bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medial Meniscus Root Repair
Authors: Tjoumakaris Fotios P. , Lombardi Nick J. , Tucker Bradford S. , Levi Dave , Austin Amy , Pepe Matthew D. 
Published: March 2015

Objectives: Meniscus root tears are associated with loss of hoop stress, increased peak pressure, and reduction in contact area of the affected compartment of the knee. Reversal of this outcome is predicated on the successful restoration of the meniscus through biologic healing to the tibial attachment. The purpose of this investigation was to evaluate the biologic healing of meniscus root tears through high resolution MRI and correlate this appearance to clinical outcome Methods: Nine patients were identified as having undergone a medial meniscus root repair using an identical pull-out surgical technique by a single surgeon. Outcomes were determined using Lysholm and WOMAC scores and quality of meniscus healing was assessed using a 3 Tesla MRI. MRI studies were reviewed by two fellowship trained musculoskeletal radiologists according to pre-defined criteria. Results: There were 4 females and 5 males in the study group. The average follow-up time was 30 months (range 21-41). MRI demonstrated a new tear medial to the prior repair in 4/9 patients. 4 patients demonstrated recurrence of tear or lack of biologic healing of the root attachment. In patients with recurrent tears of the root, meniscal extrusion averaged 1.5mm. In patients with evidence of healing, extrusion averaged 1.0mm. The average WOMAC and Lysholm scores were 11.2 and 81.6 respectively. There was no correlation between healing and clinical outcome scores in this series. Conclusion: 4 of 9 patients demonstrated recurrent tearing of the meniscus root. There was an increase in peripheral meniscus tears away from the repair in 4/9 patients, indicating excessive stress induced by the repair. Successful repair and healing was associated with decreased meniscus extrusion; however, this did not correlate with functional outcome scores, indicating that biologic healing is not a pre-requisite for good clinical outcome. A similar finding has been shown in studies evaluating rotator cuff repair.
The Use of Osteochondral Allograft Transplantation for Primary Treatment of Cartilage Injuries in the Knee
Authors: Briggs Dustin , Sadr Kamran N. , Pulido Pamela , Bugbee William 
Published: March 2015

Objectives: To assess the clinical outcome of OCA transplantation used as primary treatment for chondral and osteochondral lesions in the knee. In most treatment algorithms, osteochondral allograft (OCA) transplantation is regarded as a salvage procedure when previous treatments have failed. No publications have assessed the outcome of OCA transplantation used as primary treatment for cartilage lesions in the knee. Methods: Our OCA outcomes database was used to identify 61 patients who underwent OCA transplantation as primary treatment for a chondral or osteochondral defect and had a minimum follow-up of two years. None of the patients had previous surgery on the involved knee prior to the OCA. Included in the analysis were 32 males and 29 females with a mean age of 32.9 years (range 15.7-67.8 years). The most common diagnoses were osteochondritis dissecans (44.3%) and avascular necrosis (31.1%), followed by osteoarthritis (8.2%), degenerative chondral lesion (6.6%), traumatic chondral injury (6.6%), and fracture (3.2%). The mean graft area was 9.6 cm2. The majority of grafts were located on the medial (47.5%) and lateral (24.6%) femoral condyles. Thirty-five patients (57.4%) had one graft, 22 (36.2%) had two grafts, and 4 (6.6%) had three grafts. Each patient was evaluated pre- and postoperatively with the International Knee Documentation Committee (IKDC), a modified Merle d’Aubigné-Postel (18-point) scale, and Knee Society function (KS-F) score. Patients came in for a clinical evaluation or were contacted via telephone for follow-up. The number and type of reoperations following the OCA transplantation was captured. Failure was defined as revision OCA or conversion to arthroplasty. Patient satisfaction was assessed. Results: The mean follow-up duration was 7.6 years (range, 1.9 to 22.6 years). Eighteen knees (29.5%) had further surgery following the OCA transplantation. Seven knees (11.5%) had procedures unrelated to the allograft and 11 knees (18%) were considered OCA failures with eight conversions to arthroplasty, two revision OCA, and one patellectomy. The mean time to failure was 5.9 years (range, 0.5-13.7 years). OCA survivorship was 89.5% at 5 years and 74.7% at 10 years. Forty-three (70.5%) knees had their OCA still in situ at latest follow-up. Thirty-eight (84.5%) were rated good/excellent on the 18-point scale. The mean IKDC scores improved from 36.9 preoperatively to 80.4 postoperatively. The KS-F scores improved from 66.5 to 89.7. Eighty-six percent of patients reported being “extremely satisfied” or “satisfied.” Conclusion: OCA transplantation is an acceptable primary treatment method for some chondral and osteochondral defects of the knee. Failure of previous surgical treatment is not a prerequisite for OCA surgery. Outcomes in this group are comparable to other cartilage repair treatment options.
The Epidemiology of Revision Anterior Cruciate Ligament Reconstruction in Adults from Ontario, Canada
Authors: Leroux Timothy , Wasserstein David , Dwyer Tim , Ogilvie-Harris Darrell , Marks Paul H. , Bach Bernard R. , Townley John , Mahomed Nizar , Chahal Jaskarndip 
Published: March 2015

