bluuebunny/crossref_metadata_2025 huggingface dataset:
Biomechanical Comparison of Synthetic Polytetrafluoroethylene (PTFE) vs Human Dermal Allograft (HDA), 2 vs 3 Glenoid Anchors, and Suture vs Minitape in Superior Capsule Reconstruction
Authors: Ting Ryan S. , Guo Allen A. , Rosenthal Ron , Al-Housni Hilal S. A. , Lam Patrick H. , Murrell George A. C.
Published: July 2022

Background: Superior capsule reconstruction (SCR) is an option for the treatment of massive, irreparable rotator cuff tears. However, which materials yield the strongest constructs remains undetermined. Purposes: We sought to investigate whether SCR with polytetrafluoroethylene (PTFE) or human dermal allograft (HDA), 2 or 3 glenoid anchors, and suture or minitape resulted in better failure load properties at the patch-glenoid interface. Methods: We conducted a biomechanical study in 30 glenoid-sided SCR repairs in Sawbones models divided into 5 groups. Each was pulled to failure to assess mode of failure, peak load (N), stiffness (N/mm), yield load (N), peak energy (N m), and ultimate energy (N m). The 5 groups were as follows: group 1—PTFE, 2 anchors, and suture; group 2—PTFE, 2 anchors, and minitape; group 3—HDA, 2 anchors, and suture; group 4—HDA, 2 anchors, and minitape; group 5—PTFE, 3 anchors, and minitape. Results: Repairs failed by button-holing of suture/minitape. Group 5 had greater peak load, stiffness, yield load, and peak energy (384 ± 62 N; 24 ± 3 N/mm; 343 ± 42 N; 4 ± 2 N m) than group 3 (226 ± 67 N; 16 ± 4 N/mm; 194 ± 74 N; 2 ± 1 N m) or group 4 (274 ± 62 N; 17 ± 4 N/mm; 244 ± 50 N; 2 ± 1 N m) and greater ultimate energy (8 ± 3 N m) than all other groups. Conclusions: This biomechanical study of SCR repairs in Sawbones models found that yield load was greater in PTFE than HDA, 3 anchors were better than 2, and minitape was no better than suture.
The unique contribution of gendered racial stress to depressive symptoms among pregnant Black women
Authors: Clarke Lasha S , Riley Halley EM , Corwin Elizabeth J , Dunlop Anne L , Hogue Carol J Rowland
Published: July 2022

Introduction:

Pregnant Black women are at disproportionate risk for adverse birth outcomes, in part associated with higher prevalence of stress. Stress increases risk of depression, a known risk factor for preterm birth. In addition, multiple dimensions of stress, including perceived stress and stressful life events, are associated with adverse birth outcomes, independent of their association with prenatal depression. We use an intersectional and contextualized measure of gendered racial stress to assess whether gendered racial stress constitutes an additional dimension to prenatal depression, independent of stressful life events and perceived stress.

Methods:

In this cross-sectional study of 428 Black women, we assessed gendered racial stress (using the 39-item Jackson Hogue Phillips Reduced Common Contextualized Stress Measure), perceived stress (using the Perceived Stress Scale), and stressful life events (using a Stressful Life Event Index) as psychosocial predictors of depressive symptoms (measured by the Edinburgh Depression Scale). We used bivariate analyses and multivariable regression to assess the association between the measures of stress and prenatal depression.

Results:

Results revealed significant bivariate associations between participant scores on the full Jackson Hogue Phillips Reduced Common Contextualized Stress Measure and its 5 subscales, and the Edinburgh Depression Scale. In multivariable models that included participant Perceived Stress Scale and/or Stressful Life Event Index scores, the Jackson Hogue Phillips Reduced Common Contextualized Stress Measure contributed uniquely and significantly to Edinburgh Depression Scale score, with the burden subscale being the strongest contributor among all variables. No sociodemographic characteristics were found to be significant in multivariable models.

Conclusion:

For Black women in early pregnancy, gendered racial stress is a distinct dimension of stress associated with increased depressive symptoms. Intersectional stress measures may best uncover nuances within Black women’s complex social environment.
Task-irrelevant filler items alter the dynamics of electrical brain activity during visual search
Authors: Drisdelle Brandi Lee , Corriveau Isabelle , Fortier-Gauthier Ulysse , Jolicoeur Pierre
Published: July 2022

In electroencephalography (EEG) studies of visual search, task-irrelevant fillers are included in displays to balance bottom-up stimulation across the visual field and generally considered as inconsequential for performance or EEG results. We examined the impact of fillers on target and distractor processing using lateralised event-related potentials (ERPs). Two task-relevant items (TRIs) were presented, with or without fillers. One TRI (target or target-colour distractor) was on the vertical midline and the other in a lateral position (left or right visual field) on an imaginary circle around fixation. An N2pc was elicited by lateral targets and task-relevant distractors, suggesting that attention was allocated to the lateral TRI because it possessed a target defining feature (colour). A Ptc was only elicited by lateral task-relevant distractors, in line with previous research suggesting that this component is associated with distractor processing. When fillers were also in the circular arrangement, alterations in performance and neural activity occurred. Fillers enhanced and delayed attentional deployment (N2pc) and delayed distractor processing (Ptc). Critically, we observed no difference in Ptc amplitude according to filler presence. Thus, if the Ptc reflects active suppression (or attentional disengagement), it was not required for fillers. ERPs were also modulated by the distance between TRIs (which could be separated by one or four filler positions), but differently according to the colour scheme (blue TRIs with grey fillers or vice versa). Our results suggest that fillers affect lateralised electrophysiological activity at multiple loci during visual search and should not be considered inconsequential.
A glance into the future of gout
Authors: Sivera Francisca , Andres Mariano , Dalbeth Nicola
Published: July 2022

