Brett D Owens

Publications (86)193.7 Total impact

• Article: Current recommendations for anterior cruciate ligament bracing: when to use.

  Brendan D Masini, Brett D Owens
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  ABSTRACT: Braces are often used during various stages of recovery from an anterior cruciate ligament tear despite there being sparse definitive research supporting their use. This article reviews the literature on brace use for patients with anterior cruciate ligament tears in order to provide a guide for clinicians. There is evidence to support immediate postoperative bracing, with the goals of maintaining full extension and decreasing effusion. There may be a psychological benefit for its use in return to sport; however, this should be weighed against decreased performance. In the context of modern graft-fixation techniques and early mobilization protocols, empiric functional brace prescription is not required for successful long-term clinical outcomes and return to sport.
  The Physician and sportsmedicine 02/2013; 41(1):35-9. · 1.02 Impact Factor
• Article: Serum relaxin levels in young athletic men are comparable with those in women.

  Jennifer Moriatis Wolf, Kenneth L Cameron, Kari B Clifton, Brett D Owens
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  ABSTRACT: Relaxin was originally described as a reproductive hormone that mediated joint laxity in pregnant women and has been minimally studied in men. The purpose of this descriptive laboratory and clinical study was to evaluate serum relaxin in a young, primarily male population and compare levels between the sexes. In addition, the authors evaluated the relationship between relaxin and generalized laxity.
  Orthopedics 02/2013; 36(2):128-31. · 2.66 Impact Factor
• Article: Simple Method of Glenoid Bone Loss Calculation Using Ipsilateral Magnetic Resonance Imaging.

  Brett D Owens, Travis C Burns, Scot E Campbell, Steven J Svoboda, Kenneth L Cameron
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  ABSTRACT: BACKGROUND:Current methods for estimating glenoid bone loss in patients with chronic shoulder instability include computed tomography imaging with 3-dimensional reconstruction, specialized computer software, and imaging of the contralateral shoulder. An ideal method of glenoid measurement would require only magnetic resonance imaging (MRI) of the injured shoulder. PURPOSE:To determine whether MRI measurement of glenoid height, as well as sex, could be used to estimate glenoid width in healthy subjects with no history of shoulder instability. STUDY DESIGN:Cross-sectional study; Level of evidence, 3. METHODS:Bilateral shoulder MRIs were obtained in a healthy cohort of young athletes as part of the baseline assessment in a prospective cohort study. A musculoskeletal radiologist measured glenoid height and width using the sagittal MRI cuts. Univariate and multivariate regression analyses were performed to determine whether demographic and MRI measurements of the glenoid could be used to estimate glenoid width. RESULTS:Of the 1264 shoulder MRIs evaluated, the mean glenoid width was 26.67 mm (±2.49 mm), and the mean glenoid height was 42.15 mm (±3.00 mm). There were significant differences between the 129 female glenoids and the 1035 male glenoids for both width (23.1 mm, 27.1 mm, respectively, P < .0001) and height (37.9 mm, 42.7 mm, respectively, P < .0001); however, the relationship between glenoid height and width was similar for both men and women. The glenoid width was found to correlate with the height measurement (r = 0.56) for the entire cohort. Based on the results of linear regression analysis, controlling for the influence of sex, a formula was created that represents the relationship between these variables for male subjects: Glenoid Width = (1/3 Height) + 15 mm. Female patients are estimated with a formula that represents the same slope but a different intercept: W = 1/3 H + 13 mm. CONCLUSION:Significant differences in glenoid height and width were found by sex; however, the relationship between height and width was similar. These variables are correlated, and the resultant formula can be used to estimate the expected glenoid width in a patient with bone loss. This formula allows for easy calculation of the amount of glenoid bone loss with only a ruler and an MRI of the injured shoulder.
  The American journal of sports medicine 01/2013; · 3.61 Impact Factor
• Article: Normative Values for the KOOS and WOMAC in a Young Athletic Population: History of Knee Ligament Injury Is Associated With Lower Scores.