Objectives: The morbidity associated with revision anterior cruciate ligament reconstruction (ACLR) is largely unknown. The objective of this study was to determine the rate of and risk factors for re-revision, re-operation, and re-admission following revision ACLR in the general population. Methods: All patients who underwent first revision ACLR in Ontario, Canada from January 2004 to December 2010 were identified and followed to December 2012. Exclusions included age (<16 years), previous osteotomy, or multi-ligament knee reconstruction. The main outcome was re-revision ACLR. Secondary outcomes included re-operation [irrigation and debridement (I&D), meniscectomy, manipulation under anesthesia (MUA), contralateral ACLR, and total knee arthroplasty (TKA)], and re-admission within 90 days of surgery. Survival to re-revision was determined using the Kaplan-Meier (KM) approach. A Cox proportional hazards model or logistic regression were used to determine the influence of patient factors (age, sex, neighborhood income quintile, and comorbidity), surgical factors (graft choice, concurrent meniscal procedure, and fixation method), and provider factors (surgeon volume, surgeon years in practice, and hospital status) on outcomes. A post-hoc analysis was performed to determine the influence of the aforementioned factors on overall post-operative infection risk, including both operative and non-operative cases. Results: Overall, 827 patients were included (median age: 30 years; 58.8% males). Single stage revisions comprised 92.9% of cases, and a meniscal procedure (repair or debridement) was performed in 45.3% of cases. The re-revision rate at a mean follow-up of 4.8±2.2 years was 4.4%, and the five-year survival rate was 95.4% (Figure 1). The rates of I&D, meniscectomy, contralateral ACLR, and re-admission were 0.8%, 3.1%, 3.4%, and 4.1%, respectively. MUA and TKA were rare. Young age significantly increased contralateral ACLR risk (risk decreased by 5.1% with each year of age above 16 years, p=0.02), but not re-revision ACLR risk. Low surgeon annual volume of revision ACLR [<4 revisions/year: odds ratio (OR) 1.2, p=0.02)] and male sex (OR 13.3, p=0.01) significantly increased overall infection risk, while male sex also influenced I&D risk. No other factors significantly influenced re-revision, re-operation, or re-admission risk. Conclusion: Re-revision, re-operation, and re-admission rates following revision ACLR are low. The risk of I&D, overall infection, and contralateral ACLR were influenced by male sex, low surgeon volume, and young age, respectively. This is the first study of this magnitude to determine rates of and risk factors for morbidity following revision ACLR, providing clinicians with reference data from the general population.
Prevalence Of Osteochondritis Dissecans Of The Capitellum In Young Baseball Players Based On Ultrasonographic Findings
Authors: Matsuura Tetsuya , Suzue Naoto , Iwame Toshiyuki , Sairyo Koichi 
Published: March 2015