Gout is characterized by monosodium urate (MSU) crystal deposits in and within joints. These deposits result from persistent hyperuricaemia and most typically lead to recurrent acute inflammatory episodes (gout flares). Even though some aspects of gout are well characterized, uncertainties remain; this upcoming decade should provide further insights into many of these uncertainties. Synovial fluid analysis allows for the identification of MSU crystals and unequivocal diagnosis. Non-invasive methods for diagnosis are being explored, such as Raman spectroscopy and imaging modalities. Both ultrasound and dual-energy computed tomography (DECT) allow the detection of MSU crystals; this not only provides a mean of diagnosis, but also has furthered gout knowledge defining the presence of a preclinical deposition in asymptomatic hyperuricaemia. Scientific consensus establishes the beginning of gout as the beginning of symptoms (usually the first flare), but the concept is currently under review. For effective long-term gout management, the main goal is to promote crystal dissolution treatment by reducing serum urate below 6 mg/dL (or 5 mg/dL if faster crystal dissolution is required). Current urate-lowering therapies’ (ULTs) options are limited, with allopurinol and febuxostat being widely available, and probenecid, benzbromarone, and pegloticase available in some regions. New xanthine oxidase inhibitors and, especially, uricosurics inhibiting urate transporter URAT1 are under development; it is probable that the new decade will see a welcomed increase in the gout therapeutic armamentarium. Cardiovascular and renal comorbidities are common in gout patients. Studies determining whether optimal treatment of gout will positively impact these comorbidities are currently lacking, but will hopefully be forthcoming. Overall, the single change that will most impact gout management is greater uptake of international rheumatology society recommendations. Innovative strategies, such as nurse-led interventions based on these recommendations have recently demonstrated treatment success for people with gout.
Paper 17: Follow-Up of Heterotopic Ossification (HO) After Platelet-Rich Plasma (PRP) for Groin Injuries
Authors: Roedl Johannes , Coleman Struan , Zoga Adam , Meyers William , Poor Alexander
Published: July 2022

Objectives:

A 2015 study of PRP for groin injuries in NFL players* alerted us to the possibility of PRP causing heterotopic ossification. This study of athletes seen from 2014 to 2019 provides a more comprehensive analysis of that observation.

Methods:

All athletes seen at one institution and identified at their first visit as having received PRP for a core muscle injury were followed and compared to core muscle injury patients who had not previously received PRP. HO was observed on MRI and intraoperatively and confirmed pathologically. All PRP patients were followed for at least two years.

Results:

PRP patients had a 40.7% occurrence of HO, compared to 0.7% in the non-PRP cohort (See Table). Three athletes who had PRP retired early from their sports due to the HO and scar issues. The occurrence of HO did not correlate with any technique of PRP administration. Twenty-two of 28 (78.6%) NFL players who received PRP developed HO, compared to 0 (0%) in 28 NFL randomly selected, age-, position- and injury matched controls. Three-month “success” rates were 67.9% and 96.4% respectively in the two groups (p<0.006) in terms of return to play at previously high-level levels of performance or greater, according to their own subjective assessments. Differences were mostly due to scar issues. Most “failure” patients in the PRP group had returned to play but not at their previously high levels.

Conclusions:

This longer-term, more comprehensive study confirms the previous preliminary analysis that caregivers should take a cautious approach to treatment with PRP for groin injuries. None None None [Table: see text]
Paper 47: Clinical Outcomes in Patients with Femoral Acetabular Impingement Syndrome and Acetabular Retroversion: A 3D Analysis
Authors: Knapik Derrick , Lambers Floor , Malloy Phil , Chahla Jorge , Nho Shane , Alter Thomas
Published: July 2022

Objectives:

To use computed tomography (CT)-based three-dimensional (3D) bone models to (1) quantify acetabular version in patients with femoroacetabular impingement syndrome (FAIS) and (2) explore the relationship between the magnitude of acetabular version and clinical outcomes following hip arthroscopy.

Methods:

Preoperative CT scans were acquired in 105 consecutive patients prior to hip arthroscopy for FAIS, of which 84 (80.0%) completed minimum two-year patient reported outcomes. 3D models of the pelvis and femur were generated by semi-automated segmentation, and aligned to a standard coordinate system. Acetabular version was quantified at the 12, 2, and 3 o’clock position. (Figure I) Acetabular version classifications were based on the version at the 3 o’clock position, and were defined as follows: acetabular retroversion (AR [<15°]), normal acetabular version (NV [15°-25°]), and acetabular anteversion (AA [>25°]). Patient demographic characteristics and clinical outcomes including the Hip Outcome Score – Activities of Daily Living (HOS-ADL), Hip Outcome Score – Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), and Visual Analog Scale (VAS) for pain and satisfaction were analyzed.

