bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extra-articular Drilling for Adolescents with Osteochondritis Dissecans of the Talus
Authors: Edmonds Eric W. , Roocroft Joanna Helena , Bastrom Tracey P. , Pennock Andrew T. 
Published: August 2015

Objectives: To determine the radiographic outcome and need for further surgery in children with osteochondritis dissecans (OCD) of the talus treated with extra-articular drilling. Children requiring further surgery for pre-operative risk factors of the initial failure were also evaluated. Methods: Fifty-six ankles were identified between August 2006 and August 2012 with talus OCD that underwent extra-articular talar drilling. Demographic data, mechanism of injury, conservative treatment history, surgical details of initial treatment and subsequent treatment, if necessary, was collected. Pre-operatively, radiographs were evaluated for physeal status, signs of osteoarthritis according the Kellgren and Lawrence Scale, location of the lesion, border, and size of the lesion. Each lesion was classified according to the Berndt and Harty classification for radiographs, Hepple classification for MRI, and Ferkel and Sgaglione for CT. Radiographs at each follow-up visit were evaluated by a Healing matrix that assessed serial changes in lesion length, lesion depth, perilesional sclerosis, or density of the lesion. At final follow-up, lesion size, border, Berndt and Harty classification, and signs of osteoarthritis were recorded. Results: At final follow-up, all but one lesion showed radiographic improvement but no lesion reached complete radiographic resolution. The mean Healing matrix score at final follow-up was 59/100. Risk factors for reaching statistical significance for poor healing included closed physes (p = 0.025) and lesions with a distinct border (p = 0.029). Age, size of lesion, and length of follow-up did not correlate with healing. Comparison of pre-operative and final follow-up radiographs showed no significant change in the size or border of the lesion. For the 23% of children who underwent a second surgery, they were found to have a lower Healing matrix score after index surgery compared to those without repeat surgery, p < 0.001). Moreover, patients with closed physes were more likely to have second surgery, 38% vs. 14% (OR 3.7). After a second extra-articular talar drilling surgery, the mean Healing matrix score improved to match the mean of the entire cohort. Conclusion: Extra-articular talar drilling of OCD does not appear to improve radiographic outcomes as compared with other reported techniques of intra-articular drilling. As with other joints, successful radiographic resolution is associated with open physes - highlighting that children have better OCD healing potential. Other modalities of talus OCD treatment should be explored, especially for higher-grade lesions at risk for instability, since the radiographic results of current drilling techniques are disappointing.
The Cost-Effectiveness of Utilizing Platelet-Rich Plasma During Rotator Cuff Repair
Authors: Samuelson Eric M. , Fleischli James E. 
Published: August 2015

Objectives: A certain percentage of repaired rotator cuffs do not heal postoperatively. There has been significant interest in enhancing the healing potential of repaired rotator cuffs using biologic factors such as cytokines, gene therapy, scaffolds, mesenchymal stem cells, etc. Platelet-rich plasma (PRP) has been one of the most studied of these biologic factors. The purpose of this study was to determine whether or not PRP augmentation of rotator cuff repair (RCR) is cost-effective. Methods: Utility values, retear rates, and transition probabilities were derived from the best evidence available in the literature regarding rotator cuff tears, their repair, and the augmentation of the repair with PRP. Costs were determined by examining the typical patient undergoing treatment for a full-thickness rotator cuff tear in a private orthopaedic clinic and outpatient surgery center. (Table 1) A Markov decision model was constructed using this data to perform a cost-effectiveness analysis. (Figure) Results: The cost per quality-adjusted life year ($/QALY) of RCR with and without PRP was $6775/QALY and $6612/QALY respectively. In the base case scenario, the use of PRP to augment RCR was not cost-effective as it had exactly the same ‘effectiveness’ as RCR without PRP augmentation while being associated with a higher cost (additional $750). Sensitivity analysis revealed that in order to achieve a willingness-to-pay threshold of $50,000/QALY, the addition of PRP would need to be associated with a 9.1% reduction in retears. If the cost of PRP were increased to $1000, the retear rate would need to be reduced 12.1% in order to reach this same threshold. This compared to a reduction of only 6.1% if the additional cost of PRP was $500. (Table 2) Conclusion: This cost-effectiveness analysis reveals that, currently, the use of PRP to augment RCR is not cost-effective. Sensitivity analysis evealed that PRP augmented repairs would have to show a reduced retear rate of at least 9.1% before its additional cost would be considered cost-effective. Future research needs to show a significant and reliable reduction in retear rates or improvement in outcomes before PRP augmented RCR can be considered cost-effective.