Objectives: Osteochondritis dissecans (OCD) of the capitellum is a well-recognized cause of elbow pain and disability in adolescent athletes. However, little is known about the prevalence of OCD in adolescent baseball players. This study aimed to determine the prevalence of OCD in baseball players aged 10-12 years based on ultrasonographic findings and to investigate the clinical characteristics of those with OCD lesions. Methods: A total of 1,040 players aged 10-12 years completed a questionnaire, ultrasound imaging, and radiographic examination to investigate OCD. Sonographic findings were classified into 5 grades (0, 1a, 1b, 2, and 3). Sonographic findings were graded as follows: grade 0, normal; grade 1a, irregular surface of subchondral bone; grade 1b, a cystic lesion of the subchondral bone surface; grade 2, irregularity of the subchondral bone; and grade 3, discontinuity of the subchondral bone. Subjects with grade 1a, 1b, 2, or 3 were considered to have abnormal findings of the capitellum and were advised to undergo radiography. Radiographic and ultrasonographic findings were then compared. The prevalence of OCD was calculated and differences by age and player position were determined. Results: Of the 1,040 players, 33 (3.2%) had an abnormal finding on initial ultrasonography screening, and all 33 agreed to undergo radiography. Of them, 22 (66.7%) were found to have OCD of the capitellum on radiographs, giving an overall prevalence of 2.1%. Seven subjects (31.8%) had no history of elbow pain. Based on our radiographic classification, 20 subjects (90.9%) had stage I lesions (radiolucent area). Analysis of OCD by age and player position revealed no significant differences. Conclusion: The prevalence of OCD of the capitellum was 2.1% in 1,000 baseball players aged 10-12 years, with no differences in prevalence according to age or player position.
Arthroscopic Management of Dysplastic Hip Morphologies
Authors: Larson Christopher M. , Ross James R. , Stone Rebecca M. , Samuelson Kathryn M. , Giveans Russell , Bedi Asheesh 
Published: March 2015

Objectives: Previous reports regarding arthroscopic management of dysplastic hip morphologies have conflicting results. Arthroscopy alone in the setting of dysplastic morphologies is controversial. Methods: We retrospectively reviewed 88 hips (77 patients, 71% female, mean age 33.9 years) with radiographic findings consistent with hip dysplasia and a mean 26.0 months follow-up (range 12-80 months) after hip arthroscopy. Procedures performed included 67 labral repairs (76%), 20 selective labral debridements (23%), 72 capsular repair / plications (82%), and management of associated cam-type morphology in 63 hips (72%). All radiographs were evaluated for parameters consistent with dysplasia including the LCE, Neck Shaft angle, Tonnis angle, Extrusion index, femoral head lateralization, and break in Shenton’s line. Preoperative and post-operative function were evaluated prospectively using the Modified Harris Hip Score (MHHS), SF-12 scoring, and pain on a visual analog score (VAS). Patient demographics, procedures performed, and radiographic parameters were evaluated with regards to functional outcomes. In addition, the results of the dysplastic cohort were compared to an aged matched cohort of 231 hips (215 patients, 52% female, mean age 32 years) performed during the study period with a mean follow-up 22.7 months (12-60 months) that underwent arthroscopic FAI correction without the diagnosis of dysplasia. Results: The mean LCE was 20.8 degrees (range, 8.7 - 24.5), and mean Tonnis angle was 11.0 (range, 0 - 22.2 degrees). The dysplastic cohort had a mean latest MHHS of 81.3 (range, 34-100) and mean 15.6 point (range, -28 - 60) improvement in MHHS compared to 88.4 points and 24.4 points, respectively, in the FAI cohort (p<0.01). The dysplastic cohort had 60.9% good to excellent results and 32.2% failures, compared to 81.2% good/excellent results and 10.5% failures for the FAI cohort (p<0.01). Decreased head neck offset (cam-type morphology) trended towards being predictive of better scores in the dysplastic cohort (p=0.079). In addition, dysplastic hips that underwent capsular plications and labral repairs had greater good / excellent results and lower failure rates (p>0.05). Grade 4 chondral defects were predictive of lower scores (p=0.02). There were no statistically significant differences for functional outcomes regarding gender or age for either cohort (p>0.05). There were no iatrogenic subluxations / dislocations in either group. Conclusion: Although functional scores were improved post-arthroscopy in hips with mild to borderline dysplastic morphologies, Good/Excellent results were inferior and Failure rates were higher compared to an FAI cohort. These results were independent of gender. Associated cam-type FAI, and labral repair / capsular plications were predictive of better clinical outcomes in the dysplastic cohort. Outcomes after pelvic osteotomy in this borderline population are required to determine the optimal treatment.
OCD Lesions Of The Patella And Trochlea In Children
Authors: Kramer Dennis E. , Yen Yi-Meng , Simoni Michael , Miller Patricia , Micheli Lyle J. , Kocher Mininder S. , Heyworth Benton E. 
Published: March 2015

