bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in Articular Cartilage Treatments of the Knee
Authors: Westermann Robert W. , Duchman Kyle R. , Amendola Annunziato 
Published: August 2015

Objectives: Full-thickness articular cartilage defects of the knee are often encountered during arthroscopy. Management likely varies between surgeons and may include chondroplasty, microfracture, or osteochondral grafting procedures. The purpose of this study is to evaluate the trends in treatment of articular cartilage lesions over the past decade using data obtained from the ABOS database. Methods: The American Board of Orthopaedic Surgery part II database was queried from 2004 through 2013. Cases involving Common Procedural Terminology (CPT) codes representing chondroplasty (29877), microfracture (29879), and osteochondral grafting procedures (27415, 27416, 29866, 29867) were selected. Surgical cases were categorized by year and by surgeon and patient variables provided by the database. Surgeon-specific variables of interest will include determination of fellowship training status. Patient-specific variables of interest will include age. Univariate analysis including chi-square test for categorical variables and Student's t-test for continuous variables will be performed to determine any significant changes in practice patterns based on the location and year of the procedure as well as previously noted surgeon- and patient-specific variables. The level of significance will be set to p < 0.05. Results: Between 2004-2013, 27,707 procedures addressing articular cartilage lesions were identified in the ABOS database. Overall, the reported surgical volume for treatment of articular cartilage lesions of the knee has decreased from 3126 cases/year in 2004 to 1690 cases/year in 2013. The most common procedure performed overall was chondroplasty (76.0%) followed by microfracture (19.9%) and Osteochondral grafting procedures (4%). The mean age of patients undergoing chondroplasty was 46.9; this was significantly higher than microfracture (mean age 40.5) or Osteochondral grafting procedures (mean age 31.6), p<0.0005. The age of patients undergoing chondroplasty, microfracture and Osteochondral grafting procedures significantly decreased between 2004-2013 (p<0.0001). The volume of microfracture has gradually decreased over time. A sharp decrease in reported chondroplasty procedures was observed between 2011 and 2012, and that trend has continued. A sharp increase in the utilization of Osteochondral grafting was observed beginning in 2011 by fellowship trained sports medicine surgeons. Conclusion: The overall decrease in surgical volume for articular cartilage treatments of the knee appears to be driven by a sharp decline in the use of chondroplasty since 2011. The average age of patients undergoing procedures addressing articular cartilage defects is decreasing. The volume of osteochondral grafting procedures has remained steady, and may be increasing; this is most pronounced in surgeons with sports medicine fellowship training.
Hyaluronic Acid versus Platelet-Rich Plasma
Authors: Cole Brian J. , Fortier Lisa A. , Karas Vasili , Hussey Kristen Elizabeth , Tilton Annemarie K. , Merkow David B. , Verma Nikhil N. , Bach Bernard R. , Forsythe Brian 
Published: August 2015

Objectives: Osteoarthritis (OA) is a debilitating disease that, in some form, affects up to 47 million Americans each year and is estimated to affect 67 million by 2030. Hyaluronic acid (HA) is currently utilized as an intra-articular injection for treatment of patients with knee OA. A movement in biochemical research has emerged that focuses on analysis of catabolic and anabolic growth factors of the joint. It is proposed that platelet-rich plasma (PRP) is a biologic alternative to HA that may alter the intra-articular biologic milieu to mitigate the symptoms of OA. The purpose of this double-blind prospective randomized clinical trial is to compare the effects of PRP to HA for the treatment of OA in the knee using validated clinical outcome measures and biologic correlates associated with OA. Methods: Patients with a minimum of 3 months of symptomatic unilateral knee OA and Kellgren-Lawrence Grade 1-3 OA were randomized into two cohorts. One cohort received three weekly ultrasound-guided injections of HA and the other received three weekly injections of PRP. Patients in both cohorts were seen again at 6-, 12-, and 24-weeks following their index treatment. At each visit, including the treatment and index visits, patients completed a survey that included Lysholm, IKDC, WOMAC, and VAS pain, and underwent a clinical examination. Patients also underwent an ultrasound-guided aspiration of the knee for synovial fluid analysis during each of the treatment visits and at 3-month and 6-month follow up. Synovial fluid was grouped and analyzed via ELISA assay. Results: 111 patients (mean age 56.2 +/- 10.2 years; 53 male, 58 female) met inclusion criteria and were randomized into either the HA or PRP cohort. Eleven (9.9 %) patients were lost to follow-up or unwilling to complete the study. In all of the scales measured, outcomes improved significantly from the index visit at 6 months post treatment (p<.01). PRP had a higher IKDC (p<.02) at 6-month follow up when compared to HA. Patients in the PRP group also reported lower VAS pain scores at 6-month follow up as well (p<.01). The remainder of the outcome measures (Lysholm, WOMAC) demonstrated trends toward greater improvement in the PRP group but did not demonstrate statistical significance. Synovial fluid aspirated was analyzed using ELISA assay for catabolic factors TNF-α, IL-1B/IL-F2, IL-1ra/IL-1F3, IL-6, and CXCL8/IL-8. The PRP cohort had significantly higher IL-6 concentration than the HA cohort at 6-month follow up (p=.02). The PRP and HA groups were not found to have significant differences in concentrations of the other catabolic factors analyzed. Conclusion: The findings of this study support a significant improvement of pain and function at 6 months with the use of intra-articular PRP as well as HA for the treatment of OA. Findings further suggest that PRP may be a superior treatment for the active patient with OA.
Outcomes of 1038 Hip Arthroscopies
Authors: Lodhia Parth , Martin Tim , Gui Chengcheng , Stake Christine E. , Vemula S Pavan , Suarez-Ahedo Carlos , Chandrasekaran Sivashankar , Domb Benjamin G. 
Published: August 2015

