bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arthroscopy Skills Development with a Surgical Simulator: A Comparative Study in Orthopaedic Surgery Residents
Authors: Rebolledo Brian J. , Leali Alejandro , Hammann Jennifer , Ranawat Anil S. 
Published: August 2014

Objectives: Traditional resident assessment of orthopaedic surgical technical proficiency relies exclusively on subjective parameters. More standardized objective measures are needed to ensure training consistency and surgical competency. The purpose of this study was to determine if orthopaedic surgery residents who train with a virtual reality simulator can lead to improved arthroscopy performance and to determine if a standardized arthroscopic shoulder and knee test were appropriate means for evaluating a resident's arthroscopic skill after completing a training course. Methods: Study participants were first and second year orthopaedic surgery residents at a single institution who were randomized to either train on the virtual reality surgical simulator ( Insight Arthro VR) for a total of 2.5 hours (n=8) or receive 2 hours of didactic lectures with models (non-simulator) (n=6). Both groups were then evaluated in both knee and shoulder arthroscopy using a cadaver. Performance was measured by time to completion of a standardized protocol checklist and cartilage grading index (CGI) (scale 0-10). Results: All subjects had no previous arthroscopy experience prior to the study. The simulator group had a shorter time to completion in both knee (simulator: 5.1 ± 1.8 min, non-simulator: 8.0 ± 4.4 min; p=0.09) and shoulder (simulator: 6.1 ± 1.5 min, non-simulator: 9.9 ± 3.2 min; p=0.02) arthroscopy. Similarly, the simulator group had improved CGI scores in both the knee (simulator: 4.0 ± 1.1, non-simulator: 5.3 ± 1.5; p=0.07) and shoulder (simulator: 3.4 ± 0.8, non-simulator: 5.5 ± 1.6; p=0.008) arthroscopy. Conclusion: This study suggests that surgical simulators are beneficial in arthroscopy skills development for orthopaedic surgery residents. An arthroscopic testing model was able to measure a statistical improvement for a resident's arthroscopic skill. Instituting standardized cadaveric testing based on common orthopaedic surgical procedures such as knee and shoulder arthroscopy will not only ensure graduating residents possess the necessary skills to be technically proficient surgeons but it will also allow objective identification of residents in need of remediation.
Comparison of Transtibial and Tibial Inlay Techniques for Posterior Cruciate Ligament Reconstruction with an Average of 10 Year- Follow-up
Authors: Seon Jong Keun , Song Eun Kyoo , Park Hyoungwon 
Published: August 2014

Objectives: We performd this study to determine the long-term results based on clinical and radiographic outcome comparison following either transtibial or tibial inlay technique, and to find out factors related to osteoarthritis after PCL reconstruction. Methods: Seventy-seven patients (77 knees) treated with the PCL reconstruction for chronic injuries constituted the study cohort. The 77 patients were divided into 2 groups, namely, transtibial (44 patients) and tibial inlay (33 patients). The mean time from injury to reconstruction was 12.2 months (range, 2 to 60 months), and their average follow-up was 142 months (range, 97 to 192 months). Outcomes were measured using Lysholm knee scores, Tegner activity scores, laxity test using Telos device, and development of osteoarthritis. Results: There was significant improvement of Lysholm knee scores, Tegner activity scores, and laxity test using Telos device between the preoperative values and final follow-up values ( P < .05). However, there was no significant difference in the final follow-up outcomes ( P > .05). The final follow-up radiographs according to International Knee Documentation Committee guidelines showed that 7 patients (22.7%) in transtibial group and 4 patients (18.2%) in tibial inlay group were rated as Grade C. We found correlation between meniscectomy and osteoarthritis, but other factors including reconstruction technique, sex, age, and posterior instability did not influence the arthritic changes in both groups (Fig 1). Conclusion: The clinical and radiographic outcomes between the two surgical techniques of PCL reconstruction were comparable. Osteoarthritis was observed in some patients with a significant proportion showing some loss of joint space, and factors except meniscectomy did not show correlation with development of osteoarthritis.
Prospective Hip and Knee Strength Measures Associated with Increased Risk for Patellofemoral Pain Incidence
Authors: Herbst Kristen , Foss Kim D. Barber , Hewett Timothy E. , Stanfield Denver T. , Myer Gregory D. 
Published: August 2014

