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  • 1
    Online Resource
    Online Resource
    Differences in Mechanisms of Failure, Intraoperative Findings, and Surgical Characteristics Between Single- and Multiple-Revision ACL Reconstructions : A MARS Cohort Study
    SAGE Publications ; 2013
    In:  The American Journal of Sports Medicine Vol. 41, No. 7 ( 2013-07), p. 1571-1578
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 41, No. 7 ( 2013-07), p. 1571-1578
    Abstract: The factors that lead to patients failing multiple anterior cruciate ligament (ACL) reconstructions are not well understood. Hypothesis: Multiple-revision ACL reconstruction will have different characteristics than first-time revision in terms of previous and current graft selection, mode of failure, chondral/meniscal injuries, and surgical charactieristics. Study Design: Case-control study; Level of evidence, 3. Methods: A prospective multicenter ACL revision database was utilized for the time period from March 2006 to June 2011. Patients were divided into those who underwent a single-revision ACL reconstruction and those who underwent multiple-revision ACL reconstructions. The primary outcome variable was Marx activity level. Primary data analyses between the groups included a comparison of graft type, perceived mechanism of failure, associated injury (meniscus, ligament, and cartilage), reconstruction type, and tunnel position. Data were compared by analysis of variance with a post hoc Tukey test. Results: A total of 1200 patients (58% men; median age, 26 years) were enrolled, with 1049 (87%) patients having a primary revision and 151 (13%) patients having a second or subsequent revision. Marx activity levels were significantly higher (9.77) in the primary-revision group than in those patients with multiple revisions (6.74). The most common cause of reruptures was a traumatic, noncontact ACL graft injury in 55% of primary-revision patients; 25% of patients had a nontraumatic, gradual-onset recurrent injury, and 11% had a traumatic, contact injury. In the multiple-revision group, a nontraumatic, gradual-onset injury was the most common cause of recurrence (47%), followed by traumatic noncontact (35%) and nontraumatic sudden onset (11%) ( P 〈 .01 between groups). Chondral injuries in the medial compartment were significantly more common in the multiple-revision group than in the single-revision group, as were chondral injuries in the patellofemoral compartment. Conclusion: Patients with multiple-revision ACL reconstructions had lower activity levels, were more likely to have chondral injuries in the medial and patellofemoral compartments, and had a high rate of a nontraumatic, recurrent injury of their graft.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546513487980
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2013
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  • 2
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    Descriptive Epidemiology of the MOON Shoulder Instability Cohort
    SAGE Publications ; 2018
    In:  The American Journal of Sports Medicine Vol. 46, No. 5 ( 2018-04), p. 1064-1069
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 46, No. 5 ( 2018-04), p. 1064-1069
    Abstract: Shoulder instability is a common diagnosis among patients undergoing shoulder surgery. Purpose: To perform a descriptive analysis of patients undergoing surgery for shoulder instability through a large multicenter consortium. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing surgery for shoulder instability who were enrolled in the MOON Shoulder Instability Study were included. Baseline demographics included age, sex, body mass index, and race. Baseline patient-reported outcomes (PROs) included the American Shoulder and Elbow Surgeons (ASES) score, Shoulder Activity Score, Western Ontario Shoulder Instability Index (WOSI), 36-Item Health Survey (RAND-36), and Single Assessment Numeric Evaluation (SANE). The preoperative physician examination included active range of motion (ROM) and strength testing. Preoperative imaging assessments with plain radiography, magnetic resonance imaging (MRI), and computed tomography were also included and analyzed. Results: Twenty-six surgeons had enrolled 863 patients (709 male, 154 female) across 10 clinical sites. The mean age for the cohort was 24 years (range, 12-63 years). Male patients represented 82% of the cohort. The primary direction of instability was anterior for both male (74%) and female (73%) patients. Football (24%) and basketball (13%) were the most common sports in which the primary shoulder injury occurred. No clinically significant differences were found in preoperative ROM between the affected and unaffected sides for any measurement taken. Preoperative MRI scans were obtained in 798 patients (92%). An anterior labral tear was the most common injury found on preoperative MRI, seen in 66% of patients, followed by a Hill-Sachs lesion in 41%. Poor PRO scores were recorded preoperatively (mean: ASES, 72.4; WOSI, 43.3; SANE, 46.6). Conclusion: The MOON Shoulder Instability Study has enrolled the largest cohort of patients undergoing shoulder stabilization to date. Anterior instability is most common among shoulder instability patients, and most patients undergoing shoulder stabilization are in their early 20s or younger. The results of this study provide important epidemiological information for patients undergoing shoulder stabilization surgery.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    URL: Article
