Anthony Yi

Prevalence of abnormal vitamin D levels among division I NCAA athletes.

Background: Up to 1 billion people have insufficient or deficient vitamin D levels. Despite the well-documented, widespread prevalence of low vitamin D levels and the importance of vitamin D for athletes, there is a paucity of research investigating the prevalence of vitamin D deficiency in athletes. Hypothesis: We investigated the prevalence of abnormal vitamin D levels in National Collegiate Athletic Association (NCAA) Division I college athletes at a single institution. We hypothesized that vitamin D insufficiency is prevalent among our cohort. Study Design: Cohort study. Level of Evidence: Level 1. Methods: We measured serum 25-hydroxyvitamin D (25(OH)D) levels of 223 NCAA Division I athletes between June 2012 and August 2012. The prevalence of normal (≥32 ng/mL), insufficient (20 to <32 ng/mL), and deficient (<20 ng/mL) vitamin D levels was determined. Logistic regression was utilized to analyze risk factors for abnormal vitamin D levels. Results: The mean serum 25(OH)D level for the 223 members of this study was 40.1 ± 14.9 ng/mL. Overall, 148 (66.4%) participants had sufficient 25(OH)D levels, and 75 (33.6%) had abnormal levels. Univariate analysis revealed the following significant predictors of abnormal vitamin D levels: male sex (odds ratio [OR] = 2.83; P = 0.0006), Hispanic race (OR = 6.07; P = 0.0063), black race (OR = 19.1; P < 0.0001), and dark skin tone (OR = 15.2; P < 0.0001). Only dark skin tone remained a significant predictor of abnormal vitamin D levels after multivariate analysis (adjusted OR = 15.2; P < 0.0001). Conclusion: In a large cohort of NCAA athletes, more than one third had abnormal vitamin D levels. Races with dark skin tones are at much higher risk than white athletes. Male athletes are more likely than female athletes to be vitamin D deficient. Our study demonstrates a high prevalence of vitamin D deficiency among healthy NCAA athletes. Clinical Relevance: Many studies indicate a significant prevalence of vitamin-D insufficiency across various populations. Recent studies have demonstrated a direct relationship between serum 25(OH)D levels and muscle power, force, velocity, and optimal bone mass. In fact, studies examining muscle biopsies from patients with low vitamin D levels have demonstrated atrophic changes in type II muscle fibers, which are crucial to most athletes. Furthermore, insufficient 25(OH)D levels can result in secondary hyperparathyroidism, increased bone turnover, bone loss, and increased risk of low trauma fractures and muscle injuries. Despite this well-documented relationship between vitamin D and athletic performance, the prevalence of vitamin D deficiency in NCAA athletes has not been well studied.

A Comparison of Rehabilitation Methods After Arthroscopic Rotator Cuff Repair A Systematic Review

Context: Despite the significant attention directed toward optimizing arthroscopic rotator cuff repair, there has been less focus on rehabilitation after rotator cuff repair surgery. Objective: To determine the effect of different rehabilitation protocols on clinical outcomes by comparing early versus late mobilization approaches and continuous passive mobilization (CPM) versus manual therapy after arthroscopic rotator cuff repair. Data Sources: PubMed was searched for relevant articles using the keywords rotator cuff, rotator, cuff, tears, lacerations, and rehabilitation to identify articles published from January 1980 to March 2014. Study Selection: Inclusion criteria consisted of articles of level 1 or 2 evidence, written in the English language, and with reported outcomes for early versus late mobilization or rehabilitation with CPM versus manual therapy after primary arthroscopic rotator cuff repair. Exclusion criteria consisted of articles of level 3, 4, or 5 evidence, non-English language, and those with significantly different demographic variables between study groups. Included studies were evaluated with the Consolidated Standards of Reporting Trials criteria. Study Design: Systematic review. Level of Evidence: Level 2. Data Extraction: Level of evidence, study type, number of patients enrolled, number of patients at final follow-up, length of follow-up, age, sex, rotator cuff tear size, surgical technique, and concomitant operative procedures were extracted from included articles. Postoperative data included clinical outcome scores, visual analog score for pain, shoulder range of motion, strength, and rotator cuff retear rates. Results: A total of 7 studies met all criteria and were included in the final analysis. Five studies compared early and late mobilization. Two studies compared CPM and manual therapy. Conclusion: In general, current data do not definitively demonstrate a significant difference between postoperative rotator cuff rehabilitation protocols that stress different timing of mobilization and use of CPM.

