bluuebunny/crossref_metadata_2025_split huggingface dataset:
Two Helpful MRI Signs for Evaluation of Posterolateral Bundle Tears of the Anterior Cruciate Ligament
Authors: Volokhina Yulia V. , Syed Hasan M. , Pham Peter H. , Blackburn Allie K. 
Published: August 2015

Background: Diagnosis of partial anterior cruciate ligament (ACL) tears is difficult on magnetic resonance imaging (MRI), particularly the isolated tears of the posterolateral bundle. Purpose: To describe 2 MRI signs of partial ACL tear involving the posterolateral bundle on conventional knee MRI sequences, specifically, the “gap” and “footprint” signs. Study Design: Case-control study. Methods: We retrospectively reviewed the MRI appearance of the ACL in 11 patients with arthroscopically proven partial ACL tears isolated to the posterolateral bundle, as well as in 10 patients with arthroscopically proven intact ACLs, and evaluated for the presence of gap and/or footprint signs. Results: There was high degree of sensitivity and specificity associated with the MRI findings of “gap” and “footprint” signs with arthroscopically proven isolated posterolateral bundle tears. Conclusion: Gap and footprint signs are suggestive of posterolateral bundle tear of the ACL, and the presence of 1 or both of these imaging findings should alert the radiologist to the possibility of a posterolateral bundle tear.
Outcomes 2 Years After ACLR In Athletes
Authors: Failla Mathew , Logerstedt David , Grindem Hege , Axe Michael J. , Engebretsen Lars , Risberg May Arna , Snyder-Mackler Lynn 
Published: August 2015

Objectives: At least 175,000 Anterior Cruciate Ligament Reconstructions (ACLR) are performed yearly in the United States, with the goal of restoring static knee stabilization for full return to previous level of function. Large data registries have reported general population outcomes after ACLR, but less is known about the athletic population. The purpose of this study is to evaluate functional outcomes, return to sport rates, and re-injury rates 2 years after ACLR from an all athlete cohort and make comparisons to outcomes reported in the literature. Methods: Three hundred subjects were prospectively enrolled after ACL injury. All subjects sustained an isolated ACL injury and were enrolled within 7 months of injury. Subjects regularly participated in level I or II sports greater than 50 hours per year. All subjects underwent preoperative neuromuscular training. 201 of these subjects underwent ACLR. 157 patients returned for follow-up 2 years after surgery for performance-based and patient-reported testing. Quadriceps strength testing was completed either isometrically or isokinetically using an electromechanical dynamometer, and reported as quadriceps index (QI) [involved/uninvolved x 100]. Patient reported measures included The International Knee Documentation Committee 2000 Subjective Knee Form (IKDC2000), return to pre-injury activity (RTS), return to pre-injury activity competitive level (RTS-L), and re-injury. Statistics are expressed in means and standard deviations with T-tests or Chi-square for comparisons with values reported in literature. Results: Two year follow up QI (mean±SD: 96.94±13.4%) revealed significantly higher quadriceps index compared to Hamada 2001 (89.8±16.5%) ( P<.001). IKDC2000 (90.40±11.0; median: 94) scores were higher than the median score reported by the MOON group at 2 years (median: 75). Our RTS (72%) was significantly higher than Arden et al. 2014 (65%) ( P=.012), whereas, our RTS-L (55%) was similar to Arden 2014 (55%) ( P=.997). Our Re-injury rate was 13.9% (19 ipsilateral, 9 contralateral) which was significantly less (P=.002) than Paterno 2014 (29.5%). Conclusion: A comprehensive pre-operative rehabilitation program including neuromuscular training, combined with a post-operative rehabilitation program resulted in higher quadriceps strength, return to sport rates, and re-injury rates in athletes 2 years after ACLR compared to recent findings in the scientific literature. These findings highlight that despite excellent clinical outcomes, ACLR does not guarantee return to sport, and re-injury rates remain high. Limitations include motivational differences in athletes compared to general populations as well as age differences compared to Paterno 2014. Further research is needed to determine how to improve return to sport competitive levels rates and reduce subsequent injury risk in athletes after ACLR.
Do Ankle Sleeves And Lace-Up Braces Effect Neuromuscular Control And Athletic Performance?
Authors: Bodendorfer Blake , Stover Gary , James Christopher Ryan , Arnold Nicholas R. , Summerhays Ben , Gray Aaron D. , Sherman Seth Lawrence 
Published: August 2015