Results:

Mean age and body mass index (BMI) of patients was 33.9±12.6 years and 26.0±5.4 kg/m2, respectively, while 70.2% were female. The average acetabular version at 12, 2, and 3 o’clock for the study cohort was 9.3° ± 9.3°, 12.3° ± 7.4°, and 20.9° ± 5.7°, respectively (Figure II). After stratification based on the magnitude of acetabular anteversion at the 3 o’clock position, the number of patients and the average torsion within each group were as follows: AR (n=12; 11.3°±2.7°), NT (n=56; 20.7°±2.9°), AA (n=16; 28.5°±2.7°) (Figure III). At minimum two-year follow-up, significant between group differences in mHHS, iHOT-12, VAS for pain and satisfaction (P < 0.05) were appreciated (Table I). Post hoc analysis with Bonferroni correction ( P < 0.0167) found lower scores on mHHS, iHOT-12, VAS for pain and satisfaction in patients with AR compared to NV (Table I). Lower VAS for satisfaction scores were reported in patients with AR when compared to AA ( P = 0.006), but not mHHS (0.023), iHOT-12 (0.032), or VAS for pain (0.072) (Table I).

Conclusions:

Patients with AR reported inferior outcomes when compared to patients with NV and AA following hip arthroscopy for FAIS.
Paper 56: Defining Clinically Significant Outcomes After Gluteus Medius Repair at 5-Years
Authors: Sivasundaram Lakshmanan , Browning Robert , Holland Tai , Paul Katlynn , Nho Shane , Rice Morgan
Published: July 2022

Objectives:

To define minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) at a minimum of 5-years for patients undergoing endoscopic and open gluteus medius repair.

Methods:

A retrospective review was performed of prospectively collected data from all patients undergoing primary open or endoscopic repair of gluteus medius tears between January 2012 and December 2015 with a minimum 5-years follow-up. Patient data collected included patient demographics, preoperative clinical function scores, and pre and postoperative patient-reported outcomes (PROs). Patient reported outcome measures included the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports Subscale (HOS-SS), Modified Harris Hip Score (mHHS) and Internation Hip Outcome Tool 12 questions (iHOT-12). The minimal clinically important difference (MCID) values were calculated for each PRO using the distribution method while PASS was determined via the anchor-based method utilizing ROC curves and Youden’s index using SPSS Statistics (Version 27, IBM, Armonk, NY).

Results:

A total of 46 patients were included in the study. A majority of patients were female (91.3%), with an average age and BMI of 61.26 ± 9.74 and 27.42 ± 6.02, respectively. Differences in preoperative and 5-year postoperative PROs were statistically significant for each of the four measures (p<0.001). The MCID threshold values for the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Sport-Specific (HOS-SS) subscale, modified Harris Hip Score (mHHS), and the international Hip Outcome Tool-12 (iHOT) were calculated to be 13.1, 14.5, 12.6 and 11.2 respectively. The PASS scores of HOS-ADL, HOS-SS, mHHS and iHOT were calculated to be 85.6, 79.7, 68.2 and 60.5 respectively. In addition, 86.1% of patients achieved either MCID or PASS postoperatively, with 90.9% and 69.8% reaching at least 1 threshold score for achieving MCID and PASS respectively, and 69.7% achieving both any MCID and any PASS.

Conclusions:

In patients undergoing open or endoscopic gluteus medius repair, our study defines MCID and PASS at mid-term follow-up. A majority of patients achieved any MCID (90.9%) and any PASS (69.7%) at 5-years postoperatively.
Paper 60: Objective Diagnosis of Multidirectional Instability in Adolescent Patients Based on Glenohumeral Joint Capsule Dimensions on MR Analysis
Authors: Yoder Mason , Veerkamp Matthew , McDonald Colin , Parikh Shital
Published: July 2022

Objectives:

Multidirectional Instability (MDI) of shoulder in adolescents is a clinical diagnosis and there are no defined objective criteria to validate the diagnosis. Most patients with MDI have no identifiable labral or capsular tear pattern on MR imaging. The objective of this study was to identify objective criteria for MDI diagnosis based on rotator interval and glenohumeral capsular dimensions on MR imaging in surgically confirmed adolescents with MDI.

Methods:

In a comparative retrospective study, the clinical records and MR arthrogram of adolescent patients treated for shoulder instability at our center between 2008 and 2019 were reviewed. Twenty-four adolescents with surgically confirmed MDI were age-matched to 25 control patients. The width and depth of the rotator interval and multiple linear dimensions of the glenohumeral capsule were measured on sagittal-oblique MR arthrography sequences, after controlling for glenoid size (Fig 1). The measurements that differed significantly were identified using unpaired t-tests. These values were plotted on receiver operator characteristic (ROC) curves, which were used to determine threshold values for identifying MDI. Power analysis showed a sample size of 16 in each group to be sufficient to detect 5 mm difference in average capsular dimension of 20 mm (power 0.8)

Results:

24 patients (28 shoulders) 20 females, 4 males were in the MDI group; average age at time of surgery was 15.2 years (range, 8-20 yrs). The control group consisted of 25 patients (27 shoulders), 9 females, 16 males; average age was 15.4 years (range, 11-18 yrs). Rotator interval depth was significantly greater in the MDI group vs control (MDI 8.5mm; Control 6.1mm) (p <0.01), as were the inferior, posteroinferior, and posterior dimensions of the glenohumeral joint capsule (24.5 vs 20.4mm, 26.4 vs 21.9mm, and 22.5 vs 19.3mm, respectively; p <0.01) (Table 1). Rotator interval width and anterior capsular dimensions were not significantly different between groups. The ROC-derived threshold values for identifying MDI using MR arthrography were Rotator interval depth = 7.4mm; Posterior capsule = 20.9mm; Inferior capsule = 22.4mm; Posteroinferior capsule = 24.0mm.