  Kenneth L Cameron, Brandon S Thompson, Karen Y Peck, Brett D Owens, Stephen W Marshall, Steven J Svoboda
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  ABSTRACT: BACKGROUND:The use of patient-reported outcome measures to assess clinical outcomes after injury and surgery has become common in treating young athletes with orthopaedic injuries; however, normative data for these measures are limited and often include a wide range of ages and activity levels. PURPOSE:To provide normative data for the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in a young and athletic population, and to compare scores between participants with a history of knee ligament injury and those with no history. STUDY DESIGN:Cross-sectional study; Level of evidence, 3. METHODS:We administered the KOOS and WOMAC to 1177 college freshmen entering the United States Military Academy in June 2011. All participants were healthy and had been medically screened to meet the physical induction standards for military service. We calculated means, standard deviations, percentiles, ranges, and interquartile ranges for the KOOS and WOMAC by sex and injury history. We also compared median scale scores for those with a history of knee ligament injury with those with no history using the Kruskal-Wallis test. RESULTS:Among the 1177 participants, 971 were male (age, 18.8 ± 0.9 years), and the remaining 206 were female (age, 18.7 ± 0.8 years). Normative median values and interquartile ranges (IQRs) for the KOOS scale scores among men with no history of knee ligament injury were the following: Symptoms (96.4; IQR, 10.7), Pain (100; IQR, 2.8), Functional Activities of Daily Living (ADL) (100; IQR, 0.0), Sports and Recreation Function (100; IQR, 5.0), and Knee-Related Quality of Life (QOL) (100; IQR, 12.5). For women with no history of knee ligament injury, the KOOS scale scores were the following: Symptoms (92.9; IQR, 14.3), Pain (100; IQR, 5.6), Functional ADL (100; IQR, 2.9), Sports and Recreation Function (100; IQR, 10.0), and Knee-Related QOL (93.8; IQR, 18.8). Among the men, 139 (14%) reported a history of knee ligament injury, while 33 (16%) women also reported a history of injury. All KOOS scale scores and the WOMAC Stiffness and Function scale scores were significantly lower (P < .05) for men who reported a history of knee ligament injury. Similarly, Symptoms, Pain, and Knee-Related QOL on the KOOS and Pain on the WOMAC were significantly lower among women with a history of knee ligament injury. CONCLUSION:Normative values for all KOOS scales suggest a high level of functioning among participants with no history of knee ligament injury. Despite meeting the medical standards for military service, participants with a history of knee ligament injury had significantly lower KOOS and WOMAC scores upon entry to military service.
  The American journal of sports medicine 01/2013; · 3.61 Impact Factor
• Article: Anatomic mapping for surgical reconstruction of the proximal tibiofibular ligaments.

  Aaron See, Russell R Bear, Brett D Owens
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  ABSTRACT: Injury to the proximal tibiofibular joint is uncommon. Previous studies regarding the anatomy of this region have predominantly focused on joint orientation. As radiographic technology has advanced, later studies have attempted to evaluate the capsular anatomy. However, no reports specifically map the ligaments to this joint. The objectives of the current study were to define specific ligamentous structures that provide stability to the proximal tibiofibular joint, describe easily identifiable and reproducible surgical landmarks to aid in surgical reconstruction, and add to the understanding of the posterolateral structures of the knee previously described by other authors.The proximal tibiofibular joint ligaments were identified in 10 fresh-frozen cadaveric specimens. Average ligament length, width, and thickness and area of the footprints of the tibial and fibular attachments were measured. Distances from the ligament footprints to known anatomic landmarks (eg, Gerdy's tubercle, tibial articular surface, and fibular styloid) were also measured. The anterior ligament tibial attachment was a mean of 15.6 mm lateral and posterior to Gerdy's tubercle and 17.3 mm anterior and inferior from the fibular styloid. Posterior ligament tibial insertion was a mean of 15.7 mm inferior to the tibial articular surface on the tibial side and 14.2 mm medial and slightly inferior from the fibular styloid.Definable ligaments provide stability to the proximal tibiofibular joint and can be reconstructed in an anatomic fashion using the landmarks and parameters described. This information allows for an anatomic reconstruction of the proximal tibiofibular joint, which should provide patients with better outcomes and fewer postoperative sequelae.
  Orthopedics 01/2013; 36(1):e58-63. · 2.66 Impact Factor
• Article: Military movement training program improves jump-landing mechanics associated with anterior cruciate ligament injury risk.

  Brett D Owens, Kenneth L Cameron, Michele L Duffey, Donna Vargas, Michael J Duffey, Sally B Mountcastle, Darin Padua, Bradley J Nelson
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  ABSTRACT: As part of the physical education program at the United States Military Academy, all cadets complete a movement training course designed to develop skills and improve performance in military-related physical tasks as well as obstacle navigation. The purpose of this study was to determine if completion of this course would also result in changes in jump-landing technique that reduce the risk of anterior cruciate ligament (ACL) injury. Analysis of landing mechanics on a two-footed jump landing from a height of 30 cm with a three-dimensional motion capture system synchronized with two force plates revealed both positive and negative changes. Video assessment using the Landing Error Scoring System (LESS) revealed an overall improved landing technique (p=.001) when compared to baseline assessments. The studied military movement course appears to elicit mixed but overall improved lower extremity jump-landing mechanics associated with risk for ACL injury.
  Journal of surgical orthopaedic advances 01/2013; 22(1):66-70.
• Article: Shoulder arthroscopy simulator performance correlates with resident and shoulder arthroscopy experience.

