Sports Medicine Commons^™

Anterior Cruciate Ligament Hybrid Remnant Preservation Reconstruction Demonstrates Similar Outcomes As Traditional Reconstruction After 6 Months: A Randomized Control Trial, Joshua P. Castle, Eleftherios L. Halkias, Brittaney Pratt, Ashley Frei, Matthew A. Gasparro, Vasilios Moutzouros

Medical Student Research Symposium

Background

The anterior cruciate ligament (ACL) is often debrided during reconstruction (ACLR) to improve visualization. However, remnant ACL tissue contains nerve fibers and including remnant tissue in ACLR could provide benefit. Therefore, a technique was developed that preserves the tibial remnant and incorporates it into ACLR: Hybrid Remnant Preservation Reconstruction (HRPR) ACLR. This study compares HRPR-ACLR to traditional reconstruction by comparing patient reported outcomes and complications.

Methods

Patients presenting to one surgeon's clinic with an ACL injury are screened. Exclusion criteria are patient age<14 years, multi-ligament injury, chronic tears, and revision ACLR. Patients are consented and randomized to HRPR or traditional ACLR. Demographics, patient-reported outcomes, range of motion (ROM) and complications were collected.

Results

Thirty-three patients were included, 20 HRPR and 13 controls. No demographic differences were noted. PROMIS-PF, …

Influences Of Athletic Trainers' Return-To-Activity Assessments For Patients With An Ankle Sprain, Ryan S. Mccann, Cailee E. Welch Bacon, Ashley M. B. Suttmiller, Phillip A. Gribble, Julie M. Cavallario

Rehabilitation Sciences Faculty Publications

Context: Athletic trainers (ATs) inconsistently apply rehabilitation-oriented assessments (ROASTs) when deciding return-to-activity readiness for patients with an ankle sprain. Facilitators and barriers that are most influential to ATs' assessment selection remain unknown.

Objective: To examine facilitators of and barriers to ATs' selection of outcome assessments when determining return-to-activity readiness for patients with an ankle sprain.

Design: Cross-sectional study.

Setting: Online survey.

Patients or other participants: We sent an online survey to 10 000 clinically practicing ATs. The survey was accessed by 676 individuals, of whom 574 submitted responses (85% completion rate), and 541 respondents met the inclusion criteria.

Main outcome …

The Top 50 Most Cited Articles On The Medial Patellofemoral Ligament (Mpfl): A Bibliometric Analysis, Varag Abed, Alex Duvall, Jonathan D. Rexroth, Alyssa Goodwin, Joseph Liu, Austin Stone

Medical Student Research Symposium

Objectives: To determine which original articles on the topic of the medial patellofemoral ligament (MPFL) have been cited the most in the literature utilizing a bibliometric approach. Secondarily, to determine temporal trends between article types.

Methods: Articles on the topic of the MPFL were identified by utilizing the Web of Science Database. The search yielded 1,596 results and the top 50 cited original articles were collected for further analysis. The following information was gathered for all included articles: title, first author's name, journal name, year of publication, impact factor of the journal in 2021, total number of citations of the …

Do Lower Extremity Injuries Of Nfl Players Affect Their Yearly Income?, Abdullah Sahyouni, Robert De La Torre, Gautham Pavar, Kinan Sawar, Yasmeen Alcodray, Bohdan Matsko, Justin Bennie, Nicole Xu, Harika Bollineni

Medical Student Research Symposium

Introduction: Injuries are arguably the most daunting career setbacks professional sports players have to face. To better understand the drawbacks of sports injuries, we decided to examine players’ annual income before and after sports injuries. Income is arguably the most important metric of success for professional athletes. To make the study more relevant for the US, we collected data on one of the most viewed professional sports leagues in the country: the National Football League (NFL).

Methods: We examined the NFL’s weekly injury reports for seasons from 2016 to 2020, and recorded players with lower extremity injuries (LEI) (Hamstring, Calves, …

The Effect Of Concussion History On Lower Extremity Injury Risk In College Athletes: A Systematic Review And Meta Analysis, Vanessa Ramirez, Ryan Mccann, Eric Schussler, Jessica Martinez

Rehabilitation Sciences Faculty Publications

INTRODUCTION: Collegiate athletes who suffer a concussion may possess prolonged impairments even after clearance for return-to-participation, which may place them at an increased risk of lower extremity injury.

OBJECTIVE: To conduct a systematic review and meta-analysis of studies examining risk of lower extremity musculoskeletal injury following a concussion in collegiate athletes.

