Publications by authors named "Joseph E Manzi"

44 Publications

Developmental delay: is this pediatric patient population at risk for complications following open treatment of femoral shaft fracture?

Eur J Orthop Surg Traumatol 2022 Aug 9. Epub 2022 Aug 9.

Department of Orthopaedic Surgery, Children's National Health System, Washington, DC, USA.

Purpose: Femoral shaft fractures are common in the pediatric population, accounting for over 20% of inpatient pediatric fractures. Patients with developmental delays are a population group whose medical care and recovery come with a unique set of considerations and challenges. The purpose of this study was to evaluate the impact of developmental delay on outcomes following open treatment of femoral shaft fractures in the pediatric population.

Methods: Pediatric patients undergoing open treatment of femoral shaft fracture from 2012 to 2019 were identified in the National Surgical Quality Improvement Program-Pediatric database. Patients were divided into two groups: patients with developmental delay and patients without developmental delay. Patient demographics, comorbidities, and various postoperative outcomes were compared between the two groups using bivariate and multivariate analyses.

Results: Of the 5896 pediatric patients who underwent open treatment of femoral shaft fracture, 5479 patients (92.9%) did not have developmental delay whereas 417 (7.1%) had developmental delay. Patients with developmental delay were more likely to have other medical comorbidities. Following adjustment on multivariable regression analysis to control for the baseline differences between the two groups, patients with developmental delay had an increased risk of readmission to the hospital (OR 4.762; p = 0.014).

Conclusion: Developmental delay in the pediatric population was found to be an independent risk factor for hospital readmission following open treatment of femoral shaft fractures. Taking these patients into special consideration when evaluating the optimal treatment plan can be beneficial to reduce the risks of readmission, which can decrease costs for both the patient and the hospital.
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http://dx.doi.org/10.1007/s00590-022-03348-2DOI Listing
August 2022

Evaluation of the National Institutes of Health-Supported Relative Citation Ratio among Fellowship trained American Orthopaedic Joint Reconstruction Surgery Faculty: A New Bibliometric Measure of Scientific Influence.

J Arthroplasty 2022 Aug 5. Epub 2022 Aug 5.

Orthopedic Surgery, Monmouth Medical Center, Long Branch, NJ, USA.

Background: The Relative Citation Ratio (RCR), a novel National Institutes of Health-Supported measure of research productivity, allows for accurate interdisciplinary comparison of publication influence. This study evaluates the RCR of fellowship trained Adult Reconstructive Orthopaedic Surgeons with the goal of analyzing potentially influential physician demographics.

Methods: Adult Reconstruction Accreditation Council for Graduate Medical Education (ACGME) fellowship-trained faculty for orthopaedic residency programs were identified via departmental websites. The National Institutes of Health's iCite database was retrospectively reviewed for mean RCR, weighted RCR, and publication count by surgeon. Multivariate analyses were performed using the Wilcoxson rank-sum tests and Analyses of Variance testings (ANOVA) to compare sex, career length, academic rank, and professional degrees in addition to an M.D. or D.O. Significance was considered p<0.05.

Results: A total of 488 fellowship trained Adult Reconstruction faculty from 144 programs were included in the analysis. Overall, faculty recorded a median RCR of 1.65 (IQR 1.01 - 2.28) and a median weighted RCR of 16.59 (IQR 3.98 - 61.92). Weighted RCR and total number of publications were associated with academic rank and career longevity, while mean RCR was associated with academic rank. Median RCR ranged from 1.12 to 1.87 for all subgroups.

Conclusion: Adult Reconstruction faculty are exceptionally productive and generate highly impactful studies as evidenced by the high median RCR value relative to the National Institute of Health standard value of 1.0. Our data has important implications in the assessment of grant outcomes, promotion, and continued evaluation of research influence within the hip and knee community.
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http://dx.doi.org/10.1016/j.arth.2022.07.022DOI Listing
August 2022

Kinetic and Kinematic Comparisons in High School Pitchers with Low and High Pitch Location Consistency.

J Shoulder Elbow Surg 2022 Aug 2. Epub 2022 Aug 2.

Sports Medicine Institute Hospital for Special Surgery, New York, NY, USA.

Purpose: While the performance metric ball velocity has often been associated with increased kinetics at the upper extremity and risk of injury in youth and adolescent pitchers, it is unclear if the performance metric pitch location consistency has any positive/negative associations with pitching kinetics.

Methods: High school pitchers(n=59) pitched 8-12 fastballs using 3D motion-capture(480 Hz). Pitchers were divided into high consistency(HiCon) and low consistency(LoCon) groups based on the absolute center deviation of each pitcher's pitch to the center of the pitchers mean pitch location. 95% confidence ellipses with major and minor radii were constructed, while kinematics and kinetics were compared.

Results: HiCon pitchers had decreased lead hip flexion at elbow extension(40±12° vs. 52±13° respectfully, p=0.008) while at foot contact, decreased back hip extension(1±10° vs. 10±13° respectfully, p=0.038) and increased back hip internal rotation(9±15° vs. -2±15° respectfully, p=0.043). LoCon pitchers achieved maximum lead hip flexion earlier(61.3±23.2% vs. 75.8±15.1% respectfully, p=0.039). A multi-regression model could predict 0.49 of variance in pitch location consistency using kinematic inputs.

Conclusion: Pitchers who differ in pitch location consistency outcomes do not appear to demonstrate physiologically unsafe kinematics. High school pitchers who strive for improved pitch consistency can consider adjusting parameters of hip kinematics during early portions of the pitch.
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http://dx.doi.org/10.1016/j.jse.2022.06.011DOI Listing
August 2022

Evaluation of the National Institutes of Health-supported relative citation ratio among American orthopedic spine surgery faculty: A new bibliometric measure of scientific influence.

N Am Spine Soc J 2022 Sep 14;11:100143. Epub 2022 Jul 14.

Professional Orthopedic Associates, Tinton Falls, NJ, USA.

Background: Publication metrics have been traditionally used to compare research productivity amongst academic faculty. However, traditional bibliometrics lack field-normalization and are often biased towards time-dependent publication factors. The National Institutes of Health (NIH) has developed a new, field-normalized, article-level metric, known as the "relative citation ratio" (RCR), that can be used to make accurate self, departmental, and cross-specialty comparisons of research productivity. This study evaluates the use of the RCR amongst academic orthopedic spine surgery faculty and analyzes physician factors associated with RCR values.

Methods: A retrospective data analysis was performed using the iCite database for all fellowship trained orthopedic spine surgery (OSS) faculty associated with Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopedic surgery residency program. Mean RCR, weighted RCR, and total publication count were compared by sex, career duration, academic rank, and presence of additional degrees. A value of 1.0 is the NIH-funded field-normalized standard. Student t-tests were used for two-group analyses whereas the analysis of variance tests (ANOVA) was used for between-group comparisons of three or more subgroups. Statistical significance was achieved at P < 0.05.

Results: A total of 502 academic OSS faculty members from 159 institutions were included in the analysis. Overall, OSS faculty were highly productive, with a median RCR of 1.62 (IQR 1.38-2.32) and a median weighted RCR of 68.98 (IQR 21.06-212.70). Advancing academic rank was associated with weighted RCR, career longevity was associated with mean RCR score, and male sex was associated with having increased mean and weighted RCR scores. All subgroups analyzed had an RCR value above 1.0.

Conclusions: Academic orthopedic spine surgery faculty produce impactful research as evidenced by the high median RCR relative to the standard value set by the NIH of 1.0. Our data can be used to evaluate research productivity in the orthopedic spine community.
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http://dx.doi.org/10.1016/j.xnsj.2022.100143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9344340PMC
September 2022

Posteromedial tibial plateau bone bruises are associated with medial meniscal ramp lesions in patients with concomitant anterior cruciate ligament ruptures: a systematic review & meta-analysis.