  Kevin D Martin, Kenneth Cameron, Philip J Belmont, Andrew Schoenfeld, Brett D Owens
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  ABSTRACT: The technical skills required to perform arthroscopy are multifaceted and require supervised training and repetition. Obtaining this basic arthroscopic skill set can be costly and time-consuming. Simulation may represent a viable training source for basic arthroscopic skills. Our goal was to evaluate the correlation between timed task performance on an arthroscopic shoulder simulator and both resident experience and shoulder arthroscopy experience. Twenty-seven residents were voluntarily recruited from an orthopaedic residency program. Each subject was tested annually for three consecutive years on an arthroscopic shoulder simulator and objectively scored on time to completion of a standardized object localization task. Each subject's total number of shoulder arthroscopies, all arthroscopies, and cases were calculated according to postgraduate year from their Accreditation Council for Graduate Medical Education (ACGME) case log. Generalized estimating equation multivariate regression analysis was performed to determine the correlation between simulation performance and total numbers of shoulder arthroscopies, all arthroscopies, and cases. Univariate analyses revealed that postgraduate year, total number of shoulder arthroscopies, total number of arthroscopies of any joint, and total number of surgical cases performed during residency training prior to testing were associated with the mean time required to complete the simulator task. The number of prior shoulder arthroscopies performed (r = 0.55) and postgraduate year in training (r = 0.60) correlated most strongly with simulator basic task performance. In the multivariate analysis, the number of prior shoulder arthroscopies and postgraduate year remained independent predictors of faster completion of the simulator task. For every additional postgraduate year, there was a sixteen-second improvement in the time required to complete the simulator task (p < 0.005). Similarly, after controlling for the influence of postgraduate year, there was a twelve-second decrease in the time to complete the simulator task for every additional fifty shoulder arthroscopies performed during residency training (p < 0.008). These results showed a significant relationship between performance of basic arthroscopic tasks in a simulator model and the number of shoulder arthroscopies performed. The data confirmed our hypothesis that simulator performance is representative of both resident experience and shoulder arthroscopy experience. This study suggests that greater resident clinical experience and shoulder arthroscopy experience are both reflected in improved performance of basic tasks on a shoulder simulator. These findings warrant further investigation to determine if training on a validated arthroscopic shoulder simulator would improve clinical arthroscopic skills.
  The Journal of Bone and Joint Surgery 11/2012; 94(21):e1601-5. · 3.27 Impact Factor
• Source

  Available from: Giampietro L Vairo

  Article: Clinical descriptive measures of shoulder range of motion for a healthy, young and physically active cohort.

  Giampietr L Vairo, Michele L Duffey, Brett D Owens, Kenneth L Cameron
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  ABSTRACT: The objective of this innovative research study was to describe clinical shoulder complex range of motion (ROM) measures for a young, healthy, and physically active population. This investigation represents a cross-sectional experiment conducted at a military academy-based sports medicine center. Military cadets with no history of shoulder complex injury were assessed within two months of enrollment in the academy; 548 men (18.8 ± 1.0 yr, 75.2 ± 12.2 kg, 178.3 ± 7.4 cm) and 74 women (18.7 ± 0.9 yr, 63.2 ± 8.9 kg, 165.2 ± 6.9 cm) participated. Descriptive measures included cross-body adduction (CAD), flexion (FLX), external rotation (ER0) with the shoulder complex in adduction and elbow flexed to 90°, internal and external rotation (IR, ER) with the shoulder complex at 90° of abduction and elbow flexed to 90° as well as arc (ARC) of IR-ER using standardized clinical quantification techniques. Bilateral and sex differences were evaluated using dependent and independent t-tests, respectively. Percentiles by arm dominance and sex were also calculated for all ROM measures. Data were normally distributed. Active and passive ROM measures indicated significant bilateral differences (P < 0.05) except for ARC. Sex differences (P < 0.05) were noted for active and passive CAD, FLX and ER0 for the dominant arm as well as active and passive CAD, FLX and ARC for the non-dominant arm. These original data provide descriptive measures for shoulder complex ROM excursions, assisting sports medicine practitioners in potentially identifying clinical deficiencies and functional outcomes following shoulder injury.
  Sports Medicine Arthroscopy Rehabilitation Therapy & Technology 09/2012; 4(1):33.
• Article: Clavicle fractures in the United States military: incidence and characteristics.

