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  • 1
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 40, No. 10 ( 2012-10), p. 2236-2241
    Abstract: Anterior cruciate ligament (ACL) reconstruction tunnel placement is often evaluated by radiographs. This study examines the interobserver reliability of various radiographic measurements of ACL tunnels. Hypothesis: When ideal radiographic views are obtained, the interobserver reliability of the measurements among experienced surgeons would be good to excellent. Study Design: Descriptive laboratory study. Methods: Tunnels for single-bundle ACL reconstruction were drilled and filled with metal interference screws or a tibial reamer on 73 cadaveric knees. Ideal fluoroscopic radiographs were obtained. Three independent reviewers performed 18 measurements including a modification of the grid method. For the grid method analysis, reviewers fit a 16 × 12 grid to the lateral knee radiograph, and the center of the femoral tunnel was marked. Interobserver reliability of the measurements was performed using intraclass correlation coefficients (ICCs). A precision grouping analysis was performed for the grid measurements to calculate the mean radius and standard deviation grouping distances. Results: The ICCs were excellent ( 〉 .75) for the tibial tunnel angles and tunnel measurements, the clock face measurement, and the Aglietti et al and Jonsson et al measurements. The ICCs were good (.4-.75) for an estimation of graft impingement, Harner et al measurements, and notch height. The mean radius for grid measurements was 0.6 ± 0.4 units (range, 0-2.36 units), with each unit being 1 box in the 16 × 12 grid. When a circle was constructed with a 1.3-unit radius, 95% of the 3 surgeons’ measurements would be included in the area of that circle. Conclusion: Reliability of ACL tunnel measurements was good to excellent under ideal circumstances for the majority of measurements. The modified grid method demonstrated very acceptable reliability. Clinical Relevance: Measurements with good to excellent reliability can be used to evaluate ACL tunnel placement when ideal radiographic views are obtained.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 2
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 40, No. 12 ( 2012-12), p. 2737-2746
    Abstract: Little is known about surgeon agreement and accuracy using arthroscopic evaluation of anterior cruciate ligament (ACL) tunnel positioning. Purpose: To investigate agreement on ACL tunnel position evaluated arthroscopically between operating surgeons and reviewing surgeons. We hypothesized that operating and evaluating surgeons would characterize tunnel positions significantly differently. Study Design: Controlled laboratory study. Methods: Twelve surgeons drilled ACL tunnels on 72 cadaveric knees using transtibial (TT), medial portal (MP), or 2-incision (TI) techniques and then completed a detailed assessment form on tunnel positioning. Then, 3 independent blinded surgeon reviewers each arthroscopically evaluated tunnel position and completed the assessment form. Statistical comparisons of tunnel position evaluation between operating and reviewing surgeons were completed. Three-dimensional (3D) computed tomography (CT) scans were performed and compared with arthroscopic assessments. Arthroscopic assessments were compared with CT tunnel location criteria. Results: Operating surgeons were significantly more likely to evaluate femoral tunnel position (92.6% vs 69.2%; P = .0054) and femoral back wall thickness as “ideal” compared with reviewing surgeons. Tunnels were judged ideal by reviewing surgeons more often when the TI technique was used compared with the MP and TT techniques. Operating surgeons were more likely to evaluate tibial tunnel position as ideal (95.5% vs 57.1%; P 〈 .0001) and “acceptable” compared with reviewers. The ACL tunnels drilled using the TT technique were least likely to be judged as ideal on the tibia and the femur. Agreement among surgeons and observers was poor for all parameters (κ = −0.0053 to 0.2457). By 3D CT criteria, 88% of femoral tunnels and 78% of tibial tunnels were placed within applied criteria. Conclusion: Operating surgeons are more likely to judge their tunnels favorably than observers. However, independent surgeon reviewers appear to be more critical than results of 3D CT imaging measures. When subjectively evaluated arthroscopically, the TT technique yields more subjectively poorly positioned tunnels than the TI and MP techniques. Surgeons do not agree on the ideal placement for single-bundle ACL tunnels. Clinical Relevance: This study demonstrates that surgeons do not currently uniformly agree on ideal single-bundle tunnel placement and that the TT technique may yield more poorly placed tunnels.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 3
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 39, No. 12 ( 2011-12), p. 2588-2594