Phys Sportsmed 2022 Aug 5:1-8. Epub 2022 Aug 5.

Department of Radiology, Musculoskeletal Imaging, Yale School of Medicine, New Haven, CT, USA.

Objective: To determine if posteromedial tibial plateau (PMTP) bone bruising on pre-operative MRI is significantly associated with a ramp lesion identified during arthroscopy in patients with concomitant ACL ruptures.

Methods: PubMed, CINAHL, Scopus, Web of Sciences, EMBASE, and Cochrane Library were searched systematically for studies that investigated the association between PMTP bone bruises on preoperative MRI and ramp lesions confirmed during arthroscopy. Eight studies met inclusion criteria. The Methodological Index for Nonrandomized Studies (MINORS) checklist was used to assess quality. A meta-analysis was performed to analyze odds of a ramp lesion after PMTP bone bruising identified on magnetic resonance imaging (MRI). Publication bias was assessed by funnel plot and Egger's linear regression test.

Results: There are 2.05 greater odds of medial meniscal ramp lesions in patients with an ACL rupture when PMTP bone bruising is found on preoperative MRI (95% CI, 1.29-3.25; = 0.002). Heterogeneity of the pooled studies may be substantial (= 65%; = 0.006). Funnel plot analysis and Egger's linear regression test ( > 0.5) determined no publication bias among the studies included in the meta-analysis.

Conclusion: Patients with acute ACL injuries and PMTP bone bruising on MRI have 2.05 times greater odds of a concomitant medial meniscal ramp lesion than those without this bone bruise pattern.
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http://dx.doi.org/10.1080/00913847.2022.2108350DOI Listing
August 2022

Variability in Pitch Count Limits and Rest Day Requirements by State: Implications of Season-Long Pitch Counts in High School Baseball Pitchers.

Am J Sports Med 2022 08 21;50(10):2797-2804. Epub 2022 Jul 21.

Hospital for Special Surgery Florida, West Palm Beach, Florida, USA.

Background: It is unknown how different pitch count limits and rest day requirements affect cumulative pitch counts during a baseball season.

Purpose: To determine (1) the variability of pitch count rules in high school baseball and (2) the theoretical effect of different pitch count limits and rest day combinations on game, weekly, and seasonal pitch totals in high school baseball pitchers.

Study Design: Cross-sectional study.

Methods: Pitch count rules for the 2019-2020 academic year for 48 sanctioned states were recorded from each state's athletic association website. Maximum pitch count limits were recorded along with the number of pitches allowed before requiring 0 to 5 rest days before the next pitching outing. Rules were also analyzed for several distinctions, including the athlete's level of competition, age, and grade. To determine the effect of pitch count rules and rest days, a theoretical 3-month season was calculated in the following scenarios: (1) variable maximum pitch count limits with a universal 3-day rest requirement, (2) universal 110 pitch count limit with variable rest day requirements (3, 4, or 5 days), and (3) actual pitch count limits and required rest days for every state assuming pitchers throw as many pitches as allowed. Analysis of variance and Student tests were used to compare between-group and intragroup seasonal pitch totals based on variations in required rest days.

Results: The most common maximum pitch count limit for a varsity high school athlete was 110 pitches (range, 100-125 pitches) with 4 rest days (range, 0-5 days). We found that 23 states (48%) did not make distinctions for pitch count rules based on the athlete's level of competition, age, or grade. We noted a 25% increase in total seasonal pitch counts between the smallest and largest pitch count limit when assuming constant 3-day rest. We found a 53% difference in total seasonal pitch count when rest days varied between 3 and 5 days with a constant 110-pitch limit. Allowing 140 pitches in a 4-day span without a specific rest day requirement resulted in the highest seasonal pitch count (Nevada). There was a 49% difference in maximum seasonal pitch counts between the most and least restrictive states ( < .001). Submaximum pitch limits resulted in higher seasonal pitch counts than maximum pitch limits in 56% of states.

Conclusion: Pitch count rules vary widely by state. Required rest days influenced total seasonal pitch counts more than maximum or submaximum pitch count limits.
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http://dx.doi.org/10.1177/03635465221111098DOI Listing
August 2022

The influence of shoulder abduction and external rotation on throwing arm kinetics in professional baseball pitchers.

Shoulder Elbow 2022 Jul 28;14(1 Suppl):90-98. Epub 2021 Apr 28.

Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA.

Background: The relationships between shoulder abduction and external rotation with peak kinetic values at the shoulder and elbow in professional baseball pitchers are not well established.

Methods: Professional pitchers ( = 322) threw 8-12 fastballs under 3D motion analysis (480 Hz). Pitchers were stratified into quartiles by shoulder abduction and external rotation at distinct timepoints. Regression analyses were performed to quantify associations between shoulder position and kinetics.

Results: Shoulder abduction remained relatively consistent throughout the pitch (foot contact-ball release: 85.5 ± 11.1-90.7 ± 8.4°); shoulder external rotation increased dramatically (foot contact-ball release: 30.8 ± 24.6-165.2 ± 9.7°). For every 10° increase in maximum shoulder rotation, shoulder superior force increased by 2.3% body weight ( < 0.01), shoulder distraction force increased by 5.9% body weight ( < 0.01), and ball velocity increased by 0.60 m/s ( < 0.01). Shoulder abduction was significantly associated with shoulder superior force at all timepoints but not with ball velocity ( > 0.05). For every 10° increase in shoulder abduction at ball release, shoulder superior force increased by 3.7% body weight ( < 0.01) and shoulder distraction force increased by 11.7% body weight ( < 0.01).

Conclusion: Increased shoulder abduction at ball release and increased maximum shoulder external rotation were associated with greater superior and distraction forces in the shoulder. Pitchers can consider decreasing shoulder abduction at later stages of the pitch to around 80° in order to minimize shoulder superior force, with no impact on ball velocity.
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http://dx.doi.org/10.1177/17585732211010300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9284251PMC
July 2022

Evaluating the Association between Anesthesia Type and Postoperative Complications for Patients Receiving Total Ankle Arthroplasty.

Iowa Orthop J 2022 06;42(1):113-119

Department of Anesthesiology, New York-Presbyterian Hospital/ Weill Cornell Medical Center, New York, New York, USA.

Background: Total ankle arthroplasty (TAA) is performed for ankle arthritis and there has been interest investigating which anesthetic method is the best choice in order to optimize perioperative outcomes. In this study, we compared postoperative complications after TAA for patients receiving either 1) general anesthesia alone or 2) general anesthesia plus regional anesthesia.

Methods: Patients undergoing primary TAA from 2007 to 2018 were identified in a national database. Patients were stratified into 2 cohorts: general anesthesia and general anesthesia combined with regional anesthesia. In this analysis, 30-day wound, cardiac, pulmonary, renal, thromboembolic, and sepsis complications, as well mortality, postoperative transfusion, urinary tract infection, extended length of stay, and reoperation were assessed. Bivariate analyses and multivariable logistical regression were performed.

Results: Of 1,084 total patients undergoing TAA, 878 patients (81.0%) had general anesthesia and 206 (19.0%) had general anesthesia combined with regional anesthesia. Following adjustment, there were no increased risk of postoperative complications in the combined general and regional anesthesia group compared to those who only underwent general anesthesia.