Quality of Life and Functional Outcomes after Multi-Ligament Knee Reconstruction

Objectives: Although dislocation of the knee is rare, the high-energy nature of most injuries often results in high morbidity and sometimes limb-threatening injury. Literature regarding knee dislocations tends to focus upon management. There is a lack of research investigating quality of life for patients having undergone multi-ligament knee reconstruction. The purpose of our study was to review quality of life and functional outcomes as well as examine preoperative variables that may affect these outcomes for patients having undergone multi-ligament knee reconstruction. Methods: Retrospectively, we identified a total of 31 patients who underwent a standardized method of surgical reconstruction for multi-ligament knee injuries since 2006 at a single institution. A single surgeon performed all operations. A total of 28 knees (26 patients) were included in the final analysis. We contacted patients at a minimum of 12 months postoperatively (mean: 40.5 months; range: 12-111 months) and administered the Multi-ligament Quality of Life Questionnaire (ML-QOL), 2000 International Knee Documentation Committee Subjective Knee Form (IKDC), and Lysholm Knee Scoring Scale. We performed independent two-sample t-tests to examine the difference in quality of life and functional measures for the following factors: age (≤ 40 vs. > 40), sex, mechanism of injury, time to surgery ( 3 weeks), vascular injury, nerve injury, concomitant fracture, other injuries, Schenk classification for knee dislocation, manipulation, surgical release, previous knee ligament surgery, and subsequent revision. We then performed age-adjusted multivariable linear regression analysis, including factors that we found to be statistically significant in univariate analysis. A p-value of 0.05 was used for statistical significance and all analysis was performed using STATA (College Station, TX). Results: For ML-QOL, we found that patients who had undergone previous knee ligament surgery had significantly worse mean scores relative to patients who had not undergo previous knee ligament surgery (122.9 vs. 80.2; p = 0.001) (higher score indicates worse quality of life). All other differences in ML-QOL scores were not statistically significant. IKDC and Lysholm scores did not differ significantly with regards to the studied variables. After stratifying patients by history of previous knee ligament surgery (7 vs. 21), we found that patients with Schenk classifications of III or IV had significantly worse mean ML-QOL scores relative to patients with Schenk classifications of I or II (91.3 vs. 62.1; p = 0.0152). Conclusion: To our knowledge, our study is the first to investigate both quality of life and functional outcome measures for patients undergoing multi-ligament reconstruction after knee dislocation. We found that patients with a previous history of knee ligament surgery had a significantly worse quality of life relative to those with no history of knee ligament surgery. Among patients with no history of knee ligament surgery, higher Schenk classification was associated with worse ML-QOL scores.

Measurement of Clavicle Fracture Shortening Using Computed Tomography and Chest Radiography.

Background Nonoperative management of midshaft clavicle fractures has resulted in widely disparate outcomes and there is growing evidence that clavicle shortening poses the risk of unsatisfactory functional outcomes due to shoulder weakness and nonunion. Unfortunately, the literature does not clearly demonstrate the superiority of one particular method for measuring clavicle shortening. The purpose of this study was to compare the accuracy of clavicle shortening measurements based on plain radiographs with those based on computed tomography (CT) reconstructed images of the clavicle. Methods A total of 51 patients with midshaft clavicle fractures who underwent both a chest CT scan and standardized anteroposterior chest radiography on the day of admission were included in this study. Both an orthopedic surgeon and a musculoskeletal radiologist measured clavicle shortening for all included patients. We then determined the accuracy and intraclass correlation coefficients for the imaging modalities. Bland-Altman plots were created to analyze agreement between the modalities and a paired t-test was used to determine any significant difference between measurements. Results For injured clavicles, radiographic measurements significantly overestimated the clavicular length by a mean of 8.2 mm (standard deviation [SD], ± 10.2; confidence interval [CI], 95%) compared to CT-based measurements (p < 0.001). The intraclass correlation was 0.96 for both plain radiograph- and CT-based measurements (p = 0.17). Conclusions We found that plain radiograph-based measurements of midshaft clavicle shortening are precise, but inaccurate. When clavicle shortening is considered in the decision to pursue operative management, we do not recommend the use of plain radiograph-based measurements.

Subacromial volume and rotator cuff tears Does an association exist

Background: Rotator cuff pathology occurs commonly and its cause is likely multifocal in origin. The development and progression of rotator cuff injury, especially in relation to extrinsic shoulder compression, remain unclear. Traditionally, certain acromial morphologies have been thought to contribute to rotator cuff injury by physically decreasing the subacromial space. The relationship between subacromial space volume and rotator cuff tears (RCT) has, however, never been experimentally confirmed. In this study, we retrospectively compared a control patient population to patients with partial or complete RCTs in an attempt to quantify the relationship between subacromial volume and tear type. Materials and Methods: We retrospectively identified a total of 46 eligible patients who each had shoulder magnetic resonance imaging (MRI) performed from January to December of 2008. These patients were stratified into control, partial RCT, and full-thickness RCT groups. Subacromial volume was estimated for each patient by averaging five sequential MRI measurements of subacromial cross-sectional areas. These volumes were compared between control and experimental groups using the Students t-test. Results: With the numbers available, there was no statistically significant difference in subacromial volume measured between: the control group and patients diagnosed partial RCT (P > 0.339), the control group and patients with complete RCTs (P > 0.431). Conclusion: We conclude that subacromial volumes cannot be reliably used to predict RCT type.

Acute Compartment Syndrome after Non-Contact Peroneus Longus Muscle Rupture

This case demonstrates a rare variation in the pattern of injury and the presentation of acute lateral compartment syndrome of the leg. Although uncommon, lateral compartment syndrome of the leg after an ankle inversion leading to peroneus longus muscle rupture has been previously documented. This case was unusual because there was no overt ankle injury and the patient was able to continue physical activity, in spite of a significant rupture of the peroneus longus muscle that was determined later. This case highlights the necessary vigilance clinicians must maintain when assessing non-contact injuries in patients with possible compartment syndrome.