  Mark S Hsiao, Kenneth L Cameron, Jeannie Huh, Joseph R Hsu, Matthew Benigni, JoAnna C Whitener, Brett D Owens
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  ABSTRACT: Although it is generally known that clavicle fractures represent a common injury of the shoulder girdle in the general population, the true incidence in the active duty military population is unknown. Given the implications for such injuries on the ability to perform occupation-specific tasks, determining the incidence in the U.S. military population is worthwhile. The purpose of this study was to determine the incidence of clavicle fractures in the U.S. military and to identify any demographic risk factors for injury. We performed a query of the Defense Medical Epidemiology Database with the code from the International Classification of Diseases, Ninth Revision, for clavicle fractures for the years 1999 through 2008. An overall injury incidence was calculated, in addition to multivariate analysis, to determine independent risk factors among the following demographic considerations: sex, race, branch of military service, rank, and age. During the study period, a total of 12,514 clavicle fractures were documented among an at-risk population of 13,770,767 person-years for an incidence rate (IR) of 0.91 per 1,000 person-years in the U.S. Military. Males, when compared with females, were more than twice as likely to sustain a clavicle fracture (IR ratios [IRR], 2.30; 95% confidence intervals [CI], 2.12-2.49). The peak incidence of clavicle fractures occurred in the age groups of <20 and 20 to 24. Compared to black service members, the white service members were associated with significantly higher rate of clavicle fractures (IRR, 2.45; 95% CI, 2.28-2.63). The service members serving in the Marine Corps were associated with a higher IR of clavicle fractures when compared to those in the Navy (IRR, 1.44; 95% CI, 1.35-1.53). Junior enlisted service members were 34% as likely to sustain a clavicle fracture when compared to senior officers (IRR, 1.46; 95% CI, 1.34-1.60 and IRR, 1.12; 95% CI, 0.99-1.28, respectively). The incidence of clavicle fractures among U.S. military personnel (0.908 per 1,000 person-years) is higher than previous epidemiological reports.
  Military medicine 08/2012; 177(8):970-4. · 0.92 Impact Factor
• Article: Incidence of greater trochanteric pain syndrome in active duty US military servicemembers.

  Elizabeth Blank, Brett D Owens, Robert Burks, Philip J Belmont
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  ABSTRACT: Although greater trochanteric pain syndrome is thought to be a common musculoskeletal disorder, little has been reported on the incidence rates of the disorder. The purpose of this study was to determine the incidence and demographic risk factors of greater trochanteric pain syndrome in a United States military population. Multivariate Poisson regression analysis was used to estimate the rate of greater trochanteric pain syndrome per 1000 person-years, controlling for sex, race, age, rank, and branch of service. The overall unadjusted incidence rate of greater trochanteric pain syndrome was 2.03 per 1000 person-years. Women had a significantly increased adjusted incidence rate ratio for greater trochanteric pain syndrome of 5.03 (95% confidence interval [CI], 4.91-5.16). The adjusted incidence rate ratio for White servicemembers compared with Black servicemembers was 1.36 (95% CI, 1.32-1.40). The adjusted incidence rate ratio for the 40+ age group compared with the 25 to 29 age group was 2.81 (95% CI, 2.68-2.95). Compared with junior officers, junior and senior enlisted ranks had an increased adjusted incidence rate ratio of 1.94 (95% CI, 1.84-2.04) and 1.17 (95% CI, 1.12-1.23), respectively. Compared with the Navy, each branch of service had an increased adjusted incidence rate ratio, with the Army at 2.90 (95% CI, 2.80-3.01), the Marines at 1.96 (95% CI, 1.87-2.07), and the Air Force at 1.33 (95% CI, 1.27-1.38). Female servicemembers had a five-fold greater incidence of greater trochanteric pain syndrome. Increasing age, enlisted rank groups, and service in the Army, Marines, or Air Force were also significant risk factors.
  Orthopedics 07/2012; 35(7):e1022-7. · 2.66 Impact Factor
• Article: Epidemiology of acromioclavicular joint injury in young athletes.