Conclusion: Compared to general anesthesia alone, the addition of regional anesthesia to general anesthesia for TAA is not associated with increased risk of complications in the perioperative period. .
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210406PMC
June 2022

The association between diabetes status and postoperative complications for patients receiving ACL reconstruction.

Eur J Orthop Surg Traumatol 2022 Jun 29. Epub 2022 Jun 29.

Department of Orthopaedic Surgery, Johns Hopkins, Columbia, MD, USA.

Purpose: It is well established that diabetes is associated with complications following surgical procedures across the wide array of surgical subspecialties. The evidence on the effect of diabetes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction (ACLR), however, is not as robust, and findings have not been consistent. It was hypothesized that patients with diabetes are at increased risk of complications and a higher rate of hospital admission following ACLR.

Methods: The National Surgical Quality Improvement Program database was queried for patients undergoing ACL reconstruction from 2006 to 2019. Two patient cohorts were defined in this retrospective study: patients with diabetes and patients without diabetes. The various patient demographics, medical comorbidities, and postoperative outcomes were compared between the two groups, with the use of bivariate and multivariate analyses.

Results: Of 9,576 patients who underwent ACL reconstruction, 9,443 patients (98.6%) did not have diabetes, whereas 133 patients (1.4%) had diabetes. Following adjustment on multivariate analyses, compared to non-diabetic patients, those with diabetes had an increased risk of admission to the hospital within thirty days of the surgery (OR 2.14; p = 0.002).

Conclusion: Patients with diabetes have a significantly higher risk of being admitted to the hospital compared to those without the disease. Clinicians should be aware of diabetic patients who undergo ACLR to ensure appropriate pre- and postoperative care to minimize complications in this patient population.
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http://dx.doi.org/10.1007/s00590-022-03316-wDOI Listing
June 2022

Is seizure disorder a risk factor for complications following surgical treatment of hip dysplasia in the pediatric population?

J Pediatr Orthop B 2022 Jun 27. Epub 2022 Jun 27.

Department of Orthopedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

The impact of seizure disorders on pediatric patients who undergo hip dysplasia surgery has yet to be elucidated. This study focused on identifying the effect of seizure disorders on the incidence of complications following surgical management of hip dysplasia. Pediatric patients undergoing surgical treatment for hip dysplasia from 2012 to 2019 were identified in the National Surgical Quality Improvement Program-Pediatric database. Patients were divided into two cohorts: patients with and patients without a seizure disorder. Patient demographics, comorbidities and postoperative outcomes were compared between the two groups. Bivariate and multivariate analyses were performed. Of 10 853 pediatric patients who underwent hip dysplasia surgery, 8117 patients (74.8%) did not have a seizure disorder whereas 2736 (25.2%) had a seizure disorder. Bivariate analyses revealed that compared to patients without a seizure disorder, patients with a seizure disorder were at increased risk of developing surgical site infections, pneumonia, unplanned reintubation, urinary tract infection, postoperative transfusion, sepsis, extended operation time and length of stay and readmission (P < 0.05 for all). Following adjustment for patient demographics and comorbidities on multivariate analysis, there were no differences in any postoperative complications between pediatric patients with and without a seizure disorder. There were no differences in 30-day postoperative complications in patients with and without a seizure disorder. Due to potential decreased bone mineral density as an effect of antiepileptic drugs and the risk of femur fracture during surgery for hip dysplasia, pediatric patients with a seizure disorder should be closely monitored as they may be more susceptible to injury. Level of Evidence: III.
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http://dx.doi.org/10.1097/BPB.0000000000000998DOI Listing
June 2022

The Relationship Between Maximum Shoulder Horizontal Abduction and Adduction on Peak Shoulder Kinetics in Professional Pitchers.

Sports Health 2022 Jun 27:19417381221104038. Epub 2022 Jun 27.

Sports Medicine Institute Hospital for Special Surgery, New York, New York.

Background: Repetitive horizontal shoulder abduction during pitching can cause increased contact between the posterosuperior aspect of the glenoid and the greater tuberosity of the humeral head, theoretically putting baseball pitchers at increased risk of shoulder internal impingement and other shoulder pathologies.

Hypothesis: Increased shoulder horizontal abduction is associated with increased shoulder anterior force, while increased horizontal adduction is associated with increased shoulder distraction force.

Study Design: Descriptive laboratory study.

Level Of Evidence: Level 4.

Methods: A total of 339 professional baseball pitchers threw 8 to 10 fastball pitches using 3D motion capture (480 Hz). Pitchers were divided into 2 sets of quartiles based on maximum shoulder horizontal abduction and adduction. Elbow flexion, shoulder external rotation, and peak shoulder kinetics were compared between quartiles with post hoc linear regressions conducted for the entire cohort.

Results: At maximum shoulder horizontal abduction, there was no difference in ball velocity between quartiles ( = 0.76). For every 10º increase in maximum shoulder horizontal abduction, shoulder anterior force decreased by 2.2% body weight (BW) ( < 0.01, B = -0.22, β = -0.38), shoulder adduction torque decreased by 0.5%BW × body height (BH) ( < 0.01, B = -0.05, β = -0.19), and shoulder horizontal adduction torque decreased by 0.4%BW × BH ( < 0.01, B = -0.04, β = -0.48). For every 10º increase in maximum shoulder horizontal adduction, shoulder anterior force increased by 2%BW and ball velocity decreased by 1.2 m/s (2.7 MPH).

Conclusion: Professional pitchers with the least amount of maximum horizontal adduction had faster ball velocity and decreased shoulder anterior force. Pitchers with greater maximum shoulder horizontal abduction had decreased shoulder anterior force, shoulder adduction torque, and shoulder horizontal adduction torque. To maximize ball velocity as a performance metric while minimizing shoulder anterior force, pitchers can consider decreasing maximum shoulder adduction angles at later stages of the pitch.

Clinical Relevance: Identifying risk factors for increased throwing shoulder kinetics (ie, shoulder anterior force, shoulder adduction torque) has potential implications in injury prevention. Specifically, mitigating shoulder anterior forces may be beneficial in reducing risk of injury.
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http://dx.doi.org/10.1177/19417381221104038DOI Listing
June 2022

YouTube as a source of patient education information for elbow ulnar collateral ligament injuries: a quality control content analysis.

Clin Shoulder Elb 2022 Jun 23;25(2):145-153. Epub 2022 May 23.

Weill Cornell Medicine, New York, NY, USA.

Background: While online orthopedic resources are becoming an increasingly popular avenue for patient education, videos on YouTube are not subject to peer review. The purpose of this cross-sectional study was to evaluate the quality of YouTube videos for patient education in ulnar collateral ligament (UCL) injuries of the elbow.

Methods: A search of keywords for UCL injury was conducted through the YouTube search engine. Each video was categorized by source and content. Video quality, reliability, and accuracy were assessed by two independent raters using five metrics: (1) Journal of American Medical Association (JAMA) benchmark criteria (range 0-4) for video reliability; (2) modified DISCERN score (range 1-5) for video reliability; (3) Global Quality Score (GQS; range 1-5) for video quality; (4) ulnar collateral ligament-specific score (UCL-SS; range 0-16), a novel score for comprehensiveness of health information presented; and (5) accuracy score (AS; range 1-3) for accuracy.

Results: Video content was comprised predominantly of disease-specific information (52%) and surgical technique (33%). The most common video sources were physician (42%) and commercial (23%). The mean JAMA score, modified DISCERN score, GQS, UCL-SS, and AS were 1.8, 2.4, 1.9, 5.3, and 2.7 respectively.