Objectives: Athletes commonly wear fitted silicone ankle sleeves (SAS) and lace-up ankle braces (LAB). There is limited data about their effect on neuromuscular control or athletic performance. Our goal is to evaluate their efficacy in a young, active population during athletic tasks using motion analysis. Methods: Ten subjects (5 males, 5 females) without prior musculoskeletal injury were recruited. They were asked to perform the Drop Vertical Jump test (DVJ), 45 degree bound, and cutting maneuvers under three conditions: No brace, SAS, LAB. DVJ was used as a surrogate for neuromuscular control, and the 45 degree bound and cutting for athletic performance. Tasks were performed in separate sessions to minimize effects of fatigue. Markerless motion-capture technology was used for data collection. For the DVJ, knee flexion, hip internal rotation, and dynamic valgus were measured during both contact and loading phases of landing. Ankle torque and range of motion were also evaluated. For the 45 degree bound, ankle torque was measured during the initial movement to the dominant knee. Performance time for the cutting with the dominant pivot foot was recorded. Statistics were calculated using a two-tailed Student's t-test with significance set at p=0.05. Results: When compared to controls for both the contact and loading phases of the DVJ, use of the SAS or LAB demonstrated significantly decreased hip internal rotation (67%, 15%, respectively), ankle torque (13%, 11% respectively), and ankle range of motion (p<0.01). Knee flexion was increased at initial contact in both the SAS and LAB groups compared to control (p<0.01). There was no significant effect of the braces on dynamic knee valgus, and no differences detected between the SAS and LAB on all parameters. When compared to controls for the 45 degree bound, ankle torque was significantly reduced for subjects wearing either SAS or LAB (24%, 13.5% respectively, p<0.01). The use of SAS or LAB had no significant effect on timed cutting maneuver vs. controls (p=0.1181, p=0.1124 respectively). There were no differences detected between the SAS and LAB for all parameters. See Figure 1 for results. Conclusion: Athletes wearing ankle sleeves and lace-up braces demonstrated improvements in neuromuscular control during the DVJ (decreased hip internal rotation, increased knee flexion at initial contact), decreased ankle torque during 45 degree bounding maneuvers, and no performance time deficit versus control during cutting maneuvers. There were no differences detected in either neuromuscular control or athletic performance between the brace types. The effect that these findings have on the incidence of lower extremity injury remains largely unknown and requires further investigation.
The Use of Micronized Allograft Articular Cartilage (BioCartilage) and Platelet Rich Plasma to Augment Marrow Stimulation in an Equine Model of Articular Cartilage Defects
Authors: Cole Brian J. , Fortier Lisa A. , Cook James L. , Cross Jessica , Chapman Hannah-Sophie , Roller Brandon 
Published: August 2015

Objectives: Microfracture continues to be a dominant treatment strategy for symptomatic articular cartilage defects. Improving the histologic and clinical outcomes with biologic adjuncts offers promise to enhance this widely utilized technique. Specifically, the use of a novel scaffold that is potentially conductive and inductive such as micronized allograft articular cartilage (BioCartilage-BC) combined with platelet rich plasma (PRP) was investigated as an adjunct to microfracture in an equine model of articular cartilage defects. Methods: Five adult horses were anesthetized and 2 - 10mm diameter full thickness cartilage defects were created in the trochlear ridge in both knees; one proximal (high load) and another distal (low load). In one knee, microfracture (MFx) followed by grafting with BioCartilage(BC). BioCartilage was mixed with PRP and injected into the defect with a touhey needle and sealed with fibrin under CO2 arthroscopy. The opposite limb served as a control and received MFx only. Horses were euthanized at 13 months post-operatively. Outcome was assessed with serial arthroscopy, 3T T2 and T1rho MRI, microCT, and histology. Statistics were performed using a mixed effect model with response variable contrasts. P≤0.05 was considered significant. Results: No complications such as joint inflammation, infection or lameness were encountered. The score for overall repair (12=normal, 0=complete degeneration) in both the proximal and distal defects was significantly better in the BC group compared to MFx (proximal BC 7.4±0.51, MFx 4.8±.1; p=0.041)(distal BC 5.6±0.98, MFx 2.6±1.5; p=0.022). All significant findings on histology (100=normal, o=complete degeneration) were confined to the proximal, high load defects. Graft perimeter integration (BC 96±8.9, MFx 68±19; p=0.02), graft base integration (BC 100+/- 0.0, MFx 70±37;p=0.044), subchondral bone architecture under the graft (BC 66±18, MFx 34±16; p=0.050) and collagen type II BC 82+/-8, MFx 58±11; p=0.051. There were no significant differences between BC and MFx in MRI or uCT analyses. Conclusion: Micronized allograft articular cartilage (BioCartilage) and PRP improve cartilage repair compared to marrow stimulation alone in an equine model of articular cartilage defects. This technology offers promise for the use of homologous allograft tissue as a low-cost and safe augmentation procedure for traditional microfracture surgery.
The Effect of Recombinant Human Parathyroid Hormone (rhPTH) on Tendon-to-Bone Healing in a Rat Rotator Cuff Model
Authors: Duchman Kyle R. , Goetz Jessica , Hettrich Carolyn M. 
Published: August 2015