The Fate Of Meniscus Tears Left in situ At The Time Of Anterior Cruciate Ligament Reconstruction
Authors: Duchman Kyle R. , Westermann Robert W. , Spindler Kurt P. , Amendola Annunziato , Wolf Brian R. , Parker Richard D. , Andrish Jack T. , Withrow Laura J. , Reinke Emily , Kaeding Christopher C. , Wright Rick W. , Marx Robert G. , McCarty Eric C. , Wolcott Michelle Lora , Dunn Warren R. 
Published: August 2015

Objectives: Meniscus tears frequently accompany acute anterior cruciate ligament ruptures. Management of meniscus tears is highly variable and includes repair, meniscectomy, and non-treatment of tears identified at the time of ACL reconstruction. The purpose of this study is to determine the rate of subsequent reoperation and clinical outcome of meniscal tears left in situ without treatment at the time of ACL reconstruction with a minimum follow-up of 6 years. Methods: Patients with meniscus tears left untreated at the time of primary ACL reconstruction were identified from a multicenter study group between 2002 and 2004 with minimum 6-year follow-up. Patient demographic variables, comorbidities, meniscus tear characteristics, and information on subsequent surgery were obtained. The primary endpoint of the study was need for reoperation for meniscal pathology. Univariate and multivariate analyses were used in order to determine patient demographic variables and meniscus tear characteristics that served as risk factors for reoperation. Results: There were 1440 primary ACL reconstructions performed during the timeframe of the study. There were 955 patients (66.3%) with concomitant meniscal tears identified. Of these, 143 (15.3%) had meniscal tears left in situ at the time of surgery. There were 11 patients (7.9%) who underwent reoperation for meniscal pathology within the same compartment as the meniscal tear left in situ (Table 1). Reoperation was performed more frequently for medial meniscus tears as compared to lateral meniscus tears (17.6% vs. 4.3%, p = 0.048). Medial meniscus tears and tears ≥10 mm in length were identified as risk factors for reoperation. Conclusion: Lateral and medial meniscus tears left in situ at the time of ACL reconstruction did not require reoperation at minimum 6-year follow-up in 95.7% and 82.4% of patients, respectively. Our results suggest that surgeons should consider alternative treatment for medial meniscus tears and tears ≥ 10 mm in length at the time of ACL reconstruction.
A Comparison of Non-Operative and Operative Treatment of Complete Proximal Hamstring Ruptures
Authors: Olsen Joshua , Kellum Ethan L. , Lacerte Edward , Miller Suzanne Laura 
Published: August 2015

Objectives: Early repair of acute proximal hamstring ruptures provides better clinical results than delayed repairs. However, it is unclear how the non-operative treatment compares to the operative treatment of these injuries. We compare the clinical results of non-operative and operative treatment of acute proximal hamstring ruptures. Methods: A retrospective case-control study of patients with a complete, retracted, proximal hamstring rupture was performed from 2007 to 2013. All patients were given the option of a proximal hamstring repair at the time of initial evaluation. Patients at least 12 months from the time of surgery or injury were included for evaluation. Acute proximal hamstring injuries were included; and partial proximal hamstring tears and chronic injuries repaired were excluded. The primary outcome measure was the lower extremity functional score (LEFS). Secondary outcome measures included the SF-12 physical and mental component scores, a single leg hop (average of three jumps), the patient's perception of strength (0-100%), and ability to return to activity. Results: A total of 25 patients were enrolled. The 14 patients treated surgically sustained injuries at 46.98 ± 9.73 years of age, were repaired at 28.14 ± 14.06 days, and evaluated at 50.62 ± 10.11 years of age. The 11 patients treated non-operatively sustained injuries at 55.6 ± 10.45 years of age (p = 0.05), attempted therapy an average of 4.6 ± 3.22 months, and were evaluated at 58.4 ± 8.31 years of age (p= 0.06). The LEFS for the surgical and non-surgical groups was 74.71 ± 5.38 and 68.5 ± 