bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reliability of the ROCK Osteochondritis Dissecans Knee Arthroscopy Classification System - Multi-center Validation Study
Authors: Carey James L. , Wall Eric J. , Kevin G. Shea, MD  , Nathan L. Grimm, BS  , Allen F. Anderson, MD  , Eric W. Edmonds, MD  , Henry G. Chambers, MD  , Benton E. Heyworth, MD  , Mininder S. Kocher, MD, MPH  , Roger M. Lyon, MD  , Michael Lucas Murnaghan, MD  , Carl W. Nissen, MD  , John Polousky, MD  , Jennifer Weiss, MD  , Rick W. Wright, MD  
Published: September 2013

Objectives: Very few predictors of healing have been identified to help guide OCD treatment decisions for patients, families and physicians. As this condition is not common, multi-center study groups will be necessary to determine optimal diagnostic and treatment strategies. For staging systems to be useful, there must be agreement among observers of each stage, and from different centers. Although arthroscopic staging systems exist for OCD, none have been tested for intra-observer and inter-observer reliability. Using an expert consensus method, the ROCK OCD study group developed an arthroscopy classification system for OCD of the knee. The purpose of this study was to determine the reliability of an OCD classification system in a multicenter study group. Methods: We developed a classification system for arthroscopic evaluation of OCD of the knee based on the experience of a 13 centers experienced in the care of OCD. The classification system produced 6 arthroscopic categories (Cue Ball, Shadow, Wrinkle in the Rug, Locked Door, Trap Door, and Crater). A training module including arthroscopic photos, iconic sketches, and representative videos was developed to describe each stage. A total of 30 representative arthroscopic videos were viewed by 10 orthopedic surgeons who had not participated in the video case selection and preparation. After 60 days, the 30 videos were reviewed a second time in a new, randomly selected order and classified. An inter-rater reliability assessment was performed using the intra-class correlation method. Results: The intra-class correlation coefficient was 0.92, indicating a very good to excellent reliability of this classification system amongst orthopedic surgeons within the ROCK group. Conclusion: The ROCK OCD Knee arthroscopy classification system demonstrated high reliability. Relatively rare conditions will require multi-center study groups to perform high quality outcome studies. This classification system will facilitate multi-center studies for OCD.
The Demographics, Epidemiology, and Incidence of Progression to Surgery of Osteochondritis Dissecans of the Knee in Children and Adolescents
Authors: Kessler Jeffrey I. , Nikizad Hooman , Shea Kevin G. , Jacobs John C. , Ishkhanian Rita M. , Weiss Jennifer 
Published: September 2013

Objectives: To assess the demographics and epidemiology of osteochondritis dissecans (OCD) of the knee in patients age 2-19 and the frequency with which these lesions progress to surgery. Methods: A retrospective EMR chart review of an integrated health system was done on OCD between 2007 and 2011. Inclusion criteria included OCD of the knee and patients aged 2-19, with approximately 1 million patients in this cohort. Lesion location, laterality, and all patient demographics were recorded. OCD incidence was determined for the group as a whole and by age group (divided into age 2-5, group A=6-11, group B=12-19). Differences in progression toward surgery were compared between age groups, gender, and joint location. Results: 192 patients with a total of 206 OCD lesions fit the inclusion criteria. No OCD lesions were found in 2-5 year olds. 53.4% of lesions were right-sided, 46.6% left-sided. The medial femoral condyle was the most commonly affected location with 63.6% of the knee OCD lesions, followed by the lateral femoral condyle with 32.5%. Lesions of the femoral trochlea, patella, and lateral tibial plateau represented less than 4% of the total combined. No OCD lesions were found in the 2-5 year-olds. The incidence of knee OCD for patients aged 6-19 was 9.6 per 100,000 for all patients, and 15.7 and 3.3 per 100,000 for males and females, respectively. Group B represented the vast majority of OCD, with an incidence of 21.8 per 100,000 in 12-19 year olds versus 8.7 in group A. Females in group A and B had an incidence of 4.6 and 13.3 per 100,00, respectively, while males had an incidence of 12.5 and 30.1 per 100,00 for group A and B, respectively. The overall male/female ratio for knee OCD was 3.7/1. 