Conclusions: Overall, YouTube is not a reliable or high-quality source for patients seeking information regarding UCL injuries, especially with videos uploaded by non-physician sources. The multiplicity of low quality, low reliability, and irrelevant videos can create a cumbersome and even inaccurate learning experience for patients.
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http://dx.doi.org/10.5397/cise.2021.00717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9185119PMC
June 2022

Interval Throwing Programs at Distances Beyond 150 Feet Can Be Equivalent to Pitching Over Five Innings.

Arthroscopy 2022 Jun 2. Epub 2022 Jun 2.

Hospital for Special Surgery Sports Medicine Institute, New York, New York, U.S.A.

Purpose: To determine the cumulative elbow varus torque (EVT) experienced during created interval throwing programs (ITP) and derive innings pitched equivalent for each step.

Methods: High school pitchers wearing the motusBASEBALL sensor who had at least 50 throws at 90, 120, 150, and 180 ft and game pitches were included in this analysis. Means for EVT per throw and torque per minute were calculated at each distance. Three throwing programs were created using a template of 1 phase at each distance with 2 steps per phase. Programs varied only by number of throws per set (20, 25, and 30 throws for Program A, B, and C, respectively). Total EVT for each step, phase, and program were calculated using mean EVT per throw at each distance. Total EVT for each step and program were converted to a mean inning pitched equivalent (IPE) and maximum pitch count equivalent (MPE), respectively, using in-game pitching torque values and expected mean pitch counts (15 pitches/inning and maximum 105 pitches/game).

Results: In total, 3,447 throws were analyzed from 7 subjects (16.7 years ± 0.8 years). EVT per throw increased at each distance (range 36.9-45.5 N·m), comparable to game pitches (45.7 N·m). Mean EVT per minute was highest for 90 ft throws (193.4 N·m/min) and lowest for game pitches (125 N·m/min). Throwing Program A had the lowest range of IPE (Step 1: 2.0 and Step 8: 3.7), and Program C had the highest range (Step 1: 3.0 and Step 8: 5.6). The phases of Program A never exceeded 1MPE. Program B exceeded this threshold after Phase 1, and Program C exceeded 1MPE at every phase. Total program MPE ranged from 3.5 to 5.2 (Program A and C, respectively).

Conclusions: Programs requiring 25 or more throws per set reached approximately 5 IPE per day. Increasing throwing repetitions by 10 throws resulted in a nearly 50% increase in IPE and MPE.

Level Of Evidence: IV, retrospective cohort study.
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http://dx.doi.org/10.1016/j.arthro.2022.05.006DOI Listing
June 2022

Evaluating Pelvis Rotation Style at Foot Contact: A Propensity Scored Biomechanical Analysis in High School and Professional Pitchers.

Am J Sports Med 2022 07 23;50(8):2271-2280. Epub 2022 May 23.

Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.

Background: Early pelvis rotation has been associated with decreased throwing arm kinetics and conventionally was considered a component of proper pitching form in baseball throwers. However, previous assessments of pelvis rotation style have not accounted for confounders such as playing level, anthropometric characteristics, or ball velocity and have not evaluated sufficient sample sizes.

Purpose: To compare kinetic and kinematic parameters based on pelvis rotation style in high school and professional pitchers.

Study Design: Descriptive laboratory study.

Methods: High school and professional baseball pitchers threw 8 to 12 fastball pitches while being evaluated using 3-dimensional motion capture (480 Hz). These pitchers were 1:1 propensity score matched by age, height, weight, handedness, and ball velocity based on early (<60°) versus late (≥60°) pelvis rotation style at foot contact. A total of 26 kinematic and 10 kinetic parameters were compared between groups. The kinematic parameters were used to conduct a linear regression between early and late pelvis rotation at foot contact.

Results: Pelvis rotation at foot contact was not significantly associated with ball velocity for either high school ( = .243) or professional pitchers ( = .075). No difference was found in elbow varus torque between high school early rotators (57.5 ± 14.9 N·m) and late rotators (51.3 ± 14.7 N·m; = .036) and between professional early rotators (80.1 ± 11.8 N·m) and late rotators (79.0 ± 11.2 N·m; = .663). At foot contact in high school pitchers, stride length increased by 2.1% of body height (B = -0.205; β = -0.470; < .001), trunk rotation increased by 4.2° (B = -0.417; β = -0.488; < .001), and trunk flexion at foot contact decreased by 4.4° (B = 0.442; β = 0.476; < .001) with every 10° increase in pelvis rotation. At foot contact in professional pitchers, stride length increased by 2.3% of body height (B = -0.229; β = -0.478; < .001), trunk rotation increased by 4.3° (B = -0.431; β = -0.515; < .001), and trunk flexion decreased by 4.0° (B = 0.404; β = 0.373; < .001) with every 10° increase in pelvis rotation.

Conclusion: Pelvis rotation at foot contact was associated with several kinematic parameters in both groups and may influence mechanics further along the kinetic chain. Landing open or closed was not significantly associated with throwing arm kinetics or ball velocity for both high school and professional baseball pitchers, contrary to previous thought.

Clinical Relevance: Coaches and players may better focus their efforts on refining other kinematic parameters for enhanced performance outcomes and safe pitching mechanics.
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http://dx.doi.org/10.1177/03635465221094323DOI Listing
July 2022

Extended length of stay in diabetic octogenarians following revision total hip arthroplasty.

Eur J Orthop Surg Traumatol 2022 May 10. Epub 2022 May 10.

Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, 2300 Eye St NW, Washington, DC, 20037, USA.

Purpose: Past research has shown diabetic patients, including those of geriatric age, to be at an increased risk of postoperative complications following various surgeries, including revision total hip arthroplasty (rTHA). However, whether these risks are disproportionately greater in octogenarian patients has not been well investigated. This study aimed to determine whether diabetic octogenarians are at an increased risk of postoperative complications following rTHA.

Methods: The national surgical quality improvement program database was used to identify all diabetic patients who underwent rTHA from 2007 to 2018. Patients were divided into two groups: an aged 65 to 79 cohort and an aged 80 to 89 cohort. Patient demographics, comorbidities, and postoperative complications were assessed and compared between the two aged cohorts, with the utilization of bivariate and multivariate analyses.

Results: Of the 1184 diabetic patients who underwent rTHA, 906 (76.5%) patients were in the aged 65 to 79 cohort and 278 (23.5%) patients were in the aged 80 to 89 cohort. After adjusting for patient demographics and medical comorbidities, compared to patients in the aged 65 to 79 group, diabetic patients who were 80 to 89 years old were found to have an increased risk of extended length of hospital stay (OR 1.67; p = 0.017).

Conclusion: Diabetic octogenarian patients have an increased risk for a prolonged hospital stay following rTHA relative to their younger diabetic geriatric counterparts. Orthopedic surgeons should be aware of these increased risks to properly educate diabetic octogenarians and assist in surgical management decision making in these patients considering rTHA.
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http://dx.doi.org/10.1007/s00590-022-03277-0DOI Listing
May 2022

Evaluating the association between pulmonary abnormalities and complications following pediatric hip dysplasia surgery.

Eur J Orthop Surg Traumatol 2022 May 9. Epub 2022 May 9.

Department of Orthopaedic Surgery, Children's National Health System, Washington, DC, USA.

Purpose: Developmental dysplasia of the hip (DDH) encompasses a wide range of abnormal hip development and is a common condition in the pediatric population. Congenital pulmonary abnormalities are typically mild in the pediatric population but can be associated with severe comorbid conditions. The purpose of this study was to analyze the effect of structural pulmonary/airway abnormalities on the incidence of postoperative complications following surgical management of DDH.

