Differences in Outcomes Between Anterior and Posterior Shoulder Instability After Arthroscopic Bankart Repair: A Systematic Review and Meta-analysis

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Background: The glenohumeral joint is one of the most frequently dislocated joints in the body, particularly in young, active adults. Purpose: To conduct a systematic review and meta-analysis to evaluate and compare outcomes between anterior versus posterior shoulder instability. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed using the PubMed, Cochrane Library, and MEDLINE databases (from inception to September 2019) according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they were published in the English language, contained outcomes after anterior or posterior shoulder instability, had at least 1 year of follow-up, and included arthroscopic soft tissue labral repair of either anterior or posterior instability. Outcomes including return-to-sport (RTS) rate, postoperative instability rate, and pre- and postoperative American Shoulder and Elbow Surgeons (ASES) scores were recorded and analyzed. Results: Overall, 39 studies were included (2077 patients; 1716 male patients and 361 female patients). Patients with anterior instability had a mean age of 23.45 ± 5.40 years (range, 11-72 years), while patients with posterior instability had a mean age of 23.08 ± 8.41 years (range, 13-61 years). The percentage of male patients with anterior instability was significantly higher than that of female patients (odds ratio [OR], 1.36; 95% CI, 1.04-1.77; P = .021). Compared with patients with posterior instability, those with anterior instability were significantly more likely to RTS (OR, 2.31; 95% CI, 1.76-3.04; P < .001), and they were significantly more likely to have postoperative instability (OR, 1.53; 95% CI, 1.07-2.23; P = .018). Patients with anterior instability also had significantly higher ASES scores than those with posterior instability (difference in means, 6.74; 95% CI, 4.71-8.77; P < .001). There were no significant differences found in postoperative complications between the anterior group (11 complications; 1.8%) and the posterior group (3 complications; 1.6%) (OR, 1.12; 95% CI, 0.29-6.30; P = .999). Conclusion: Patients with anterior shoulder instability had higher RTS rates but were more likely to have postoperative instability compared with posterior instability patients. Overall, male patients were significantly more likely to have anterior shoulder instability, while female patients were significantly more likely to have posterior shoulder instability

Imaging Modalities for the Glenoid Track in Recurrent Shoulder Instability: A Systematic Review

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Background: The glenoid track (GT) concept illustrates how the degree of glenoid bone loss and humeral bone loss in the glenohumeral joint can guide further treatment in a patient with anterior instability. The importance of determining which lesions are at risk for recurrent instability involves imaging of the glenohumeral joint, but no studies have determined which type of imaging is the most appropriate. Purpose/Hypothesis: The purpose of this study was to determine the validity and accuracy of different imaging modalities for measuring the GT in shoulders with recurrent anterior instability. We hypothesized that 3-dimensional computed tomography (3D-CT) would be the most accurate imaging technique. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, Scopus, Medline, and Cochrane libraries between database inception and July 2019. We included all clinical trials or cadaveric studies that evaluated imaging modalities for assessing the GT. Results: A total of 13 studies were included in this review: 1 study using 2-dimensional CT, 6 studies using 3D-CT, 4 studies using magnetic resonance imaging (MRI), 1 study using magnetic resonance arthrography (MRA)/MRI, and 1 study combining CT and MRI. The mean sensitivity, specificity, and accuracy for 2D-CT was 92%, 100%, and 96%, respectively. For MRI, the means were 72.2%, 87.9%, and 84.2%, respectively. No papers included 3D-CT metrics. The mean intraclass correlation coefficients (ICCs) for intraobserver reliability were 0.9046 for 3D-CT and 0.867 for MRI. ICCs for interobserver reliability were 0.8164, 0.8845, and 0.43 for 3D-CT, MRI, and MRA/MRI, respectively. Conclusion: There is evidence to support the use of both CT and MRI imaging modalities in assessing the GT. In addition, few studies have compared radiographic measurements with a gold standard, and even fewer have looked at the GT concept as a predictor of outcomes. Thus, future studies are needed to further evaluate which imaging modality is the most accurate to assess the GT

Experimental Study of Drilling Temperature, Geometrical Errors and Thermal Expansion of Drill on Hole Accuracy When Drilling CFRP/Ti Alloy Stacks

The drilling of holes in CFRP/Ti (Carbon Fiber-Reinforced Plastic/Titanium alloy) alloy stacks is one of the frequently used mechanical operations during the manufacturing of fastening assemblies in temporary civil aircraft. A combination of inhomogeneous behavior and poor machinability of CFRP/Ti alloy stacks in one short drilling brought challenges to the manufacturing community. The impact of the drilling temperature and time delay factor under various cutting conditions on hole accuracy when machining CFRP/Ti alloy stacks is poorly studied. In this paper, the drilling temperature, the phenomenon of thermal expansion of the drill tool, and hole accuracy are investigated. An experimental study was carried out using thermocouples, the coordinate measuring machine method, and finite element analysis. The results showed that the time delay factor varied from 5 (s) to 120 (s), influences the thermal-dependent properties of CFRP, and leads to an increase in hole roundness. Additionally, the thermal expansion of the drill significantly contributes to the deviation of the hole diameter in Ti alloy