7.92 (p = 0.04), respectively. SF-12 mental and physical components scores were similar between groups. The average single leg hop of the injured extremity in the surgical and non-surgical groups was 119.1 ± 27.68 cm and 56.1 ± 31.2 cm (p = 0.0001), respectively. When compared to the uninjured leg, the average single leg hop in the injured leg was 5.1 ± 12.1 cm and 1.2 ± 17.2 cm (p = 0.51) shorter in both the surgical and non-surgical groups, respectively. The LEFS had a weak correlation with the average single leg hop and age in the surgical (R2 = 0.2478 and 0.0664, respectively) and non-surgical (R2 = 0.0023 and 0.052, respectively) groups. The patient's perception of strength was similar between the surgical and non-surgical groups (86.07 ± 12.12% and 83.6 ± 14.15%, p = 0.64). All patients in the operative group were able to return to pre-injury activities whereas three were unable to in the non-operative group (chi-square stat = 4.33, p = 0.03). Conclusion: Patients with acute proximal hamstring ruptures treated surgically have better lower extremity function and a higher likelihood of returning to pre-injury activities than patients treated non-surgically.
Epidemiology of Isolated Meniscus Tears in Young Athletes
Authors: Masini Brendan David , Dickens Jonathan F. , Tucker Christopher J. , Cameron Kenneth L. , Svoboda Steven J. , Owens Brett D. 
Published: August 2015

Objectives: Meniscus tears are common in athletic populations; however, there are few studies of the epidemiology of meniscal tears in a stable knee, and particularly tears in young populations. The purpose of this study was to define the incidence of isolated meniscus tears and to determine demographic and athletic risk factors. Methods: A longitudinal cohort study was performed to determine the incidence and characteristics of isolated meniscus tears at the United States Military Academy between 2005 and 2012. Injuries identified in the Cadet Illness and Injury Tracking System (CIITS) were confirmed by clinic, surgical, and radiographic data for inclusion. Cooper's classification was used to localize meniscus tears. Incidence rates (IR) per 1000 person-years and per 1000 athlete-exposures (AE) were determined for sport and level of competition. Demographic, injury characteristic and time loss data were also evaluated. Results: There were 79 instances of meniscus tears in stable knees in a cohort of 9086 subjects from 2005-2012. Of these, 68 (86%) were in males and 11 (14%) in females. Right (40) and Left (39) knees were equally affected. The lateral meniscus (70%) was torn at a greater rate than medial meniscus (30%). Body mass index (BMI) of the meniscus injured population was 25.7 vs. 24.6 for the uninjured cohort (p less than .05). BMI was also greater in subjects with lateral (26.4) vs. medial (23.9) meniscus tears (p less than .05). The average time lost from activity was 102 days. Surgically managed injuries lost 112.7 days vs. 36.1 for non-operative cases (p less than .05). Of the operative cases, repairs lost 150.8 days vs. 101.0 for debridement (p less than .05). There was no significant difference in time lost from medial (90.9 days) vs. lateral (106.9 days) injuries. The greatest percentages of meniscus tears were found in football (19%), wrestling (13%) and rugby (9%) activities. Military combative training accounted for 5% of meniscus tears. The IR per 1000 AE for intercollegiate athletes was greatest in wrestling (0.157) and rugby (0.150). This was mirrored in the intramural population with rates of 0.125 and 0.138 respectively. Rates per AE in football were lower at 0.045 and 0.062 for intercollegiate and intramural competition. Conclusion: Isolated meniscus tears are relatively common in young athletes and cause significant loss of time from athletic pursuits with meniscus repair causing greater loss than debridement. Lateral meniscus tears are more prevalent in this population. A significantly greater BMI was seen in those with vs. without isolated meniscus tear in this cohort, and between those with lateral vs. medial meniscus tear among the injured. Wrestling and rugby carry the greatest risk of meniscus injury per exposure at both the intercollegiate and intramural level of competition.