    DOI: 10.1177/0363546518755752
    DOI: 10.21203/rs.2.15080/v2
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2063945-4
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  • 3
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    Surgeon variation in glenoid bone reconstruction procedures for shoulder instability
    Elsevier BV ; 2023
    In:  Journal of Shoulder and Elbow Surgery Vol. 32, No. 1 ( 2023-01), p. 133-140
    Details
    In: Journal of Shoulder and Elbow Surgery, Elsevier BV, Vol. 32, No. 1 ( 2023-01), p. 133-140
    Type of Medium: Online Resource
    ISSN: 1058-2746
    URL: Article
    DOI: 10.1016/j.jse.2022.09.001
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
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  • 4
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    Patients Undergoing Shoulder Stabilization Surgery Have Elevated Shoulder Activity Compared With Sex- and Age-Matched Healthy Controls
    SAGE Publications ; 2017
    In:  Sports Health: A Multidisciplinary Approach Vol. 9, No. 1 ( 2017-01), p. 59-63
    Details
    In: Sports Health: A Multidisciplinary Approach, SAGE Publications, Vol. 9, No. 1 ( 2017-01), p. 59-63
    Abstract: Shoulder activity level may be a risk factor for shoulder instability, an indication for surgical intervention, and a risk factor for failure of operative stabilization. Hypothesis: Patients undergoing shoulder stabilization surgery have a higher activity level compared with sex- and age-matched healthy controls. Study Design: Cross-sectional study. Level of Evidence: Level 2. Methods: Patients undergoing shoulder stabilization surgery aged 18 to 50 years were prospectively enrolled. As part of data collection, patients completed a previously validated shoulder activity scale, which generates a score reporting frequency of activity ranging from 0 (least active) to 20 (most active). The activity level of these patients was compared with sex- and age-matched norms for a healthy population with no history of shoulder disorders. Results: A total of 409 subjects (343 male, 66 female) undergoing shoulder instability surgery completed the activity scale. Seventy-seven percent of patients had higher shoulder activity level than sex- and age-matched controls. Seventy-nine percent aged 18 to 30 years had a higher shoulder activity level than controls, with an identical distribution for men (79%) and women (79%). Among patients aged 31 to 50 years, 70% had higher activity than controls. However, men were more likely to have a higher activity level than controls (72%) versus women (59%). In patients aged 18 to 30 years, median activity level for instability patients was 14 in men compared with 10 in controls, and 13 in women compared with 8 in controls. In patients aged 31 to 50 years, median activity level was 13 in men compared with 10 in controls and 10 in women compared with 8 in controls. Conclusion: Patients undergoing shoulder stabilization surgery have a higher activity level than sex- and age-matched healthy controls. Clinical Relevance: Shoulder activity is especially elevated in younger, male instability patients.
    Type of Medium: Online Resource
    ISSN: 1941-7381 , 1941-0921
    URL: Article
    DOI: 10.1177/1941738116676810
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2474978-3
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  • 5
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    Current cellular and molecular biology techniques for the orthopedic surgeon-scientist
    Elsevier BV ; 2023
    In:  Journal of Shoulder and Elbow Surgery Vol. 32, No. 1 ( 2023-01), p. e11-e22
    Details
    In: Journal of Shoulder and Elbow Surgery, Elsevier BV, Vol. 32, No. 1 ( 2023-01), p. e11-e22
    Type of Medium: Online Resource
    ISSN: 1058-2746
    URL: Article
    DOI: 10.1016/j.jse.2022.07.004
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
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  • 6
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    Influential and Highest Cited Shoulder Instability Articles: A Bibliometric Analysis
    SAGE Publications ; 2021
    In:  Orthopaedic Journal of Sports Medicine Vol. 9, No. 3 ( 2021-03-01), p. 232596712199257-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 9, No. 3 ( 2021-03-01), p. 232596712199257-
    Abstract: In orthopaedic surgery and other fields, the effect of influential journal articles has been evaluated by their citation counts and their correlation with methodological quality. Purpose: To identify and characterize the 50 most cited articles on shoulder instability, examine trends in publication characteristics, and evaluate the correlation of citations with quality of evidence. Study Design: Cross-sectional study. Methods: The Web of Science and Scopus online databases were searched to identify the top 50 most cited articles on shoulder instability, based on the average number of citations from each database. Article characteristics were recorded, and level of evidence and methodological quality were assessed using the modified Coleman Methodology Score (mCMS), Jadad scale, and Methodological Index for Non-Randomized Studies (MINORS). Spearman correlation was used to evaluate relationships between citations or citation density (citations/y) and level of evidence or methodological scoring. Top