Objectives: Successful rotator cuff tendon repair is predicated upon secure tendon-to-bone healing. A recent study has shown that recombinant human parathyroid hormone (rhPTH) treatment results in improved tendon-to-bone healing at the latter stages of healing, but not at early time points. We hypothesized that delaying administration of rhPTH until after the acute inflammatory phase would improve tendon-to-bone healing at all time points in a rat rotator cuff repair model. Methods: One hundred and eight male Sprague Dawley rats underwent detachment and subsequent repair of the supraspinatus tendon based on an a priori power analysis. Fifty four rats underwent repair alone and 54 rats received repair plus daily subcutaneous injections of 10 µg/kg of rhPTH beginning on postoperative day 7 and continuing for 12 weeks. Rats were sacrificed at 2 and 16 weeks postoperatively for biomechanical testing or histologic and immunohistochemical analysis. Histologic slides were digitized, and the enthesis was evaluated quantitatively using NIH Image J and VisioMorph software. Results: At 2 weeks postoperatively, the rhPTH group had significantly higher load to failure than the control group (10.85 versus 5.16 N; p = 0.003). At 16 weeks, there was no significant difference in load to failure between the two groups (Figure 1). With respect to stiffness of the repair, there was no significant difference between the two groups at either time point, but there was a trend toward increased stiffness in the rhPTH group at 2 weeks postoperatively compared to the control group (5.09 vs. 3.77 N/mm; p = 0.12). Histologically, the rhPTH specimens had more fibrocartilage and osteoblasts at all time points, with significantly better collagen fiber orientation at 2 weeks. Conclusion: Administration of rhPTH significantly increased load to failure at 2 weeks postoperatively in a rat rotator cuff repair model, with improved collagen fiber organization and increased fibrocartilage formation. Delaying administration of rhPTH until postoperative day number 7, after the resolution of the acute inflammation from surgery had subsided, improved rotator cuff healing in the early postoperative period while maintaining later-stage mechanical strength.
The Effects of Latarjet Reconstruction on Glenohumeral Instability in the Presence of Combined Bony Defects
Authors: Patel Ronak Maneklal , Walia Piyush , Gottschalk Lionel , Jones Morgan H. , Fening Stephen D. , Miniaci Anthony 
Published: August 2015