Objectives: The purpose of this report is to evaluate the functional outcomes of surgical management of OCD lesions of the patella and trochlea in children. Secondary aims include elucidating predictors for higher functional outcomes, determining complication rates, surgical satisfaction and ability to return to sports. Methods: Patients age ≤ 18 years who were surgically treated for OCD of the patellar or trochlea were identified. Charts were queried to record patient/lesion data, surgical procedure, results and complications. Pre- and postoperative imaging was reviewed. Patients were asked to complete a follow-up athletic questionnaire and a Pediatric International Knee Documentation Committee (Pedi-IKDC) score. Statistical analysis was conducted to look for predictors for reoperation, residual pain, ability to return to sports and lower Pedi-IKDC scores. Results: Twenty-six children (9 female, 17 male, 3 bilateral) were identified. Mean age was 14.7 (range: 9-18), 21/29 (72%) had open physes, and median follow-up was 3.8 years (range: 1-9 years). The most common location was the trochlea (17/29, 59%). Twenty-two lesions (76%) underwent transarticular drilling (n=14) or drilling with fixation (8), while 7 underwent excision and marrow stimulation. Four patients (14%) required unplanned re-operation. Internal fixation was predictive of reoperation (OR= 8.7, 95% CI= 2.8-26.9, P=0.04). At final follow up, 14 knees (48%) were pain-free, 14 (48%) had mild residual pain. Female gender was predictive of residual pain (OR= 9, 95% CI= 2-56, P=0.02). Twenty-two patients (85%) returned to sports. Longer duration of preoperative pain negatively impacted return to sports (OR= 0.32, 95% CI= 0.05-0.97, P=0.04). On postoperative imaging, the lesion appeared completely healed in 5 cases (42%) and partially healed in 12 cases (58%). All 15 survey respondents were satisfied with surgery. The mean Pedi-IKDC score was 82.4 ± 17.8 (range: 40.2 -100). Conclusion: Surgical treatment of patellofemoral OCD in children produces a high rate of satisfaction and return to sports. Female gender, prolonged duration of symptoms and internal fixation may be associated with worse outcomes.
Effect of Biceps Tenodesis Using PEEK Screw on the Torsional Strength of Humerus
Authors: Mellano Chris , Shin Jason J. , Mascarenhas Randhir , Shewman Elizabeth , Wang Vincent , Romeo Anthony A. , Verma Nikhil N. , Forsythe Brian 
Published: March 2015

Objectives: Biceps tendoesis is a commonly accepted surgical option for long head biceps related pathology. Sub-pectoral tenodesis with interference screw offers reproducible outcomes with high biomechanical strength allowing for accelerated rehabilitiation. However, there is concern regarding potential fracture risk associate with a diaphyseal humeral tunnel particularly in an athletic population. The purpose of this study was to determine the amount of torsional strength reduction in the humerus resulting from an unicortically drilled hole, and to evaluate the effect of inserting a tenodesis screw into the drilled defect. We hypothesized that unicortical drilling would weaken the humerus and that the use of tenodesis screws would restore strength to the humerus. Methods: Twenty (10 matched pairs) of fresh frozen full length humeri (mean age 55.3 years, range 37-70 years) were used to perform this study. All humeral specimens were stripped of all soft tissue, except for the pectoralis major tendon, which was used to determine location of the tenodesis. Specimens were allocated to either Screw (n=5) or Empty Ream Group (n=5) and the matching contralateral pairs remained intact. In the Empty Ream specimens, an 8 mm unicortical hole was placed into the bicipital groove 1 cm proximal to the inferior border of the pectoralis major tendon. The humeri in the Screw Group were prepared in the same manner and filled with a 8mm x 12 mm polyetheretherketone (PEEK) screw. All specimens were tested until failure under torsional loading at a rate of 1 degree/second. Peak torque, angular deformation at peak, and total energy to failure were recorded. A paired t-test was used to compare data from left and right humeri for each of the two groups. Data were also evaluated as the ratio of the intervention humerus to its contralateral intact humerus in order to compare Tenodesis Screw and Empty Ream groups via a 2-tailed, unpaired t-test. Statistical significance was assumed for P <0.05. Results: When compared with intact group, both Screw and Empty Ream groups showed a significant reduction in peak torque, energy and angular displacement (P < 0.05). No statistical differences were noted between Screw and Empty Ream group for all measured values (Table 1). Conclusion: Drilling an 8mm unicortical hole for subpectoral biceps tenodesis reduces the torsional load to failure of the proximal humerus at time zero. Placing a PEEK tenodesis screw alone does not appear to increase the strength of the humerus.
Paracetamol therapy and outcome of critically ill patients: a multicenter retrospective observational study
Authors: Suzuki Satoshi , Eastwood Glenn M , Bailey Michael , Gattas David , Kruger Peter , Saxena Manoj , Santamaria John D , Bellomo Rinaldo 
Published: March 2015