cited articles from recent years were also aggregated. Results: The top 50 most cited papers had a mean ± SD number of citations of 381.5 ± 166.7, with a mean of 15.0 ± 8.8 citations/y. Overall, 15 articles (30%) were biomechanical/cadaveric studies, and 15 (30%) were case series. Only 3 (6%) were considered to have level 1 evidence. The mean ± SD mCMS was 54.4 ± 12.7, mean ± SD Jadad score was 3.1 ± 1.4, and mean ± SD MINORS score was 10.5 ± 3.3. There were no significant correlations between citation rank or density and methodological assessments. There were weak correlations between citation rank and publication year ( r s = 0.32; P = .022) and between rank and level of evidence ( r s = –0.38; P = .047). The correlation between citation density and publication year was moderate ( r s = 0.70; P 〈 .0001). There was no difference in citation density of the top 10 articles from 2010 to 2020 compared with the top 10 from the overall list (23.8 ± 5.3 vs 28.8 ± 9.5; P = .16). Conclusion: Influential articles in shoulder instability included a high proportion of biomechanical/cadaveric studies. The majority of top cited articles had lower evidence levels and poorer methodological quality without strong correlation with citations or citation density. There was a moderate correlation between citation density and year of publication.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967121992577
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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  • 7
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    Influential Articles on Pediatric and Adolescent Anterior Cruciate Ligament Injuries: A Bibliometric Analysis
    SAGE Publications ; 2021
    In:  Orthopaedic Journal of Sports Medicine Vol. 9, No. 6 ( 2021-06-01), p. 232596712110107-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 9, No. 6 ( 2021-06-01), p. 232596712110107-
    Abstract: The understanding of pediatric anterior cruciate ligament (ACL) injuries and optimal treatment has evolved significantly. Influential articles have been previously evaluated using article citations to determine impact. Purpose: To identify and characterize the 50 most cited and recent influential articles relating to pediatric and adolescent ACL injuries, to examine trends in publication characteristics, and to evaluate correlations of study citations with quality of evidence. Study Design: Cross-sectional study. Methods: The top 50 most cited articles on pediatric and adolescent ACL injuries were gathered using the Web of Science and Scopus online databases by averaging the number of citations from each database. Articles from recent years were also aggregated and sorted by citation density (citations/year). Publication and study characteristics were recorded. Level of evidence and methodologic quality were assessed where applicable using the modified Coleman Methodology Score (mCMS), modified Jadad scale, and Methodological Index for Non-Randomized Studies (MINORS). Spearman correlation was used to evaluate the association between citation data and level of evidence or methodologic quality scorings. Results: The top 50 cited papers had a mean of 117.5 ± 58.8 citations (range, 58.5-288.5 citations), with a mean citation density of 9.4 ± 5.4 citations per year (range, 2.9-25.8 citations/year); 80% were published in 2000 or later, and 6% were considered basic science. Articles were mainly level 4 evidence (27/42; 64.3%), and none was level 1. There were moderate, significant associations between publication year and level of evidence ( r S = −0.45; P = .0030) and citation density and publication year ( r S = 0.59; P 〈 .001). Mean methodologic quality scores were as follows: mCMS, 53 ± 7.2 (range, 39-68); modified Jadad scale, 3.2 ± 1.1 (range, 2-6); and MINORS, 11.2 ± 3.2 (range, 6-20). There was a significant, strong correlation between rank of mean citations and modified Jadad scale ( r S = 0.76; P 〈 .0001), suggesting poorer score associated with more mean citations. Conclusion: Influential articles on pediatric and adolescent ACL injuries were relatively recent, with a low proportion of basic science–type articles. Most of the studies had a lower evidence level and poor methodologic quality scores. Higher methodologic quality did not correlate positively with citation data.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/23259671211010772
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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  • 8
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    Beach Chair Versus Lateral Decubitus Position: Differences in Suture Anchor Position and Number During Arthroscopic Anterior Shoulder Stabilization
    SAGE Publications ; 2021
    In:  The American Journal of Sports Medicine Vol. 49, No. 8 ( 2021-07), p. 2020-2026
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 49, No. 8 ( 2021-07), p. 2020-2026