Methods: From 2012 to 2019, the National Surgical Quality Improvement Program-Pediatric database was utilized to identify pediatric patients undergoing surgical treatment for hip dysplasia. Patients were stratified into two groups: patients with a structural pulmonary/airway abnormality and patients without a pulmonary abnormality. Patient demographics, comorbidities, and postoperative complications were compared between the two cohorts with the use of various statistical analyses, including bivariate and multivariate analyses.

Results: Of the 10,853 patients who underwent surgical treatment for hip dysplasia, 10,157 patients (93.6%) did not have a structural pulmonary/airway abnormality whereas 696 (6.4%) had an airway abnormality. Following adjustment on multivariate analysis, patients with a structural pulmonary abnormality had an increased risk of cardiac arrest requiring cardiopulmonary resuscitation (OR 2.342; p = 0.045).

Conclusion: The results indicated that patients with a structural pulmonary abnormality had an increased risk of cardiac arrest requiring cardiopulmonary resuscitation compared to those without a pulmonary abnormality. Ensuring appropriate preoperative evaluation with a multidisciplinary team and close monitoring postoperatively is important to prevent the risk of severe outcomes in this vulnerable patient population.
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http://dx.doi.org/10.1007/s00590-022-03276-1DOI Listing
May 2022

Increased Knee and Meniscal Injury Incidence in Professional Baseball Pitchers With Wider, Positive Stride Width.

Sports Health 2022 May 2:19417381221092024. Epub 2022 May 2.

Sports Medicine Institute Hospital for Special Surgery, New York, New York.

Background: Professional baseball pitchers sustain 75% of knee injuries while at the pitcher's mound, yet no pitching motion has been associated directly with such injuries. Stride width is a potential, modifiable risk factor worth investigating.

Hypothesis: Increased stride width in both the positive and negative directions (deviations from neutral stride width) would correlate with increased incidence of knee injury in pitchers.

Study Design: Descriptive laboratory.

Level Of Evidence: Level 5.

Methods: Professional pitchers (n = 199) were evaluated with motion capture (480 Hz) while pitching. Injury history over 10 years was recorded at face-to-face interviews with pitchers. Players were subsequently grouped into stride width tertiles, compared for previous injury incidence of the lower extremities. Regressions were performed to observe performance benefits of stride width with ball velocity, accuracy, or consistency in pitch location as secondary outcomes.

Results: Of the 40 lower extremity injuries reported, meniscal injury (27.5%) was the most common, followed by foot stress fracture (20.0%). Significant differences in injury incidence were noted between the least and most positive stride width tertiles: lower extremity (10.4% vs 25.8%, respectively; = 0.03), knee (3.0% vs 15.2%, respectively; = 0.02), and meniscal (0.0% vs 12.1%; = 0.00). Stride width of pitchers with meniscal injury in the lead (32.6 ± 7.1 cm, n = 5; = 0.02) and stance leg (33.5 ± 10.6 cm, n = 5; = 0.03) was significantly more positive than that of uninjured pitchers (21.1 ± 11.5 cm, n = 164). No significant relationships were established between stride width and ball velocity ( = 0.54) or pitch location metrics ( > 0.05).

Conclusion: Pitchers with increased positive, stride width had significantly higher incidence of lower extremity injury (knee and meniscus). Wider, positive stride width may increase the degree of external rotation on the lead knee in a loaded state, which can place the medial side of the knee (and meniscus) at higher risk of injury.

Clinical Relevance: Decreasing stride width may be beneficial for professional pitchers to reduce the rate of lower extremity injury, while also preserving performance metric outcomes.
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http://dx.doi.org/10.1177/19417381221092024DOI Listing
May 2022

Thirty-Day Morbidity and Mortality in Patients With COPD Following Open Reduction and Internal Fixation for Rotational Ankle Fractures.

J Foot Ankle Surg 2022 Apr 7. Epub 2022 Apr 7.

Department of Orthopedic Surgery, Einstein Healthcare Network, Philadelphia, PA.

Prior orthopedic literature has found patients with chronic obstructive pulmonary disease (COPD) to be at an increased risk for postoperative morbidity and mortality. Thus, the purpose of this study is to identify whether there are any differences in risk for 30-day morbidity or mortality following ORIF for ankle fractures between adult patients with COPD and without COPD. Patients undergoing operative treatment for ankle fracture were identified in the National Surgical Quality Improvement Program database from 2006 to 2018. Patients were divided into 2 cohorts: non-COPD and COPD patients. In this analysis, demographics data, medical comorbidities, and thirty-day postoperative outcomes were analyzed between the 2 cohorts. Bivariate and multivariate analyses were performed. Of 10,346 total patients who underwent operative treatment for ankle fracture, 9986 patients (96.5%) did not have a history of COPD whereas 360 (3.5%) had COPD. Following adjustment to control for demographic and comorbidity data, relative to patients without COPD, those with COPD had an increased risk of pneumonia (odds ratio [OR] 4.601; p = .001), unplanned intubation (OR 3.085; p = .043), and hospital readmission (OR 1.828; p = .020). Patients with COPD did not have a statistically significant difference with regards to mortality (OR 2.729; p = .080). Adult patients with COPD are at an increased risk for pneumonia, unplanned intubation, and hospital readmission within 30 days following ORIF of ankle fractures compared to patients without COPD. Despite these risks, this is a relatively safe procedure for these patients and the presence of COPD alone should not serve as a barrier to surgery.
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http://dx.doi.org/10.1053/j.jfas.2022.03.015DOI Listing
April 2022

Total Joint Arthroplasty and Osteoporosis: Looking Beyond the Joint to Bone Health.

J Arthroplasty 2022 Sep 18;37(9):1719-1725.e1. Epub 2022 Apr 18.

Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.

Background: Metabolic bone diseases in the total joint arthroplasty (TJA) population are undertested and undertreated, leading to increased risk of adverse outcomes such as periprosthetic fractures. This study aims to better characterize the current state of bone care in TJA patients using Fracture Risk Assessment Tool (FRAX) score risk stratifications.

Methods: In total, 505 consecutive TJA patients who meet the Endocrine Society guidelines for osteoporosis screening were included for review. They were divided into a high risk or low risk group depending on FRAX scores and were compared based on screening, diagnosis, and treatment of metabolic bone disease. Logistic regression models were used to analyze factors influencing screening and treatment. A population analysis involving 2,000 TJA patients, and a complication analysis involving 40 periprosthetic fracture patients were conducted.

Results: Among high risk patients undergoing TJA, 90% did not receive any pharmacological treatment for osteoporosis, 45% were not treated with vitamin D or calcium, and 88% did not receive bone density testing in the routine care period. Among patients with pre-existing osteoporosis undergoing TJA, 80% were not treated with any osteoporosis medications and 33% of these patients were not taking vitamin D or calcium. Female gender and past fracture history contributed to whether patients received screening and treatment. Patients with periprosthetic hip fractures have significantly higher FRAX scores compared to control THA patients.

Conclusion: There are significant gaps in metabolic bone care of the geriatric TJA population regarding both screening and treatment. Metabolic bone care and risk identification with FRAX should be highly considered for TJA patients.
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http://dx.doi.org/10.1016/j.arth.2022.04.010DOI Listing
September 2022

The influence of stride width on kinematic and kinetics in high school and professional baseball pitchers: A propensity-matched biomechanical evaluation.

J Sci Med Sport 2022 Jul 18;25(7):599-605. Epub 2022 Mar 18.

Sports Medicine Institute Hospital for Special Surgery, United States of America. Electronic address:

Objectives: To evaluate kinematic and kinetic parameters for high school (HS) and professional (PRO) pitchers differentiated by stride width.