    Abstract: Background: The Snyder classification scheme is the most commonly used system for classifying superior labral injuries. Although this scheme is intended to be used for arthroscopic visual classification only, it is thought that other nonarthroscopic historical variables also influence the classification. Purpose: This study was conducted to evaluate the intrasurgeon and intersurgeon agreement in classifying variable presentations of the superior labrum and to evaluate the influence of clinical variables on the classification and treatment choices of surgeons. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A group of arthroscopic shoulder surgeons were asked to rank in order of importance clinical variables considered in diagnosing and treating the superior labrum. The surgeons then watched 50 arthroscopic videos of the superior labrum, ranging from normal to pathologic, on 3 different occasions. The first and third viewings were accompanied by no clinical information. The second viewing was accompanied by a detailed clinical vignette for each video. The surgeons selected a classification and treatment for each video. Results: A patient’s job/sport, age, and physical examination findings were considered the most important clinical variables surgeons consider during management of the superior labrum. Comparing the 2 viewings without clinical information, surgeons selected a different classification 28.5% of the time from the first to the second time. A different classification was chosen 71.5% of the time when the surgeon was supplied a clinical vignette at the subsequent viewing. Similarly, the treatment selected changed in 36% and 69.1% of cases when viewed again without vignettes and with vignettes, respectively. Intersurgeon agreement was moderate without clinical vignettes and fair with vignettes. Historical, physical examination, and surgical observations were found to influence the odds of change of classification. Conclusion: There is significant intrasurgeon and intersurgeon variability in classification and treatment of the superior labrum. Clinical historical, examination, and surgical findings influence classification and treatment choices.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2011
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 4
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 41, No. 6 ( 2013-06), p. 1265-1273
    Abstract: Multicenter and multisurgeon cohort studies on anterior cruciate ligament (ACL) reconstruction are becoming more common. Minimal information exists on intersurgeon and intrasurgeon variability in ACL tunnel placement. Purpose/Hypothesis: The purpose of this study was to analyze intersurgeon and intrasurgeon variability in ACL tunnel placement in a series of The Multicenter Orthopaedic Outcomes Network (MOON) ACL reconstruction patients and in a clinical cohort of ACL reconstruction patients. The hypothesis was that there would be minimal variability between surgeons in ACL tunnel placement. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Seventy-eight patients who underwent ACL reconstruction by 8 surgeons had postoperative imaging with computed tomography, and ACL tunnel location and angulation were analyzed using 3-dimensional surface processing and measurement. Intersurgeon and intrasurgeon variability in ACL tunnel placement was analyzed. Results: For intersurgeon variability, the range in mean ACL femoral tunnel depth between surgeons was 22%. For femoral tunnel height, there was a 19% range. Tibial tunnel location from anterior to posterior on the plateau had a 16% range in mean results. There was only a small range of 4% for mean tibial tunnel location from the medial to lateral dimension. For intrasurgeon variability, femoral tunnel depth demonstrated the largest ranges, and tibial tunnel location from medial to lateral on the plateau demonstrated the least variability. Overall, surgeons were relatively consistent within their own cases. Using applied measurement criteria, 85% of femoral tunnels and 90% of tibial tunnels fell within applied literature-based guidelines. Ninety-one percent of the axes of the femoral tunnels fell within the boundaries of the femoral footprint. Conclusion: The data demonstrate that surgeons performing ACL reconstructions are relatively consistent between each other. There is, however, variability of average tunnel placement up to 22% of mean condylar depth, likely reflecting the difference in individual surgeons’ preferred tunnel locations. Individual surgeons are relatively consistent in their cases of ACL tunnels.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2013
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 5
    Online Resource
    Online Resource
    Informa UK Limited ; 2022
    In:  International Journal of Circumpolar Health Vol. 81, No. 1 ( 2022-12-31)
    In: International Journal of Circumpolar Health, Informa UK Limited, Vol. 81, No. 1 ( 2022-12-31)
    Type of Medium: Online Resource
    ISSN: 2242-3982
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2022
    detail.hit.zdb_id: 2180439-4
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  • 6
    Online Resource
    Online Resource
    Centers for Disease Control MMWR Office ; 2022
    In:  MMWR. Morbidity and Mortality Weekly Report Vol. 71, No. 22 ( 2022-06-03), p. 730-733
    In: MMWR. Morbidity and Mortality Weekly Report, Centers for Disease Control MMWR Office, Vol. 71, No. 22 ( 2022-06-03), p. 730-733
    Type of Medium: Online Resource
    ISSN: 0149-2195 , 1545-861X
    Language: English
    Publisher: Centers for Disease Control MMWR Office
    Publication Date: 2022