Conclusions:

Rotator interval depth and dimensions of glenohumeral joint capsule in the inferior, posterior and posteroinferior quadrant on MR arthrography were significantly greater in adolescent patients with MDI. Measurement of rotator interval depth and glenohumeral capsular dimensions on MR arthrography can be used to supplement clinical diagnosis of MDI. [Table: see text]
Paper 62: Influence of Gender, Race/Ethnicity & Socioeconomic Factors on Meniscus Treatment with Pediatric and Adolescent ACL Reconstruction
Authors: Mercurio Angela , Coene Ryan , Cook Danielle , Feldman Lanna , Milewski Matthew
Published: July 2022

Objectives:

The rate of anterior cruciate ligament reconstruction (ACLR) in pediatric/adolescent populations has increased over time. However, there is less evidence to support the relative change in concomitant meniscus procedures over time. Demographics and socioeconomic (SES) factors may be implicated in the rate and usage of meniscectomy vs. meniscal repair as treatment. The purpose of this study is to assess if the rate of concomitant meniscus procedure with ACLR is increasing and what factors may be contributing to this rise. We hypothesize that age, sex, race/ethnicity, income, or insurance type may affect the rate of concomitant meniscus procedures.

Methods:

The Pediatric Health Information System (PHIS) Database was queried for all patients 18 years or younger who underwent ACLR with or without concomitant meniscus procedures based on CPT code from 2015-2019. Data from 39 out of 52 centers were included based on completeness of their data. Basic demographic information including age, sex, self-identified race/ethnicity, and insurance status was collected. Urban and rural designation was identified based on rural-urban commuting area (RUCA) codes. Based on the 2015 Department Health & Human Services Federal Poverty Guidelines (FPL), patients were stratified into lower (<199% of FPL) and higher (≥200% of FPL) income brackets. Linear regression was used to model trends and multiple logistic regression modeling was used to test for associations.

Results:

14,398 patients underwent ACLR during the study period with 8,337 patients (58%) having concomitant meniscal procedures with a 1.24-fold increase over five years (Figure 1). Of the 8,337 patients with concomitant meniscus treatment, 46% had a meniscectomy and 54% had a meniscus repair. There was a 0.86-fold change in meniscectomy and a 1.70-fold increase in meniscus repair during the study period (Figure 2). Males, older patients, Black race, living in an urban area, and those with non-private insurance had increased odds of undergoing a concomitant meniscus procedure (all p<0.05). Patients of Black or other race and those with non-private insurance had increased odds of having a meniscectomy vs. meniscus repair (all p£0.01). There were no associations detected between income bracket and our outcomes.

Conclusions:

This study shows that in pediatric and adolescent patients undergoing ACLR, there is a rise in concomitant meniscus procedures from 2015-2019. In addition, patients of non-white race and those with non-private insurance have increased odds of undergoing meniscectomy vs. meniscus repair. This study identifies access and inequality issues in ACLR with concomitant meniscus procedures in pediatric and adolescent populations. [Figure: see text][Figure: see text]
Paper 69: Traumatic Rotator Cuff Tears Have Greater Improvements in Functional Outcomes than Non-Traumatic Tears Following Arthroscopic Rotator Cuff Repair
Authors: Godshaw Brian , Hughes Jonathan , Lin Albert , Lesniak Bryson , Boden Stephanie
Published: July 2022

Objectives:

Rotator cuff tears may occur due to a traumatic event that causes acute tearing of the rotator cuff tendons or secondary to chronic tendon degeneration and subsequent atraumatic tearing. The role that tear etiology plays in outcomes after repair is not well understood. The purpose of this study is to determine if a difference exists in outcomes after rotator cuff repair based on tear etiology.

Methods:

221 consecutive patients who underwent arthroscopic rotator cuff repair were evaluated with prospectively collected preoperative and at least 2-year postoperative data via chart review. Shoulder range-of-motion, strength and standard shoulder physical exam findings were recorded both preoperatively and postoperatively. Outcome measures including visual acuity scale pain score (VAS), subjective shoulder value (SSV), Patient-Reported Outcomes Measurement Information System (PROMIS) scores (both mental and physical components), and American Shoulder and Elbow Surgeons Scores (ASES) were examined.

Results:

Of the 221 patients, 73 had traumatic tears and 148 had atraumatic/degenerative tears. There were no differences in age, body-mass-index, or Charlson comorbidity index between groups. Patients in the atraumatic cohort had significantly longer duration of symptoms prior to presentation (17.9 months vs 6.5 months, p<0.05). Preoperatively, the traumatic cohort had less motion to forward elevation (138.0° vs 151.7°, p<0.05). Postoperatively, both groups experienced significant improvements in VAS and SSV scores (p<0.05). However, only the traumatic cohort demonstrated improvements in ASES and the physical PROMIS scores. Patients with traumatic rotator cuff tears had greater improvements in SSV (40.6% vs 29.2%, p<0.05), forward elevation (21.6° vs 2.3°, p<0.05), and strength to forward elevation, external rotation, and internal rotation compared to those with atraumatic tears (p<0.05).

Conclusions:

Patients with traumatic rotator cuff tears experience greater improvements in range-of-motion, strength, and perceived shoulder function than those with degenerative/atraumatic tears.
Paper 74: Psychopathology and Volitional Instability: Who should we be operating on?
Authors: Duchman Kyle , Cohen Brian , Wolf Brian , Bishop Julie , Baumgarten Keith , Shoulder MOON , Brophy Robert , Hettrich Carolyn , Dunn Warren
Published: July 2022

Objectives:

There has been a hesitation by surgeons to operate on shoulder instability patients with maladaptive psychopathological traits, especially those with volitional instability, as these may portend a poor prognosis. The purpose of this study was to investigate the prevalence of maladaptive psychopathological traits, volitional instability, and their effect on two-year outcomes in patients undergoing shoulder stabilization surgery.

