bluuebunny/crossref_metadata_2025_split huggingface dataset:
Normal Parameters Of Skeletally Immature Knees
Authors: Bathen Mary , Bastrom Tracey P. , Edmonds Eric W. 
Published: September 2013

Objectives: A child’s knee undergoes significant morphologic changes during development. Age-specific normal parameters have not been previously described. The purpose of this study was to delineate the changes that occur with growth utilizing magnetic resonance imaging (MRI). Methods: A retrospective review of a radiologic database of MRI knees, ages 4 to 18 years, was undertaken using “normal” diagnosis codes, including: knee pain, plicae, septic arthritis, jumper’s knee, growing pains, benign neoplasm, and osteomyelitis. 19 osseous parameters were measured, plus their cartilaginous counterparts, if different. Spearman’s rho correlations were calculated between age and MRI measures. Results: 132 MR images were reviewed. Significant correlation with age was observed in all but MPFL insertion on the sagittal view for the osseous measurements (p<0.05). Similarly, the cartilage measures all demonstrated significant correlation with age except MPFL insertion on the sagittal view, but also the Notch-Width index, and trochlear morphology. The magnitude of correlation was significantly different between the osseous and cartilage measures for all but 3 of the variables: osseous and cartilage Insall-Salvati ratios, and insertion of MPFL on the femur. Osseous patella height stabilizes by age 10 with values ranging from 0.9-1.2 until age 18. Cartilage patella height demonstrates a modest linear increase with age (rho=0.352). MPFL insertion on the sagittal view remains stable with age (rho=0.036, p>0.05) and the mean insertion remains below the growth plate (11.5 mm to 4.9 mm). On the coronal view, MPFL insertion modestly increases with age (rho=0.33, p<0.001) starting below the growth plate on average (4.3 mm to 2.6 mm), until age 7 when the mean insertion appears to be at or above the growth plate. Conclusion: Most of the studied parameters follow a clear trend of growth and change in size that correlates with maturity. However, the normal Insall-Salvati ratio that delineates patella alta does not appear to be within the normal range until age 10. Furthermore, the discrepancy in the literature concerning the location of the MPFL insertion on the femur in relation to the physis may be attributed to migration of the insertion site during maturation, with the MPFL insertion being below the physis until age 7 when it migrates to insert at or above the physis.
CT And MRI Measurements Of Tibial Tubercle To Trochlear Groove Distances (TT-TG) Are Not Equivalent
Authors: Camp Christopher L. , Bond Jeffrey R. , Collins Mark S. , Stuart Michael J. , Krych Aaron John , Levy Bruce A. , Dahm Diane Lynn 
Published: September 2013

Objectives: TT-TG distance is a commonly used measurement for surgical decision-making in patients with patellofemoral malalignment and instability. This measurement has historically been performed utilizing axial CT scans. More recently, MRI has been proposed as an equivalent test for measurement of TT-TG distance. We sought to determine the reliability of TT-TG measurements on both MRI and CT, and to determine whether the measurements can be used interchangeably. Methods: All patients diagnosed with patellar instability who had received both CT and MRI of the knee between 2003 and 2011 were included (n=59 knees in 54 patients). Two fellowship trained musculoskeletal radiologists measured the TT-TG distances for each patient by CT and MRI in a randomized, blinded fashion for a total of 236 measurements. Inter-observer reliability was calculated between radiologists for both imaging modalities and inter-methods reliability was calculated between the two imagining modalities. The results are reported using intraclass correlation coefficients (ICC) and Bland Altman analysis (BAA). Results: The 59 knees had a mean TT-TG distance of 16.9 mm (range: 8.3-25.8) by CT and 14.7 mm (range: 1.5-25.1) by MRI. Eighteen patients (31%) had a TT-TG ≥ 20 mm by CT, and only 9 (15%) had a TT-TG ≥ 20 mm by MRI. Inter-observer reliability between the radiologists was considered excellent for both CT and MRI (ICC = 0.777 and 0.843 respectively). When comparing CT to MRI, however, the ICC was considered only fair for each of the two raters (0.532 and 0.539). A total of 11 patients (19%) had a TT-TG ≥ 20 mm on CT preoperatively and underwent distal realignment by tibial tubercle osteotomy (TTO). In this surgical subgroup, the mean TT-TG on CT was 22.5 mm (range 19.8-25.8) while the mean TT-TG on MRI was only 18.7 mm (range 14.4-22.8). Conclusion: TT-TG distance can be measured with excellent inter-rater reliability on both MRI and CT scans; however, the values derived from these two tests may not be interchangeable. This observation should be taken into consideration when MRI is used for surgical planning since MRI may underestimate TT-TG distance when compared to CT.
Conflict of Interest in Sports Medicine
Authors: Tjoumakaris Fotios P. , Tucker Bradford S. , Pepe Matthew D. , Hammoud Sommer , Cohen Steven B. , Ciccotti Michael C. 
Published: September 2013