Poor Static Balance is a Novel Risk Factor for Non-contact Anterior Cruciate Ligament Injury
Authors: Oshima Takeshi , Nakase Junsuke , Takata Yasushi , Numata Hitoaki , Tsuchiya Hiroyuki 
Published: August 2015

Objectives: The anterior cruciate ligament (ACL) injury is common and affects young individuals, particularly female, who are active in sports that involve jumping, pivoting, as well as change of direction. ACL injury is associated with potential long-term complications including reduction in activity levels and osteoarthritis. In recent years, the focus on the ACL injury prevention has increased and many studies exploring risk factors for ACL injury have been published. However, the influence of the static balance on ACL injuries is poorly documented. The purpose of this study was to investigate the relationship between the static balance and incidence of ACL injury among high school female athletes. Methods: A 3-year prospective cohort study was conducted with 287 high school female handball or basketball players. All subjects were 15 years old and included 111 handball players and 176 basketball players. At baseline, using gravicorder, postural sway was measured for 30 seconds during two-leg standing with eye open. The measured parameters of postural sway were locus length per time (LG), which indicates postural control function by proprioceptive reflexes, and environmental area (AR), which indicates the degree of equilibrium impairment. After the baseline examination was performed at high school entry, all players were followed for 36 months to register any subsequent incidence of ACL injury. We compared the differences in the static balance between injured and uninjured players using an unpaired t-test. Values of p < 0.05 were considered statistically significant. Results: In the present study, 28 of the 287 players (9.6%) suffered an ACL injury during the 3-year observation period. Two players suffered both knees. Twenty five injured players sustained a non-contact injury and three injured players sustained a contact injury. Sixteen players were injured during the game and other players were injured during the practice. In this study three contact injury players were excluded. There were not significantly different between the ACL injured group and uninjured group in the stature characteristics such as age, height and weight. The mean values for LG and AR for the two-leg standing of the eye-open test were 1.30 ± 0.36 cm/s and 2.44 ± 1.34cm2 (ACL injured group), 1.15 ± 0.26 cm/s and 1.98 ± 1.02 cm2 (uninjured group). There was significantly difference between the injured group and uninjured group in LG (p = 0.045). However there was no significant difference two groups in AR (P = 0.107). (Table1) Conclusion: In the present study, locus length per time was significantly longer in injured players compared with uninjured players. This result showed that the postural control function by proprioceptive reflexes is the one of the risk factors for non-contact ACL injury. The proprioceptive training may be effective in ACL prevention with clinical relevance.
Biomechanical Consequences of Lateral Meniscal Posterior Root Avulsions
Authors: Geeslin Andrew G. , Civitarese David Marc , Turnbull Travis L. , Dornan Grant , Fuso Fernando , LaPrade Robert F. 
Published: August 2015

Objectives: Lateral meniscal posterior root avulsions are commonly found with anterior cruciate ligament (ACL) tears. The purpose of this study was to investigate the biomechanical effects of lateral meniscal posterior root avulsions with and without intact meniscofemoral ligaments (MFLs), and with concurrent ACL tears, on lateral compartment contact mechanics. Methods: A controlled laboratory study was performed using ten nonpaired fresh-frozen cadaveric knees. Tekscan sensors were used to simultaneously measure contact area and pressure (Figure) in the lateral and medial compartments. Specimens were tested with 6 conditions (1: Intact; 2: Lateral meniscal posterior root avulsion; 3: Root avulsion and torn MFL; 4: Condition 3 with ACL tear; 5: Condition 4 with ACL reconstruction; 6: ACL reconstruction with root repair) at 5 flexion angles (0, 30, 45, 60, and 90 degrees), under a 1000 N axial load. Results: Compared to the intact state, condition 2 did not significantly alter lateral compartment contact area or pressure (p < 0.05). A significant decrease in contact area and increase in mean contact pressure occurred in condition 3. Conditions 4 and 5 (ACL tear and reconstruction of the ACL, respectively, both with deficient MFLs and lateral meniscal posterior root avulsion) also produced significantly lower contact areas than the intact condition (p < 0.05), and were not substantially different than Condition 3 (Figure). Changes in contact mechanics tended to be greater at increased flexion angles; for condition 3 at 0 and 90 degrees, contact area decreased 37% and 52% (95% CI [21,53] and [39,66], respectively) and mean contact pressure increased 55% and 87% (95% CI [33,76] and [59,114], respectively). Condition 6 (root repair with ACL reconstruction) was not significantly different from the intact state (p < 0.05). Conclusion: The meniscofemoral ligaments protect the lateral compartment from changes in contact mechanics in the setting of a lateral meniscal posterior root avulsion, whereas combined lateral meniscal root avulsion and deficient meniscofemoral ligaments leads to substantial changes. Concurrent ACL reconstruction and root repair restores contact area and mean contact pressure to the intact state.