  Mark Pallis, Kenneth L Cameron, Steven J Svoboda, Brett D Owens
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  ABSTRACT: Acromioclavicular (AC) joint injuries, particularly sprains, are common in athletic populations and may result in significant time lost to injury. However, surprisingly, little is known of the epidemiology of this injury. To define the incidence of AC joint injuries and to determine the risk factors for injury. Descriptive epidemiological study. A longitudinal cohort study was performed to determine the incidence and characteristics of AC joint injury at the United States Military Academy between 2005 and 2009. All suspected AC joint injuries were reviewed by an independent orthopaedic surgeon using both chart reviews as well as assessments of radiological imaging studies. Injuries were graded according to the modified Rockwood classification system as well as dichotomized into low-grade (Rockwood types I and II) and high-grade (Rockwood types III, IV, V, and VI) injuries for analysis. Injury mechanisms, return-to-play timing, and athlete-exposures were documented and analyzed. χ(2) and Poisson regression analyses were performed, with statistical significance set at P < .05. During the study period, 162 new AC joint injuries and 17,606 person-years at risk were documented, for an overall incidence rate of 9.2 per 1000 person-years. The majority of the AC joint injuries were low-grade (145 sprains, 89%) injuries, with 17 high-grade injuries. Overall, male patients experienced a significantly higher incidence rate for AC joint injuries than female patients (incidence rate ratio [IRR], 2.18; 95% confidence interval [CI], 1.21-4.31). An AC joint injury occurred most commonly during athletics (91%). The incidence rate of AC joint injury was significantly higher in intercollegiate athletes than intramural athletics when using athlete-exposure as a measure of person-time at risk (IRR, 2.11; 95% CI, 1.31-3.56). Similarly, the incidence rate of AC injury was significantly higher among male intercollegiate athletes when compared to female athletes (IRR, 3.56; 95% CI, 1.74-8.49) when using athlete-exposure as the denominator. The intercollegiate sports of men's rugby, wrestling, and hockey had the highest incidence rate of AC joint injury. Acromioclavicular injuries resulted in at least 1359 total days lost to injury and an average of 18.4 days lost per athlete. The average time lost to injury for low-grade sprains was 10.4 days compared with high-grade injuries at 63.7 days. Of the patients with high-grade injuries, 71% elected to undergo coracoclavicular/AC reconstructions. The rate of surgical intervention was 19 times higher for high-grade AC joint injuries than for low-grade injuries (IRR, 19.2; 95% CI, 7.64-48.23; P < .0001). Acromioclavicular separations are relatively common in young athletes. Most injuries occur during contact sports such as rugby, wrestling, and hockey. Male athletes are at greater risk than female athletes. Intercollegiate athletes are at greater risk than intramural athletes. The average time lost to sport due to AC joint injury was 18 days, with low-grade injuries averaging 10 days lost. High-grade injuries averaged 64 days lost to sport, and 71% elected to undergo surgical repair/reconstruction.
  The American journal of sports medicine 06/2012; 40(9):2072-7. · 3.61 Impact Factor
• Article: Survival comparison of allograft and autograft anterior cruciate ligament reconstruction at the United States Military Academy.

  Mark Pallis, Steven J Svoboda, Kenneth L Cameron, Brett D Owens
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  ABSTRACT: There is recent evidence that use of allograft tendons for anterior cruciate ligament (ACL) reconstruction in young patients may result in increased failure rates compared with autologous grafts. Allograft ACL reconstruction will result in higher failure rates in young athletes compared with autograft reconstruction. Cohort study; Level of evidence, 2. A prospective cohort study of cadets at the United States Military Academy (USMA) was performed to assess performance of ACL reconstructions performed before entrance to service. Members of the classes of 2007 through 2013 who had undergone prior ACL reconstruction were identified through the Department of Defense Medical Evaluation Review Board reporting and waiver process and evaluated on the first day of matriculation. These participants were followed during their tenure at the academy with revision ACL reconstruction as the primary outcome measure of interest. Kaplan-Meier survival analysis was performed for all graft types using STATA with significance set as P < .05. A total of 120 cadets underwent 122 ACL reconstructions (2 bilateral) before matriculation and compose the prospective cohort. This cohort included 30 female and 90 male cadets. Of these 122 knees with prior ACL reconstructions, the grafts used were 61 bone-patellar tendon-bone (BTB), 45 hamstring, and 16 allograft. A total of 20 failures occurred among this cohort at an average of 545 days from matriculation. Of the failures requiring revision, 7 were BTB (11% of all BTB), 7 were allograft (44% of all allograft), and 6 were hamstring (13% of all hamstring). There was no significant difference in the graft failure between the BTB and hamstring autograft groups. In contrast, those who entered the USMA with an allograft were 7.7 times more likely to experience a subsequent graft failure during the follow-up period when compared with the BTB autograft group (hazard ratio = 7.74; 95% confidence interval [CI], 2.67-22.38; P < .001). When allografts were compared with all autografts combined, a similar increase failure was noted in the allograft group (hazard ratio = 6.71; 95% CI, 2.64-17.06; P < .001). In this young active cohort, individuals having undergone an allograft ACL reconstruction were significantly more likely to experience clinical failure requiring revision reconstruction compared with those who underwent autologous graft reconstruction. The authors recommend the use of autograft in ACL reconstruction in young athletes.
  The American journal of sports medicine 04/2012; 40(6):1242-6. · 3.61 Impact Factor
• Article: Non-emergent orthopaedic injuries sustained by soldiers in Operation Iraqi Freedom.