METHODS: A literature search was performed using the following databases: PubMed, CINAHL, SPORTDiscus. The following search terms were used to identify relevant articles, ["concussion" OR "brain injury" OR "mild traumatic brain injury" OR "mTBI"] AND ["lower extremity injury" OR "musculoskeletal injury"]. Articles were included if they were published between …

The Role Of Neck Musculature In Traumatic Brain Injuries In Older Adults: Implications From Sports Medicine, Tyler A. Wood, Steven Morrison, Jacob J. Sosnoff

Rehabilitation Sciences Faculty Publications

Traumatic brain injuries (TBIs) are common and serious injuries to older adults. The majority of TBIs in older adults are sustained when the head impacts the ground or other surface during a fall. While several non-modifiable risk factors have been identified for fall-related TBIs in older adults, there still remains a dearth of knowledge surrounding modifiable risk factors. Thus, this significant knowledge gap warrants an investigation into research across disciplines. The sports medicine literature has examined several modifiable risk factors to prevent a mild form of TBI known as concussion. While this research has identified several risk factors, one particular …

Femoroacetabular Impingement As A Complication Of Acetabular Fracture Fixation, David A. Zuelzer, Christopher B. Hayes, Raymond D. Wright, Stephen T. Duncan

Orthopaedic Surgery and Sports Medicine Faculty Publications

Case

We present the case of a thirteen-year-old female who sustained a posterior wall acetabular fracture dislocation. She underwent urgent closed reduction and subsequent uncomplicated open reduction and internal fixation. Post reduction computed tomography demonstrated a concentrically reduced hip joint with no evidence of femoroacetabular impingement (FAI). She subsequently healed her fracture and returned to running activities; however, one year later presented with aching pain in her thigh. Radiographs demonstrated the development of a large osseous prominence on her anterolateral femoral neck consistent with femoroacetabular impingement. Based on these findings she was evaluated by a hip preservation specialist. She subsequently …

Using Platelet-Rich Plasma To Reverse The Effects Of Tendinopathy And Prevent Tendon Re-Rupture After Surgery In Athletes: The Search For A Standardized Protocol, Shiv Patel

Auctus: The Journal of Undergraduate Research and Creative Scholarship

30-50% of all lesions amateur and professional sports players will experience during activity are related to the tendon. Moreover, the incidence of tendinopathy, a precursor to tendon rupture, is much higher in both of these groups due to excessive loading of tendons during physical activity, insufficient rest afterwards and certain antibiotic use. The tendon anatomically has both a low blood supply and a low cell turnover rate, which contribute to the relative ease by which an athlete can develop tendinopathy. Chronic tendinopathy has very few high-success treatments but in recent years, platelet-rich plasma (PRP), a treatment in which platelets are …

Influence Of Tendon Tears On Ultrasound Echo Intensity In Response To Loading, Kayt E. Frisch, David Marcu, Geoffrey S. Baer, Darryl G. Thelen, Ray Vanderby

Faculty Publications - Biomedical, Mechanical, and Civil Engineering

Acoustoelastic (AE) ultrasound image analysis is a promising non-invasive approach that uses load-dependent echo intensity changes to characterize stiffness of tendinous tissue. The purpose of this study was to investigate whether AE can detect localized changes in tendon stiffness due to partial and full-thickness tendon tears. Ovine infraspinatus tendons with different levels of damage (Intact, 33%, 66% and full thickness cuts initiated on the articular and bursal sides) were cyclically loaded in a mechanical testing system while cine ultrasound images were recorded. The load-induced changes in echo intensity on the bursal and articular side of the tendon were determined. Consistent …

Interleukin-1 Receptor Antagonist Modulates Inflammation And Scarring After Ligament Injury, Connie S. Chamberlain, Ellen M. Leiferman, Kayt E. Frisch, Sarah E. Duenwald-Kuehl, Stacey L. Brickson, William L. Murphy, Georffrey S. Baer, Ray Vanderby

Faculty Publications - Biomedical, Mechanical, and Civil Engineering

Ligaments have limited regenerative potential and as a consequence, repair is protracted and results in a mechanically inferior tissue more scar-like than native ligament. We previously reported that a single injection of interleukin-1 receptor antagonist (IL-1Ra) delivered at the time of injury, decreased the number of M2 macrophage-associated inflammatory cytokines. Based on these results, we hypothesized that IL-1Ra administered after injury and closer to peak inflammation (as would occur clinically), would more effectively decrease inflammation and thereby improve healing. Since IL-1Ra has a short half-life, we also investigated the effect of multiple injections. The objective of this study was to …

The Influence Of Partial And Full Thickness Tears On Infraspinatus Tendon Strain Patterns, Kayt E. Frisch, David Marcu, Geoffrey S. Baer, Darryl G. Thelen, Ray Vanderby

Faculty Publications - Biomedical, Mechanical, and Civil Engineering

Tears on the bursal and articular sides of the rotator cuff tendons are known to behave differently and strain is thought to play a role in this difference. This study investigates the effect of tear location on the changes in three strain measurements (grip-to-grip, insertion, and mid-substance tissue) in a sheep infraspinatus tendon model during axial loading. We introduced a 14mm wide defect near the insertion from either the articular or bursal side of the tendon to three depths (3 mm, 7mm & full) progressively. For each condition, tendons were sinusoidally stretched (4% at 0.5 Hz) while insertion and midsubstance …