Objectives: The American Academy of Orthopaedic Surgeons (AAOS) and other orthopaedic societies require members who present original research to disclose conflicts so that audiences can make informed decisions when interpreting data. To what degree members use this information when interpreting studies has never been investigated. The purpose of our study was to evaluate how a reported conflict of interest by the primary research team can influence the perceived value of data presented in original research. Methods: We devised a hypothetical prospective study (https://www.surveymonkey.com/s/MPCCLCX) and asked orthopaedic surgeons and non operative sports medicine specialists to rate the perceived clinical value of the data that was obtained based upon variations of study design, statistical significance of outcomes between treatment groups, and characteristics of the research setting (academic v. private institution). The research team in question was disclosed to have the following conflict of interest: the project was funded by a pharmaceutical company and that all authors received compensation for consulting services. Results: 750 sports medicine physicians were sent a survey request to participate in this IRB approved study. 522 responses were obtained for an overall response rate of 70%. 99% of respondents were orthopaedic surgeons. The majority of respondents were from the Northeastern U.S. (32%) and male (96%). Most have been in practice for over 20 years (40%) and were from private practice single specialty groups (58%). 80% of respondents strongly agreed with the statement that conflict disclosure is important when interpreting study results. 62% of respondents reported always reading the disclosure slide during academy or other meeting presentations. 41% of respondents reported always using this information when deciding how to interpret scientific data. Using a case series design with significant positive results at an academic center, 24% reported that the study was likely trustworthy. When the setting of the study was changed to a community hospital, this number decreased to 5%. When no significant difference was found between the groups, 42% believed the study to be trustworthy. When the study design was Level I evidence (RCT trial) and at an academic center, 57% believed the study to be trustworthy. With the same criteria but at a community hospital, this number decreased to 39%. When the results of this design showed no difference among groups, the majority of respondents believed the study to be trustworthy (62%). Conclusion: Although the majority of orthopaedic surgeons in our analysis believed that disclosure of conflict of interest is important, less than half used this information when interpreting studies. Changing the study design from a case series to a randomized controlled trial improved the perceived reliability of the data, but was not as important as the reporting of “negative” results.
Complications Following Arthroscopic Knee Surgery
Authors: Salzler Matthew J. , Miller Chealon Dain , Lin Albert , Herold Sara , Irrgang James J. , Harner Christopher D. 
Published: September 2013