Design: Descriptive laboratory study.

Methods: HS (n = 36) and PRO (n = 172) baseball pitchers pitched 8-12 fastballs using 3D-motion capture (480-Hz). Pitchers were 1:1 propensity-scored matched by age, height, weight, and ball velocity based on 'narrow' versus 'wide' stride widths and kinematics and kinetics were compared using independent t-tests. Independent associations between variables and stride width were determined utilizing linear regressions.

Results: At foot contact, HS wide (n = 18) had significantly less lead knee flexion (41 ± 9° vs. 49 ± 6°, p = 0.007, d = -1.0) and less pelvis rotation (66 ± 9° vs. 57 ± 14°, p = 0.003 d = 0.8) compared to HS narrow (n = 18). PRO wide (n = 86) at ball release had significantly less pelvis rotation (-10 ± 10° vs. -15 ± 14°, p = 0.008, d = 0.4) and increased shoulder horizontal adduction (4±8° vs. -1±9°, p=0.003, d=0.5) compared to PRO narrow (n = 86). For every 10 cm increase in stride width, pelvis rotation at ball release decreased by 2° (B:0.10, β:0.20, p < 0.001) in HS and 1.3° (B:0.08, β:0.13, p = 0.002) in PRO.

Conclusions: HS and PRO pitchers differentiated by stride width demonstrated no significant difference in throwing arm kinetics. For both groups, wider stride width was associated with decreased pelvis rotation, which may contribute to inefficient utilization of kinetic energy. Ultimately, coaches and players may better focus their efforts on refining other kinematics for enhanced performance outcomes and safe pitching mechanics.
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http://dx.doi.org/10.1016/j.jsams.2022.03.009DOI Listing
July 2022

The relationship among lead knee extension, fastball velocity and elbow torque in professional baseball pitchers.

Sports Biomech 2022 Mar 17:1-11. Epub 2022 Mar 17.

American Sports Medicine Institute, Birmingham, AL, USA.

The purpose of this study was to investigate potential differences in lead knee extension velocity, elbow varus torque and lead knee extension (the change in lead knee flexion from foot contact to ball release) in high and low velocity professional pitchers. Three-dimensional motion capture (480 Hz) was used to assess 322 professional pitchers.         T-test were used to compare the two groups and multiple linear regression analyses were performed on all pitchers (n = 322). The high-velocity group (n = 99; 40.3 ±  0.9m/s) had greater lead knee extension (17 ± 13 vs 5 ± 14°, p < 0.001, g = 0.9), lead knee extension velocity (419 ± 135 vs 297 ± 121°/s, p < 0.001, g = 0.9) and elbow varus torque (91.1 ± 15.5 vs 84.0 ± 14.7 Nm, p < 0.001, g = 0.5) compared to the low-velocity group (n = 88; 36.1  ± 1.2 m/s). Lead knee extension (R = 0.352, p < 0.001) and lead knee extension velocity (R = 0.326, p < 0.001) were found to be positive predictors of ball velocity but not elbow varus torque (p = 0.807). Instructing professional pitchers to utilise a lead leg bracing technique that facilitates increased lead knee extension can contribute to faster ball velocity, but most likely results from a combination of other mechanics.
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http://dx.doi.org/10.1080/14763141.2022.2050801DOI Listing
March 2022

The influence of excessive ipsilateral trunk tilt on upper-extremity throwing mechanics: a newly characterized parameter for biomechanical evaluation in high school and professional pitchers.

J Shoulder Elbow Surg 2022 Mar 9. Epub 2022 Mar 9.

Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA. Electronic address:

Background: Although contralateral trunk tilt has been recognized, the phenomenon of excessive ipsilateral trunk tilt, often observed during earlier portions of the pitch, has not been explored as a potential correlate with throwing-arm kinetics among baseball pitchers. The purpose of this study was to evaluate kinetic and kinematic parameters among high school and professional pitchers related to excessive ipsilateral and contralateral trunk tilt.

Methods: Professional and high school pitchers were assessed with a 3-dimensional motion capture system (480 Hz) while pitching. Pitchers were grouped as follows: excessive ipsilateral tilt at foot contact (FC), neutral, or excessive contralateral tilt at ball release (BR). Trunk and shoulder kinematics as well as throwing-arm kinetics were compared between subgroups via post hoc regression analysis.

Results: Professional pitchers (n = 287) had significantly higher ipsilateral trunk tilt at FC (P < .001) than high school pitchers (n = 59). High school pitchers with excessive contralateral trunk tilt at BR experienced significantly higher shoulder superior force (27.0% ± 7.4% body weight [BW] vs. 17.6% ± 5.1% BW, P < .001) and shoulder anterior force (39.6% ± 8.2% BW vs. 35.7% ± 5.4% BW, P < .001) compared with the ipsilateral trunk tilt cohort but had comparable ball velocity (30.2 ± 3.2 m/s vs. 30.4 ± 2.1 m/s, P = .633). For professionals, for every 10° increase in ipsilateral trunk tilt at FC, ball velocity increased by 0.2 m/s (B = 0.02, β = 0.07, standard error [SE] = 0.005, P = .010) whereas elbow varus torque decreased by 0.1% BW × height (B = -0.01, β = -0.08, SE = 0.002, P < .001) and shoulder internal rotation torque decreased by 0.1% BW × height (B = -0.01, β = -0.07, SE = 0.002, P = .005).

Conclusion: High school and professional pitchers with excessive ipsilateral trunk tilt at FC consistently demonstrated significantly decreased throwing-arm kinetics (shoulder anterior force and shoulder superior force for high school pitchers and shoulder internal rotation torque and elbow varus torque for professional pitchers) compared with pitchers with excessive contralateral trunk tilt at BR, with equivalent ball velocity. In addition, professional pitchers appeared to engage in significantly greater ipsilateral trunk tilt during early portions of the pitch when compared with high school pitchers, which may represent a kinetically favorable method adopted by pitchers at higher playing levels to maintain adequate ball velocity while concomitantly minimizing throwing-arm kinetics.
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http://dx.doi.org/10.1016/j.jse.2022.01.153DOI Listing
March 2022

Kinematic and kinetic analyses of professional pitchers with history of core or groin injuries: A propensity-score matched analysis.

J Orthop 2022 Mar-Apr;30:108-114. Epub 2022 Mar 1.

Sports Medicine Institute Hospital for Special Surgery, New York, NY, USA.

Background: Core injuries in professional baseball pitchers have been linked to both diminished performance and time missed during the season injury was sustained. It is currently unclear how a history of a core injury may affect the future pitching performance and mechanics of professional baseball pitchers.

Purpose: To compare kinetic and kinematic variables between professional baseball pitchers with prior core/groin injuries and those without prior injury.

Study Design: Descriptive laboratory study.

Methods: Professional baseball pitchers with a history of core injury pitched 8-12 fastball pitches while evaluated with 3D-motion capture (480 Hz). Inclusion criteria necessitated that the core injury occurred within one to four-years prior to biomechanical evaluation and that the core injury required time off from professional play for a minimum of 2 weeks and maximum of 3 months. These pitchers were 4:1 propensity-scored matched by age, height, weight, and handedness to pitchers with no prior injury history (control). Twenty kinematic and eleven normalized and non-normalized kinetic parameters were compared between groups using appropriate parametric testing. Sub-analysis of pitchers with distinct core muscle and spinal injuries were also analyzed.