Objectives: Hip and knee strength abnormalities have been implicated in patellofemoral pain (PFP) in multiple studies in the recent literature. However, many authors have noted that hip muscle weakness has not yet been defined as having a causal relationship to PFP due to the fact that many studies used subjects already diagnosed with PFP. The purpose of this study was to compare prospective hip and knee isokinetic strength measures in young females who subsequently went on to develop PFP relative to their uninjured healthy peers. Methods: Middle and high school female athletes (n=255) were evaluated by a physician for PFP prevalence. Isokinetic strength measurements of the knee (flexion and extension at 300°/sec) and hip (abduction at 120°/sec) were obtained prior to the start of their basketball and soccer seasons. Isokinetic torque measures (newton*meters) were normalized to leg length by mass and are described as a normalized torque (NT). Those diagnosed with PFP at pre-season were excluded and the remaining athletes were monitored by certified athletic trainers for PFP incidence during their competitive seasons. A one-way ANOVA was used to determine significant differences in knee and hip strength measures between the incident PFP and the control groups. Results: Young females who developed PFP were not different in age 12.6 ± 0.9 yrs., mass 51.4 ± 13.2 kg, height 158.8 ± 7.3 cm, or leg length 83.8 ± 4.2 cm compared to the referent control group (P>0.05). Females who developed PFP demonstrated increased normalized hip strength 0.013 ± 0.003 NT relative to the referent control group 0.011 ± 0.003 NT (P<0.05). Normalized knee extension and knee flexion strength were not different between the females with incident PFP compared to the referent control group (P>0.05). Conclusion: The findings in this study indicate that young females with greater hip abduction strength may be at an increased risk for the development of PFP. Previous studies that have looked at landing biomechanics indicated that those with PFP have increased knee abduction and increased hip adduction during landing. Combining our current data and previous literature, we theorize that greater hip abduction strength may be a resultant symptom of increased eccentric loading of the hip abductors associated with increased dynamic valgus biomechanics demonstrated to underlie increased PFP incidence. Future research is warranted to dissect the relative contributions of hip strength and recruitment and dynamic valgus alignments during landing to the pathomechanics of PFP.
The Effect Of Peroneus Brevis Tendon Anatomy On Stability Of Fractures At The Fifth Metatarsal Base
Authors: Farrow Lutul D. , Morris Parisa M. , Francois Annie G. , Marcus Randall E. 
Published: August 2014

Objectives: Fractures of the fifth metatarsal base are not uncommon. Both fracture management and outcomes can differ greatly depending on fracture location. The purpose of the present study is to evaluate the influence of the peroneus brevis (PB) tendon on proximal fifth metatarsal fracture stability. We hypothesize that proximal fifth metatarsal fractures distal to the PB tendon footprint are inherently less stable than more proximal fractures. Methods: We utilized 5 matched pairs of fresh-frozen cadaveric specimens. We carefully exposed the 5th metatarsal and PB tendon. We measured the length of the PB insertion at the base of the fifth metatarsal with calipers. The PB and Achilles tendons were then whip-stitched proximally to facilitate loading. A custom leg holder was fabricated to allow loading and fluoroscopic evaluation. Two conditions were utilized for biomechanical testing; (1) a simulated fracture distal to the PB insertion (Jones equivalent) and (2) a simulated fracture within the footprint of the PB insertion (avulsion equivalent). All fractures were carefully created with a narrow osteotome. Following fracture creation, the plantar flexed foot was statically loaded through the Achilles and PB tendons. Oblique images with and without loading and digital measurements were performed to evaluate for fracture separation. We utilized a paired student T test and intraclass correlation coefficient (ICC) for all statistical analysis. Results: The average length of the PB footprint was 15.2 mm. Compared to fractures within the PB footprint, fractures distal to the PB tendon insertion demonstrated greater fracture widening following loading of the PB tendon. Fractures within the PB footprint widened 0.4 mm on loading (Figure 1A to 1B) compared to 1.1 mm of widening in the fractures distal to the PB insertion (Figure 1C to 1D). This difference was significant (p = 0.02). Intraobserver reliability for all radiographic measurements showed substantial agreement. Conclusion: Avulsion fractures at the base of the fifth metatarsal have much better healing potential than the so-called Jones fracture. Poor vascularity has been cited as a cause for poor healing potential following Jones fractures. The principal findings of this study demonstrate that proximal fifth metatarsal fractures distal to the PB insertion are significantly more unstable than more proximal fractures. In our study, the PB exerts a deforming force on the proximal fragment of fractures distal to the PB footprint. This deforming force was less pronounced in fractures within the PB footprint. Our findings help support the notion that a mechanical component may contribute to the poor healing potential of Jones fractures secondary to deformation exerted by the PB tendon. This would help explain why screw fixation is often recommended to address Jones fractures. Further research is needed to evaluate the biomechanics of these fractures.
Lumbar Spine Injury/Pathology as a Predictor of Outcomes in National Football League Athletes
Authors: Lynch Thomas Sean , Schroeder Greg , Gibbs Daniel , Chow Ian , LaBelle Mark , Savage Jason W. , Patel Alpesh , Hsu Wellington , Nuber Gordon W. 
Published: August 2014