    Abstract: Arthroscopic shoulder capsulolabral repair using glenoid-based suture anchor fixation provides consistently favorable outcomes for patients with anterior glenohumeral instability. To optimize outcomes, inferior anchor position, especially at the 6-o’clock position, has been emphasized. Proponents of both the beach-chair (BC) and lateral decubitus (LD) positions advocate that this anchor location can be consistently achieved in both positions. Hypothesis: Patient positioning would be associated with the surgeon-reported labral tear length, total number of anchors used, number of anchors in the inferior glenoid, and placement of an anchor at the 6-o’clock position. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study was a cross-sectional analysis of a prospective multicenter cohort of patients undergoing primary arthroscopic anterior capsulolabral repair. Patient positioning in the BC versus LD position was determined by the operating surgeon and was not randomized. At the time of operative intervention, surgeon-reported labral tear length, total anchor number, anchor number in the inferior glenoid, and anchor placement at the 6-o’clock position were evaluated between BC and LD cohorts. Descriptive statistics and between-group differences (continuous: t test [normal distributions], Wilcoxon rank sum test [nonnormal distributions] , and chi-square test [categorical]) were assessed. Results: In total, 714 patients underwent arthroscopic anterior capsulolabral repair (BC vs LD, 406 [56.9%] vs 308 [43.1%] ). The surgeon-reported labral tear length was greater for patients having surgery in the LD position (BC vs LD [mean ± SD], 123.5°± 49° vs 132.3°± 44°; P = .012). The LD position was associated with more anchors placed in the inferior glenoid and more frequent placement of anchors at the 6-o’clock (BC vs LD, 22.4% vs 51.6%; P 〈 .001). The LD position was more frequently associated with utilization of ≥4 total anchors (BC vs LD, 33.5% vs 46.1%; P 〈 .001). Conclusion: Surgeons utilizing the LD position for arthroscopic capsulolabral repair in patients with anterior shoulder instability more frequently placed anchors in the inferior glenoid and at the 6-o’clock position. Additionally, surgeon-reported labral tear length was longer when utilizing the LD position. These results suggest that patient positioning may influence the total number of anchors used, the number of anchors used in the inferior glenoid, and the frequency of anchor placement at the 6 o’clock position during arthroscopic capsulolabral repair for anterior shoulder instability. How these findings affect clinical outcomes warrants further study. Registration: NCT02075775 (ClinicalTrials.gov identifier)
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465211013709
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2063945-4
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  • 9
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    Factors Associated With Shoulder Activity Level at Time of Surgery and at 2-Year Follow-up in Patients Undergoing Shoulder Stabilization Surgery
    SAGE Publications ; 2022
    In:  The American Journal of Sports Medicine Vol. 50, No. 6 ( 2022-05), p. 1503-1511
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 50, No. 6 ( 2022-05), p. 1503-1511
    Abstract: Patients undergoing shoulder stabilization surgery have been shown to have elevated activity levels. Factors associated with shoulder activity in this patient population at baseline and after surgery are unknown. Hypothesis: Patient-specific variables are associated with shoulder activity level at baseline and at 2-year follow-up in a cohort of patients undergoing shoulder stabilization surgery. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing shoulder stabilization surgery were prospectively enrolled. As part of the data collection process, patients completed a previously validated Shoulder Activity Scale. A regression analysis was performed to assess the association of patient characteristics with baseline and 2-year follow-up shoulder activity levels. Results: A total of 764 (n = 612 men, n = 152 women) out of 957 patients (80%) undergoing shoulder stabilization surgery with a median age of 25 years had baseline and 2-year follow-up data and were included in the current analysis. The baseline shoulder activity level was associated with race ( P 〈 .0001) and preoperative duration of instability ( P 〈 .0001). At 2 years, 52% of the cohort had returned to the same or higher activity level after surgery. Predictors of higher shoulder activity level at 2-year follow-up included higher baseline activity level ( P 〈 .0001), male sex ( P 〈 .0001), younger age ( P = .004), higher body mass index (BMI) ( P = .03), more dislocations ( P = .03), nonsmokers ( P = .04), and race ( P = .04). Conclusion: A longer duration of preoperative symptoms was associated with a lower baseline activity in this cohort. High baseline preoperative shoulder activity, younger age, male sex, higher BMI, number of dislocations, and nonsmoking status predicted higher shoulder activity 2 years after shoulder stabilization surgery. Registration: NCT02075775 ( ClinicalTrials.gov identifier).
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465221085978
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 10
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    Sex-related differences in patients undergoing surgery for shoulder instability: a Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort study
    Elsevier BV ; 2019
    In:  Journal of Shoulder and Elbow Surgery Vol. 28, No. 6 ( 2019-06), p. 1013-1021
    Details
    In: Journal of Shoulder and Elbow Surgery, Elsevier BV, Vol. 28, No. 6 ( 2019-06), p. 1013-1021
    Type of Medium: Online Resource
    ISSN: 1058-2746
    URL: Article
    DOI: 10.1016/j.jse.2019.02.020
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2019
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