Methods:

A prospective multi-center cohort study led by the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group targeted all subjects having surgical shoulder stabilization and collected patient-reported outcomes at baseline and at two years postoperatively. Psychopathological traits were assessed using the Personality Assessment Screener (PAS), a validated personality assessment tool. Longitudinal analyses were performed using multivariable regression models to determine predictors of two-year outcomes adjusting for confounders measured at index such as age, sex, smoking, BMI, volitional instability, and intraarticular pathology.

Results:

The cohort (n = 890) was 80% male with a median age of 21.5 years. The prevalence of psychopathological traits was 20%. While all patients improved between baseline and 2 years, with adjusted analyses, the presence of maladaptive psychological traits present at the time of index surgery were predictive of lower WOSI (p = 0.001), ASES (p = 0.016), SANE (p = 0.03), and SF-36 MCS (p = 0.001) scores as well as a higher risk of failure (p = 0.04) at two years. As a main effect, volitional instability was not a predictor of WOSI, ASES, SANE, SF-36 or failure at two years. However, all models allowed for the interaction between volitional instability and the PAS, and this interaction was significant for WOSI (p = 0.006), SANE (p = 0.03), and SF-36 MCS (p = 0.003) scores at two years. In other words, the effect of volitional instability on the WOSI, SANE, and SF-36 MCS scores depends on the value of the PAS, and with high PAS scores it is associated with worse outcomes. This data is depicted in Figures 1-3.

Conclusions:

While all patients improved, the presence of maladaptive psychopathological traits at the time of index surgery was a predictor of poorer outcomes at two years. Voluntary dislocators did similarly as non-voluntary dislocators up to a PAS score of ˜ 20, where above this they had worse WOSI, SANE, SF-36 MCS and higher failure rates at 2 years post-operatively. [Figure: see text][Figure: see text][Figure: see text]
Paper 75: Development and Validation of the KOOS-ACL: A Short-form Version of the KOOS for Young Patients with ACL Tears
Authors: Tremblay Paul , Getgood Alan , Bryant Dianne , Marmura Hana
Published: July 2022

Objectives:

To develop and validate a short form, disease-specific version of the KOOS appropriate for the young active ACL deficient population: the KOOS-ACL.

Methods:

A baseline dataset of 605 young patients (< 25 years) with ACL tears was divided into a development and validation sample. Exploratory factor analyses were conducted in the development sample to identify the underlying factor structure and reduce the number of KOOS items based on statistical and conceptual indicators. Confirmatory factor analyses were conducted to check fit indices of the proposed KOOS-ACL model in both samples. Structural validity, reliability, and responsiveness to change were assessed in the full sample at five timepoints: baseline and 3 months, 6 months, 12 months and 24 months post-operatively.

Results:

Two factors were deemed most appropriate for the KOOS-ACL: Functionality and Sport. Fifteen items were removed from the full length KOOS based on discriminant validity (i.e., lack of distinctiveness between some proposed constructs) and another fifteen items were removed for repetitive content. The final KOOS-ACL model showed acceptable structural validity (CFI and TLI > 0.9, RMSEA and SRMR < 0.08), internal consistency reliability (a > 0.8), and responsiveness to change (effect size > 0.8) at all five timepoints in the dataset. The KOOS-ACL showed strong and significant correlations to the original KOOS and IKDC at all timepoints (r > 0.7).

Conclusions:

The new KOOS-ACL questionnaire contains 12 items and two subscales relevant to young active ACL patients. The KOOS-ACL would reduce patient burden by more than two thirds and provides improved structural validity compared to the full length KOOS while maintaining adequate psychometric properties and relatedness to other popular outcome measures currently used following ACL injuries. The KOOS-ACL may be a more relevant outcome to use with young active ACL patients within the two years of surgery.
Paper 95: Adolescent Tarsal Navicular Bone Stress Injuries: A Multicenter Retrospective Analysis of 110 Patients
Authors: Mehta Shayna , Zheng Evan , Segovia Nicole , Rizzone Katherine , Halstead Mark , Bohon Tiffany , Brown Naomi , Stinson Zachary , Nussbaum Eric , Gray Aaron , Kraus Emily , Heyworth Benton
Published: July 2022

Objectives:

To describe demographic and presenting clinical characteristics, diagnostic features, treatment approaches, and clinical outcomes of adolescent tarsal navicular BSI’s.

Methods:

A retrospective chart review of patients with tarsal navicular BSIs was performed at eight academic centers. Diagnosis was confirmed by radiologic imaging in all cases. The following variables were collected utilizing a REDCap database and analyzed with basic descriptive and comparative statistics: age, sex, primary sport, physical exam (PE) findings, diagnostic imaging modality, treatment modalities, surgical technique (when applicable), time of protected weight-bearing, time to running, and time to return to sport.