Objectives: The purpose of this study is to determine if a pre-existing lumbar diagnosis such as spondylosis, a herniated lumbar disc, or spondylolysis affects a football player’s draft status or his performance and longevity in the NFL. Methods: The written medical evaluations and imaging reports of prospective professional American football athletes from 2003-2011 from one NFL franchise during the NFL combine (annual college football player evaluation prior to the NFL draft) were compiled and evaluated. All players were evaluated for a pre-existing lumbar diagnosis which were compiled from previous injury/medical records including radiographic imaging reports. Those players with a lumbar spine diagnosis and with appropriate radiograph, MRI and CT imaging were included in this study. These athletes were then matched by age, position, year, and round drafted to control draftees without a lumbar spine diagnosis. Career statistics were compiled including length of play and number of games started. Additionally, a previously established “Performance Score” was calculated for all players excluding offensive linemen. The continuous variables of each cohort were compared using a two-sided (tailed) Student’s t-test for normally distributed data. A chi-squared analysis was performed to analyze the categorical data. Statistical significance was accepted with a p < 0.05. Results: Out of a total of 2,965 athletes evaluated from the NFL combine, 414 players were identified with a pre-existing lumbar spine diagnosis. Athletes who attended the NFL combine without a lumbar spine diagnosis were significantly more likely to be drafted than those with one (74% vs. 61% respectively, p < 0.01). There was no difference between the investigational and control group with regard to round drafted, age, year drafted, or position. Overall, athletes with a lumbar spine injury compared to the control group had no difference in the number of years played (4.0 vs. 4.3 years, respectively, p = 0.13), games played (46.5 vs. 50.7, respectively, p = 0.15), games started (28.1 vs. 30.6, respectively, p = 0.39) or performance score (1.4 vs. 1.8, respectively, p = 0.3) (Figure 1). Conclusion: The data in this study suggests that a pre-existing lumbar spine diagnosis was associated with a significantly lower draft status for NFL athletes. However, the data in our study suggests that such a diagnosis did not affect a player’s career longevity or performance. Further study will be required to determine the individual effects of specific conditions on performance.
Eccentric Strengthening at Long Muscle Lengths Reduces Hamstring Strain Recurrences: Results of Long Term Follow-up
Authors: Tyler Timothy F. , Schmitt Brandon , Gellert Joshua M. , McHugh Malachy P. 
Published: August 2014