Objectives: Recurrent glenohumeral instability is often as a result of underlying bony defects in the glenoid and/or humeral head. Anterior glenoid augmentation with a bone block (i.e. Latarjet) has been recommended for glenoid bone loss in the face of recurrent instability. However, no study has investigated the effect of Latarjet augmentation in the setting of both glenoid and humeral head defects (Hill-Sachs Defects (HSD)). The purpose of this study was to evaluate the stability achieved through a Latarjet procedure in the presence of combined bony defects. Methods: Eighteen fresh-frozen cadaveric specimens were tested at all combinations of glenohumeral abduction (ABD) angles of 20°, 40°, and 60° and three external rotation (ER) levels (0°, 40°, and 80°). Each experiment comprised of anterior dislocation by translating the glenoid under a 50N medial load applied on the humerus, simulating the static load of soft tissues. Translational distance and medial-lateral displacement of the humeral head, along with horizontal reaction forces were recorded for every trial. Specimens were tested in an intact condition (no defect), different combinations of defects, and with Latarjet augmentation. The Latarjet was performed for 20% and 30% glenoid defects by transferring the specimen's coracoid process anterior to the glenoid flush with the articulating surface. Four different humeral head defects were created of sizes 6%, 19%, 31%, and 44% of humeral diameter. Repeated measures analysis of variance (ANOVA) was performed with statistical significance set at p <0.05. Results: Results are summarized in Fig. 1. The vertical axis represents the normalized distance to dislocation with respect to the values of the intact joint. The horizontal axis represents the varying sizes and combinations of bony defects. At 20° ABD and 0°ER, increasing HSD size did not affect percentage of intact translation with a constant glenoid defect of 20% before and after Latarjet augmentation (Fig. 1A). However, at an arm position of 60° ABD and 80° ER increasing HSD size led to a decrease in stability for both the defect state and post-Latarjet trials (Fig. 1B). Nevertheless, Latarjet augmentation helped in regaining stability for every combination of bony defects. With a HSD size of 44% the defect state had 0% intact translation for all 18 specimens. Conclusion: Clinically, these results demonstrate that some degree of stability can be regained for combined bony Bankart and Hill-Sachs defects with a Latarjet procedure. However, for humeral defects larger than 30%, the rotational effect of the HSD led to persistent instability. Thus, directly addressing the humeral defect to restore the articular surface should be considered in these cases. In conclusion, this study demonstrated that Latarjet procedure can restore the stability for combined defects, however for humeral defects greater than 31% may need attention.
Clinical Outcomes Following Revision Anterior Shoulder Stabilization
Authors: Frank Rachel M. , Mellano Chris , Shin Jason J. , Feldheim Terrence F. , Mascarenhas Randhir , Yanke Adam Blair , Cole Brian J. , Nicholson Gregory P. , Romeo Anthony A. , Verma Nikhil N. 
Published: August 2015

Objectives: The purpose of this study was to determine the clinical outcomes following revision anterior shoulder stabilization performed either via all-arthroscopic soft tissue repair or via Latarjet coracoid transfer. Methods: A retrospective review of prospectively collected data on 91 shoulders undergoing revision anterior shoulder stabilization was performed. All patients underwent prior soft tissue stabilization; those with prior open bone grafting procedures were excluded. For patients with 25% glenoid bone loss, Latarjet was performed (n=28). Patients were queried regarding recurrent instability (subluxation or dislocation). Clinical outcomes were evaluated using validated patient reported outcome questionnaires including the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), visual analog scale (VAS) for pain, and Western Ontario Shoulder Instability Index (WOSI). Results: A total of 63 shoulders in 62 patients (46 males, 16 females) with an average age of 23.2 ± 6.9 years were included in the revision arthroscopy group. At an average follow-up of 46.9 ± 16.8 months (range, 15 to 78), the mean WOSI score was 80.1 (range, 15.0 to 100), and there were significant improvements (p<0.001) in ASES (63.7 to 85.1), SST (6.2 to 9.1), and VAS pain scores (2.89 to 0.81). Recurrent instability occurred in 12 of 63 shoulders (19%); the number of prior surgeries and baseline hyperlaxity were significant risk factors for failure (p<0.001 and p=0.04, respectively). No patients developed clinical or radiographic evidence of arthritis. A total of 28 shoulders in 28 patients (21 male, 7 female) with an average age of 27.5 years (range 14 to 45) were included in the Latarjet group. Thirteen (46%) had more than one previous stabilization attempt. ), the average WOSI score was 71.9, and there were significant improvements (p<0.001) in ASES (65.7 to 87.0), SST (7.2 to 10.3), and VAS (3.1 to 1.1). Recurrent instability occurred in 2 of 28 shoulders (7%), including 1 patient with symptomatic subluxation and 1 patient with a recurrent dislocation resulting in rapid arthrosis requiring revision to hemiarthroplasty at 20 months after Latarjet. Conclusion: Both arthroscopic revision stabilization and Latarjet coracoid transfer result in satisfactory outcomes in patients who have failed previous arthroscopic capsulolabral repair. Recurrent instability rates were higher in the all-arthroscopic group (19% versus 7%). Longer-term studies are required to determine whether similar results are maintained over time, and to provide guidance on focused clinical indications for this challenging patient population.
Is MRI Subchondral Acetabular Edema or Cystic Change a Contraindication for Hip Arthroscopy in Patients with FAI?
Authors: Krych Aaron John , King Alexander Harrison , Berardelli Rebecca L. , Sousa Paul L. , Levy Bruce A. 
Published: August 2015