  Gens P Goodman, Andrew J Schoenfeld, Brett D Owens, Jason R Dutton, Robert Burks, Philip J Belmont
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  ABSTRACT: The majority of soldiers deployed to the theater of combat operations return safely after completion of the deployment. Many of these soldiers sustain non-emergent musculoskeletal injuries that initially are treated nonoperatively and ultimately require surgery following their combat tour. A prospective evaluation of the orthopaedic surgery consultations and surgical procedures required by soldiers returning from a full combat deployment was performed. Demographic information (including age and sex) as well as information on the mechanism of injury, the reason for orthopaedic consultation, and the procedures performed was collected for each soldier. The overall incidence of non-emergent orthopaedic injuries was calculated, and multivariate Poisson regression analysis was utilized to determine the effect of age and sex on the type of orthopaedic injury sustained. There were 3787 soldiers who returned from combat operations at the end of a fifteen-month deployment without having been medically evacuated. There were 731 orthopaedic surgical consultations for the evaluation of a non-emergent musculoskeletal complaint, and 140 orthopaedic operations were performed as a result. An age of thirty years or more was an important risk factor for requiring an orthopaedic consultation (p < 0.0001). The most common surgical procedures were performed for shoulder stabilization, for superior labrum anterior to posterior lesion repair, for the treatment of internal derangement of the knee, and for the treatment of foot deformity. Nineteen percent of all soldiers who completed a combat deployment required an orthopaedic surgical consultation on return, and 4% of soldiers required orthopaedic surgery. More than half of the surgical procedures involved the knee or shoulder. This represents a large burden of care for returning soldiers on orthopaedic surgical services and has important implications for future resource utilization.
  The Journal of Bone and Joint Surgery 04/2012; 94(8):728-35. · 3.27 Impact Factor
• Article: Patellar dislocation in the United States: role of sex, age, race, and athletic participation.

  Brian R Waterman, Philip J Belmont, Brett D Owens
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  ABSTRACT: Patellar instability has been extensively studied in selected, high-risk cohorts, but the epidemiology in the general population remains unclear. A longitudinal, prospective epidemiological database was used to determine the incidence and demographic risk factors for patellar dislocations presenting to emergency departments of the United States. The National Electronic Injury Surveillance System was queried for all patellar dislocations presenting to emergency departments between 2003 and 2008. Incidence rate ratios (IRRs) were then calculated with respect to sex, age, and race. The hypothesis was that patellar dislocation is influenced by sex, age, race, and athletic participation. An estimated 40,544 patellar dislocations occurred among an at-risk population of 1,774,210,081 person-years for an incidence rate of 2.29 per 100,000 person-years in the United States. When compared with males, females showed no significant overall or age-stratified differences in the rates of patellar dislocation (IRR 0.85, 95% CI 0.71, 1.00; p = 0.08; p > 0.05). Peak incidence of patellar dislocation occurred between 15 and 19 years of age (11.19/100,000 person-years). When compared with Hispanic race, black and white race were associated with significantly higher rates of patellar dislocation (IRR 4.30 [95% CI 1.63, 6.97; p = 0.02], IRR 4.02 [95% CI 1.06, 6.98; p = 0.03], respectively). Nearly half (51.9%) of all patellar dislocation occurred during athletic activity, with basketball (18.2%), soccer (6.9%), and football (6.3%) associated with the highest percentage of patellar dislocation during athletics. Age between 15 and 19 years is associated with higher rates of patellar dislocation. Sex is not a significant risk factor for patellar dislocation. Black and white race are a significant risk factor for patellar dislocation when compared with Hispanic race. Half of all patellar dislocation occurs during athletic activity. This study was conducted on the Level of evidence II.
  The journal of knee surgery 03/2012; 25(1):51-7.
• Article: Incidence of elbow dislocations in the United States population.