Objectives: The purpose of this study was to evaluate clinical outcomes, pain, and patient satisfaction following all hip arthroscopies performed by a single surgeon at a high volume referral center with a mean 2-year follow-up. Methods: During the study period, February 2008 to June 2012, data were collected on all patients undergoing hip arthroscopy. All patients were assessed pre- and post-operatively with 4 patient-reported outcome (PRO) measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sport Specific Subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS). Patient satisfaction was measured on a scale from 0 to 10. The number of patients who underwent revision arthroscopy, total hip arthroplasty, or a resurfacing procedure during the study period is also reported for primary and revision hip arthroscopies. Results: One thousand and thirty eight patients underwent hip arthroscopy during the study period. The score improvement from preoperative to 2-year follow-up was 60.9 to 77.6 for mHHS, 62.8 to 78.9 for HOS-ADL, 40.0 to 63.43 for HOS-SSS, 57.4 to 76.2 for NAHS. VAS decreased from 5.86 preoperatively to 3.15 postoperatively. All scores demonstrated statistically significant improvement (p<0.001). Overall patient satisfaction was 7.57. One hundred and seven (10.3%) patients underwent revision hip arthroscopy during the study period. Sixty-three (6.07%) patients underwent either total hip arthroplasty (THA) or hip resurfacing (HR) procedures during the study period. Of these, 51 (5.48%) were after primary hip arthroscopies and 12 (11.2%) were after revision hip arthroscopies suggesting a relative risk of 2.05 for a THA/HR after revision procedures. Figure 1 shows a Kaplan-Meier survivorship curve for patients who underwent primary and revision hip arthroscopies with THA/HR. The overall complication rate was 5.5%. Conclusion: Hip arthroscopy for all indications results in improved clinical outcomes, decreased pain, and high satisfaction at a mean 2-year follow-up. Patients should be counseled regarding the potential progression of degenerative change leading to arthroplasty, and the potential for revision surgery.
Does Revision Hip Arthroscopy Result in Improved Clinical Outcomes? - A 2-Year Clinical Follow-up On All Revision Hip Arthroscopies Performed at a High Volume Referral Center
Authors: Gupta Asheesh , Redmond John M. , Dunne Kevin F. , Stake Christine E. , Domb Benjamin G. 
Published: August 2015

Objectives: The purpose of this study was to evaluate clinical outcomes, pain, and patient satisfaction following revision hip arthroscopy at a high volume referral center with a minimum 2-year follow-up. Methods: During the study period, April 2008 to October 2011, data was prospectively collected on all patients undergoing revision hip arthroscopy. All patients were assessed pre- and post-operatively with 4 patient-reported outcome (PRO) measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sport Specific Subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS). Patient satisfaction was measured on a scale from 0 to 10. Results: Eighty-seven patients underwent revision hip arthroscopy during the study period. Seventy (80.5%) patients were included in our study. In terms of residual FAI morphology, 45.7% of patients had preoperative alpha angles ≥55 degrees and 7.14% of patients had a LCEA ≥40 degrees. The score improvement from preoperative to 2-year follow-up was 57.84 to 73.65 for mHHS, 62.79 to 83.04 for HOS-ADL, 37.33 to 54.93 for HOS-SSS, 55.65 to 70.79 for NAHS. VAS decreased from 6.72 preoperatively to 4.08 postoperatively. All scores demonstrated statistically significant improvement (P<.001). Overall patient satisfaction was 7.67. Our success rate was 74.58% for primary revision hip arthroscopy and 100% for secondary revision hip arthroscopy. Ten (14.29%) patients underwent total hip arthroplasty during the study period. Our hip survivorship was 85.7%. Five (7.14%) patients underwent secondary revision hip arthroscopy during the study period. We found an overall minor complication rate of 10%. Conclusion: Revision hip arthroscopy for all procedures performed on aggregate has excellent clinical outcomes for all PROs and patient satisfaction scores at short-term follow-up. Patients should be counseled regarding the potential progression of degenerative change leading to arthroplasty, and the potential for revision surgery.
Foot Progression Angle Walking Test- An Effective Dynamic Test for the Diagnosis of Femoroacetabular Impingement and Hip Instability
Authors: Ranawat Anil S. , Park Caroline , Licatesi Thomas , Rebolledo Brian J. , Satalich James 
Published: August 2015