Abstract
Introduction
In this study, we aimed to examine the association between paracetamol administration in the intensive care unit (ICU) and mortality in critically ill patients.

Methods
We conducted a multicenter retrospective observational study in four ICUs. We obtained information on paracetamol use, body temperature, demographic, clinical and outcome data from each hospital’s clinical information system and admissions and discharges database. We performed statistical analysis to assess the association between paracetamol administration and hospital mortality.

Results
We studied 15,818 patients with 691,348 temperature measurements at 4 ICUs. Of these patients, 10,046 (64%) received at least 1 g of paracetamol. Patients who received paracetamol had lower in-hospital mortality (10% vs. 20%, P <0.001), and survivors were more likely to have received paracetamol (66% vs. 46%; P <0.001). However, patients treated with paracetamol were also more likely to be admitted to the ICU after surgery (70% vs. 51%; P <0.001) and/or after elective surgery (55% vs. 37%; P <0.001). In multivariate logistic regression analysis including a propensity score for paracetamol treatment, we found a significant and independent association between the use of paracetamol and reduced in-hospital mortality (adjusted odds ratio =0.60 (95% confidence interval (CI), 0.53 to 0.68), P <0.001). Cox proportional hazards analysis showed that patients who received paracetamol also had a significantly longer time to death (adjusted hazard ratio =0.51 (95% CI, 0.46 to 0.56), P <0.001). The association between paracetamol and decreased mortality and/or time to death was broadly consistent across surgical and medical patients. It remained present after adjusting for paracetamol administration as a time-dependent variable. However, when such time-dependent analysis was performed, the association of paracetamol with outcome lost statistical significance in the presence of fever and suspected infection and in patients in the lower tertiles of Acute Physiology and Chronic Health Evaluation II scores.

Conclusions
Paracetamol administration is common in the ICU and appears to be independently associated with reduced in-hospital mortality and time to death after adjustment for multiple potential confounders and propensity score. This association, however, was modified by the presence of fever, suspected infection and lesser illness severity and may represent the effect of indication bias.
Pressure ulcers: how much do nursing students really know?
Authors: Rafiei Hossein , Mehralian Hossein , Abdar Mohammad E. , Madadkar Tayebeh 
Published: March 2015

Aim: Taking care of patients with pressure ulcers requires a high level of knowledge. The purpose of this study was to determine the level of nursing students' knowledge of pressure ulcer prevention, classification and management. Methods: The study was conducted in two nursing colleges (Razi Nursing and Midwifery College and Shahrekord Nursing and Midwifery College) in Iran. All final-year bachelors nursing students in both colleges were invited to participate in the study. Data were collected using Pieper's Pressure Ulcer Knowledge Test (PPUKT). Results: Participants answered correctly 67% of all 41 items in three sections (prevention, classification and evaluation). The students' rate of correct answers in the pressure ulcer evaluation category was significantly higher than the correct answers in the other two categories. Conclusion: The study revealed that nursing students had insufficient knowledge of pressure ulcers. It was concluded that courses aimed at raising students' knowledge of pressure ulcers are needed in nurse education.