  Jason W Stoneback, Brett D Owens, Joshua Sykes, George S Athwal, Lauren Pointer, Jennifer Moriatis Wolf
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  ABSTRACT: There is minimal published information regarding the epidemiology of simple elbow dislocations. The purpose of this study was to report the estimated incidence of elbow dislocations in the United States, with use of the National Electronic Injury Surveillance System (NEISS) database. The NEISS database includes 102 hospitals representing a random sampling of all patients presenting to U.S. emergency departments. The database was queried for elbow dislocation events. NEISS data for 2002 through 2006 were used for raw data and weighted injury counts. Incidence rates with 95% confidence intervals (95% CI) were calculated by age group and sex, with use of U.S. census data. One thousand and sixty-six elbow dislocations were identified, representing a weighted estimate of 36,751 acute dislocations nationwide. A calculated incidence of 5.21 dislocations per 100,000 person-years (95% CI, 4.74 to 5.68) was noted. The highest incidence of elbow dislocations (43.5%) occurred in those who were ten to nineteen years old (6.87 per 100,000 person-years; 95% CI, 5.97 to 7.76). The incidence rate ratio for the comparison of dislocations in males with those in females was 1.02 (5.26 per 100,000 for males and 5.16 per 100,000 for females). In patients ten years or older, 474 injuries (44.5% of total dislocations) were sustained in sports. Males dislocated elbows in football, wrestling, and basketball. Females sustained elbow dislocations most frequently in gymnastics and skating activities. The estimated incidence of elbow dislocations in the U.S. population is 5.21 per 100,000 person-years, with use of a national database. Adolescent males are at highest risk for dislocation. Nearly half of acute elbow dislocations occurred in sports, with males at highest risk with football, and females at risk with gymnastics and skating activities.
  The Journal of Bone and Joint Surgery 02/2012; 94(3):240-5. · 3.27 Impact Factor
• Source

  Available from: Kenneth L Cameron

  Article: Incidence and risk factors associated with meniscal injuries among active-duty US military service members.

  Jennifer C Jones, Robert Burks, Brett D Owens, Rodney X Sturdivant, Steven J Svoboda, Kenneth L Cameron
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  ABSTRACT: Few population-based studies have examined the incidence of meniscal injuries, and limited information is available on the influence of patient's demographic and occupational factors. To examine the incidence of meniscal injuries and the influence of demographic and occupational factors among active-duty US service members between 1998 and 2006. Cohort study. Using the International Classification of Diseases (9th revision) codes 836.0 (medial meniscus), 836.1 (lateral meniscus), and 836.2 (meniscus unspecified), we extracted injury data from the Defense Medical Surveillance System to identify all acute meniscal injuries among active-duty military personnel. Active-duty military personnel serving in all branches of military service during the study period. Incidence rate (IR) per 1000 person-years at risk and crude and adjusted rates by strata for age, sex, race, rank, and service. During the study period, 100201 acute meniscal injuries and 12115606 person-years at risk for injury were documented. The overall IR was 8.27 (95% confidence interval [CI] = 8.22, 8.32) per 1000 person-years. Main effects were noted for all demographic and occupational variables (P < .001), indicating that age, sex, race, rank, and service were associated with the incidence of meniscal injuries. Men were almost 20% more likely to experience an acute meniscal injury than were women (incidence rate ratio = 1.18, 95% CI = 1.15, 1.20). The rate of meniscal injury increased with age; those older than 40 years of age experienced injuries more than 4 times as often as those under 20 years of age (incidence rate ratio = 4.25, 95% CI=4.08,4.42). The incidence of meniscal injury was substantially higher in this study than in previously reported studies. Male sex, increasing age, and service in the Army or Marine Corps were factors associated with meniscal injuries.
  Journal of athletic training 01/2012; 47(1):67-73. · 1.80 Impact Factor
• Article: Arthroscopic basic task performance in shoulder simulator model correlates with similar task performance in cadavers.