Objectives: The purpose of the study was to examine the nature and frequency of complications following the most common arthroscopic knee procedures, with particular attention to fellowship training, geographic location of practice, and age and sex of the patient. Methods: Data were obtained from the ABOS database for orthopaedic surgeons who sat for the part II examination from 2003-2009. The database was queried to determine the type and frequency of complications for patients who underwent knee arthroscopy and for those who underwent sports medicine knee arthroscopy including arthroscopic partial meniscectomy, meniscal repair, chondroplasy, microfracture, anterior cruciate ligament reconstruction, or posterior cruciate ligament reconstruction. Factors affecting complication rates that were investigated included type of procedure, fellowship training status, geographic location of practice and age and sex of the patient. Results: There were 4435 complications out of 92,565 knee arthroscopic procedures obtained from the ABOS database for an overall candidate-reported complication rate of 4.8%. The complication rate was highest for PCL reconstruction (20.1%) and ACL reconstruction (9.7%). The complication rates for meniscectomy, meniscal repair, and chondroplasty were 2.8%, 7.7%, and 3.5%, respectively. The complication rate for sports fellowship trained candidates was higher than for non-sports trained candidates (5.1%: sports, 4.1%: no sports) and for male patients (4.9% vs. 4.3%). The complication rate was highest for surgeons in the Northwest (4.9%) and lowest in the South (4.2%). Younger patients (60, 3.6%). The overall rate of pulmonary embolus was 0.11%. Surgical complications were more common than medical or anesthetic complications (Table 1), and infection was the most common complication overall (0.84%). Conclusion: The overall self-reported complication rate for arthroscopic knee procedures was 4.7%, which may be even higher given that the data are self-reported. PCL and ACL reconstruction had the highest complication rate amongst arthroscopic procedures in this study. The increased risk of complications for sports fellowship trained surgeons may be explained by a higher percentage of complex procedures being performed by fellowship trained surgeons. Knee arthroscopy is not a benign procedure and patients should be aware of the risk of complications. In order to reduce the number of complications, surgeons should be aware of the complexity of the procedure, patient factors, and regional differences in care. Limitations of the study include self-reporting of data, which may underestimate their actual complication rate, and that surgeons in their board collection period are more likely to be earlier in their career, which may overestimate the complication rate for more experienced surgeons.
Complications after Hip Arthroscopy
Authors: Larson Christopher M. , Clohisy John C. , Beaule Paul , Kelly Bryan T. , Giveans Russell , Stone Rebecca M. , Samuelson Kathryn M. 
Published: September 2013

Objectives: There is very little published literature looking at comprehensive complication rates after hip arthroscopy with current techniques and indications. Methods: Between 01/2011 and 11/2012, 1,026 consecutive hips (507 males, 519 females) with a mean age of 31.2 years (range 12 - 73) underwent hip arthroscopy at three institutions. The diagnosis, demographic information, and procedures were recorded, and a validated complications grading classification for hip joint surgery (Clavian classification) was utilized for all patients prospectively. Results: There were 951 primary hip arthroscopies and 75 revision hip arthroscopies. Arthroscopy was performed for FAI in 936 hips (91.2%), and 760 hips (74.1%) had a labral repair and 229 hips (22.3%) had a labral debridement. The most common event (18.7% of hips) noted was post-operative sensory disturbance adjacent to the portals or involving the distal anterolateral thigh consistent with LFC nerve disturbance. This was typically not noticed by patients and found on physical examination and only persisted beyond 6 months in 7 hips (0.7%). Iatrogenic chondral injury was noted for 20 hips (1.9%), iatrogenic labral puncture in 11 hips (1.1%), superficial portal infection in 6 hips (0.6%), sensory deficit about the foot in 9 hips (0.9%), deep venous thrombosis in 3 hips (0.3%), pulminary embolism in 1 hip (0.1%), pulmonary edema in 1 hip (0.1%), wound hematoma in 2 hips (0.2%), perineal numbness (pudendal nerve) in 9 hips (0.9%), heterotopic ossification in 4 hips (0.4%), reflex sympathetic dystrophy in 1 hip (0.1%) and wound/skin (traction) dehiscence in 1 hips (0.1%). There were no femoral neck fractures, iatrogenic instability, AVN, or extra-abdominal fluid extravasation in this cohort. The overall complication rate not including temporary periportal and thigh numbness (sequalae) was 6.9% (71 hips). Overall 88.7% had a grade 1, 5.6% Grade 2, 4.2% grade 3, and 1.4% grade 4 complication. There was no difference in the rate of complications between males and females (p=.221), primary vs revision cases (p=.159) or labral repair vs debridement (p=.173), and BMI had no effect on complication rate. Conclusion: The overall complication rate after hip arthroscopy was 6.9% and higher than previously reported in the literature. This rate of complications is in line with complication rates after open surgical dislocation using the same classification system.
Injury to the Suprascapular Nerve During SLAP repair
Authors: Morgan Ryan , Henn Ralph Frank , Dreese James C. 
Published: September 2013