Objectives: Clinical diagnosis of femoroacetabular impingement (FAI) and hip instability is determined by accurate history, physical examination, and imaging assessment. Currently, there is no ideal physical examination maneuver and certainly no dynamic method of testing. In this prospective study, we evaluate the Foot Progression Angle Walking (FPAW) test as a novel diagnostic tool that is sensitive and specific for the detection of FAI and hip instability. Methods: A prospective cohort of patients who presented with hip pain underwent FPAW testing in addition to the gold standard assessments for impingement and instability, the Flexion Adduction and Internal Rotation (FADIR) test and the Abduction and External Rotation (ABER) test, respectively. Baseline foot progression angles were initially recorded. Patients were then instructed to walk with foot progression angles: 1) internally rotated (-15º) and 2) externally rotated (+15º). A positive FPAW test was defined by an increase in hip pain with either internal or external rotation. Radiographs and/or magnetic resonance imaging were then used to evaluate for abnormal hip morphology and confirm diagnosis. Results: 80 patients (53 Female) with hip pain were evaluated by FPAW testing. Imaging used to assess for hip pathology exhibited FAI (n=48), instability (n=26) and normal anatomic morphology (n=13). Baseline measurements showed a neutral foot progression (64%), out-toeing gait (35%), and in-toeing gait (1%). Analysis of FPAW testing showed a sensitivity of 75% and specificity of 66% for FAI; sensitivity 54% and specificity 61% for instability. A positive predictive value (FAI: 77%; Instability 40%) and negative predictive value (FAI 64%; Instability 73%) were also determined. In comparison, the FADIR test showed a sensitivity and specificity of 96% and 13% for FAI, respectively. Its positive predictive value was 62% while its negative predictive value was 67%. Abduction and external rotation testing showed a sensitivity and specificity of 42% and 96%, respectively for diagnosing instability. Its positive predictive value was 85% and negative predictive value was 78%. Conclusion: FPAW testing was found to be more sensitive and specific for detecting FAI than instability. The higher specificity and positive predictive value of FPAW in comparison to the FADIR test makes it a reliable tool to identify patients with impingement. The FPAW test appears to be an effective tool to reproduce hip pathology in FAI patients during weight-bearing activity and could be a useful adjunct to give further clinical prospective in FAI and hip instability.
Risk Factors for Early Conversion to Total Hip Arthroplasty following Hip Arthroscopy
Authors: Redmond John M. , Gupta Asheesh , Dunne Kevin Fanning , Stake Christine E. , Domb Benjamin G. 
Published: August 2015

Objectives: The most common reason for reoperation following arthroscopic hip surgery is conversion to total hip arthroplasty (THA). The purpose of this study was to identify clinical and radiographic risk factors for early conversion to THA. Methods: Data were prospectively collected on all hip arthroscopy patients from January 2009 through December 2011. Inclusion criteria for the study group were patients undergoing hip arthroscopy for a labral tear who eventually converted to THA. Patients were then compared to a control group of patients who underwent hip arthroscopy for a labral tear and did not convert to THA during the same period. Exclusion criteria were patients with previous hip conditions such as Legg-Calves-Perthes, slipped capital femoral epiphysis, pigmented villonodular synovitis, and avascular necrosis. A bivariate analysis of 41 preoperative and intraoperative variables was performed. Results: A total of 792 patients met inclusion and exclusion criteria. A total of 72 (9%) converted to THA. The control group consisted of 720 patients who did not convert to THA. Bivariate analysis demonstrated that the study group had significantly higher means or frequencies than the control group for the following variables: male gender, age at time of surgery, BMI, back pain, previous back surgery, Tönnis grade above 0, acetabular inclination angle, alpha angle, Seldes combined-type labral tear, labral tear size, chondral injury, traction time, labral debridement (versus repair), number of anchors used repair or reconstruction, and capsular release (versus repair). The study group had significantly lower means or frequencies than the control group for the following variables: preoperative patient reported outcome scores, crossover sign, lateral center edge angle, and psoas release. A statistically significant difference in average joint space was not observed. Conclusion: Multiple risk factors are possible preoperative and intraoperative risk factors for conversion to THA following hip arthroscopy. The clinician and patient should be aware of these variables.
Stability of the Glenohumeral Joint with Combined Humeral Head and Glenoid Defects
Authors: Gottschalk Lionel , Walia Piyush , Patel Ronak Maneklal , Kuklis Matthew , Jones Morgan H. , Fening Stephen D. , Miniaci Anthony 
Published: August 2015