Objectives: Arthroscopic treatment for femoroacetabular impingement (FAI) generally has good results, but the outcome can worsen with increasing arthritis, largely defined as joint space narrowing. There remains a subset of hips with maintained joint space but with subchondral edema and cystic change of the acetabulum on MRI, with unknown outcome. Therefore, the purpose of this study was (1) to determine if postoperative outcome was worse for patients with subchondral edema on preoperative MRI compared to a matched control group and (2) to identify risk factors on MRI leading to inferior outcome. Methods: A review of patients who underwent arthroscopic hip surgery for FAI between 2007 and 2013 identified 530 patients. Of these, 39 patients had evidence of subchondral edema or subchondral cyst on the preoperative MRI with maintained joint space on preoperative radiographs. Lesions were characterized by grade, location and type using an established radiographic MRI classification system. A matched cohort of patients without evidence of subchondral edema or cyst was identified, and 2:1 matching was based on patient age, surgeon, surgery year within one year, surgical procedure, Tegner activity score, and Tonnis grade osteoarthritis changes on preoperative x-ray. Outcome was compared using the Hip Outcome Score and Modified Harris Hip Score between the two groups. Risk factors were then analyzed for type of lesion, grade and location of bone marrow lesion. Results: Thirty-nine patients (20 males, 19 females) showed preoperative MRI evidence of subchondral edema, and were followed for a mean of 23 months postoperatively (range, 12 - 60 months). Patients had an average age of 41 years (range, 19 - 67) and a preoperative Tegner score of 3.8 (range, 1 - 9). 87% of patients with subchondral cystic change had evidence of a grade IV full thickness cartilage lesion at the time of hip arthroscopy. Average Modified Harris Hip Scores were inferior for the subchondral group (79.9 ± 18.7) compared to the control group (86.6 ± 12.5; p = 0.027). In addition, Sport sub-scales of the Hip Outcome Score showed significantly lower scores for the subchondral group for both score (69.1 ± 27.0 vs. 79.5 ± 21.4, p = 0.018) and rating (66.7 ± 27.5 vs. 78.0 ± 20.8, p = 0.044). No radiographic risk factors, including type, location, or size of lesion were significant predictors of outcome. Two patients in the subchondral group were later converted to a total hip replacement. Conclusion: The presence of a subchondral acetabular cyst on MRI is indicative of a full thickness cartilage lesion at the time of arthroscopy. These patients have inferior outcomes for arthroscopic treatment of FAI compared to patients with similar age and activity level without MRI subchondral changes. Therefore, we recommend caution with consideration of hip arthroscopy in this patient subset.
Open-Access Video-Based Orthopaedic Instructional Content is Inaccurate
Authors: Urch Ekaterina Y. , Taylor Samuel A. , Cody Elizabeth , Fabricant Peter D. , Burket Jayme , O’Brien Stephen J. , Dines David M. , Dines Joshua S. 
Published: August 2015

Objectives: The internet has an increasing role in both patient and physician education. While several recent studies critically appraised the quality and accuracy of web-based written information available to patients, no studies have evaluated such parameters for open access video content designed for provider use. The present study sought to determine utilization of video resources by orthopaedic residents and assess the quality and accuracy of their content Methods: Surveys were distributed to orthopaedic surgery residents to to determine their use of open access instructional video content. An assessment of quality and accuracy of said video content was performed using the basic shoulder examination as a suragate for the “best-case scenario” due to its widely accepted components that are stable over time. Three search terms (“shoulder”, “examination” and “shoulder exam”) were entered into the four online video resources most commonly accessed by orthopaedic surgery residents (VuMedi, G9MD, Orthobullets, and YouTube). Videos were captured and independently reviewed by three orthopedic surgeons. Quality and accuracy were assessed in accordance with previously published standards. Results: Of the 72 orthopaedic residents surveyed, 70% use open-access videos as a resource monthly and 25% weekly. Over 70% or respondents perceived the video content to be accurate and informative. We reviewed 39 unique video tutorials on physical examination. Of the 39 videos, 61% rated poor (<25% accurate) or fair (<50% accurate). Specific shoulder tests such as Hawkins, O’Brien Sign, and Neer Impingement were accurately demonstrated in only 50%, 36%, and 27% of videos respectively. Inter-rater reliability was excellent (mean Kappa 0.80, range 0.79-0.81). Conclusion: We demonstrated that orthopaedic surgery residents often turn to open-access video tutorials as a supplemental education tool. While the majority residents believed the content is accurate, our results suggest an alarming inaccuracy of these video tutorials. Trainee exposure to inaccurate information has far reaching implications on the education process. As such, training programs should help guide their residents to pre-screened or peer-reviewed video resources.