Objectives: The suprascapular nerve is potentially at risk during superior labrum repair. We compared risk of injury to the suprascapular nerve during suture anchor placement through an anterosuperior versus a rotator interval portal. Our hypothesis was that the rotator interval portal provides a safer and more reproducible method for repair of Type-II SLAP tears. Methods: Each pair of ten bilateral fresh human cadaveric shoulders was randomized to suture anchor placement through an anterosuperior portal on one shoulder and a rotator interval portal on the contralateral shoulder. Suture anchors were placed into the glenoid rim (one o’clock, eleven o’clock, and ten o’clock positions for right shoulder; eleven o’clock, one o’clock, and two o’clock for left shoulder). Standard 3 × 14 mm suture anchors were placed, and the suprascapular nerve was carefully dissected. When glenoid perforation occurred, the distance from the suture anchor tip to the suprascapular nerve was measured. The anchors were removed, and the distance from the glenoid rim to the suprascapular nerve and drill hole depth at each suture anchor entry site was recorded. Results: All far posterior suture anchors (ten o’clock anchor for right shoulders, two o’clock anchor for left shoulders) perforated the glenoid rim using the anterosuperior or rotator interval portal. For the far posterior anchor, distance from anchor tip to suprascapular nerve averaged 8.02 mm (range, 3.4 to 14 mm) using the anterosuperior portal and 2.1 mm (range, 0 to 5.5 mm) using the rotator interval portal, a statistically significant difference of 5.92 mm (95% confidence interval [CI]: −7.81 to −4.04; p ≤ 0.001). Conclusion: Using an anterosuperior or rotator interval portal results in consistent penetration of one o’clock and two o’clock posterior suture anchors and may place the suprascapular nerve at risk of iatrogenic injury. Based on the high likelihood of glenoid perforation and closer proximity of the suture anchor tip to the suprascapular nerve, the risk of injury is significantly greater with a rotator interval portal for superior labrum anterior and posterior repair. Clinical Relevance: It is important to recognize the high rate of glenoid perforation and risk of injury to the suprascapular nerve when placing anchors in the posterior glenoid from either portal.
Symptomatic Femoroacetabular Impingement
Authors: Clohisy John C. , Nepple Jeffrey J. 
Published: September 2013

Objectives: The purpose of this study was to compare the clinical, radiographic and intraoperative characteristics of symptomatic FAI in males and females, to determine gender-specific differences in FAI presentation. Methods: We retrospectively identified consecutive cohorts of 50 male and 50 female patients treated for symptomatic FAI by a single surgeon. Established clinical and radiographic methods were used for disease characterization. Statistical analysis was performed to identify significant differences in clinical, radiographic, and intraoperative findings between males and females. Results: Statistical differences in age, BMI, and pain chronicity by gender were not detected. Modified Harris hip scores and UCLA activity scores were significantly lower in females (54.4 vs. 63.7, p 0.005 and 6.8 vs. 8.1, p 0.014, respectively). Females were significantly more likely to have a component of lateral hip pain (38% vs. 20%, p 0.047), in addition to anterior/groin pain. Females had significantly more internal rotation range of motion in flexion than males (16.4° vs. 6.9°, p<0.001), with 58.0% and 86.0% having less than 20°, respectively (p 0.002). Males were significantly more likely than females to have elevated alpha angle (>50 in 94% vs. 70%, p 0.002) and decreased head-neck offset (<0.17 in 96% vs. 78%, p 0.007). Elevated alpha angles on the AP pelvis radiographs were more common in males with FAI compared to females (72% vs. 28%, p<0.001). A crossover sign greater than 10 mm from the acetabular sourcil was significantly more likely in males than in females (64.3% vs. 23.5%, p 0.001). Acetabular articular cartilage cleavage or defects were significantly more common in males (56% vs 24%, p 0.001). The distribution of labral lesions was not significantly different (82% vs 80% detachment). Conclusion: Significant differences in disease characteristics exist between males and females with FAI. Female patients have greater disability at presentation and are less active than males with FAI at presentation, despite less advanced acetabular cartilage pathology. Female patients generally had milder cam-type deformities and less acetabular retroversion than males.
The Demographics of High-level and Recreational Athletes With Intra-articular Hip Injury
Authors: Tibor Lisa M. , Bedi Asheesh , Oltean Hanna N. , Gagnier Joel Joseph , Kelly Bryan T. 
Published: September 2013