Objectives: Shoulders with recurrent anterior shoulder instability often have combined defects of the humeral head and glenoid. The aim of this study is to define the relationship of combined humeral head and glenoid defects on anterior shoulder instability. We hypothesize that combined humeral head and glenoid defects will produce greater instability than either defect found alone, and that the size of humeral head and glenoid defects which are “critical” and need to be repaired in order to restore glenohumeral stability will be smaller when the defects are found together than when either defect is found alone. Methods: Eighteen shoulder specimens (mean age 57 years) were tested at 60° of glenohumeral abduction and 80° of glenohumeral external rotation (equivalent to 90° of abduction and 90° of external rotation relative to the trunk). Humeral head defect sizes included 6%, 19%, 31%, and 44% of the humeral head diameter. Glenoid defect sizes included 10%, 20%, and 30% of the glenoid width. Outcome measures included Percent of Intact Stability Ratio (stability ratio for a given trial divided by the stability ratio in the intact state for that specimen) and Percent of Intact Translation (distance to dislocation for a given trial divided by the distance to dislocation in the intact state for that specimen). Results: There was a progressive decrease in stability as humeral head defect size increased and as glenoid defect size increased. The decrease in Percent of Intact Stability Ratio reached statistical significance for humeral head defects of 44%, for glenoid defects of 30%, and additionally for a combined 19% humeral head defect with a 20% glenoid defect. The mean Percent of Intact Stability Ratio was 65% for a combined 19% humeral head defect with a 20% glenoid defect. The decrease in Percent of Intact Translation reached statistical significance for humeral head defects of 31% and 44%, for glenoid defects of 20% and 30%, and additionally for a combined 19% humeral head defect with a 10% glenoid defect. The mean Percent of Intact Translation was 69% for a combined 19% humeral head defect with a 10% glenoid defect. Conclusion: The humeral head and glenoid defect sizes required to produce instability are smaller when the defects are found together than when either defect is found alone. In patients with combined humeral head and glenoid defects bony reconstruction may be indicated for humeral head defects as small as 19% of the humeral head diameter and glenoid defects as small as 10-20% of the glenoid width.
Arthroscopic Transosseous Rotator Cuff Repair
Authors: Austin Luke , Black Eric M. , Lombardi Nick J. , Pepe Matthew D. , Lazarus Mark 
Published: August 2015

Objectives: Health expenditures in the United States are outpacing national income, and affordability has become a major policy issue. Over 500,000 rotator cuff repairs (RCR) are performed annually in the United States making RCR a potential source of cost savings. Arthroscopic trans-osseous equivalent (TOE) repair using a double row of anchors has shown superior biomechanical strength compared to other techniques, but at a higher cost. The arthroscopic transosseous (TO) repair is a novel technique allowing arthroscopic rotator cuff repair to be performed without suture anchors. Arthroscopic TO repair may be a means to provide similarly excellent patient outcomes while lowering the cost of care. The primary purpose is to compare the price differential and time of surgery for an arthroscopic rotator cuff repair using anchorless TO repair verses an anchor trans-osseous equivalent (TOE) repair. A secondary purpose of the study was to evaluate outcomes at 6 months postoperatively. Methods: A prospective, case-controlled study evaluating arthroscopic rotator cuff repair using two techniques was performed. The study group consisting of 21 patients undergoing TO repair was compared to a control group consisting of 22 patients undergoing TOE repair. The groups were controlled for size of tear, biceps treatment, acromioplasty, distal clavicle excision, and labral pathology. The primary outcome measures were surgical time as well as total cost of implants and equipment for each surgery, determined by an independent third party, Atlanticare Hospital. Secondary outcomes were changes in the SST, VAS, and SANE scores. Results: Mean total surgical implant/equipment cost per procedure for TOE repair was $2348.03 (SD 490.30) and for TO repair was $1204.97 (SD 330.69; p<0.0001). Mean cut to close time for TOE repair was 85 minutes (95% CI is 77-90) verses 74 (95% CI = 71-98) for TO repair. A log rank test revealed no difference in time (p =0.95). A linear regression model was developed to evaluate the change in SST, VAS, and SANE scores from pre-op to 6 months follow-up. Our study was underpowered but no difference in outcome was observed. Conclusion: Arthroscopic TO rotator cuff repair is a cost savings and time neutral technique compared to TOE repair. A mean of $1100 can be saved in surgical cost per case. In a country that performs over 500,000 RCRs annually, utilizing a TO repair technique can provide substantial cost savings to the healthcare system.