Results:

110 patients (mean age: 14.7 years +/-2.7 years; 65% female) met inclusion criteria, 103 (94%) of whom reported a primary sport, most commonly cross country/track and field (33%) and gymnastics/dance (27%). Common PE findings included navicular tenderness (96%), pain with walking (89%), and pain with resisted inversion (55%). Both x-ray and MRI were obtained in the majority of patients (91%), while CT was obtained for 30%. A radiologically detectable fracture line was present in 44%, most commonly on the dorsal navicular cortex. Non-operative treatment was successful in 85% of patients, consisting of protective boot (79%) or cast (21%). Operative treatment was pursued for 15% of patients, with 73% treated with open reduction internal fixation and 27% undergoing percutaneous screw fixation. All operative patients underwent fixation with either 1 (50%) or 2 screws (50%). Bone grafting was performed in 5 patients (31%). Significant differences between non-operative and operative cohorts included presence of fracture line (38% vs. 88%, P<0.001), age (14.3 years vs. 17.1, P<0.001), time of protected weightbearing (7 weeks vs 10 weeks, P=0.012), time to running (12 weeks vs 18 weeks, P=0.001), and time to return to sport (14 weeks vs 20 weeks, P=0.001).

Conclusions:

Adolescent tarsal navicular BSIs occur most commonly in sports involving repetitive loading, such as cross country, track and field, gymnastics, and dance. The most common PE findings are navicular tenderness to palpation, pain with walking, and pain with resisted inversion. Patients that ultimately require surgical treatment were more likely to have a radiologic fracture line, prolonged return to weightbearing, running and sport than those successfully treated non-operatively. [Table: see text][Table: see text]
Poster 104: The Role of Patient Demographic Factors in the Composition of Bone Marrow Aspirate Concentrate: A Flow Cytometry Analysis
Authors: Tauro Tracy , Credille Kevin , Dandu Navya , Wong Stephanie , Chahla Jorge , Forsythe Brian , Yanke Adam , Cole Brian , Verma Nikhil , Huddleston Hailey
Published: July 2022

Objectives:

Bone marrow aspirate concentrate (BMAC) is one type of orthobiologic that has gained increased popularity over the last decade for a variety of orthopedic procedures. Multiple factors have been demonstrated to influence the MSCs concentration and chondrogenic potential in BMA and thus BMAC, ranging from aspiration location to amount extracted to peripheral blood platelet count. Some studies have suggested that age may affect chondrogenic potential of BMAC derived MSCs but may not affect initial MSC concentration. Therefore, the purpose of this study was to 1) investigate the concentration value and variance BMAC content and 2) investigate the effects of donor age, sex, and other demographic factors on the amount of MSCs as measured by flow cytometry in bone marrow aspirate concentrate (BMAC).

Methods:

A review of patients who underwent BMAC treatment as part of a clinical trial were enrolled and complete BMAC flow cytometry data were included in analysis. Chart review was performed to identify patient demographic factors to determine their relationship to flow cytometry cell count. Flow cytometry was performed on both patient bone marrow aspirate (BMA) and BMAC samples to identify multipotent MSC phenotype defined as cell-surface co-expression of the antigens CD105, CD73, and CD90 (≥95% positive) and the absence of hematopoietic lineage markers CD45, CD34, CD14 or CD11b, CD79a or CD19, and HLA-DR (≤2% positive). The ratio of cells in BMA: BMAC samples was calculated, and Spearman correlations and Kruskall-Wallis tests were used to determine the relationship of cell concentration to demographic factors.

Results:

A total of 80 patients were included in analysis (49% male, mean age: 49.93±12.17 years). Mean concentration of BMA and BMAC was 2,048.13±2,004.14 MSCs/mL and 5618.87±7568.54 MSC/mL, respectively, with a mean BMAC:BMA ratio of 4.35 ± 2.09 (Figure 1). A significantly higher MSC concentration was observed in the BMAC samples (P=0.005). No patient demographic factors (age, sex, height, weight, BMI, smoking status) significantly impacted MSC concentration in the BMAC samples.

Conclusions:

This study validates that BMAC concentrates and increases MSCs from BMA approximately four-fold. In addition, in opposition to our hypothesis, no demographic factors affected the final number of MSCs observed with flow cytometry analysis. These preliminary results suggest that BMAC successfully concentrates BMA and provides a higher number of MSCs. Baseline patient characteristics likely have minimal effects on the number and concentration of MSCs in BMAC, and therefore may not limit patient selection for BMAC for clinical use. [Figure: see text]
Poster 111: Poor Inter-observer Reliability of TT-TG Measurement Among Orthopaedic Sports Medicine Surgeons Regardless of Measurement Technique
Authors: Cullen Matthew , Sequeira Sean , Douoguih Wiemi , Lincoln Andrew , Svoboda Steven , Gould Heath
Published: July 2022

Objectives:

Tibial tubercle-trochlear groove distance (TT-TG) is an important radiologic parameter in the diagnosis and treatment of patellar instability. However, there is substantial heterogeneity in the literature regarding the most appropriate measurement protocol for assessing TT-TG distance. The objective of this study was to evaluate the inter- and intra-observer reliability of TT-TG distance measurement in healthy knees performed by fellowship-trained orthopaedic sports medicine surgeons.

Methods:

A convenience sample of 29 magnetic resonance imaging scans (MRIs) of the knee was assembled after screening to ensure there was no ligamentous rupture, meniscal pathology, cartilage injury, subchondral edema, or abnormal masses in the bone or muscle. An a priori power analysis determined that this number of MRIs would provide greater than 90% power to detect a statistically significant difference in intraclass correlation of 0.95 (a < 0.05). Three fellowship-trained orthopaedic sports medicine surgeons read the MRIs and recorded the TT-TG distance using their method of choice. After a minimum of 5 months, the MRIs were read again, this time using a standardized evidence-based method to measure the TT-TG distance. Kappa statistics were calculated to evaluate inter- and intra-observer reliability.