Objectives: Hamstring injuries are among the most common injuries in sports involving sprinting and have a high recurrence rate (20-33% recurrence rates reported in the literature). Rehabilitation protocols that can prevent recurrences are needed. The purpose of this study was to determine if a protocol emphasizing eccentric strength training with the hamstrings in a stretched position resulted in a low recurrence rate after return to play. Methods: Forty-eight athletes (age 35±16 yr; 31 men, 17 women) with unilateral hamstring strains (3 G1, 41 G2, 4 G3; 27 recurrent injuries) followed a 3-phase rehabilitation protocol (phase 1: isometric and isotonic strengthening at short to intermediate muscle lengths; phase 2: eccentric strengthening at short to intermediate lengths; phase 3: eccentric strengthening in a stretched position). Athletes progressed to the next phase when pain free with maximum contractions and were discharged to sports when pain free with maximal eccentric contractions in a stretched position and with functional tests. Prior to discharge, isometric strength was assessed bilaterally at 80º, 60º, 40º and 20º knee flexion in sitting with the thigh flexed to 40º above horizontal. Eight athletes chose to return to play prior to completing the rehabilitation and were categorized as noncompliant (5 completed phase 2, 3 completed phase 1). Reinjury rates and hamstring strength were compared between compliant and noncompliant athletes using Fisher exact tests and analysis of variance. Results: None of the 40 compliant athletes had sustained a reinjury at an average of 20±13 months after returning to sports (18>2 yr, 7 1-2 yr, 15<1 yr). Three of the 8 noncompliant athletes sustained reinjuries between 3 and 5 months after return to play (P<0.01 vs. compliant athletes). At time of return to sport, noncompliant athletes had significant hamstring weakness, which was progressively worse at longer muscle lengths (20% deficit at 80º, 23% at 60º, 31% at 40º, 43% at 20º; Angle effect P<0.001). Compliant athletes had symmetrical strength at all angles (P=0.99). Compliant athletes averaged 17±7 treatments over 11±7 wks versus 12±7 treatments over 13±11 wks for noncompliant athletes (P=0.11, P=0.53). Conclusion: Rehabilitation with an emphasis on eccentric strength training with the hamstrings in a stretched position resulted in zero recurrent injuries at an average of 1.7 years after return to play.
The Efficacy Of The Fifa 11+ Injury Prevention Program In The Collegiate Male Soccer Player
Authors: Silvers Holly J. , Mandelbaum Bert R. , Adeniji Ola , Insler Stephanie , Bizzini Mario , Dvorak Jiri 
Published: August 2014

Objectives: To examine the efficacy of the FIFA 11+ injury prevention program in Men’s NCAA collegiate soccer. Methods: A prospective randomized controlled trial was conducted in Division I and Division II NCAA men’s soccer teams during the Fall, 2012 season. Every athletic director, head soccer coach and head athletic trainer from each Divion I and Division II member institution with a men’s collegiate soccer program (N=411) was contacted via a formal letter, email and phone call. Sixty-one member institutions consented to participate. Human ethics review board approval was obtained through Quorum IRB, Seattle, WA, USA. After randomization was completed, the intervention group received an instructional DVD, teaching manual and exercise placards thoroughly describing the FIFA 11+ intervention. An injury surveillance database was utilized (HealtheAthleteTM, Overland Park, Kansas). Every athletic exposure, injury incurred, utilization of the 11+ program and compliance data was entered weekly. Sixty-one institutions completed the study: 34 control institutions (N=850 athletes) and 27 intervention institutions (N=675 athletes). The FIFA 11+ program served as the intervention program over the course of one collegiate season. The warm-up was utilized two to three times per week for the duration of the season. Results: In the intervention Group (IG), 285 Injuries were reported (mean=10.56 injuries/team+/-3.64) compared to 665 Injuries (mean=20.15 injuries +/- 11.01) in the control group (CG). The number of athletic exposures was 35,226 (Games: 10,935 AE, Practice: 24,291 AE) for the IG and 44,212 (Games: 13,624 AE, Practice: 30,588 AE) in the CG). The incidence rate (IR) was 8.09/1,000 AE (95% CI) in the IG compared to 15.04/1000 AE (CI=95%) in the CG (p=0.00117). Total days missed due to injury was 2824 (mean=9.94) in the IG compared to 8776 days (mean =13.20) in the CG. Conclusion: The FIFA 11+ was shown to significantly reduce injury rates and time loss in the competitive male collegiate soccer player in a statistically significant manner. There was a significant reduction in ACL injuries, hamstring injuries and ankle sprains in the intervention group compared to the control group. A biomechanical analysis has been planned in order to fully understand the neuromuscular changes imparted onto the participating athlete by the FIFA 11+ program.
The Effect of Femoral Nerve Block on Strength and Patient-reported Outcomes Following ACL Reconstruction
Authors: Magnussen Robert A. , Pottkotter Kristy , DiStasi Stephanie , Paterno Mark V. , Wordeman Samuel Clayton , Schmitt Laura , Flanigan David C. , Kaeding Christopher C. , Hewett Timothy E. 
Published: August 2014