Evaluation Of Three-Dimensional Motion During Side-step Cutting After Anterior Cruciate Ligament Reconstruction in Pediatric Athletes
Authors: Pace James Lee , Mueske Nicole , Katzel Mia , Zaslow Tracy , Chua Matthew , Wren Tishya , Zaslow Tracy 
Published: August 2015

Objectives: This study assessed three-dimensional kinematic and kinetic data during side-step cutting in young athletes following anterior cruciate ligament (ACL) reconstruction. Methods: The study included 28 pediatric athletes (mean age 15.6 ± 2.2 years) who underwent ACL reconstruction due to a non-contact injury. Lower extremity and trunk three-dimensional kinematic and kinetic data was collected during a side-step cut. Testing occurred within 12 months (mean time since surgery 5.3 ± 2.1 months) post-surgery. Outcomes were evaluated at initial foot contact and between initial foot contact and maximum knee flexion of the cutting limb. Differences between the operative limb and non-operative (contralateral) limb were investigated using paired t-tests. Results: The operative limb had higher peak adduction (-0.14° ± 7.3 vs. -6.1° ± 5.0, p=0.001) and higher peak pelvic obliquity (14.0° ±6.2 vs. 10.5° ±5.7, p=0.01) compared to the non-operative limb. While there was no significant difference in peak ground reaction force (23.2 N/kg ± 4.7 vs. 24.5 N/kg ± 4.5, p=0.15), the operative limb had lower peak knee flexion (53.3° ± 13.5 vs. 59.6° ±10.0, p=0.004), ankle dorsiflexion (14.5° ± 7.5 vs. 18.6° ± 6.5, p=0.007), and external knee flexor moment (1.4 Nm/kg ± 0.61 vs. 1.9 Nm/kg ± 0.62, p=0.002) leading to the operative limb having less power absorption at the knee (0.38 Ws/kg ± 0.31 vs. 0.58 Ws/kg ± 0.28, p=0.005). At initial contact the operative limb was more adducted (-5.0° ± 7.6 vs. -8.6° ± 3.9; p=0.02) and flexed (56.3° ± 11.4 vs. 52.5° ± 12.7; 0.06) at the hip and more flexed at the knee (21.5° ± 17.1 vs. 17.2° ± 13.6; p=0.06). The operative limb also had more pelvic elevation (8.1° ± 7.0 vs. 5.5° ± 3.8; p=0.04) and had more trunk rotation (rotation relative to the lab; -11.4° ±7.2 vs. -5.3° ±8.6; p=0.004). Eight of the 28 operative limbs had an asymmetry greater than 10% of the non-operative limb on one of the kinematic or kinetic variables; though all eight limb asymmetries occurred on different movement variables. Conclusion: Following ACL reconstruction pediatric athletes exhibit asymmetry several months post-surgery. The operative limb displayed deficits and asymmetry in hip control and shock absorption strategies after initial contact until maximum knee flexion which could increase the risk of future re-injury based on prior biomechanical studies. The contralateral limb also demonstrated deficits and asymmetries at initial contact. These asymmetrical movement patterns and deficits potentially put the non-operative limbs at an increased risk for injury and potentially lend insight into why patients who tear one ACL are at increased risk of contralateral ACL injury. If asymmetry is indicative of future injury risk, this should be considered during treatment, rehabilitation and return to sport decision-making.