33.8% of all lesions progressed to surgery. Lesion location did correlate with progression to surgery, with rare trochlear lesions and tibial lesions more likely to undergo surgery (100%, 100%) than lateral and medial femoral condyle lesions (40.3% and 28.7%) and patellar lesions (33.3%). Conclusion: In this population-based cohort study of pediatric OCD in nearly 1 million children, males had a much greater incidence of OCD and the majority were right sided lesions. Teenagers had nearly 3 times the incidence of OCD as compared to the 6-11 year old group. Although most OCD lesions were located on the medial femoral condyle, lateral femoral condyle lesions were also common. The incidence of OCD in this study was similar to a smaller Swedish study by Linden et al 40 years previously. The knowledge of likelihood of progression to surgery of OCD by location, sex, and age is useful in counseling patients and in planning treatment. To our knowledge, this is the largest study of the demographics, epidemiology, and incidence of progression to surgery of OCD of the knee in children ever reported.
Knee Dislocation from Minor Trauma in Morbidly Obese Patients
Authors: Vaidya Rahul , Nanavati Dhiren , Prince Matthew , Sethi Anil 
Published: September 2013

Objectives: To present a series of atraumatic knee dislocations in obese and morbidly obese patients. Methods: An IRB approved retrospective study was preformed at a level 1 tertiary care trauma center. Eighteen patients who presented with a knee dislocation from a minor injury were included in the study. Charts, Radiographs, MRI’s were reviewed and patients were contacted in to examine them at latest follow up. We include patients in our database from 2001-2011. Results: The mean age at presentation was 33 (range of 15-74 years) with 4 males and 14 females. The average BMI was 43 range (34- 64.4) with an average follow up of 29 months (range 9- 72 months) Five patients (27%) had a popliteal artery injury and 8 (44.4%) had a peroneal nerve injury at presentation. All 5 had a vascular repair, and 4/8 patients had return of peroneal nerve. Surgical repair was preformed on 10 individuals. The average operating time for ligament reconstruction was 183% of that with injury matched patients. All patients had external fixation to protect the repair post op which was removed at 6 weeks post op and accompanied with a manipulation intra-op. Two patients failed reconstruction, one at 5 years due to a second injury and another at 4 months from a fall. We were unable to fit custom braces on these individuals so it was abandoned. Opposite knees were determined to have hyper mobility in all 16 patients who had an adequate exam. Eight operative patients who complied with therapy had an average range of 91.4 degrees (60-110). One patient was noncompliant by not taking therapy and ended up with only 40 degrees of flexion..The non operative patients had an avg ROM of 53.6 degrees (range 30-90) and may have been that they had less aggressive rehabilitation. Three of these had gone on to TKA. Conclusion: Knee dislocations from minor falls occur in obese patients and often have neurovascular complications. Surgical reconstruction is more time consuming and more difficult then in normal weighted individuals. It may be preferable to non operative treatment
Arthroscopic Transfer of the Long Head of the Biceps Tendon
Authors: Taylor Samuel , Baret Nikolas J. , Newman Ashley , Delos Demetris , Drakos Mark , Copple Zachary M. , DiPietro James R. , O'Brien Stephen J. 