Results:

Among the initial TT-TG distance measurements, kappa was equal to -0.006 (P = 0.690) when assessing inter-observer reliability. Introduction of the standardized measurement protocol was associated with no significant change in inter-observer reliability (kappa = 0.124, P = 0.070). The individual TT slice that was selected for TT-TG distance measurement demonstrated a kappa statistic of 0.192 (P < 0.001) for the surgeons’ method of choice and a kappa statistic of 0.037 (P = 0.455) for the standardized method. Similarly, TG slice selection using the surgeons’ method of choice yielded a kappa statistic of -0.005 (P = 0.949) and a kappa statistic of -0.102 (P = 0.140) for the standardized method.

Conclusions:

Our findings demonstrate poor inter-observer reliability of TT-TG distance measurement in healthy knees that was not improved with the application of a standardized evidence-based measurement protocol. TT and TG slices selected by surgeons varied widely. Future research should focus on comparing TT-TG distance measurements across a wider variety of knees (ranging from healthy to those with patellar instability), as this may improve the inter-observer reliability of TT-TG measurement. [Table: see text]
Poster 119: Outcomes after Surgery for Thoracic Outlet Syndrome in Professional Baseball Players: A Matched Cohort Analysis
Authors: Chalmers Peter , Erickson Brandon , Thompson Robert , Pearl Gregory , Romeo Anthony , Hoenecke Heinz , Fronek Jan , Chauhan Aakash
Published: July 2022

Objectives:

Determine the performance and return to play (RTP) outcomes for professional baseball players that undergo surgical treatment for thoracic outlet syndrome.

Methods:

All professional baseball players who underwent surgical treatment of TOS between 2010-2017 were identified using the major league baseball (MLB) HITS (Health and Injury Tracking System) database. Demographic and performance data (pre and post-surgery) for each player was recorded. Standard demographic and return to play outcomes were measured for all players and compared between different types of TOS and league status. Performance variables were analyzed for pitchers and compared to a 1:1 matched set of control pitchers.

Results:

Overall, 52 players underwent surgery for TOS of which 46 (88%) were pitchers. Neurogenic TOS was the most common and seen in 69% of players. Venous TOS was seen in 29% of players, and a single player had arterial TOS. Following TOS surgery, 79% of players returned to play at the same level (RTSP) and played at least 3 years after surgery. There was no differences in RTSP rate based on the type of TOS. There was no statistically significant difference in RTP and RTSP rates between major and minor league players. In pitchers only, there was a 76% RTSP, which was not different from the natural attrition of control pitchers (p=0.874). Following TOS surgery, pitchers saw a decline in several performance metrics, but not statistically different when compared to the control pitchers. This indicated that the decline in performance following TOS surgery was similar to the decline seen in healthy professional pitchers as they age.

Conclusions:

The most common type of TOS seen in professional baseball players is neurogenic. The RTSP rate following surgery for TOS in all professional baseball players is 79%. There was no statistically significant difference in ability to RTP based on the type of TOS or league status. Pitchers who underwent surgery for TOS had no significant difference in pitching performance metrics following surgery compared to matched controls. Overall, surgery for thoracic outlet syndrome can help prolong a professional baseball players career and help pitchers maintain their performance over time similar to their peers who have not had surgery for TOS. [Table: see text][Table: see text][Table: see text][Table: see text]
Poster 142: Identifying the Bony and Soft Tissue Mechanisms Responsible for Glenohumeral Internal Rotation Range of Motion
Authors: Erickson Brandon , Cohen Steven , Ciccotti Michael , Hefta Michael , Buchheit Paul , Rauch Joseph , Fcasni Shawn , Plum Alexander , Hoback Aaron , Thomas Stephen , Paul Ryan
Published: July 2022

Objectives:

Shoulder and elbow injuries account for about one-fourth of the total injuries in professional baseball players. The loss of shoulder internal rotation range of motion (IR ROM) has been identified as a significant risk factor for upper extremity injuries in pitchers across all ages. Several anatomic structures have been independently associated with IR ROM. First, greater amounts of humeral retroversion (HR) have been related to decreased IR ROM. Second, increased posterior capsule thickness (PCT) has also been related to decreased IR ROM. Lastly, adaptations to the teres minor muscle pennation angle (PA) has been related to losses in IR ROM and the PA of both the infraspinatus and teres minor have been related to the acute decrease in IR ROM following pitching. However, these three anatomic structures have not been collectively measured in baseball pitchers to determine the underlying mechanisms responsible for IR ROM. Therefore, this study will determine the contributions of HR, PCT, and posterior rotator cuff PA on IR ROM in healthy professional baseball pitchers. We hypothesized that HR, PCT, and posterior rotator cuff PA would have a significant contribution to IR ROM.

Methods:

51 healthy professional pitchers were recruited for this cross-sectional study at the beginning of the 2021 Major League Baseball spring training. Participants received a bilateral IR ROM assessment while laying supine with the shoulder at 90 degrees of abduction and the scapula stabilized. Ultrasound imaging was also performed bilaterally to assess HR, PCT, infraspinatus (superficial + deep) PA, and teres minor (superficial + deep) PA. All ultrasound imaging was performed utilizing a previously published standardized technique. A stepwise regression was performed which included both arms to determine the mechanisms of IR ROM.

Results:

The first variable to enter into the stepwise regression model was HR which had a moderate relationship with IR ROM (regression coefficient of -0.502). PCT also entered the model, as measuring both HR and PCT improved the relationship with IR ROM from moderate to strong (regression coefficient of -0.657). Infraspinatus and teres minor PA did not enter the predictive model of IR ROM.