Objectives: Femoral nerve block (FNB) has been proposed for pain control following anterior cruciate ligament (ACL) reconstruction. Although numerous high level studies have assessed the efficacy of FNB’s, there has been little to no research into the effect of such blocks on post-operative strength and patient-reported outcomes. Exacerbation of post-operative quadriceps weakness by a FNB could negatively impact recovery, particularly in the early post-operative period. We hypothesized that performance of a FNB would result in decreased quadriceps strength and poorer patient-reported outcome score in the first three months following ACL reconstruction. Methods: Thirty patients scheduled to undergo hamstring autograft ACL reconstruction following an acute ACL injury were randomized to a single shot FNB group or a control group. The surgical procedure and post-operative rehabilitation were performed identically in both groups. Pre-operatively, all patients completed a KOOS and isokinetic quadriceps strength testing at 60 deg/s. At 6 weeks post-operative, all patients completed a KOOS and isometric quadriceps strength testing at 90 deg. At 12 weeks post-operative, all patients but three completed a KOOS and isokinetic strength testing. Quadriceps strength limb symmetry indices (LSI) were calculated at all time points by dividing the strength of the involved limb by the strength of the uninvolved limb. LSI and KOOS subscales for Activities of Daily Living (ADL), Pain, and Symptoms at 6 weeks and 12 weeks were compared with pre-operative values. Results: Patients who underwent nerve block demonstrated a significant decrease in their LSI from pre-operative (0.80 ± 0.14) to 6 weeks post-operative (0.67 ± 0.29) (p = 0.05). Patients who did not undergo nerve block demonstrated no significant difference in the pre-operative (0.77 ± 0.23) and 6-week post-operative (0.78±0.28) LSI (p = 0.99). At 12 weeks post-operative, both groups demonstrated LSI values that were not statistically different from pre-operative. Patients who had a FNB demonstrated no change in their KOOS subscales from pre-op to 6 weeks post-op, while those patients who did not undergo FNB demonstrated a statistically significant increase in KOOS ADL, pain, and symptoms subscales from pre-operative to 6 weeks post-operative (Figure 1). All patients, regardless of group, demonstrated significant increases in KOOS subscales at 12 weeks relative to pre-operative (Figure 1). Conclusion: Femoral nerve block is associated with decreased quadriceps strength at 6 weeks post-operative, slowing the post-operative improvement in patient-reported outcome scores. While strength returns to pre-operative levels at 12 weeks post-operative, the effect of early quadriceps weakness on movement patterns and functional outcome at later time points has yet to be determined.
Thromboembolic Events after Arthroscopic Knee Surgery: Increased Risk at High Altitude
Authors: Tyson Jared J. , Bjerke Brian , Genuario James , Noonan Thomas J. 
Published: August 2014

Objectives: The purpose of this study was evaluate the incidence of thromboembolic events in patients undergoing arthroscopic surgery of the knee in surgery centers located at elevations near sea level and comparing those rates with the patients undergoing the same operations at surgery centers located in cities at high altitude. Methods: A retrospective review was conducted using a database of a major health care system with surgery centers located throughout the United States. Over 115 surgery centers located in 15 different states were analyzed for any reported thromboembolic events including deep vein thromboses (DVT) and pulmonary embolism (PE) in patients who had undergone knee arthroscopy over a 2 year period. The surgical centers located at elevations lower than 1000 ft were considered sea level centers. Those centers located at elevations above 4000 ft were considered high altitude centers. Any surgical center located between 1000 ft and 4000 ft elevation was excluded. Results: 35,877 patients underwent a knee arthroscopy procedure at a low altitude center between 2011-2012. 10,181 patients underwent a knee arthroscopy procedure at a high altitude center between 2011-2012. During that same time period, 45 total VTEs including 12 PEs occurred at centers considered low altitude while 50 VTEs including 4 PEs occurred at centers considered high altitude. The incidence of VTE at centers considered low altitude was 0.13%. The incidence of VTE at centers considered high altitude was 0.49%. The difference was statistically significant with a p-value <0.0001. The relative risk of developing a VTE was 3.8 times higher at high altitude. Conclusion: Patients undergoing arthroscopic procedures of the knee in cities located at high altitude are at higher risk of developing a VTE than those undergoing the same procedures at cities located at elevations near sea level.