Published: September 2013

Objectives: Evaluation of the mid-term clinical and functional outcome in a cohort of patients who underwent transfer of the long head of the biceps tendon (LHBT). Methods: Patients diagnosed with biceps instability or related pathology that underwent arthroscopic assisted or all arthroscopic transfer of the long head of the biceps tendon to the conjoint tendon were considered. The procedure was performed either as an isolated procedure on in conjunction with another procedure by the senior author. Outcome surveys were collected for 157 patients with a subset of 43 patients available for clinical examination at 2-10 years postop time point. Outcome measures were based on American Society of Shoulder and Elbow Surgeons (ASES), University of California at Los Angeles (UCLA), and L’Insalata questionnaires. Ipsilateral and contralateral metrics were also evaluated. Results: 157 patients (25 female, 132 male; average age 50 years; average postop 4.9 years) were evaluated with L’Insalata, UCLA, and ASES questionnaires, scoring 84.78, 29.77, and 83.4, respectively. In the 33 patients who had an isolated LHBT transfer, the L’Insalata, UCLA, and ASES scores were 79.52, 27.6, and 83.95, respectively. 43 shoulders (7 female, 36 male; average age 50 years; average postop 5.1 years) were available for clinical examination by a physician other than the treating surgeon. There was no statistically significant side-to- side strength difference using a 10-pound weight. All of the patients reported no arm pain at rest with regard to the biceps. 81% of patients reported no biceps tenderness upon palpation of the bicipital groove and 85.8% had a negative throwing test. 95.2% of patients had a negative active compression test. Speed’s and Yergason’s tests were negative in 90.5% and 95.2% of patients respectively. One patient (3%) complained of fatigue discomfort (soreness) isolated to the biceps muscle following resisted elbow flexion. Five patients (12.0%) had a Popeye sign and one patient (3%) exhibited biceps subsidence. 86% of patients were self-rated as good to excellent, with the remaining 14% reporting fair or poor results. Conclusion: Arthroscopic subdeltoid transfer of the LHBT to the conjoint tendon is an appropriate and reliable intervention for active patients with chronic, refractory biceps pathology. There was no loss of strength for biceps curls. All patients reported no pain isolated to biceps muscle at rest. Ninety-seven percent of patients had resolution of their preoperative biceps symptoms.
Professional Pitchers with GIRD Display Greater Dominant Humeral Retrotorsion than Pitchers with Normal ROM
Authors: Noonan Thomas J. , Shanley Ellen , Bailey Lane Brooks , Wyland Douglas J. , Kissenberth Michael , Hawkins Richard J. , Thigpen Charles A. 
Published: September 2013

Objectives: Glenohumeral internal rotation deficit (GIRD) in the dominant shoulder of a throwing athlete is a previously recognized phenomenon which has been associated with upper extremity injury. The relationship between GIRD and humeral torsion has not clearly been elucidated. The purpose of this study was to compare humeral torsion between professional pitchers presenting with GIRD and those with normal ROM. Methods: Humeral torsion and shoulder range of motion (ROM) was measured in 128 professional pitchers prior to spring training from 2009-2012. Shoulder external (ER) and internal (IR) ROM was assessed in 90º of abduction with the scapula stabilized. Humeral torsion was measured via ultrasound using previously described and validated methods. GIRD was defined as the loss of internal rotation > 15º with a concomitant loss of 10º total arc of motion. The side-to-side difference in HT was calculated by subtracting the dominant arm (D) HT from the non-dominant (ND) HT. A mixed model ANOVA(side X GIRD) were used to compare pitchers dominant and non-dominant HT between pitchers with GIRD to those without GIRD. Independent t-tests were used to compare the side to side difference in HT between pitchers with GIRD and those without (α=0.05). Results: Pitchers with GIRD displayed alterations in ROM (ER=131.8±14.3, IR= 29.1±10.1, Total Arc=160.9±15.5 ) compared with those with normal ROM (ER=132.0±14.2 , IR= 40.5±11.3 , Total Arc= 172.5 ±16.2 ). Pitchers with GIRD displayed significantly less humeral torsion (i.e. greater retro torsion) in their dominant arm compared to those without (GIRD=4.4±12.0º, Normal=10.4±11.6º, P=0.002). Pitchers with GIRD also displayed a greater side to side difference in humeral retro torsion (GIRD=19.5±11.9 compared with 12.4±12.4º, P=0.001). There was no difference in non-dominant humeral torsion in pitchers with and without GIRD ( P>0.05). Conclusion: Professional pitchers who display deficits in total arc of motion on the internal rotation side greater than 15º tend to also have greater dominant humeral retro torsion and greater side to side differences. An adaptive increase in humeral retro torsion in the dominant arm due to repetitive throwing may limit internal rotation in the follow through phase of the throwing motion. This, in turn, may increases forces on the posterior soft tissues of the glenohumeral joint leading to the development of GIRD. Given that deficits in total arc of motion and internal rotation are associated with increased arm injury risk future studies should examine the amount of humeral torsion that predisposes a shoulder to develop GIRD.