Results: The No Prior Injury (NPI) subgroup (n = 76) had significantly less elbow flexion at ball release (31 ± 5° vs. 35 ± 6° respectfully, p = 0.044) compared to the Core Musculature/Soft Tissue subgroup (CM/ST, n = 10), with no significant difference in kinematics for other injury groups (p > 0.05). The General Core/Groin injury group (GCG, n = 19) had significantly greater normalized elbow anterior force (43.9 ± 4.7 vs. 40.0 ± 5.2 %BodyWeight[BW], p = 0.006) and elbow flexion torque (4.3 ± 0.5 vs. 3.8 ± 0.5 %BWxBodyHeight[BH], p = 0.001) than the NPI pitchers. CM/ST had significantly greater normalized elbow anterior force (p = 0.031), elbow flexion torque (p = 0.002), and shoulder adduction torque (p = 0.007) than NPI pitchers.

Conclusion: Professional baseball pitchers with prior core/groin injuries demonstrated increased elbow anterior force and elbow flexion torque compared to pitchers with no prior core injuries. One possible explanation for this finding includes inadequate recruitment and utilization of the lower extremities as a component of the kinetic chain leading to compensation at the level of the throwing arm. Whether these kinetic differences arise as a consequence of injury or present a risk for such warrants additional investigation.
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http://dx.doi.org/10.1016/j.jor.2022.02.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8899407PMC
March 2022

A retrospective study evaluating the association between hypoalbuminemia and postoperative outcomes for patients receiving open rotator cuff repair.

J Orthop 2022 Mar-Apr;30:88-92. Epub 2022 Feb 23.

Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Purpose: Malnutrition has historically been shown to influence surgical outcomes. Although the diagnosis of malnutrition can be multifactorial, serum albumin levels serve as a useful indicator of malnutrition in patients undergoing orthopaedic surgery. The purpose of this study is to examine the prevalence of post-operative complications in patients with malnutrition (hypoalbuminemia) who underwent open rotator cuff repair. We hypothesized that patients with low preoperative albumin levels will have an increased risk for postoperative complications, readmission, reoperation, and prolonged hospital stay.

Methods: The National Surgical Quality Improvement Program database was queried for patients undergoing open rotator cuff repair from 2006 to 2019. Two patient cohorts were defined: patients with hypoalbuminemia (<3.5 g/dL) and patients with normal preoperative serum albumin (≥3.5 g/dL), with the former being an indicator for malnutrition. In this analysis, demographics, comorbidities, and postoperative complications were compared between the two cohorts using bivariate analyses. Confounding factors found in the control group included sex, race, age, body mass index, smoking status, chronic obstructive pulmonary disease, hypertension, dialysis, diabetes, and dyspnea. To eliminate potential biases, multivariable logistic regression was used to adjust for these confounding factors.

Results: Of 3,052 patients undergoing open rotator cuff repair with serum albumin levels recorded within 90 days before the surgery, 2,914 patients (95.5%), with an age range of 21-90 years, had normal albumin levels and 138 patients (4.5%), with an age range of 24-87 years, were hypoalbuminemic. Following adjustment on multivariate analyses, compared to patients with normal preoperative serum albumin, those with hypoalbuminemia had an increased risk of extended length of hospital stay (OR 7.47; p < 0.001) and hospital readmission (OR 4.16; p = 0.002).

Conclusion: Hypoalbuminemia is associated with extended length of stay and readmission after receiving open rotator cuff repair surgery.
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http://dx.doi.org/10.1016/j.jor.2022.02.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8889027PMC
February 2022

Racial Disparities in Postoperative Outcomes Following Operative Management of Pediatric Developmental Dysplasia of the Hip.

J Pediatr Orthop 2022 May-Jun 01;42(5):e403-e408

Department of Orthopaedic Surgery, Children's National Health System, Washington, DC.

Background: Developmental dysplasia of the hip in pediatric patients can be managed conservatively or operatively. Understanding patient risk factors is important to optimize outcomes following surgical treatment of developmental dysplasia of the hip. Racial disparities in procedural outcomes have been studied, however, there is scarce literature on an association between race and complications following pediatric orthopaedic surgery. Our study aimed to determine the association between pediatric patients' race and outcomes following operative management of hip dysplasia by investigating 30-day postoperative complications and length of hospital stay.

Methods: The National Surgical Quality Improvement Program-Pediatric database was utilized from the years 2012 to 2019 to identify all pediatric patients undergoing surgical treatment for hip dysplasia. Patients were stratified into 2 groups: patients who were White and patients from underrepresented minority (URM) groups. URM groups included those who were Black or African American, Hispanic, Native American or Alaskan, and Native Hawaiian or Pacific Islander. Differences in patient demographics, comorbidities, and postoperative outcomes were compared between the 2 cohorts using bivariate and multivariate analyses.

Results: Of the 9159 pediatric patients who underwent surgical treatment for hip dysplasia between 2012 and 2019, 6057 patients (66.1%) were White and 3102 (33.9%) were from URM groups. In the bivariate analysis, compared with White patients, patients from URM groups were more likely to experience deep wound dehiscence, pneumonia, unplanned reintubation, cardiac arrest, and extended length of hospital stay. Following multivariate analysis, patients from URM groups had an increased risk of unplanned reintubation (odds ratio: 3.583; P=0.018).

Conclusions: Understanding which patient factors impact surgical outcomes allows health care teams to be more aware of at-risk patient groups. Our study found that pediatric patients from URM groups who underwent surgery for correction of hip dysplasia had greater odds of unplanned reintubation when compared with patients who were White. Further research should investigate the relationship between multiple variables including race, low socioeconomic status, and language barriers on surgical outcomes following pediatric orthopaedic procedures.

Level Of Evidence: Level III-retrospective cohort analysis.
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http://dx.doi.org/10.1097/BPO.0000000000002102DOI Listing
April 2022

Boston Carpal Tunnel Questionnaire Scores Alone Do Not Predict Surgical Intervention for Patients With Carpal Tunnel Syndrome.

Hand (N Y) 2022 Feb 21:15589447211072226. Epub 2022 Feb 21.

Hospital for Special Surgery, New York, NY, USA.

Background: With the expanded indications for telemedicine, there is increased utility for screening methods to determine which patients are likely to progress to surgical intervention, requiring in-person visits. Patient-rated tools such as the Boston Carpal Tunnel Questionnaire (BCTQ) may be one such tool for screening patients with carpal tunnel syndrome (CTS). The aim of the study was to evaluate whether BCTQ scores were predictive of offering conservative treatment or surgical intervention for CTS.

Methods: Patients diagnosed with CTS from January 2017 to February 2020 completed BCTQ questionnaires prior to in-person office visits. Demographics, comorbidities, and highest level of intervention recommended were recorded for each patient as conservative, injection, or surgery. Pearson χ and independent-samples tests were conducted to determine whether BCTQ symptom severity and functional scores were associated with intervention type.

Results: A total of 200 patients with CTS were included. Of these, 103 were recommended conservative or injection treatment and 97 were recommended surgery. There were no differences in comorbidities between groups, including other upper extremity pathology ( = .57), previous upper extremity surgery ( = .32), hypertension ( = .17), hypothyroidism ( = .15), rheumatoid arthritis ( = .34), and diabetes ( = .30). Between these groups, there were no differences in BCTQ symptom severity score (symptom severity scale [SSS]; = .16) or BCTQ functional severity score (functional severity scale [FSS]; = .96).

Conclusions: There is no correlation between comorbidities and BCTQ SSS or FSS score, and offering surgery for CTS. In an era of minimizing non-essential health care visits, the BCTQ is insufficient in screening patients as potential surgical candidates.
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http://dx.doi.org/10.1177/15589447211072226DOI Listing
February 2022

Evaluating the Association of Anesthesia Type With Postoperative Complications in Patients Undergoing Ankle Fracture Repair.