  Kevin D Martin, Philip J Belmont, Andrew J Schoenfeld, Michael Todd, Kenneth L Cameron, Brett D Owens
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  ABSTRACT: Attainment of the technical skill necessary to safely perform arthroscopic procedures requires the instruction of orthopaedic surgery residents in basic arthroscopic skills. Although previous studies involving shoulder arthroscopy simulators have demonstrated a correlation between task performance and the level of prior arthroscopic experience, data demonstrating the correlation of simulator performance with arthroscopic skill in a surgical setting are scarce. Our goal was to evaluate the correlation between timed task performance in an arthroscopic shoulder simulator and timed task performance in a cadaveric shoulder arthroscopy model. Subjects were recruited from among residents and attending surgeons in an orthopaedic surgery residency program. Each subject was tested on an arthroscopic shoulder simulator and objectively scored on the basis of the time taken to complete a standardized object selection program. After an interval of at least two weeks, each subject was then tested on a cadaveric shoulder arthroscopy model designed to replicate the shoulder arthroscopy simulator testing protocol, and the time to completion was again recorded. Both testing protocols involved the simple task of placing a probe on a series of assigned locations in the glenohumeral joint. Spearman rank correlation analysis was performed, and regression analysis was used to determine the predictive ability of the simulator score. The performance time on the simulation program was strongly correlated with the performance time on the cadaveric model (r = 0.736, p < 0.001). The time required to complete the simulator task was a significant predictor of the time required to complete the cadaveric task (t = 4.48, p < 0.001). These results demonstrated a strong correlation between performance of basic arthroscopic tasks in a simulator model and performance of the same tasks in a cadaveric model.
  The Journal of Bone and Joint Surgery 11/2011; 93(21):e1271-5. · 3.27 Impact Factor
• Article: Surgical management of posterior shoulder instability

  Brett D. Owens, Christopher J. Tucker, Michael Zacchilli
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  ABSTRACT: Posterior glenohumeral joint instability is becoming increasingly recognized. Subluxations are predominant, but true dislocations can occur. Patients typically present with pain with provocative activity and may or may not have a sensation of instability. A fall onto an outstretched hand or elbow is a classic traumatic mechanism, while bench press and pushups are bothersome in chronic cases. Advances in physical examination and diagnostic imaging modalities have improved the ability to identify the lesions associated with posterior instability. While physical therapy remains the mainstay of initial management, surgical stabilization is required if conservative means are unsuccessful in an active patient. Outcomes of arthroscopic labral repair either with or without capsular plication have been good to excellent in recent mid-term follow-up studies. While these studies are promising, longer-term studies are needed to determine the durability of this surgical management technique. While most patients with posterior glenohumeral joint instability can be treated arthroscopically, certain conditions (bone loss, significant glenoid retroversion, revision, etc) may be best managed through an open approach.
  Current Orthopaedic Practice 10/2011; 22(6):474–482.
• Article: Meniscus repair and transplantation techniques.

  Travis C Burns, Jeffrey R Giuliani, Steven J Svoboda, Brett D Owens
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  ABSTRACT: Modern meniscal repair incorporates multiple techniques and adjunctive measures. The classic inside-out repair remains the gold standard and is most appropriate for a bucket-handle type tear of the medial or lateral meniscus. The all-inside technique has gained in popularity recently and has outcomes that approach those of the inside-out repair with decreased morbidity but increased cost. The choice of this technique is most appropriate for small tears requiring few sutures to repair. Outside-in repair can also be employed and is preferred for anterior horn tears. Surgeons may use a hybrid technique that incorporates all techniques in some challenging cases. Meniscal debridement is used for degenerative tears that are not amenable to repair. Meniscal transplantation is an option for symptomatic meniscal deficiency in young, active patients. This article discusses the technical considerations for meniscal debridement, repair, and transplantation.
  The journal of knee surgery 09/2011; 24(3):167-74.
• Article: Performance of military tasks after clavicle plating.

  Jeannie Huh, Matthew A Posner, Russell R Bear, Rahul Banerjee, Brett D Owens, Joseph R Hsu
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  ABSTRACT: Management of displaced midshaft clavicle fractures in the military, a largely shoulder-bearing population, is controversial. We aimed to report the military-relevant functional outcomes after plate fixation. We performed a nested cross-sectional analysis of active duty service members enrolled in an ongoing multicenter, randomized trial on clavicle plating. For this analysis, we included subjects with 26 months follow-up. Outcome measures included radiographic appearance, physical examination, a military-specific questionnaire, and validated shoulder surveys. Mean follow-up for 28 clavicle fractures was 13 months. Union rate by 12 weeks was 93% (26/28). There was one case of soft tissue irritation requiring hardware removal. At latest follow-up, 75% of patients were satisfied; 68% had mild/no pain; 79% had full range of motion; 75% could perform push-ups; and 21% have deployed. For the majority of active duty personnel, rapid healing, return to military-specific tasks, and satisfaction with outcome are possible after plate fixation of clavicle fractures. However, approximately 25% report some functional limitations at 1 year.
  Military medicine 08/2011; 176(8):950-5. · 0.92 Impact Factor