Shoulder and Scapular Kinematics during the Windmill Softball Pitch
Authors: Backus Sherry I. , Kraszewski Andrew , Kontaxis Andreas , Gibbons Mandi , Bido Jennifer , Graziano Jessica , Hafer Jocelyn , Jones Kristofer J. , Hillstrom Howard , Fealy Stephen 
Published: September 2013

Objectives: Pitch count has been studied extensively in the overhand throwing athlete. However, pitch count and fatigue have not been systematically evaluated in the female windmill (underhand) throwing athlete. Direct kinematic measurements of the glenohumeral and scapulo-thoracic joint have not to be correlated and determined. The purpose is to measure scapular kinematics for the high school female windmill softball pitcher and identify kinematic adaptions and changes in pitching performance due to fatigue. Methods: Eight female high school softball pitchers without previous shoulder injury were enrolled. Three-dimensional (3D) motion of the humerus, scapula and trunk were recorded with surface markers at 250 Hz. Marker placement and the anatomical calibration of bony landmarks followed recommendations by the ISB (Wu et al. 2005) and Kontaxis et al (2009). A custom marker cluster was used to dynamically track the scapula (Karduna et al. 2001). The pitching mound was at regulation distance (43’) from the strike zone target. All athletes completed 105 pitches in sets of 15 with a rest of 5 minutes between sets. Ball speed recorded with a radar gun, 3D angular rotations of the glenohumeral joint, scapulo-thoracic joint and thorax with respect to the room were calculated for all throws. The last five pitches of every set were averaged for analysis. Results: Ball speed (Figure 1, n=8 subjects) and peak glenohumeral, scapulo-thoracic and thoracic angular rotations (n=4 subjects) were consistent across all sets. Examples of kinematics at two of these joints are presented across all sets (Figure 2, n=4). Data across all planes demonstrated similar consistency. Conclusion: This study presents a systematic protocol for the study of fatigue during windmill softball pitching. To our knowledge, this is one of the first studies to analyze glenohumeral as well as scapulo-thoracic kinematics during this task. The consistency in the glenohumeral, scapulo-thoracic and torso kinematics during the throwing protocol demonstrates that despite completing 105 pitches, these athletes are able to maintain shoulder kinematics and ball speed during the underhand pitch. This contrasts to the common observation that male overhand pitchers fatigue around 90 pitches.