Interleukin Expression After Injury And The Effects Of Interleukin-1 Receptor Antagonist, Connie S. Chamberlain, Ellen M. Leiferman, Kayt E. Frisch, Stacey L. Brickson, William L. Murphy, Geoffrey S. Baer

Faculty Publications - Biomedical, Mechanical, and Civil Engineering

Ligament and tendon repair involves a complex series of coordinated events orchestrated by various cell types, cytokines and other factors. The repair process extends months to years and results in scar tissue mechanically inferior to native tissue. This is in clear contrast to tissue "regeneration" which would recapitulate the native tissue. Numerous approaches to stimulate a regenerative scenario have been attempted, including tissue-engineering, non-steroidal anti-inflammatories, ultrasonic, or electrical stimulation, but none have resulted in complete regeneration. In pursuit of a more regenerative outcome, it is important to understand the fundamentals of the normal healing process. Previous work from our lab …

Quantification Of Collagen Organization Using Fractal Dimensions And Fourier Transforms, Kayt E. Frisch, Sarah E. Duenwald-Kuehl, Hirohito Kobayashi, Connie S. Chamberlain, Roderic S. Lakes, Ray Vanderby Jr.

Faculty Publications - Biomedical, Mechanical, and Civil Engineering

Collagen fibers and fibrils that comprise tendons and ligaments are disrupted or damaged during injury. Fibrillogenesis during healing produces a matrix that is initially quite disorganized, but remodels over time to resemble, but not replicate, the original roughly parallel microstructure. Quantification of these changes is traditionally a laborious and subjective task. In this work we applied two automated techniques, fast Fourier transformation (FFT) and fractal dimension analysis (FA) to quantify the organization of collagen fibers or fibrils. Using multi-photon images of collagen fibers obtained from rat ligament we showed that for healing ligaments, FA differentiates more clearly between the different …

The Influence Of Macrophage Depletion On Ligament Healing, Connie S. Chamberlain, Ellen M. Leiferman, Kayt E. Frisch, Sijian Wang, Xipei Yang, Nico Van Rooijen, Geoff S. Baer, Stacey L. Brickson, Ray Vanderby

Faculty Publications - Biomedical, Mechanical, and Civil Engineering

Despite a complex cascade of cellular events to reconstruct damaged extracellular matrix (ECM), ligament healing results in a mechanically inferior, scar-like tissue. During normal healing, the number of macrophages significantly increases within the wound site. Then, granulation tissue expands into any residual, normal ligamentous tissue (creeping substitution), resulting in a larger region of healing, greater mechanical compromise, and an inefficient repair process. To study the effects of macrophages on the repair process, bilateral, surgical rupture of their medial collateral ligaments (MCLs) was done on rats. Treatment animals received liposome-encapsulated clodronate, 2 days before rupture to ablate phagocytosing macrophages. Ligaments were …

The Influence Of Interleukin-4 On Ligament Healing, Connie S. Chamberlain, Ellen M. Leiferman, Kayt E. Frisch, Sijian Wang, Xipei Yang, Stacey L. Brickson, Ray Vanderby

Faculty Publications - Biomedical, Mechanical, and Civil Engineering

Despite a complex cascade of cellular events to reconstruct the damaged extracellular matrix, ligament healing results in a mechanically inferior scarred ligament. During normal healing, granulation tissue expands into any residual normal ligamentous tissue (creeping substitution), resulting in a larger region of healing, greater mechanical compromise and an inefficient repair process. To control creeping substitution and possibly enhance the repair process, the antiinflammatory cytokine, interleukin-4 (IL-4), was administered to rats before and after rupture of their medial collateral ligaments. In vitro experiments showed a time-dependent effect on fibroblast proliferation after IL-4 treatment. In vivo treatments with IL-4 (100 ng/mL IV) …

Ultrasound Echo Is Related To Stress And Strain In Tendon, Sarah Duenwald, Hirohito Kobayashi, Kayt E. Frisch, Roderic Lakes, Ray Vanderby Jr.

Faculty Publications - Biomedical, Mechanical, and Civil Engineering

The mechanical behavior of tendons has been well studied in vitro. A noninvasive method to acquire mechanical data would be highly beneficial. Elastography has been a promising method of gathering in vivo tissue mechanical behavior, but it has inherent limitations. This study presents acoustoelasticity as an alternative ultrasound-based method of measuring tendon stress and strain by reporting a relationship between ultrasonic echo intensity (B-mode ultrasound image brightness) and mechanical behavior of tendon in vitro. Porcine digital flexor tendons were cyclically loaded in a mechanical testing system while an ultrasonic echo response was recorded. We report that echo intensity …