LEAN MASS AND MUSCLE MORPHOLOGY OF M. QUADRICEPS FEMORIS AFTER KNEE ARTHROSCOPY

Ashley A. Herda1, Traci Smiley2, Kyle Martin2, Kyle Veazey2, Christopher J. Cleary1, and Bryan M. Vopat2,3 1University of Kansas, Department of Health, Sport, and Exercise Sciences, Overland Park, Kansas; 2University of Kansas Health Systems, Sports Medicine and Performance Center, Overland Park, Kansas; 3University of Kansas Health Systems, Department of Orthopedic Surgery and Sports Medicine, Overland Park, Kansas PURPOSE: The purpose of this investigation was to document the progressive changes in muscle following knee arthroscopy. METHODS: Seven males (mean ± SD: age (yrs): 18.3±1.3; height (cm): 185.1±6.6; body mass (kg): 83.2±8.7) were observed before and up to 12-weeks after knee arthroscopy. The patients data was collected using a retrospective chart review and intermittent ultrasound monitoring to quantify muscle mass cross-sectional area (mCSA) of the rectus femoris (RF), vastus lateralis (VL), and vastus medialis (VM). Imaging was conducted using a diagnostic ultrasound with linear array probe and transverse plane imaging software. The treatment provided to patients included the standard of care with pre-and post-operative consultation and education on treatment plan, twice weekly physical therapy (PT) sessions, and, as necessary, blood flow restriction therapy (BRFT) during the sessions. The time points of capture included 2-, 6-, and 12-weeks post-operative PT visits. Data analyses include three, (2 X 3) two-way repeated measures ANOVAs (OP vs. NO) X (2W vs. 6W vs. 12W) for each mCSA. Level of significance was set at an alpha of 0.05 for all analyses. RESULTS: The 2-way ANOVAs resulted in no significant interaction for VL and VM mCSA (p=0.398 and p=0.301, respectively), however there was a main effect for time (p\u3c0.001 and p\u3c0.001, respectively) and leg (p=0.01 and p=0.01, respectively). Follow-up analyses indicated there was a drop in mCSA from 2W to 12W and 6W to 12W (p=0.016, mean difference=4.0 cm2 and p=0.006, mean difference=5.1 cm2, respectively) for VL and 2W to 12W (p=0.030, mean difference=2.4 cm2) for VM. Additionally, OP was smaller than NO across times (VL: p=0.001, mean difference=7.3 cm2; VM: p=0.006, mean difference=4.73 cm2). There was no interaction for RF mCSA (p=0.708), nor was there a main effect for time (p=0.882) or leg (p=0.062). CONCLUSIONS: These preliminary data suggest all superficial quadriceps muscles significantly atrophy through the 12-weeks of PT post knee arthroscopy. These first 6-12 weeks seem to be a critical time where rapid atrophy is occurring. Implementation of the most restorative treatments, such as BFRT, may be most beneficial if they extend beyond 12 weeks

Adhesive-deformation relationships and mechanical properties of nc-AlCrN/a-SiNx hard coatings deposited at different bias voltages

A series of Al-Cr-Si-N hard coatings were deposited on WC-Co substrates with a negative substrate bias voltage ranging from -50 to -200 V using cathodic arc evaporation system. A Rockwell-C adhesion test demonstrated that excellent adhesion was observed at lower bias voltages of -50 V and -80 V, while further increases in bias voltage up to -200 V led to severe delamination and worsening of the overall adhesion strength. X-ray diffraction and transmission electron microscopy analysis revealed a single phase cubic B1-structure identified as an AlCrN solid solution with a nanocomposite microstructure where cubic AlCrN nanocrystals were embedded in a thin continuous amorphous SiNx matrix. Coatings exhibited a 002-texture evolution that was more pronounced at higher bias voltages (amp;gt;=-120 V). Stress-induced cracks were observed inside the coatings at high bias voltages (amp;gt;=-150 V), which resulted in stress relaxation and a decline in the overall residual stresses.Funding Agencies|Ministry of Education, Science, Research and Sport of the Slovak Republic within the Research and Development Operational Programme [ITMS 26240220084, ITMS: 26220120048]; Slovak Research and Development Agency [APVV-15-0168, APVV-14-0173]</p