Arthroscopic Shoulder Surgery in Female Professional Tennis Players
Authors: Young Simon W. , Safran Marc R. , Dakic Jodie , Nguyen Michael L. , Stroia Kathleen 
Published: September 2013

Objectives: Recent publications have highlighted the relatively poor outcome of other overhead athletes, particularly baseball players, with regard to return to sports at the same or higher level after shoulder surgery. However, true assessment of their ability when returning to sport is not as clear. Further, ability to return to other overhead sports has not been reported. Our objective was to assess outcome and time to return to previous level of function following shoulder surgery in professional tennis players. Methods: The records of all female tennis players on the Women’s Tennis Association (WTA) professional circuit between January 2008 and June 2010 were reviewed to identify players who underwent shoulder surgery on their dominant (serving) shoulder. Details of the surgery including date, procedures performed, and complications were recorded. The primary outcomes were ability and time to return to professional play, and if they were able to return to their previous level of function, as determined by singles ranking. Pre and post-operative singles rankings were used to determine rate and completeness of return to preoperative function. Their highest ranking pre-injury, post operatively, and the time to return to pre-injury ranking were evaluated. Results: During the study period eight professional women tennis players from the WTA underwent shoulder surgery on their dominant arm. All surgery was performed arthroscopically, 7 out of 8 players had more than one procedure performed during the surgery. In total, 3 players underwent debridement of a partial rotator cuff tear and 2 players underwent repair of a complete supraspinatus tear. Three players had an anterior labral repair or reconstruction for anterior instability, and one player underwent repair of a SLAP lesion. Two players underwent neurolysis of a suprascapular nerve, and three players in total underwent a subacromial decompression. All players (100%) returned to professional play. The mean time to return to play was 6.7 months after surgery. However, only 25% (2 out of 8) players had achieved their pre-injury singles rank or better by 18 months post operatively. In total, three players returned to their pre-injury singles ranking, with their peak singles ranking being attained at a mean of 2.5 years post operatively. Conclusion: This study demonstrates that in professional female tennis players, a high return to play rate following arthroscopic shoulder surgery is also associated with a prolonged and often incomplete return to previous level of performance. Thus, counselling the patient to this fact is important to manage their expectations.
A Prospective Randomized Trial of Functional Outcomes Following Rotator Cuff Repair With and Without Acromioplasty
Authors: Tetteh Elizabeth , Hussey Kristen Elizabeth , Abrams Geoffrey D. , Gupta Anil K. , Dhawan Aman , Karas Vasili , Cole Brian J. , Romeo Anthony A. , Verma Nikhil N. 
Published: September 2013

Objectives: The purpose of this study is to report the clinical outcomes of patients undergoing an arthroscopic rotator cuff repair with and without acromioplasty at a minumul of two year follow-up. Methods: Patients undergoing arthroscopic repair of full thickness rotator cuff tears were randomized into acromioplasty or non-acromioplasty groups. Pre-operatively, validated outcome scores including the Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons score (ASES), UCLA score, and SF-12 health assessment were collected along with physical examination including range of motion and dynamometer strength testing. Pre-operative imaging was also reviewed to classify the acromial morphology, acromial angle, and lateral acromial angulation. Intra-operative data including tear size, repair configuration, and concomitant procedures were recorded. Postoperatively, data was collected at 6 weeks, 6 months, one year and at two years. Results are reported as mean ± standard deviation. Student’s t-test was utilized for statistical analysis with an alpha value of 0.05 set as significant. Results: Sixty-one patients completed surveys pre- and post-operatively at a mean 2.6 years. All patients had at least two year follow-up. Thirty-five patients with an average age of 58.4 years (range 44.4 - 74.7) were randomized to the acromioplasty group (22 male, 13 female) and 26 patients with a mean age of 58.2 years (range 42.9-77.0) to the non-acromioplasty group (17 male, 9 female). All outcome scores improved significantly (p < 0.05) in both groups from pre- to post-operatively at two year follow-up. In the acromioplasty group, improvements were observed for SST (5.6 ± 2.7 to 10.7 ± 1.7), ASES (53.5 ± 16.8 to 91.0 ± 13.5) and UCLA (10.7 ± 3.1 to 17.9 ± 30.0) scores. In the non-acromioplasty group, SST increased from 5.6 ± 3.1 to 10.5 ± 2.2; ASES from 58.9 ± 19.1 to 93.5 ± 10.8, and UCLA from 12.0 ± 2.8 to 17.4 ± 3.7. There was no statistical difference in clinical outcome when comparing the groups. Conclusion: The results of this study demonstrate no difference in clinical outcomes following rotator cuff repair with or without acromioplasty at two years postoperatively. These data suggest that acromioplasty may not need to be performed following rotator cuff repair, particularly in the setting of normal acromial architecture.