    detail.hit.zdb_id: 2067586-0
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  • 7
    In: Computer Aided Surgery, Informa UK Limited, Vol. 17, No. 5 ( 2012-09), p. 221-231
    Type of Medium: Online Resource
    ISSN: 1092-9088 , 1097-0150
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2012
    detail.hit.zdb_id: 2006641-7
    detail.hit.zdb_id: 2870722-9
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  • 8
    Online Resource
    Online Resource
    SAGE Publications ; 2009
    In:  The American Journal of Sports Medicine Vol. 37, No. 10 ( 2009-10), p. 2037-2042
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 37, No. 10 ( 2009-10), p. 2037-2042
    Abstract: In the last 25 years, it is estimated that over 42,000 male and female swimmers have competed at the National Collegiate Athletic Association (NCAA) Division I-A level. Despite the magnitude of these numbers, little is known about the epidemiology of collegiate swimming injuries. Purpose To describe the pattern of injuries incurred for one NCAA Division I collegiate men’s and women’s swimming team over 5 seasons. Study Design Descriptive epidemiology study. Methods Musculoskeletal and head injuries reported in the Sports Injury Management System for a Division I swimming team from 2002–2007 were identified. Gender, body part, year of eligibility, position, stroke specialty, scholarship status, and team activity during which the injury occurred and lost time were recorded. Risk of injury was assessed relative to gender, stroke specialty, and year of eligibility. Results From 2002–2007, 44 male and 50 female athletes competed for the University of Iowa swimming and diving team. The overall injury rates were estimated as 4.00 injuries per 1000 exposures for men and 3.78 injuries per 1000 exposures for women. Thirty-seven percent of injuries resulted in missed time. The shoulder/upper arm was the most frequently injured body part followed by the neck/back. Freshman swimmers suffered the most injuries as well as the highest mean number of injuries per swimmer. A significant pattern of fewer injuries in later years of eligibility was also demonstrated. The relative risk (RR) for injury was higher among nonfreestyle stroke specialties (RR, 1.33 [1.00–1.77]). Injury most often occurred as a result of, or during, practice for all swimmers. However, 38% of injuries were the result of team activities outside of practice or competition, such as strength training. No significant relationship was found between occurrence of injury and gender or scholarship status. There was no significant relationship between body part injured and stroke specialty. An increased number of total injuries and an increased risk of injuries in freshman collegiate swimmers were found. Conclusion Particular attention should be given to swimmers making the transition into collegiate level swimming. These data also suggest that injury surveillance and potential prevention strategies should focus on the shoulder for in-pool activities and the axial spine for cross-training activities.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 9
    In: Shoulder & Elbow, SAGE Publications, Vol. 2, No. 4 ( 2010-10), p. 305-313
    Abstract: The present study aimed to describe the comorbidity burden of a rotator cuff disease cohort and to examine the effects of patient comorbidities on general health and shoulder-specific outcome measures. Methods A retrospective cohort of patients with rotator cuff disease was identified using the coding of the International Classification of Diseases, Ninth Revision, Clinical Modification. Demographic variables and numbers of systemic and musculoskeletal comorbid conditions were collected. General health and shoulder-specific tools were used to assess disability. Analyses using regression, correlation and analysis of variance were performed to assess the impact of comorbidity upon outcome measures. Results Three hundred and seventy-three patients with rotator cuff disease were identified. Two-thirds of the group reported at least one systemic comorbidity. Non-shoulder musculoskeletal comorbidities were reported by 80% of the cohort. Women reported a significantly greater number of comorbid conditions than men ( p 〈 0.02). Baseline health-related quality of life and self-reported shoulder function were impacted significantly by comorbidity when controlling for patient demographic characteristics. Discussion Comorbidities are common in this population and significantly affect health-related quality of life and self-reported shoulder pain and disability in patients presenting with rotator cuff-related symptoms. Comorbidities should be considered when shoulder disability measures are utilized in clinical practice and when studying outcomes.
    Type of Medium: Online Resource
    ISSN: 1758-5732 , 1758-5740
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2010
    detail.hit.zdb_id: 2503300-1
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  • 10
    In: Arthroscopy: The Journal of Arthroscopic & Related Surgery, Elsevier BV, Vol. 28, No. 7 ( 2012-07), p. 942-951
    Type of Medium: Online Resource
    ISSN: 0749-8063
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2012
    detail.hit.zdb_id: 1491233-8
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