Conclusions:

HR and PCT were found to be the primary anatomic mechanisms responsible for glenohumeral IR ROM. Surprisingly, the posterior rotator cuff PA was not found to be a significant predictor of IR ROM. The posterior rotator cuff may instead contribute more to the acute decrease in IR ROM following pitching, which has recently been reported. As deficits in IR ROM can have harmful effects in baseball pitchers, understanding which anatomic structures are most responsible for IR ROM is important for injury prevention and treatment. [Figure: see text][Table: see text]
Poster 147: Operative Treatment of Acromioclavicular Injuries in the Military: Trends and Complications
Authors: Feeley Scott
Published: July 2022

Objectives:

To identify the demographics and characteristics of operative acromioclavicular joint separations, as well as characterize reconstruction techniques and associated complications.

Methods:

The United States Military Health System Data Repository was queried for patients with a Current Procedural Terminology (CPT) code for coracoclavicular ligament reconstruction between October 2013 and March 2020. Patient demographics, radiology and operative reports, and clinical notes were reviewed to characterize reconstruction techniques and associated postoperative complications.

Results:

A total of 956 coracoclavicular ligament reconstructions (896 primary repairs or reconstructions, 60 revision reconstructions) were performed between October 2013 and March 2020. The 896 primary coracoclavicular ligament reconstructions were indicated for a range of acromioclavicular joint separation severities: three grade two separations, 392 grade three separations, 48 grade four separations, and 386 grade 5 separations; the remaining 67 patients did not have a definitive injury grade defined by the treating surgeon. Of the primary procedures, 356 were performed acutely within 6 weeks of injury, while 538 were performed greater than 6 weeks after injury. Two hundred and twenty eight primary procedures were categorized as repairs, while 652 were categorized as reconstructions utilizing a graft. Following these procedures, there were 104 major complications requiring return to the operating room, including 48 symptomatic failures requiring revision, 18 fractures of the clavicle or coracoid, 25 deep surgical site infections and 9 cases of symptomatic hardware requiring removal of hardware, and 4 cases of adhesive capsulitis requiring manipulation under anesthesia. There were 160 minor postoperative complications, including 5 non-operative fractures of the clavicle or coracoid, 16 superficial surgical site infections, 7 cases of non-operative adhesive capsulitis, 57 cases of neuropathy, 1 deep venous thrombosis, and 74 cases of persistent acromioclavicular joint pain. There were no significant differences in complication rates between injury grade, acute versus chronic treatment, repair versus reconstruction, or suspensory versus non-suspensory technique. The rate of major complications was 1.8 per 100 person-years and the rate of minor complications was 2.77 per 100 person-years. The overall complication rate was 4.57 per 100 person-years. At the conclusion of the acromioclavicular joint separation care, 60 service members necessitated medical separation from the military.

Conclusions:

Coracoclavicular ligament reconstruction is a relatively common and safe procedure in a physically active population. The rate of major complication was 1.8 per 100 person-years, while the overall complication rate in our series was 4.57 complications per 100 person-years. Complications are rare, however, when they occur, they frequently require one or more secondary surgeries to treat.
Poster 183: Acromial Morphology Predicts Glenoid Bone Loss in Patients with Posterior Glenohumeral Instability
Authors: Livesey Michael , Tran Andrew , Baird Michael , LeClere Lance , Kilcoyne Kelly , Gilotra Mohit , Dickens Jonathan , Bedrin Micheal
Published: July 2022

Objectives:

The relationship between acromial morphology and glenohumeral instability is not well understood. It is unknown whether a flatter acromion predisposes a nonarthritic shoulder to increased posterior glenoid bone loss (GBL). The purpose of this study was to determine whether acromial morphology influences the extent or pattern of posterior glenoid bone loss in a cohort of patients with posterior glenohumeral instability.

Methods:

A comprehensive review of case logs between two academic institutions was performed to identify patients treated for primary posterior glenohumeral instability. MRI and/or CT scans were examined by two independent reviewers and the following measurements were obtained: total area glenoid bone loss (GBL) using the perfect circle technique, glenoid version, obliquity of GBL relative to the long axis of the glenoid, arc of GBL, acromial tilt, posterior acromial height (PAH), and anterior/posterior acromial coverage. The primary outcome was the association between acromial morphology parameters and glenoid bone loss.

Results:

A total of 89 shoulders with primary posterior glenohumeral instability were included. The mean age was 28.3 years (range 18-49), and male:female ratio was 11:1. Fifty-nine patients had measurable posterior glenoid bone loss and 30 patients had posterior labral tears without bone loss. Linear regression analysis revealed a significant negative correlation between acromial tilt and posterior GBL (R2= 0.09, p=0.005), a positive correlation between PAH and posterior GBL (R2= 0.04, p=0.046), and a negative correlation between posterior acromial coverage and posterior GBL (R2= 0.03, p=0.005). Increasing PAH and decreasing posterior acromial coverage were associated with a more superior extent of GBL (R2= 0.1, p=0.044 and 0.024, respectively). Subgroup analysis stratified by total area of GBL demonstrated that the area of posterior glenoid bone loss increases as the acromial tilt decreases.

Conclusions:

A flatter, higher acromion with less posterior coverage relative to the center of the glenoid is associated with increased posterior glenoid bone loss in patients with posterior glenohumeral instability. [Table: see text]