really Indicated?
Authors: Jayakar Rohit , Merz Alexa , Plotkin Benjamin , Wang Dean , Seeger Leanne L. , Hame Sharon L. 
Published: August 2015

Objectives: Arthroscopy for acetabular labral tears has minimal impact on pain and function in patients older than 50 years of age in the setting of concomitant osteoarthritis. Despite this, many physicians continue to seek diagnoses of labral tears in older arthritic patients with magnetic resonance arthrography. The inefficacy of surgical management and the suggested high prevalence of this condition in both symptomatic and asymptomatic patients call into question the utility of diagnosis through an invasive and expensive imaging modality. The purpose of this study is to assess the frequency of acetabular labral tears in patients aged 50 years and older with hip pain and to correlate the likelihood of a labral tear with the severity of osteoarthritis as visualized on conventional radiograph. Methods: From 2004-2013, 208 patients aged 50 years and older who underwent hip MR arthrogram and hip radiographs within a 12-month period were identified. Age, gender, grade and location of labral tear, hip alpha angle, hip Tönnis grade, and hip joint space width were documented for each patient. Labral tears and alpha angle were identified and measured on MR arthrogram. Tönnis grade and joint space width were measured on hip radiographs by a musculoskeletal radiologist. Results: On MR arthrography, labral pathology was identified in 93% of patients (73.1% labral tearing, 20.2% labral fraying or degeneration). In patients with moderate to severe osteoarthritis (Tönnis grade 2-3), 100% had labral pathology (73.1% labral tearing, 26.9% labral fraying or degeneration). Similarly, in patients with joint space width ≤ 2mm, 100% had labral pathology (81.2% labral tearing, 18.8% labral fraying or degeneration). There were no statistically significant correlations between labral tear grade and Tönnis grade or joint space width. Conclusion: Given the high frequency of tears, as well as the questionable efficacy of arthroscopic surgical intervention in these patients, only good surgical candidates with chronic hip pain and minimal evidence of osteoarthritis (joint space width > 2mm, Tönnis grade 0-1) on initial radiographic evaluation should be considered for magnetic resonance arthrography.
Labral Reconstruction with Iliotibial Band Autograft and Semitendinosus Allograft Improves Hip Joint Contact Area and Contact Pressure: An In-Vitro Analysis
Authors: Lee Simon , Wuerz Thomas H. , Shewman Elizabeth , McCormick Francis , Salata Michael Jonathan , Philippon Marc J. , Nho Shane Jay 
Published: August 2015

Objectives: Labral reconstruction using iliotibial band (ITB) autograft and semitendinosus (Semi-T) allograft have recently been described in cases of labral deficiency. The current study seeks to understand the biomechanical effects of an intact labrum, segmental labral resection, and labral reconstruction on joint contact area, contact pressure, and peak force. Methods: Ten fresh-frozen human cadaver hips were analyzed utilizing thin-film piezoresistive load sensors to measure contact area, contact pressure, and peak force 1) with the native intact labrum, 2) after segmental labral resection and 3) after graft labral reconstruction with either ITB autograft or Semi-T allograft. Each specimen was examined at 20° extension and 60° flexion. Statistical analysis was conducted through one-way ANOVA with post-hoc Games-Howell tests. Results: For the ITB group, labral resection significantly decreased contact area (20°: 73.2%±5.38, P=0.0010; 60°: 78.5%±6.93, P=0.0063) and increased contact pressures (20°: 106.7%±4.15, P=0.0387; 60°: 103.9%±1.15, P=0.0428). ITB reconstruction improved contact area (20°: 87.2%±12.3, P=0.0130; 60°: 90.5%±8.81, P=0.0079) and contact pressures (20°: 98.5%±5.71, P=0.0476; 60°: 96.6%±1.13, P=0.0056) from the resected state. Contact pressure at 60° flexion was significantly lower compared to the native labrum ( P = 0.0420). For the Semi-T group, labral resection significantly decreased contact area (20°: 68.1±12.57, P=0.0002; 60°: 67.5%±6.70, P=0.0002) and increased contact pressures (20°: 105.3%±3.73, P=0.0304; 60°: 106.8%±4.04, P=0.0231). Semi-T reconstruction improved contact area (20°: 87.9%±7.95, P=0.0087; 60°: 92.9%±13.2, P=0.0014) and contact pressures (20°: 97.1%±3.18, P=0.0017; 60°: 97.4%±4.39, P=0.0027) from the resected state. Comparative analysis demonstrated no statistically significant differences between either graft reconstruction in relation to contact area, contact pressure, or peak forces. (Figure 1). Conclusion: Segmental anterosuperior labral resection results in significantly decreased contact area and increased contact pressures, while labral reconstruction partially restores time-zero acetabular contact areas and pressures as compared to the resected state. Although labral reconstruction improved the measured biomechanical properties as compared to the resected state, some of these properties remained significantly different compared to the native intact labrum.