J Foot Ankle Surg 2022 Jan 31. Epub 2022 Jan 31.

Department of Orthopaedic Surgery, Children's National Health System, Washington, DC.

General and neuraxial anesthesia are both successful anesthesia techniques used in many orthopedic procedures. The purpose of this study was to compare the complications and length of hospital stay between patients who underwent general anesthesia versus neuraxial anesthesia during the repair of ankle fractures. Patients undergoing open reduction and internal fixation for ankle fracture from 2014 to 2018 were identified in the National Surgical Quality Improvement Program database. Patients were stratified into 2 cohorts: general anesthesia and neuraxial anesthesia. In this analysis, demographics data, comorbidities, and postoperative complications were collected and compared between the two cohorts. Bivariate analyses and multivariable logistical regression were performed. Of 3585 patients who underwent operative treatment for ankle fracture, 3315 patients (92.5%) had general anesthesia and 270 (7.5%) had neuraxial anesthesia. On bivariate analyses, patients who had neuraxial anesthesia were more likely to develop pulmonary complications (p = .173) or extended length of stay more than 5 days (p = .342) compared to the general anesthesia group. Following adjustment on multivariate analyses, the neuraxial anesthesia cohort no longer had increased likelihood of pulmonary complications or extended length of stay compared to the general anesthesia group. Healthy ankle fracture patients could also benefit from neuraxial anesthetic methods, and they should be considered for this anesthetic type regardless of their lack of comorbidities.
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http://dx.doi.org/10.1053/j.jfas.2022.01.025DOI Listing
January 2022

A Review of Laser Therapy and Low-Intensity Ultrasound for Chronic Pain States.

Curr Pain Headache Rep 2022 Jan 8;26(1):57-63. Epub 2022 Feb 8.

Department of Interventional Pain Medicine, New-York Presbyterian Hospital, Weill Cornell Medical Center, 1300 York Ave, New York, NY, 10065, USA.

Purpose Of Review: Chronic pain management therapies have expanded quickly over the past decade. In particular, the use of laser therapy and ultrasound in the management of chronic pain has risen in recent years. Understanding the uses of these types of therapies can better equip chronic pain specialists for managing complicated chronic pain syndromes. The purpose of this review was to summarize the current literature regarding laser radiation and ultrasound therapy used for managing chronic pain syndromes.

Recent Findings: In summary, there is stronger evidence supporting the usage of laser therapy for managing chronic pain states compared to low-intensity ultrasound therapies. As a monotherapy, laser therapy has proven to be beneficial in managing chronic pain in patients with a variety of pain syndromes. On the other hand, LIUS has less clear benefits as a monotherapy with an uncertain, optimal delivery method established. Both laser therapy and low-intensity ultrasound have proven beneficial in managing various pain syndromes and can be effective interventions, in particular, when utilized in combination therapy.
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http://dx.doi.org/10.1007/s11916-022-01003-3DOI Listing
January 2022

Increased Elbow and Olecranon Injury History in Professional Pitchers With Increased Elbow Flexion at Ball Release.

Am J Sports Med 2022 03 2;50(4):1054-1060. Epub 2022 Feb 2.

Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.

Background: Elbow flexion at late portions of the pitch has been associated with increased elbow varus torque, a kinetic surrogate associated with injury risk. Direct examinations of injury incidence with elbow flexion angles have not been conducted in professional pitchers.

Purpose: To compare elbow and shoulder injury incidence among professional baseball players stratified by degree of elbow flexion at ball release (BR).

Study Design: Descriptive laboratory study.

Methods: Professional pitchers (N = 314) were instructed to pitch between 8 and 12 fastballs while being evaluated using motion capture technology. Upper extremity injury incidence was recorded upon interview. Pitchers were subsequently subdivided into 3 groups based on increasing elbow flexion at BR. Analysis of variance was used to compare participant characteristics and kinematic and peak kinetic variables. An odds ratio (OR) was calculated to determine the risk of having a previous upper extremity injury based on the degree of elbow flexion at BR.

Results: A total of 116 pitchers (132 documented injuries) had a previous upper extremity injury, with elbow injury (76 injuries; 57.6%) being the most common. Evaluation of kinetic values showed that pitchers with the smallest elbow flexion at BR had significantly less peak elbow flexion torque than did those with greatest elbow flexion at BR (3.8 ± 0.5 vs 4.1 ± 0.6 %weight × height; = .003). Pitchers who demonstrated a greater than average degree of elbow flexion at BR when pitching were more likely to have a history of elbow injury (OR, 1.97; 95% CI, 1.14-3.40; = .015) and olecranon spur formation or stress fracture (OR, 5.79; 95% CI, 1.25-26.85; = .025).

Conclusion: Pitchers with greater elbow flexion at BR had significantly higher odds of previous injury of the elbow and olecranon. Increasing elbow flexion has been shown to place the medial elbow in a position to carry a greater amount of load, which may be exacerbated during the final moments of the pitching motion. Professional pitchers can consider decreasing elbow flexion at BR as a potential, modifiable risk factor for elbow injury, in particular for olecranon spur formation and fracture.

Clinical Relevance: This study attempts to associate injury incidence with a modifiable, kinematic variable for an at-risk population.
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http://dx.doi.org/10.1177/03635465211072223DOI Listing
March 2022

Risk Factors for Failure After Osteochondral Allograft Transplantation of the Knee: A Systematic Review and Exploratory Meta-analysis.

Am J Sports Med 2022 Jan 20:3635465211063901. Epub 2022 Jan 20.

Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.

Background: Graft failure after osteochondral allograft transplantation (OCA) of the knee is a devastating outcome, often necessitating subsequent interventions. A comprehensive understanding of the risk factors for failure after OCA of the knee may provide enhanced prognostic data for the knee surgeon and facilitate more informed shared decision-making discussions before surgery.

Purpose: To perform a systematic review and meta-analysis of risk factors associated with graft failure after OCA of the knee.

Study Design: Systematic review and meta-analysis; Level of evidence, 4.

Methods: The PubMed, Ovid/MEDLINE, and Cochrane databases were queried in April 2021. Data pertaining to study characteristics and risk factors associated with failure after OCA were recorded. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and graft failure by generating effect estimates in the form of odds ratios (ORs) with 95% CIs, while mean differences (MDs) were calculated for continuous data. Qualitative analysis was performed to describe risk factors that were variably reported.

Results: A total of 16 studies consisting of 1401 patients were included. The overall pooled prevalence of failure was 18.9% (range, 10%-46%). There were 44 risk factors identified, of which 9 were explored quantitatively. There was strong evidence to support that the presence of bipolar chondral defects (OR, 4.20 [95% CI, 1.17-15.08]; = .028) and male sex (OR, 2.04 [95% CI, 1.17-3.55]; = .012) were significant risk factors for failure after OCA. Older age (MD, 5.06 years [95% CI, 1.44-8.70]; = .006) and greater body mass index (MD, 1.75 kg/m [95% CI, 0.48-3.03]; = .007) at the time of surgery were also significant risk factors for failure after OCA. There was no statistically significant evidence to incontrovertibly support that concomitant procedures, chondral defect size, and defect location were associated with an increased risk of failure after OCA.

Conclusion: Bipolar chondral defects, male sex, older age, and greater body mass index were significantly associated with an increased failure rate after OCA of the knee. No statistically significant evidence presently exists to support that chondral defect size and location or concomitant procedures are associated with an increased graft failure rate after OCA of the knee. Additional studies are needed to evaluate these associations.
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http://dx.doi.org/10.1177/03635465211063901DOI Listing
January 2022
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