Quality of Life and Functional Outcomes after Multiligament Knee Reconstruction

&NA; We aimed to determine factors that affect the quality of life of patients undergoing a standardized surgical and postoperative management protocol for knee dislocations. A total of 31 patients (33 knees) were included in this study. We contacted patients at a minimum of 12 months postoperatively (mean: 38 months; range, 12‐111 months) and administered the previously validated Multiligament Quality of Life questionnaire (ML‐QOL), 2000 International Knee Documentation Committee Subjective Knee Form (IKDC), and Lysholm Knee Scoring Scale. We performed independent two‐sample t ‐tests and age‐adjusted multivariable linear regression analysis to examine the difference in these scores. Patients who underwent previous knee ligament surgery had significantly worse mean ML‐QOL scores relative to patients who did not undergo previous knee ligament surgery (114.3 versus 80.4; p = 0.004) (higher score indicates worse quality of life). All other differences in the ML‐QOL scores were not statistically significant. IKDC and Lysholm scores did not differ significantly with regards to the studied variables. Among patients with no previous knee ligament surgery, patients undergoing surgery within 3 weeks of injury had significantly worse mean ML‐QOL scores relative to patients undergoing surgery greater than 3 weeks after their injury (98.7 versus 74.7; p = 0.042) and patients with Schenck classification of III or IV had significantly worse mean ML‐QOL scores relative to patient with a Schenck classification of I or II (88.7 versus 62.9; p = 0.015). We found that patients with a previous history of knee ligament surgery had a significantly worse quality of life relative to those with no history of knee ligament surgery. This is a level III, retrospective cohort study.

Effect of tourniquet use during total knee arthroplasty on global inflammatory cytokine changes associated with ischemia- reperfusion injury

The use of tourniquets during total knee arthroplasties has been debated given the possibility that prolonged application of a tourniquet may result in ischemia-reperfusion injury, potentially contributing to post-operative muscle atrophy. The goal of this study is to elucidate the influence that tourniquet use may have on the induction of ischemia-reperfusion injury in muscle tissue following total knee arthroplasties surgeries. We hypothesize that prolonged operative use of a tourniquet will cause global increases in pro-inflammatory cytokines indicating the occurrence of ischemia-reperfusion injury, which may contribute to post-operative muscle atrophy. Fifty patients undergoing total knee arthroplasties surgeries were separated into three groups: no tourniquet (n = 17), operative tourniquet (n = 15), and tourniquet during implant cementation (n = 18). Induction of ischemia-reperfusion injury was evaluated by measuring changes in inflammatory cytokines in blood samples collected from an antecubital vein before and after surgery. Analysis suggests statistically significant differences in the concentrations of specific cytokines depending on variable tourniquet application. Overall, both pro-inflammatory and anti-inflammatory cytokines (including tumor necrosis factor-α, interleukin 1β, 4, 5, 12, and monocyte chemtactic protein-1) were found to increase upon application of tourniquets during cementation and decrease without tourniquet use or upon application of operative tourniquets. In general only slight changes in inflammatory cytokines occurred based on altered tourniquet use during total knee arthroplasties. Using global changes in inflammatory cytokine levels as an indicator of ischemia-reperfusion injury, these data may suggest that the use of a tourniquet does not significantly contribute to induction of ischemia-reperfusion injury in total knee arthroplasty surgeries. However, additional studies comparing local plasma cytokine changes near the tourniquet site and utilizing larger sample sizes are necessary to determine if tourniquets can be used in total knee arthroplasty without inducing ischemia-reperfusion injury.

Arthroscopic Decompression and Bone Grafting of Proximal Humeral Intraosseous Ganglion: A Novel Technique

Intraosseous ganglia are rare lesions that can cause pain and leave patients susceptible to pathologic fracture. To date, these lesions have been treated with curettage and bone grafting through an open approach, although more recent techniques have allowed arthroscopic treatment of lesions located at the wrist, knee, and ankle. We present a novel, arthroscopic technique to treat intraosseous ganglion lesions of the proximal humerus. Using an arthroscopic approach, these lesions can be visualized, decompressed and curettage, with the ability to evaluate the extent of pathologic tissue remaining. This approach also allows for identification and treatment of additional glenohumeral pathology. Furthermore, we present a novel, completely arthroscopic technique of bone grafting and compaction to fill the resultant void.

Combined Glenoid and Humeral Head Reconstruction with Allografts

Case:We present two cases of anterior glenohumeral instability in which both the humeral head and the glenoid were reconstructed concurrently with use of allografts; we discuss the midterm outcomes at four and one-half and five years of follow-up, respectively. Conclusion:In our experience, concomitant glenoid and humeral head allograft reconstruction for anterior glenohumeral instability with severe combined humeral head and glenoid pathology yielded good midterm clinical, functional, and radiographic outcomes. This treatment approach may be a viable option for young and active patients presenting with severe combined glenoid and humeral pathology and warrants additional investigation.