Objectives: The pathoanatomy that causes femoroacetabular impingement (FAI) is common, but not everyone develops hip pain or arthrosis. Symptomatic FAI is likely due to a combination of anatomy and biomechanical demands, including sports participation. The primary purpose of this study was to determine demographic differences between high-level and recreational athletes undergoing hip arthroscopy. The secondary purpose of this study was to look at the demographics of high-level athletes grouped by sports with similar mechanical demands on the hip. We hypothesize that high-level and recreational athletes will differ by age, gender, and need for bilateral surgery. We also predict that demographics for high-level athletes will differ for sports with unique demands for hip kinematics. Methods: Using our hip preservation center registry, a retrospective review of prospectively collected data from patients undergoing hip arthroscopy between March 2010 and April 2012 was performed. Athletes were categorized as high-level (high school, collegiate, Olympic/international, or professional) or recreational. Subgroup analysis was performed for high-level athletes, looking at differences between contact, rotational running, impingement, overhead/asymmetric, endurance, and flexibility sports. Results: 288 high-level athletes and 334 recreational athletes were included. Being a high level athlete was associated with younger age (average age 20.2 vs 33.0, OR=0.69, P<0.001) and male gender (61.5% vs 53.6%, OR=1.75, P=0.03). The percentage of high-level athletes undergoing bilateral surgery was higher than for recreational athletes (28.4% vs 15.9%); however, this association was found to be confounded by age in multivariate analysis The most common sports for high-level athletes were soccer, hockey, and football. Athletes participating in rotational running sports were significantly younger than flexibility, contact, or impingement athletes. Similarly, endurance athletes were significantly younger than athletes in impingement sports. Conclusion: There are significant differences between high-level and recreational athletes that are likely to be important when counseling patients and reporting surgical outcomes. This study also provides important information about sports that provoke hip pain. Identifying biomechanical mechanisms that place young athletes at risk for hip injury enables anticipatory guidance and preventative strategies for these patients.
Comparison of the Amount of Iliopsoas Tendon Lengthening That Occurs after ArthroscopicLabral-Level and Lesser Trochanteric Tenotomies
Authors: Bayer Jennifer L. , Keene James S. 
Published: September 2013

Objectives: The success of arthroscopic iliopsoas tenotomies (AIT’s) performed at the level of the lesser trochanter for treatment of a painful snapping tendon is well documented. Currently, iliopsoas labral-level tenotomies have been advocated for treatment of this problem. However, a recent study reported a high incidence (∼50%) of recurrent snapping after iliopsoas tendon (IT) releases at this level (1). The purpose of this study was to determine if there is a difference in the amount of tendon separation/lengthening following AIT’s at the labral and lesser trochanteric levels. To date, the amount of tendon separation that occurs after releases at these two sites has not been reported. Methods: From the senior author’s data base of 900 hip arthroscopies, 80 patients who had arthroscopic iliopsoas tenotomies performed:1) at the level of the labrum (40 patients); or 2) at the lesse rtrochanter (40 patients) were identified. The amount of tendon separation/lengthening in these 80 patients was determined either from direct intra-operative measurements (40 patients) or from measurements made off of the intra-operative photographs. Image magnification on the intra-operative photographs was controlled for by basing the measurements of tendon separation on the known dimensions of the radiofrequency probe or 5 mm cannula that was present in each iliopsoas release picture (Figure 1). Two sample t tests were used for data analysis with p = <0.05 defined as significant. Results: Average age of the 40 patients with labral-level (LL) tenotomies was 36 years (range 16-58 years), and there were 9 males and 31 females and 19 left and 21 right hips in this group. Average age of the 40 patients with lesser trochanteric (LT) tenotomies was 32 years (range 17-55 years), and there were 8 males and 32 females, and 11 left and 29 right hips in this group. In the LL tenotomy group, the average tendon separation was 8.3 ± 2.04 mm. In the LT tenotomy group, the average tendon separation was 13.3 ± 3.01 mm. The 0.5 cm difference in the amount of tendon separation between the two groups was statistically significant at the p<0.001 level. Conclusion: An arthroscopic, lesser trochanteric iliopsoas tenotomy produces significantly greater (0.5 cm) tendon separation than tenotomies performed at the level of the labrum. The difference in the amount of tendon separation that occurs at these two sites may explain the high rates of recurrent snapping (∼50%) that have been reported with arthroscopic and open labral-level releases.