The Epidemiology of Lisfranc Injuries at the NFL Combine

Category: Sports Introduction/Purpose: Lisfranc injuries can have detrimental consequences to an athlete’s career. If left inadequately treated, these injuries can result in persistent pain and lead to advanced osteoarthritis. Understanding the prevalence of these injuries in collegiate athletes and their effect on NFL draft position can help team physicians counsel future players and determine optimal treatment. The purpose of this study was to determine the epidemiology of Lisfranc injuries in players participating in the NFL combine and to determine the positions that are at higher risk for sustaining these injuries. Methods: Data was collected from the NFL combine website on all players who participated in the combine and had sustained a Lisfranc injury before entering the NFL from 2009 to 2015. Medical records, imaging, and treatments were reviewed on players who were identified with these injuries. The epidemiology of Lisfranc injuries was determined by evaluating the number of injuries, surgeries, games missed, position played and draft position of each player. Odds ratios were calculated using logistic regression to assess the risk of sustaining each injury by position. Two-sample, two-tailed T-tests were computed to assess games missed and draft position in players with operative versus non-operative management. Players with a Lisfranc injury as well a second primary midfoot injury (n=3) were excluded from analysis. Results: Thirty-nine(1.7%) players at the NFL combine had an isolated Lisfranc injury during their collegiate football career. Of these players, 27(69.2%) required surgical intervention. The average number of collegiate football games missed for this injury was 3.0±5.0. The average number of games missed for players requiring operative fixation was statistically greater(4.2±5.7) than those in the non-operative group (0.3 ±0.9, p=0.02). The average NFL draft position was 141.7±69.4, and 13(33.3%) went undrafted. There was no statistical difference in the average draft position(p=0.84) and number of undrafted players(p=0.15) between the operative and non-operative groups. No position was found to be at increased risk for Lisfranc injury; however, as a whole, offensive players had a significantly increased risk(Odds ratio=2.7, p = 0.01) of having a Lisfranc injury when compared to all other players. Overall, 24(61.5%) of the players with a Lisfranc injury played on offense. Conclusion: The majority of players who reported a Lisfranc injury required operative intervention, and offensive players were at a higher risk for this injury. Lisfranc requiring operative management did not significantly change a player’s draft position or chance of being drafted

The Epidemiology of Navicular Injuries at the NFL Combine

Category: Sports Introduction/Purpose: Navicular injuries are documented to have the potential for significant impairment of foot function. Regardless of treatment choice, these injuries can result in persistent pain, advanced osteoarthritis, and chronic dysfunction. A clearer understanding of their prevalence in collegiate athletes as well as their impact on their NFL career would help team physicians better counsel players and their teams, and perhaps also aid in defining optimal treatment. The purpose of this study was to 1) determine the epidemiology of navicular fractures in players participating in the NFL combine, 2) define positions that might be at higher risk for sustaining this injury, and 3) evaluate the impact of navicular injuries on NFL draft position and NFL game play compared to matched controls. Methods: Data was collected from the NFL combine website on all participating players who had sustained a navicular injury before entering the NFL between 2009 and 2015. Medical records, imaging, and treatments were reviewed on all individuals who met these criteria. The epidemiology of navicular injuries was determined by evaluating the number of injuries, surgeries, games missed, position played and draft position of each player. Available exam and imaging findings were reviewed for each player. Players from 2009 to 2013 with a navicular injury were compared to matched controls. Control groups consisted of players who missed less than 2 games in college, played the same position, and did not have a previous surgery. NFL performance outcomes were evaluated through analysis of draft position, career length ≥2 years, and number of games played and games started within their first 2 years. All NFL performance data was obtained from STATS.com. Odds ratios were calculated using logistic regression to assess the risk of sustaining a navicular injury by position. Two-sample, two-tailed T-tests were computed to assess games missed in college and draft position in players with a navicular injury and NFL career consisting of games played, and started in the NFL in the first 2 years of their career versus control players. Results: A total of 2285 foot players participated in the NFL combine between 2009 – 2015. There were 15 navicular injuries (14 players) with an incidence of 0.6% of NFL football players participating in the combine during this time frame. Defensive backs had a statistically significant increased odds ratio (Odds ratio = 3.0, p=0.03) of sustaining a navicular injury, however only 3 defensive backs had a navicular injury. Three players had nonunions or a refracture and 2 players required a revision surgery. Fifty-seven percent of players with navicular injuries (72.7% of fractures) were undrafted versus 30.9% in the control group (P< 0.001). Twenty-nine percent of players with navicular fractures played 2 years in the NFL compared to 69.6% in the control group (P< 0.01). Conclusion: While only a small percentage of players at the NFL combine had a navicular injury, there was a significant increase in percentage of players undrafted and a decreased percent of players who played two years in the NFL when compared to controls. This demonstrates the detrimental effect this injury may have to a player’s career